bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of abdominal circumference and salivary amylase activities after unsedated colonoscopy using carbon dioxide and air insufflations
Authors: Kiriyama Shinsuke , Naitoh Hiroshi , Fukuchi Minoru , Yuasa Kazuhisa , Horiuchi Katsuhiko , Fukasawa Takaharu , Tabe Yuichi , Yamauchi Hayato , Suzuki Masaki , Yoshida Tomonori , Saito Yutaka , Kuwano Hiroyuki
Published: December 2015

Objective

To assess and compare abdominal distention and stress in unsedated colonoscopy using carbon dioxide (CO2) and air insufflations.

Methods

Two hundred and five patients underwent colonoscopic examinations without sedation using either CO2 or air insufflation. Abdominal circumference and salivary amylase (sAMY) activities before and 0 and 15 min after colonoscopy were measured by a nurse who was blinded to the grouping of the patients.

Results

In all, 102 and 103 patients were randomly recruited in the CO2 and air insufflation groups, respectively. sAMY activities before and 0 and 15 min after colonoscopy were not significantly different between the two groups. Abdominal circumference measured immediately and 15 min after colonoscopy was significantly smaller in CO2 insufflation group than in the air insufflation group (81.2 cm vs 84.0 cm, and 79.7 cm vs 83.6 cm, respectively; P <0.05). The increasing ratio of abdominal circumference immediately after colonoscopy was not significantly different between the two groups; however, the ratio at 15 min after colonoscopy using CO2 insufflation was significantly lower than that in the air insufflation group (1.007 vs 1.028, P <0.001).

Conclusion

sAMY activities after unsedated colonoscopy using CO2 insufflation were not improved; however, CO2 insufflation decreases abdominal circumference after colonoscopy compared with air insufflation.
Innovative molecular diagnosis of Trichinella species based on β‐carbonic anhydrase genomic sequence
Authors: Zolfaghari Emameh Reza , Kuuslahti Marianne , Näreaho Anu , Sukura Antti , Parkkila Seppo
Published: December 2015

Trichinellosis is a helminthic infection where different species of Trichinella nematodes are the causative agents. Several molecular assays have been designed to aid diagnostics of trichinellosis. These assays are mostly complex and expensive. The genomes of Trichinella species contain certain parasite‐specific genes, which can be detected by polymerase chain reaction (PCR) methods. We selected β‐carbonic anhydrase (β‐CA) gene as a target, because it is present in many parasites genomes but absent in vertebrates. We developed a novel β‐CA gene‐based method for detection of Trichinella larvae in biological samples. We first identified a β‐CA protein sequence from Trichinella spiralis by bioinformatic tools using β‐CAs from Caenorhabditis elegans and Drosophila melanogaster. Thereafter, 16 sets of designed primers were tested to detect β‐CA genomic sequences from three species of Trichinella, including T. spiralis, Trichinella pseudospiralis and Trichinella nativa. Among all 16 sets of designed primers, the primer set No. 2 efficiently amplified β‐CA genomic sequences from T. spiralis, T. pseudospiralis and T. nativa without any false‐positive amplicons from other parasite samples including Toxoplasma gondii, Toxocara cati and Parascaris equorum. This robust and straightforward method could be useful for meat inspection in slaughterhouses, quality control by food authorities and medical laboratories.
Daily alcohol use as an independent risk factor for HIV seroconversion among people who inject drugs
Authors: Young Samantha V. , Wood Evan , Dong Huiru , Kerr Thomas , Hayashi Kanna
Published: December 2015

Aims

To estimate the relationship between daily alcohol use and HIV seroconversion among people who inject drugs (PWID) in a Canadian setting.

Design and Setting

Data from an open prospective cohort study of PWID in Vancouver, Canada, recruited via snowball sampling and street outreach between May 1996 and November 2013. An interviewer‐administered questionnaire including standardized behavioural assessment and HIV antibody testing were conducted semi‐annually. Baseline HIV‐seronegative participants completing ≥ 1 follow‐up visits were eligible for the present analysis.

Participants

A total of 1683 eligible participants, were followed for a median of 79.8 [interquartile range (IQR) = 33.3–119.1] months.

Measurements

The primary end‐point was time to HIV seroconversion, with the date of HIV seroconversion estimated as the mid‐point between the last negative and the first positive antibody test results. The primary explanatory variable was self‐reported daily alcohol use in the previous 6 months assessed semiannually. Other covariates considered included demographic, behavioural, social/structural and environmental risk factors for HIV infection among PWID (e.g. daily cocaine injection, methadone use, etc.).

Findings

Of 1683 PWID, there were 176 HIV seroconversions during follow‐up with an incidence density of 1.5 [95% confidence interval (CI) = 1.3–1.7] cases per 100 person‐years. At baseline, 339 (20.1%) consumed alcohol at least daily in the previous 6 months. In multivariable extended Cox regression analyses, daily alcohol use remained associated independently with HIV seroconversion (adjusted hazard ratio: 1.48; 95% CI = 1.00–2.17).

Conclusions

Daily alcohol use appears to be an independent risk factor for HIV seroconversion among our cohort of PWID.
Medical treatments for opioid use disorder in Iran: a randomized, double‐blind placebo‐controlled comparison of buprenorphine/naloxone and naltrexone maintenance treatment
Authors: Mokri Azarakhsh , Chawarski Marek C. , Taherinakhost Hamidreza , Schottenfeld Richard S.
Published: December 2015

Aims

With the broad goals of developing a clinical research and training program and disseminating effective opioid use disorder treatments in Iran, this pilot clinical trial compared the effectiveness of oral naltrexone (NTX) and sublingual buprenorphine/naloxone (BNX).

Design

Twelve‐week single‐site, two‐group parallel randomized double‐blind clinical trial.

Setting

An out‐patient clinical research program in Tehran, Iran.

Participants

Following medically assisted withdrawal, participants with opioid use disorder were assigned randomly to NTX (n = 51) or BNX (n = 51).

Intervention

Medications were administered three times per week, double‐blind, double‐dummy for 12 weeks. All participants received weekly group drug counseling.

Measurements

The primary outcome was initial duration of opioid abstinence verified by urine toxicology tests. Secondary outcomes included the number of opioid‐negative urine tests, treatment retention and proportions with sustained, verified opioid‐abstinence for 12 weeks.

Findings

Mean [95% confidence interval (CI)] number of days of initial duration of verified abstinence was 28.8 (20.0–37.5) with BNX and 21.6 (14.4–28.7) with NTX (P = 0.205). The mean (95% CI) number of opioid‐negative urine tests was 19.7 (17.7–21.6) with BNX and 15.4 (13.1–17.8) with NTX (P = 0.049). The mean (95% CI) number of days in treatment was 70.6 (63.6–77.7) with BNX versus 56.5 (47.8–65.3) with NTX (P = 0.013). The rate of sustained, 12‐week opioid abstinence was 16% (8/51) in the BNX group and 8% (4/51) in the NTX group (P = 0.219).

Conclusions

Among patients with opioid use disorder in Iran, sublingual buprenorphine/naloxone was associated with a greater number of opioid‐negative urine tests and treatment retention than oral naltrexone, but not significantly greater initial abstinence duration or proportions with sustained abstinence.
Drivers of vegetation change in grasslands of the Sheffield region, northern England, between 1965 and 2012/13
Authors: Stevens Carly J. , Ceulemans Tobias , Hodgson John G. , Jarvis Susan , Grime J. Philip , Smart Simon M.
Published: December 2015

Questions

How has vegetation species diversity and species composition changed between 1965 and 2012/13 in acidic and calcareous grasslands? What has driven this change in vegetation?

Location

A 2400‐km2 area around Sheffield, northern England.

Methods

In 1965 a survey was conducted to describe grassland vegetation of the Sheffield region. We repeated this survey in 2012/13, revisiting acidic and calcareous grassland sites (455 quadrats). Climate, N and sulphur deposition, cattle and sheep stocking rates, soil pH, altitude, aspect and slope were considered to be potential drivers of variation in vegetation. We analysed temporal changes in vegetation and examined relationships with spatial and temporal variation in driver variables.

Results

Both acidic and calcareous grasslands showed clear changes in species composition between the two time periods. In acidic grasslands there was no significant change in richness but there were declines in diversity. There were significant increases in Ellenberg N. Nitrogen deposition and grazing were identified as potential drivers of spatial and temporal patterns but it was not possible to discriminate the respective impacts of potential drivers. In calcareous grasslands there were declines in species richness, diversity and appropriate diversity indices. Climate and soil pH were identified as potential drivers of spatial and temporal patterns.

Conclusions

Despite only small site losses compared to other surveys in the UK, especially within the national park, both calcareous and acidic grasslands showed very clear changes in species composition. In acidic grasslands, high abundance of Pteridium aquilinum was a particular problem and had increased considerably between the two survey periods. Atmospheric N deposition and grazing were identified as drivers of species diversity. A number of calcareous grasslands showed signs of reduced management intensity leading to scrub invasion.
Subcategorization of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS): a study applying Thyroid Imaging Reporting and Data System (TIRADS)
Authors: Yoon Jung Hyun , Kwon Hyeong Ju , Kim Eun‐Kyung , Moon Hee Jung , Kwak Jin Young
Published: December 2015

Objective

To evaluate the clinical significance and compare the imaging features according to the Thyroid Image Reporting and Data System (TIRADS) between atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) subcategories.

Design & patients

A total of 192 thyroid nodules in 188 patients (mean age: 50·2 ± 11·8 years) that had been initially diagnosed as AUS/FLUS on US‐guided fine needle aspiration (US‐FNA) were included. One cytopathologist retrospectively reviewed the cytology slides, subcategorizing cytology results into AUS and FLUS. A TIRADS category was assigned to each thyroid nodule according to the number of suspicious US features. Clinical, US features and malignancy rates were compared between the two subcategories.

Results

Of the 192 AUS/FLUS lesions, 149 (77·6%) were subcategorized as AUS and 43 (22·4%) as FLUS. Of the 192 AUS/FLUS nodules, 82 (42·7%) were malignant. The malignancy rates between AUS and FLUS subcategories were not significantly different, 45·6% to 32·6%, respectively (P = 0·127). When applying TIRADS, significant differences were seen in TIRADS category between benign and malignant nodules in the AUS subcategory (P < 0·001), but not in the FLUS subcategory (P = 0·414). The malignancy rates in TIRADS categories 3, 4a, 4b, 4c and 5 were 15·4%, 22·2%, 33·3%, 57·1% and 80·0% (P < 0·001) in AUS nodules and 40·0%, 50·0%, 23·5%, 22·2% and 0·0% (P = 0·414) in FLUS nodules, respectively.

Conclusion

Suspicious US features are useful in predicting malignancy among AUS subcategories but not in FLUS subcategories. Subcategorization into AUS and FLUS cytology may be helpful in deciding upon treatment or management of thyroid nodules.
Thyrotoxicosis associated with the use of amiodarone: the utility of ultrasound in patient management
Authors: Theodoraki Aikaterini , Vanderpump Mark P. J.
Published: December 2015

Amiodarone is an anti‐arrhythmic drug that commonly affects the thyroid, causing hypothyroidism or thyrotoxicosis. Amiodarone‐induced thyrotoxicosis (AIT) is caused by excessive thyroid hormone biosynthesis in response to iodine load in autonomously functioning thyroid glands with pre‐existing nodular goitre or underlying Graves' disease (type 1 or AIT 1), or by a destructive thyroiditis typically occurring in normal glands (type 2 or AIT 2). Indeterminate or mixed forms are also recognized. The distinction is clinically useful as AIT 1 is treated predominantly with thionamides, whereas AIT 2 is managed with glucocorticoids. We review the tools used to differentiate type 1 from type 2 thyrotoxicosis, with specific reference to the imaging modalities used.
Testosterone and cardiac mass and function in men with type 1 diabetes in the Epidemiology of Diabetes Interventions and Complications Study (EDIC)
Authors: Kim Catherine , Bebu Ionut , Braffett Barbara , Cleary Patricia A. , Arends Valerie , Steffes Michael , Wessells Hunter , Orchard Trevor , Sarma Aruna V. ,   DCCT/EDIC Research Group
Published: December 2015

Objective

Low testosterone concentrations have been reported to be associated with increased risk of congestive heart failure, but the mechanisms are unclear. Our objective was to examine the relationship between endogenous testosterone and measures of cardiac mass and function among men with type 1 diabetes.

Design

Secondary analysis of a prospective observational study.

Participants

Men (n = 508) in the Epidemiology of Diabetes Interventions and Complications (EDIC) study, the observational follow‐up of the Diabetes Control and Complications Trial (DCCT).

Measurements

Testosterone assessed by liquid chromatography mass spectrometry at EDIC year 10 and cardiac magnetic resonance imaging (CMR) measures at EDIC years 14/15. Linear regression models were used to assess the relationship between testosterone, sex hormone binding globulin (SHBG) and left ventricular (LV) mass, volume, ejection fraction and cardiac index before and after adjustment for age, randomization arm, alcohol and cigarette use, macroalbuminuria, haemoglobin A1c, insulin dose, body mass index, lipids, blood pressure, use of antihypertensive medications and microvascular complications.

Results

In fully adjusted models, total testosterone concentrations were significantly associated with LV mass (P = 0·014), end‐diastolic volume (P = 0·002), end‐systolic volume (P = 0·012) and stroke volume (P = 0·022), but not measures of LV function after adjustment for cardiac risk factors. Bioavailable testosterone was associated with LV mass, but not volume or function, while SHBG was associated with volume, but not mass or function.

Conclusions

Among men with type 1 diabetes, higher total testosterone was associated with higher LV mass and volume, but not with function. The clinical significance of this association remains to be established.
Glucocorticoid therapy for adrenal insufficiency: nonadherence, concerns and dissatisfaction with information
Authors: Chapman S.C.E. , Llahana S. , Carroll P. , Horne R.
Published: December 2015

Objective

Appropriate self‐management of glucocorticoid therapy (GC) is crucial for patients with adrenal insufficiency (AI). We aimed to describe patients’ self‐reported nonadherence to GC, evaluate perceived doubts about need for GC, concerns about adverse effects, and dissatisfaction with information received about GC.

Design

Cross‐sectional survey.

Patients

Patients prescribed GC for AI (n = 81) from five European countries.

Measurements

Online survey including the Medication Adherence Report Scale (MARS), Beliefs about Medicines Questionnaire© (BMQ Specific, adapted for AI) and Satisfaction with Information about Medicines Scale© (Prof Rob Horne; SIMS).

Results

Most patients (85·2%) reported a degree of nonadherence to GC. The most frequent types of nonadherence concerned changing the timing of GC doses, for example taking a dose later in the day than advised (37·0%). Few patients doubted their personal need for daily GC, but most reported high concerns about GC including potential weight gain (50·6%), osteoporosis (53·6%) and the continuing risk of adrenal crisis (50·6%). Dissatisfaction with information about GC was frequent, with participants particularly dissatisfied with the amount of information they had received about potential problems with GC. People who expressed dissatisfaction with information about GC, and concerns about its adverse effects were also more likely to report nonadherence (P < 0·05).

Conclusions

Nonadherence to treatment, concerns about potential adverse effects and dissatisfaction with the information provided about treatment were frequently reported by this European sample of AI patients. Many AI patients may need additional information about their GC and support to address concerns about GC and facilitate adherence.
Informality and Flexible Specialization: Apprenticeships and Knowledge Spillovers in an Indian Silk Weaving Cluster
Authors: Basole Amit
Published: December 2015

This article draws on quantitative and qualitative data from the Banaras (Varanasi) silk weaving cluster in North India to show how informal institutions based on family and community interact with the relations of production to enable flexible specialization while reproducing or accentuating inequality. The family‐based apprenticeship system produces a supply of highly skilled workers but contributes to labour surplus by lowering the costs of entry and making exit difficult. Surplus labour ensures that productivity gains resulting from technical improvements do not accrue to weavers as higher wages. A community of artisans called thenaqsheband(designers) produces fabric patterns that are central to the industry's market. Geographical clustering results in quick diffusion of these designs and free imitation is the key to innovation. But this entails hyper‐competition, conservative changes, a culture of secrecy and quickly dissipating monopoly rents. The Banaras case enables us to understand how collective efficiencies as well as inefficiencies are created by the same institutions.
Substantial proportion of MODY among multiplex families participating in a Type 1 diabetes prediction programme
Authors: Petruzelkova L. , Dusatkova P. , Cinek O. , Sumnik Z. , Pruhova S. , Hradsky O. , Vcelakova J. , Lebl J. , Kolouskova S.
Published: December 2015

Aims

Patients with maturity‐onset diabetes of the young (MODY) might be over‐represented in families with histories of Type 1 diabetes. Our aim was to re‐evaluate families participating in the Czech T1D Prediction Programme (PREDIA.CZ) with at least two members affected with diabetes to assess the proportion of MODY among these families and determine its most significant clinical predictors.

Methods

Of the 557 families followed up by the PREDIA.CZ, 53 (9.5%) had two or more family members with diabetes. One proband with diabetes from these families was chosen for direct sequencing of the GCK, HNF1A, HNF4A and INS genes. Non‐parametric tests and a linear logistic regression model were used to evaluate differences between MODY and non‐MODY families.

Results

MODY was genetically diagnosed in 24 of the 53 families with multiple occurrences of diabetes (45%). Mutations were detected most frequently in GCK (58%), followed by HNF1A (38%) and INS (4%). MODY families were more likely to have a parent with diabetes and had a higher proportion of females with diabetes than non‐MODY families. Higher age (P < 0.001), a lower level of HbA1c (P < 0.001) at clinical onset and at least two generations affected by diabetes were the variables most predictive for probands of MODY families already presenting with diabetes.

Conclusions

A prediction programme for Type 1 diabetes would provide a useful new source of patients with MODY most likely to benefit from an accurate diagnosis. This identification has implications for patient treatment and disease prognosis.
A long‐term risk‐benefit analysis of low‐dose aspirin in primary prevention
Authors: Wu I‐Chen , Hsieh Hui‐Min , Yu Fang‐Jung , Wu Meng‐Chieh , Wu Tzung‐Shiun , Wu Ming‐Tsang
Published: December 2015

Background

The long‐term risk‐benefit effect of occasional and regular use of low‐dose aspirin (≤ 100 mg per day) in primary prevention of vascular diseases and cancers was calculated.

Methods

One representative database of 1 000 000 participants from Taiwan's National Health Insurance scheme in 1997–2000 was used. The potential study subjects were those aged 30–95 years, were found not to have been prescribed aspirin before 1 January 2000, but to have first been prescribed low‐dose aspirin (≤ 100 mg per day) after that date and were followed up to 31 December 2009. Participants prescribed low‐dose aspirin < 20% during the study period were considered occasional users and those prescribed ≥ 80% regular users. After the propensity score matching, rate differences of haemorrhage, ischaemia and cancer between these users were calculated their net clinical risk.

Results

A total of 1720 pairs were analysed. During the study period, haemorrhage and ischaemia occurred in 25 (1·45%) and 67 participants (3·90%) in occasional users and 69 (4·01%) and 100 participants (5·81%) in regular users, whereas cancer occurred in 32 participants (1·86%) in occasional users and 26 participants (1·51%) in regular users. The crude and adjusted net clinical risks of low‐dose aspirin use between the two frequency of users (≥ 80% vs. < 20%) were 4·12% (95% CI = 2·19%, 6·07%; P < 0·001) and 3·93% (95% CI = 2·01%, 5·84%; P < 0·001).

Conclusions

A long‐term regular use of low‐dose aspirin might not be better than occasional use in the primary prevention against major vascular diseases and cancer.
Developmental plasticity increases at the northern range margin in a warm‐dependent amphibian
Authors: Orizaola Germán , Laurila Anssi
Published: December 2015

Accurate predictions regarding how climate change affects species and populations are crucial for the development of effective conservation measures. However, models forecasting the impact of climate change on natural environments do not often consider the geographic variation of an organism's life history. We examined variation in developmental plasticity to changing temperature in the pool frog (Pelophylax lessonae) across its distribution by studying populations from central areas (Poland), edge populations (Latvia) and northern marginal populations (Sweden). Relative to central and edge populations, northern populations experience lower and less variable temperature and fewer episodes of warm weather during larval development. Plasticity in larval life‐history traits was highest at the northern range margin: larvae from marginal populations shortened larval period and increased growth rate more than larvae from central and edge populations when reared at high temperature. Maintaining high growth and development under the scarce spells of warm weather is likely adaptive for high‐latitude populations. The detection of high levels of developmental plasticity in isolated, marginal populations suggests that they may be better able to respond to the temperature regimes expected under climate change than often predicted, reflecting the need to incorporate geographic variation in life‐history traits into models forecasting responses to environmental change.
Ex vivo comparison of the giant and transfixing knot in equine open and closed castration
Authors: Comino F. , Giusto G. , Caramello V. , Pagliara E. , Bellino C. , Gandini M.
Published: December 2015

Reasons for performing study

In equine castration, application of a ligature on the spermatic cord to prevent complications such as haemorrhage and evisceration has been reported with controversial results. Characteristics of commonly used knots have not been studied.

Objectives

To compare the modified transfixing and giant knots and the emasculator in open and closed equine castration techniques.

Study design

Ex vivo experiment.

Methods

A total of 144 testicles were randomly assigned to 2 groups for open or closed castration. Both groups were divided into 3 subgroups of 18 specimens each: emasculator only, emasculator plus giant knot and emasculator plus transfixing knot and the open castration group also contained 2 further subgroups of 18 testicles each: giant knot only and transfixing knot only. The length of suture material used was measured for each knot and the leaking pressure of the testicular artery measured using dye injection. In the closed castration group, parietal tunic tensile strength was measured with a tensiometer.

Results

Leaking pressure was higher in open compared with closed castration, with no significant difference among subgroups. In the closed castration group, minimum leaking pressure for the emasculator plus transfixing knot and emasculator only subgroups were close to standard physiological arterial pressures. The giant knot required less suture material than the transfixing knot. Parietal tunic tensile strength was higher when ligatures were applied.

Conclusions

The giant and transfixing knot techniques have comparable haemostatic capability and parietal tunic tensile strength, but the giant knot requires less suture material. In open castration, using the emasculator alone may produce adequate haemostasis. In closed castration, using the giant knot in combination with the emasculator increases the bursting pressure and possibly reduces the incidence of haemorrhage. In closed castration, application of a ligature may reduce the risk of evisceration.
Preclinical modeling of hematopoietic stem cell transplantation – advantages and limitations
Authors: Stolfi Jessica L. , Pai Chien‐Chun S. , Murphy William J.
Published: December 2015

Hematopoietic stem cell transplantation, which was first successfully performed in the 1950s, remains a critical therapeutic modality for treatment of a diverse array of diseases, including a multitude of hematological malignancies, autoimmune disorders, amyloidosis and inherited genetic hematological disorders. Although great advances have been made in understanding and application of this therapy, significant complications still exist, warranting further investigation. Of critical importance, graft‐versus‐host disease (GVHD), in both acute and chronic forms, remains a major complication of hematopoietic stem cell transplantation, responsible for both the development of chronic illness and morbidity, as well as mortality. Use of an appropriate preclinical model may provide significant insight into the mechanistic pathways leading to the development and progression of graft‐versus‐host disease, as well as cancer in general. However, existing preclinical modeling systems exhibit significant limitations, and development of models that recapitulate the complex and comprehensive clinical scenario and provide a tool by which therapeutic intervention may be developed and assessed is of utmost importance. Here, we review the present status of the field of graft‐versus‐host disease research. We discuss and summarize the preclinical models currently in use, as well as their advantages and limitations.
Making sense of plant autoimmunity and ‘negative regulators’
Authors: Rodriguez Eleazar , El Ghoul Hassan , Mundy John , Petersen Morten
Published: December 2015

Genetics studies the structure/function of genes via the characterization of their mutant phenotypes. In plants, a readily scorable mutant phenotype comprises macroscopic lesions symptomatic of disease in the absence of pathogens. Such mutants therefore exhibit autoimmune phenotypes. Many of these mutants are considered to be associated with immunity and the corresponding genes have been described as ‘negative regulators’ of immunity and/or cell death. Pathogens deliver effectors into host cells to increase infectivity by modifying or removing host proteins. Plants detect effectors via nucleotide‐binding, leucine‐rich repeat (NLR) immune receptors, which monitor host effector targets. In response to effector‐mediated target tampering, NLR proteins potentiate immunity. The guard hypothesis proposes that NLRs ‘guard’ host ‘guardees’ targeted by pathogen effectors. An obvious corollary to this guard model is that forms of plant autoimmunity are a result of inappropriate NLR protein activation. In this review, we discuss what is known about some of the ‘negative regulators’ of immunity, and propose simple strategies that may help to characterize autoimmune mutants.
Investigation of ductile rupture in U‐notched Al 6061‐T6 plates under mixed mode loading
Authors: Torabi A.  R. , Habibi R.
Published: December 2015

The aim of the present research is to evaluate ductile failure of U‐notched components under mixed mode I/II loading conditions. For this purpose, first, several rectangular plates made of the aluminium alloy Al 6061‐T6 and weakened by central bean‐shaped slit with two U‐shaped ends are tested under mixed mode I/II loading conditions, and the load‐carrying capacity of the specimens are experimentally measured. Then, using the equivalent material concept, Al 6061‐T6, which is a highly ductile material, is equated with a virtual brittle material, and the load‐carrying capacity of the same U‐notched specimens virtually made of the equivalent material is theoretically predicted by using two well‐known stress‐based brittle fracture criteria. Finally, the theoretical failure loads of the virtual specimens are compared with the experimental ones of the real Al 6061‐T6 specimens. It is revealed that the experimental results could very well be predicted by means of both brittle fracture criteria without conducting time‐consuming elastic–plastic analyses.
Who will make an indulgent food choice after having fulfilled their healthy eating goal?
Authors: Chen Ming‐Yi
Published: December 2015

This research considers how subjective nutrition knowledge and calorie consciousness moderate the effects of eating goals on indulgent vs. healthy consumers and their on subsequent choices. A two between‐subjects design (an eating goal invoked by a main course: healthy vs. indulgent) was conducted, where the choice of salad dressing (healthy or indulgent) was a dependent variable. Two individual traits (subjective nutrition knowledge and calorie consciousness) were considered as moderators between eating goals and food choices. The results indicated that individuals with high levels of subjective knowledge about nutrition or with a high level of consciousness about calories were more likely to choose a healthy option when their indulgent goal had been invoked. However, they were more likely to make indulgent choices when their healthy goal had been fulfilled by the main course. In contrast, for those with low levels of subjective nutrition knowledge or with a low level of consciousness about calories, food choices were not influenced by the eating goal which had been invoked. The findings could help practitioners in the food industry to develop different food combinations with which to satisfy their customers through understanding personality traits.
A heuristic approach for designing cyclic group codes
Authors: Strapasson João E. , Torezzan Cristiano
Published: December 2015

In this paper, we propose a heuristic technique for distributing points on the surface of a unit n‐dimensional Euclidean sphere, generated as the orbit of a finite cyclic subgroup of orthogonal matrices, the so‐called cyclic group codes. Massive numerical experiments were conducted and many new cyclic group codes have been obtained in several dimensions at various rates. The results assure that the performance of the heuristic approach is comparable to a brute‐force search technique with the advantage of having low complexity, which allows designing codes with a large number of points in high dimensions.
Intervention types and outcomes of integrated care for diabetes mellitus type 2: a systematic review
Authors: Busetto Loraine , Luijkx Katrien Ger , Elissen Arianne Mathilda Josephus , Vrijhoef Hubertus Johannes Maria
Published: December 2015

Rationale, aims and objectives

The delivery of integrated care is a priority in many countries' efforts to improve health outcomes for people at risk of or with diabetes. This study aims to provide an overview of the different types of integrated care interventions for type 2 diabetes and to report their outcomes.

Methods

A systematic literature search was conducted inPubMed andCochrane for the period 2003–2013. Article selection and data extraction were performed independently by three researchers and results were discussed together. The chronic care model (CCM) was used to describe intervention types.

Results

Forty‐four articles met the inclusion criteria. Most interventions included allCCMcomponents and a variety of sub‐components. Most studies reported positive patient, process and health service utilization measures. The information on costs was limited and inconsistent. The low number of articles reporting comparable outcome measures made it difficult to make meaningful statements about an association between intervention type and outcomes.

Conclusions

Future research would benefit from a more uniform understanding of integrated care as well as intermediate outcome measurements that allow for the establishment of a chain of evidence from specific intervention types to specific outcomes achieved. It is expected that such a comprehensive approach will reveal important insights as to which integrated care intervention types and settings are most conducive to successful implementation and would thereby be of relevance to policy makers and practitioners involved in the financing, management and delivery of integrated care.
Evaluating impact of clinical guidelines using a realist evaluation framework
Authors: Reddy Sandeep , Wakerman John , Westhorp Gill , Herring Sally
Published: December 2015

Rationale, aims and objectives

The Remote Primary Health Care Manuals (RPHCM) project team manages the development and publication of clinical protocols and procedures for primary care clinicians practicing in remoteAustralia. The Central Australian Rural Practitioners Association Standard Treatment Manual, the flagship manual of theRPHCMsuite, has been evaluated for accessibility and acceptability in remote clinics three times in its 20‐year history. These evaluations did not consider a theory‐based framework or a programme theory, resulting in some limitations with the evaluation findings. With theRPHCMhaving an aim of enabling evidence‐based practice in remote clinics and anecdotally reported to do so, testing this empirically for the full suite is vital for both stakeholders and future editions of theRPHCM.

Methods

The project team utilized a realist evaluation framework to assess how, why and for what theRPHCMwere being used by remote practitioners. A theory regarding the circumstances in which the manuals have and have not enabled evidence‐based practice in the remote clinical context was tested. The project assessed this theory for all the manuals in theRPHCMsuite, across government and aboriginal community‐controlled clinics, in three regions ofAustralia.

Conclusion

Implementing a realist evaluation framework to generate robust findings in this context has required innovation in the evaluation design and adaptation by researchers. This article captures theRPHCMteam's experience in designing this evaluation.
Rationality, practice variation and person‐centred health policy: a threshold hypothesis
Authors: Djulbegovic Benjamin , Hamm Robert M. , Mayrhofer Thomas , Hozo Iztok , Van den Ende Jef
Published: December 2015

Variation in practice of medicine is one of the major health policy issues of today. Ultimately, it is related to physicians' decision making. Similar patients with similar likelihood of having disease are often managed by different doctors differently: some doctors may elect to observe the patient, others decide to act based on diagnostic testing and yet others may elect to treat without testing. We explain these differences in practice by differences in disease probability thresholds at which physicians decide to act: contextual social and clinical factors and emotions such as regret affect the threshold by influencing the way doctors integrate objective data related to treatment and testing. However, depending on a theoretical construct each of the physician's behaviour can be considered rational. In fact, we showed that the current regulatory policies lead to predictably low thresholds for most decisions in contemporary practice. As a result, we may expect continuing motivation for overuse of treatment and diagnostic tests. We argue that rationality should take into account both formal principles of rationality and human intuitions about good decisions along the lines of Rawls' ‘reflective equilibrium/considered judgment’. In turn, this can help define a threshold model that is empirically testable.
Management of T1 colorectal cancers after endoscopic treatment based on the risk stratification of lymph node metastasis
Authors: Miyachi Hideyuki , Kudo Shin‐ei , Ichimasa Katsuro , Hisayuki Tomokazu , Oikawa Hiromasa , Matsudaira Shingo , Kouyama Yuta , Kimura Yui Jennifer , Misawa Masashi , Mori Yuichi , Ogata Noriyuki , Kudo Toyoki , Kodama Kenta , Hayashi Takemasa , Wakamura Kunihiko , Katagiri Atsushi , Baba Toshiyuki , Hidaka Eiji , Ishida Fumio , Kohashi Kenichi , Hamatani Shigeharu
Published: December 2015

Background and Aim

Recent advances in endoscopic technology have allowed many T1 colorectal carcinomas to be resected endoscopically with negative margins. However, the criteria for curative endoscopic resection remain unclear. We aimed to identify risk factors for nodal metastasis in T1 carcinoma patients and hence establish the indication for additional surgery with lymph node dissection.

Methods

Initial or additional surgery with nodal dissection was performed in 653 T1 carcinoma cases. Clinicopathological factors were retrospectively analyzed with respect to nodal metastasis. The status of the muscularis mucosae (MM grade) was defined as grade 1 (maintenance) or grade 2 (fragmentation or disappearance). The lesions were then stratified based on the risk of nodal metastasis.

Results

Muscularis mucosae grade was associated with nodal metastasis (P = 0.026), and no patients with MM grade 1 lesions had nodal metastasis. Significant risk factors for nodal metastasis in patients with MM grade 2 lesions were attribution of women (P = 0.006), lymphovascular infiltration (P < 0.001), tumor budding (P = 0.045), and poorly differentiated adenocarcinoma or mucinous carcinoma (P = 0.007). Nodal metastasis occurred in 1.06% of lesions without any of these pathological factors, but in 10.3% and 20.1% of lesions with at least one factor in male and female patients, respectively. There was good inter‐observer agreement for MM grade evaluation, with a kappa value of 0.67.

Conclusions

Stratification using MM grade, pathological factors, and patient sex provided more appropriate indication for additional surgery with lymph node dissection after endoscopic treatment for T1 colorectal carcinomas.
Retracted: Anti‐inflammatory properties of tianeptine on lipopolysaccharide‐induced changes in microglial cells involve toll‐like receptor‐related pathways
Authors: Slusarczyk Joanna , Trojan Ewa , Glombik Katarzyna , Piotrowska Anna , Budziszewska Boguslawa , Kubera Marta , Popiolek‐Barczyk Katarzyna , Lason Wladyslaw , Mika Joanna , Basta‐Kaim Agnieszka
Published: December 2015

Accumulating evidence suggests that activation of microglia plays a key role in the pathogenesis of depression. Activated microglia produce a wide range of factors whose prolonged or excessive release may lead to brain disorders. Thus, the inhibition of microglial cells may be beneficial in the treatment of depressive diseases. Tianeptine is an atypical antidepressant drug with proven clinical efficacy, but its mechanism of action remains still not fully understood. In the present study, using microglial cultures we investigated whether tianeptine modifies microglial activation after lipopolysaccharide (LPS) stimulation and which intracellular pathways are involved in the activity of this antidepressant. Our study shows that tianeptine attenuated the LPS‐evoked inflammatory activation of microglia by decreasing the expression of proinflammatory cytokines such as IL‐1β, IL‐18, IL‐6 and tumor necrosis factor α (TNF‐α), the release of nitric oxide (NO) and reactive oxygen species (ROS) as well as the expression of inducible nitric oxide synthase. Analyses of signaling pathways demonstrate that tianeptine led to the suppression of LPS‐induced TLR4 expression and ERK1/2 phosphorylation. Furthermore, our study reveals the inhibitory impact of tianeptine on caspase‐3‐induced PKCδ degradation and consequently on the activation of NF‐κB factor in microglial cells. Taken together, present results show anti‐inflammatory properties of tianeptine in microglial cultures stimulated by LPS. This study provides evidence that the inhibition of microglial activation may underlie the therapeutic activity of tianeptine.

image

Our findings show the anti‐inflammatory effect of tianeptine (TIA) in lipopolisaccharide (LPS)‐stimulated microglial cells. The beneficial tianeptine action is mediated through the inhibition of Toll‐like receptor 4 (TLR4) expression as well as the TLR4‐related pathways: extracellular signal‐regulated kinase 1/2 (ERK1/2), caspase‐3‐dependent protein kinase δ (PKCδ) cleavage and the expression of nuclear factor kappa‐light‐chain‐enhancer of activated B cells (NF‐κB). These findings may provide a new therapeutic strategy for treatment of disorders based on neuroinflammation, including depression.
Public Understanding of the Role of Nurses During Ebola
Authors: McGillis Hall Linda , Kashin Jordana
Published: December 2015

Purpose

To examine media portrayals of nurses and their roles during the 2014–2015 Ebola epidemic in western Africa.

Methods

The study used document analysis and in‐depth content analysis to review and assess literature on the Ebola epidemic. A total of 234 potentially relevant articles were identified; 109 were excluded and 125 were included in the analysis.

Findings

The analysis revealed a gap in system preparedness for global health events and a lack of public awareness of the critical role of nurses. Little attention was paid to nurses and their knowledge and expertise as they worked through the Ebola event. The perception of nurses evolved over the epidemic.

Conclusions

Portrayals of nurses and their work during the Ebola epidemic evolved over the epidemic, from positive to negative, and health systems were shown to be unprepared for a major epidemic.

Clinical Relevance

Media coverage of major health events can demonstrate system inadequacies, but inaccurate and misleading portrayals of nurses and the nursing profession can undermine and diminish the image of the nursing profession.
“this winged nature fraught”: Suicide and Agency in Women's Poetry
Authors: Higonnet Margaret R.
Published: December 2015

This essay focuses on representations of female suicide by Romantic poets Felicia Hemans and Mary Robinson. In short lyric narratives, the two poets exploited themes of maternal, revolutionary, and Sapphic suicide. Their literary representations of women's voluntary death can both draw from and generate narratives of political resistance: the repudiation of slavery, of empire, of tyranny. Female suicide may also invoke discourses about the nature and function of poetic voice, genre, and authorship. Selected fatal moments point toward the political and metapoetic implications of gesture and voice. In the penultimate sonnet of Robinson's Sappho and Phaon, for example, the classical poet—the tenth muse—reflects upon her impending death. Perched on the Leucadian rock, Sappho gazes up at the sky, and not down toward her watery grave;Robinson's imagery suggests soaring flight rather than precipitous fall. Sappho anticipates posthumous fame more triumphant, more transcendent, than that which she achieved in life: then shall “loftier passions prompt the loftier theme!” In this way Sappho's suicidal genius stands in for the neglected genius of Romantic women writers; it figures the self‐reflexive, paradoxical condition of the female writer at once legitimated and effaced by the authorial role. For these authors, the rhetoric and imagery of female suicide does not provide textual closure, nor does it determine, finally, a poem's meaning. Rather, suicide opens up the text.
Living to Labour, Labouring to Live: The Problem of Suicide in Charlotte Smith'sElegiac Sonnets
Authors: Parisot Eric
Published: December 2015

In herElegiac Sonnets, Charlotte Smith presents the reader with a suffering poetic persona, one heavily burdened by a melancholic longing for death as a release from the ills of the world. Although this image of a despairing sentimental heroine cultivates a perception that this persona, or even Smith herself, harbours suicidal intentions, this essay argues that such desires remain inert throughout the sonnet sequence. In comparing Smith's imagining of Werther's suicidal experience – as articulated in a five‐sonnet sequence within theElegiac Sonnets– with the envisioned dejection of Smith's poetic persona, it is arguable that Smith is, instead, careful to delineate the ways in which these respective experiences diverge, and how the persistence of reason in particular, as both a blessing and a curse, prevents Smith's speaker from following Werther to the grave. Finally, it is a further reminder that (literary) suicide, often seen as the quintessentially transcendent Romantic destiny, was not a viable option for Romantic female writers who aspired to sympathetic identification and elegiac remembrance.
Side‐by‐Side Alterations in Glycocalyx Thickness and Perfused Microvascular Density During Acute Microcirculatory Alterations in Cardiac Surgery
Authors: Koning Nick J. , Vonk Alexander B. A. , Vink Hans , Boer Christa
Published: December 2015

Objectives

Endothelial glycocalyx injury causes microcirculatory perfusion disturbances in experimental studies, but the relevance in a clinical setting remains unknown. We investigated whether glycocalyx dimensions are reduced after onset of CPB and whether this is associated with alterations in microvascular perfusion.

Methods

The current observational study included 36 patients undergoing cardiac surgery without or with CPB, using either nonpulsatile or pulsatile flow. Sublingual microcirculatory perfusion was assessed perioperatively and analyzed for perfused vessel density and PBR, an inverse parameter of endothelial glycocalyx dimensions.

Results

Perfused vessel density decreased after onset of CPB in parallel with an increase in PBR in both pulsatile and nonpulsatile groups. In the nonpulsatile CPB group, these alterations were still persistent in the ICU (PVD: T1 19.8 ± 2.8 mm/mm2 vs. T3 15.3 ± 2.6 mm/mm2; p = 0.004. PBR: T1 2.40 ± 0.35 μm vs. T3 2.60 ± 0.31 μm; p = 0.020). In the off‐pump group, perfused vessel density remained unaltered. An inverse correlation between perfused vessel density and PBR was detected.

Conclusions

This study shows that endothelial glycocalyx dimensions decrease after onset of CPB and are closely related to microvascular perfusion when assessed with a novel, noninvasive technique.