bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding and avoiding interaction‐based instability in pervasive computing environments
Authors: Zamudio Victor , Callaghan Victor
Published: July 2009

Purpose

This paper aims to address a fundamental problem related to the interaction of rule‐based autonomous agents in pervasive and intelligent environments. Some rules of behaviour can lead a multi‐agent system to display unwanted periodic behaviour, such as networked appliances cycling on and off.

Design/methodology/approach

The paper presents a framework called interaction networks (INs) as a tool to describe and analyse this phenomena. In support of this, and as an aid to the visualisation and understanding of the temporal evolution of agent states, a graphical multi‐dimensional model (MDM) is offered. An instability prevention system (INPRES) based in identifying and locking network nodes is described.

Findings

Both IN, MDM and INPRES enable system designers to identify and prevent cyclic instability. The effectiveness of the approach is evaluated using both simulated and physical implementations.

Research limitations/implications

The problem of cyclic instability is strongly related to the number of cycles in the IN associated. It is postulated that high coupling and high number of cycles contributes to the system to self‐lock; however, more research is needed in this direction.

Practical implications

The MDM, interaction benchmark, IN theory, INPRES and intelligent locking offer a practical solution to the problem of cyclic behaviour.

Originality/value

Before this work there was no framework for analysing and eliminating the problem of cyclic instability in rule‐based multi‐agent systems.
A multi‐hop mobility management protocol for heterogeneous wireless networks
Authors: George Abraham , Kumar Anup , Srinivasan S.
Published: July 2009

Purpose

Mobility management for single‐hop cellular networks has received much research attention in the last few years. One of the research challenges for 4G wireless systems is the design of mobility management techniques that integrate cellular and ad‐hoc networks. Currently, there are no structured mobility management schemes for these heterogeneous multi‐hop networks. This paper aims to address these issues.

Design/methodology/approach

This paper describes techniques for tracking a mobile node (MN) in an integrated architecture with minimum overhead. This paper proposes group rerouting concept.

Findings

The paper implements and evaluates the proposed protocol by using the network simulator (NS‐2). The proposed protocol increases performance compared to broadcasting schemes.

Research limitations/implications

This scheme considers devices with two interfaces only.

Practical implications

The paper proposes a scheme to extend the coverage of cellular base stations by using ad‐hoc devices.

Originality/value

This paper describes techniques for tracking an MN in an integrated architecture with minimum overhead. This scheme is independent of the routing protocol used in a multi‐hop network.
Five rivers and where they meet (cross‐disciplinary reflections on development, policy and place)
Authors: Eversole Robyn
Published: July 2009

Purpose

The purpose of this paper is to describe and make sense of the confluence of theoretical and practical preoccupations that contribute to the current interest in place management.

Design/methodology/approach

The paper presents an overview and interpretation of trends that have led both policy‐makers and academics to an interest in the management and development of places. It demonstrates how various streams of thought coalesce into five key concepts: participation, distinctiveness, knowledge, relationships and values – that provide, at their meeting point, a cross‐disciplinary conceptual framework for place management and development.

Findings

The field of place management is located – both strategically and challengingly – at the crux of key contemporary policy issues in development and governance. There is a need to draw together insights across disciplines into a conceptual framework that will help both practitioners and academics make sense of the challenges we face.

Research limitations/implications

Understanding where we have come from helps them to chart where we are going. There is opportunity to build a new a theoretical and policy framework around place management that articulates why and how place is important in the context of larger development and governance debates.

Originality/value

As a big‐picture overview of a cutting‐edge space, this paper is intended to help both practitioners and academics position their work in its broader context.
Local perceptions of the reimaging process
Authors: Reiser Dirk , Crispin Stuart
Published: July 2009

Purpose

The purpose of this paper is to explore local perceptions of the process of place reimaging, and the forces that influence this process. As locals engage with a place more frequently than visitors, they are better placed to get an “insider's view” of reimaging and the forces that influence the process.

Design/methodology/approach

A case study method is employed in this paper. The case area is the Sullivans Cove waterfront precinct, located in the Australian City of Hobart. Between 1972 and 2006 this area underwent a process of reimaging; changing from a working port to a tourism, arts and entertainment precinct. Primary data are collected through semi‐structured interviews with representatives from local interest group. Secondary data are also collected from a range of government and non‐government sources.

Findings

The findings of this paper are twofold. First, it finds that locals are actively engaged in the process of reimaging and are broadly accepting of the reimaging process. Second, locals identified a number of forces that influenced the process of reimaging within Sullivans Cove, and that the interplay between these factors create a more multifaceted place image.

Originality/value

Little extant research has explored local perceptions of the reimaging process, and this paper brings new insights into this process.
Marketing the downtown through geographically enhanced consumer segmentation
Authors: Anderson Emily , Chakrapani Chuck , Hernandez Tony
Published: July 2009

Purpose

The purpose of this paper is to identify, using a case study, whether consumers in a metropolitan area can be meaningfully segmented geographically such that it can understand the way they perceive and interact with the downtown district and to delineate the implications of the findings for business improvement area marketing initiatives from a management perspective.

Design/methodology/approach

A total of 650 visitors to downtown Toronto are interviewed using a pretested questionnaire. Their responses are related to their location within the metropolitan area. Correspondence analysis (CA) is applied to the data to visually identify possible market segments.

Findings

The analysis identified four distinct place‐based visitor segments. Each of these segments exhibited behaviour patterns that are distinct and intrinsically meaningful. The analysis further shows that perceptions and current interactions with the district are likely to change depending on where in the metropolis its consumers live.

Practical implications

Since visitor perceptions are place dependent, it is difficult to implement a single place marketing campaign that is relevant to each segment. The results suggest that it needs to develop communication strategies that are specific to each segment, incorporating an understanding of why they visit downtown, what they think of the area, what media they consume, how they get around and what their needs are in terms of lifestage.

Originality/value

By going beyond the traditional analysis of geographic variables and incorporating consumer response variables in the analysis, this paper provides a stronger basis for market segmentation and management action with regard to place marketing. The application of CA provides a visual way to understand the segments.
Retail regeneration in Southampton: seeking the bigger picture
Authors: Hallsworth Alan , Orchard John
Published: July 2009

Purpose

The purpose of this paper is to present a critical evaluation of city centre regeneration via the creation of a major new shopping destination. The City of Southampton is chosen since that very process has been well documented. The research shows that this process of creating successful cities can be negative for some existing traders.

Design/methodology/approach

There are two main methodologies employed. One is a quantitative analysis of changes in rateable values. This is used as a surrogate for trading impact from the new development. The other is qualitative interviews with urban officials in the city being studied.

Findings

Quantitative results show that the market power of the retailer is a better explanation for rates relief than is the physical distance from the impactful new centre. Analysis of the qualitative interviews shows that the urban officials expected that there would be negative impacts for some existing traders by setting up that process of rates relief. However, the wider picture shows that the opportunities for small‐scale innovative retailers may be reducing. Further, that the style of retailing introduced does not necessarily assist the resident population with their everyday shopping.

Research limitations/implications

Though the sample of respondents for the qualitative interviews is small, it does access the key local officials. A wider issue is the poor level of quantitative data available on small shops. This limitation is also found by the 2006‐2008 Competition Commission Inquiry into the grocery sector.

Practical implications

Highly publicised success stories such as West Quay Southampton need deeper scrutiny to ensure they fit a wider ambition to deliver the environment that local residents deserve. Better data availability would assist in such analysis.

Originality/value

The paper constitutes an attempt to show how deeper scrutiny of the type the paper commends may be approached. Greater resources will be needed in order to gain fuller insights. The findings are of value to all who seek to understand the functioning of policymaking in the urban arena.
Light Night: an “enlightening” place marketing experience
Authors: Jiwa Salim , Andres Coca‐Stefaniak J. , Blackwell Martin , Rahman Toyubur
Published: July 2009

Purpose

The Light Night initiative currently under development in the UK offers an innovative approach to revitalising town and city centres by involving residents and visitors through culture and the arts. This initiative is based on the successful Nuit Blanche (White Night) culture‐led urban revitalisation model tested in cities like Brussels, Madrid, Montreal, Rome, São Paulo, Skopje and Toronto, where the Nuit Blanche programme alone resulted in an estimated $4.9 million economic impact on the city and attracted 800,000 people (Toronto). This paper aims to review elements of good practice internationally in the implementation of this concept and suggest a way forward for its realisation in the UK.

Design/methodology/approach

This case study builds on the 24‐hour city concept and provides a practical example of how culture‐led urban revitalisation through the Light Night programme can be implemented in Birmingham, Leeds, Liverpool, Nottingham and Sheffield based on successful international experiences.

Findings

Evidence gathered through a review of the literature provided in this case study would suggest that community involvement through creative culture‐led urban revitalisation initiatives can be instrumental in developing sustainable places and communities. Furthermore, it may provide a pathway towards overcoming some of the negative perceptions associated with the night‐time economy in many British town and city centres. The Light Night programme provides an opportunity for key social stakeholders to implement this through its focus on shared culture, history and identity.

Originality/value

This paper reviews the evolution of the European Nuit Blanche initiative using a case study approach, and its interpretation in the UK through the Light Night programme. It further explores the economic, cultural and social benefits of Light Nights and Nuit Blanche on community cohesion, tourism and regeneration. This paper is of value to practitioners and policy‐makers in place marketing, town centre management, local authority economic development officers, business managers, urban regeneration consultants, academics, tourism officers, community leaders and town centre residents.
Barriers to implementing corporate environmental responsibility in Thailand
Authors: Setthasakko Watchaneeporn
Published: July 2009

Purpose

The purpose of this paper is to gain an understanding of the primary barriers to the implementation of environmental responsibility in organizations.

Design/methodology/approach

The paper employs semi‐structured interviews with key informants and site observations. Key informants include top and senior managers of three frozen seafood processing companies in Thailand.

Findings

The paper identifies three primary barriers: the lack of a system perspective on seafood sustainability, absence of top management commitment and cultural diversity.

Research limitations/implications

As an exploratory case study, findings cannot necessarily be extrapolated to broader populations. To improve generalization of the findings, future research should broaden the sample. It would also be beneficial to pursue comparative research between industries, countries and regions.

Practical implications

Implementing corporate environmental responsibility requires raising “green culture” ideology throughout an organization. A system perspective on seafood sustainability, top management commitment and proper management of cultural diversity plays a significant role in affecting organizational change towards sustainability.

Originality/value

This paper contributes to a greater understanding of the role of humans and culture in greening the seafood supply chain.
Managerial perspective on the impact of globalization in an African commercial bank
Authors: Mamman Aminu , Baydoun Nabil
Published: July 2009

Purpose

The purpose of this paper is to investigate the perceived impact of globalization amongst Nigerian bank managers and professionals. Managerial and organizational cognition (MOC) literature is used to evaluated perceptions of impact.

Design/methodology/approach

The paper adopts a survey methodology to gather the information needed to achieve the objectives of the paper. Descriptive statistics and statistical analyses are used to evaluate various relationships.

Findings

Respondents view the outcome of globalization as unfair. They also view globalization as endangering the economy and cultural values of Nigeria. However, they see the benefits of globalization in terms of transfer of good management and business practices as well as flow of foreign direct investment. They also seem to believe that globalization is open enough to accommodate other economic and political systems. However, they also believe that globalization hinders nation states to formulate polices favourable to the economy. Similarly, the majority do not believe that the world will be a better and fairer place if all countries adopt the philosophy and principles underpinning globalization.

Research limitations/implications

Managers' interpretation of the impact of globalization can influence their decisions and ultimately organizational strategy. Depending on the perceived benefits of globalization, managers who can influence government policy would try to lobby against excessive liberalization that might affect their local market position.

Originality/value

There is an attempt to link macro‐ and micro‐dimensions of globalization research. A multidisciplinary approach opens up the possibility for researchers from management discipline and other disciplines (e.g. economics, sociology and politics) to team up and study globalization. Future research should adopt both a quantitative and qualitative methodology. For example, the use of in‐depth interviews should reveal more information on how respondents perceive the impact of globalization on values and beliefs. Future studies should also target policy makers and senior executives across industries and the non‐governmental organization sector.
Factors that affect women entrepreneurs: evidence from an emerging economy
Authors: Naser Kamal , Rashid Mohammed Wojoud , Nuseibeh Rana
Published: July 2009

Purpose

The purpose of this paper is to identify factors that motivate women in the United Arab Emirates (UAE) to become self‐employed.

Design/methodology/approach

Different factors, documented in previous research, that affect women's decisions to start their own businesses were included in a questionnaire. A total of 750 women entrepreneurs in the UAE were asked to express the degree of agreement with the factors listed in the questionnaire. Of them, 449 completed the questionnaire.

Findings

Financial support from the government especially in the start‐up capital is an important factor that motivates women to establish their own businesses. Self‐fulfillment, knowledge, skills and experience, including relationship to spouse/father business, are all important factors in the development of women entrepreneurs. Unlike previous research factors such social norms, market network, and competition do not seem to be barriers for women in becoming entrepreneurs.

Research limitations/implications

Questionnaires were mainly distributed in Abu Dhabi and Dubai. To give a clear picture of factors affecting women's decision to start their own businesses in the UAE, the opinion of women located in other Emirates needs to be investigated. The questionnaire survey targeted women entrepreneurs. To give a clear picture, future studies should target women who chose not to start their own businesses.

Practical implications

The outcome of this study will be used by researchers and policy makers to motivate women to become entrepreneurs. Women involvement in developing their businesses provides job opportunities and ensures that women are taking active part in the development of the national economy.

Originality/value

This is the first study that uses empirical evidence to identify factors that motivate women in the UAE to become self‐employed.
Family contributions to entrepreneurial development in Lebanon
Authors: Fahed‐Sreih Josiane , Pistrui David , Huang Wilfred , Welsch Harold
Published: July 2009

Purpose

The purpose of this paper is to profile the characteristics, attributes and growth orientations of Lebanese entrepreneurs, including the relationships, roles, and contributions that family and culture make and play in the development of private small and medium‐sized enterprises.

Design/methodology/approach

Drawing on a sample of 112 entrepreneurs, psychographic motives, demographic attributes, and business activities are revealed. A series of 112 in‐depth personal interviews was conducted over a 12 month period between May 2006 and 2007. The entrepreneurial profile questionnaire (EPQ) was utilized as a data collection instrument. The EPQ was designed to survey the effect of individual, societal, and environmental factors on entrepreneurship and family business development by collecting a combination of demographic information and extensive detail related to characteristics and orientations.

Findings

The findings suggest that entrepreneurs are motivated by the need for independence and flexibility. Entrepreneurs were found to rely heavily on family member participation to establish, develop, and grow their enterprises. The majority of the entrepreneurs surveyed employ at least one family member on a full‐time basis. Entrepreneurs were also found to use family finances as the primary source of start‐up capital. Family participation in the form of employment and investment was found to have a positive impact on entrepreneurial growth intentions and expansion plans.

Originality/value

The paper offers insights into family contributions to entrepreneurial development in Lebanon.
Prevalence of high‐risk human papillomavirus type 16/18 infection among women with normal cytology: risk factor analysis and implications for screening and prophylaxis
Authors: Gupta S. , Sodhani P. , Sharma A. , Sharma J. K. , Halder K. , Charchra K. L. , Sardana S. , Singh V. , Sehgal A. , Das B. C.
Published: July 2009

Objective: To determine the prevalence of high‐risk human papillomavirus (HR‐HPV) 16/18 infection of uterine cervix among women in the reproductive age group, with cytologically normal cervical (Pap) smears; to analyse the risk factors for HR‐HPV acquisition and to address their implications for cervical cancer screening and prophylaxis in a low resource setting.

Methods: Cervical samples from 769 cytologically negative women (age 18–45 years) attending a tertiary care centre in Delhi were subjected to HPV DNA testing and HR‐HPV 16/18 and low‐risk (LR)‐HPV 6/11 sub‐typing by polymerase chain reaction. Univariate risk factor analysis was carried out in HR‐HPV positive (n = 86) versus HR‐HPV negative women (n = 683) by chi‐square test.

Results: The overall HPV prevalence among cytologically normal women was 16.6%. HR‐HPV16 was detected in 10.1%, whereas HPV18 was detected in 1% of women. HR‐HPV 16/18 comprised 67% of the total HPV positives. There was no decline in HR‐HPV positivity with age, and women aged 40–44 years were at significantly increased risk for HR‐HPV prevalence (P = 0.03). Statistically significant associations of HR‐HPV infection were found with risk factors such as high parity (P = 0.04), cervicitis/hypertrophic cervix (P = 0.01), unhealthy cervix (P = 0.04), rural residence (P = 0.03), low socioeconomic status (P = 0.01) and illiteracy (P = 0.07).

Conclusions: Although the sample size was small, based on the observation that HR‐HPV 16 and 18 contributed significantly to the overall HPV prevalence in our setting, we speculate that testing/prophylaxis for these prevalent high‐risk types could perhaps make cervical cancer screening and preventive programmes cost‐effective. Larger community‐based studies on HPV prevalence and persistence are required to validate these findings before definitive recommendations can be made to the policy makers.
Outcome predictors in African‐American deceased‐donor renal allograft recipients
Authors: Brown Kristian L. , El‐Amm Jose M. , Doshi Mona D. , Singh Atul , Cincotta Elizabeth , Morawski Katherina , Losanoff Julian E. , West Miguel S. , Gruber Scott A.
Published: July 2009

Abstract:  The relative importance of donor and recipient risk factors in predicting outcomes in African‐American (AA) renal allograft recipients receiving contemporary immunosuppression, including early steroid withdrawal, has not been previously examined. We assessed the impact of 21 risk factors on five primary outcomes in 132 deceased‐donor AA renal allograft recipients transplanted from July 2001 to August 2006 with follow‐up 6–67 (mean 35 ± 17) months by univariate and multivariate analysis. Thymoglobulin or basiliximab was given for induction, and mycophenolate mofetil with either tacrolimus or sirolimus (SRL) ± prednisone for maintenance. Non‐compliance accounted for 26% of graft loss (GL) and 19% of acute rejection (AR) episodes, and was more prevalent in patients who were HCV+ and those on prednisone. Delayed graft function remained a significant predictor of GL, but not via increased AR, and donor ethnicity emerged as an important predictor of patient death. De novo use of SRL resulted in increased AR, and only increased recipient age significantly predicted new‐onset diabetes mellitus. Our preliminary results suggest the need for improvements in patient education, pre‐transplant psychosocial assessment, and late post‐transplant psychosocial support and can be utilized to help guide donor/recipient selection and tailor immunosuppressive management to optimize outcomes in this challenging group of patients.
A new vascular approach to the modified multivisceral graft procurement
Authors: Fridell Jonathan A. , Joseph Tector A. , Mangus Richard S. , Kazimi Marwan M. , Hollinger Edward F. , Vianna Rodrigo M.
Published: July 2009

Abstract:  Modified multivisceral (MMV) transplantation including the stomach, pancreaticoduodenal complex and intestine requires preservation of the left gastric and splenic arteries. The previously described techniques require division of the hepatic artery proximal to the gastroduodenal artery leaving the liver transplant team with a very short and small caliber vessel. To increase MMV graft availability and provide the liver transplant team with an appropriate quality vessel, we developed the following technique. We also describe two cases where we used this method to support the technical feasibility of this procedure.
Single versus dual renal transplantation from donors with significant arteriosclerosis on pre‐implant biopsy
Authors: Kayler Liise K. , Mohanka Ravi , Basu Amit , Shapiro Ron , Randhawa Parmjeet S.
Published: July 2009

Abstract:  Background:  Transplantation of kidneys from donor with arteriosclerosis seen on pre‐implantation biopsy has not been well studied.

Methods:  We retrospectively evaluated 20 dual kidney transplant (DKT) and 28 single (SKT) kidney transplant recipients with ≥12 months follow‐up from donors with moderate arteriosclerosis (≥25% luminal diameter narrowing).

Results:  Death censored graft survival was 100% and 79%, respectively (p = 0.0339). DKT recipients had significantly lower mean creatinine levels at one, three, six, and nine months and spent somewhat less time on the waiting list (181 ± 160 vs. 318 ± 306 d, p = 0.1429). DKT patients received kidneys from significantly older donors (64 ± 7 vs. 54 ± 11 yr; p = 0.0012), proportionately more expanded criteria donors (95% vs. 54%; p = 0.0029), and more donors with hypertension (81% vs. 48%, p = 0.0344) and death related to cerebrovascular accident (100% vs. 71%, p = 0.0143); however, more DKT kidneys underwent machine perfusion (95% vs. 57%, p = 0.0068). Baseline recipient variables were comparable between the two groups including age, race, gender, retransplantation, and HLA mismatch. Pre‐implant biopsy was notable for similar frequencies of moderate interstitial fibrosis (10% vs. 14%, respectively) and glomerulosclerosis.

Conclusion:  Among recipients of deceased‐donor kidneys with >25% arteriosclerosis, short‐term outcomes after DKT were superior to that of SKT grafts. This approach may help to expand the donor‐organ pool while optimizing outcomes.
Usefulness of a program of neoplasia surveillance in liver transplantation. A preliminary report
Authors: Herrero J. Ignacio , Alegre Felix , Quiroga Jorge , Pardo Fernando , Iñarrairaegui Mercedes , Sangro Bruno , Rotellar Fernando , Montiel Custodia , Prieto Jesus
Published: July 2009

Abstract:  De novo malignancies are frequent complications after liver transplantation. Aim of the study is to evaluate whether a surveillance program for malignancy may improve patient survival. We have compared the survival after the diagnosis of malignancy (excluding cutaneous and hepatobiliary carcinomas and lymphoproliferative disease) of patients with symptomatic or incidental malignancies with patients with neoplasia diagnosed on screening. Two hundred and eighty patients with a follow‐up greater than three months were followed for a median of 77.5 months (total follow‐up: 1515 patient‐yr). Thirty‐three patients developed 41 malignancies. When compared with general population, the entire cohort of liver transplant recipients had a significantly higher risk of malignancy (relative risk: 2.34), gastrointestinal tract (relative risk: 2.52), urological tract (relative risk: 2.94) and head and neck cancer (relative risk: 4.14), and cancer‐related death (relative risk: 2.35). All nine patients diagnosed with cancer with active screening are currently alive and free of malignancy after a median follow‐up of 25 months. By contrast, 18/24 patients with diagnosis of cancer prompted by symptoms or incidentally diagnosed died as a consequence of the cancer (median survival: 13.5 months). The difference in survival between both groups was significant (p = 0.002). In conclusion, a close surveillance protocol for the diagnosis of malignancy could be life‐saving in liver transplant recipients.
Donor transmission of malignant melanoma to a liver graft recipient: case report and literature review
Authors: Kim Jason K. , Carmody Ian C. , Cohen Ari J. , Loss George E.
Published: July 2009

Abstract: Post‐transplant malignancy of donor origin is a rare complication of organ transplantation, most likely transmitted as micrometastases within the parenchyma of the donor organ or from circulating tumor cells contained within the organ. Patient survival is dependent upon early diagnoses, and differentiation of the malignancy as of donor or recipient derivation is important in developing a treatment modality. The utilization of fluorescentin situhybridization chromosome analysis and DNA sequence analysis of the tumor cells can assist in this determination. This case report describes the management of donor transmitted malignant melanoma in a liver graft recipient and a review of the current literature.
Domino liver transplantation using a graft from a donor with familial hypercholesterolemia: seven‐yr follow‐up
Authors: Popescu Irinel , Habib Nagy , Dima Simona , Hancu Nicolae , Gheorghe Liana , Iacob Speranta , Mihaila Mariana , Dorobantu Bogdan , Matei Emil , Botea Florin
Published: July 2009

Abstract: A 46‐yr‐old female with hepatocellular carcinoma and severe hepatitis B‐related liver cirrhosis received a domino liver graft from a 25‐yr‐old female with homozygous familial hypercholesterolemia (HFHC) in September 2001. Hypercholesterolemia occurred in the graft recipient within one yr after transplantation and was partially controlled by atorvastatin. Three yr after transplantation, an autologous CD34+cell transplantation was performed in order to better control the hypercholesterolemia. Only preliminary results of this domino liver transplantation (DLT) were published in 2003, without a long‐term analysis of the hypercholesterolemic effects in recipient. Subsequent to DLT, the average plasma cholesterol level in the domino donor rapidly normalized and seven yr after had a value of 182 mg/dL. After seven‐yr follow‐up, the domino recipient has no hepatocarcinoma recurrence. Moreover, no signs of cardiovascular or atherosclerotic lesions were noted despite an elevated plasma cholesterol level (339 mg/dL after seven yr of follow‐up) resistant to drug therapy and stem cell autotransplantation. In conclusion, DLT using a liver graft from a patient with HFHC provides a viable option for marginal recipients.
Coverage of the organ donation process on Grey’s Anatomy: the story of Denny Duquette
Authors: Quick Brian L.
Published: July 2009

Abstract:  This investigation examined the impact of Grey’s Anatomy viewing on a host of organ donation‐related variables: organ donation beliefs and attitudes and a willingness to discuss organ donation with family. Following exposure to a storyline in which two myths were presented: (i) the rich and famous can buy their way to the top of organ waiting lists (purchase myth) and (ii) friends and family of medical professionals receive organ transplants quicker than other individuals (relationship myth), results revealed that loyal viewers of Grey’s Anatomy are less likely to believe the purchase myth compared to non‐viewers. No difference emerged between these two groups with respect to the relationship myth. Additionally, loyal viewers were more likely to talk about their willingness to donate organs than non‐viewers. Results are discussed with an emphasis on how Grey’s Anatomy portrayals can impact perceptions and action tendencies related to organ donation.
Positron emission tomography scanning in the setting of post‐transplant lymphoproliferative disorders
Authors: Blaes Anne H. , Cioc Adina M. , Froelich Jerry W. , Peterson Bruce A. , Dunitz Jordan M.
Published: July 2009

Abstract:  Background:  Post‐transplant lymphoproliferative disorder (PTLD) is a serious complication of transplantation. We examined the role of positron emission tomography (PET) scanning in PTLD.

Methods:  All patients treated for PTLD from 2001–2006 who also underwent PET scans were reviewed.

Results:  Nineteen PTLD patients were included. Seventeen patients had PET scans for staging at diagnosis. Of these, two patients with primary central nervous system lymphoma and one patient with only bone marrow involvement after complete surgical resection of a bowel lesion had no abnormalities on CT or PET scan. The remaining patients had measurable, extracranial disease by CT scan and PET scan. The median maximum standard uptake value was 8.2 (range 3–30). Thirteen patients had a PET scan following treatment. Eleven of 13 patients had a complete response (CR). Two of 13 patients had persistent disease following therapy; in one of these patients, relapsed disease was documented by PET scan alone. Of the 11 patients with CR, three patients relapsed shortly thereafter. In each case, at the time of relapse, the PET scan confirmed recurrent disease regardless of histopathologic subtype.

Conclusions:  PET scans may have a role in the staging and follow‐up of patients with PTLD. Additional prospective studies are warranted.
Fever of unknown origin in renal transplant patients with tacrolimus
Authors: Hochegger Kathrin , Rudnicki Michael , Auinger Martin , Mark Walter , Margreiter Raimund , Mayer Gert , Rosenkranz Alexander R.
Published: July 2009

Abstract:  The immunosuppressive agent tacrolimus is now widely used for the prevention of acute and chronic rejection in renal allograft recipients. We here report on three patients, who developed drug‐induced fever due to tacrolimus one to five months after renal transplantation. Extensive search for a focus, autoantibodies and virus infection remained inconclusive. Therefore, drug‐induced fever was suggested. After discontinuing tacrolimus and switching to cyclosporine A fever completely resolved within 24 h. This report demonstrates that tacrolimus‐induced drug fever should be included in the differential diagnosis of fever of unknown origin in renal transplant recipients.
Roux limb volvulus after pancreas transplantation: an unusual cause of pancreatic graft loss
Authors: Dib Martin J. , Ho Karen J. , Hanto Douglas W. , Karp Seth J. , Johnson Scott R.
Published: July 2009

Abstract:  Pancreas transplantation with enteric drainage avoids the long‐term urological complications of bladder drainage. Increasing use of this technique raises the possibility of complications from the enteric reconstruction. This report describes a patient five yr after left‐sided pancreas transplant with Roux‐en‐Y enteric drainage, presenting with abdominal pain, leukocytosis and radiological evidence of bowel obstruction. Exploration revealed a volvulus of the Roux limb as it passed through the mesocolon, with necrosis of the allograft duodenum and marked congestion of the pancreas. This is the first report of pancreas graft loss due to this entity, which should be recognized as an unusual cause of abdominal pain after pancreas transplantation. Potential bowel complications related to the sigmoid mesentery in left‐sided pancreas transplantation are additional reasons for right‐sided placement of the pancreas allograft.
Clinical significance of C4d deposition in stable renal allografts in the early post‐transplantation period
Authors: Yoon Hye Eun , Kim Su Hyun , Kim Jin Young , Oh Eun‐Jee , Park Sun Cheol , Choi Bum Soon , Choi Yeong Jin , Moon In Sung , Kim Yong Soo , Yang Chul Woo
Published: July 2009

Abstract:  The clinical significance of C4d positivity in patients with stable graft function is undetermined. This study evaluated the clinical outcome of protocol biopsy‐proven C4d‐positive renal transplants with stable graft function in the early post‐transplantation period. Protocol biopsies (n = 79) were performed on stable allografts on the 14th post‐transplant day, and indication biopsies (n = 74) were performed on dysfunctioning allografts within one yr after transplantation. Clinical and histological findings, graft function and graft survival rates were compared between C4d‐positive and C4d‐negative grafts in each group. The incidence of C4d positivity was 5.1% in protocol biopsies and 9.5% in indication biopsies. In protocol biopsies, C4d‐positive allografts showed minimal tubulointerstitial inflammation, and the graft function and graft survival rate did not differ from C4d‐negative allografts. All C4d‐positive allografts maintained stable graft function without anti‐rejection therapy, and follow‐up biopsies of two patients showed no C4d deposition or evidence of rejection. On the other hand, C4d‐positive allografts in indication biopsies showed severe tissue injury, and the graft survival rate was significantly lower than C4d‐negative allografts. In conclusion, C4d‐positive allografts with stable graft function in the early post‐transplantation period take an indolent course.
Post‐transplant erythrocytosis: a disappearing phenomenon?
Authors: Kiberd Bryce A.
Published: July 2009

Abstract: Background: Erythrocytosis is relatively common post‐kidney transplantation and may have adverse consequences. This study examined whether the incidence of erythrocytosis has remained stable over time and explored the impact of this condition on patient outcomes.

Methods: This was a retrospective single center review of an incidence cohort (transplanted between 1993 and 2005). Predictors of erythrocytosis and hemoglobin levels and subsequent patient and allograft survival were examined.

Results: Erythrocytosis (hemoglobin >170 g/L for >1 month) was observed in 59 of 511 recipients. Erythrocytosis developed in only 8.1% of those transplanted from 1997 to 2005, compared with 18.7% in those transplanted from 1993 to 1996 (p = 0.0005). Independent predictive factors were use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs) (HR 0.176, 95% CI 0.040–0.71, p = 0.016), male gender (HR 3.72, 95% CI 1.54–9.0, p = 0.003), and mycophenolic acid agents (HR 0.49, 95% CI 0.237–0.99, p = 0.049). Patients with erythrocytosis had superior overall survival (HR for death 0.105, 95% CI 0.014–0.760, p = 0.026) but a trend for worse death censored graft loss (univariate HR 2.06, 95% CI 0.91–4.65, p = 0.084).

Conclusions: The incidence of erythrocytosis is falling and is likely related to greater ACEi/ARB use and possibly more antiproliferative immunosuppression. Patient survival is excellent in those with erythrocytosis, but long‐term graft survival may be compromised.
Transplant tourism to China: the impact on domestic patient‐care decisions
Authors: Biggins Scott W. , Bambha Kiran , Terrault Norah , Inadomi John , Roberts John P. , Bass Nathan
Published: July 2009

Abstract:  Organ procurement in China has been criticized because of its reliance on executed prisoners as donors. We aimed to assess the influence of perceptions about organ procurement practices in China on domestic patient‐care decisions.

Methods:  An anonymous internet administered case‐based questionnaire was used to survey a sample of healthcare professionals with affiliations to hepatology and transplantation professional societies.

Results:  Of 674 completed surveys, the vast majority (93%) of the respondents were physicians, surgeons or allied transplant professionals actively caring for liver transplant patients and 81% practiced in the US. A strong majority believed procurement practices were ethically sound in the US and Europe (87% and 73%) but fare fewer believed that procurement practices were ethically sound in China (4%, p < 0.001). In case‐based questions, lack of confidence in the ethical standards of organ procurement in China predicted patient‐care decisions. The majority would provide post‐transplantation care for patients who underwent liver transplantation at another domestic center, in a foreign country and in China (90%, 78%, and 63%, respectively, p < 0.001) yet respondents who suspected unethical procurement practices in China were more reluctant to do so (p < 0.001).

Conclusions:  Transplant professionals expressed concern about organ procurement practices in China which influenced their patient‐care decision‐making.
High complete remission rate and durable remissions achieved with rational use of autologous stem‐cell transplantation, thalidomide maintenance, and non‐myeloablative allogeneic transplantation in patients with multiple myeloma
Authors: Oyan Basak , Koc Yener , Ozdemir Evren , Kars Ayse , Turker Alev , Tekuzman Gulten , Kansu Emin
Published: July 2009

Abstract:  Autologous stem‐cell transplantation (ASCT) has emerged as the standard approach in patients with multiple myeloma, although it is unlikely to achieve cure. Thalidomide maintenance and non‐myeloablative allogeneic transplantation (NST) may increase complete remission (CR) rate and increase overall survival. In this study, 35 ASCT and 10 NST were performed in 33 patients. Patients, who were resistant or relapsed following ASCT, underwent NST if they had an HLA‐matched sibling, otherwise treated with a second ASCT. Thalidomide was started as maintenance after ASCT. After first transplantation, three patients underwent second ASCT and 10 patients underwent NST. Following first transplantation, CR rate was 39% and increased to 60% (overall response 93%) with addition of thalidomide, bortezomib, and second transplantation. CR was durable in 14 (42%) patients. During a median follow‐up of 24 months, 18 patients progressed and nine patients died. The 100‐d transplant‐related mortality was <5%. The four‐yr progression‐free survival (PFS) was 52.4%. In conclusion, ASCT followed by thalidomide and NST in resistant patients can lead to high CR and PFS rates. As a second transplantation has not been performed routinely, patients having durable CR had a chance to avoid or delay a second transplantation without compromising disease control.
Spinal cord biopsy findings of anti‐aquaporin‐4 antibody‐negative recurrent longitudinal myelitis in a patient with sicca symptoms and hepatitis C viral infection
Authors: Takahashi‐Fujigasaki Junko , Takagi Satoshi , Sakamoto Tsuyoshi , Inoue Kiyoharu
Published: July 2009

We describe the pathological features of a spinal cord biopsy from a 69‐year‐old woman with anti‐aquaporin‐4 antibody‐negative recurrent longitudinal myelitis. Spinal cord MRI showed T2 high‐intensity lesions with strong gadolinium enhancement, when episodes of sensory‐motor impairment were repeated. The radiological abnormality was corrected by corticosteroid administration, but improvement of the symptoms was minimal. Although the patient had sicca symptoms and fulfilled four of the diagnostic criteria for Sjögren syndrome, the diagnosis was excluded, because of infection with hepatitis C virus, an exclusion criterion of Sjögren syndrome. In the spinal cord lesions, necrotic changes affected both myelin and axons. Infiltrating lymphocytes were predominantly T‐cells. The proliferation of small vessels with hyalinization and concomitant occlusive change was remarkable. These pathological findings resembled those previously reported in Sjögren syndrome. Ultrastructurally, the endothelial cells of the small vessels showed features of activated cells and contained vesiculo‐tubular structures in the cytoplasm, indicating that increased blood‐brain barrier (BBB) permeability might contribute to pathogenesis. We speculated that increased BBB permeability and T‐cell entry in the spinal parenchyma triggered pathological reactions resulting in necrotic changes in the spinal cord. Obstruction of small vessels might add ischemic damage to the lesions. The clinical course and pathological findings indicated that damage progressed rapidly in the spinal cord and was irreversible. The lesions apparently differed from typical demyelination plaques. Faced with such spinal cord lesions, a preventive therapeutic approach is necessary to avoid attack‐associated disability.
Papilledema revisited: is its pathophysiology really understood?
Authors: Killer Hanspeter E , Jaggi Gregor P , Miller Neil R
Published: July 2009

Abstract

The term ‘papilledema’ is used to describe swelling of the optic disc that is thought or known to be associated with increased intracranial pressure (ICP) transmitted to the subarachnoid space (SAS) surrounding the optic nerve (ON). In most cases, the diagnosis of increased ICP is confirmed by lumbar puncture, the results of which are believed to represent the pressure in all of the cerebrospinal fluid (CSF) spaces. Until recently, all CSF spaces were thought to communicate freely and that CSF pressure and composition in one location were the same throughout the central nervous system (CNS) unless there was an acquired structural disturbance. However, the concept of continuous CSF flow and pressure throughout the CNS does not explain why some patients with elevated ICP do not develop papilledema, why some patients have highly asymmetrical papilledema, or why some patients with papilledema have normal ICP during 24‐hour monitoring. In addition, CSF sampling during lumbar puncture and during ON sheath fenestration demonstrates an increased concentration of lipocalin‐like prostaglandin D synthase, a substance toxic to astrocytes, in the SAS of the ON compared with that in the lumbar CSF space, and also a difference in CSF dynamics between the lumbar and ON SAS in some patients with papilledema. We therefore suggest that papilledema does not result from raised ICP alone but in some cases by compartmentation of the SAS of the ON, leading to a toxic milieu around the nerve.
Phosphodiesterase inhibitors and the eye
Authors: Kerr Nathan M , Danesh‐Meyer Helen V
Published: July 2009

Abstract

Phosphodiesterase type 5 (PDE5) inhibitors are effective oral treatments for erectile dysfunction and have become one of the most widely prescribed medications worldwide. The mechanism of action is to reduce the degradation of cyclic GMP (cGMP) potentiating the effect of nitric oxide in the corpus cavernosum and allowing erectile function to occur by consequent relaxation of penile smooth muscle. Because of the presence of PDE5 in choroidal and retinal vessels these medications increase choroidal blood flow and cause vasodilation of the retinal vasculature. The most common symptoms are a blue tinge to vision and an increased sensitivity to light. There have been reports of non‐arteritic anterior ischaemic optic neuropathy and serous macular detachment in users of PDE5 inhibitors, although a causal relationship has not been conclusively shown. Despite the role of cGMP in the production and drainage of aqueous humour these medications do not appear to alter intraocular pressure and are safe in patients with glaucoma. All PDE5 inhibitors weakly inhibit PDE6 located in rod and cone photoreceptors resulting in mild and transient visual symptoms that correlate with plasma concentrations. Psychophysical tests reveal no effect on visual acuity, visual fields or contrast sensitivity; however, some studies show a mild and reversible impairment of blue‐green colour discrimination. PDE5 inhibitors transiently alter retinal function on electroretinogram testing but do not appear to be retinotoxic. Despite the role of cyclic nucleotides in tear production there is no detrimental effect on tear film quality. Based on the available evidence PDE5 inhibitors have a good ocular safety profile.