bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Left Ventricular Electrical Delay on the Acute Hemodynamic Response with Cardiac Resynchronization Therapy
Authors: GOLD MICHAEL R. , LEMAN ROBERT B. , WOLD NICHOLAS , STURDIVANT J. LACY , YU YINGHONG
Published: January 2014

Effect of QLV on CRT Hemodynamic Response

Introduction

Cardiac resynchronization therapy (CRT) improves hemodynamic function, as well as reduces hospitalizations and mortality among patients with systolic dysfunction, QRS prolongation, and heart failure. The magnitude of the hemodynamic response is associated with improved outcomes, so optimization of this parameter is a goal of therapy. The purpose of this study was to evaluate the effect of left ventricular (LV) electrical delay, as assessed by the QLV interval, on the acute hemodynamic response to CRT.

Methods and Results

This study included 31 patients undergoing biventricular ICD placement. At implant, invasive LV dP/dt was measured by a micromanometer catheter during biventricular (BV) or LV only pacing. Both atrial sensing (AS) and atrial pacing (AP) modes were evaluated at 5 different AV delays, tested in randomized order. The QLV interval was measured at the LV pacing site. Compared with intrinsic rhythm, CRT increased LV dP/dtmax by 9.5 ± 8.8% with BV pacing and 10.0 ± 9.2% with LV pacing (P = 0.38) during AS. With AP, CRT increased LV dP/dtmax by 16.0 ± 10.8% and 15.3 ± 11.1%, respectively (P = 0.47). QLV was strongly correlated with the hemodynamic response in all pacing configurations. Multivariate analysis showed that with BV pacing QLV was an independent predictor of the hemodynamic response with a 1.7% increase in %LV dP/dt for every 10 milliseconds prolongation of QLV.

Conclusions

LV electrical delay is a strong predictor of the acute hemodynamic response to CRT. This relationship is independent of pacing mode.
Poly(ADP‐ribose) polymerase inhibition with HYDAMTIQ reduces allergen‐induced asthma‐like reaction, bronchial hyper‐reactivity and airway remodelling
Authors: Lucarini Laura , Pini Alessandro , Gerace Elisabetta , Pellicciari Roberto , Masini Emanuela , Moroni Flavio
Published: January 2014

Activation of poly(ADP‐ribose) polymerases (PARPs) is considered a key event in the molecular and cellular processes leading from acute asthma attacks to bronchial hyper‐reactivity, leucocyte recruitment, chronic inflammation, airway remodelling and lung damage. The present investigation has been carried out to investigate the action of hydroxyl‐dimethylaminomethyl‐thieno[2,3‐c]isoquinolin‐5(4H)‐one (HYDAMTIQ), a new potent PARP inhibitor, in the process leading from asthma‐like events to airway damage. Ovalbumin‐sensitized guinea pigs exposed two times to allergen inhalation were treated for 8 days with vehicle or HYDAMTIQ. Asthma‐like signs, bronchial hyper‐reactivity to methacholine, cytokine production, histamine release from mast cells, airway remodelling, collagen deposition and lung damage were evaluated. Repeated HYDAMTIQ administration (1‐10 mg/kg/day i.p.) reduced lung PARP activity, delayed the appearance and reduced the severity of allergen‐induced cough and dyspnoea and dampened the increased bronchial responses to methacholine. HYDAMTIQ‐treated animals presented reduced bronchial or alveolar abnormalities, lower number of eosinophils and other leucocytes in the lung and decreased smooth muscle or goblet cell hyperplasia. The treatment also reduced lung oxidative stress markers, such as malondialdehyde or 8‐hydroxy‐2′‐deoxyguanosine and the lung content of pro‐inflammatory cytokines (TNF‐α, interleukin (IL)‐1β, IL‐5, IL‐6 and IL‐18). Finally, mast cells isolated from the peritoneal or pleural cavities of sensitized, HYDAMTIQ‐treated animals had a reduced ability to release histamine when exposed to ovalbumin in vitro. Our findings support the proposal that PARP inhibitors could have a therapeutic potential to reduce chronic lung inflammation, airway damage and remodelling in severe unresponsive asthmatic patients.
Oral glucose tolerance test‐based calculation identifies different glucose intolerance phenotypes within the impaired fasting glucose range
Authors: Carnevale Schianca Gian Piero , Fra Gian Paolo , Bigliocca Marcello , Mella Roberto , Rossi Luca , Bartoli Ettore
Published: January 2014

Aims/Introduction

The conventional oral glucose tolerance test (OGTT) cannot detect future diabetics among isolated impaired fasting glucose (is‐IFG) nor normal glucose tolerant (NGT) groups. By analyzing the relationship between fasting (FPG) and 2‐h plasma glucose (2hPG), the present study identifies is‐IFG subjects liable to worsening glucose homeostasis.

Materials and Methods

Oral glucose tolerance test was carried out in 619 patients suffering from obesity, hypertension or dyslipidemia, whose FPG was in the 100–125 mg/dL range. We calculated the percentage increment of 2hPG with respect to FPG (PG%) in these patients using the formula: ([2hPG − FPG] / FPG) × 100. Differences in β‐cell function within is‐IFG patients were assessed by estimated insulin sensitivity index (EISI), first‐phase insulin release (1stPH) and 1stPH/1/EISI (1stPHcorrected).

Results

Diabetes was diagnosed in 69 patients (11.2%), combined IFG/impaired glucose tolerance (IGT) in 185 patients (29.9%) and is‐IFG in 365 patients (58.9%). Is‐IFG was subdivided into PG% tertile groups: the percentage of females increased from 25% in the lowest to 45.2% in the highest tertile (χ2 = 18.7, P < 0.001). Moving from the lowest to the highest PG% tertile group, insulin and 2hPG concentrations rose, whereas FPG, EISI, and 1stPHcorrected decreased progressively and significantly. Furthemore, PG% correlated inversely with EISI (r = −0.44, P < 0.0001) and 1stPHcorrected (r = −0.38, P < 0.0001).

Conclusions

Oral glucose tolerance test does differentiate the great heterogeneity in metabolic disorders of patients with FPG 100–125 mg/dL. Furthermore, PG% can expand the diagnostic power of OGTT in the is‐IFG range by distinguishing metabolic phenotypes very likely to herald different clinical risks.
Marker‐based estimates of relatedness and inbreeding coefficients: an assessment of current methods
Authors: Wang J.
Published: January 2014

Inbreeding (F) of and relatedness (r) between individuals are now routinely calculated from marker data in studies in the fields of quantitative genetics, conservation genetics, forensics, evolution and ecology. Although definable in terms of either correlation coefficient or probability of identity by descent (IBD) relative to a reference, they are better interpreted as correlations in marker‐based analyses because the reference in practice is frequently the current sample or population whose F and r are being estimated. In such situations, negative estimates have a biological meaning, a substantial proportion of the estimates are expected to be negative, and the average estimates are close to zero for r and equivalent to FIS for F. I show that although current r estimators were developed from the IBD‐based concept of relatedness, some of them conform to the correlation‐based concept of relatedness and some do not. The latter estimators can be modified, however, so that they estimate r as a correlation coefficient. I also show that F and r estimates can be misleading and become biased and marker dependent when a sample containing a high proportion of highly inbred and/or closely related individuals is used as reference. In analyses depending on the comparison between r (or F) estimates and a priori values expected under ideal conditions (e.g. for identifying genealogical relationship), the estimators should be used with caution.
Detailed Process of Shell Construction in the Photosynthetic Testate Amoeba Paulinella chromatophora (Euglyphid, Rhizaria)
Authors: Nomura Mami , Nakayama Takuro , Ishida Ken‐ichiro
Published: January 2014

Most euglyphids, a group of testate amoebae, have a shell that is constructed from numerous siliceous scales. The euglyphid Paulinella chromatophora has photosynthetic organelles (termed cyanelles or chromatophores), allowing it to be cultivated more easily than other euglyphids. Like other euglyphids, P. chromatophora has a siliceous shell made of brick‐like scales. These scales are varied in size and shape. How a P. chromatophora cell makes this shell is still a mystery. We examined shell construction process in P. chromatophora in detail using time‐lapse video microscopy. The new shell was constructed by a specialized pseudopodium that laid out each scale into correct position, one scale at a time. The present study inferred that the sequence of scale production and secretion was well controlled.
Association of cannabinoid type 1 receptor and fatty acid amide hydrolase genetic polymorphisms in Chinese patients with irritable bowel syndrome
Authors: Jiang Yingjie , Nie Yuqiang , Li Yuyuan , Zhang Long
Published: January 2014

Background and Aim

The endocannabinoid system is involved in the pathophysiology of irritable bowel syndrome (IBS). Here, we investigated whether genetic variants of the cannabinoid type 1 receptor (CNR1) and fatty acid amide hydrolase (FAAH) are associated with the pathogenesis of IBS.

Methods

In total, 292 patients with IBS and 298 healthy controls were enrolled. Polymerase chain reaction (PCR) and DNA sequencing were applied to determine the genotyping of polymorphic triplet AAT repeats located at the 3′‐end of the CNR1 gene. The single nucleotide polymorphism (SNP) C385A at the FAAH gene (rs324420) was determined by PCR using TaqMan SNP Genotyping Assay Sets.

Results

A total of eight alleles with AAT triplet repeats in the CNR1 gene were detected. The alleles were divided into two groups (≤ 10 and > 10) and three genotypes (≤ 10/≤ 10, ≤ 10/> 10, and > 10/> 10). The frequency of > 10 alleles was significantly higher in the IBS group (90.6%) when compared with the control group {81.7%, P < 0.001, odds ratio (OR) (95% confidence interval [CI]) = −0.128}. In addition, the genotypes > 10/> 10 were significantly associated with IBS (P < 0.001, OR [95% CI] = −0.163). The frequency of the A allele and the distribution of the AA genotype in the FAAH gene in the IBS group were not significantly different from those in the control group (P > 0.05), even though the frequency of the AA genotype was lower in the IBS group (1.0%) than that in the control group (3.4%, P = 0.089, OR [95% CI] = 3.345).

Conclusions

The variation in the (AAT)n repeat of the CNR1 gene conferred an increased risk for developing IBS, while rs324420 (C385) in the FAAH gene was not associated with IBS pathogenesis.
Issues associated with the emergence of coeliac disease in the Asia–Pacific region: A working party report of the World Gastroenterology Organization and the Asian Pacific Association of Gastroenterology
Authors: Makharia Govind K , Mulder Chris J J , Goh Khean Lee , Ahuja Vineet , Bai Julio C , Catassi Carlo , Green Peter H R , Gupta Siddhartha Datta , Lundin Knut E A , Ramakrishna Balakrishnan Siddartha , Rawat Ramakant , Sharma Hanish , Sood Ajit , Watanabe Chikako , Gibson Peter R ,   World Gastroenterology Organization‐Asia Pacific Association of Gastroenterology Working Party on Celiac Disease
Published: January 2014

Background and Aim

Once thought to be uncommon in Asia, coeliac disease (CD) is now being increasingly recognized in Asia–Pacific region. In many Asian nations, CD is still considered to be either nonexistent or very rare. In recognition of such heterogeneity of knowledge and awareness, the World Gastroenterology Organization and the Asian Pacific Association of Gastroenterology commissioned a working party to address the key issues in emergence of CD in Asia.

Methods

A working group consisting of members from Asia–Pacific region, Europe, North America, and South America reviewed relevant existing literature with focus on those issues specific to Asia–Pacific region both in terms of what exists and what needs to be done.

Results

The working group identified the gaps in epidemiology, diagnosis, and management of CD in Asian–Pacific region and recommended the following: to establish prevalence of CD across region, increase in awareness about CD among physicians and patients, and recognition of atypical manifestations of CD. The challenges such as variability in performance of serological tests, lack of population‐specific cut‐offs values for a positive test, need for expert dietitians for proper counseling and supervision of patients, need for gluten‐free infrastructure in food supply and creation of patient advocacy organizations were also emphasized.

Conclusions

Although absolute number of patients with CD at present is not very large, this number is expected to increase over the next few years or decades. It is thus appropriate that medical community across the Asia–Pacific region define extent of problem and get prepared to handle impending epidemic of CD.
Mechanisms of isoniazid‐induced idiosyncratic liver injury: Emerging role of mitochondrial stress
Authors: Boelsterli Urs A , Lee Kang Kwang
Published: January 2014

Idiosyncratic drug‐induced liver injury (DILI) is a significant adverse effect of antitubercular therapy with isoniazid (INH). Although the drug has been used for many decades, the underlying mode of action (both patient‐specific and drug‐specific mechanisms) leading to DILI are poorly understood. Among the patient‐specific determinants of susceptibility to INH‐associated DILI, the importance of HLA genetic variants has been increasingly recognized, whereas the role of polymorphisms of drug‐metabolizing enzymes (NAT2 and CYP2E1) has become less important and remains controversial. However, these polymorphisms are merely correlative, and other molecular determinants of susceptibility have remained largely unknown. Regarding the drug‐specific mechanisms underlying INH‐induced liver injury, novel concepts have been emerging. Among these are covalent protein adduct formation via novel reactive intermediates, leading to hapten formation and a potential immune response, and interference with endogenous metabolism. Furthermore, INH and/or INH metabolites (e.g. hydrazine) can cause mitochondrial injury, which can lead to mitochondrial oxidant stress and impairment of energy homeostasis. Recent studies have revealed that underlying impairment of complex I function can trigger massive hepatocellular injury induced by otherwise nontoxic concentrations of INH superimposed on these mitochondrial deficiencies. This review discusses these emerging new paradigms of INH‐induced DILI and highlights recent insights into the mechanisms, as well as points to the existing large gaps in our understanding of the pathogenesis.
Comparison of efficacy, pharmacokinetics, and immunogenicity between infliximab mono‐ versus combination therapy in ulcerative colitis
Authors: Hayes Michael J , Stein Adam C , Sakuraba Atsushi
Published: January 2014

Background

The association of concomitant immunosuppressant use with infliximab (IFX) and therapeutic outcomes in correlation with pharmacokinetic properties in ulcerative colitis (UC) remains unclear.

Aims

To assess the effect of concomitant immunosuppressant use on the duration of IFX therapy, and the pharmacokinetic properties of IFX in patients with UC.

Methods

A retrospective analysis of UC patients treated with IFX. Duration of efficacious IFX therapy, and serum IFX and antibody‐to‐IFX (ATI) levels were compared between those receiving IFX as monotherapy and in combination with an immunosuppressant.

Results

Among the 85 UC patients who received IFX, 46 (54.1%) received concomitant immunosuppressants, and 38 (45.9%) received IFX monotherapy. Concomitant immunosuppressant use was associated with increased duration of IFX therapy as 90% of patients receiving immunosuppressants remained on therapy at 1 year versus 61% of patients on monotherapy (Log‐rank, P = 0.016). Concomitant immunosuppressant use, as compared with monotherapy, was associated with greater IFX levels (20.4 mg/L vs 10.5 mg/L, P = 0.025) and less frequent ATI formation (4.5% vs 33.3%, P = 0.031). Patients receiving greater than 2.0 mg/kg of azathioprine had greater IFX levels than those receiving less than 2.0 mg/kg (26.0 vs 10.6 mcg/mL, P = 0.03) and those receiving IFX monotherapy (26.0 vs 11.2 mcg/mL, P = 0.03). The duration of IFX therapy among patients receiving less than 2.0 mg/kg azathioprine was indistinguishable from patients on IFX monotherapy (Log‐rank, P = 0.95).

Conclusion

Concomitant immunosuppressant therapy with IFX improves outcomes in UC as shown by increased duration of therapy, decreased immunogenicity against IFX, and increased blood levels of IFX. Our data suggest that this benefit may be dependent on the dose of concomitant immunosuppression.
The efficacy of hybrid therapy as first‐line regimen for Helicobacter pylori infection compared with sequential therapy
Authors: Oh Dong Hyun , Lee Dong Ho , Kang Kyu Keun , Park Young Soo , Shin Cheol Min , Kim Nayoung , Yoon Hyuk , Hwang Jin Hyeok , Jeoung Sook Hyang , Kim Jin Wook , Jang Eun Sun , Jung Hyun Chae
Published: January 2014

Background and Aim

Recent prospective studies have shown that the sequential therapy has not achieved the target Helicobacter pylori eradication rate of > 80% in Korea. The aim of this study was to therefore assess the efficacy of the hybrid therapy as a first‐line treatment for H. pylori eradication in a prospective trial.

Methods

From December 2012 to August 2013, 184 patients with confirmed H. pylori infections received either the 14‐day hybrid therapy or the 14‐day sequential therapy. Eradication outcomes were evaluated using a 13C‐urea breath test at least 4 weeks after treatment cessation.

Results

A total of 184 patients (90 receiving hybrid treatment and 94 receiving sequential treatment) completed the study. The eradication rates of the hybrid and sequential therapy groups were 81.1% (73/90; 95% confidence interval [CI] = 73.0–89.2%) and 79.8% (75/94; 95%CI = 71.7–87.9%), respectively, by intention‐to‐treat analysis (P = 0.821). By per protocol analysis, eradication rates were 85.9% (73/85; 95%CI = 78.5–93.3%) and 82.0% (73/89; 95%CI = 74.0–89.9%; P = 0.489), respectively. There were no significant intergroup differences in treatment compliance or discontinuation induced by severe side effects.

Conclusions

The hybrid therapy achieved acceptable eradication rate (85.9%), but not statistically significantly higher rates than the sequential therapy (82.0%). Further studies are therefore needed to identify first‐line treatments with even better eradication rates in the Korean population.
Randomized trial of 2‐L polyethylene glycol + ascorbic acid versus 4‐L polyethylene glycol as bowel cleansing for colonoscopy in an optimal setting
Authors: Moon Chang Mo , Park Dong Il , Choe Young Ghil , Yang Dong‐Hoon , Yu Yeon Hwa , Eun Chang Soo , Han Dong Soo
Published: January 2014

Background and Aim

Prior studies have reported 2‐L polyethylene glycol (PEG) plus ascorbic acid (PEG + Asc) is an effective alternative to standard 4‐L PEG for bowel preparation before colonoscopy, but they are limited because of some confounders. Therefore, we compared the efficacy, patient compliance, satisfaction, and safety of 2‐L PEG + Asc versus 4‐L PEG for bowel cleansing in optimal preparation strategies.

Methods

In this prospective, randomized, single‐blind trial, consenting outpatients were randomly assigned to one of two arms. All colonoscopies were scheduled in the morning and cleansing solutions were administered as a split‐dose regimen. Bowel‐cleansing efficacy in three different segments was measured on a five‐point scale with four‐point overall grading. Patients' opinions of the preparation regimens were obtained by questionnaire.

Results

There was no significant difference between the 2‐L PEG + Asc (159/163; 97.5%) and 4‐L PEG (162/164; 98.8%) with respect to the overall success of bowel cleansing (mean difference = −1.3 [−4.1–∞]). Patient compliance, acceptability, and satisfaction were better in the 2‐L PEG + Asc arm than the 4‐L PEG arm (P < 0.05). Additionally, the incidence of side effects was lower in the 2‐L PEG + Asc than the 4‐L PEG (overall, 57.7% vs 73.2%, P < 0.05). However, no significant difference was seen in patients' rating of taste.

Conclusions

In an optimal preparation setting, 2‐L PEG + Asc has equal efficacy as a bowel cleanser prior to colonoscopy as 4‐L PEG, with the advantages of better patient compliance, satisfaction, and safety.
Effect of Multiple Pharmacy Use on Medication Adherence and Drug–Drug Interactions in Older Adults with Medicare Part D
Authors: Marcum Zachary A. , Driessen Julia , Thorpe Carolyn T. , Gellad Walid F. , Donohue Julie M.
Published: January 2014

Objectives

To assess the association between multiple pharmacy use and medication adherence and potential drug–drug interactions (DDIs) in older adults.

Design

Cross‐sectional propensity score‐weighted analysis.

Setting

2009 claims data.

Participants

A nationally representative sample of 926,956 Medicare Part D beneficiaries aged 65 and older continuously enrolled in fee‐for‐service Medicare and Part D that year who filled one or more prescriptions at a community retail or mail order pharmacy.

Measurements

Multiple pharmacy use was defined as concurrent (overlapping time periods) or sequential use (non‐overlapping time periods) of ≥2 pharmacies in the year. Medication adherence was calculated using a proportion of days covered of 0.80 or greater for eight therapeutic categories (beta‐blockers, renin angiotensin system antagonists, calcium channel blockers, statins, sulfonylureas, biguanides (metformin), thiazolidinediones, and dipeptidyl peptidase‐IV inhibitors). Potential DDIs arising from use of certain drugs across a broad set of classes were defined as the concurrent filling of two interacting drugs.

Results

Overall, 38.1% of the sample used multiple pharmacies. Those using multiple pharmacies (concurrently or sequentially) consistently had higher adjusted odds of nonadherence (ranging from 1.10 to 1.31, P < .001) across all chronic medication classes assessed after controlling for sociodemographic, health status, and access to care factors than single pharmacy users. The adjusted predicted probability of exposure to a DDI was also slightly higher for those using multiple pharmacies concurrently (3.6%) than for single pharmacy users (3.2%, adjusted odds ratio (AOR) = 1.11, 95% confidence interval (CI) = 1.08–1.15) but lower in individuals using multiple pharmacies sequentially (2.8%, AOR = 0.85, 95% CI = 0.81–0.91).

Conclusions

Filling prescriptions at multiple pharmacies was associated with lower medication adherence across multiple chronic medications and a small but statistically significant greater likelihood of DDIs in concurrent pharmacy users.
A Modern‐Day Purgatory: Older Adults in the Emergency Department with Nonoperative Injuries
Authors: Platts‐Mills Timothy F. , Owens Scott T. , McBride J. Marvin
Published: January 2014

Older adults frequently present to the emergency department (ED) with injuries that do not require operative treatment but are sufficiently severe to make it unsafe for them to return home. These individuals typically do not meet criteria for hospital admission, but because of limited reimbursement for observation, admitting physicians are often reluctant to accept these individuals for observation. Admission to a skilled nursing or assisted living facility from the ED or rapid access to additional in‐home care is also often difficult or impossible. As a result, older adults with nonoperative injuries often spend a long time in the ED waiting for an appropriate disposition. The challenges of identifying an appropriate disposition for these individuals, the consequences for patients, and some potential solutions to this commonly encountered problem are described.
Disability and Capability: Exploring the Usefulness of Martha Nussbaum's Capabilities Approach for the UN Disability Rights Convention
Authors: Harnacke Caroline
Published: January 2014

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) aims at empowering people with disabilities by granting them a number of civil and political, but also economic, social, and cultural rights. This is a groundbreaking agreement for all persons with disabilities, especially because it is the first human rights agreement for disabled people, and it is legally binding. For those states who signed it, it also brings various governmental obligations. Implementing the CRPD will clearly be politically challenging and also very expensive for all states, but even more so for poor ones.
Expanding the Horizons of Disability Law in India: A Study from a Human Rights Perspective
Authors: Chopra Tushti
Published: January 2014

Human rights are basic, inalienable, interdependent, and universally recognized rights that aresine qua nonfor existence and growth of any human to be his best. These human rights are to be enjoyed by all human beings (individually or collectively) by virtue of being human, irrespective of their limitations or disabilities; due to the stated reason, the rights of disabled people as a “group right” are recognized as a third-generation human right.
Subversive Subjects: Rule-Breaking and Deception in Clinical Trials
Authors: Dresser Rebecca
Published: January 2014

Scientific reports about clinical research appear objective and straightforward. They describe a study's findings, methods, subject population, number of subjects, and contribution to existing knowledge. The overall picture is pristine: the research team establishes the requirements of study participation and subjects conform to these requirements. Readers are left with the impression that everything was done correctly, by the book.

In other places, however, one finds a different and messier picture of clinical research. In this picture, research subjects deviate from the prescribed plan. One author contrasted the “tidy graphics” and “crisp prose” of theNew England Journal of Medicine'sHIV/AIDS trial publications with reports that subjects shared medications and broke other trial rules. Awareness of this behavior, he wrote, could lead insiders to “conclude that knowledge was resting on something rather less solid than bedrock.”
Supporting Second Victims of Patient Safety Events: Shouldn't These Communications Be Covered by Legal Privilege?
Authors: de Wit Mélanie E. , Marks Clifford M. , Natterman Jeffrey P. , Wu Albert W.
Published: January 2014

The harmful impact of an adverse event ripples beyond injured patients and their families to affect physicians, nurses, and other health care staff that are involved. These “Second Victims” may experience intense feelings of anxiety, guilt, and fear. They may doubt their clinical competence or ability to continue working at all. Some go on to suffer post-traumatic stress disorder and depression.

Medical institutions long ignored this problem, preferring to believe that adverse events, or “errors,” occur due to incompetence — the unfortunate work of a few “bad” practitioners who deserve, if anything, a reprimand for their negligence. Study after study has rejected this attribution and shown that adverse events in health care stem primarily from systemic flaws, not “bad apples.” Devastating errors, in other words, can, do, and always will happen in the care of competent, well-trained, and caring practitioners.
Another Look at the Legal and Ethical Consequences of Pharmacological Memory Dampening: The Case of Sexual Assault
Authors: Chandler Jennifer A. , Mogyoros Alexandra , Rubio Tristana Martin , Racine Eric
Published: January 2014

Post-traumatic stress disorder (PTSD) is a “young” disorder formally recognized in the early 1980s, although the symptoms have been noted for centuries particularly in relation to military conflicts. PTSD may develop after a serious traumatic experience that induces feelings of intense fear, helplessness or horror. It is currently characterized by three key classes of symptoms which must cause clinically significant distress or impairment of functioning: (1) persistent and distressing re-experiencing of the trauma; (2) persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness; and (3) persistent symptoms of hyper-arousal. One of the possible symptoms within the second class is difficulty in remembering an important aspect of the traumatic event.

PTSD is not an uncommon condition, with an estimated lifetime prevalence of about 7-9% based on studies conducted in the United States and Canada, with women at higher risk than men. While not everyone who experiences a significant trauma will go on to develop PTSD, about a third will do so. Sexual assault, along with other forms of assaultive violence, pose a comparatively high risk of PTSD.
The Right to Language
Authors: Humphries Tom , Kushalnagar Raja , Mathur Gaurav , Napoli Donna Jo , Padden Carol , Rathmann Christian , Smith Scott
Published: January 2014

We argue for the existence of a state constitutional legal right to language. Our purpose here is to develop a legal framework for protecting the civil rights of the deaf child, with the ultimate goal of calling for legislation that requires all levels of government to fund programs for deaf children and their families to learn a fully accessible language: a sign language. While our discussion regards the United States, the argument we make is based on human rights and the nature of law itself, and can likely be adapted to any country.

We begin with an introduction to the biological facts surrounding language acquisition and how these facts impact the deaf child, where lack of language has devastating effects on individuals and negative effects on society in general.
Adherence to the Request Criterion in Jurisdictions Where Assisted Dying is Lawful? A Review of the Criteria and Evidence in the Netherlands, Belgium, Oregon, and Switzerland
Authors: Lewis Penney , Black Isra
Published: January 2014

Some form of assisted dying (voluntary euthanasia and/or assisted suicide) is lawful in the Netherlands, Belgium, Oregon, and Switzerland. In order for individual instances of assisted dying to be lawful in these jurisdictions, a valid request must precede the provision of assistance to die. Non-adherence to the criteria for valid requests for assisted dying may be a trigger for civil and/or criminal liability, as well as regulatory sanctions where the assistor is a medical professional.

In this article, we review the criteria and evidence in respect of requests for assisted dying in the Netherlands, Belgium, Oregon, and Switzerland. Our aim is to establish whether individuals who receive assisted dying do so on the basis of valid requests.
Predictive Genetic Testing of Children and the Role of the Best Interest Standard
Authors: Ross Lainie Friedman
Published: January 2014

The genetic testing and screening of children has been fraught with controversy since Robert Guthrie developed the bacterial inhibition assay to test for phenylketonuria and advocated for rapid uptake of universal newborn screening in the early 1960s. Today with fast and affordable mass screening of the whole genome on the horizon, the debate about when and in what scenarios children should undergo genetic testing and screening has gained renewed attention. United States (US) professional guidelines — both the American College of Medical Genetics (ACMG)/American Society of Human Genetics (ASHG) statement (1995) and the American Academy of Pediatrics (AAP) Statement on the genetic testing of children (2001) and the new AAP and ACMG joint policy statement (2013) and technical report (2013) — as well as the old UK guidelines by the Working Part of the Clinical Genetics Society (1994) and the new United Kingdom (UK) guidelines by the British Society of Human Genetics (BSHG) (2010) all give the same answer: genetic testing and screening should only be done if it is in the child’s best interest.
Improving the Weight of the Nation by Engaging the Medical Setting in Obesity Prevention and Control
Authors: Foltz Jennifer L. , Belay Brook , Blackburn George L.
Published: January 2014

Engaging the health care setting at the systems level to support healthy eating and active living and prevent obesity can help address the problem of obesity. A number of key attributes of the clinical realm impacts population-level obesity prevention. Health care facilities serve large groups of people, including patients seen at the medical facility, the family and friends who accompany them for visits, as well as the large number of employees who provide care and service the facilities. Thus, system-level improvements to the health care setting have great potential for large reach and impact. In 2011 there were more than 5,700 hospitals registered with the American Hospital Association, with more than 36 million inpatient admissions in the U.S. Even more medical facilities are included in the reach of clinics and other places providing care. These facilities also have the potential to influence the health of the surrounding community by serving as promoters and models of healthy eating and active living, which may influence good health practices. A health care facility services communities by integrative work in both the primary care and public health domains.
Preventing Obesity through Schools
Authors: Nihiser Allison , Merlo Caitlin , Lee Sarah
Published: January 2014

With more than 95% of school-aged youth enrolled in schools for 6 hours per day for up to 13 years, schools offer a broad reach to obesity prevention initiatives. Schools reach students of all races and ethnic backgrounds, income levels, and U.S. regions. Therefore, integrating health promotion activities into schools may equalize health disparities by providing access to a healthy environment for most of the nation’s youth, regardless of background. In addition, health behaviors, including physical activity (PA) and nutrition, are related to academic achievement.
The Role of Community, State, Territorial, and Tribal Public Health in Obesity Prevention
Authors: Sommers Janice K. , Heiser Claire
Published: January 2014

Across the nation, local, state, territorial, and tribal governments are engaged in successful efforts to protect and promote the health of their citizens by supporting healthy eating and active living initiatives. The ten essential services define a role for public health at multiple levels of influence (see Table 1). These functions provide a framework for obesity prevention that is consistent with the systems approach presented by the Institute of Medicine in “Accelerating Progress in Obesity Prevention.”

Governmental public health authorities can contribute to public health efforts to address obesity by monitoring prevalence of obesity and association risk factors, investigating the contributing factors, informing the public, and work with the citizens in their jurisdiction to develop solutions that fit the needs and sensibilities of the people.
Beyond the Code Book: Legal Tools for Accelerating Progress in Obesity Prevention
Authors: Aoki Julie Ralston , Kappagoda Manel , Mermin Seth E.
Published: January 2014

Each of the five main goals set out in the IOM’s report, Accelerating Progress in Obesity Prevention (“IOM Report”), includes recommended strategies and actions that raise questions of law and legal authority. In many instances, the IOM’s recommendations can be accomplished most directly and efficiently through mandatory regulation or legislation — for example, imposing taxes to decrease consumption of sugar-sweetened beverages (SSBs), passing laws that require substantial physical education periods in schools, or promulgating regulations that ensure nutrition standards for foods and beverages sold or served in educational settings. Much has been written on using legislation to support obesity prevention efforts. The route of direct legislation, however, is not always readily available — as the so-far-unsuccessful effort to pass taxes on SSBs, for example, vividly illustrates.
Type 1 diabetes patients' experiences of, and need for, social support after attending a structured education programme: a qualitative longitudinal investigation
Authors: Rankin David , Barnard Kath , Elliott Jackie , Cooke Debbie , Heller Simon , Gianfrancesco Carla , Taylor Carolin , Lawton Julia ,   the UK NIHR DAFNE Study Group
Published: January 2014

Aims and objectives

To explore patients' experiences of, views about and need for, social support after attending a structured education programme for type 1 diabetes.

Background

Patients who attend structured education programmes attain short‐term improvements in biomedical and quality‐of‐life measures but require support to sustain self‐management principles over the longer term. Social support can influence patients' self‐management practices; however, little is known about how programme graduates use other people's help.

Design

This study was informed by the principles of grounded theory and involved concurrent data collection and analysis. Data were analysed using an inductive, thematic approach.

Methods

In‐depth interviews were undertaken postcourse, six and 12 months later, with 30 adult patients with type 1 diabetes recruited from Dose Adjustment for Normal Eating courses in the United Kingdom.

Results

Patients' preferences for social support from other people ranged from wanting minimal involvement, to benefiting from auxiliary forms of assistance, to regular monitoring and policing. New self‐management skills learnt on their courses prompted and facilitated patients to seek and obtain more social support. Support received/expected from parents varied according to when patients were diagnosed, but parents' use of outdated knowledge could act as a barrier to effective support. Support sought from others, including friends/colleagues, was informed by patients' domestic/employment circumstances.

Conclusion

This study responds to calls for deeper understanding of the social context in which chronic illness self‐management occurs. It highlights how patients can solicit and receive more social support from family members and friends after implementing self‐care practices taught on education programmes.

Relevance to clinical practice

Health professionals including diabetes specialist nurses and dietitians should explore: patients' access to and preferences for social support; how patients might be encouraged to capitalise on social support postcourse; and new ways to inform/educate people within patients' social networks.
Physical and sexual intimate partner violence, women's health and children's behavioural functioning: entry analysis of a seven‐year prospective study
Authors: Symes Lene , Maddoux John , McFarlane Judith , Nava Angeles , Gilroy Heidi
Published: January 2014

Aims and objectives

To increase knowledge of physical and sexual intimate partner violence against women, its impact on women's health and children's behavioural functioning.

Background

Physical assault and sexual assault frequently co‐occur. Women who experience both physical and sexual violence are at risk of poorer health outcomes than women who experience only physical violence. The behavioural functioning of children of women who experience partner violence may be adversely affected.

Design

Cross‐sectional, using baseline data from a seven‐year prospective study.

Methods

Data related to severity of abuse (both physical and sexual) and the outcome measures of maternal (n = 300) mental health measures, risk of lethality, chronic pain and child (n = 300) behavioural functioning were analysed.

Results

Higher physical abuse scores were significantly correlated with higher sexual abuse scores, and higher levels of physical abuse were associated with higher maternal anxiety and higher child externalisation scores. Higher levels of sexual abuse were associated with higher maternal somatisation and post‐traumatic stress disorder symptoms and higher child internalisation scores and total problems.

Conclusions

These initial findings suggest that children have behavioural functioning and coping that is closely related to their mothers' functioning, which is based on the type of abuse experienced by the mothers. As we gain a greater understanding of these issues, we will be better able to develop effective policies and therapeutic interventions to help abused women and their children.

Relevance to clinical practice

Findings for the mental health functioning of women participating in this study add to the overwhelming evidence for the importance of screening for partner violence when women present for health care and for the need for effective assistance services for women who have or are currently experiencing partner violence. They also support emerging research that indicates the great need to provide effective services for the children of abused women.
A Food Service Intervention Improves Whole Grain Access at Lunch in Rural Elementary Schools
Authors: Cohen Juliana F. W. , Rimm Eric B. , Bryn Austin S. , Hyatt Raymond R. , Kraak Vivica I. , Economos Christina D.
Published: January 2014

BACKGROUND

Whole grain (WG) options are often limited in schools, which may impact rural, low‐income students who rely on school meals for a substantial portion of their food intake. This study examined the changes in the availability and quantity of WG and refined grain foods offered in schools participating in the Creating Healthy, Active and Nurturing Growing‐up Environments (CHANGE) study, a randomized, controlled intervention among rural communities (4 intervention and 4 control).

METHODS

Foods were assessed using production records, recipes, and nutrition labels from breakfast and lunch over 1 week during fall 2008 and spring 2009. Key informant interviews were conducted with school food service directors in the spring 2009.

RESULTS

The CHANGE intervention schools significantly increased the average percent of school days WGs were offered (p = .047) and the amount of WGs offered/food item (ounces) at lunch compared with control schools (p = .02). There was a significant decrease in the percent of students with access to refined grains at lunch compared with control schools (p = .049), although there were no significant differences in WG availability during breakfast.

CONCLUSIONS

The CHANGE schools improved WG availability, enabling student's WG consumption to be closer to national recommendations.
Piloting “Sodabriety”: A School‐Based Intervention to Impact Sugar‐Sweetened Beverage Consumption in Rural Appalachian High Schools
Authors: Smith Laureen H. , Holloman Christopher
Published: January 2014

BACKGROUND

Sugar‐sweetened beverages (SSBs) are the largest source of added sugar in the US diet. In adolescents aged 12‐19, these drinks account for 13% to 28% of total daily calories. Compared with other adolescents, those residing in Appalachia have the highest consumption rates of SSBs.

METHODS

Using a Teen Advisory Council (TAC), a student‐designed and student‐led intervention was conducted at 2 high schools in a rural Appalachian county. Using repeated‐measures models design with Bonferroni correction, data were collected on daily and weekly consumption of SSBs and of water at baseline, immediately post‐intervention, and 30 days post‐intervention. Vending machine surveys were completed.

RESULTS

The 186 participants reported purchasing SSBs from school vending machines (41.4%), cafeteria (36.5%), and school stores (7.7%). Daily SSB servings decreased from an average of 2.32 (SD = 2.14) to 1.32 (SD = 1.29) (p < .001). Weekly consumption decreased from an average of 4.30 (SD = 2.40) days/week to 2.64 (SD = 1.91) (p < .001). Water consumption increased 19% from baseline to immediately post‐intervention.

CONCLUSIONS

Student‐directed efforts to support behavioral change are feasible and effective at affecting individual lifestyle behaviors. Small and manageable changes may lead to net improvements in lifestyle behaviors.
Elementary and Middle School Children's Acceptance of Lower Calorie Flavored Milk as Measured by Milk Shipment and Participation in the National School Lunch Program
Authors: Yon Bethany A. , Johnson Rachel K.
Published: January 2014

BACKGROUND

The United States Department of Agriculture's (USDA) new nutrition standards for school meals include sweeping changes setting upper limits on calories served and limit milk offerings to low fat or fat‐free and, if flavored, only fat‐free. Milk processors are lowering the calories in flavored milks. As changes to milk impact school lunch participation and milk consumption, it is important to know the impact of these modifications.

METHODS

Elementary and middle schools from 17 public school districts that changed from standard flavored milk (160‐180 kcal/8 oz) to lower calorie flavored milk (140‐150 kcal/8 oz) between 2008 and 2009 were enrolled. Milk shipment and National School Lunch Program (NSLP) participation rates were collected for 3 time periods over 12 months (pre‐reformulation, at the time of reformulation, and after reformulation). Linear mixed models were used with adjustments for free/reduced meal eligibility.

RESULTS

No changes were seen in shipment of flavored milk or all milk, including unflavored. The NSLP participation rates dropped when lower calorie flavored milk was first offered, but recovered over time.

CONCLUSIONS

While school children appear to accept lower calorie flavored milk, further monitoring is warranted as most of the flavored milks offered were not fat‐free as was required by USDA as of fall 2012.
Rural‐Urban Disparities in School Nursing: Implications for Continuing Education and Rural School Health
Authors: Ramos Mary M. , Fullerton Lynne , Sapien Robert , Greenberg Cynthia , Bauer‐Creegan Judith
Published: January 2014

Purpose

Little is known about the professional and educational challenges experienced by rural school nurses. We conducted this study to describe disparities between the urban and rural professional school nurse workforce in New Mexico and to identify how best to meet the continuing education needs of New Mexico's rural school nurse workforce.

Methods

We analyzed state data from a 2009 New Mexico Department of Health school nurse workforce survey (71.7% response rate). We included all survey respondents who indicated working as a school nurse in a public school setting in any grade K‐12 and who identified their county of employment (N = 311).

Findings

Rural school nurses were twice as likely as metropolitan nurses to provide clinical services to multiple school campuses (67.3% compared to 30.1%, P < .0001). They were less likely to hold a nursing degree at the baccalaureate level or higher (62.7% compared to 82.3%, P = .0002). Rural school nurses were less likely than metropolitan nurses to have received recent continuing education on anaphylaxis (P < .0001), asthma (P = .027), body mass index (BMI)/healthy weight (P = .0002), diabetes (P < .0001), lesbian, gay, bisexual and transgender (LGBT) health (P = .0004), and suicide risk identification and prevention (P = .015). Online courses and telehealth were identified by rural school nurses as among the preferred means for receiving continuing education.

Conclusions

Our findings support the provision of online courses and telehealth content to address urban‐rural disparities in school nursing education and support rural school health.