bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimal Timing of Resumption of Warfarin After Intracranial Hemorrhage
Authors: Majeed Ammar , Kim Yang-Ki , Roberts Robin S. , Holmström Margareta , Schulman Sam
Published: October 2010

Background and Purpose—

The optimum timing of resumption of anticoagulation after warfarin-related intracranial hemorrhage in patients with indication for continued anticoagulation is uncertain. We performed a large retrospective cohort study to obtain more precise risk estimates.

Methods—

We reviewed charts of 2869 consecutive patients with objectively verified intracranial hemorrhage over 6 years at 3 tertiary centers. We calculated the daily risk of intracranial hemorrhage or ischemic stroke with and without resumption of warfarin; we focused on patients who survived the first week and had cardiac indication for anticoagulation or previous stroke. Using a Cox model, we estimated rates for these 2 adverse events in relation to different time points of resumed anticoagulation. The combined risk of either a new intracranial hemorrhage or an ischemic stroke was calculated for a range of warfarin resumption times.

Results—

We identified warfarin-associated intracranial hemorrhage in 234 patients (8.2%), of whom 177 patients (76%) survived the first week and had follow-up information available; the median follow-up time was 69 weeks (interquartile range [IQR] 19–144). Fifty-nine patients resumed warfarin after a median of 5.6 weeks (IQR 2.6–17). The hazard ratio for recurrent intracranial hemorrhage with resumption of warfarin was 5.6 (95% CI, 1.8–17.2), and for ischemic stroke it was 0.11 (95% CI, 0.014–0.89). The combined risk of recurrent intracranial hemorrhage or ischemic stroke reached a nadir if warfarin was resumed after approximately 10 to 30 weeks.

Conclusion—

The optimal timing for resumption of warfarin therapy appears to be between 10 and 30 weeks after warfarin-related intracranial hemorrhage.
Personalized Approaches to Clopidogrel Therapy
Authors: Anderson Christopher D. , Biffi Alessandro , Greenberg Steven M. , Rosand Jonathan
Published: October 2010

Clopidogrel is one of the most commonly prescribed medications worldwide. Recent advisories from the US Food and Drug Administration have drawn attention to the possibility of personalized decision-making for people who are candidates for clopidogrel. As is the case with antihypertensives, statins, and warfarin, common genetic sequence variants can influence clopidogrel metabolism and its effect on platelet activity. These genetic variants have, in multiple studies, been associated with adverse clinical outcomes. Concurrent medication use also influences how the body handles clopidogrel. Proton pump inhibitors, widely prescribed in conjunction with clopidogrel, may blunt its effectiveness. We address implications for bedside decision-making in light of accumulated data and current Food and Drug Administration advisories and conclude that genetic testing for CYP2C19 genotype and limitation of proton pump inhibitor interactions do not yet appear to offer an opportunity to optimize treatment given the current state of knowledge.
Residual Vessel Length on Magnetic Resonance Angiography Identifies Poor Responders to Alteplase in Acute Middle Cerebral Artery Occlusion Patients
Authors: Hirano Teruyuki , Sasaki Makoto , Mori Etsuro , Minematsu Kazuo , Nakagawara Jyoji , Yamaguchi Takenori
Published: October 2010

Background and Purpose—

It remains unknown whether the effects of 0.6 mg/kg alteplase differ with occlusion site of the middle cerebral artery (MCA). We therefore evaluated the effects of 0.6 mg/kg intravenous alteplase in patients with different sites of MCA occlusion.

Methods—

An exploratory analysis was made of 57 patients enrolled in the Japan Alteplase Clinical Trial II (J-ACT II), originally designed to evaluate 0.6 mg/kg alteplase in Japanese patients with unilateral occlusion of the MCA (M1 or M2 portion). The residual vessel length (in mm), determined by pretreatment magnetic resonance angiography, was used to reflect the occluded site. The proportions of patients with valid recanalization (modified Mori grade 2 to 3) at 6 and 24 hours and a modified Rankin Scale (mRS) score of 0 to 1 and of 0 to 2 at 3 months were compared between the groups dichotomized according to length of the residual vessel. Multiple logistic-regression models were generated to elucidate the predictors of valid recanalization, mRS 0 to 1, and mRS 0 to 2.

Results—

Receiver operating characteristics analysis revealed that 5 mm was the practical cutoff length for dichotomization. In patients with an M1 length <5 mm (n=12), the frequencies of valid recanalization at 6 and 24 hours (16.7% and 25.0%) were significantly lower compared with those (62.1% and 82.8%, respectively) of the 45 patients with a residual M1 length ≥5 mm and an M2 occlusion (
P
=0.008 for 6 hours,
P
<0.001 for 24 hours). The proportions of patients who achieved an mRS of 0 to 1 and an mRS of 0 to 2 were also lower for those with an M1 length <5 mm (8.3% and 16.7%, respectively) compared with the other group (57.8% and 68.9%, respectively;
P
=0.003 for mRS 0 to 1,
P
=0.002 for mRS 0 to 2). In logistic-regression models, the site of MCA occlusion (<5 mm) was a significant predictor of valid recanalization at 6 and 24 hours and of an mRS of 0 to 1 and of mRS of 0 to 2.

Conclusions—

In patients with acute MCA occlusion, a residual vessel length <5 mm on magnetic resonance angiography can identify poor responders to 0.6 mg/kg alteplase.

Clinical Trial Registration—

URL: http://www.clinicaltrials.gov. Unique identifier: NCT00412867.
Maps of Time to Maximum and Time to Peak for Mismatch Definition in Clinical Stroke Studies Validated With Positron Emission Tomography
Authors: Zaro-Weber Olivier , Moeller-Hartmann Walter , Heiss Wolf-Dieter , Sobesky Jan
Published: October 2010

Background and Purpose—

Perfusion-weighted imaging-derived maps of time-to-maximum (Tmax) are increasingly used to identify the tissue at risk in clinical stroke studies (eg, DEFUSE and EPITHET). Using quantitative positron emission tomography (PET), we evaluated Tmax to define the penumbral flow threshold in stroke patients and compared its performance to nondeconvolved time-to-peak (TTP) maps.

Methods—

Comparative perfusion-weighted imaging and quantitative 15O-water PET images of acute stroke patients were analyzed using cortical regions of interest. A receiver-operating characteristic curve analysis described the threshold independent performance of Tmax (area under the curve) and identified the best threshold (equal sensitivity and specificity threshold) to identify penumbral flow (<20 mL/100 g/min on PET cerebral blood flow). The results were compared with nondeconvolved TTP and other current perfusion-weighted imaging maps using the Mann–Whitney rank-sum test.

Results—

In 26 patients (time delay between MRI and PET, 65 minutes), the best threshold for penumbral flow was 5.5 seconds for Tmax (median; interquartile range, 3.9–6.6; sensitivity/specificity, 88%/89%). The area under the curve value was 0.95 (median; interquartile range, 0.93–0.97). Deconvolved Tmax did not perform significantly better than TTP (
P
=0.34).

Conclusion—

Maps of Tmax detected penumbral flow but did not perform better than the easy-to-obtain maps of nondeconvolved TTP. Thus, “simple” TTP maps still remain suitable for clinical stroke studies if detailed postprocessing is not feasible.
Retinal Vascular Calibers and the Risk of Intracerebral Hemorrhage and Cerebral Infarction
Authors: Wieberdink Renske G. , Ikram M. Kamran , Koudstaal Peter J. , Hofman Albert , Vingerling Johannes R. , Breteler Monique M.B.
Published: October 2010

Background and Purpose—

Narrower retinal arteriolar calibers and wider venular calibers are associated with cardiovascular disease, including cerebral infarction. We investigated the association between retinal vascular calibers and the long-term risk for stroke and its subtypes with particular focus on intracerebral hemorrhage.

Methods—

We included 5518 participants (aged ≥55 years) from the prospective population-based Rotterdam Study who were stroke-free at baseline (1990–1993) and of whom digital retinal images were available. Follow-up for incident stroke was complete up to January 1, 2007. Data were analyzed with Cox proportional hazards models adjusted for age and sex and additionally for potential confounders. Arteriolar and venular calibers were entered both separately and simultaneously in the models.

Results—

During an average follow-up of 11.5 years, 623 participants developed a first-ever stroke (50 hemorrhagic, 361 ischemic, 212 unspecified). Larger venular caliber was independently associated with an increased risk for stroke (hazard ratio [HR] per SD increase: 1.20; 95% confidence interval [CI]: 1.09 to 1.33), cerebral infarction (HR: 1.28; 95% CI: 1.13 to 1.46), and intracerebral hemorrhage (HR: 1.53; 95% CI: 1.09 to 2.15). Much weaker, only borderline significant associations were found between arteriolar caliber and risk for stroke (HR per SD decrease: 1.12; 95% CI: 0.99 to 1.23), cerebral infarction (HR: 1.12; 95% CI, 0.98 to 1.27), and intracerebral hemorrhage (HR: 1.25; 95% CI: 0.87 to 1.79). Retinal vascular calibers were strongly associated with lobar hemorrhages and oral anticoagulant-related hemorrhages.

Conclusion—

Larger retinal venular caliber is associated with an increased risk for stroke in the general population and, in particular, with an increased risk for intracerebral hemorrhage.
The Juneau Terrain-Induced Turbulence Alert System
Authors: Politovich Marcia K. , Goodrich R. Kent , Morse Corrinne S. , Yates Alan , Barron Robert , Cohn Steven A.
Published: October 2010

The Juneau, Alaska, airport vicinity experiences frequent episodes of moderate and severe turbulence, which affect arriving and departing air traffic. The Federal Aviation Administration funded the National Center for Atmospheric Research to develop a warning system, consisting of carefully placed anemometers and wind profilers, along with data communications, an algorithm, and display, to warn pilots of potentially hazardous situations. The system uses regressions based on comparisons of research aircraft data with measurements from the ground-based sensors to estimate the turbulence intensity along selected flight paths. This paper describes the development of the turbulence warning system, from meteorological characteristics through sensor placement, algorithm construction and evaluation, and display design. The discussion includes how best estimates of winds were made in adverse meteorological and topographic conditions, how turbulence was calculated from aircraft conducting various flight maneuvers, how bad data were identified and removed from the system, how the regressors were selected, and the skill of the system.
The Occurrence of Particle Size Distribution Bimodality in Midlatitude Cirrus as Inferred from Ground-Based Remote Sensing Data
Authors: Zhao Yang , Mace Gerald G. , Comstock Jennifer M.
Published: October 2010

Data collected in midlatitude cirrus clouds by instruments on jet aircraft typically show particle size distributions that have distinct distribution modes in both the 10–30-μm maximum dimension (D) size range and the 200–300-μm D size range or larger. A literal interpretation of the small D mode in these datasets suggests that total concentrations Nt in midlatitude cirrus are, on average, well in excess of 1 cm−3 whereas more conventional analyses of in situ data and cloud process model results suggest Nt values a factor of 10 less. Given this wide discrepancy, questions have been raised regarding the influence of data artifacts caused by the shattering of large crystals on aircraft and probe surfaces. This inconsistency and the general nature of the cirrus particle size distribution are examined using a ground-based remote sensing dataset. An algorithm using millimeter-wavelength radar Doppler moments and Raman lidar-derived extinction is developed to retrieve a bimodal particle size distribution and its uncertainty. This algorithm is applied to case studies as well as to 313 h of cirrus measurements collected at the Atmospheric Radiation Measurement site near Lamont, Oklahoma, in 2000. It is shown that particle size distributions in cirrus can often be described as bimodal, and that this bimodality is a function of temperature and location within cirrus layers. However, the existence of Nt > 1 cm−3 in cirrus is rare (<1% of the time) and the Nt implied by the remote sensing data tends to be on the order of 100 cm−3.
Climate Determinism Revisited: Multiple Equilibria in a Complex Climate Model
Authors: Ferreira David , Marshall John , Rose Brian
Published: October 2010

Multiple equilibria in a coupled ocean–atmosphere–sea ice general circulation model (GCM) of an aquaplanet with many degrees of freedom are studied. Three different stable states are found for exactly the same set of parameters and external forcings: a cold state in which a polar sea ice cap extends into the midlatitudes; a warm state, which is ice free; and a completely sea ice–covered “snowball” state. Although low-order energy balance models of the climate are known to exhibit intransitivity (i.e., more than one climate state for a given set of governing equations), the results reported here are the first to demonstrate that this is a property of a complex coupled climate model with a consistent set of equations representing the 3D dynamics of the ocean and atmosphere. The coupled model notably includes atmospheric synoptic systems, large-scale circulation of the ocean, a fully active hydrological cycle, sea ice, and a seasonal cycle. There are no flux adjustments, with the system being solely forced by incoming solar radiation at the top of the atmosphere.

It is demonstrated that the multiple equilibria owe their existence to the presence of meridional structure in ocean heat transport: namely, a large heat transport out of the tropics and a relatively weak high-latitude transport. The associated large midlatitude convergence of ocean heat transport leads to a preferred latitude at which the sea ice edge can rest. The mechanism operates in two very different ocean circulation regimes, suggesting that the stabilization of the large ice cap could be a robust feature of the climate system. Finally, the role of ocean heat convergence in permitting multiple equilibria is further explored in simpler models: an atmospheric GCM coupled to a slab mixed layer ocean and an energy balance model.
Environment and Early Evolution of the 8 May 2009 Derecho-Producing Convective System
Authors: Coniglio Michael C. , Corfidi Stephen F. , Kain John S.
Published: October 2010

This study documents the complex environment and early evolution of the remarkable derecho that traversed portions of the central United States on 8 May 2009. Central to this study is the comparison of the 8 May 2009 derecho environment to that of other mesoscale convective systems (MCSs) that occurred in the central United States during a similar time of year. Synoptic-scale forcing was weak and thermodynamic instability was limited during the development of the initial convection, but several mesoscale features of the environment appeared to contribute to initiation and upscale growth, including a mountain wave, a midlevel jet streak, a weak midlevel vorticity maximum, a “Denver cyclone,” and a region of upper-tropospheric inertial instability.

The subsequent MCS developed in an environment with an unusually strong and deep low-level jet (LLJ), which transported exceptionally high amounts of low-level moisture northward very rapidly, destabilized the lower troposphere, and enhanced frontogenetical circulations that appeared to aid convective development. The thermodynamic environment ahead of the developing MCS contained unusually high precipitable water (PW) and very large midtropospheric lapse rates, compared to other central plains MCSs. Values of downdraft convective available potential energy (DCAPE), mean winds, and 0–6-km vertical wind shear were not as anomalously large as the PW, lapse rates, and LLJ. In fact, the DCAPE values were lower than the mean values in the comparison dataset. These results suggest that the factors contributing to updraft strength over a relatively confined area played a significant role in generating the strong outflow winds at the surface, by providing a large volume of hydrometeors to drive the downdrafts.
Who Is a Mentor? A Review of Evolving Definitions and Implications for Research
Authors: Haggard Dana L. , Dougherty Thomas W. , Turban Daniel B. , Wilbanks James E.
Published: October 2010

The authors’ review of the mentoring literature describes how the construct has changed since Kram’s influential work in the early 1980s, the implications of such changes for the field, and suggestions for the future. In addition to highlighting changes over time in the topics mentoring researchers have studied, the authors provide an in-depth review of the way researchers have defined mentoring and the implications of those definitions. They identified approximately 40 different definitions used in the empirical literature since 1980. The discussion of definitions is followed by a delineation of the core attributes of all mentoring relationships and recommendations for specific information that researchers should collect about the relationship. The authors conclude by describing research trends and directions for future mentoring research.
Comparative Phenotypic Assessment of Cardiac Pathology, Physiology, and Gene Expression in C3H/HeJ, C57BL/6J, and B6C3F1/J Mice
Authors: Auerbach Scott S. , Thomas Reuben , Shah Ruchir , Xu Hong , Vallant Molly K. , Nyska Abraham , Dunnick June K.
Published: October 2010

Human cardiomyopathies often lead to heart failure, a major cause of morbidity and mortality in industrialized nations. Described here is a phenotypic characterization of cardiac function and genome-wide expression from C3H/HeJ, C57BL/6J, and B6C3F1/J male mice. Histopathologic analysis identified a low-grade background cardiomyopathy (murine progressive cardiomyopathy) in eight of nine male C3H/HeJ mice (age nine to ten weeks), but not in male C57BL/6J and in only of ten male B6C3F1/J mice. The C3H/HeJ mouse had an increased heart rate and a shorter RR interval compared to the B6C3F1/J and C57BL/6J mice. Cardiac genomic studies indicated the B6C3F1/J mice exhibited an intermediate gene expression phenotype relative to the 2 parental strains. Disease-centric enrichment analysis indicated a number of cardiomyopathy-associated genes were induced in B6C3F1/J and C3H/HeJ mice, including Myh7, My14, and Lmna and also indicated differential expression of genes associated with metabolic (e.g., Pdk2) and hypoxic stress (e.g. Hif1a). A novel coexpression and integrated pathway network analysis indicated Prkaa2, Pdk2, Rhoj, and Sgcb are likely to play a central role in the pathophysiology of murine progressive cardiomyopathy in C3H/HeJ mice. Our studies indicate that genetically determined baseline differences in cardiac phenotype have the potential to influence the results of cardiotoxicity studies.
Accountability as a Differentiated Value in Supranational Governance
Authors: Martinsen Dorte Sindbjerg , Jørgensen Torben Beck
Published: October 2010

Accountability differs in its meaning, scope, and impact. Consequently, its expression as a value and an instrument of “good governance” differs across time within and between organizations. Through the prism of theories on public values, this article examines accountability as a value in the administration of the European Union, that is, the European Commission. The article presents a theoretical discussion of value hierarchies, causality, and conflicts. Theoretical suggestions are included in an empirical examination of value conflicts in the administrative reforms of the European executive. It is argued that organizational characteristics of the European Commission condition value implementation. The article finds that although accountability appears as the “good value per se,” its applied period is brief and its status is contradicted by conflicting values.
The Theory of Monopolistic Competition, Marketing’s Intellectual History, and the Product Differentiation Versus Market Segmentation Controversy
Authors: Hunt Shelby D.
Published: October 2010

Edward Chamberlin’s theory of monopolistic competition influenced greatly the development of marketing theory and thought in the 1930s to the 1960s. Indeed, marketers held the theory in such high regard that the American Marketing Association awarded Chamberlin the Paul D. Converse Award in 1953, which at the time was the AMA’s highest honor. However, the contemporary marketing literature virtually ignores Chamberlin’s theory. The author argues that the theory of monopolistic competition deserves reexamining on two grounds. First, marketing scholars should know their discipline’s intellectual history, to which Chamberlin’s theory played a significant role in developing. Second, understanding the theory of monopolistic competition can inform contemporary marketing thought. Although our analysis will point out several contributions of the theory, one in particular is argued in detail: the theory of monopolistic competition can contribute to a better understanding of the ‘‘product differentiation versus market segmentation’’ controversy in marketing strategy.
Stabilization process within a sewage sludge landfill determined through both particle size distribution and content of humic substances as well as by FT-IR analysis
Authors: Ying Zhu  , Youcai Zhao
Published: October 2010

Landfill is largely considered as a reliable option for sewage sludge disposal in most metropolitan areas worldwide due to the huge quantities of this waste to be disposed of and the relatively low costs of such a kind of sludge management. It has been found that the sludge in the landfill degrades rapidly and becomes stabilized within a few years. In the present study, the sludge from different landfill stages was characterized by particle size distribution, humic substances contents and elemental composition, and Fourier transform infrared spectroscopy (FT-IR), as the landfill time increased. In general, the mean particle size of the sludge increased from 37 μm at day 0 to 143 μm at 300 days and the corresponding median particle size increased from 13 to 70 μm. The stability of particle size distribution can be assessed by the mean or median particle size. The humic acid (HA) and fulvic acid (FA) contents extracted from dry sludge after different landfill periods increased from 4.2 and 2.7% of day 0 to 5.6 and 3.1%, respectively, at 400 days, thereby indicating that the stabilization process of sludge in a landfill is also a humification process. The HA samples contained more carbon and nitrogen, and less hydrogen and oxygen than the FA samples, indicating a high degree of maturity and humification of these HA samples. The FT-IR spectra indicated that easily degradable organic matter components, such as aliphatic chains and protein, were distinctly decomposed during landfill. Based on the changes in the band relative intensity, it was concluded that after 300 days in a landfill the sludge is still in the process of degradation and maturity.
The Reliability and Validity of WISC-IV Scores With Deaf and Hard-of-Hearing Children
Authors: Krouse Hailey E. , Braden Jeffery P.
Published: October 2010

The present study examined the reliability and validity of the Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV) for use with deaf and hard-of-hearing (D/HOH) children. Psychologists ( n = 10) provided data for 128 D/HOH children who were assessed with the WISC-IV as part of routine assessments. All the WISC-IV subtests (8) and indexes (2) examined had split-half internal consistency coefficients that were higher ( p < .05) than the values reported for the normative sample. The mean Perceptual Reasoning Index ( M = 93.21) and Verbal Comprehension Index ( M = 80.86) for D/HOH children were lower ( p < .05) than the population mean ( M = 100). Of the 44 inter-subtest correlations calculated, 29 were significantly greater than zero. The results support the reliability of the WISC-IV scores for D/ HOH children, although the findings suggest that the Perceptual Reasoning Index may have a different meaning than Performance IQ for D/HOH children.
Fiscal freedom and the making of Hong Kong’s capitalist society
Authors: Goodstadt Leo F.
Published: October 2010

Fiscal autonomy is a defining principle of China’s arrangements for Hong Kong’s postcolonial administration and was a major feature of British rule before 1997. This article begins with a discussion of how this colony achieved unusual freedom from London’s usual oversight of colonial governments. After rejecting Colonial Office demands for a modern income tax, Hong Kong stuck to the principle of “low tax, small government,” defying London’s repeated calls for increased public expenditure on social development while resisting local business pressures for subsidies and tax concessions. The analysis then identifies fiscal freedom’s contribution to Hong Kong’s growth as an international financial center. The discussion explains the link between Hong Kong’s unfashionable fiscal conservatism in the 1950s and 1960s and the buildup of government reserves to a level which permitted Hong Kong to control its own monetary affairs, including an independent currency. The final section assesses the gains and losses, both economic and social, which accompanied this fiscal independence. The analysis makes extensive use of unpublished archival material.
Judicial autonomy in Hong Kong
Authors: Tai Benny Y. T.
Published: October 2010

To assess the degree of judicial autonomy under an autonomous framework, there are five criteria concerning the courts of the autonomous entity: (1) judicial independence; (2) jurisdiction on purely local matters; (3) the power of final adjudication; (4) the power of final interpretation of its own constitution; and (5) a fair mechanism to resolve disputes arising from conflicts between the exercise of powers by the autonomous entity and the sovereign state. The judicial autonomy of Hong Kong after China resumed to exercise sovereignty over Hong Kong is examined according to these criteria. The substantial differences between Hong Kong’s economic, legal, constitutional, and political systems and China’s may explain the subtle conflicts that the Hong Kong judiciary has encountered in the last 13 years. The Hong Kong Judiciary has learned that it can only exercise its judicial autonomy in accordance with its sense of constitutional justice inherited mainly from the common law if it can tactfully handle the inherent differences between “one country” and “two systems.” However, whether that means a weakened version of judicial autonomy or a strategic way to achieve the highest attainable degree of judicial autonomy within constraints is a matter on which commentators have different opinions.
Central-provincial relations amid greater centralization in China
Authors: Tao-chiu Lam
Published: October 2010

This article examines central—provincial relations in the context of greater centralization. Focusing on the background of provincial leaders, the leadership management system, and the fiscal system, it suggests that there has been an unmistakable trend toward greater central control. However, greater centralization has coexisted with decentralization in many areas of governance. While greater centralization has not completely changed the particularistic character of central— provincial interactions, the arena has shifted to bargaining and lobbying for central largess. Provincial bargaining now occurs in a context in which the central government is in control of considerably greater resources and more capable of setting the rules of the game. This study of the central—provincial relations helps to contextualize the study of Hong Kong’s relationship with Beijing first by pointing to their different natures and characters. At the same time, salient developments in central—provincial relations in the main body politics also form the context for Hong Kong’s relationship with Beijing.
“One country, two systems” and its antagonists in Tibet and Taiwan
Authors: Hung Ho-fung , Kuo Huei-ying
Published: October 2010

In turning the vast and diverse territory of the Qing Empire into a singular nation-state, Beijing has kept redefining its conception and institution of nationhood in response to challenges from the recalcitrant or not-yet-incorporated peripheral regions including Tibet, Hong Kong, and Taiwan. Since 1949, Beijing has attempted to solve the Tibet and Taiwan questions with the institutional design of “one country, two systems.” This design, widely thought of as a 1980s invention, can in fact be dated back to the early 1950s with respect to Tibet. This design has been far from successful in Tibet and Taiwan. While the “one country, two systems” experiment in Tibet failed with the Lhasa uprising and the flight of the Dalai Lama in 1959, the proposal of “one country, two systems” lost its appeal and had become a taboo among politicians of all strips in Taiwan by the 21st century. In this article, we argue that the success of “one country, two systems” requires a very delicate balance and virtuous interaction between the political center in Beijing and the elite, as well as popular classes, in the periphery concerned. It can easily be jeopardized if the center tilts too much to the left or right.
Diagnosing and responding to violations in the positivity assumption
Authors: Petersen Maya L , Porter Kristin E , Gruber Susan , Wang Yue , van der Laan Mark J
Published: October 2010

The assumption of positivity or experimental treatment assignment requires that observed treatment levels vary within confounder strata. This article discusses the positivity assumption in the context of assessing model and parameter-specific identifiability of causal effects. Positivity violations occur when certain subgroups in a sample rarely or never receive some treatments of interest. The resulting sparsity in the data may increase bias with or without an increase in variance and can threaten valid inference. The parametric bootstrap is presented as a tool to assess the severity of such threats and its utility as a diagnostic is explored using simulated and real data. Several approaches for improving the identifiability of parameters in the presence of positivity violations are reviewed. Potential responses to data sparsity include restriction of the covariate adjustment set, use of an alternative projection function to define the target parameter within a marginal structural working model, restriction of the sample, and modification of the target intervention. All of these approaches can be understood as trading off proximity to the initial target of inference for identifiability; we advocate approaching this tradeoff systematically.
An Existentialist in Iqaluit: Existentialism and Reflexivity Informing Pedagogy in the Canadian North
Authors: Yue Anthony R.
Published: October 2010

Reflecting on the personal experience of teaching human resource management in the Canadian Arctic, the author explores the utility of an existentialist approach to pedagogy. The author outlines select aspects of existentialism that are pertinent to the teaching and discusses the implications of using reflexive existential thought as guidance in a specific educational context. The author’s aim is to extend the dialogue concerning freedom and pedagogy using existentialism as a mechanism to navigate the implications of such.
A Fast Molecular Nondestructive Protocol for Evaluating Aerobic Bacterial Load on Fresh-Cut Lettuce
Authors: Gómez P. , Pagnon M. , Egea-Cortines M. , Artés F. , Weiss J.
Published: October 2010

Elaboration of minimally processed or fresh-cut vegetables requires a quick and reliable method for detection of bacterial contamination over the recommended limits. PCR-based methods fulfil these requirements, but amplification from DNA preparations of the food product is often hampered due to inhibiting substances. The purpose of this study was to develop a fast quantitative PCR (qPCR)-based method for aerobic bacterial enumeration in fresh-cut lettuce, using as reference the centrifugation water (CW) that comes up during processing instead of the food matrix itself. Comparisons between bacterial numbers on lettuce leaves before processing and bacterial numbers in the CW both for naturally occurring bacterial populations and for artificially inoculated lettuce were performed. On an average, 35% of the natural bacterial population and 64% of inoculated bacteria were recovered in the CW. Bacterial number in CW was proportional to initial lettuce contamination suggesting that measures on CW allow a narrow estimation of lettuce contamination. In qPCR, a 23S rDNA region was amplified from bacterial DNA present in the CW, followed by melting peak analyses and quantification. Enumeration of cell number by qPCR did not differ significantly from plate assay and might therefore replace it. The proposed protocol, which includes sample taking, DNA extraction and qPCR from the CW can be performed within less than 5 h. The resulting quantification might be used as a proxy of initial lettuce contamination, allowing direct intervention measures before fresh-cut commodity is shipped from the factory.
A Study on the Subjective Response for Corrected Colour Temperature Conditions in a Specific Space
Authors: Park Byoung-Chul , Chang Jun-Ho , Kim Yu-Sin , Jeong Jae-Weon , Choi An-Seop
Published: October 2010

The luminous environment in a space is one of the key factors affecting the occupants' work performance and mood. An illuminance value is quantitatively standardised and recommended for a specific space, but correlated colour temperature (CCT) is not. Although some studies on CCT conditions have shown that higher CCT conditions appear brighter to people than lower CCT conditions, other studies have indicated that there is no relationship between brightness perception and CCT conditions. This paper reports the results of two subjective evaluations of different CCTs on personal preferences: brightness perception, subjective impression and work performance; and describes suitable CCT conditions for a specific space and activities. One subjective evaluation (field test) was performed with four different CCT fluorescent lamps in an office space, and another (photo-image test) was performed with pictures under four different CCT conditions in an office, living room and bedroom. The results were statistically analysed for gender, preferred CCT, suitable CCT of each space and brightness sensitivity. The results showed that people preferred different CCT due to the purpose of a space, and different CCT conditions for specific activities performed in that space. The study suggests that changeable CCT lightings are better than fixed CCT for occupants in a space.
‘Clearing’ the cervical spine in the unconscious trauma patient
Authors: Blackham Julian , Benger Jonathan
Published: October 2010

This is a systemic review of the published evidence regarding cervical spine management in unconscious trauma patients. We examine the literature in the following sections: use of plain radiography; use of flexion/extenson views; use of computed tomography; use of magnetic resonance imaging. We also review surveys of practice and current guidelines.

In contrast to the conscious trauma patient there have been no large prospective multicentre studies to derive a clinical decision rule for the exclusion of cervical spine injury. This review therefore assesses currently available evidence to reach a logical conclusion regarding the most appropriate imaging strategy to exclude significant injury in the cervical spine, whilst minimising the time that a patient needs to remain immobilised.
Dynamics of Elastic Knitted Fabrics for Sports Wear
Authors: Senthilkumar M. , Anbumani N.
Published: October 2010

The garment stretch and recovery characteristics due to body movements can be indirectly assessed by the dynamic elastic recovery (DER) value of the fabrics at different extension levels. In order to study DER of elastic fabrics, a comparative analysis was made between spandex-plated cotton fabric and spandex core cotton spun (SCCS) fabric. It was found that the spandex-plated cotton fabric has higher DER value than that of SCCS fabric. The results of this study show that this phenomenon is due to the residual energy of the elastane unraveled from these fabrics. The stress values of these fabrics have no significant effect at 95% confidence level. It is concluded that the spandex-plated cotton fabric is suitable than SCCS fabric, for the tight fit garments meant for the sports like Javelin, shot-put, and athletics.
Mechanism of transfusion-related acute lung injury induced by HLA class II antibodies
Authors: Sachs Ulrich J. H. , Wasel Wiebke , Bayat Behnaz , Bohle Rainer M. , Hattar Katja , Berghöfer Heike , Reil Angelika , Bux Jürgen , Bein Gregor , Santoso Sentot , Weissmann Norbert
Published: October 2010

Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-associated mortality in the United States and other countries. In most TRALI cases, human leukocyte antigen (HLA) class II antibodies are detected in implicated donors. However, the corresponding antigens are not present on the cellular key players in TRALI: neutrophils and endothelium. In this study, we identify monocytes as a primary target in HLA class II–induced TRALI. Monocytes become activated when incubated with matched HLA class II antibodies and are capable of activating neutrophils, which, in turn, can induce disturbance of an endothelial barrier. In an ex vivo rodent model, HLA class II antibody–dependent monocyte activation leads to severe pulmonary edema in a relevant period of time, whenever neutrophils are present and the endothelium is preactivated. Our data suggest that in most TRALI cases, monocytes are cellular key players, because HLA class II antibodies induce TRALI by a reaction cascade initiated by monocyte activation. Furthermore, our data support the previous assumption that TRALI pathogenesis follows a threshold model. Having identified the biologic mechanism of HLA class II antibody–induced TRALI, strategies to avoid plasma from immunized donors, such as women with a history of pregnancy, appear to be justified preventive measures.
Predictive factors for outcome and response in patients treated with second-generation tyrosine kinase inhibitors for chronic myeloid leukemia in chronic phase after imatinib failure
Authors: Jabbour Elias , Kantarjian Hagop , O'Brien Susan , Shan Jenny , Garcia-Manero Guillermo , Wierda William , Ravandi Farhad , Borthakur Gautam , Rios Mary Beth , Cortes Jorge
Published: October 2010

We assessed the predictive factors for outcome and response in 123 patients with chronic myeloid leukemia in chronic phase treated with second-generation tyrosine kinase inhibitors (TKIs) after imatinib failure. Better event-free survival rates with second-generation TKI therapy were associated with a previous cytogenetic response to imatinib (P < .001) and a performance status of 0 (P = .001). Patients with 0, 1, or 2 adverse factors had 2-year event-free survival rates of 78%, 49%, and 20% (P < .001), respectively; 2-year overall survival rates of 95%, 85%, and 40%, (P = .002), respectively; and a 12-month probability of achieving a major cytogenetic response of 64%, 36%, and 20% (P = .007), respectively. In conclusion, patients with poor performance status and no previous cytogenetic response to imatinib therapy have a low likelihood of responding to second-generation TKI with poor event-free survival and therefore should be offered additional treatment options. This scoring system could serve to advise patients of their prognosis and treatment options, as well as to evaluate the benefit of newer alternate options.
NKp46 and DNAM-1 NK-cell receptors drive the response to human cytomegalovirus-infected myeloid dendritic cells overcoming viral immune evasion strategies
Authors: Magri Giuliana , Muntasell Aura , Romo Neus , Sáez-Borderías Andrea , Pende Daniela , Geraghty Daniel E. , Hengel Hartmut , Angulo Ana , Moretta Alessandro , López-Botet Miguel
Published: October 2010

Information on natural killer (NK)–cell receptor-ligand interactions involved in the response to human cytomegalovirus (HCMV) is limited and essentially based on the study of infected fibroblasts. Experimental conditions were set up to characterize the NK response to HCMV-infected myeloid dendritic cells (DCs). Monocyte-derived DCs (moDCs) infected by the TB40/E HCMV strain down-regulated the expression of human leukocyte antigen class I molecules and specifically activated autologous NK-cell populations. NKG2D ligands appeared virtually undetectable in infected moDCs, reflecting the efficiency of immune evasion mechanisms, and explained the lack of antagonistic effects of NKG2D-specific monoclonal antibody. By contrast, DNAM-1 and DNAM-1 ligands (DNAM-1L)–specific monoclonal antibodies inhibited the NK response at 48 hours after infection, although the impact of HCMV-dependent down-regulation of DNAM-1L in infected moDCs was perceived at later stages. moDCs constitutively expressed ligands for NKp46 and NKp30 natural cytotoxicity receptors, which were partially reduced on HCMV infection; yet, only NKp46 appeared involved in the NK response. In contrast to previous reports in fibroblasts, human leukocyte antigen-E expression was not preserved in HCMV-infected moDCs, which triggered CD94/NKG2A+ NK-cell activation. The results provide an insight on key receptor-ligand interactions involved in the NK-cell response against HCMV-infected moDCs, stressing the importance of the dynamics of viral immune evasion mechanisms.
Discovery of recurrent t(6;7)(p25.3;q32.3) translocations in ALK-negative anaplastic large cell lymphomas by massively parallel genomic sequencing
Authors: Feldman Andrew L. , Dogan Ahmet , Smith David I. , Law Mark E. , Ansell Stephen M. , Johnson Sarah H. , Porcher Julie C. , Özsan Nazan , Wieben Eric D. , Eckloff Bruce W. , Vasmatzis George
Published: October 2010

The genetics of peripheral T-cell lymphomas are poorly understood. The most well-characterized abnormalities are translocations involving ALK, occurring in approximately half of anaplastic large cell lymphomas (ALCLs). To gain insight into the genetics of ALCLs lacking ALK translocations, we combined mate-pair DNA library construction, massively parallel (“Next Generation”) sequencing, and a novel bioinformatic algorithm. We identified a balanced translocation disrupting the DUSP22 phosphatase gene on 6p25.3 and adjoining the FRA7H fragile site on 7q32.3 in a systemic ALK-negative ALCL. Using fluorescence in situ hybridization, we demonstrated that the t(6;7)(p25.3;q32.3) was recurrent in ALK-negative ALCLs. Furthermore, t(6;7)(p25.3;q32.3) was associated with down-regulation of DUSP22 and up-regulation of MIR29 microRNAs on 7q32.3. These findings represent the first recurrent translocation reported in ALK-negative ALCL and highlight the utility of massively parallel genomic sequencing to discover novel translocations in lymphoma and other cancers.
Increased thioredoxin-1 production in human naturally occurring regulatory T cells confers enhanced tolerance to oxidative stress
Authors: Mougiakakos Dimitrios , Johansson C. Christian , Jitschin Regina , Böttcher Martin , Kiessling Rolf
Published: October 2010

Levels of regulatory T cells (Tregs) are increased in different cancer types as well as in inflammatory diseases, such as rheumatoid arthritis. Treg accumulation may result from aberrant proliferation and trafficking as well as greater resilience to oxidative stress compared with conventional T cells. This enhanced antioxidative capacity of Tregs possibly serves as feedback inhibition during inflammation and prevents uncontrolled immune reactions by favoring survival of suppressor rather than effector cells. In this study, we demonstrate that human Tregs express and secrete higher levels of thioredoxin-1, a major antioxidative molecule. Thioredoxin-1 has an essential role in maintaining their surface thiol density as the first line of antioxidative defense mechanisms and is sensitive to proinflammatory stimuli, mainly tumor necrosis factor-α, in a nuclear factor-κB-dependent fashion. The antiapoptotic and oncogenic potential of (secreted) Trx-1 suggests that it may exert effects in Tregs beyond redox regulation.
Assessment of problematic severe asthma in children: Figure 1–
Authors: Lødrup Carlsen K.C. , Hedlin G. , Bush A. , Wennergren G. , de Benedictis F.M. , De Jongste J.C. , Baraldi E. , Pedroletti C. , Barbato A. , Malmström K. , Pohunek P. , Pedersen S. , Piacentini G.L. , Middelveld R.J.M. , Carlsen K.H.
Published: October 2010

Assessment of problematic severe asthma in children should be performed in a step-wise manner to ensure an optimal approach. A four-step assessment scheme is proposed. First, a full diagnostic work-up is performed to exclude other diseases which mimic asthma. Secondly, a multi-disciplinary assessment is performed to identify issues that may need attention, including comorbidities. Thirdly, the pattern of inflammation is assessed, and finally steroid responsiveness is documented.

Based upon these four steps an optimal individualised treatment plan is developed. In this article the many gaps in our current knowledge in all these steps are highlighted, and recommendations for current clinical practice and future research are made.

The lack of good data and the heterogeneity of problematic severe asthma still limit our ability to optimise the management on an individual basis in this small, but challenging group of patients.
Stressful life events and the onset of asthma
Authors: Lietzén R. , Virtanen P. , Kivimäki M. , Sillanmäki L. , Vahtera J. , Koskenvuo M.
Published: October 2010

The status of stressful life events as a risk factor for asthma is unclear and may be dependent on pre-existing allergic rhinitis. This study examined whether exposure to stressful life events predicted the onset of asthma in adults.

This is a prospective, population-based cohort study of 16,881 males and females, aged 20–54 yrs and free of diagnosed asthma at the beginning of the follow-up (January 1, 2004). Data about stressful life events were gathered with a postal survey. The onset of asthma was ascertained through national registers until December 31, 2005.

During the follow-up period, 192 incident cases of asthma were identified. High total exposure to stressful life events, as indicated by a cumulative severity score, predicted the onset of asthma (hazard ratio 1.96, 95% CI 1.22–3.13). This association was robust to adjustment for demographics, smoking and having a cat/dog at home and it was observed both among those with and without allergic rhinitis at baseline. Of the 10 most stressful life events, the illness of a family member, marital problems, divorce or separation and conflicts with a supervisor were associated with the onset of asthma.

Our study suggests that stressful life events may increase the onset of asthma.