bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association between initial manifestations of childhood‐onset systemic lupus erythematosus and the survival
Authors: Fatemi Alimohammad , Matinfar Mohammad , Saber Mina , Smiley Abbas 
Published: December 2015

AbstractIntroductionChildhood‐onset systemic lupus erythematosus (cSLE) comprises 15–20% of patients with SLE. Although several studies have reported the outcomes of adult‐onset SLE, few investigations have been conducted on cSLE in the Middle East.MethodsIn a retrospective study, all children with SLE admitted to our tertiary referral center between 1992 and 2011 were recruited. The clinical and laboratory data at the time of onset were recorded and analyzed. Kaplan–Meier analysis was used to calculate the survival rates. Cox regression analysis was applied to assess the predictors of mortality.ResultsOne hundred and eighty‐eight children diagnosed with SLE were enrolled during the study period. Nine patients were censored due to loss to follow‐up (6) and incomplete data (3 cases). Mean age of patients at the time of onset was 14.4 (3.05) years. Only 22 (11.8%) children were younger than 10 years at the time of disease onset. In total, 20 patients (11%) died, all after the first decade of life. The most common cause of death was lupus nephritis (10 patients, 50% of deaths) followed by infections (35%), cerebrovascular accidents (10%) and alveolar hemorrhage (5%). Cumulative survival rate after 5, 10, 15 and 20 years was 91, 87, 85, and 79%, respectively. Having hematuria or pleurisy at the time of SLE onset had a negative effect on survival in multivariate analysis.ConclusioncSLE survival in Iran was comparable to that in other developing countries. Baseline presentation with hematuria predominantly increased the mortality rate in cSLE. Prospective and larger studies in future may unfold other aspects of cSLE.
Assessing ageist behaviours in undergraduate nursing students using the Relating to Older People Evaluation (ROPE) survey
Authors: Frost Jane , Ranse Kristen , Grealish Laurie 
Published: December 2015

AimTo describe the prevalence of ageist behaviours amongst first‐year undergraduate nursing students.MethodsA cross‐sectional survey design. The Relating to Older People Evaluation (ROPE) survey was administered to first‐year undergraduate nursing students in one Australian university.ResultsOne hundred and eighty‐five students responded (response rate (RR) 85.3%). Up to 97.8% of students reported engaging in some ageist behaviours, with positive ageist behaviours ranked highest. Up to 87.5% of the cohort reported engaging in negative behaviours, such as talking slow and loud to an older person. Most students (63.2%) indicated that they would work in aged care in the future.ConclusionNursing students report engaging in ageist behaviours that can have a negative effect on their future relationships with older patients. The ROPE survey can be used to make collective ageist behaviours explicit to students. Combining explicit collective information on ageist behaviours with educational strategies is proposed to address ageism in undergraduate nursing curricula.
Improving hand surgery access and care through service redesign
Authors: Isedale Grant , Harris Ian , Rider Mark 
Published: December 2015

AbstractBackgroundThe hand surgery service in our major trauma centre comprised predominantly emergency surgery with poor theatre access, resulting in many cases being postponed and performed after hours and with low rates of supervision.MethodWe report the results of a before‐and‐after study describing the change in processes and outcomes associated with a change in the model of care to a sequestered, area‐wide hand surgery service. The study uses data from 12 months prior to and 12 months after the change in practice.ResultsThe hand service experienced a 24.7% increase in demand for surgery in the first 12 months after the relocation. However, demand for overnight beds fell by 303%, the rate of specialist supervision increased from 23.5% to 81.3% (P < 0.0001), the time between admission and surgery fell from 5.1 to 2.7 h (P < 0.0001), the rate of cancellations fell from 21.8% to 7.7% (P < 0.0001), the proportion of emergency surgery conducted in normal hours increased from 65.8% to 93.6% (P < 0.0001), the 28‐day unplanned reoperation rate fell from 1.2% to 0.5% (P = 0.02) and surgical time decreased to an equivalent of 41 half day operating sessions per year.ConclusionThese outcomes are in line with international experiences of service centralization. The project may be used as a template for practice change in other surgical fields.
Patient‐related factors influence the risk of developing intestinal stoma complications in early post‐operative period
Authors: Harilingam Mohanraj , Sebastian Joseph , Twum‐Barima Charlene , Boshnaq Mohamed , Mangam Sudhakar , Khushal Amjad , Marzouk Deya , Tsavellas George 
Published: December 2015

AbstractBackgroundFew studies have investigated the risk factors associated with developing intestinal stoma complications using appropriate multivariable methods. We aimed to determine the prevalence of, and risk factors for, stomal complications.MethodsA retrospective, case‐control methodology was used to investigate 12 explanatory variables and four outcome variables in 202 consecutive patients receiving stomas in a district general hospital in the United Kingdom between January 2013 and December 2014. Univariable and multivariable logistic regression were used to calculate odds ratios (ORs).ResultsThere were 69 complications (69/202; 34.2%) in the early post‐operative period (median 12 months) in total, the most common being retraction (30.4%). Performance status (World Health Organization score 1 or more; OR 2.67; 95% confidence intervals (CIs) 1.33–5.33; P = 0.006) and body mass index (>30 kg/m2; OR 3.30; 95% CIs 1.61–6.78; P = 0.001) were significantly associated with developing complications in multivariable analysis. Surgery‐related risk factors, such as time of day or week of operation and grade of surgeon, were not associated with the development of stoma complications. Thirty‐eight patients (18.8%) died over the follow‐up period, but mortality was not related to the development of stoma complications (1.01; 0.48–2.13, P = 0.98).ConclusionPatient‐related risk factors influence the risk of developing a stoma complication more than surgery‐related risk factors. Preoperative and post‐operative interventions, planning, vigilance and management should be focussed to at‐risk groups, particularly obese patients.
Quantification of the filtering bleb's structure with anterior segment optical coherence tomography
Authors: Kokubun Taiki , Kunikata Hiroshi , Tsuda Satoru , Himori Noriko , Maruyama Kazuichi , Nakazawa Toru 
Published: December 2015

AbstractBackgroundThe aim of the study is to determine the relationship between post‐trabeculectomy bleb structure evaluated using anterior segment optical coherence tomography (AS‐OCT) and postoperative intraocular pressure (IOP).DesignRretrospective is showed for the design of this study.ParticipantsThere are twenty‐seven eyes of 27 trabeculectomy patients.MethodsWe drew contour lines for the bleb and cleft on 8‐radius‐scanned AS‐OCT images, and determined correlations of AS‐OCT measurements to postoperative IOP at 6 months.Main Outcome MeasuresThe parameter used in this study is an anterior segment optical coherence tomography measurements of bleb structure, including cleft volume, wall volume, and the brightness of the bleb wall.ResultsWe found significant correlations between postoperative IOP at 6 months and cleft volume at 3 and 6 months (r = −0.56, P = 0.007 and r = −0.82, P <0.001), bleb wall volume at 6 months (r = −0.48, P = 0.042), bleb vertical brightness at 3 and 6 months (r = 0.73, P < 0.001 and r = 0.49, P = 0.040), and bleb horizontal brightness at 1 week, 2 weeks, 3 months and 6 months (r = 0.49, P = 0.016, r = 0.65, P < 0.001, r = 0.52, P = 0.013 and r = 0.71, P = 0.001). A stepwise multiple regression analysis of bleb structural measurements made ≤2 weeks postoperatively showed that the strongest independent factor indicating postoperative IOP at 6 months was bleb horizontal brightness at 2 weeks (β = 0.50, P = 0.006).ConclusionsEarly postoperative AS‐OCT measurements of blebs, especially horizontal brightness of the bleb wall, were associated with postoperative IOP at 6 months. AS‐OCT measurements of blebs may be useful predictors of trabeculectomy outcomes.
Controlling range expansion in habitat networks by adaptively targeting source populations
Authors: Hock Karlo , Wolff Nicholas H. , Beeden Roger , Hoey Jessica , Condie Scott A. , Anthony Kenneth R. N. , Possingham Hugh P. , Mumby Peter J. 
Published: December 2015

AbstractControlling the spread of invasive species, pests, and pathogens is often logistically limited to interventions that target specific locations at specific periods. However, in complex, highly connected systems, such as marine environments connected by ocean currents, populations spread dynamically in both space and time via transient connectivity links. This results in nondeterministic future distributions of species in which local populations emerge dynamically and concurrently over a large area. The challenge, therefore, is to choose intervention locations that will maximize the effectiveness of the control efforts. We propose a novel method to manage dynamic species invasions and outbreaks that identifies the intervention locations most likely to curtail population expansion by selectively targeting local populations most likely to expand their future range. Critically, at any point during the development of the invasion or outbreak, the method identifies the local intervention that maximizes the long‐term benefit across the ecosystem by restricting species’ potential to spread. In so doing, the method adaptively selects the intervention targets under dynamically changing circumstances. To illustrate the effectiveness of the method we applied it to controlling the spread of crown‐of‐thorns starfish (Acanthaster sp.) outbreaks across Australia's Great Barrier Reef. Application of our method resulted in an 18‐fold relative improvement in management outcomes compared with a random targeting of reefs in putative starfish control scenarios. Although we focused on applying the method to reducing the spread of an unwanted species, it can also be used to facilitate the spread of desirable species through connectivity networks. For example, the method could be used to select those fragments of habitat most likely to rebuild a population if they were sufficiently well protected.
On the importance of trait interrelationships for understanding environmental responses of stream macroinvertebrates
Authors: Pilière A. F. H. , Verberk W. C. E. P. , Gräwe M. , Breure A. M. , Dyer S. D. , Posthuma L. , de Zwart D. , Huijbregts M. A. J. , Schipper A. M. 
Published: December 2015

Summary

Biological traits of organisms are expected to provide increased mechanistic understanding of species–environment relationships. Linking traits to environmental conditions is, however, not straightforward, as traits are interconnected within species and can affect the adaptive value of each other. The aim of our study was to evaluate the importance of these trait interrelationships for understanding environmental responses of freshwater macroinvertebrates.

To this end, we investigated whether environmental responses of macroinvertebrates sharing a given trait were consistent or differed according to their taxonomy or to their other traits. We divided the macroinvertebrates into groups based on single traits (49 single‐trait modalities), on taxonomy (10 orders) and on their overall trait profile (10 trait profile groups [TPGs], defined using self‐organising maps clustering). Abundances of each of these 69 groups were related to 24 environmental variables using boosted regression tree (BRT) modelling, to assess the environmental responses of single traits, orders and TPGs.

Cross‐validated predictive power (R2) of the BRT models ranged from < 1% to 38%. Environmental responses of macroinvertebrates sharing a given trait were inconsistent and varied according to order and/or TPG. Single‐trait responses often reflected the responses of the most abundant taxonomic group expressing the trait, suggesting that analysis of trait responses simply revealed patterns in habitat use by the most abundant species and not necessarily mechanistic relationships.

Further, taxa from the same TPG (hence showing large overlap in their traits) but belonging to different orders showed different environmental responses. This indicates that the order a taxon belongs to confers unique information related to its evolutionary history that was not captured by our 49 trait modalities. However, groupings by orders cannot replace trait‐based approaches, since TPGs also revealed differences in trait profiles within some orders, which were associated with different environmental responses.

Our results highlight the importance of considering multiple rather than single traits when linking macroinvertebrates to environmental variables, including the potential information conveyed by evolutionary history.
Substance use prevention program for adolescents with intellectual disabilities on special education schools: a cluster randomised control trial
Authors: Kiewik M. , VanDerNagel J. E. L. , Kemna L. E. M. , Engels R. C. M. E. , DeJong C. A. J. 
Published: December 2015

AbstractBackgroundStudents without intellectual disability (ID) start experimenting with tobacco and alcohol between 12 and 15 years of age. However, data for 12‐ to 15‐year old students with ID are unavailable. Prevention programs, like ‘prepared on time’ (based on the attitude–social influence–efficacy model), are successful, but their efficacy has not been studied in students with ID. The objectives of this study were (1) to undertake a cluster randomised control trial to test the efficacy of the e‐learning program among 12‐ to 15‐year old students with mild and borderline ID in secondary special‐needs schools and (2) to examine the tobacco and alcohol use for this population.MethodsFive schools, randomly selected to be part of either the experimental group or the control group, participated in this study. Passive informed consent was used in which parents and their children can refuse to participate in the study, resulting in 111 students in the experimental group and 143 students in the control group. A total of 210 students completed both baseline and follow‐up questionnaires. Primary outcome variables are the knowledge and attitude towards alcohol and tobacco use. This study is registered in the ISRCTN registry with number ISRCTN95279686.ResultsBaseline findings showed that a large proportion of all respondents had initiated smoking (49%) and drinking (75%), well above the expected numbers based on national figures. ‘prepared on time’ did not affect the behavioural determinants (i.e. attitude, subjective norm and self‐efficacy), except modelling on smoking. Additionally, alcohol‐related knowledge of students in the experimental group increased after the completion of the program.ConclusionsTo obtain effective results on behavioural outcomes from ‘prepared on time’, a greater degree of flexibility (i.e. repetition, extension of the program, role playing, etc.) is required. Furthermore, prevention needs to be implemented at a younger age, as 6% of the students tried their first cigarette and 15% of the students drank alcohol at the age of 10 years or younger.
Case of pituitary stalk transection syndrome ascertained after breech delivery
Authors: Fukuta Kaori , Hidaka Takao , Ono Yosuke , Kochi Keiko , Yasoshima Kuniaki , Arai Takashi 
Published: December 2015

AbstractPituitary stalk transection syndrome (PSTS) is a rare complication that can accompany breech delivery. Early diagnosis of this syndrome is difficult, and it may cause a serious delay in the diagnosis. We present a case of PSTS ascertained after breech delivery. A 20‐year‐old woman presented with primary amenorrhea. The patient was born by breech delivery and had a history of treatment for pituitary dwarfism. Her laboratory findings showed pituitary hypothyroidism, and hormone replacement therapy was initiated. At 28 years old, she became pregnant and had a normal delivery at 38 weeks' gestation. One year after delivery, her thyroid hormone level changed. Laboratory test showed adrenocortical insufficiency, and magnetic resonance imaging of the pituitary gland showed transection of the pituitary stalk and development of an ectopic posterior lobe. These findings were compatible with PSTS. When a patient who has been born by breech delivery presents with symptoms of pituitary deficiency, PSTS should be considered in the differential diagnosis.
Randomized trial of ultrasound‐indicated cerclage in singleton women without lower genital tract inflammation
Authors: Otsuki Katsufumi , Nakai Akihito , Matsuda Yoshio , Shinozuka Norio , Kawabata Ikuno , Makino Yasuo , Kamei Yoshimasa , Iwashita Mitsutoshi , Okai Takashi 
Published: December 2015

AbstractAimThis is the first report of a randomized trial of cerclage on pure cervical shortening without vaginosis or cervicitis. The objective of our multicenter randomized controlled trial was to assess the benefits of ultrasound‐indicated cervical cerclage in the mid‐trimester to prevent preterm birth in women who have no signs of infection or inflammation of the lower genital tract.Material and MethodsWomen with a short cervical length < 25 mm between 16 and 26 weeks of gestation were randomly assigned to receive a Shirodkar cerclage, McDonald cerclage, or bedrest (no cerclage). Before being randomly assigned to one of the three groups, all women were screened for infection/inflammation of the lower genital tract; those with positive results were excluded from the study. The ratio of preterm delivery as a primary end‐point was evaluated in the groups.ResultsA total of 106 singleton patients with a short cervical length were assessed for study eligibility; 106 patients were randomized to the three treatment options. Ultimately, 98 patients (in the Shirodkar [n = 34], McDonald [n = 34] and bedrest [n = 30] groups) were analyzed. No differences in preterm delivery or perinatal outcomes were found between the three groups. Significantly fewer patients in the Shirodkar group required hospitalization for treatment of threatened preterm labor when compared to patients in the bedrest group.ConclusionFor women with a short cervical length < 25 mm between 16 and 26 weeks of gestation, Shirodkar cerclage might be considered to reduce the occurrence of threatened preterm labor.
USPIO‐Enhanced MRI Neuroimaging: A Review
Authors: Gkagkanasiou Maria , Ploussi Agapi , Gazouli Maria , Efstathopoulos Efstathios P. 
Published: December 2015

ABSTRACTMRI is a powerful tool for the diagnosis and management for a variety of central nervous system (CNS) diseases. Ultrasmall superparamagnetic iron oxide (USPIO) nanoparticles are a novel category of MRI contrast agents that seem to play a crucial role in the imaging of CNS. Due to their physical properties, USPIOs act as blood pool agents. USPIOs improve visualization of tumor vasculature and relative cerebral blood volume measurements, tumor‐associated inflammation, inflammatory‐immune mediated disorders, stroke and vascular malformations. Ferumoxytol, a new type of USPIO agent, appears to have ideal characteristics for the imaging of CNS. The last few years, ferumoxytol has been successfully used to image CNS neoplasms, CNS inflammations and cerebral malformations offering useful information on cellular and molecular level. In addition, ferumoxytol studies focused on the pathophysiology of other CNS disorders like multiple sclerosis and epilepsy are already in progress. Aim of this review article is to provide the potential role of USPIO‐enhanced MRI and the latest clinical applications of ferumoxytol agent in CNS imaging.
Influence of Cyclic Fatigue in Water on Screw Torque Loss of Long‐Span One‐Piece Implant‐Supported Zirconia Frameworks
Authors: Tiossi Rodrigo , Gomes Érica Alves , Faria Adriana Cláudia Lapria , Rodrigues Renata Cristina Silveira , Ribeiro Ricardo Faria 
Published: December 2015

AbstractPurposeIt is still unclear whether four, six, or more implants should be used when restoring fully edentulous maxillae. This research evaluated the in vitro screw torque loss of zirconia frameworks supported by six implants and cantilevered zirconia frameworks supported by four implants.Materials and MethodsComputer aided design/computer‐assisted machining was used to fabricate 10 one‐piece frameworks. Standardized pressable porcelain crowns were fabricated and luted to the frameworks. Specimens were divided into two groups (n = 5): AO4, cantilevered 12‐unit full‐arch fixed dental prosthesis supported by four implants; AO6, 14‐unit supported by six implants. An opposing mandibular dental arch was fabricated with bis‐acrylic composite resin. Specimens were submitted to 200 N underwater cyclic load at 2‐Hz frequency for 1 × 106 cycles in a controlled 37°C temperature. A digital torque gauge assessed the initial and postload screw removal torque. Linear mixed‐effects model was used for statistical analysis (α = 0.05).ResultsSignificant screw torque loss was found for AO6 after cyclic loading (before: 36.20%/after: 52.82%; p < 0.05). Group AO6 (36.20%) presented lower preload loss before the cyclic loadings compared with AO4 (60.10%) (p < 0.05).ConclusionsCyclic loading and lower implant‐to‐replaced‐units ratio do not seem to compromise screw stability compared with higher implant‐to‐replaced‐units ratio; however, a steep drop in preload was found before cyclic loading for both groups.
Vascular and Chronological Age in Subjects with Erectile Dysfunction: A Cross-Sectional Study
Authors: Rastrelli Giulia , Corona Giovanni , Mannucci Edoardo , Maggi Mario 
Published: December 2015

ABSTRACT

Introduction
Vascular age, as derived from the SCORE project algorithm for cardiovascular (CV) risk estimation, is an effective way for communicating CV risk. However, studies on its clinical correlates are scanty.

Aim
To evaluate if the difference between vascular and chronological age (Δage), in a population of subjects with erectile dysfunction (ED), can identify men with a worse risk profile.

Methods
A consecutive series of 2,853 male patients attending the outpatient clinic for erectile dysfunction (ED) for the first time was retrospectively studied. Among them, 85.4% (n  = 2,437) were free of previous MACE and were analyzed.

Main Outcome Measures
Several clinical, biochemical, and penile color Doppler parameters were studied. Vascular age was derived from the SCORE project algorithm, and the Δage was considered.

Results
Higher Δage is associated with several conventional (family history of CV diseases, hyperglycemia, elevated triglycerides, and increased prevalence of metabolic syndrome) and unconventional (severity of ED, frequency of sexual activity, alcohol abuse, lower education level, fatherhood, extramarital affairs, compensated hypogonadism, and low prolactin levels) risk factors. Δage is inversely related to penile color Doppler parameters, including flaccid and dynamic peak systolic velocity and flaccid acceleration (β = −0.125, −0.113, and −0.134, respectively, all P  &lt; 0.0001).

Conclusions
In subjects referring for ED without a personal history of CV events, Δage is associated with an adverse cardio-metabolic profile and worse penile color Doppler ultrasound parameters. Δage provides a simple method for identifying high-risk men that must undergo significant modification in their lifestyle and risk factors. In addition, it can be considered a simple, inexpensive, and safe surrogate marker of penile arterial damage.