bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Adverse Effects of Endothelin Receptor Antagonists: Insights From the Meta‐Analysis of 4894 Patients From 24 Randomized Double‐Blind Placebo‐Controlled Clinical Trials
Authors: Wei Anhua , Gu Zhichun , Li Juan , Liu Xiaoyan , Wu Xiaofan , Han Yi , Pu Jun 
Published: October 2016

Background
Evidence of the clinical safety of endothelin receptor antagonists (ERAs) is limited and derived mainly from individual trials; therefore, we conducted a meta‐analysis.

Methods and Results

After systematic searches of the Medline, Embase, and Cochrane Library databases and the
ClinicalTrials.gov
website, randomized controlled trials with patients receiving ERAs (bosentan, macitentan, or ambrisentan) in at least 1 treatment group were included. All reported adverse events of ERAs were evaluated. Summary relative risks and 95% CIs were calculated using random‐ or fixed‐effects models according to between‐study heterogeneity. In total, 24 randomized trials including 4894 patients met the inclusion criteria. Meta‐analysis showed that the incidence of abnormal liver function (7.91% versus 2.84%; risk ratio [RR] 2.38, 95% CI 1.36–4.18), peripheral edema (14.36% versus 9.68%; RR 1.44, 95% CI 1.20–1.74), and anemia (6.23% versus 2.44%; RR 2.69, 95% CI 1.78–4.07) was significantly higher in the ERA group compared with placebo. In comparisons of individual ERAs with placebo, bosentan (RR 3.78, 95% CI 2.42–5.91) but not macitentan (RR 1.17, 95% CI 0.42–3.31) significantly increased the risk of abnormal liver function, whereas ambrisentan (RR 0.06, 95% CI 0.01–0.45) significantly decreased that risk. Bosentan (RR 1.47, 95% CI 1.06–2.03) and ambrisentan (RR 2.02, 95% CI 1.40–2.91) but not macitentan (RR 1.08, 95% CI 0.81–1.46) significantly increased the risk of peripheral edema. Bosentan (RR 3.09, 95% CI 1.52–6.30) and macitentan (RR 2.63, 95% CI 1.54–4.47) but not ambrisentan (RR 1.30, 95% CI 0.20–8.48) significantly increased the risk of anemia. ERAs were not found to increase other reported adverse events compared with placebo.

Conclusions
The present meta‐analysis showed that the main adverse effects of treatment with ERAs were hepatic transaminitis (bosentan), peripheral edema (bosentan and ambrisentan), and anemia (bosentan and macitentan).
Delayed Time to Peak Velocity Is Useful for Detecting Severe Aortic Stenosis
Authors: Kamimura Daisuke , Hans Sartaj , Suzuki Takeki , Fox Ervin R. , Hall Michael E. , Musani Solomon K. , McMullan Michael R. , Little William C. 
Published: October 2016

Background

Time to peak velocity (
TPV
) is an echocardiographic variable that can be easily measured and reflects a late peaking murmur, a classic physical finding suggesting severe aortic stenosis (
AS
). The aim of this study was to investigate the usefulness of
TPV
to evaluate
AS
severity.

Methods and Results

This study included 700
AS
patients, whose aortic valve area (
AVA
) was <1.5 cm
2
, and 200 control patients. The
TPV
was defined as the time from aortic valve opening to when the flow velocity across the aortic valve reaches its peak.
AS
severity was classified as follows: High gradient severe
AS
, mean pressure gradient ≥40 mm Hg and
AVA
index (
AVAI
) <0.6 cm
2
/m
2
; Low gradient severe
AS
, mean pressure gradient <40 mm Hg,
AVAI
<0.6 cm
2
/m
2
, and dimensionless index <0.25; moderate
AS
, mean pressure gradient <40 mm Hg,
AVAI
≥0.6 cm
2
/m
2
. The area under the receiver operating characteristic curve of
TPV
to predict high gradient severe AS was 0.94 (95%
CI
: 0.92–0.97,
P
<0.001).
TPV
was significantly delayed in low gradient severe AS compared with moderate
AS
both in patients with preserved (102±13 ms versus 83±13 ms,
P
<0.001) and with reduced ejection fraction (110±18 ms versus 88±13 ms,
P
<0.001). Delayed
TPV
was associated with increased all‐cause mortality or need for aortic valve replacement after adjustment for confounders (hazard ratio for first quartile, reference is fourth quartile: 7.31, 95%
CI
4.26–12.53,
P
<0.001).

Conclusions

TPV
is useful to evaluate
AS
severity and predict poor prognosis of
AS
patients.
Treatment Intensification for Hypertension in US Ambulatory Medical Care
Authors: Mu Lin , Mukamal Kenneth J. 
Published: October 2016

Background
Hypertension is widely prevalent yet remains uncontrolled in nearly half of US hypertensive adults. Treatment intensification for hypertension reduces rates of major cardiovascular events and all‐cause mortality, but clinical inertia remains a notable impediment to further improving hypertension control. This study examines the likelihood and determinants of treatment intensification with new medication in US ambulatory medical care.

Methods and Results
Using the nationally representative National Ambulatory Medical Care Survey (2005–2012) and National Hospital Ambulatory Medical Care Survey (2005–2011), we identified adult primary care visits with diagnosed hypertension and documented blood pressure exceeding goal targets and assessed the weighted prevalence and odds ratios of treatment intensification by initiation or addition of new medication. Approximately 41.7 million yearly primary care visits (crude N: 14 064, 2005–2012) occurred among US hypertensive adults with documented blood pressure ≥140/90 mm Hg, where treatment intensification may be beneficial. However, only 7.0 million of these visits (95% confidence interval 6.2–7.8 million) received treatment intensification with new medication, a weighted prevalence of 16.8% (15.8% to 17.9%). This proportion was consistently low and decreased over time. This decline was largely driven by decreasing medication initiation levels among patients on no previous hypertension medications from 31.8% (26.0% to 38.4%) in 2007 to 17.4% (14.0% to 21.4%) in 2012, while medication addition levels remained more stable over time.

Conclusions
US hypertensive adults received treatment intensification with new medication in only 1 out of 6 primary care visits, a fraction that is declining over time. A profound increase in intensification remains a vast opportunity to maximally reduce hypertension‐related morbidity and mortality nationwide.
Shape Discrimination Using the Tongue: Implications for a Visual-to-Tactile Sensory Substitution Device
Authors: Vincent Margaret , Tang Hao , Khoo Wai , Zhu Zhigang , Ro Tony 
Published: October 2016

Sensory substitution devices have the potential to provide individuals with visual impairments with more information about their environments, which may help them recognize objects and achieve more independence in their daily lives. However, many of these devices may require extensive training and might be limited in the amount of information that they can convey. We tested the effectiveness and assessed some of the limitations of the BrainPort device, which provides stimulation through a 20 × 20 electrode grid array on the tongue. Across five experiments, including one with blind individuals, we found that subjects were unable to accurately discriminate between simple shapes as well as different line orientations that were briefly presented on the tongue, even after 300 trials of practice with the device. These experiments indicate that such a minimal training regimen with the BrainPort is not sufficient for object recognition, raising serious concerns about the usability of this device without extensive training.
Shared decision making about palliative chemotherapy: A qualitative observation of talk about patients’ preferences
Authors: Henselmans Inge , Van Laarhoven Hanneke WM , Van der Vloodt Jane , De Haes Hanneke CJM , Smets Ellen MA 
Published: October 2016

Background: Particularly at the end of life, treatment decisions should be shared and incorporate patients’ preferences. This study examines elaboration and preference construction. Aim: To examine the values, appraisals and preferences that patients express, as well as the oncologists’ communicative behaviour that facilitates these expressions in consultations on palliative chemotherapy. Design: Verbatim transcripts of audio-recorded consultations ( n = 60) were analysed in MAXqda10 software. Two independent coders identified and categorised patients’ preference-related utterances and oncologists’ utterances, preceding and following such expressions. Setting/participants: Cancer patients ( n = 41) with a median life expectancy <1 year and oncologists ( n = 13) meeting with them in either initial or evaluative follow-up consultations. Results: Most frequent were patients’ expressions of treatment preferences (65% of consultations), often the simple wish to have treatment. Expressions of underlying values (48%) and appraisals of treatment aspects (50%) were less common. Most preference-related utterances concerned single statements (59%); in 51% of the consultations, true dialogue was observed. Preference-related utterances were least common in follow-up consultations concerning stable disease or response. Preference-related fragments were patient-initiated (42%), oncologist-facilitated (28%) or oncologist-invited (30%). Oncologist responses likely to trigger more preference-related talk were showing empathy, checking and probe questioning. Likely to reduce space were providing information, personally agreeing and neutral responses. Conclusion: Elaboration and joint preference construction is not standard practice in consultations on palliative chemotherapy. Oncologists may benefit from realising this and training skills that support this key step of shared decision making. Also, repeated shared decision making throughout the course of palliative chemotherapy should be stimulated.
Magnetic resonance imaging of breast cancer: does the time interval between biopsy and MRI influence MRI–pathology discordance in lesion sizing?
Authors: Mennella Simone , Paparo Francesco , Revelli Matteo , Baccini Paola , Secondini Lucia , Barbagallo Stella , Friedman Daniele , Garlaschi Alessandro 
Published: October 2016

Background Breast magnetic resonance imaging (MRI) is more accurate than ultrasound and mammography in estimating local extension of both invasive breast cancer and ductal carcinoma in situ (DCIS) and it is part of a breast cancer patient’s preoperative management. Purpose To verify if time interval between breast biopsy and preoperative MRI, lesion margins, and biopsy technique can influence tumor sizing on MRI. Material and Methods By a database search, we retrospectively identified all women with a newly diagnosed, biopsy-proven, primary breast cancer who underwent MRI before surgery. The time interval between biopsy and MRI, the type of biopsy procedure, and various pathological features of tumors were collected. We defined the concordance between MRI and pathology measurements as a difference of <5 mm in lesion sizing. Results One hundred and sixty-six women (mean age, 51.4 ± 10.4 years) were included. The time interval between biopsy and MRI showed only a weak correlation with the absolute MRI–pathology difference (r = 0.236). Stratifying the whole cohort of patients using a cutoff value of 30 days, we found that the MRI–pathology discordance was significantly higher in patients with a biopsy–MRI time interval >30 days ( P < 0.05). By means of multivariate analysis, we found that DCIS subtype and the presence of poorly defined margins on MRI are the only two factors independently and strongly associated with MRI–pathology discordance in lesion sizing. Conclusion Size, histology, and margins of tumors may affect the accuracy of MRI measurements. The type of biopsy procedure and the time interval between biopsy and preoperative MRI are not independently associated to MRI–pathology discordance.
Endoscopic lung volume reduction coil treatment in patients with chronic hypercapnic respiratory failure: an observational study
Authors: Simon Marcel , Harbaum Lars , Oqueka Tim , Kluge Stefan , Klose Hans 
Published: October 2016

Background: Endoscopic lung volume reduction coil (LVRC) treatment is an option for selected patients with severe emphysema. In the advanced stages, emphysema leads to respiratory failure: hypoxemia and eventually chronic hypercapnic respiratory failure. It can be hypothesized that LVRC treatment, a procedure targeting hyperinflation and thereby reducing ventilatory workload, may be especially beneficial in patients with chronic hypercapnic respiratory failure. This study was conducted to gain first insights into the effects and the safety of LVRC treatment in patients with emphysema and chronic hypercapnic respiratory failure. Methods: A retrospective observational study conducted in the Department of Respiratory Medicine at the University Medical Center Hamburg-Eppendorf, Germany on all patients with chronic hypercapnic respiratory failure in whom bilateral LVRC treatment was performed between 1 April 2012 and 30 September 2015. Results: During the study period, bilateral LVRC treatment was performed in 10 patients with chronic hypercapnic respiratory failure. Compared with baseline, bilateral LVRC treatment led to a significant increase in mean forced expiratory volume in one second (FEV1) from 0.5 ± 0.1 l to 0.6 ± 0.2 l ( p = 0.004), a decrease in residual volume (RV) from 6.1 ± 0.9 l to 5.6 ± 1.1 l ( p = 0.02) and a reduction in partial pressure of carbon dioxide in arterial blood (PaCO2) from 53 ± 5 mmHg to 48 ± 4 mmHg ( p = 0.03). One case of hemoptysis requiring readmission to hospital was the only severe adverse event. Conclusions: LVRC treatment was safe and effective in patients with nonsevere chronic hypercapnic respiratory failure. It led not only to an improvement in lung function but also to a significant decrease in PaCO2.
Morphology and distribution of taste papillae and oral denticles in the developing oropharyngeal cavity of the bamboo shark,Chiloscyllium punctatum
Authors: Atkinson Carla J. L. , Martin Kyle J. , Fraser Gareth J. , Collin Shaun P. 
Published: October 2016

ABSTRACTGustation in sharks is not well understood, especially within species that ingest food items using suction. This study examines the morphological and immunohistochemical characterisation of taste papillae and oral denticles in the oropharynx of the brown-banded bamboo shark Chiloscyllium punctatum and compares their distribution during development. Taste papillae of C. punctatum are located throughout the oropharyngeal region and are most concentrated on the oral valves (2125-3483 per cm2 in embryos; 89-111 per cm2 in mature adults) close to the tooth territories. Papillae appearance is comparable at all stages of development, with the exception of the embryos (unhatched specimens), where no microvilli are present. Oral valve papillae are comparable in structure to Type I taste buds of teleost fishes, whereas those of the rest of the oropharyngeal region are comparable to Type II. Both types of papillae show immunofluorescence for a number of markers of taste buds, including β-Catenin and Sox2. Taste papillae densities are highest in embryos with 420-941 per cm2 compared to 8-29 per cm2 in mature adults. The total number of papillae remains around 1900 for all stages of development. However, the papillae increase in diameter from 72±1 μm (mean±s.e.m.) in embryos to 310±7 μm in mature individuals. Microvilli protrude in multiple patches at the apical tip of the papilla covering ∼0.5% of the papillar surface area. We further document the relationship between taste papillae and the closely associated oral denticles within the shark orophayngeal cavity. Oral denticles first break through the epithelium in the antero-central region of the dorsal oral cavity, shortly after the emergence of teeth, around time of hatching. Denticles are located throughout the oropharyngeal epithelium of both immature and mature stages, with the highest concentrations in the antero-dorsal oral cavity and the central regions of the pharynx. These denticle-rich areas of the mouth and pharynx are therefore thought to protect the epithelium, and importantly the taste papillae, from abrasion since they correlate with regions where potential food items are processed or masticated for consumption. Taste papillae and denticles are more dense in anterior oropharyngeal regions in close association with the oral jaws and teeth, and in the juvenile or hatchling shark taste units are functional, and innervated, allowing the shark to seek out food in utero, at birth or on emergence from the egg case.
Η νομοθεσία της ειδικής αγωγής στην Ελλάδα και την Αγγλία: μια συγκριτική προσέγγιση.
Authors: Κοκκινάκη Δήμητρα , Κοκκινάκη Αριάδνη 
Published: October 2016

<p align="JUSTIFY"><span style="font-family: 'Times New Roman', serif;"><span style="font-size: medium;">Σκοπός της εργασίας είναι η παρουσίαση της εξέλιξης της νομοθεσίας και της ιστορίας της ειδικής αγωγής στην Αγγλία και στην Ελλάδα.</span></span><span style="font-family: 'Times New Roman', serif;"><span style="font-size: medium;">Ιδιαίτερη έμφαση δίνεται στο νομοθετικό πλαίσιο και στις προσπάθειες που έχουν καταβληθεί για τη θεσμοθέτηση της ειδικής αγωγής στην Αγγλία, αλλά κυρίως στη χώρα μας. Στην Αγγλία οι βασικότερες νομοθετικές προσπάθειες είναι: οι νόμοι του 1870,1876 και 1880, η έκθεση Egerton το 1889, ο νόμος του 1970, η έκθεση Warnock (1978), οι Νόμοι του 1981, 1995 και 2001. Στην Ελλάδα θεσπίστηκαν μέτρα από τις κυβερνήσεις Καποδίστρια και Όθωνα, ενώ η πρώτη σημαντική προσπάθεια ήταν το 1913 καθώς και η μεταρρύθμιση του 1929. Τη δεκαετία 1960-70, δεν παρατηρούνται αξιοσημείωτες αλλαγές. Το διάστημα 1970-1980 σημειώνεται έντονη κινητικότητα. Μεγάλη πρόοδος όμως παρατηρείται την περίοδο 1984-89. Η ειδική αγωγή στην Αγγλία πέρασε από την πλήρη απόρριψη, τη φιλανθρωπική απομόνωση και την εκπαίδευση σε ιδρύματα, στη σημερινή εποχή αναγνώρισης και σεβασμού της διαφορετικότητας, διεκδίκησης για κοινωνική συμμετοχή και συνεκπαίδευση. Και παρόλο που η ειδική αγωγή εξελίσσεται εμφανώς καθυστερημένα στη χώρα μας σε σχέση με την Αγγλία, τα τελευταία χρόνια έχουν σημειωθεί αρκετές προσπάθειες ανάπτυξης του κλάδου. </span></span></p>
Απώλειες και δυναμική διεργασία του πένθους στο σχολείο
Authors: Αντωνάτου Χρύσα 
Published: October 2016

<p>Το αποτελεσματικό σχολείο παρέχει στους μαθητές γνωστικά και συναισθηματικά εφόδια προκειμένου να ανταποκριθούν στις όποιες προκλήσεις της ζωής. Με δεδομένο ότι στη ζωή η εμπειρία της απώλειας, υλική ή άϋλη, είναι αναπόφευκτη και ότι κάθε αλλαγή εμπεριέχει την απώλεια και κάθε απώλεια απαιτεί αλλαγή, θεωρείται απαραίτητη και η συστηματική ένταξη μαθησιακών δραστηριοτήτων με στόχο την αποδοχή και τη διαχείριση του βιώματος της απώλειας, του πένθους, ώστε οι μαθητές να εξοικειωθούν με τις πολλαπλές πτυχές των. </p><p>Στην παρούσα εργασία, θα αναφερθούμε στις διαφορετικές εκφάνσεις της απώλειας: στις εξελικτικές απώλειες, στον παραγνωρισμένο θρήνο αλλά και σε απρόσμενες απώλειες όπως ο θάνατος ενός αγαπημένου προσώπου, αρρώστια που απειλεί τη ζωή, διαζύγιο γονέων αλλά και απώλειες που καταργούν το ευρύτερο κοινωνικό πλαίσιο του μαθητή, μετανάστευση, προσφυγιά, φυσική καταστροφή. Θα εστιάσουμε στο πένθος, ως μια δυναμική διεργασία στην οποία το άτομο συμμετέχει ενεργά. Η κατανόηση του πενθούντος, ως ενεργό υποκείμενο που αγωνίζεται να προσαρμοστεί σε μια νέα πραγματικότητα ανακατασκευάζοντας τα νοήματα θα κατευθύνει τον εκπαιδευτικό σε αποτελεσματική στήριξη τόσο του μαθητή όσο και της ομάδας, (κονστρουκτιβιστική προσέγγιση). Η δε συστηματική και εξειδικευμένη κατάρτιση των εκπαιδευτικών θα καταστήσει τη σχολική κοινότητα ικανή να ανταποκριθεί αποτελεσματικά τόσο σε επίπεδο πρόληψης, όσο και σε επίπεδο στήριξης όταν μέλος της κοινότητας της βιώνει οποιαδήποτε μορφή απώλειας.</p>
Διαχείριση Προβλημάτων Συμπεριφοράς στη Σχολική Τάξη: Τεχνικές Πρόληψης και Τεχνικές Παρέμβασης
Authors: Παναγάκος Ιωάννης 
Published: October 2016

<p>Για την αντιμετώπιση της προβληματικής συμπεριφοράς στο σχολείο οι διάφορες ψυχολογικές σχολές δίνουν τη δυνατότητα στον εκπαιδευτικό να καθορίσει τη προσέγγισή του ανάλογα με την ένταση και τη φύση του προβλήματος, την ηλικία, την προσωπική ιδιαιτερότητα του μαθητή και διάφορους άλλους εξωτερικούς παράγοντες.</p><p>Θέμα αυτής της εργασίας είναι η συνοπτική περιγραφή συγκεκριμένων τεχνικών πρόληψης και τεχνικών αντιμετώπισης προβληματικών συμπεριφορών. Είναι αυτονόητο ότι η ιδιαιτερότητα της προσωπικότητας του κάθε μαθητή καθιστά αναποτελεσματική την απλή και μηχανική εφαρμογή γενικών μεθόδων προσέγγισης. Γι’ αυτό έμφαση δίδεται στις προσεγγίσεις εκείνες οι οποίες συμπεριλαμβάνουν την ενεργή συνεργασία του μαθητή για την αντιμετώπιση των αιτίων της παραβατικής συμπεριφοράς και δεν περιορίζονται μόνο στη φαινομενική και συνήθως προσωρινή συμμόρφωση του μαθητή σε κάποιους αποδεκτούς τρόπους συμπεριφοράς.</p><p>Στο τέλος της εργασίας γίνεται ειδική αναφορά στις προβλεπόμενες ποινές καθώς και στους βασικούς κανόνες που πρέπει να διέπουν τις ποινές έτσι ώστε να είναι αποτελεσματικότερες.</p><p> </p>
Η Προσέγγιση της κλασματικής έννοιας από Άτομα με Αναπηρία Όρασης: Μια πιλοτική έρευνα
Authors: Μαγκλάρα Γεωργία , Αργυρόπουλος Βασίλειος 
Published: October 2016

<p align="JUSTIFY"><span style="font-family: 'Times New Roman', serif;"><span style="font-size: medium;">Η παρούσα εργασία μελετά τις δυσκολίες που αντιμετωπίζουν τα άτομα με αναπηρία όρασης όταν καλούνται να προσεγγίσουν και να ερμηνεύσουν την έννοια του κλάσματος. Επιμέρους στόχοι της παρούσας πιλοτικής έρευνας αποτελούν: α) η διερεύνηση των στάσεων και συναισθημάτων για τα κλάσματα από συμμετέχοντες με και χωρίς αναπηρία όρασης, και β) η διερεύνηση των τρόπων μέσω των οποίων διδάχθηκαν τα κλάσματα συμμετέχοντες με και χωρίς αναπηρία όρασης. Στην έρευνα συμμετείχαν έξι τελειόφοιτοι παιδαγωγικών τμημάτων (3 βλέποντες και 3 με αναπηρία όρασης). Η συλλογή των ερευνητικών δεδομένων έγινε μέσω ημιδομημένων συνεντεύξεων. Τα αποτελέσματα της ερευνητικής διαδικασίας ανέδειξαν: α) την ύπαρξη δυσκολιών στη διαχείριση της κλασματικής έννοιας τόσο από τους βλέποντες όσο και από τους συμμετέχοντες με αναπηρία όρασης, και β) την απουσία διαφοροποιημένου διδακτικού υλικού και κατάλληλων μεθόδων διδασκαλίας που θα μπορούσαν να καταστήσουν προσεγγίσιμο όλο το φάσμα της κλασματικής έννοιας στα παιδιά με αναπηρία όρασης. Η παρούσα πιλοτική έρευνα καταλήγει σε ένα σύνολο προτάσεων που αφορά κυρίως στην ανάγκη για αξιοποίηση διαφοροποιημένων μεθόδων διδασκαλίας, καλύπτοντας τις ανάγκες όλων των μαθητών συμπεριλαμβανομένων και εκείνων που έχουν αναπηρία όρασης, ενισχύοντας με αυτό τον τρόπο τη </span></span><span style="font-size: medium; font-family: 'Times New Roman', serif;">διαδικασία συνεκπαίδευσης. </span></p><p align="JUSTIFY"> </p>