bluuebunny/crossref_metadata_2025 huggingface dataset:
Disclosure of myelodysplastic syndrome diagnosis: improving patients' understanding and experience
Authors: Besson Caroline , Rannou Sandrine , Elmaaroufi Hicham , Guirimand Nicolas , Tresvaux du Fraval Frédéric , Cartron Laure , Jenny Sarah , Festy Patrick , Fenaux Pierre , Leplège Alain
Published: December 2012

Purpose

How a diagnosis of cancer is disclosed can affect psychological morbidity. Haematological malignancy specialised terminology may make the disclosure difficult. We analysed how disclosure of a diagnosis of myelodysplastic syndrome (MDS) is experienced by patients.

Methods

Patients from the French MDS support group were questioned about their demographic and clinical characteristics, diagnosis disclosure circumstances as well as experiences and expectations. After a phase test, a written questionnaire was sent to the 150 members of the support group.

Results

Of the 73 patients who returned a useable questionnaire, disclosure had been experienced negatively by 32 patients (45%). Only 53% of those patients were satisfied with the information provided compared with 80% of those who had positive/neutral feelings (P = 0.02). Overall, patients felt they should have been given fuller information at the time of disclosure. In retrospect, almost all patients (94%) thought that comprehensive, accurate information should be provided at disclosure, even if the truth might be hard to cope with. Patients reporting not having been given satisfactory information complained about a lack of perspective (3) or clarity (7), eight (11%) mentioned cancer during the interview, and four explicitly expressed that this word should be more frequently used.

Conclusion

Many patients had experienced disclosure negatively, frequently finding that the information provided had been insufficient and feeling that MDS was not well understood as a disease. Haematologists disclosing diagnosis to patients with a blood malignancy may benefit from following the same guidelines as oncologists in delivering comprehensive, understandable information.
Outcome of poor response paediatric AML using early SCT
Authors: Wareham Neval E. , Heilmann Carsten , Abrahamsson Jonas , Forestier Erik , Gustafsson Britt , Ha Shau‐Yin , Heldrup Jesper , Jahnukainen Kirsi , Jónsson Ólafur G. , Lausen Birgitte , Palle Josefine , Zeller Bernward , Hasle Henrik
Published: December 2012

Background

Children with poor response acute myeloid leukaemia (AML) generally have a very poor outcome. Allogeneic stem cell transplantation (SCT) is often recommended for these children but the benefit is unclear. The aim of this study was to investigate survival for poor response AML patients treated with SCT.

Material and Methods

Treatment was given according to the NOPHO‐AML 2004 protocol. All patients received AIET (Cytarabine, Idarubicin, Etoposide, Thioguanine) and AM (Cytarabine, Mitoxantrone) as induction. We included poor response defined as > 15% blasts on day 15 after AIET (n = 17) or > 5% blasts after AM (n = 14, refractory disease). Poor response patients received intensively timed induction and proceeded to SCT when a donor was available.

Results

Thirty‐one of 267 evaluable patients (12%) had a poor response. SCT was performed in 25; using matched unrelated donors in 13, matched sibling donors in 6, cord blood donor in 4, and haploidentical donor in two. The median follow‐up for the 31 poor responding patients was 2.6 years (range 0.4 ‐ 8.1 years) and 3‐year probability of survival 70% (95% CI 59‐77%).

Conclusions

The poor responders in the NOPHO‐AML 2004 protocol had a favourable prognosis treated with time‐intensive induction followed by SCT.
Microbial phylotype composition and diversity predicts plant productivity and plant–soil feedbacks
Authors: Bever James D. , Broadhurst Linda M. , Thrall Peter H.
Published: December 2012

The relationship between ecological variation and microbial genetic composition is critical to understanding microbial influence on community and ecosystem function. In glasshouse trials using nine native legume species and 40 rhizobial strains, we find that bacterial rRNA phylotype accounts for 68% of amoung isolate variability in symbiotic effectiveness and 79% of host specificity in growth response. We also find that rhizobial phylotype diversity and composition of soils collected from a geographical breadth of sites explains the growth responses of two acacia species. Positive soil microbial feedback between the two acacia hosts was largely driven by changes in diversity of rhizobia. Greater rhizobial diversity accumulated in association with the less responsive host species, Acacia salicina, and negatively affected the growth of the more responsive Acacia stenophylla. Together, this work demonstrates correspondence of phylotype with microbial function, and demonstrates that the dynamics of rhizobia on host species can feed back on plant population performance.
Planting methods matter for cost‐effective rainforest restoration
Authors: Preece Noel D. , van Oosterzee Penny , Lawes Michael J.
Published: December 2012

Forest restoration efforts in Australia's Wet Tropics establish <100 ha/year, compared with 20‐year average clearing rates of 1661 ha/year. Establishment costs are serious impediments to restoration efforts. Costs range from $25,000 to $67,000/ha, compared with less than $5,000/ha in other areas using other methods. Some of this difference stems from methods used to plant trees. Augered holes are used commonly in environmental plantings, whereas planting spades are used mostly in forestry plantings. To determine the most cost‐effective planting method between auger and spade planting methods, we compared the planting costs and the survival and growth of seedlings of local rainforest species, The speed of planting with a spade is on average four times quicker than with an auger, whereas the survival (range = 89–94%, spade vs auger respectively), and growth (slightly greater height growth for auger planted individuals) rates were only marginally different. Given these results, using planting spades is a cost‐effective alternative to augering holes.
Long‐distance dispersal of Black Spear Grass (Heteropogon contortus) seed on socks and trouser legs by walkers in Kakadu National Park
Authors: Ansong Michael , Pickering Catherine
Published: December 2012

Humans can contribute to the long‐distance dispersal of many plants, including weeds. We assessed the distance for which seed remained attached to the socks and trouser legs of walkers. The experiment in Kakadu National Park, Australia used seed of the Australian native Black Spear Grass (Heteropogon contortus) as a surrogate for the potential dispersal of weed seed. Two models were fitted to the data, with a double exponential model fitting the data slightly better than a power exponential model. Although 19% of seed were dispersed within the first 5 m of walking, most (55%) seed remained attached to socks and trousers at 5 km. Humans may, therefore, unintentionally carry and eventually disperse this grass and other invasive grasses with similar long awns and pointed seeds over long distances. Implementing strategies to reduce the potential for seed to attach to walkers (gaiters) and reduce potential dispersal (removal and careful disposal of seed) would reduce the risks posed by this type of human‐mediated seed dispersal.
Self‐assessed health status changes in a community cohort of people with multiple sclerosis: 11 years of follow‐up
Authors: Giordano A. , Ferrari G. , Radice D. , Randi G. , Bisanti L. , Solari A. ,   the POSMOS study
Published: December 2012

Background and purpose

Few data are available on the health status of people with multiple sclerosis (PwMS) in the community. We assessed changes in self‐perceived health status and health related quality of life of a community‐based cohort of PwMS over a decade, and identified predictors of such changes.

Methods

In 1999 we started the POSMOS study (Postal Survey of Self‐Assessed Health of MS Adults and their Significant Others) on a random sample of 251 adults with MS from the Milan area (mean age 42 years, range 18–71 years), and prospectively assessed changes in self‐perceived health status over 11 years. Participants completed the Multiple Sclerosis Quality‐of‐Life‐54 (MSQOL‐54) and a general/clinical questionnaire. We re‐assessed the cohort in 2004 and 2010, sending the same questionnaires plus the Chicago Multiscale Depression Inventory.

Results

There were 205 (86%) respondents in 2004, 171 (74%) in 2010; 28 (11%) died during the study. Severely impaired [self‐determined Expanded Disability Status Scale (EDSS) > 6.5] increased from 19% to 32%. One‐fifth remained fully ambulatory (EDSS < 4.0): 25% women (median age 44 years [interquartile range, IQR 39–53], median years from diagnosis 16 [IQR 12–19]); and 17% men (median age 40 years [IQR 38–45], median years from diagnosis 14 [IQR 12–17]). Changes in MSQOL‐54 composite scores were negligible; but among individual scales, change in health, cognitive function and general health worsened, and social function and emotional wellbeing improved significantly. Depressive symptoms were high and stable.

Conclusions

Multiple sclerosis had a pervasive but inhomogeneous impact on the lives of our MS sufferers. Notwithstanding overall clinical deterioration and aging, hospital admissions and medical consultations decreased, suggesting reduced use of health care resources. By contrast, housing adaptations and home care increased, psychological burden was high and self‐perceived cognitive functioning worsened.
Imaging actinic keratosis by high‐definition optical coherence tomography. Histomorphologic correlation: a pilot study
Authors: Boone Marc A. L. M. , Norrenberg Sarah , Jemec Gregor B. E. , Del Marmol Veronique
Published: December 2012

With the continued development of non‐invasive therapies for actinic keratosis such as PDT and immune therapies, the non‐invasive diagnosis and monitoring become increasingly relevant. High‐definition optical coherence tomography is a high‐resolution imaging tool, with micrometre resolution in both transversal and axial directions, enable to visualize individual cells up to a depth of around 570 μm filling the imaging gap between conventional optical coherence tomography and reflectance confocal microscopy. We sought to determine the feasibility of detecting and grading of actinic keratosis by this technique using criteria defined for reflectance confocal microscopy compared to histology. In this pilot study, skin lesions of 17 patients with a histologically proven actinic keratosis were imaged by high‐definition optical coherence tomography just before excision and images analysed qualitatively. The surrounding normal looking skin has been used as control group. In lesional skin, dyskeratotic and atypical keratinocytes could be noticed with this new technique. An atypical honeycomb pattern in variable degree or a disarranged epidermal pattern could be observed. A good correlation between the dimension of atypia and/or disarrangement of the spinous–granular layer on en face images and the histopathological grading could be demonstrated. Relevant cross‐sectional imaging criteria could be defined for the different histopathological variants of actinic keratoses. The surrounding skin displayed features of photodamage. Using features already suggested by reflectance confocal microscopy, the study implies that high‐definition optical coherence tomography facilitates in vivo diagnosis of actinic keratosis and allows the grading of different actinic keratosis lesions for increased clinical utility.
Expression profiles of cortisol‐inactivating enzyme, 11β‐hydroxysteroid dehydrogenase‐2, in human epidermal tumors and its role in keratinocyte proliferation
Authors: Terao Mika , Itoi Saori , Murota Hiroyuki , Katayama Ichiro
Published: December 2012

The enzyme 11β‐hydroxysteroid dehydrogenase (11β‐HSD) catalyzes the interconversion between hormonally active cortisol and inactive cortisone within cells. There are two isozymes: 11β‐HSD1 activates cortisol from cortisone and 11β‐HSD2 inactivates cortisol to cortisone. 11β‐HSD1 was recently discovered in skin, and we subsequently found that the enzyme negatively regulates keratinocyte proliferation. We verified 11β‐HSD1 and 11β‐HSD2 expression in benign and malignant skin tumors and investigated the role of 11β‐HSD in skin tumor pathogenesis. Randomly selected formalin‐fixed sections of skin lesions of seborrheic keratosis (SK), squamous cell carcinoma (SCC), and basal cell carcinoma (BCC) were stained with 11β‐HSD1 and 11β‐HSD2 antibodies, and 11β‐HSD expression was also evaluated in murine epidermis in which hyperproliferation was induced by 12‐O‐tetradecanoylphorbol‐13 acetate (TPA). We observed that 11β‐HSD1 expression was decreased in all SK, SCC, and BCC lesions compared with unaffected skin. Conversely, 11β‐HSD2 expression was increased in SK and BCC but not in SCC. Overexpression of 11β‐HSD2 in keratinocytes increased cell proliferation. In the murine model, 11β‐HSD1 expression was decreased in TPA‐treated hyperproliferative skin. Our findings suggest that 11β‐HSD1 expression is decreased in keratinocyte proliferative conditions, and 11β‐HSD2 expression is increased in basal cell proliferating conditions, such as BCC and SK. Assessing 11β‐HSD1 and 11β‐HSD2 expression could be a useful tool for diagnosing and characterizing skin tumors.
Effects of sliding on rolling contact fatigue of railway wheels
Authors: LANGUEH A. M. G. , BRUNEL J.‐F. , CHARKALUK E. , DUFRÉNOY P. , TRITSCH J.‐B. , DEMILLY F.
Published: December 2012

This paper proposes a numerical approach based on a steady‐state algorithm to predict the rolling contact fatigue crack initiation in railway wheels in practical conditions. This work suggests taking into account the cyclic hardening of the wheel's material and one of its originality is to conduct a complete numerical approach whatever the loading level. The main stages are the characterization and modelling of the material behaviour, the determination of the stress–strain fields using a numerical steady‐state method and the application of a high cycle fatigue criterion. Computations were made with the Abaqus FE commercial software. Three cases are studied: rolling with or without sliding and skating. The numerical results give several types of mechanical responses: elastic or plastic shakedown. Otherwise, the results show that the location where the shear stress is maximal is not the same as where the risk of crack is the highest.
The role of subtropical zooplankton as grazers of phytoplankton under different predation levels
Authors: LACEROT GISSELL , KRUK CARLA , LÜRLING MIQUEL , SCHEFFER MARTEN
Published: December 2012

1. Large zooplankton such asDaphniaplay a fundamental role as consumers of phytoplankton in temperate lakes. These organisms are scarce in subtropical lakes where smaller cladocerans or copepods take this niche. However, such smaller grazers appear to be less able to exert an effective top–down control on the phytoplankton community.

2. We experimentally analysed the ability of zooplankton typical of subtropical, nutrient‐rich lakes to graze effectively on the phytoplankton community. We conducted two outdoor mesocosm experiments in a hypertrophic lake, with combinations of three different zooplankton densities and three different omnivorous fish densities. In the first experiment, the zooplankton community was dominated by a small‐sized cladoceran (Moina micrura) and in the second by a calanoid copepod (Notodiaptomus incompositus). The phytoplankton community also differed between experiments, with dominance of large size classes and less palatable species in the first experiment and edible sizes in the second.

3. In both experiments, the effect of fish on the largest zooplankton was strong and negative, and low fish densities were sufficient to eliminate the larger zooplankton. Fish presence had positive effects on the biovolume of the largest phytoplankton size fraction (30–100 μm) in the first experiment. This effect was more pronounced in combination with high zooplankton biomass, suggesting that nutrient recycling by both fish and zooplankton may have been an important mechanism promoting phytoplankton growth.

4. None of the zooplankton communities tested had significant top–down effects on the phytoplankton community. In view of the phytoplankton species that dominated the communities at the end of both experiments, inedibility, toxicity and antigrazer defences may explain the absence of significant effects of zooplankton grazing.

5. Our results support the idea that in subtropical nutrient‐rich lakes, drastic removal of small omnivorous fish may be needed to allow an increase in zooplankton biomass. In addition, our results imply that for such a change to result in effective top–down control of phytoplankton, a shift in zooplankton community composition is essential too, as the experimental increase in small‐sized grazers had little effect on the phytoplankton communities.
Proximate weather patterns and spring green‐up phenology effect Eurasian beaver (Castor fiber) body mass and reproductive success: the implications of climate change and topography
Authors: Campbell Ruairidh D. , Newman Chris , Macdonald David W. , Rosell Frank
Published: December 2012

Low spring temperatures have been found to benefit mobile herbivores by reducing the rate of spring‐flush, whereas high rainfall increases forage availability. Cold winters prove detrimental, by increasing herbivore thermoregulatory burdens. Here we examine the effects of temperature and rainfall variability on a temperate sedentary herbivore, the Eurasian beaver, Castor fiber, in terms of inter‐annual variation in mean body weight and per territory offspring production. Data pertain to 198 individuals, over 11 years, using capture‐mark‐recapture. We use plant growth (tree cores) and fAPAR (a satellite‐derived plant productivity index) to examine potential mechanisms through which weather conditions affect the availability and the seasonal phenology of beaver forage. Juvenile body weights were lighter after colder winters, whereas warmer spring temperatures were associated with lighter adult body weights, mediated by enhanced green‐up phenology rates. Counter‐intuitively, we observed a negative association between rainfall and body weight in juveniles and adults, and also with reproductive success. Alder, Alnus incana, (n = 68) growth rings (principal beaver food in the study area) exhibited a positive relationship with rainfall for trees growing at elevations >2 m above water level, but a negative relationship for trees growing <0.5 m. We deduce that temperature influences beavers at the landscape scale via effects on spring green‐up phenology and winter thermoregulation. Rainfall influences beavers at finer spatial scales through topographical interactions with plant growth, where trees near water level, prone to water logging, producing poorer forage in wetter years. Unlike most other herbivores, beavers are an obligate aquatic species that utilize a restricted ‘central‐place’ foraging range, limiting their ability to take advantage of better forage growth further from water during wetter years. With respect to anthropogenic climate change, interactions between weather variables, plant phenology and topography on forage growth are instructive, and consequently warrant examination when developing conservation management strategies for populations of medium to large herbivores.
Evaluation of the GrazeIn model of grass dry‐matter intake and milk production prediction for dairy cows in temperate grass‐based production systems. 2 – Animal characteristics
Authors: O'Neill B. F. , Lewis E. , O'Donovan M. , Shalloo L. , Mulligan F. J. , Boland T. M. , Delagarde R.
Published: December 2012

This study evaluated the prediction accuracy of grass dry‐matter intake (GDMI) and milk yield predicted by the GrazeIn model using a large database representing 8787 per cow GDMI measurements. In this study, the animal input variables (age, parity, week of lactation, potential peak milk yield, milk fat content, milk protein content, bodyweight, body condition score (BCS), week of conception, BCS at calving and calf birth weight) were investigated. The mean actual GDMI of the database was 15·9 kg DM per cow d−1and GrazeIn predicted a mean GDMI for the database of 15·5 kg DM per cow d−1. The mean bias was −0·4 kg DM per cow d−1. GrazeIn predicted GDMI for the total database with an RPE of 15·5% at cow level. The mean actual daily milk yield of the database was 21·3 kg per cow d−1and GrazeIn predicted a daily milk yield for the database of 22·2 kg per cow d−1. The mean bias was +0·9 kg per cow d−1. GrazeIn predicted milk yield for the total database with an RPE of 16·7% at cow level. From the evaluation, GrazeIn predicted milk yield of all cows in late lactation with a larger level of error than in early and mid‐lactation. This error appears to be due to the persistency of the lactation curve used by the model, which results in a higher predicted milk yield in late lactation compared with the actual milk yield.
Hydrolysis of factor VIII mediated by catalytic antibodies occurs in haemophilia A patients with or without factor VIII inhibitors
Authors: Grosbois S. S. , Brionne M. F. , de Longcamp A. L. F. , Gautier P. , V Kaveri S. , Borel‐Derlon A. , Repessé Y.
Published: December 2012

The major complication of the substitutive treatment of haemophilia A (HA) is the development of antifactor VIII (FVIII) antibodies. Most of these antibodies neutralize FVIII procoagulant activity, and are identified as FVIII inhibitor. A subgroup of these antibodies, ‘catalytic antibodies’, catalyses the FVIII hydrolysis. We investigated the frequency and the activity of catalytic antibodies, according to the phenotype of HA and the presence or absence of FVIII inhibitor. IgG from 16 patients with inhibitor and 17 patients without inhibitor were purified. Rates of FVIII hydrolysis and inhibitor titres were evaluated. Anti‐FVIII catalytic antibodies were detected in 63.6% of patients with HA, irrespective of the HA phenotype and the presence of FVIII inhibitor. The frequency was significantly higher for severe HA patients (73.3%) and patients with inhibitor (87.5%), but their FVIII‐proteolytic activity was not significantly different from patients with mild or moderate HA and patients without inhibitor. The evolution of both catalytic and inhibitory activities was studied for 11 patients with FVIII inhibitor. We observed two profiles. In the profile 1, 18.2% of patients, the catalytic activity and the inhibitor titre coevolved. In contrast, a dissociated evolution of these two parameters was observed in 72.8% patients in profile 2. These data confirm the importance of anti‐FVIII catalytic activity in patients with severe, moderate and mild HA. Interestingly, most of the patients presented a dissociated profile, suggesting that anti‐FVIII antibodies might not systematically act as FVIII inhibitors.
Screening for fall risk in patients with haemophilia
Authors: Flaherty L. M. , Josephson N. C.
Published: December 2012

Many risk factors for falls identified in the general population are found in patients with haemophilia. Furthermore, fall risk increases with age and patients with haemophilia are increasingly entering the over 65 age group. After a fall occurs, there are often behavioural changes that have significant health consequences and further increase fall risk. Fall risk can be quickly assessed in the clinical setting with specific questions in the medical history and by a variety of performance‐based screening tools. Identification of fall risk enables early intervention, thereby preventing injury and fear of physical activity, both of which have been associated with falling and may carry an increased risk in patients with haemophilia. Review of the existing literature on assessment of fall risk reveals the importance of screening in the clinical setting, which is commonly done via a fall history and performance‐based assessment tools. Selecting appropriate fall risk screening tools is an important step in identifying and providing optimal interventions for those at risk. Assessments of fall history, fear of falling, gait velocity, gait variability and vestibular dysfunction are suggested as screening tools for patients with haemophilia. Additional research is needed to determine the optimal screening, evaluation and treatment techniques for these patients. The longitudinal physical therapy care provided by Haemophilia Treatment Centres presents a unique opportunity for instituting measures that will reduce the incidence of falling in patients with haemophilia.
Shared Governance in the Modern University
Authors: Taylor Mark
Published: December 2012

A governance model is developed in which university governance is shared between the academic and governing bodies and is coordinated by the university executive. Viewing the university as a professional service organisation, and noting the importance of developing a flexible culture within a shifting, marketised external environment, it is argued that a degree of shared governance is necessary for the success of the modern university. Although the discussion is couched largely within the context and evolution of UK university governance over the past sixty years, it also draws on the US evidence and experience and the conclusions drawn are general.
Carer involvement with drug services: a qualitative study
Authors: Orr Linda C. , Barbour Rosaline S. , Elliott Lawrie
Published: December 2012

Background

Empirical research suggests that involving carers brings benefits to families and services. Consequently, drug‐related policy and guidance has increasingly encouraged drug services to involve carers at all levels of service provision.

Objective

To explore the purpose and scope of carer involvement with adult drug services in North‐east Scotland.

Design, Setting and Participants

A total of 82 participants (20 informal carers, 43 service providers and 19 policy makers) were purposively selected to take part in a qualitative study. Eight focus groups and 32 interviews were conducted between 2007 and 2008.

Findings

Three themes were identified through thematic coding: ‘Current levels of involvement’, ‘Use of the term carer’ and ‘Opportunities for change?’ Carer involvement was described as limited, unplanned and unstructured, and consisted largely of information and advice, practical and emotional support, and signposting of services. Although use of the term ‘carer’ was contested within and across the groups, caring in a drug context was considered the ‘same but different’ from caring in other contexts. Carers remained sceptical that services actually wanted to involve them in supporting their relative or to offer carers support in their own right. Many service providers and policy makers regarded carer involvement as an aspiration.

Conclusion

Encouraging carers, service providers and policy makers to reach a shared understanding of caring in a drug context may help translation of policy into practice. However, there is also a fundamental need for drug services to widen the level and type of involvement activities on offer to carers.
Intimate partner violence in women living with HIV attending an inner city clinic in the UK: prevalence and associated factors
Authors: Dhairyawan R , Tariq S , Scourse R , Coyne KM
Published: December 2012

Objectives

Studies have shown high rates of intimate partner violence (IPV) in women living with HIV, but data from the UK are lacking. We aimed to estimate the prevalence of IPV and identify associated factors in women attending our inner London HIV clinic.

Methods

We conducted a cross‐sectional study of women attending our HIV clinic in May to December 2011. Participants completed a standardized questionnaire and exposure to IPV was ascertained using a validated tool. Clinical data were collected from patient records. Logistic regression models were fitted to estimate adjusted odds ratios (AORs).

Results

This analysis was based on 191 women with available data on IPV. The median age of women was 38 years (range 21−71 years); 74.1% were African‐born Black. Over half (99 of 191; 52%) reported experiencing IPV in their lifetime, with 27 of 191 (14.1%) reporting IPV within the past year and 27 of 191 (14.1%) reporting it in pregnancy. Lifetime experience of IPV was associated with mental health problems [AOR 3.44; 95% confidence interval (CI) 1.24−9.57; P < 0.05] and ‘other’ Black (born outside sub‐Saharan Africa) ethnicity (AOR 4.63; 95% CI 1.06–20.11; P < 0.05). We also found an association between older age and decreased likelihood of lifetime IPV (AOR 0.92; 95% CI 0.86–0.97; P < 0.05).

Conclusions

Over half of the women in this study reported lifetime experience of IPV. We found associations between IPV and mental health problems, younger age and other Black ethnicity. In view of its high prevalence, we advocate greater awareness of IPV among HIV healthcare professionals and recommend universal screening.
Prolonged prothrombin time correlates with serum monoclonal protein concentration in patients with plasma cell dyscrasia
Authors: Pandey S. , Post S. R. , Alapat D. V. , Smock K. J. , Post G. R.
Published: December 2012

Introduction

Abnormal screening coagulation tests are frequently observed in asymptomatic patients with multiple myeloma and other plasma cell neoplasms.

Methods

Prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen activity were correlated with clinical history and disease parameters in patients referred to the Myeloma Institute for Research and Therapy.

Results

An isolated prolonged PT was the most common abnormal coagulation test (25%). Prolonged PT was more frequently observed in patients with multiple myeloma (n = 157) compared to MGUS patients (n = 34) or other diagnostic categories of plasma cell dyscrasia. There were no differences in age, gender, previous chemotherapy, or immunoglobulin isotype in patients with isolated prolonged PT (n = 62) compared to those with normal screening coagulation tests (n = 173). Fibrinogen activity was significantly lower in patients with prolonged PT; however, there was no correlation between fibrinogen activity and PT. Serum M protein concentrations were significantly greater in patients with prolonged PT and were positively correlated with PT.

Conclusion

An association between disease severity and prolonged PT is suggested by our finding that patients with multiple myeloma were more likely to have prolonged PT than patients with other plasma cell neoplasms. Of the factors examined, the monoclonal protein level was significantly higher in patients with isolated prolonged PT and correlated with PT.
Strategies for basic laboratory diagnostics of the hemoglobinopathies in multi‐ethnic societies: interpretation of results and pitfalls
Authors: Giordano P. C.
Published: December 2012

The consistent multi‐ethnic migrations of the last decades have considerably changed the epidemiology of the hemoglobinopathies. Healthy carriers of these conditions are present today in many nonendemic parts of the world, and severely affected children are now born where these diseases were previously rare or unknown. Improving the competence in carrier diagnostics at the laboratory level is one of the first concerns when introducing management and primary prevention of the severe conditions in nonendemic areas. This review describes how and when carriers should be correctly diagnosed and informed. The essential technologies needed for basic carrier diagnostics in different situations are summarized in some detail, and interpretation of the results and a number of related problems are discussed. The role of the hematology laboratory is essential, particularly in nonendemic areas where the first line of health care is often insufficiently aware of hemoglobinopathy management. Carriers living in nonendemic areas can be appropriately diagnosed and informed regarding genetic risk and prevention by well‐organized laboratories. Both basic and specialized diagnostics are needed for the correct treatment for the anemic carriers, for primary prevention in couples at risk and for state‐of‐the art care of severely affected patients.
Feasibility of a novel extraperitoneal two‐port laparoendoscopic approach for radical prostatectomy: An initial study
Authors: Nakane Akihiro , Akita Hidetoshi , Okamura Takehiko , Ando Ryosuke , Kobayashi Takahiro , Naiki Taku , Yasui Takahiro , Kohri Kenjiro
Published: December 2012

The aim of this study was to describe the surgical technique and to report the early outcomes of an original extraperitoneal two‐port laparoendoscopic approach for radical prostatectomy. A total of 22 consecutive patients diagnosed with early‐stage prostate cancer (cT1c, cT2N0) were operated on and included in this analysis. A multichannel port with three 5‐mm trocars, providing easier instrument handling, was inserted extraperitoneally through a 2.5‐cm lower umbilical “U” incision. An additional 12‐mm port was inserted into the left fossa to allow an adequate working angle to facilitate the most critical steps of the surgical procedures. The operation was successfully completed in all patients; one patient required an additional 5‐mm port to control bleeding. The median operation time was 259 min (range 207–453 min), and the fluid loss, including urine and blood, was 946 mL (range 257–1821 mL). The median Foley catheter indwelling period was 6 days (range 3–11 days) after surgery. No intraoperative complications occurred. Judging from this initial trial, this procedure can be safely carried out if the surgeon is familiar with conventional five‐port laparoscopic radical prostatectomy.
Japan Cancer of the Prostate Risk Assessment for combined androgen blockade including bicalutamide: Clinical application and validation
Authors: Kitagawa Yasuhide , Hinotsu Shiro , Shigehara Kazuyoshi , Nakashima Kazufumi , Kawaguchi Shohei , Yaegashi Hiroshi , Mizokami Atsushi , Akaza Hideyuki , Namiki Mikio
Published: December 2012

Objectives

The Japan Cancer of the Prostate Risk Assessment was developed as a risk stratification instrument for patients undergoing primary androgen deprivation therapy. However, there have been no studies to validate the accuracy of the Japan Cancer of the Prostate Risk Assessment in predicting clinical outcomes. We examined whether the clinical outcomes of patients treated with combined androgen blockade could be stratified using the Japan Cancer of the Prostate Risk Assessment.

Methods

A total of 319 patients with prostate cancer treated with luteinizing hormone‐releasing hormone agonist plus bicalutamide were included in this analysis. Progression‐free survival, cause‐specific survival and overall survival were compared among patients divided according to the prostate‐specific antigen level at diagnosis, Gleason score on biopsy specimens, tumor–nodes–metastasis classification and Japan Cancer of the Prostate Risk Assessment score.

Results

The median age of the patients was 75 years, and the median prostate‐specific antigen at diagnosis was 25.4 ng/mL. A total of 102 patients (32.0%) had lymph node and/or distant metastases. On univariate analysis, the factors adopted in the Japan Cancer of the Prostate Risk Assessment points were significant predictors of progression‐free survival. On multivariate analysis, clinical T stage and M stage were significant predictors of progression‐free survival. The probabilities of progression‐free survival and cause‐specific survival were significantly different among the groups categorized according to the Japan Cancer of the Prostate Risk Assessment risk strata. The probability of overall survival in the low‐risk group was higher than in the other groups.

Conclusions

The progression‐free survival, cause‐specific survival and overall survival of prostate cancer patients treated by combined androgen blockade with bicalutamide were stratified by the Japan Cancer of the Prostate Risk Assessment. The Japan Cancer of the Prostate Risk Assessment score is clinically useful as a predictor of the prognosis of prostate cancer treated with combined androgen blockade.
Modelling electrical conductivity for earth media with macroscopic fluid‐filled fractures
Authors: Berryman James G. , Hoversten G. Michael
Published: December 2012

Effective‐medium theories for either highly conductive or more resistive electrical inclusions in a moderately conducting background medium are presented for modelling macroscopic (i.e., large‐scale) fluid‐filled fractures or cracks in a potential reservoir rock or granular medium. Conductive fluids are most often brine and the resistive fluids of interest are oil, gas, air and/or CO2. Novel features of the presentation for conductive fluids include results for both non‐interacting inclusions (using a Maxwell approximation) and for interacting inclusions (via a self‐consistent effective‐medium scheme). The anisotropic analysis is specifically designed to handle reservoirs with multiple orientations (usually three orthogonal sets) of oblate spheroidal cracks/fractures, while also having arbitrary aspect ratios. But these aspect ratios are strictly <1, thus excluding spherical pores and simple granular media – both already widely studied by others. Results show that the self‐consistent approximation depends on fracture aspect ratio α and that this approximation becomes important when fracture porosity is about φ= 1% for aspect ratio α≃ 0.05, or φ= 3% for aspect ratio α≃ 0.10. It is shown that the self‐consistent analysis is most important when the fractures have a very small aspect ratio — the inferred reason being that the fracture (or crack) number density (ρc≡φ/α) then becomes very high and the fracture relative spacing correspondingly very small for any fixed value of porosity (but with decreasing values of the aspect ratio). Hybrid methods (combining self‐consistent and non‐self consistent formulas) are also developed to deal with high volume fractions and multiple sets of fractures having different aspect ratios. Whenever possible and appropriate, the results are also compared to rigorous bounds, including the Wiener bounds and the Hashin‐Shtrikman bounds, in order to provide one type of partial validation of the methods being developed.
Pressure ulcers in the intensive care unit: the relationship between nursing workload, illness severity and pressure ulcer risk
Authors: Cremasco Mariana F , Wenzel Fernanda , Zanei Suely SV , Whitaker Iveth Y
Published: December 2012

Aims and objective. To verify association between PU development with nursing workload and illness severity and to verify whether nursing workload and illness severity are related with Braden Scale scores.

Background. Critically ill patients are more susceptible to treatment complications because of the severity of their clinical condition.

Design. Prospective descriptive study.

Methods. Patients consecutively admitted to three intensive care units (ICUs) of a public university hospital located in Sao Paulo, Brazil and without pressure ulcer (PU) at admission and a minimum stay of 24 hours were included in the sample. Prospective data collection included demographic, clinical and hospitalisation data, Nursing Activities Score (NAS), Simplified Acute Physiology Score (SAPSII) and Braden Scale. Multivariate linear regression analysis was applied to verify whether nursing workload and illness severity are related with Braden Scale scores. Multivariate logistic regression analysis was used to verify whether nursing workload and illness severity were risk factors associated with PU development.

Results. The study sample included 160 patients. The mean Braden score was 12·0 and PU incidence was 34·4%. Multivariate linear regression analysis identified as factors related to variation of Braden scores: illness severity (SAPSII), nursing workload (NAS) and age. Multivariate logistic regression showed a model with risk factors associated with PU development: sex, length of ICU stay, illness severity and nursing workload.

Conclusion. Nursing workload, severity of illness, sex and length of ICU stay were identified as risk factors associated with PU development. However, nursing workload acted as a protective factor. Illness severity, nursing workload and age were related to Braden scores.

Relevance to clinical practice. Accurate identification of risk factors and the use of clinical judgment in skin assessment are prerequisites for determining appropriate strategies to prevent pressure ulcers, to improve quality of care for patient safety and to reduce length of ICU and hospital stay and costs.
Implications for better nursing practice: psychological aspects of patients undergoing post‐operative wound care
Authors: Murakami Reiko , Shiromaru Mizue , Yamane Reiko , Hikoyama Hiroko , Sato Mikiyo , Takahashi Natsuko , Yoshida Sumie , Nakamura Misuzu , Kojima Yoshikazu
Published: December 2012

Aims and objectives

To understand the psychological aspects in patients undergoing post‐operative wound care and to gain insights for improving nursing practice.

Background

Very few studies have examined education on or practice of wound care with a view towards the patient's psychology.

Design

Descriptive exploratory qualitative study.

Methods

Four patients who had undergone open surgery of the upper gastrointestinal tract were interviewed using a semi‐structured format to gain an understanding of their feelings and opinions with regard to wound care. Interview transcripts were analysed using an inductive coding approach.

Results

Fifteen categories of responses were finally identified from the data. Patients wanted nursing staff to observe their wound more often so that patients could recognise improvement, to have better knowledge of the patient's disease and condition, to explain the patient's situation more completely and to appropriately answer questions. Patients also said that they felt more comfortable in posing questions or concerns regarding their condition to nursing staff than to their surgeons and did so while the wounds were being taken care of by nurses.

Conclusions

These findings suggested the importance of nursing staff to fully understand and to be ready to share feelings regarding a patient's postoperative condition and to have skills in properly explaining the importance of each procedure or steps in treatments that a patient must undergo. The present study also indicates that it is imperative for nursing staff to learn methods to build relationships with patients so that they can express their feelings of fear or anxiety freely to nurses.

Relevance to clinical practice

It is not possible to develop nursing practice without understanding psychological aspects of patients undergoing postoperative wound care.
Cytological, genetic, and biochemical characteristics of an unusual non‐Chlorella photobiont of Stentor polymorphus collected from an artificial pond close to the shore of Lake Biwa, Japan
Authors: Hoshina Ryo , Sato Emi , Shibata Aika , Fujiwara Yuko , Kusuoka Yasushi , Imamura Nobutaka
Published: December 2012

Stentor polymorphus (Müller) Ehrenberg (Heterotrichea, Ciliophora) is a trumpet‐form ciliate with endosymbiotic green algae (photobionts). Previous reports have indicated that this photobiont has a form typical of Chlorella Beijerinck (Trebouxiophyceae), with one chloroplast and a distinct pyrenoid. We collected S. polymorphus from an artificial pond on the shore of Lake Biwa in Japan. Microscopic examination demonstrated that there was no pyrenoid in the photobiont, and thus we analyzed the cytological, genetic, and biochemical characteristics of these algal cells. Cultured photobionts were smaller than those in hospite. Phylogenetic analyses placed the photobiont within the genus Mychonastes Simpson and Van Valkenburg, a chlorophycean alga occurring in fresh/brackish waters that lacks pyrenoids. Mychonastes provided little photosynthate to its host; the quantity of carbohydrate amounted to only 2% of that provided to Paramecium bursaria (Ehrenberg) Focker by its photobiont.
Comparing the low‐salinity tolerance of Ulva species distributed in different environments
Authors: Ichihara Kensuke , Miyaji Kazuyuki , Shimada Satoshi
Published: December 2012

The green macroalgal genus Ulva (Ulvales, Ulvophyceae, Chlorophyta) is distributed worldwide from marine to freshwater environments. Comparative analyses of hyposalinity tolerance among marine, brackish, and freshwater Ulva species were performed by fluorescein diacetate viability counts. The subtidal marine species Ulva sp., collected from a depth of 30 m, showed the poorest tolerance to low salinity. This species died in 5 practical salinity units (PSU) artificial seawater or freshwater within 1 day. Its closely related species U. linza L. (an intertidal species) and U. prolifera Müller (a brackish species) showed varying tolerances to low salinity. After 7 days of freshwater exposure, the viability of U. linza L. decreased to approximately 20%, while U. prolifera Müller showed nearly 100% viability. The freshwater species U. limnetica Ichihara et Shimada, not yet found in coastal areas, was highly viable in seawater.
CURRENT ACCOUNT ADJUSTMENT IN DEVELOPING COUNTRIES: THE ROLE OF EXCHANGE RATE REGIMES
Authors: MU XIAOYI , YE HAICHUN
Published: December 2012

This article employs hazard models to investigate the role of exchange rate regimes in the timing of current account adjustment in developing countries. We identify high current account deficit spells and find that fixed exchange rate regimes increase the duration of high deficit spells and thus delay current account adjustment. The result is robust to a variety of model specifications and alternative classifications of exchange rate regimes. When distinguishing between hard pegs and soft pegs, we notice that the delay in the current account adjustment is primarily driven by hard pegs rather than soft pegs. (JEL F3, F4)
TRADE ADJUSTMENT, POLITICAL PRESSURE, AND TRADE PROTECTION PATTERNS
Authors: YOTOV YOTO V.
Published: December 2012

This paper introduces trade adjustment considerations as active determinants of trade policy. Using novel U.S. data sets, I show that, despite their small monetary value, trade‐induced unemployment and trade‐adjustment costs can incite an incumbent politician to grant protection to an unorganized industry, even in the presence of political pressure by organized sectors. This finding complements the theoretical predictions from Grossman and Helpman (American Economic Review, 84, 1994, 833–50) who argue that the government should protect organized industries but should subsidize imports in unorganized sectors. (JEL D73, F13, F14, F16, J68)
Specters, Inc.: The Elusive Basis of the Corporation
Authors: Veldman Jeroen , Parker Martin
Published: December 2012

In this article we discuss the political and economic consequences of the contemporary legal theory of incorporation. We argue that incorporation has developed historically in a way that makes it internally inconsistent, but that this inconsistency is useful for the powerful because of its legal and economic effects. The corporation can “shape shift,” which is very helpful for claiming some rights and disavowing certain responsibilities. Of course this flexibility comes at the expense of consistent concepts and this leads to the creation of what we term an “ideal‐type reified singular representation.” We go on to show the far‐reaching effects of this representation for legal studies, economics, and political theory, and show it worked in the pro‐corporate decision in the recent Citizens United case. We conclude by providing several alternative ways to think about the nature of corporate organization.