bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of renal response parameters for juvenile membranous plus proliferative lupus nephritis versus isolated proliferative lupus nephritis: a cross-sectional analysis of the CARRA Registry
Authors: Boneparth A , Ilowite NT ,   for the CARRA Registry Investigators
Published: April 2014

Lupus nephritis (LN) affects many patients with juvenile systemic lupus erythematosus (SLE) and is a significant cause of disease morbidity. Membranous plus proliferative LN (M + PLN) may represent a more difficult to treat subtype of juvenile LN, compared to isolated proliferative LN (PLN). In this retrospective observational study, we utilized data from the Childhood Arthritis and Rheumatism Research Alliance (CARRA) registry to compare response rates for pediatric M + PLN versus PLN. Response was assessed at the most recent CARRA registry visit gathered ≥6 months after diagnostic kidney biopsy. Estimated glomerular filtration rate (GFR) less than 90 ml/min/1.73 m2, indicating renal insufficiency, was found in 16.1% of patients with M + PLN and 6.1% of patients with PLN ( P = 0.071). We found no significant difference in achievement of response in either hematuria or proteinuria between PLN and M + PLN groups or between subgroups determined by presence of class III vs. class IV proliferative disease. Exposure rates to mycophenolate, cyclophosphamide, and rituximab were similar between groups. Future studies will be necessary to correlate pediatric LN renal histology data with treatment response as well as other disease outcome measures.
Antiphospholipid antibodies in neonates with stroke—a unique entity or variant of antiphospholipid syndrome?
Authors: Berkun Y , Simchen MJ , Strauss T , Menashcu S , Padeh S , Kenet G
Published: April 2014

Objective

YB current affiliation: Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, Israel YB and MJS contributed equally to the study and should be regarded as joint first authors on this manuscript. Antiphospholipid syndrome (APS) may present with thrombosis and persistently elevated titers of antiphospholipid antibodies (aPL) in the neonatal period. Our aim was to investigate the course and impact of elevated titers of aPL in a cohort of infants presenting with either perinatal arterial ischemic stroke (PAS) or cerebral sinus vein thrombosis (CSVT) during the perinatal period.

Study design

Sixty-two infants with clinically and radiologically confirmed PAS or CSVT presenting in the neonatal period underwent thrombophilia workup that included Factor V Leiden (FVL), PII20210A mutation, MTHFR 677T polymorphism, protein C, protein S, aPL namely either circulating lupus anticoagulant (CLA), anticardiolipin antibodies (aCL) or anti-β2-glycoprotein-1 (β2GP1). Mothers also underwent thrombophilia workup.

Results

Twelve infants with persistently elevated aPL were prospectively followed. Infants with positive aPL showed no concordance with presence of maternal aPL. All children were followed for a median of 3.5 years (range: nine months to 19 years) with repeated aPL testing every three to six months. Anticoagulant therapy initiation and therapy duration varied at the physician’s discretion. In 10/12 cases aPL decreased to normal range within 2.5 years; one female with complex thrombophilia risk factors required indefinite prolonged anticoagulation. None of the infants showed recurrent thrombosis or any other APS manifestations, despite lack of prolonged anticoagulation.

Conclusions

The presence of aPL may be important in the pathogenesis of cerebral thrombosis in neonates. Nevertheless, the nature of thrombophilia interactions in this period and their therapeutic impact warrants further investigation.
Blame, Shame, and Lack of Support
Authors: Kirk Sara F. L. , Price Sheri L. , Penney Tarra L. , Rehman Laurene , Lyons Renee F. , Piccinini-Vallis Helena , Vallis T. Michael , Curran Janet , Aston Megan
Published: April 2014

In this research, we examined the experiences of individuals living with obesity, the perceptions of health care providers, and the role of social, institutional, and political structures in the management of obesity. We used feminist poststructuralism as the guiding methodology because it questions everyday practices that many of us take for granted. We identified three key themes across the three participant groups: blame as a devastating relation of power, tensions in obesity management and prevention, and the prevailing medical management discourse. Our findings add to a growing body of literature that challenges a number of widely held assumptions about obesity within a health care system that is currently unsupportive of individuals living with obesity. Our identification of these three themes is an important finding in obesity management given the diversity of perspectives across the three groups and the tensions arising among them.
The Barriers to High-Quality Inpatient Pain Management
Authors: Lin Richard J. , Reid M. Carrington , Liu Lydia L. , Chused Amy E. , Evans Arthur T.
Published: April 2014

The current literature suggests deficiencies in the quality of acute pain management among general medical inpatients. The aim of this qualitative study is to identify potential barriers to high-quality acute pain management among general medical inpatients at an urban academic medical center during a 2-year period. Data are collected using retrospective chart reviews, survey questionnaires, and semistructured, open-ended interviews of 40 general medical inpatients who have experienced pain during their hospitalization. Our results confirm high prevalence and disabling impacts of pain and significant patient- and provider-related barriers to high-quality acute pain management. We also identify unique system-related barriers such as time delay and pain management culture. Efforts to improve the pain management experience of general medical inpatients will need to address all these barriers.
Heterosynaptic Plasticity
Authors: Chistiakova Marina , Bannon Nicholas M. , Bazhenov Maxim , Volgushev Maxim
Published: April 2014

Plasticity is a universal property of synapses. It is expressed in a variety of forms mediated by a multitude of mechanisms. Here we consider two broad kinds of plasticity that differ in their requirement for presynaptic activity during the induction. Homosynaptic plasticity occurs at synapses that were active during the induction. It is also called input specific or associative, and it is governed by Hebbian-type learning rules. Heterosynaptic plasticity can be induced by episodes of strong postsynaptic activity also at synapses that were not active during the induction, thus making any synapse at a cell a target to heterosynaptic changes. Both forms can be induced by typical protocols used for plasticity induction and operate on the same time scales but have differential computational properties and play different roles in learning systems. Homosynaptic plasticity mediates associative modifications of synaptic weights. Heterosynaptic plasticity counteracts runaway dynamics introduced by Hebbian-type rules and balances synaptic changes. It provides learning systems with stability and enhances synaptic competition. We conclude that homosynaptic and heterosynaptic plasticity represent complementary properties of modifiable synapses, and both are necessary for normal operation of neural systems with plastic synapses.
High-Tech or Low-Tech? Comparing Self-Monitoring Systems to Increase Task Independence for Students With Autism
Authors: Bouck Emily C. , Savage Melissa , Meyer Nancy K. , Taber-Doughty Teresa , Hunley Megan
Published: April 2014

Independence is the ultimate goal for students with disabilities, including secondary students with autism. One avenue targeted for increasing independence and decreasing prompt-dependency is through self-monitoring. In this study, investigators sought to determine whether a difference exists in levels of task independence when three students with autism complete food preparation tasks while self-monitoring using a low-tech treatment (paper/pencil) and high-tech treatment (iPad). Although both interventions decreased the need for prompting thereby increasing independence, students needed less assistance when using the iPad. Students also maintained their levels of independence in food preparation following summer vacation. Social validity interviews indicated students preferred self-monitoring with the iPad over the paper/pencil.
Context Blindness in Autism Spectrum Disorder
Authors: Vermeulen Peter
Published: April 2014

Because of the importance of contextual sensitivity in several cognitive processes that are affected in autism spectrum disorder (ASD), such as social cognition, understanding of language, or cognitive shifting, we argue that a lack of contextual sensitivity or “context blindness” should be given more attention in a neurocognitive account of ASD. Context blindness emphasizes an aspect of the central coherence hypothesis developed by Uta Frith that has been largely overlooked in both literature and scientific research, namely, the ability to use context in sense making. In this article, we will define context blindness, describe how it can explain some of the cognitive and behavioral characteristics of ASD, and explore its relationship with the other neurocognitive theories of ASD (theory of mind, empathizing–systemizing, and executive function).
Anesthetic Management for Cardiopulmonary Bypass
Authors: Bechtel Allison , Huffmyer Julie
Published: April 2014

Cardiopulmonary bypass has revolutionized the practice of cardiac surgery and allows safe conduct of increasingly complex cardiac surgery. A brief review of the bypass circuit is undertaken in this review. A more thorough review of the anesthetic management is accomplished including choice of anesthetic medications and their effects. The inflammatory response to cardiopulmonary bypass is reviewed along with interventions that may help ameliorate the inflammation.
A Brief History of Cardiopulmonary Bypass
Authors: Hessel Eugene A
Published: April 2014

The development and application of cardiopulmonary bypass (CPB) to permit open heart surgery is considered among the most important clinical advances in medicine during the last half of the 20th century. The birth of CPB for cardiac surgery is attributed to its first successful clinical use by John Gibbon Jr, 51 years ago but its practical clinical use really began in the spring and summer of 1955 when 2 groups led by John Kirklin at the Mayo Clinic and C Walton Lillehei at the University of Minnesota, initiated the routine use of CPB for open heart surgery. However, considerable developments were necessary and preceded the clinical accomplishment of CPB, and much has followed to make it the remarkably safe and effective procedure that it has become today. Many currently practicing cardiac anesthesiologists, cardiac surgeons, and perfusionists are unaware of how brief its history is and how much the practice of CPB has changed during its short existence. The aim of this article is to review this fascinating history and the lessons that can be learned from this review, and to indicate the opportunities that still exist for advancement.
Tissue-Specific Induction of Mouse ZIP8 and ZIP14 Divalent Cation/Bicarbonate Symporters by, and Cytokine Response to, Inflammatory Signals
Authors: Gálvez-Peralta Marina , Wang Zhifang , Bao Shengying , Knoell Daren L. , Nebert Daniel W.
Published: April 2014

Mouse Slc39a8 and Slc39a14 genes encode ZIP8 and ZIP14, respectively, which are ubiquitous divalent cation/(HCO3–)2 symporters responsible for uptake of Zn2+, Fe2+, and Mn2+ into cells. Cd2+ and other toxic nonessential metals can displace essential cations, thereby entering vertebrate cells. Whereas Slc39a8 encodes a single protein, Slc39a14 has 2 exons 4 which, via alternative splicing, give rise to ZIP14A and ZIP14B; why differences exist in cell type-specific expression of ZIP14A and ZIP14B remains unknown. Inflammatory stimuli have been associated with upregulation of ZIP8 and ZIP14, but a systematic study of many tissues simultaneously in a laboratory animal following inflammatory cytokine exposure has not yet been reported. Herein, we show that C57BL/6J male mice––treated intraperitoneally with lipopolysaccharide or the proinflammatory cytokines tumor necrosis factor (TNF) or interleukin-6 (IL6)––exhibited quantatively very different, highly tissue-specific, and markedly time-dependent up- and downregulation of ZIP8, ZIP14A, and ZIP14B messenger RNA (mRNA) levels in 12 tissues. The magnitude of inflammatory response was confirmed by measuring the proinflammatory cytokine TNF, IL6, and interleukin-1β mRNA levels in the same tissues of these animals. Our data suggest that most if not all tissues use ZIP8, ZIP14A, and/or ZIP14B for Zn2+ uptake, some tissues under basal conditions and others moreso when inflammatory stressors are present; collectively, this might lead to substantial alterations in plasma Zn2+ levels due to Zn2+ redistribution not just in liver but across many vital organs. In the context of cadmium-mediated toxicity, our data suggest that tissues other than liver, kidney, and lung should also be considered.
Ambiguities of work satisfaction for middle-aged and older career women in the Netherlands: Stretching a tradition
Authors: Bendien Elena
Published: April 2014

This article explores some of the ambiguities regarding employment for middle-aged and older women in the Netherlands. The data are placed within a discussion about the historical, cultural and political factors that define the conditions under which Dutch women can remain active on the labour market until they retire. One of the main obstacles for the women in question is the historically embedded and culturally nourished image of the ‘ideal housewife’, that has not (yet) lost its attraction in the Netherlands. A series of interviews with middle-aged and older career women points out that they are satisfied with their working lives, but their accounts also reveal the complexity of the paths that these women have chosen and the concessions they were forced to make in order to continue with their jobs. Their approach towards life demonstrates that the next generation of working women will still need to stretch the prevailing rigid social traditions.
Budget support and Africa–European Union relations: Free market reform and neo-colonialism?
Authors: Langan Mark
Published: April 2014

The European Commission has promised to provide African countries with budget support to facilitate poverty eradication and the broader achievement of the United Nations Millennium Development Goals. Moreover, European Union officials state that modern ‘poverty reduction’ budget support aligns with Organisation for Economic Co-operation and Development norms of country-ownership. In particular, they assure recipients that this aid modality will not be used to coerce African states to pursue second-generation liberalisation measures. Accordingly, European Union actors in the Post-Washington Consensus appear to have learned the lessons of structural adjustment reforms undertaken in the 1980s and 1990s, opting now to promote untied aid mechanisms. This article argues, however, that European Union budget support is still very much tied to premature trade opening and economic liberalisation in Africa. Examining the cases of Tunisia, Ghana and Uganda, it points to the strategic utilisation of budget aid as a means of donor leverage for free market reform detrimental to the needs of poorer citizens. In this context, the article argues that Nkrumah’s concept of ‘neo-colonial’ states bears much significance for a contemporary evaluation of European Union budget support to Africa.
The acquisition of definiteness in Hebrew (L2) by bilingual preschool children (Russian-L1): A longitudinal multiple-case study
Authors: Schwartz Mila , Rovner Hadas
Published: April 2014

In this longitudinal study, we examined bilingual children’s acquisition of definiteness in Hebrew (L2). Hebrew distinguishes between definite and indefinite nouns by marking definiteness by article. We recorded the speech of nine bilingual Russian–Hebrew-speaking children ranging in age from three to four years old in monthly sessions over a period of seven months. Their age of onset of acquisition of Hebrew (L2) ranged from six to 42 months. The L1 of all participants was Russian, which has no definite and indefinite articles.

We compared the bilingual children’s acquisition of definiteness in Hebrew to that of monolingual Hebrew-speaking children to outline the qualitative and/or quantitative differences in the patterns found. This comparison also enabled us to determine whether the bilinguals transfer their knowledge from L1 to L2 ( transfer hypothesis) or show fluctuation in their article choice ( fluctuation hypothesis).

Four tendencies were found with regard to the bilingual children: 1. All bilingual children made omission errors in definite contexts (evidence of transfer); 2. We observed misuse of articles, overuse and syntactic errors in all the children’s utterances (evidence of fluctuation); 3. We found both similarities and differences between bilinguals and monolinguals in acquisition of definiteness; and 4. Children with early age of L2 onset (before age three) demonstrated more accelerated acquisition of definiteness than children with later onset of L2 (after age three).
Children’s scientific reasoning in the context of bilingualism
Authors: Kempert Sebastian , Hardy Ilonca
Published: April 2014

Aims and objectives:

A number of studies revealed effects of bilingualism on the cognitive development of both children and adults. Executive functions in particular seem to be enhanced due to the constant use of two language systems. In the present study, we explored whether effects of enhanced executive functioning are also related to bilinguals’ performance on a scientific reasoning task.

Methodology:

In a quasi-experimental design we compared monolingual and bilingual elementary school students on a variety of measures including language proficiency, cognitive ability, executive functions, and a modified reasoning task adapted from Kuhn and Pease (2006).

Data and analysis:

The data of 57 elementary school students were analyzed using multiple regression analysis and group comparisons via multivariate ANOVAs.

Findings:

Results revealed specific group differences on the measures of executive functions. On the measure of inhibition, the bilingual group showed superior performance, while no differences on the measure of attentional control were found. Moreover, regression analyses revealed that students’ performance on the reasoning task was best explained by the measures of cognitive ability and attentional control. However, the total amount of variance explained by our measures was less than 20%. Since there were no group differences on these variables, an advantage of bilingualism on the reasoning task was not detected.

Originality:

The results of the study contribute to the body of research on the cognitive effects of bilingualism and its specifics. Moreover, they extend research on the positive effects of bilingualism to more applied contexts.

Implications:

The results emphasize the necessity to specify the role of executive functions in reasoning tasks in order to reliably test for a possible transfer of bilingual advantages to academic learning contexts.
Surgeons’ aims and pain assessment strategies when managing paediatric post-operative pain
Authors: Twycross Alison M , Williams Anna M , Finley G Allen
Published: April 2014

Children experience moderate to severe pain post-operatively. Nurses have been found to have a variety of aims in this context. Surgeons’ aims when managing post-operative pain have not been explored. This qualitative study set out to explore paediatric surgeons’ aims when managing post-operative pain in one paediatric hospital in Canada. Consultant surgeons ( n = 8) across various specialities took part in semi-structured interviews. Surgeons’ overarching aim was to keep the child comfortable. Various definitions of comfortable were given, relating to the child’s experience of pain itself and their ability to undertake activities of daily living. Children’s behavioural pain cues seem to be a primary consideration when making treatment decisions. Parents’ views regarding their child’s pain were also seen as important, suggesting children may not be seen as competent to make decisions on their own behalf. The need to maintain a realistic approach was emphasised and pain management described as a balancing act. Surgeons may draw on both tacit and explicit knowledge when assessing children’s pain. There appears to be an expectation among surgeons that some pain is to be expected post-operatively and that the diagnostic value of pain may, in some cases, supersede concerns for the child’s pain experience.
Workplace sex composition and ischaemic heart disease: A longitudinal analysis using Swedish register data
Authors: Barclay Kieron J , Scott Kirk
Published: April 2014

Aims:  The aim of this study is to follow-up on previous research indicating that the sex composition of workplaces is related to a number of health outcomes, including sickness absenteeism and mortality. We test two hypotheses. The first is Kanter’s theory of tokenism, which suggests that minority group members suffer from an increased risk of stress. Secondly, we test the hypothesis that workplaces with a higher proportion of men will have a higher incidence rate of ischaemic heart disease (IHD), as men are more likely to engage in negative health behaviours, and through peer effects this will result in a workplace culture that is detrimental to health over the long term. Methods: Large-scale, longitudinal Swedish administrative register data are used to study the risk of overnight hospitalization for IHD amongst 67,763 men over the period 1990 to 2001. Discrete-time survival analyses were estimated in the form of logistic regression models. Results: Men have an elevated risk of suffering from IHD in non-gender-balanced workplaces, but this association was only statistically significant in workplaces with 61–80% and 81–100% males. However, after adjusting for occupation no clear pattern of association could be discerned. No pattern of association was observed for women. Conclusions: This study suggests that the gender composition of workplaces is not strongly associated with the risk of suffering from IHD.
We’ve got something for everyone: How individual differences predict different blogging motivations
Authors: Fullwood Chris , Nicholls Wendy , Makichi Rumbidzai
Published: April 2014

The principal aims of this study were to develop a Blogging Motivations Questionnaire (BMQ) and to test the hypothesis that sex, age and personality would be associated with individual blogging motivations. A total of 160 bloggers completed the BMQ and the International Personality Item Pool. Six motivations for writing blogs were confirmed: personal revelation, emotional outlet, creative outlet, selective disclosure, social networking and advertising. Conscientiousness predicted the ‘social networking’ motivation, Agreeableness predicted ‘selective disclosure’ and Openness predicted ‘creative outlet’. Women were motivated by ‘selective disclosure’, and men for ‘advertising’ and as an ‘emotional outlet’. Finally, older bloggers were motivated to use their blogs as a ‘creative outlet’. With reference to the Uses and Gratifications theory, it is likely that bloggers actively construct blogs to satisfy very personal needs. Moreover, the types of needs that one wishes to satisfy are likely to vary with personality type and with one’s age and sex.
When does brokerage matter? Citation impact of research teams in an emerging academic field
Authors: Collet François , Robertson Duncan A , Lup Daniela
Published: April 2014

Through exposure to heterogeneous sources of knowledge, actors who broker between unconnected contacts are more likely to generate valuable output. We contribute to the theory of social capital of brokerage by considering the impact of field maturity. Using longitudinal data from the field of strategic management we find that the benefits of network brokerage are stronger during the early stages of field development and diminish as the field matures. The results of our study call for further research on the interplay between network structures and processes of field emergence.
Neutrophil elastase inhibitor reduces ventilation-induced lung injury via nuclear factor-κB and NF-κB repressing factor in mice
Authors: Li Li-Fu , Lai Yi-Ting , Chang Chih-Hao , Lin Meng-Chih , Liu Yung-Yang , Kao Kuo-Chin , Tsai Ying-Huang
Published: April 2014

Mechanical ventilation used in patients with acute lung injury can damage pulmonary epithelial cells through production of inflammatory cytokines, oxygen radicals, and neutrophil infiltration, termed ventilator-induced lung injury. Neutrophil elastase, nuclear factor-κB (NF-κB), and NF-κB repressing factor (NRF) have previously been shown to participate in the regulation of macrophage inflammatory protein-2 (MIP-2) during airway inflammation. However, the mechanisms regulating interactions among mechanical ventilation, neutrophil influx, and NF-κB/NRF remain unclear. Thus, we hypothesized that neutrophil elastase inhibitor attenuated ventilation-induced neutrophil recruitment and MIP-2 production through inhibition of the NF-κB/NRF pathway. Male C57BL/6 mice were exposed to low-tidal-volume (6 mL/kg) or high-tidal-volume (30 mL/kg) mechanical ventilation using room air with or without 2 µg/g NF-κB inhibitor SN50 or 6 µg/g NRF short interfering RNA or 100 µg/g neutrophil elastase inhibitor administration. Nonventilated mice served as a control group. Evan blue dye, lung wet-to-dry weight ratio, free radicals, myeloperoxidase, histopathologic grading of lung tissue, inflammatory cytokines, Western blot of NF-κB and NRF, and gene expression of NRF were measured to establish the extent of lung injury. Neutrophil elastase inhibitor ameliorated high-tidal-volume ventilation-induced lung injury, neutrophil influx, production of MIP-2 and malondialdehyde, activation of NF-κB and NRF, apoptotic epithelial cell death, and disruption of bronchial microstructure in mice. Mechanical stretch-augmented acute lung injury was also attenuated through pharmacological inhibition of NF-κB activity by SN50 and NRF expression by NRF short interfering RNA. Our data suggest that neutrophil elastase inhibitor attenuates high-tidal-volume mechanical ventilation-induced neutrophil influx, oxidative stress, and production of MIP-2, at least partly, through inhibition of NF-κB/NRF pathway. Understanding the protective effects of neutrophil elastase inhibitor associated with the reduction of MIP-2 allow clarification of the pathophysiological mechanisms regulating severe lung inflammation and development of possible therapeutic strategies involved in acute lung injury.
Leading Dangerously
Authors: Ramthun Alex J. , Matkin Gina S.
Published: April 2014

In a qualitative case study, we described and explained shared leadership in dangerous contexts for military teams. We conducted eight semistructured interviews with shared, team, and military leadership subject matter experts in order to gain an improved understanding of the relationship between shared leadership and team performance in the presence of danger. We found the themes of mutual influence, leadership emergence, dangerous dynamism, and distributed knowledge, skills, and abilities provided rich description of the phenomenon. Specifically, our findings suggest military teams in dangerous situations use mutual influence and leadership emergence to share leadership and achieve high performance. Additionally, we found dangerous dynamism and distributed knowledge, skills, and abilities may moderate the relationship between shared leadership and performance for teams in dangerous contexts. Implication, limits, and recommendations are discussed.
Through-and-through wire technique for endovascular damage control in traumatic proximal axillary artery transection
Authors: Rohlffs Fiona , Larena-Avellaneda Axel Antonio , Petersen Jan Philipp , Debus Eike Sebastian , Kölbel Tilo
Published: April 2014

Repair of blunt shoulder trauma with transection of the subclavian or proximal axillary artery poses a surgical challenge, especially in instable patients. Endovascular treatment for initial damage control in arterial transection has evolved as a promising technique to improve outcome, but technical success can be limited in cases of complete transection as the lesion cannot be passed by a guidewire. This report describes an endovascular approach using a through-and-through brachial–femoral wire to control complete traumatic transection of the proximal axillary artery in a hemodynamically unstable patient. Endovascular therapy is used as a bridging method for open surgical repair three days later under optimized conditions with an interdisciplinary team. The brachial–femoral guidewire technique helps to overcome limitations in endovascular therapy in patients with blunt traumatic transection of thoracic outlet arteries.
Study of micro-gap reactors for pulsed electric field sterilization
Authors: Guo Jianguang , Zhao Liping , Cao Yi , Yu Ronghui , Wang Qiong , Hu Ning , Liu Yang , Yang Jun
Published: April 2014

Static and continuous-flow micro-gap reactors have been designed for the sterilization of bacteria. Their performances were verified using some pulsed electric fields. Several parameters such as electric field strength, pulse number and width, as well as flow rate, which may impact the sterilization effect, have been experimentally evaluated on these devices. Experimental results showed that the strength and width of pulses had significant impacts on the sterilization. Stronger and wider pulses favored the sterilization. More pulses could also achieve better sterilization effect. Continuous-flow manipulation contributed to realize high-efficiency sterilization. However, flow rate should be lower than a critical value. Higher flow rate may reduce the residence time in the reactor and harm the sterilization effect. Micro-gap reactor between the two parallel plate electrodes can contain more solution and the sample can be manipulated in a continuous way to realize higher sterilization throughput, but it is sometimes difficult to form even gap between these plate electrodes. Rough surface or burrs on these electrodes may induce discharge and limit the electric field strength. Some coatings on their surface may decrease the discharge, but they also undermine the electric field.
Splintage in the treatment of sagittal band incompetence and extensor tendon subluxation
Authors: Peelman J. , Markiewitz A. , Kiefhaber T. , Stern P.
Published: April 2014

This study assessed the success of splintage for traumatic and atraumatic sagittal band incompetence and its relationship to the duration of symptoms before treatment. A retrospective review of all patients with sagittal band incompetence treated with splintage was performed. All patients had extensor tendon subluxation on physical examination. Ninety-two patients were included: 68 traumatic and 24 atraumatic. Subluxation resolved with splintage in 77 patients. Traumatic tendon subluxation resolved in 95% of acute injuries, 100% of subacute injuries, and 67% of chronic injures. Atraumatic tendon subluxation resolved in 100% of patients with acute presentation, 67% of patients with subacute presentation, and 57% of patients with chronic presentation. Surgery was rarely required. Splintage proved very effective for acute sagittal band incompetence, regardless of causation, but decreased in efficiency with chronicity.

Level of evidence: Level 4
Evaluation and Treatment of Chronic Meningitis
Authors: Baldwin Kelly J. , Zunt Joseph R.
Published: April 2014

Chronic meningitis is defined as an inflammatory cerebrospinal fluid (CSF) profile that persists for at least 1 month. The presentation often includes headache, nausea, vomiting, cranial neuropathies, symptoms of elevated intracranial pressure, or focal neurologic deficits. The most common etiologies of chronic meningitis fall into 3 broad categories: infectious, autoimmune, and neoplastic. Evaluation of the patient with suspected chronic meningitis should include a detailed history and physical examination as well as repeated CSF diagnostics, serologic studies, and biopsy of the brain or other abnormal tissue (eg, lymph node or lung), when indicated. Early identification of the etiology and rapid treatment are crucial for improving morbidity and mortality, but potential infectious and neoplastic conditions should be excluded prior to empirically starting steroids or immunosuppressive medications.
Prevalence of Vitamin D Deficiency in Patients With Hip Fracture Seen in an Orthogeriatric Service in Sunny Singapore
Authors: Ramason Rani , Selvaganapathi Natesan , Ismail Noor Hafizah Binte , Wong Wei Chin , Rajamoney Ganesan Naidu , Chong Mei Sian
Published: April 2014

Background:

Vitamin D deficiency is common in older adults in Western countries with seasonal winters, when the amount of sunlight is much reduced. There is a paucity of data on the prevalence of vitamin D deficiency in patients with hip fracture in countries such as Singapore where the climate is predominantly tropical.

Objectives:

In this study, our aims were to ascertain the prevalence of vitamin D deficiency and risk factors associated with vitamin D deficiency in hospitalized elderly patients with hip fracture in Singapore.

Methods:

We prospectively studied 485 patients with hip fracture admitted to the orthopedic department over a 1-year period. Nonfragility fractures and younger patients (patients <60 years and those with high-impact injuries) were excluded. Data on patient demographics, comorbidities, functional status, and serum 25-hydroxyvitamin D3 levels were collected. Vitamin D deficiency was defined using Holick classification.

Results:

Vitamin D levels were available for 412 patients. Vitamin D deficiency was present in 57.5% (n = 237). Prevalence of vitamin D insufficiency was 34.5%, with only 8% of patients having normal vitamin D levels. Univariate analyses showed Malay race and functional factors (being housebound, requiring bathing and dressing assistance) to be associated with vitamin D deficiency. However, only ethnicity and housebound patients were significant in the multivariate model.

Conclusions:

Vitamin D deficiency and insufficiency are common in patients with hip fracture in Singapore. Vitamin D deficiency was associated with being housebound and those of Malay ethnicity. Clothing habits resulting in reduced sunlight exposure may increase the risk of vitamin D deficiency.
Alcohol Experiences and Concerns of Newly Arrived Migrant Women
Authors: Lee Susan K. , Sulaiman-Hill Cheryl M. R. , Thompson Sandra C.
Published: April 2014

Migrant women are under-represented as users of alcohol and other drug (AOD) services. This study examined AOD use by newly arrived women, identifying issues of concern to them. A questionnaire-based survey was conducted with 268 migrant women who had arrived in Perth, Western Australia, within the previous 5 years. Almost half were humanitarian entrants. Most women (76%) reported they did not drink alcohol. Of those who did, 10 were drinking at harmful levels and over half reported changes to their drinking patterns since arrival. One fifth of participants (20%) described distressing incidents related to alcohol or drug use by others. Migrant women are concerned by alcoholand drug-related problems, even if they do not drink themselves. Domestic violence and abuse by strangers were concerns that were aggravated by alcohol and drug use. As new migrants often lack strategies to prevent, or deal with alcohol-related misuse, provision of additional information and support is recommended.
Advancing Leadership
Authors: Tenuto Penny L.
Published: April 2014

Preparing students to become active citizens and contributors to a democratic society is premised on teaching democratic principles and modeling standards of democratic practice at all levels of education. The purpose of this integrative literature review is to establish a conceptual framework grounded in literature and a model for cultivating democratic professional practice in education (DPPE) to advance leadership for school improvement. This work is presented in three parts: (a) a review of historical references, reports, and legislation that culminated in increased accountability and standards in P-12 public education; (b) a discussion of social patterns in education generally associated with bureaucracy versus democracy; and (c) a new contribution to the literature, a model for cultivating DPPE is conceptualized to encourage leading and teaching professionals to reflect on beliefs and evaluate practices in advancing leadership for school improvement. Recommendations are included for further research.
Eastern Caribbean Physicians’ Responses to Providing HIV/AIDS Care in Resource-Limited Settings
Authors: Reddock Jennifer
Published: April 2014

Physicians’ ability to provide care to patients living with HIV/AIDS (PLWHA) in the Eastern Caribbean is influenced by economic constraints, sociocultural norms that govern interpersonal interactions, and the pervasive stigma linked to the disease. Although the economic environment determines national capacity to acquire various treatment and monitoring technologies, Eastern Caribbean physicians respond to practicing in a resource-limited setting by making choices that are influenced by the collectivist ethos that governs interpersonal relationships. Through qualitative interviews, the study finds that the social stigma associated with the disease requires physicians to “go the extra mile” to provide care in ways that allow PLWHA to protect their privacy in small, closely networked societies.
Doppler Tissue Imaging Is More Sensitive Than Other Echocardiographic Markers in Identifying Abnormal Relaxation in Subclinical Hypertensive Disease and Normal Ejection Fraction
Authors: Hill Jeffrey C. , Bourque Daniel P.
Published: April 2014

This report describes the use of echocardiographic measurements for the assessment of left ventricular diastolic function in two young patients with newly diagnosed hypertension. Measurements for the assessment of left ventricular relaxation and filling pressures included mitral inflow, Doppler tissue imaging (DTI), color M-mode propagation velocity slope, and the isovolumic relaxation time. The mitral inflow, propagation velocity, and isovolumic relaxation time measurements were all within normal limits; however, DTI measurements of the E′ velocity at the septal and lateral annulus were significantly reduced in both patients. Further visual inspection demonstrated discrete proximal septal wall thickening that is thought to be modulated by pressure loading (i.e., increased afterload due to hypertension) and ejection. These findings may represent a “transitional state” of early ventricular remodeling and organ failure in the development of hypertensive disease. In summary, DTI appears to be more sensitive compared to other markers in identifying abnormal relaxation in subclinical hypertensive disease and normal ejection fraction.
Improved multi-level protein–protein interaction prediction with semantic-based regularization
Authors: Saccà Claudio , Teso Stefano , Diligenti Michelangelo , Passerini Andrea
Published: April 2014

Background

Protein–protein interactions can be seen as a hierarchical process occurring at three related levels: proteins bind by means of specific domains, which in turn form interfaces through patches of residues. Detailed knowledge about which domains and residues are involved in a given interaction has extensive applications to biology, including better understanding of the binding process and more efficient drug/enzyme design. Alas, most current interaction prediction methods do not identify which parts of a protein actually instantiate an interaction. Furthermore, they also fail to leverage the hierarchical nature of the problem, ignoring otherwise useful information available at the lower levels; when they do, they do not generate predictions that are guaranteed to be consistent between levels.

Results

Inspired by earlier ideas of Yip et al. (BMC Bioinformatics 10:241, 2009), in the present paper we view the problem as a multi-level learning task, with one task per level (proteins, domains and residues), and propose a machine learning method that collectively infers the binding state of all object pairs. Our method is based on Semantic Based Regularization (SBR), a flexible and theoretically sound machine learning framework that uses First Order Logic constraints to tie the learning tasks together. We introduce a set of biologically motivated rules that enforce consistent predictions between the hierarchy levels.

Conclusions

We study the empirical performance of our method using a standard validation procedure, and compare its performance against the only other existing multi-level prediction technique. We present results showing that our method substantially outperforms the competitor in several experimental settings, indicating that exploiting the hierarchical nature of the problem can lead to better predictions. In addition, our method is also guaranteed to produce interactions that are consistent with respect to the protein–domain–residue hierarchy.
Facilitating the transition from physiology to hospital wards through an interdisciplinary case study of septic shock
Authors: Li Albert S , Berger Kenneth I , Schwartz David R , Slater William R , Goldfarb David S
Published: April 2014

Background

In order to develop clinical reasoning, medical students must be able to integrate knowledge across traditional subject boundaries and multiple disciplines. At least two dimensions of integration have been identified: horizontal integration, bringing together different disciplines in considering a topic; and vertical integration, bridging basic science and clinical practice. Much attention has been focused on curriculum overhauls, but our approach is to facilitate horizontal and vertical integration on a smaller scale through an interdisciplinary case study discussion and then to assess its utility.

Methods

An interdisciplinary case study discussion about a critically ill patient was implemented at the end of an organ system-based, basic sciences module at New York University School of Medicine. Three clinical specialists—a cardiologist, a pulmonologist, and a nephrologist—jointly led a discussion about a complex patient in the intensive care unit with multiple medical problems secondary to septic shock. The discussion emphasized the physiologic underpinnings behind the patient’s presentation and the physiologic considerations across the various systems in determining proper treatment. The discussion also highlighted the interdependence between the cardiovascular, respiratory, and renal systems, which were initially presented in separate units. After the session students were given a brief, anonymous three-question free-response questionnaire in which they were asked to evaluate and freely comment on the exercise.

Results

Students not only took away physiological principles but also gained an appreciation for various thematic lessons for bringing basic science to the bedside, especially horizontal and vertical integration. The response of the participants was overwhelmingly positive with many indicating that the exercise integrated the material across organ systems, and strengthened their appreciation of the role of physiology in understanding disease presentations and guiding appropriate therapy.

Conclusions

Horizontal and vertical integration can be presented effectively through a single-session case study, with complex patient cases involving multiple organ systems providing students opportunities to integrate their knowledge across organ systems while emphasizing the importance of physiology in clinical reasoning. Furthermore, having several clinicians from different specialties discuss the case together can reinforce the matter of integration across multiple organ systems and disciplines in students’ minds.
Self-optimization of coverage and capacity based on a fuzzy neural network with cooperative reinforcement learning
Authors: Fan Shaoshuai , Tian Hui , Sengul Cigdem
Published: April 2014

Self-organization is a key concept in long-term evolution (LTE) systems to reduce capital and operational expenditures (CAPEX and OPEX). Self-optimization of coverage and capacity, which allows the system to periodically and automatically adjust the key radio frequency (RF) parameters through intelligent algorithms, is one of the most important tasks in the context of self-organizing networks (SON). In this paper, we propose self-optimization of antenna tilt and power using a fuzzy neural network optimization based on reinforcement learning (RL-FNN). In our approach, a central control mechanism enables cooperation-based learning by allowing distributed SON entities to share their optimization experience, represented as the parameters of learning method. Specifically, SON entities use cooperative Q-learning and reinforced back-propagation method to acquire and adjust their optimization experience. To evaluate the coverage and capacity performance of RL-FNN, we analyze cell-edge performance and cell-center performance indicators jointly across neighboring cells and specifically consider the difference in load distribution in a given region. The simulation results show that RL-FNN performs significantly better than the best fixed configuration proposed in the literature. Furthermore, this is achieved with significantly lower energy consumption. Finally, since each self-optimization round completes in less than a minute, RL-FNN can meet the need of practical applications of self-optimization in a dynamic environment.
Hmga1/Hmga2 double knock-out mice display a “superpygmy” phenotype
Authors: Federico Antonella , Forzati Floriana , Esposito Francesco , Arra Claudio , Palma Giuseppe , Barbieri Antonio , Palmieri Dario , Fedele Monica , Pierantoni Giovanna Maria , De Martino Ivana , Fusco Alfredo
Published: April 2014

The HMGA1 and HMGA2 genes code for proteins belonging to the High Mobility Group A family. Several genes are negatively or positively regulated by both these proteins, but a number of genes are specifically regulated by only one of them. Indeed, knock-out of the Hmga1 and Hmga2 genes leads to different phenotypes: cardiac hypertrophy and type 2 diabetes in the former case, and a large reduction in body size and amount of fat tissue in the latter case. Therefore, to better elucidate the functions of the Hmga genes, we crossed Hmga1-null mice with mice null for Hmga2. The Hmga1−/−/Hmga2−/− mice showed reduced vitality and a very small size (75% smaller than the wild-type mice); they were even smaller than pygmy Hmga2-null mice. The drastic reduction in E2F1 activity, and consequently in the expression of the E2F-dependent genes involved in cell cycle regulation, likely accounts for some phenotypic features of the Hmga1−/−/Hmga2−/− mice.
Aspirations for automobility: family geographies and the production of young people’s aspirations for cars
Authors: Barker John
Published: April 2014

While a burgeoning body of research explores how families shape children’s everyday experiences, less is known about how families influence children’s future aspirations. Drawing on two research projects exploring children’s mobility, this article explores children and young people’s aspirations for cars in adulthood. The article considers what these aspirations can tell us about current and future relationships between children, siblings and parents. It draws on the concept of ‘habitus’ to demonstrate how expectations around future car ownership are not aspatial – aspirations are informed by locally derived cultures of parenting and local economic, political and planning contexts. In doing so, the article critiques broader theorisations of automobility that assume an independent, autonomous adult and instead points to an understanding of the role that families play in developing relationally produced aspirations about cars.