bluuebunny/crossref_metadata_2025 huggingface dataset:
CyGaMEs Selene player log dataset: Gameplay assessment, flow dimensions and non‐gameplay assessments
Authors: Reese Debbie Denise
Published: July 2015

The Selene: A Lunar Construction GaME instructional video game is a robust research environment (institutional review board approved) for investigating learning, affect, and the CyGaMEs Metaphorics approach to instructional video game design, embedded assessment, and informatics analysis and reporting. CyGaMEs applies analogical reasoning theory to translate fundamental scientific phenomena into embodied, procedural, goal‐driven, instructional gameplay and concurrent metrics of learning. Selene also collects integrated measures of affect operationalized as flow dimensions skill and challenge. Selene is a free, online Flash/Flex game available 24/7 to registered players. The player (agemean = 13; N = 3882; nfemale = 1915; nmale = 1908; nSpanish‐language version = 157) dataset, collected between April 6, 2010 and May 30, 2014, is anonymized, open and downloadable within Wheeling Jesuit University's data repository. Dataset files contain timestamped, tab‐delimited, player log data for gesture‐level gameplay; Timed Report progress toward each game/learning goal; flow dimensions; non‐gameplay assessments; demographics; paradata; and repository lexicons. Dataset analyses using traditional statistical methods (eg, multilevel modeling, interrupted time‐series) study learning trajectories, learning moments, affect (flow dimensions), persistence, gender differences, dashboard effects and the interactions among them. CyGaMEs Selene translates Timed Reports into real‐time, online dashboard report visualizations players and their registered educators can understand and use.
Developing a model of conflict in virtual learning communities in the context of a democratic pedagogy
Authors: Ozturk Tugba H. , Hodgson Vivien
Published: July 2015

In this paper, we argue that in order to get a fuller understanding of the complexity of conflict in democratic pedagogies in online and blended learning settings, it is important to know not only how to manage or resolve it, but also how it is triggered and can be avoided. The emancipatory nature of democratic pedagogies fosters differences, and differences provide the basis for the emergence of conflict among learning community members. Much has been written on certain aspects of conflict, such as conflict management or effects of conflict; however, these studies are frequently disparate and fragmented. Conflict has a cyclical dynamic and the main purpose of this study has been to experimentally build an analytical model of this cyclical dynamic of conflict, drawing on both literature and research data. We believe that such a model might empower practitioners and designers of democratic pedagogies to embrace and work with the differences that lead to conflict, as a way to support collaborative learning and action. The model of conflict which emerged at the end of the study is supported by illustrative qualitative evidence and constituted in a diagrammatic depiction of analytic themes that illustrate the connections between these themes, and the values ascribed to them. The outcomes of this study have implications for developing learning strategies for distance and blended learners.
Survey of software literacy, behavior and personal traits of freshmen accounting majors
Authors: Hung Yu Hsin , Chang Ray I. , Lin Chun Fu
Published: July 2015

In recent decades, the rapid growth of technology has resulted in software being widely applied in various domains. Attitudes toward using software play an important role in every industry. This study aims to explore the software literacy of accounting students along with their personal traits, such as learning styles and user behavior. This was a twofold study; we aimed to investigate the learning styles of accounting students and also discuss the correlation between learning styles and software literacy. Eighty‐six freshmen, majoring in accounting, were participants in this study, and the results reveal that a sequential learning style is the variable most related to software literacy. Furthermore, we also found that most of the accounting freshmen utilize an active, sensing, visual and sequential learning style.
Information externalities and intermediaries in frictional search markets
Authors: Shi Xianwen , Siow Aloysius
Published: July 2015

In frictional matching markets with heterogeneous buyers and sellers, sellers incur discrete showing costs to show goods to buyers who incur discrete inspection costs to assess the suitability of the goods on offer. We study how brokers can help reduce these costs by managing the level and mix of goods in their inventory. Intermediaries emerge and improve social welfare when there is sufficient heterogeneity in the types of goods and preferences. Learning and inventory management enable search intermediaries to internalize information externalities generated in unintermediated private search.
Should preoperative chest computed tomography be performed in all patients with colorectal cancer?
Authors: Lazzaron A. R. , Vieira M. V. , Damin D. C.
Published: July 2015

Aim

This study evaluated the accuracy of chest computed tomography (CCT) in the preoperative staging of patients with potentially resectable colorectal cancer (CRC). An attempt was made to determine whether CCT has a significant influence on management and clinical outcome.

Method

A review was conducted of all preoperative CCTs and X‐rays performed in patients submitted to elective resection of CRC at our institution between 2005 and 2012. All scans were revised by an independent radiologist who was unaware of the circumstances of each case. The findings were classified as benign, malignant or indeterminate. Patients were followed for at least 12 months after surgery to assess the clinical evolution of any lesion found on CCT and the oncological outcome.

Results

Two hundred and twenty‐three patients were included. The CCT showed normal or benign findings in 157 (70.4%) patients, a malignant lesion in 17 (7.6%), and an indeterminate lung lesion (ILL) in 49 (22%). Of the 30 patients with proven lung metastases, a plain X‐ray detected lesions in only 11 (36.7%) patients. During the postoperative follow‐up, 14 (28.6%) of the 49 patients with ILL demonstrated malignant progression of the lung lesions. Among all 223 patients, only six (2.7%) underwent lung resection.

Conclusion

CCT is superior to plain X‐ray for the detection of lung metastases. Despite the medical and financial implications of preoperative CCT, only a small number of patients will eventually undergo lung resection. We call into question the role of routine CCT in the staging of patients with CRC. A more selective approach, reserving CT for patients at high risk of lung metastases, is suggested.
The outcome and the frequency of pathological complete response after neoadjuvant radiotherapy in curative resections for advanced rectal cancer: a population‐based study
Authors: Wasmuth H. H. , Rekstad L. C. , Tranø G.
Published: July 2015

Aim

Pathological complete response (ypCR) after neoadjuvant treatment for rectal cancer is associated with favourable survival and a low rate of local recurrence. The aim of the study was to assess the incidence of ypCR among patients with advanced rectal cancer treated with neoadjuvant chemoradiotherapy and curative resection and to explore factors associated with survival.

Method

From 2000 to 2009, 1384 patients enrolled in the national population‐ based colorectal cancer registry of Norway with advanced T3 and T4 rectal cancer with N0–2, M0 received neoadjuvant long‐course (chemo)radiation. The duration of follow‐up was a median of 5 years.

Results

ypCR was achieved in 147 (10.6%) patients. The estimated 5‐year overall survival rate was 87% (confidence interval ± 5.4) among ypCR and 67% among non‐ypCR (confidence interval ± 2.7) (P < 0.0001). Distant metastasis developed in 12 (8%) of 147 and 328 (26.5%) of 1237 patients respectively (P < 0.001). In a Cox proportional hazards ratio model the effect of ypCR on survival was adjusted for age [hazard ratio (HR) 1.056, P = 0.0001], metachronous metastasis (HR 4.7, P = 0.0001), local recurrence (HR 4.3, P = 0.0001) and surgical procedure (HR 1.48, P = 0.0001). The independent effect of ypCR (HR 0.65, P = 0.041) on survival almost disappeared compared with the univariate analysis.

Conclusion

The rate of ypCR in advanced rectal cancer was about 10%. This phenomenon seems to occur in tumours with a low risk of metastasizing. The contribution of neoadjuvant therapy to ypCR on survival was small or absent.
Labor Market Dynamics and Structural Change: Evidence from China
Authors: Mao Rui , Xu Jianwei
Published: July 2015

Structural change theories usually assume agents are homogeneous. However, because of demand‐side or supply‐side heterogeneities, the probability of switching among sectors differs across people. This paper reveals these differences through restoring a long‐period, individual‐level panel dataset from China's Urban Household Survey for 1986–2009. We find that both for people who started working for the first time and those who switched jobs, the sector choice depends on personal characteristics. In particular, women and people with higher educational attainment or a previous white‐collar job are more likely to join the tertiary sector and less likely to join the primary sector. These effects are substantial even if the macroeconomic variables used in conventional structural change theories are controlled. They are also robust in various periods and at more detailed industry levels. Our research suggests that it is important to pay greater attention to the labor composition when making policy related to economic structural change.
Cyclical relationship between depressive symptoms and diabetes distress in people with Type 2 diabetes mellitus: results from the Montreal Evaluation of Diabetes Treatment Cohort Study
Authors: Burns R. J. , Deschênes S. S. , Schmitz N.
Published: July 2015

Aims

To determine if longitudinal cyclical relationships exist between depressive symptoms and diabetes distress in people with Type 2 diabetes mellitus.

Methods

Data were obtained from the Montreal Evaluation of Diabetes Treatment study, a cohort study of 1691 people with Type 2 diabetes mellitus. Depressive symptoms and diabetes distress, measured with the Patient Health Questionnaire and Diabetes Distress Scale, respectively, were assessed at baseline, 1 year and 2 years. A cross‐lagged path model analysis with all autoregressive associations was used. Paths and indirect associations were examined.

Results

All paths in the model were significant. Depressive symptoms were positively associated with diabetes distress across consecutive time points and diabetes distress was positively associated with depressive symptoms across consecutive time points. The association between depressive symptoms at baseline and depressive symptoms at 2 years was mediated by both depressive symptoms and diabetes distress at 1 year. The association between diabetes distress at baseline and diabetes distress at 2 years was also mediated by both depressive symptoms and diabetes distress.

Conclusions

Depressive symptoms and diabetes distress are cyclically related; results suggest that depressive symptoms influence diabetes distress, which, in turn, influences depressive symptoms. Although many studies focus on the differences between depressive symptoms and diabetes distress, the present study is the first to provide longitudinal evidence that these constructs are cyclically related.
Effects of exercise on postexercise ventricular–arterial coupling and pulsatile efficiency in patients with systolic dysfunction
Authors: Aslanger Emre , Assous Benjamin , Bihry Nicolas , Beauvais Florence , Logeart Damien , Cohen‐Solal Alain
Published: July 2015

Background

A suboptimal ventricular–arterial (VA) interaction may have a prolonged depressing effect on the failing heart after functional reserves forced to their limits under stress conditions such as exercise. The continuation of excessive load in the postexercise period may be more important than the load during exercise, because the sum of postexercise periods generally exceeds exercise time itself. We sought that exercise‐induced changes in postexercise VA coupling and pulsatile efficiency in patients with heart failure (HF).

Methods

Thirty consecutive HF with reduced ejection fraction (EF) and thirty age‐, sex‐ and peak VO2‐matched subjects with preserved EF were enrolled. Pre‐ and postexercise echocardiographic and tonometric measurements were taken to calculate left ventricular and arterial elastances, arterial compliance and wave reflections, and steady and pulsatile power.

Results

VA coupling significantly deteriorated in HF group (from 1·50 ± 0·47 to 2·00 ± 0·75 mmHg/mL, P < 0·01), but control group maintained basal favourable coupling status after exercise (from 1·04 ± 0·29 to 1·03 ± 0·24 mmHg/mL, P = 0·77). Pulsatile percentage of total power significantly increased with exercise in HF group, whereas it showed a significant decrease in control group. The change in pulsatile power fraction was correlated with the change in augmentation pressure (r = 0·41, ß = 3·00, P < 0·01) and inversely correlated with the change in total arterial compliance (r = −0·29, ß = −8·52, P = 0·02).

Conclusion

Our data indicate that exercise‐induced VA decoupling and pulsatile inefficiency extend into postexercise phase in patients with systolic dysfunction. The exact duration of these derangements requires further studies.
HOW MUCH ARE WE WILLING TO CONTRIBUTE FOR BETTER EDUCATIONAL OUTCOMES? EVIDENCE FROM A SURVEY EXPERIMENT
Authors: Berlinski Samuel , Busso Matias
Published: July 2015

We use a survey experiment on a sample of Argentine households to elicit willingness to contribute toward improving the performance of public school students in international educational assessments. Households are presented with a sequence of bids that they can accept or reject. Information is presented in vignettes that vary in the proportion of children who benefited from the gains in educational attainment. We find a higher willingness to contribute for larger gains. In total, households would be willing to contribute an additional 12.8% of current educational expenditure to guarantee improved education quality. (JEL I22, I25, C83, H52)
Dietary therapy is the best option for refractory nonsurgical epilepsy
Authors: Felton Elizabeth A. , Cervenka Mackenzie C.
Published: July 2015

Ketogenic diet therapies for epilepsy have been described since the fifth century and published in scientific literature since the early 1900s. Since that time, the diet's popularity has waxed and waned as newer drugs and other treatments have been introduced. However, in recent years, dietary therapy for epilepsy has been increasingly accepted by physicians and desired by patients as an alternative to new drugs and neurostimulation. The introduction of less restrictive versions of the classic ketogenic diet, such as the modified Atkins diet (MAD), have led to increased numbers of adult patients with refractory epilepsy who are initiating dietary treatment. Approximately half of adults and children who start a ketogenic diet have a >50% seizure reduction, which is impressive given that these patients typically have medically refractory epilepsy. We believe that ketogenic dietary treatment is the best option for children and adults with refractory nonsurgical epilepsy due to its efficacy, rapid seizure reduction, synergistic effects with other antiseizure treatments, known and treatable side effects, potential to treat comorbid medical conditions, and worldwide availability.
Analyzing the Space–Time Dynamics of Innovation in China: ESDA and Spatial Panel Approaches
Authors: Wang Zheye , Cheng Yeqing , Ye Xinyue , Wei Y. H. Dennis
Published: July 2015

Through applying exploratory spatial data analysis (ESDA) and confirmatory spatial data analysis (CSDA), this paper examines the space–time dynamics of innovation at the provincial level in China from 2000 to 2011. We first investigate the trend of regional inequality in innovation in China and then use ESDA methods to visualize the space–time relationship between patent applications and innovation determinants. Impacts of innovation determinants on the space–time dynamics of innovation are also examined by analyzing the knowledge production function with the spatial panel Durbin model. Knowledge spillovers from both the R&D and the innovation outcome perspectives are highlighted in CSDA. We have found an increasingly intensified coastal–interior divide with growing spatial clusters and more innovative activities in the coastal region. We have also found a close space–time relationship between innovation and its determinants. Lastly, innovation spillovers cross province boundaries, and knowledge from a province's neighboring provinces has substantial effects on innovation activities of the province. This paper highlights positive knowledge spillover effects between regions, the close relationship between innovation and its determinants, and the importance of spatial externalities in innovation activities.
Do Mandatory U.S. State Renewable Portfolio Standards Increase Electricity Prices?
Authors: Wang Hongbo
Published: July 2015

Renewable Portfolio Standards (RPS) are U.S. state mandates that utilities produce some of their electricity using renewable energy sources in an effort to reduce greenhouse gas emissions. While advocates highlight the potential long‐term benefits of RPS, critics argue that RPS will increase electricity prices due to the higher costs of renewable energy generation. However, to date, there are no published empirical studies of the effect of RPS on electricity prices. Using state‐level panel data from 1990 to 2011 and the difference‐in‐differences method, I find that implementation increases electricity prices when the RPS policy first becomes binding.
Re‐examining the Neighborhood Distribution of Higher Priced Mortgage Lending: Global versus Local Methods
Authors: Zou Yonghua
Published: July 2015

This paper demonstrates the application of the local geographically weighted regression (GWR) method to mortgage studies, using the Philadelphia metropolitan statistical area (MSA) as a case study. Previous related studies widely employed the global, ordinary least square (OLS) method to examine the spatial distribution of subprime/higher priced mortgages. The OLS method, however, masks the spatial variations in mortgage distributions. The innovative GWR method not only provides a significant improvement in model fitness but also reveals that the statistical relationships between neighborhood characteristics and the prevalence of higher priced mortgage shares are spatially varied. In addition, the GWR method can bring forward potential implications for place‐based policy making. Improving upon previous methodologies in mortgage studies, this paper shows that the GWR method can advance our understanding of how neighborhood environments are associated with mortgage lending patterns.
Persistence and productivity of selected Guinea grass ecotypes in semiarid tropical Kenya
Authors: Njarui Donald M. G. , Gatheru Mwangi , Mwangi David M. , Keya George A.
Published: July 2015

The increased frequency of drought and reduced rainfall due to effects of climate change is a major threat to the livestock feed base in semiarid Kenya. There is a need for drought tolerant and productive grasses to mitigate this effect. Persistence and productivity of 19 Guinea grass (Panicum maximum Jacq.) ecotypes was assessed over a 3‐year period (2009–2011) along with one commercial cultivar as control at three drought stress environments in eastern Kenya. Root splits were established in plots of 4 m × 4 m, replicated three times in a randomized complete block design. Plant survival and dry matter yields were influenced by the amount of rainfall. Seven out of 19 ecotypes failed to survive at the drier site of Kambi ya Mawe (KYM), while at the relatively wetter sites of Katumani and Ithookwe, all the 19 ecotypes survived throughout the experimental period. None of the ecotypes showed a consistently superior dry matter yield in all the seasons at any site. The dry matter yields were highest during the long rains 2010 season at Katumani and Kambi ya Mawe and in both short rains 2009 and long rains 2010 seasons at Ithookwe when seasonal rainfall was high. Katumani had the highest number of ecotypes (13) that attained overall seasonal mean dry matter yield of ≥3.0 t ha−1 followed by Ithookwe (8) and then KYM (4). At Ithookwe, five ecotypes (K76, K97, K100, K105 and K52‐129) attained higher (P < 0.05) overall seasonal mean dry matter yield than the control while the drier site of KYM, had two (K17 and K104) but none at Katumani. Significant differences (P < 0.05) in forage quality composition were recorded only in acid detergent fiber content and digestibility. The study shows that there are other alternative Guinea grasses that are productive and can replace the commercial cultivar in the semiarid Kenya.
Severe liver failure due to influenza A infection in a hemodialysis patient
Authors: Mok Maggie Ming Yee , Cheng Vincent Chi Chung , Lui Sing Leung , Kwan Lorraine Pui Yuen , Chan Gary Chi Wang , Yap Desmond Yat Hin , Chan Tak Mao , Lo Wai Kei
Published: July 2015

Patients with influenza infection most commonly present with upper and occasionally lower respiratory tract symptoms. However, extrapulmonary presentations such as hepatitis are infrequently observed. We report a case of a hemodialysis patient with influenza A infection who presented with severe hepatitis and liver failure, while his respiratory symptoms were mild. It is important to recognize influenza infection as an unexplained cause of hepatitis and liver failure. In our case, liver failure resolved with supportive treatment.
Health literacy–listening skill and patient questions following cancer prevention and screening discussions
Authors: Mazor Kathleen M. , Rubin Donald L. , Roblin Douglas W. , Williams Andrew E. , Han Paul K. J. , Gaglio Bridget , Cutrona Sarah L. , Costanza Mary E. , Wagner Joann L.
Published: July 2015

Objective

Patient question‐asking is essential to shared decision making. We sought to describe patients' questions when faced with cancer prevention and screening decisions, and to explore differences in question‐asking as a function of health literacy with respect to spoken information (health literacy–listening).

Methods

Four‐hundred and thirty‐three (433) adults listened to simulated physician–patient interactions discussing (i) prophylactic tamoxifen for breast cancer prevention, (ii) PSA testing for prostate cancer and (iii) colorectal cancer screening, and identified questions they would have. Health literacy–listening was assessed using the Cancer Message Literacy Test‐Listening (CMLT‐Listening). Two authors developed a coding scheme, which was applied to all questions. Analyses examined whether participants scoring above or below the median on the CMLT‐Listening asked a similar variety of questions.

Results

Questions were coded into six major function categories: risks/benefits, procedure details, personalizing information, additional information, decision making and credibility. Participants who scored higher on the CMLT‐Listening asked a greater variety of risks/benefits questions; those who scored lower asked a greater variety of questions seeking to personalize information. This difference persisted after adjusting for education.

Conclusion

Patients' health literacy–listening is associated with distinctive patterns of question utilization following cancer screening and prevention counselling. Providers should not only be responsive to the question functions the patient favours, but also seek to ensure that the patient is exposed to the full range of information needed for shared decision making.
No evidence of divergence at neutral genetic markers between the two morphologically different subspecies of the most numerous Arctic seabird
Authors: Wojczulanis‐Jakubas Katarzyna , Kilikowska Adrianna , Fort Jérôme , Gavrilo Maria , Jakubas Dariusz , Friesen Vicki
Published: July 2015

Identifying natural populations that might be considered separate units using morphology, genotype or both is important in understanding the process of speciation and for conservation. We examined the relationships between the only two subspecies of the most numerous Arctic seabird, the Little Auk Alle alle, using both morphological (wing and head‐bill lengths) and genetic data (482 base pairs of the mitochondrial control region and seven nuclear microsatellite loci). We found significant morphological differences between the subspecies, A. a. polaris being significantly larger than the nominate A. a. alle. However, we did not find the subspecies to be differentiated at either mitochondrial DNA or at microsatellite loci. Consequently, one evolutionary significant unit is proposed. The similarity of the two subspecies at neutral genetic markers may be due to contemporary gene flow between populations, as well as large population sizes both in the present and in the past, combined with recent post‐glacial colonization of the Artic.
Striking differences in estimates of infant adiposity by new and old DXA software, PEAPOD and skin‐folds at 2 weeks and 1 year of life
Authors: Barbour L. A. , Hernandez T. L. , Reynolds R. M. , Reece M. S. , Chartier‐Logan C. , Anderson M. K. , Kelly T. , Friedman J. E , Van Pelt R. E.
Published: July 2015

Background

Infant adiposity better predicts childhood obesity/metabolic risk than weight, but technical challenges fuel controversy over the accuracy of adiposity estimates.

Objective

We prospectively measured adiposity (%fat) in term newborns (NB) at 2 weeks (n = 41) and 1 year (n = 30).

Methods

%fat was measured by dual X‐ray absorptiometry (DXA), PEAPOD and skin‐folds (SF). DXAs were analyzed using Hologic Apex software 3.2(DXAv1) and a new version 5.5.2(DXAv2).

Results

NB %fat by DXAv2 was 55% higher than DXAv1 (14.2% vs. 9.1%), 45% higher than SF (9.8%), and 36% higher than PEAPOD (10.4%). Among NB, Pearson correlations were 0.73–0.89, but agreement (intra‐class correlations) poor between DXAv2 and DXAv1 (0.527), SF (0.354) and PEAPOD (0.618). At 1 year, %fat by DXAv2 was 51% higher than DXAv1 (33.6% vs. 22.4%), and twice as high compared with SF (14.6%). Agreement was poor between DXAv2 and DXAv1 (0.204), and SF (0.038). The absolute increase in %fat from 2 weeks to 1 year was 19.7% (DXAv2), 13.6% (DXAv1) and only 4.8% by SF.

Conclusion

Analysis of the same DXA scans using new software yielded considerably higher adiposity estimates at birth and 1 year compared with the previous version. Using different modalities to assess body composition longitudinally is problematic. Standardization is gravely needed to determine how early life exposures affect childhood obesity/metabolic risk.
Quality of employment in Latin America: Theory and evidence
Authors: RAMOS Joseph , SEHNBRUCH Kirsten , WELLER Jürgen
Published: July 2015

Historically, the development literature concerned with Latin American labour markets has focused on job numbers and productivity. But given the persistence of large shares of informal and now otherwise precarious employment, the authors argue that meaningful analysis also requires consideration of the implications of occupational status for the quality of employment. Based on empirical evidence from recent decades, they conclude that most dimensions of this concept – including social protection – depend on the conclusion of a written contract of employment. This finding leads them to outline policy options for stabilizing formal employment and securing adequate funding for social protection.
A multidimensional employment quality index for Brazil, 2002–11
Authors: HUNEEUS Federico , LANDERRETCHE Oscar , PUENTES Esteban , SELMAN Javiera
Published: July 2015

In countries where informal, insecure jobs are widespread, traditional labour market indicators – such as the unemployment rate, labour force participation rate and wages – are not necessarily the most meaningful. The authors use a multidimensional employment quality index to analyse the Brazilian labour market over the period 2002–11, across three dimensions: earnings, formality (measured by the existence of an employment contract and social security contributions) and job tenure. The results show a significant increase in employment quality overall, especially in the years 2009–11, but with considerable differences between wage employees and self‐employed workers, and between industries.
Medical Students’ Attitudes Towards Health Care for People with Intellectual Disabilities: A Qualitative Study
Authors: Ryan Travis A. , Scior Katrina
Published: July 2015

Background

People with intellectual disabilities experience serious health inequalities (e.g. they die younger than people without intellectual disabilities). Medical students’ attitudes towards health care for this population warrant empirical attention because, as tomorrow's doctors, they will affect the health inequalities that people with intellectual disabilities experience.

Materials and Methods

This study investigated these attitudes by interviewing 17 medical students about medical students’ attitudes towards people with intellectual disabilities and thematically analysing resultant qualitative data.

Results

Key themes were identified, such as medical students’ worries about working with patients with intellectual disabilities, and their wish for more medical teaching on, and direct experience with, this patient group.

Conclusions

This study suggests that medical schools need to better prepare medical students for their roles as providers of health care to people with intellectual disabilities by, for example, enhancing their attitudes towards health care for people with intellectual disabilities.
Single nucleotide polymorphisms associated with thermoregulation in lactating dairy cows exposed to heat stress
Authors: Dikmen S. , Wang X.‐z. , Ortega M.S. , Cole J.B. , Null D.J. , Hansen P.J.
Published: July 2015

Dairy cows with increased rectal temperature experience lower milk yield and fertility. Rectal temperature during heat stress is heritable, so genetic selection for body temperature regulation could reduce effects of heat stress on production. One aim of the study was to validate the relationship between genotype and heat tolerance for single nucleotide polymorphisms (SNPs) previously associated with resistance to heat stress. A second aim was to identify new SNPs associated with heat stress resistance. Thermotolerance was assessed in lactating Holsteins during the summer by measuring rectal temperature (a direct measurement of body temperature regulation; n = 435), respiration rate (an indirect measurement of body temperature regulation, n = 450) and sweating rate (the major evaporative cooling mechanism in cattle, n = 455). The association between genotype and thermotolerance was evaluated for 19 SNPs previously associated with rectal temperature from a genomewide analysis study (GWAS), four SNPs previously associated with change in milk yield during heat stress from GWAS, 2 candidate gene SNPs previously associated with rectal temperature and respiration rate during heat stress (ATPA1A and HSP70A) and 66 SNPs in genes previously shown to be associated with reproduction, production or health traits in Holsteins. For SNPs previously associated with heat tolerance, regions of BTA4, BTA6 and BTA24 were associated with rectal temperature; regions of BTA6 and BTA24 were associated with respiration rate; and regions of BTA5, BTA26 and BTA29 were associated with sweating rate. New SNPs were identified for rectal temperature (n = 12), respiration rate (n = 8) and sweating rate (n = 3) from among those previously associated with production, reproduction or health traits. The SNP that explained the most variation were PGR and ASL for rectal temperature, ACAT2 and HSD17B7 for respiration rate, and ARL6IP1 and SERPINE2 for sweating rate. ARL6IP1 was associated with all three thermotolerance traits. In conclusion, specific genetic markers responsible for genetic variation in thermoregulation during heat stress in Holsteins were identified. These markers may prove useful in genetic selection for heat tolerance in Holstein cattle.
Use of Ambulatory Blood Pressure Monitoring for the Screening of Obstructive Sleep Apnea
Authors: Torres Gerard , Sánchez‐de‐la‐Torre Manuel , Martínez‐Alonso Montserrat , Gómez Silvia , Sacristán Oscar , Cabau Jacint , Barbé Ferran
Published: July 2015

Obstructive sleep apnea (OSA) is a frequent and underdiagnosed disease in hypertensive individuals who experience cardiovascular events. The aim of this study was to define the best model that combined the ambulatory blood pressure (BP) monitoring (ABPM), anthropometric, sociodemographic, and biological variables to identify moderate to severe OSA. A total of 105 ABPM‐confirmed hypertensive patients were evaluated using their clinical histories, blood analyses, ABPM, and home respiratory polygraphic results. A multivariate logistic regression analysis was performed to identify the significant variables. The best model included sex, presence of obesity (body mass index ≥30 kg/m2 and abdominal obesity), mean daytime BP, mean nocturnal heart rate, and minimal diastolic nighttime BP to achieve an area under the curve of 0.804. Based on this model, a validated scoring system was developed to identify the patients with an apnea‐hypopnea index ≥15. Therefore, in untreated hypertensive patients who snored, ABPM variables might be used to identify patients at risk for OSA.
Outcome of adefovir add‐on lamivudine rescue therapy of up to 5 years in patients with lamivudine‐resistant chronic hepatitis B
Authors: Kim Sung Bae , Kim Seung Up , Kim Beom Kyung , Park Jun Yong , Kim Do Young , Ahn Sang Hoon , Han Kwang‐Hyub
Published: July 2015

Background and Aim:

We investigated the long‐term efficacy of adefovir add‐on lamivudine rescue therapy in lamivudine‐resistant chronic hepatitis B and the optimal cutoff hepatitis B virus (HBV) DNA level that predicts complete virological response (CVR) among patients without CVR after 1 year of treatment.

Methods:

We reviewed 167 lamivudine‐resistant chronic hepatitis B patients who received adefovir add‐on rescue therapy for up to 5 years. Multivariate analysis, area under the receiver operating characteristic curves, and Youden index were used.

Results:

Median age was 47.0 years; 112 patients were male. Median baseline HBV DNA level was 6.6 log10 IU/mL; hepatitis B e antigen was positive in 130 (77.4%) patients. Five‐year CVR, alanine aminotransferase normalization, hepatitis B e antigen seroconversion, and adefovir resistance rates were 86.9%, 92.5%, 16.7%, and 6.0%, respectively. One‐year HBV DNA level independently associated with CVR. Optimal cutoff HBV DNA level to predict CVR among patients who failed to achieve CVR at 1 year was 800 IU/mL (area under receiver operating characteristic curve 0.752; sensitivity 49.3%, specificity 93.5%). During the 5‐year treatment, 92.1% of patients with favorable response (HBV DNA < 800 IU/mL at 1 year) achieved CVR; 45.6% achieved CVR among suboptimal responders (HBV DNA ≥ 800 IU/mL at 1 year) (P < 0.001).

Conclusion:

Complete virological response or HBV DNA level < 800 IU/mL after 1 year adefovir add‐on lamivudine rescue therapy can favorably predict CVR.
Naso‐jejunal fluid resuscitation in predicted severe acute pancreatitis: Randomized comparative study with intravenous Ringer's lactate
Authors: Sharma Vishal , Rana Surinder S , Sharma Ravi , Chaudhary Vinita , Gupta Rajesh , Bhasin Deepak K
Published: July 2015

Introduction:

Early management of severe acute pancreatitis (SAP) includes intravenous fluid resuscitation.

Aim:

To confirm feasibility of naso‐jejunal (NJ) fluid resuscitation using oral hydration solution (ORS) and compare its efficacy with intravenous (IV) fluid resuscitation using Ringer Lactate (RL) in predicted SAP.

Patients and Methods:

All patients of predicted SAP (presence of SIRS or BISAP > 2) without significant co morbidities were randomized to NJ group (ORS: 20 ml/kg bolus and then 3 mL/kg/h) or IV group (RL infusion at same rate). The groups were compared vis‐à‐vis persistent organ failure (POF), pancreatic necrosis, and mortality.

Results:

Seventy‐seven patients were assessed and after exclusion, 49 patients were randomized to either NJ (24 patients) or IV group (25). The demographic and baseline clinical profile of both groups including BISAP score (2.25 ± 0.73 and 2.32 ± 0.56), hematocrit (40.2 ± 6.8 and 38.3 ± 6.6), blood urea nitrogen (16.88 ± 6.69 and 21.44 ± 17.56 mg/dL), and intra‐abdominal pressure (14.55 ± 4.8 and 14.76 ± 5.5 cm of water) were similar. NJ resuscitation had to be stopped in two patients because of abdominal discomfort and distension. The change in intra abdominal pressure after 48 h of hydration was comparable in both groups. The occurrence of POF (66.67% and 68%), pancreatic necrosis (69.5% and 76%), intervention (5 each), surgery (1 each), and mortality (16.5% and 8%) were comparable (P > 0.05).

Conclusion:

In select group of patients with SAP, NJ fluid resuscitation with ORS is feasible and is equally efficacious as IV fluid resuscitation with RL.
Features of electrocoagulation syndrome after endoscopic submucosal dissection for colorectal neoplasm
Authors: Yamashina Takeshi , Takeuchi Yoji , Uedo Noriya , Hamada Kenta , Aoi Kenji , Yamasaki Yasushi , Matsuura Noriko , Kanesaka Takashi , Akasaka Tomofumi , Yamamoto Sachiko , Hanaoka Noboru , Higashino Koji , Ishihara Ryu , Iishi Hiroyasu
Published: July 2015

Background and Aims

Endoscopic submucosal dissection (ESD) is a promising treatment for large gastrointestinal superficial neoplasms, although it is technically difficult, and perforation and delayed bleeding are well‐known adverse events. However, there have been no large studies about electrocoagulation syndrome after colorectal ESD. The aim of this study was to evaluate the incidence and clinical significant risk factors of post‐ESD coagulation syndrome (PECS).

Methods

This was a retrospective cohort study conducted in a referral cancer center. A total of 336 patients with colorectal neoplasms (143 adenomas or serrated lesions and 193 carcinomas) underwent ESD from January 2011 to June 2013. Incidence, outcome, and factors associated with occurrence of PECS were investigated.

Results

Occurred in 32 patients (9.5%). The median time until PECS was 15.5 h, and the median period of PECS was 32.5 h. Fever (≥37.6 °C) after ESD was found in 41% of the PECS group and 9% of the non‐PECS group (P < 0.001). All PECS cases were managed conservatively. On multivariate analysis, female patients (odds ratio [OR] = 3.2, P = 0.002), lesion location at ascending colon and cecum (OR = 3.5, P = 0.001), and resected specimen ≥40 mm (OR = 2.1, P = 0.05) were independent risk factors for PECS.

Conclusions

Occurred in 32 patients (9.5%) with colorectal ESD; however, all cases had a good outcome with conservative management. Female sex, tumor location at the ascending colon and cecum, and resected specimen ≥40 mm were independently significant risk factors for PECS.
Relationship Between Physical Frailty and Low‐Grade Inflammation in Late‐Life Depression
Authors: Arts Matheus H.L. , Collard Rose M. , Comijs Hannie C. , Naudé Petrus J.W. , Risselada Roelof , Naarding Paul , Oude Voshaar Richard C.
Published: July 2015

Objectives

To determine whether physical frailty is associated with low‐grade inflammation in older adults with depression, because late‐life depression is associated with physical frailty and low‐grade inflammation.

Design

Baseline data of a cohort study.

Setting

Primary care and specialized mental health care.

Participants

Individuals aged 60 and older with depression according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria (N = 366).

Measurements

The physical frailty phenotype, defined as three out of five criteria (weight loss, weakness, exhaustion, slowness, low physical activity level), and three inflammatory markers (C‐reactive protein (CRP), interleukin‐6 (IL‐6), and neutrophil gelatinase–associated lipocalin (NGAL)) were assessed.

Results

The physical frailty phenotype was not associated with inflammatory markers in linear regression models adjusted for sociodemographic characteristics, lifestyle characteristics, and somatic morbidity. Of the individual criteria, handgrip strength was associated with CRP (β = −0.21, P = .002) and IL‐6 (β = −0.25, P < .001), and gait speed was associated with NGAL (β = 0.15, P = .02). Principal component analysis identified two dimensions within the physical frailty phenotype: performance‐based physical frailty (encompassing gait speed, handgrip strength, and low physical activity) and vitality‐based physical frailty (encompassing weight loss and exhaustion). Only performance‐based physical frailty was associated with higher levels of inflammatory markers (CRP: β = 0.14, P = .03; IL‐6: β = 0.13, P = .06; NGAL: β = 0.14, P = .03).

Conclusion

The physical frailty phenotype is not a unidimensional construct in individuals with depression. Only performance‐based physical frailty is associated with low‐grade inflammation in late‐life depression, which might point to a specific depressive subtype.
Lower Extremity Proximal Muscle Function and Dyspnea in Older Persons
Authors: Vaz Fragoso Carlos A. , Araujo Katy , Leo‐Summers Linda , Van Ness Peter H.
Published: July 2015

Objectives

To evaluate the association between performance on a single chair stand and moderate to severe exertional dyspnea.

Design

Cross‐sectional.

Setting

Cardiovascular Health Study.

Participants

Community‐dwelling individuals aged 65 and older (N = 4,413; mean age 72.6; female, n = 2,518 (57.1%); nonwhite, n = 199 (4.5%); obese, n = 788 (17.9%); history of smoking, n = 2,410 (54.6%)).

Measurements

Performance on single chair stand (poor (unable to rise without arm use) vs normal (able to rise without arm use)), moderate to severe exertional dyspnea (American Thoracic Society grade ≥2), age, sex, ethnicity, obesity, smoking, frailty status (Fried‐defined nonfrail, prefrail, frail), high cardiopulmonary risk (composite of cardiopulmonary diseases and diabetes mellitus), spirometric impairment, arthritis, depression, stroke, and kidney disease.

Results

Poor performance on the single chair stand was established in 369 (8.4%) and moderate to severe exertional dyspnea in 773 (17.5%). Prefrail status was established in 2,210 (50.1%), frail status in 360 (8.2%), arthritis in 2,241 (51.4%), high cardiopulmonary risk in 2,469 (55.9%), spirometric impairment in 1,076 (24.4%), kidney disease in 111 (2.5%), depression in 107 (2.4%), and stroke in 93 (2.1%). In multivariable regression models, poor performance on the single chair stand was associated with moderate to severe exertional dyspnea (unadjusted odds ratio (OR) = 3.48, 95% confidence interval (CI) = 2.78–4.36; adjusted OR = 1.85, 95% CI = 1.41–2.41).

Conclusion

Poor performance on a single chair stand was associated with an adjusted 85% greater likelihood of moderate to severe exertional dyspnea than normal performance. These results suggest that reduced proximal muscle function of the lower extremities is associated with moderate to severe exertional dyspnea, even after adjusting for multiple confounders.
Physical Activity and Amyloid‐β Brain Levels in Elderly Adults with Intact Cognition and Mild Cognitive Impairment
Authors: de Souto Barreto Philipe , Andrieu Sandrine , Payoux Pierre , Demougeot Laurent , Rolland Yves , Vellas Bruno ,   the Multidomain Alzheimer Preventive Trial/Data Sharing Alzheimer Study Group
Published: July 2015

Objectives

To examine the associations between amyloid‐β brain deposition and physical activity (PA) in elderly adults without dementia and to investigate whether the association has a dose‐response relationship.

Design

Cross‐sectional study.

Setting

French community‐dwelling people.

Participants

Elderly adults with normal or mildly impaired cognition (mean age 74.7 ± 4.2; 60.4% female) with available information on current self‐reported PA and amyloid‐β brain deposition measured using positron emission tomography (PET) using the PET‐ligand florbetapir F 18 (n = 268).

Measurements

A standardized uptake value ratio (SUVR) was obtained for each subject. Participants were divided according to amyloid plaque cortical retention defined according to a SUVR cutoff of 1.10 (SUVR+ vs SUVR−).

Results

Bivariate and multivariate analyses showed that PA was not significantly associated with SUVR. SUVR+ and SUVR− participants did not differ in terms of volume (continuous PA variables) and levels (categorical PA variables) of PA. PA was not correlated with SUVR in apolipoprotein E ε4 carriers or noncarriers. PA was not associated with cognitive function.

Conclusion

Although PA protects against dementia, there is no solid evidence that this protection involves a reduction in amyloid‐β brain deposition. Further studies are needed to determine whether PA (ideally measured at several time‐points using objective measures) is involved in the pathophysiology of Alzheimer's disease.
Diagnosis and Management of Subclinical Hypothyroidism in Elderly Adults: A Review of the Literature
Authors: Hennessey James V. , Espaillat Ramon
Published: July 2015

The estimated prevalence of subclinical hypothyroidism (SCH) in the general population is 3% to 8%. As the average age of the population in the United States and other countries continues to increase, the overall prevalence of SCH may also be expected to increase. Although age‐related changes in thyroid function are well described, normal thyroid‐stimulating hormone (TSH) reference limits, derived for age‐specific populations, are not routinely used to identify thyroid dysfunction in elderly adults. Therefore, currently accepted values for the upper limit of normal of TSH may be inappropriate for diagnosing SCH in individuals aged 65 and older, resulting in potential overestimation of the prevalence of SCH in this population. This review discusses the current evidence of the effects of SCH on cardiovascular health and neuropsychiatric function in older adults. Although the results of some studies are conflicting, the overall evidence suggests that the consequences of SCH may be different for elderly adults than for younger populations. Treatment of SCH in older individuals requires special consideration with regard to thyroid hormone replacement therapy and expected clinical outcomes. Although careful identification of individuals with persistent SCH who could benefit from levothyroxine treatment is necessary, current evidence suggests that individuals with TSH levels greater than 10 mIU/L who test positive for antithyroid antibodies or are symptomatic may benefit from levothyroxine treatment to reduce the risk of progression to overt hypothyroidism, decrease the risk of adverse cardiovascular events, and improve their quality of life. After treatment is initiated, careful monitoring is essential.