bluuebunny/crossref_metadata_2025 huggingface dataset:
A realist evaluation of patients’ decisions to deprescribe in the EMPOWER trial
Authors: Martin Philippe , Tannenbaum Cara
Published: May 2017

Background and objectives

Successful mechanisms for engaging patients in the deprescribing process remain unknown but may include: (1) triggering motivation to deprescribe by increasing patients’ knowledge and concern about medications; (2) building capacity to taper by augmenting self-efficacy and (3) creating opportunities to discuss and receive support for deprescribing from a healthcare provider. We tested these mechanisms during theEliminating Medications through Patient Ownership of End Results (EMPOWER) () trial and investigated the contexts that led to positive and negative deprescribing outcomes.

Design

A realist evaluation using a sequential mixed methods approach, conducted alongside the EMPOWER randomised clinical trial.

Setting

Community, Quebec, Canada.

Participants

261 older chronic benzodiazepine consumers, who received the EMPOWER intervention and had complete 6-month follow-up data.

Intervention

Mailed deprescribing brochure on benzodiazepines.

Measurements

Motivation (intent to discuss deprescribing; change in knowledge test score; change in beliefs about the risk–benefits of benzodiazepines, measured with the Beliefs about Medicines Questionnaire), capacity (self-efficacy for tapering) and opportunity (support from a physician or pharmacist).

Results

The intervention triggered the motivation to deprescribe among 167 (n=64%) participants (mean age 74.6 years±6.3, 72% women), demonstrated by improved knowledge (risk difference, 58.50% (95% CI 46.98% to 67.44%)) and increased concern about taking benzodiazepines (risk difference, 67.67% (95% CI 57.36% to 74.91%)). Those who attempted to taper exhibited increased self-efficacy (risk difference, 56.90% (95% CI 45.41% to 65.77%)). Contexts where the deprescribing mechanisms failed included lack of support from a healthcare provider, a focus on short-term quality of life, intolerance to withdrawal symptoms and perceived poor health.

Conclusion

Deprescribing mechanisms that target patient motivation and capacity to deprescribe yield successful outcomes in contexts where healthcare providers are supportive, and patients do not have internal competing desires to remain on drug therapy.

Trial registration number

ClinicalTrials.gov:NCT01148186.
The relationship between area deprivation and prescription of long-acting reversible contraception in women of reproductive age in Lothian, Scotland, UK
Authors: Morgan Catherine Rachel , Liu Hanhua
Published: May 2017

Background

Reducing unplanned pregnancy in Scotland is a key government objective. Long-acting reversible contraception (LARC) is a cost-effective way to reduce unintended pregnancy. Abortion and teenage pregnancy rates are highest in the most deprived areas. One possible explanation could be contraceptive prescribing inequality. This study examined the relationship between area deprivation measured by the Scottish Index of Multiple Deprivation and LARC prescription.

Methods

Using Scottish electronic prescribing data from primary care and sexual and reproductive health clinics, this study analysed female Lothian residents with a valid postcode aged 16–49 years who received a contraceptive prescription from 1 April 2012 to 31 March 2014. Prescription of LARC (intrauterine, implant or injectable contraceptive) compared with non-LARC (oral pill, patch, ring or diaphragm) was examined. Logistic regression was performed adjusting for age group and prescription location.

Results

A total of 90 150 women were included; 21.1% of prescriptions were LARC and 15.3% vLARC (intrauterine method or implant). Women residing in the most deprived quintile (Q1) and prescribed contraception received a significantly higher proportion of LARC than quintiles 2–5 (Q2–5). Odds ratios compared with Q1 were: Q2 0.86, Q3 0.77, Q4 0.59 and Q5 0.51. Women in quintile 1 were also significantly more likely to receive vLARC than quintiles 2–5.

Conclusion

Women in the most deprived quintile in Lothian who are prescribed contraception are significantly more likely to receive LARC and vLARC compared with women in less deprived quintiles.
Radial and ulnar fracture treatment with paraosseous clamp‐cerclage stabilisation technique in 17 toy breed dogs
Authors: Manchi George , Brunnberg Mathias M , Shahid Muhammad , Al Aiyan Ahmad , Chow Eric , Brunnberg Leo , Stein Silke
Published: May 2017

Objective

Description of surgical technique, complications and outcome of radius/ulna fractures in toy and miniature breed dogs treated with the paraosseous clamp‐cerclage stabilisation (PCCS) method.

Study design

Retrospective study.

Methods

Clinical records of small breed dogs with fractures of the radius and ulna were reviewed between January 2011 and January 2016. Inclusion criteria were bodyweight of ≤3.5 kg, fracture of the radius and ulna of one or two limbs without previous repair attempts, available follow‐up information, and the use of PCCS for repair of the fracture as the sole method of fixation.

Results

Seventeen fractures in 17 dogs were included in the study. Radiographic union was documented in 13/17 cases. Median time to radiographic union was 13 weeks (range: 5–53 weeks). Major complications occurred in 24 per cent (4/17) due to implant failure, and for revision surgery the PCCS method was chosen in all four cases. Three of four revised fractures healed radiographically. One of the four dogs was lost for radiographic follow‐up, but the owner could be contacted for a telephone questionnaire. Eleven of 17 dogs achieved an excellent return to function without any lameness during clinical examination, but 5/17 dogs showed an intermittent mild lameness despite full radiographic union. Routine implant removal was performed in 9/17 dogs. The owners of 15/17 dogs could be contacted for a telephone questionnaire for a long‐term follow‐up. No further complications were reported.

Conclusions

PCCS is a feasible low‐cost internal fixation technique for repairing radial and ulnar fractures in toy breed dogs. Further biomechanical and clinical studies are needed for better evaluation of the PCCS method.
Future directions and priorities for Arctic bryophyte research
Authors: Lewis Lily R. , Ickert-Bond Stefanie M. , Biersma Elisabeth M. , Convey Peter , Goffinet Bernard , Hassel Kristian , Kruijer Hans (J.D.) , Farge Catherine La , Metzgar Jordan , Stech Michael , Villarreal Juan Carlos , McDaniel Stuart F.
Published: May 2017

The development of evidence-based international strategies for the conservation and management of Arctic ecosystems in the face of climate change is hindered by critical knowledge gaps in Arctic floristic diversity and evolution. Particularly poorly studied are the bryophytes, which dominate the vegetation across vast areas of the Arctic and consequently play an important role in global biogeochemical cycles. Currently, much of what is known about Arctic floristic evolution is based on studies of vascular plants. Bryophytes, however, possess a number of features, such as poikilohydry, totipotency, several reproductive strategies, and the ability to disperse through microscopic diaspores, that may cause their responses to Arctic environments to differ from those of the vascular plants. Here we discuss several priority areas identified in the Arctic Council’s “Arctic Biodiversity Assessment” that are necessary to illuminate patterns of Arctic bryophyte evolution and diversity, including dispersal, glacial refugia, local adaptation, and ecological interactions with bryophyte-associated microbiomes. A survey of digitally available herbarium data archived in the largest online aggregate, GBIF, across the Arctic to boreal zones indicates that sampling coverage of mosses is heterogeneous and relatively sparse in the Arctic sensu stricto. A coordinated international effort across the Arctic will be necessary to address knowledge gaps in Arctic bryophyte diversity and evolution in the context of ongoing climate change.
Hydrothermal synthesis of BiVO4/Bi2MoO6 composites with enhanced photocatalytic activity
Authors: Xu Chaoqi , Qian Hongzhi , Yong Haibo , Huang Xiaogu , Wang Wei , Wen Yan , Zhong Kun , Zhou Yingjie , Lai Min
Published: May 2017

BiVO4/Bi2MoO6 composites have been fabricated via the one-step hydrothermal method. The properties of composites were tailored by altering the V/Mo molar ratios. Photocatalytic activities were evaluated by measuring degradation of RhB under visible-light irradiation. BiVO4/Bi2MoO6 composites with V/Mo molar ratio of 8:1 possessing the optimal photocatalytic performance. The enhanced photocatalytic activity was attributed to the efficient charge carrier separation of composite heterostructures. In addition, the study of adsorption and photocatalytic activity suggested that a moderate amount of adsorption has a positive effect on photocatalytic reaction.
The dependence of critical current density of GdFeCo layer on composition of thermally assisted STT-RAM
Authors: Dai B. , Zhu J. , Liu K. , Yang L. , Han J.
Published: May 2017

Amorphous rare earth–transitional metal (RETM) GdFeCo memory layer with RE- and TM-rich compositions was fabricated in stacks of GdFeCo (10 nm)/Cu (3 nm)/[Co(0.2 nm)/Pd(0.4 nm)]6. Their magnetic properties and spin transfer torque (STT) switching of magnetization were investigated. The maximum magneto-resistance (MR) was around 0.24% for the TM-rich Gd[Formula: see text] (Fe[Formula: see text]Co[Formula: see text])[Formula: see text] memory layer and was −0.03% for the RE-rich Gd[Formula: see text] (Fe[Formula: see text]Co[Formula: see text])[Formula: see text] memory layer. The critical current densities [Formula: see text] to switch the GdFeCo memory layers are in the range of [Formula: see text] A/cm2–[Formula: see text] A/cm2. The dependence of critical current density [Formula: see text] and effective anisotropy constant [Formula: see text] on Gd composition were also investigated. Both [Formula: see text] and [Formula: see text] have maximum values in the Gd composition range from 21–29 at.%, suitable for thermally assisted STT-RAM for storage density exceeding Gb/inch2.
The Social Safety Net After Welfare Reform: Recent Developments and Consequences for Household Dynamics
Authors: Tach Laura , Edin Kathryn
Published: May 2017

The remarkable transformation of the American social safety net that began in the early 1990s has led to seismic shifts in who benefits and how. More than two decades later, how should these changes be judged? Expanding and updating prior influential reviews, we evaluate how the transformation of the safety net—broadly defined—has shaped economic and family dynamics within low-income households. Collectively, social safety net policies have expanded support for working poor parents quite dramatically, while the cash safety net for the nonworking poor has all but collapsed. Working poor families have come out ahead economically, with mounting evidence of positive long-term benefits for child health and development. At the same time, a substantial number of poor families have fallen through the cracks, disconnected from stable, adequate wage income and cash aid. A growing number report income so low that it can be tracked with indicators used to measure poverty in the developing world. Meanwhile, contrary to reformers’ predictions, these changes have had little effect on marriage or unwed births. We call for a reinvigorated focus on the continued evolution of the social safety net and discuss ways in which a sociological perspective can enhance such work.
Intravitreal Aflibercept as Rescue Therapy for Post-Radiation Cystoid Macular Edema Resistant to Intravitreal Bevacizumab: Outcomes at 1 Year
Authors: Khan Mohammed Ali , Mashayekhi Arman , Shields Jerry A. , Shields Carol L.
Published: May 2017

Background/Aims: To investigate the efficacy of intravitreal aflibercept as rescue therapy for post-radiation cystoid macular edema (CME) resistant to prior treatment with intravitreal bevacizumab (IVB). Methods: Retrospective, interventional, case-controlled series. Eyes with persistent post-radiation CME were treated with intravitreal aflibercept (2 mg/0.05 mL). Central macular thickness (CMT) and visual acuity were compared to a matched control group treated with only IVB at 1 year. Results: Ten eyes of 10 patients were included, with 5 eyes in the intervention and 5 in the control group. The eyes in the intervention group had previously been treated with IVB (mean 11.6 injections, range 6-22) but failed to show resolution of CME. Following rescue treatment with a mean of 9 injections of aflibercept, the mean CMT was reduced from 463 ± 138 to 267 ± 80 μm (p = 0.02) and the mean Snellen visual acuity was improved from 20/67 to 20/42 (p = 0.03). At 1 year, the eyes in the intervention group had lower CMT (267 ± 80 vs. 361 ± 71 μm, p = 0.09) and significantly better Snellen visual acuity (20/48 vs. 20/76, p = 0.02) compared to the control group. Conclusions: Aflibercept may be an effective rescue therapy for persistent post-radiation CME in eyes with incomplete response to IVB, with reduction in CMT and improvement in visual acuity.
Thrombogenesis in Thrombophilic Pregnancy: Evaluation of Low-Molecular-Weight Heparin Prophylaxis
Authors: Simeone Roberto , Giacomello Roberta , Bruno Germano , Parco Sergio , Maximova Natalia , Martinelli Monica , Zito Gabriella , Luppi Stefania , Cervi Gina , Ricci Giuseppe
Published: May 2017

The aim of this study is to investigate thrombogenesis and the hypercoagulable changes in pregnant women affected by thrombophilia who received low-molecular-weight heparin (LWMH) prophylaxis. We included 21 pregnant women affected by thrombophilia treated with LWMH and 20 nontreated normal pregnant women as the control group. The sample group of thrombophilic pregnant women included different conditions (factor V Leiden mutation, protein C deficiency, protein S deficiency, antiphospholipid antibodies syndrome, and combined defects). Three blood samples were collected during pregnancy (i.e., at 16, 20, and 24 weeks) and tested for activated partial thromboplastin time and prothrombin fragment F1 + 2 (F1 + 2); anti-FXa activity was tested only in treated thrombophilic pregnant women. F1 + 2 levels progressively increased during pregnancy in both study groups. However, the F1 + 2 increase in women exposed to heparin prophylaxis was significantly lower than that in normal pregnant women in all 3 measurements carried out during gestation (p < 0.05); a statistically significant inverse correlation between F1 + 2 levels and anti-Xa activity (R = -0.8575, p < 0.05) was observed in treated women during pregnancy. Our findings suggest that F1 + 2 in addition to anti-Xa measurement could be used to adjust LWMH prophylaxis, at least in high-risk pregnant women.
Acute Lipopolysaccharide Switches the Selection of Maternal Behavior to Predatory Behavior in Female Rats
Authors: Mendes-Lima Tiberiade , Kirsten Thiago Berti , Felicio Luciano Freitas , Teodorov Elizabeth , Queiroz-Hazarbassanov Nicolle , Bernardi Maria Martha
Published: May 2017

Objectives: A common problem during the postpartum period and during lactation is being affected by infection due to Gram-negative bacteria. In this situation, a sick mother needs to choose between caring for her pups or the need for survival. This study analyzed the effects of lipopolysaccharide (LPS)-induced sickness behavior on selection between maternal behavior (MB) and predatory behavior (PB) in lactating rats. To assess the LPS-induced sickness behavior, the plasma tumor necrosis factor-α (TNF-α) levels were measured. Methods: Lactating rats received 100 µg/kg LPS or saline solution on day 5 or 6 of lactation, 2 h before testing. Five pups and 5 cockroaches were introduced to the experimental cage at the same time and maternal and PB were observed for 30 min. The MB was measured by the pup contact, grouping, grooming, and kyphosis and the PB by contacting, eating, and foraging insects. General maternal activity was also observed, including exploration, self-grooming, and immobility. Immediately after the observations, blood was collected to measure the plasma TNF-α levels. Results: LPS administration reduced the time and frequency of pup contact, grouping, grooming, and kyphosis, with an increase in the latency to first pup contact and grouping. With regard to PB, the time of foraging and eating insects increased, and the latencies to first insect contact, eating insects, and foraging decreased. With regard to general maternal activity, immobility time and TNF-α levels increased in the LPS-treated group. Conclusions: LPS exposure switched MB to PB, prioritizing maternal survival. Thus, in more favorable situations, these rats may have new offspring and therefore her species would survive for long.
Alterations in Glucose Effectiveness and Insulin Dynamics: Polycystic Ovary Syndrome or Body Mass Index
Authors: Vuguin Patricia , Sopher Aviva B. , Roumimper Hailey , Chin Vivian , Silfen Miriam , McMahon Donald J. , Fennoy Ilene , Oberfield Sharon E.
Published: May 2017

Background/Aims: To delineate the relationship of polycystic ovary syndrome (PCOS), obesity, and hyperandrogenism (HA) with glucose and insulin dynamics in adolescents across a broad body mass index (BMI). Methods: Seventy-four PCOS subjects (aged 16 years) and 82 controls (aged 16 years) were evaluated by an oral glucose tolerance test. Subjects were categorized by BMI: normal weight (21 ± 0.4), overweight/obesity (OO; 33 ± 1.0), and severe obesity (SO; 48 ± 1.4). Indices of glucose and insulin dynamics were determined. Multiple linear regression analysis was used to evaluate the contribution of PCOS, HA, and BMI to these indices. Results: BMI was significantly associated with systolic and diastolic blood pressure and insulin resistance. A significant interaction between BMI and PCOS and indices of post-glucose load was observed. The mean difference in peak glucose, early glucose response, area under the curve for glucose, and glucose effectiveness (SgIo) between PCOS and control subjects was significantly different between OO and SO. In PCOS subjects, testosterone was positively associated with BMI, fasting insulin, early insulin response, and diastolic blood pressure, and negatively associated with SgIo. Conclusions: Abnormal glucose dynamics in adolescents with PCOS is mainly due to SO. The combination of PCOS and SO has a synergistic effect on glucose dynamics when compared to all other groups.
Impact of Mild-to-Moderate Chronic Kidney Disease on One Year Outcomes after Percutaneous Coronary Intervention
Authors: Grandjean-Thomsen Nicolas Lo , Marley Paul , Shadbolt Bruce , Farshid Ahmad
Published: May 2017

Background/Aim: Patients with severe chronic kidney disease (CKD) have a higher risk of adverse events after percutaneous coronary intervention (PCI). There is conflicting evidence regarding the benefit of drug-eluting stents (DES) in patients with CKD. This study is aimed at assessing the effect of mild-to-moderate CKD on PCI outcomes, and determining if DES reduce adverse events amongst these patients. Method: We used our PCI database to determine demographic, procedural and outcome variables for 1960 consecutive patients (October 2009-October 2012). Kidney function was measured by the estimated glomerular filtration rate (eGFR - CKD-Epidemiology Collaboration creatinine based). Multivariate analysis was performed to determine independent variables associated with mortality and major adverse cardiovascular events (MACE). Results: The independent variables, predictive of 12-month mortality in PCI patients, were: age >64 years (hazard ratio [HR] 3.10 [95% CI 1.73-5.55], p < 0.001), 3-vessel disease (HR 1.72 [95% CI 1.10-2.68], p = 0.016) and CKD stage. Compared to stage 1 CKD (eGFR >89), HR of death increased in a progressive pattern below eGFR <75: eGFR 60-74, HR 2.40 (95% CI 1.2-4.78), p = 0.013, eGFR 45-59, HR 3.27 (95% CI 1.55-6.9), p = 0.002, eGFR 30-44, HR 4.10 (95% CI 1.82-9.24), p = 0.001, eGFR <30, HR 7.97 (95% CI 3.65-17.40), p < 0.001. In patients with eGFR <75, multivariate analysis demonstrated that DES use was an independent predictor of lower MACE (HR BMS vs. DES 1.8, p = 0.0044). Conclusion: Age, severity of CKD and 3-vessel disease were independent predictors of mortality following PCI. The mortality risk in CKD patients increased progressively with eGFR <75. The use of DES was associated with a lower rate of MACE in CKD patients with eGFR <75.
Acute Intravenous Calcium Antagonist for Suspected Hemiplegic Migraine – A Case Story
Authors: Rath Charlotte Lützhøft , He Jun , Nordling Mette Maria , Wienecke Troels
Published: May 2017

Stroke mimics, like attacks of hemiplegic migraine, are challenging in acute stroke evaluation. We present a 28-year-old woman with a suspected hemiplegic migraine attack with left-sided hemiparalysis. Brain CT with perfusion imaging 1 h 54 min after symptom onset revealed hypoperfusion in the right hemisphere. The patient was treated with intravenous recombinant tissue plasminogen activator (rtPA) with no effect. After a subsequent intravenous verapamil infusion, the patient gained full motor function within 10 min. Brain magnetic resonance imaging (MRI) performed 5 h 46 min after symptom onset revealed diffusion restriction in the same area as the hypoperfusion on CT. There were no notable changes on T2 images. The patient stayed clinically in remission, except for reduced sensation for all modalities on the extremities on the left side. Although brain CT 24 h after symptom onset revealed an edema in the same area, an MRI performed 17 days later showed no new infarctions. Young patients with a history of migraine with aura admitted with symptoms of acute ischemic stroke are at risk of insufficient treatment. Calcium antagonists might be considered if there is no effect of first-line treatment with rtPA.
Deficiency of LRP1 in Mature Adipocytes Promotes Diet-Induced Inflammation and Atherosclerosis—Brief Report
Authors: Konaniah Eddy S. , Kuhel David G. , Basford Joshua E. , Weintraub Neal L. , Hui David Y.
Published: May 2017

Objective—

Mice with adipocyte-specific inactivation of low-density lipoprotein receptor–related protein-1 (LRP1) are resistant to diet-induced obesity and hyperglycemia because of compensatory thermogenic response by muscle. However, the physiological function of LRP1 in mature adipocytes and its role in cardiovascular disease modulation are unknown. This study compared perivascular adipose tissues (PVAT) from wild-type (
adLrp1
+/+
) and adipocyte-specific LRP1 knockout (
adLrp1
−/−
) mice in modulation of atherosclerosis progression.

Approach and Results—

Analysis of adipose tissues from
adLrp1
+/+
and
adLrp1
−/−
mice after Western diet feeding for 16 weeks revealed that, in comparison to
adLrp1
+/+
mice, the adipocytes in
adLrp1
−/−
mice were smaller, but their adipose tissues were more inflamed with increased monocyte–macrophage infiltration and inflammatory gene expression. The transplantation of PVAT from chow-fed
adLrp1
+/+
and
adLrp1
−/−
mice into the area surrounding the carotid arteries of
Ldlr
−/−
mice before feeding the Western diet revealed a contributory role of PVAT toward hypercholesterolemia-induced atherosclerosis. Importantly, recipients of
adLrp1
−/−
PVAT displayed a 3-fold increase in atherosclerosis compared with
adLrp1
+/+
PVAT recipients. The increased atherosclerosis invoked by LRP1-deficient PVAT was associated with elevated monocyte–macrophage infiltration and inflammatory cytokine expression in the transplanted fat.

Conclusions—

PVAT provide outside-in signals through the adventitia to modulate atherosclerotic lesion progression in response to hypercholesterolemia. Moreover, adipocytes with LRP1 deficiency are dysfunctional and more inflamed. This latter observation adds the adipose tissue to the list of anatomic sites where LRP1 expression is important to protect against diet-induced atherosclerosis.
DBA/2J Haplotype on Distal Chromosome 2 Reduces Mertk Expression, Restricts Efferocytosis, and Increases Susceptibility to Atherosclerosis
Authors: Kayashima Yukako , Makhanova Natalia , Maeda Nobuyo
Published: May 2017

Objective—

Arch atherosclerosis 4
(
Aath4
) is a quantitative trait locus for atherosclerotic plaque formation in the inner curve of the aortic arch previously identified in an F2 cross of
Apoe
−/−
mice on DBA/2J and 129S6 backgrounds.
C-mer proto-oncogene tyrosine kinase (Mertk
), coding for a ligand-activated transmembrane tyrosine kinase, is a candidate gene within the same chromosomal region. Our objective was to determine whether strain differences in
Mertk
influence plaque formation.

Approach and Results—

To dissect the strain effects of
Mertk
on atherosclerosis, we first established a congenic mouse line (
Aath4a

DBA/DBA

) in which a 5′ region of
Aath4
of DBA/2J, including
Mertk
, was backcrossed onto a 129S6-
Apoe
−/−
background. The resulting
Aath4a

DBA/DBA

male mice developed significantly larger plaques compared with control mice (
Aath4a

129/129

), proving that the DBA/2J allele of
Aath4a
is proatherogenic. Thioglycollate-elicited peritoneal macrophages from
Aath4a

DBA/DBA

mice express less than 50% of
Mertk
mRNA and cell-surface MERTK protein compared with those from the control mice. Moreover, both large and small peritoneal
Aath4a

DBA/DBA

macrophages showed reduced phagocytosis of apoptotic cells. When
Mertk
cDNAs from 129S6 and DBA/2J mice were overexpressed in HEK293T (human embryonic kidney 293T) cells, phagocytosis of apoptotic cells was equally enhanced in direct proportion to
Mertk
levels, indicating that phagocytosis is modulated by the amount of MERTK, but that it is not affected by MERTK amino acid differences between 129S6 and DBA/2J.

Conclusions—

Reduced transcription of
Mertk
, rather than differences in MERTK protein structure, determines the reduced efficiency of apoptotic cell clearance in the
Aath4a

DBA/DBA

mice, which, in turn, contributes to their increased susceptibility to atherosclerosis.
Initiation Patterns of Statins in the 2 Years After Release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Management Guideline in a Large US Health Plan
Authors: Olufade Temitope , Zhou Siting , Anzalone Deborah , Kern David M. , Tunceli Ozgur , Cziraky Mark J. , Willey Vincent J.
Published: May 2017

Background

The purpose of this study was to characterize changes in statin utilization patterns in patients newly initiated on therapy in the 2 years following the release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol management guideline in a large
US
health plan population.

Methods and Results

This retrospective, observational study used administrative medical and pharmacy claims data to identify patients newly initiated on statin therapy over 4 quarters prior to and 8 quarters following the release of the guideline (average N/quarter=3596). Patients were divided into the 4 statin benefit groups (
SBG
s) based on risk factors and laboratory lipid levels as defined in the guideline:
SBG
1 (with atherosclerotic cardiovascular disease [
ASCVD
]; N=1046/quarter),
SBG
2 (without
ASCVD
, with low‐density lipoprotein cholesterol ≥190 mg/dL; N=454/quarter),
SBG
3 (without
ASCVD
, aged 40–75 years, with diabetes mellitus, low‐density lipoprotein cholesterol 70–189 mg/dL; N=1391/quarter),
SBG
4 (no
ASCVD
or diabetes mellitus, age 40–75 years, low‐density lipoprotein cholesterol 70–189 mg/dL, estimated 10‐year
ASCVD
risk of ≥7.5%; N=705/quarter). Demographic variables, statin utilization patterns, lipid levels, and comorbidities were analyzed for pre‐ and postguideline periods. Postguideline, gradually increased high‐intensity statin initiation occurred in
SBG
1,
SBG
2, and in
SBG
3 patients with 10‐year
ASCVD
risk ≥7.5%. Moderate‐ to high‐intensity statin initiation gradually increased among
SBG
4 patients. Recommended‐intensity statin choice changed to a greater degree among patients treated by specialty care physicians. Regarding sex, target‐intensity statin initiation was lower in women in all groups before and after guideline release.

Conclusions

Prescriber implementation of the guideline recommendations has gradually increased, with the most marked change in the increased initiation of high‐intensity statins in patients with
ASCVD
and in those treated by a specialist.
A new name and nomenclatural adjustments in Erythroxylum (Erythroxylaceae)
Authors: COSTA-LIMA JAMES LUCAS DA , AMORIM ANDRÉ M.
Published: May 2017

Based on an analysis of 58 herbarium collections from South America and Europe, including types, this work proposes a new name for Erythroxylum amplifolium (Mart.) O.E.Schulz and designates lectotypes for the new name and E. cuneifolium (Mart.) O.E.Schulz, E. pachyneurum O.E.Schulz, E. patentissimum O.E.Schulz, and/or their synonyms. The complete synonymy of the accepted names and comments about the distribution and taxonomy of the species are provided.
A novel Pestalotiopsis species isolated from Bulbophyllum thouars in Guangxi Province, China
Authors: WANG YONG , RAN SHUANG-FEI , MAHARACHCHIKUMBURA SAJEEWA S. N. , AL-SADI ABDULLAH M. , HYDE KEVIN D. , WANG HUA-LEI , WANG TAO , WANG YAN-XIA
Published: May 2017

A coelomycetous fungus isolated from dead stems of Bulbophyllum thouars produced conidia with single apical and basal appendages. Combined morphological comparison and phylogenetic analysis based on four gene regions (ITS, LSU, β-tubulin and tef1) confirm this fungus as a new taxon which is named as Pestalotiopsis bulbophylli sp. nov.
Revision of the funnel-web spider genus Novalena (Araneae: Agelenidae)
Authors: MAYA-MORALES JULIETA , JIMÉNEZ MARÍA LUISA
Published: May 2017

The Western Hemisphere genus Novalena Chamberlin & Ivie 1942 (Araneae: Agelenidae) is revised. The genus now includes a total of 53 species, of which 40 are new species from USA, Mexico, Guatemala, and Costa Rica: N. ajusco sp. nov. (♀), N. alamo sp. nov. (♂), N. alvarezi sp. nov. (♀), N. atzimbo sp. nov. (♀), N. bosencheve sp. nov. (♂), N. chamberlini sp. nov. (♂ ♀), N. cieneguilla sp. nov. (♀), N. cintalapa sp. nov. (♂ ♀), N. clara sp. nov. (♂ ♀), N. comaltepec sp. nov. (♀), N. creel sp. nov. (♂ ♀), N. dentata sp. nov. (♂ ♀), N. divisadero sp. nov. (♀), N. durango sp. nov. (♀), N. franckei sp. nov. (♂ ♀), N. garnica sp. nov. (♂ ♀), N. gibarrai sp. nov. (♂ ♀), N. irazu sp. nov. (♀), N. iviei sp. nov. (♂), N. ixtlan sp. nov. (♂), N. jiquilpan sp. nov. (♀), N. leonensis sp. nov. (♂ ♀), N. mexiquensis sp. nov. (♂ ♀), N. oaxaca sp. nov. (♂ ♀), N. paricutin sp. nov. (♀), N. perote sp. nov. (♂ ♀), N. plata sp. nov. (♀), N. poncei sp. nov. (♂ ♀), N. popoca sp. nov. (♀), N. prieta sp. nov. (♀), N. puebla sp. nov. (♂ ♀), N. punta sp. nov. (♂ ♀), N. rothi sp. nov. (♂ ♀), N. saltoensis sp. nov. (♀), N. sinaloa sp. nov. (♀), N. tacana sp. nov. (♂ ♀), N. triunfo sp. nov. (♀), N. valdezi sp. nov. (♂ ♀), N. victoria sp. nov. (♀), and N. volcanes sp. nov. (♀). Nine are previously described species: N. annamae (Gertsch & Davis 1940), N. attenuata (F.O. Pickard-Cambridge 1902), N. bipartita (Kraus 1955), N. calavera Chamberlin & Ivie 1942, N. costata (F.O. Pickard-Cambridge 1902), N. laticava (Kraus 1955), N. orizaba (Banks 1898), N. shlomitae (García-Villafuerte 2009), and N. simplex (F.O. Pickard-Cambridge 1902). Four new synonyms are proposed: N. pina Chamberlin & Ivie 1942 = N. intermedia (Chamberlin & Gertsch 1930); N. idahoana (Gertsch 1934) and N. wawona Chamberlin & Ivie 1942 = N. lutzi (Gertsch 1933); N. tolucana (Gertsch & Davis 1940) = N. approximata (Gertsch & Ivie 1936). One species is transferred from Melpomene back to Novalena: N. bipunctata Roth 1967 stat. rev. One species is transferred to Hoffmannilena Maya-Morales & Jiménez 2016: H. nova (O. Pickard-Cambridge 1896) comb. nov.
Predictors of failure of DISE-directed adenotonsillectomy in children with sleep disordered breathing
Authors: Alsufyani Noura , Isaac Andre , Witmans Manisha , Major Paul , El-Hakim Hamdy
Published: May 2017

Background

Adenotonsillectomy (AT) is the most commonly performed procedure for sleep disordered breathing (SDB) in pediatrics. However, 20-40% of patients will have persistent signs and symptoms of SDB after AT. Drug-induced sleep endoscopy (DISE) has the potential to individualize surgical treatments and avoid unnecessary or unsuccessful surgeries. The objective of this study was to determine the predictors of failure of DISE-directed adenoidectomy and/or tonsillectomy in otherwise healthy children with SDB.

Methods

We retrospectively reviewed a prospective database of children who presented with SDB. All patients underwent preoperative pulse oximetry (PO), followed by DISE with T ± A, The variables documented included demographics, ethnicity, co-morbidities, family history, McGill Oximetry Score (MOS) on PO, as well as findings of collapse and or obstruction on DISE and symptom resolution based on modified Pediatric Sleep Questionnaire (PSQ). The primary outcome was the independent predictors of treatment failure based on multivariate binary logistic regression.

Results

Three hundred eighty-two patients satisfied the inclusion criteria. Based on post-operative modified PSQ, SDB resolved in 259 patients (68%), whereas 123 (32%) had persistent symptoms. On bivariate analysis, neuropsychiatric diagnosis ( r = 0.286, p = 0.042), history of sleepwalking or enuresis ( r = 0.103, p = 0.044), MOS ( r = 0.123, p = 0.033), presence of DNS ( r = 0.107, p = 0.036), and presence of laryngomalacia ( r = 0.122, p = 0.017) all positively correlated with treatment failure. Small tonsil size on DISE correlated with treatment failure ( r = −0.180, p < 0.001). Multivariate analysis identified age greater than 7 years (OR = 1.799, [95% CI 1.040–3.139], p = 0.039), obesity (OR = 2.032, [95% CI 1.043–3.997], p = 0.040), chronic rhinitis (OR = 1.334, [95% CI 1.047–1.716], p = 0.025), deviated nasal septum (OR = 1.745, [95% CI 1.062–2.898], p = 0.031) and tonsil size (OR = 0.575, [95% CI 0.429–0.772], p < 0.01) as independent predictors of treatment failure.

Conclusions

Obese, asthmatic, and children older than seven years are at increased risk of treatment failure after DISE-directed AT. Several DISE findings can independently predict AT failure, including tonsil size, degree of chronic rhinitis, and the presence of a deviated nasal septum, and can be addressed at a second stage. Further research is needed into the role of DISE in surgically naïve patients with SDB, and to compare DISE-directed surgery with the current standard of care.
Raising awareness of endometriosis in adolescent girls
Authors: Randhawa Amie , Land Lucy
Published: May 2017

It can cause significant pain and harm education in adolescents, write Amie Randhawa and Lucy Land
The cost-effectiveness of a novel soluble beta-glucan gel
Authors: Cutting K.F.
Published: May 2017

Objective:

Wounds that have stalled healing are costly in terms of patient morbidity and increase in use of material and financial resources. A natural polymer beta-glucans has been incorporated into a methylcellulose gel to provide a topical gel designed to accelerate healing in wounds where it has stalled. Although the gel provides an environment conducive to moist wound healing the active agent, beta-glucans, activate the innate immune response.

Method:

Using a Markov cohort simulation model, data were extrapolated from a double-blind randomised trial to evaluate the economic benefits of the soluble beta-glucan (SBG) gel in the treatment of diabetic foot ulcers (DFUs).

Results:

Over an annual budget cycle, SBG gel is expected to heal 94% of wounds compared with 78% when given standard care. It also healed wounds more quickly, with the average expected healed weeks 34.4 in the SBG gel group, compared with 24.7 methylcellulose dressing group. In our model this leads to a cost saving over an annual budget cycle of £503 per patient. Note: healed weeks refers to the number of weeks when the wound has healed during the 12-week period and should not be confused with weeks to healing.

Conclusion:

The shorter healing time associated with the SBG gel treatment leads to a cost saving because fewer weeks of treatment are required to heal the wound, suggesting this is a promising new cost-effective option for the treatment of DFUs.
Evaluation of skin perfusion pressure to assess refractory foot ulcers
Authors: Kawai M. , Mihara S. , Takahagi S. , Iwamoto K. , Hiragun T. , Hide M.
Published: May 2017

Objective:

The number of patients with foot gangrene caused by critical ischaemia and severe infection is increasing significantly in developed countries. The measurement of perilesional skin blood flow by skin perfusion pressure (SPP) is useful to select the appropriate treatment of gangrenous lesions, in that it is not affected by calcifications of blood vessels. However, the prognosis of a foot ulcer may also be affected by the level of blood sugar and infections. This study aimed to validate the use of SPP in cases of foot gangrene and ulcers in patients with and without diabetes mellitus (DM) and infection.

Method:

Clinical symptoms, ankle-brachial pressure index (ABPI) and SPP were assessed to evaluate the condition of each foot ulcer. Every foot ulcer was treated as independent, even if a participant had multiple ulcers. All ulcers for which we measured SPP were subject to the analysis. All ulcers were purely ischaemic in nature and were exclusively located on the foot or toes.

Results:

Data were collected from 117 foot ulcers on 91 toes and feet from 65 patients. Almost all SPP values in healed cases were > 27 mmHg. There were three patients whose ulcers failed to heal by conservative treatments were complicated with severe infection. However, no effect of DM on the relationship between SPP values and prognosis was observed. Logistic regression analysis of all ulcers except for the 5 cases complicated with infection revealed that those with 30 mmHg or lower SPP values are likely to heal by conservative treatment with 23% or lower probability, whereas any ulcer with more than 50 mmHg SPP value and without severe infection may heal without the need for further operations with 80% or higher probability.

Conclusion:

The combination of SPP and careful evaluation of infection may be a good parameter to decide the appropriate treatment for ischaemic skin ulcers, regardless of the complication of DM.
Classroom inside writing activities from perspective of pre-service teacher
Öğretmen adaylarının perspektifinden sınıf içi yazma çalışmalarının değerlendirilmesi
Authors: Ateş Seyit
Published: May 2017

Writing, which is defined as a statement of thoughts, emotions, and knowledge in a writing form, is an important skill used by any individual during lifelong. Due to this fact, writing skill have drawn more attention from educators and researchers and a number of empiric and theoretical researches have been conducted on how to acquire and develop this skill. Additionally, how this skill is transferred into classroom setting has an interest. The current research aimed to explore the writing practices in the classroom settings from the pre-service teachers’ perspectives. This research employed qualitative case study method and the data was collected though the structured observations and semi-structured focus group interviews. The fourth-year pre-service teachers studying at elementary school classroom teaching and their experienced teachers in their student teaching experience schools constituted the research sample. The data was analyzed by using descriptive techniques. The overall findings of the research showed that there was a relative lack of the practice used for developing writing skills in the classroom setting. While the grade level changed, the practices for writing di not differentiated. Based on the research findings, the recommendations were given. Extended English abstract is in the end of PDF (TURKISH) file. ÖzetZihindeki duygu, düşünce ve bilgilerin yazılı bir şekilde ifade edilmesi olarak tanımlanan yazma bireyin hayatı boyunca kullanacağı önemli bir beceridir. Bu nedenle yazma her zaman eğitimcilerin ve araştırmacıların ilgi odağı olmuş, bu becerinin kazanımı ve geliştirilmesiyle ilgili kuramsal ve uygulama temelli çok sayıda araştırma yapılmıştır. Bu araştırmaların sınıflara nasıl yansıdığı ise merak konusudur. Bu araştırmada öğretmen adaylarının perspektifinden sınıfta gerçekleştirilen yazma çalışmalarının betimlenmesi amaçlanmıştır. Araştırma nitel yaklaşımla gerçekleştirilmiş olup veriler yapılandırılmış katılımlı olmayan gözlemler ve katılımcılarla yapılan odak grup görüşmeler yoluyla elde edilmiştir. Sınıf öğretmenliği eğitimi son sınıf öğrencileri ve bu öğrencilerin staja gittikleri okullardaki öğretmenler araştırmanın çalışma grubunu oluşturmaktadır. Araştırmada gözlem ve görüşmelerden elde edilen veriler betimsel analizle çözümlenmiştir. Araştırmadan çıkarılan en genel sonuç ilkokul sınıflarında yazmanın geliştirilmesine yönelik uygulamaların yetersiz olduğu yönündedir. Sınıf düzeyinin değişmesine rağmen yazma öncesinde, yazma sırasında ve yazma sonrasında sınıflarda yapılan çalışmalar farklılaşmamaktadır. Araştırmada elde edilen sonuçlar doğrultusunda uygulamaya yönelik öneriler geliştirilmiştir.
The mediating role of basic psychological needs in the relationship between self-determination and meaning in life in adolescent
Ergenlerde öz-belirleyicilik ve yaşamda anlam ilişkisinde temel psikolojik gereksinimlerin aracı rolü
Authors: Demirbaş Çelik Nur , Tezcan Fatoş
Published: May 2017

As in every part of life, concept of meaning in life has an important place during adolescence as a determinant of well-being. In this research concepts of meaning in life of high school students have been investigated with the perception of self-determination, which is a motivation theory. The aim of the study was to test structural equation model in which the relationship between self-determination and meaning in life is mediated by basic psychological need satisfaction. The sample of the study consisteds of 348 High School Student in İstanbul. In order to gather data, Basic Psychological Need Satisfaction Scale (BPNS), Self-Determination Scale (SDS) and the Meaning in Life Questionnaire (MLQ) were used. The data were analysed by using SPSS 20 and LISREL 8.8. The results revealed that satisfaction of basic psychological needs fully mediated the relationship self-determination between and meaning in life in high school students. However, results also showed significant negative relationship between self-determination and search of meaning in life. The results and limitations of the study were discussed and recommendations have been provided to the researchers.Extended English abstract is in the end of PDF (TURKISH) file. ÖzetYaşamda anlam anlayışı, yaşamın her döneminde olduğu gibi iyi oluşun bir belirleyicisi olarak ergenlik döneminde de önemli bir noktada yer almaktadır. Bu araştırma lise öğrencilerinin yaşamda anlam anlayışlarını bir motivasyon kuramı olan öz- belirleme bakış açısıyla incelemektedir. Bu araştırmanın amacı, öz belirleyicilik ile yaşamda anlam arasındaki ilişkide temel psikolojik gereksinimlerin aracı rolünün yapısal eşitlik modeli ile test edilmesidir. Araştırmanın çalışma grubu, İstanbul’da lise öğrenimi gören 348 öğrenciden oluşmaktadır. Araştırmada veri toplamak amacıyla Temel Psikolojik İhtiyaçlar Ölçeği (TPİÖ), Özerk Benlik Yönetimi Ölçeği (ÖBYÖ) ve Yaşamda Anlam Ölçeği (YAÖ) kullanılmıştır. Veriler SPSS ve LISREL 8.8 programı kullanılarak test edilmiştir. Araştırma sonucunda, lise öğrencilerinde öz-belirleme ile yaşamda anlam arasındaki ilişkinin temel psikolojik ihtiyaçların doyumu aracılığıyla sağlandığı bulunmuştur. Bununla birlikte araştırma sonuçları, öz- belirleme ve yaşamda anlam arayışı arasında doğrudan negatif yönde anlamlı bir ilişki olduğunu göstermiştir. Araştırma bulguları ve sınırlılıkları tartışılmış bu bağlamda araştırmacılara yönelik öneriler sunulmuştur.
„Lesson study“ v českých podmínkách: Jak učitelé vnímali svou účast a jaký vliv měla na jejich všímání si didakticko-matematických jevů
Authors: Vondrová Naďa , Cachová Jana , Coufalová Jana , Krátká Magdalena
Published: May 2017

Abstrakt: Cílem článku je uvést do českého prostoru tzv. lesson study jako specifickou formu dalšího vzdělávání učitelů založenou na spolupráci učitelů při zkvalitňování výuky prostřednictvím plánování, realizace a vyhodnocení experimentální hodiny. Lesson study má společné rysy s akčním výzkumem a souvisí s pojmy kvalifikovaná reflexe a rozvíjející hospitace. Kromě popisu konkrétní realizace lesson study se článek zaměřuje na otázku, jaký vliv měla na zúčastněné učitele (n = 13) z hlediska jejich subjektivního vnímání i z hlediska všímání si didakticko-matematických jevů. Data zahrnují písemné odpovědi na reflektivní úkoly a záznamy diskusí. Data byla analyzována technikami založenými na zakotvené teorii i s použitím existujícího kategoriálního systému. Učitelé považovali práci v lesson study za smysluplnou a subjektivně vnímali, že došlo k posunu jejich schopnosti reflektovat výuku matematiky. Analýza reflektivních úkolů posun ve všímání si didakticko-matematických jevů neukázala. Byly zjištěny rozdíly v hloubce individuální a společné reflexe výukové situace. Závěrem jsou uvedeny předpoklady a bariéry rozšíření lesson study u nás. Klíčová slova: Lesson study, kvalifikovaná reflexe, rozvíjející hospitace, další vzdělávání učitelů
Videokluby jako forma profesního vzdělávání učitelů: otevřenost komunikace z pohledu učitelů
Authors: Minaříková Eva , Uličná Klára , Píšová Michaela , Janík Tomáš , Janík Miroslav
Published: May 2017

Abstrakt: Tato studie se zabývá videokluby jakožto intenzivní formou profesního vzdělávání učitelů. V teoretické části se zaměřuje na profesní učící se komunity a na využití videosekvencí v rámci profesního rozvoje učitelů. Poté je představeno naše pojetí videoklubů pro učitele anglického jazyka na základních školách. Cílem předkládané studie bylo prozkoumat, jak účastníci videoklubů popisují svou zkušenost s touto formou profesního rozvoje, především vzhledem ke komunikaci a skupinové dynamice. Videoklubů se zúčastnilo 11 učitelů anglického jazyka, kteří pracovali ve třech skupinách. Zdrojem dat byly rozhovory s jednotlivými účastníky, přepisy videozáznamů posledního setkání videoklubů a emailové zpětné vazby účastníků, které psali po každém ze setkání.  Data byla zpracována metodou tematické analýzy. Výsledky naznačují, že ačkoliv učitelé popisovali atmosféru videoklubů jako příjemnou a otevřenou, zjevně pociťovali nedostatek kritiky a přítomnost diplomacie a korektnosti. Jejich postoje ke kritice se ale lišily – některým chyběla, jiní ji naopak nevnímali jako nutnou součást videoklubů, jelikož každý z učitelů má vlastní přístup a kritizovat je proto nežádoucí. Tyto postoje otevírají otázku, zda se v některých skupinách nejednalo spíše o pseudokomunitu a vyhýbání se konfliktu a jak tomuto nastavení mohou tvůrci a facilitátoři podobných programů předejít. Klíčová slova: videokluby, profesní rozvoj učitelů, profesní učící se komunita, video v učitelském vzdělávání