bluuebunny/crossref_metadata_2025 huggingface dataset:
Relative contribution of restorative treatment to tooth extraction in a teaching institution
Authors: Alomari Q. D. , Khalaf M. E. , Al‐Shawaf N. M.
Published: April 2013

Teeth can be extracted due to multiple factors. The aim of this retrospective cross‐sectional study was to identify the relative contribution of restorative treatments to tooth loss. The study reviewed records of 826 patients (1102 teeth). Patient's gender, age and education were obtained. In addition to the main reason for extraction (caries, periodontal disease, pre‐prosthetic extraction, restorative failure and remaining root), the following information was collected about each extracted tooth: type, the status of caries if any (primary or secondary) and pulpal status (normal or reversible pulpitis, irreversible pulpitis, necrotic or root canal treated) and type and size of restoration, if present. Following data collection, descriptive analysis was performed. A log‐linear model was used to examine the association between restorative treatment and tooth loss and between reasons for tooth loss and type of tooth. Lower molars followed by upper molars were the most commonly extracted teeth. Teeth with no restorations or with crowns were less likely to be extracted (P < 0·001). Lower and upper molars and lower premolars were more likely to be extracted due to restorative failure, while lower anterior teeth were more likely to be extracted due to periodontal disease (P < 0·05). Twenty two per cent of the extractions was due to restorative failure, and at least 65·9% of these teeth had secondary caries. Gender, age and educational level were factors that affect tooth loss. In conclusion, teeth receiving multiple restorative therapies were more likely to be extracted.
Update on the investigation of children with delayed development
Authors: Silove Natalie , Collins Felicity , Ellaway Carolyn
Published: April 2013

Children develop in the domains of cognition, speech and language, motor, personal skills, social skills and activities of daily living in a predictable and organised manner. Between 3000 and 9000 Australian children born in any one year may be diagnosed with global developmental delay. Paediatricians are often faced with the dilemma of ‘who’ and ‘how’ to investigate, as the yield is often considered to be low. ‘Best practice’ guidelines on the investigation of global developmental delay have been published, but the evidence available for the specific recommendations varies significantly and is based mostly on levels III and IV evidence (non‐experimental descriptive studies and expert opinions). This paper discusses the current views and suggests a possible algorithm for clinical practice in Australia.
Postharvest Fruit rot of Persimmon (Diospyros kaki) in Spain Caused by Lasiodiplodia theobromae and Neofusicoccum spp.
Authors: Palou Lluís , Montesinos‐Herrero Clara , Besada Cristina , Taberner Verònica
Published: April 2013

Three different fungi (isolates IVIA QCV‐1, IVIA QCV‐3 and IVIA QCV‐4) were isolated as potential causal agents of postharvest decay losses observed on sweet persimmons (Diospyros kaki L.) cv. ‘Rojo Brillante’ from commercial packinghouses in the Valencia area (Spain). Disease symptoms were irregular brownish and soft lesions mainly located under and surrounding the fruit calyx (stem‐end) that expanded rapidly at room temperature and turned to dark brown or black colour producing apparent and in some cases abundant white to grey mycelium. The identification of Lasiodiplodia theobromae, Neofusicoccum mediterraneum and Neofusicoccum luteum by macroscopic and microscopic morphological observations was confirmed with the amplification and subsequent sequencing of the ribosomal DNA ITS2 region. Representative nucleotide sequences were deposited in GenBank. Pathogenicity of all three isolates was demonstrated by fulfilling Koch's postulates.
Maternal immunization promotes the immune response of neonates towards hepatitis B vaccine
Authors: Zhang W. , Guo Z. , Zhang L. , Liu Z. , Li J. , Ji Z. , Xu R. , Zhao N. , Li F. , Chen X. , Yan Y. , Zhang J. , An Q. , Yang H. , Den Z. , Shao Z.
Published: April 2013

Infants infected with hepatitis B virus (HBV) face the risk of developing severe complications. Unfortunately, in spite of universal vaccination programmes, 5% or more of vaccinated newborns still do not achieve protective levels of anti‐hepatitis B virus surface antigen titres (anti‐HBs). The aim of this study was to use animal experiments and population‐based research to determine whether maternal vaccination against HBV affects the outcome of neonatal vaccination. Six sows and 53 newborn piglets were used for this study and randomly assigned to the vaccination group (three 20 μg doses of recombinant HBV vaccine). All the piglets were followed up to 10 weeks of age, and peripheral blood was withdrawn for measurement of anti‐HBs. A cross‐sectional study was also conducted on 449 mothers with infants. A structured questionnaire was used to collect demographic, medical and maternal data, and their peripheral blood was collected for measurement of anti‐HBs. The results of animal experiments demonstrated that nonvaccinated piglets born to vaccinated sows and nonvaccinated piglets born to nonvaccinated sows were negative for anti‐HBs. Repeated measures analysis of variance showed that the titres of anti‐HBs in vaccinated piglets born to vaccinated sows were significantly higher than in vaccinated piglets born to nonvaccinated sows (P < 0.05). In a population‐based study, a cumulative logistic regression analysis showed that the strongest influences on neonatal anti‐HBs titres were delay of the first vaccination dose [OR = 3.02(95% CI: 1.72–5.30)] and maternal anti‐HBs titres [OR = 2.48(95% CI: 2.03–3.04)]. In conclusion, high maternal anti‐HBs titres can enhance the response to HBV vaccination in infants.
Vegetation succession on Mt. Kenya in relation to glacial fluctuation and global warming
Authors: Mizuno Kazuharu , Fujita Tomohiro
Published: April 2013

Questions

How has the Mt. Kenya plant community responded to recent glacial retreat? Has the recent glacial retreat been affected by increases in temperature? How have number of plant clumps and proportion of vegetation cover changed with distance from the glacier edge (i.e. till age)?

Location

From Tyndall Tarn to the foot of Tyndall Glacier of Mt. Kenya (0°6′ S, 37°18′ E), Kenya.

Methods

The topography, soils, vegetation and glacial distribution around the Tyndall Glacier of Mt. Kenya were investigated from 1992 to 2011. The effect of glacial retreat on the rate of movement of leading edge (upper distribution limit) of plant species was examined. The distribution of vegetation was examined in a permanent plot that was surveyed in 1996 and 2011. The effects of temperature variation on glacial retreat were assessed with a least squares regression model.

Results

Tyndall Glacier retreated at a rate of ~3 m·yr−1from 1958 to 1997, which increased to 7–15 m·yr−1between 1997 and 2011. The leading edge ofSenecio keniophytum, the first pioneer species to establish after glacial retreat, advanced with glacial recession. It was sparse in 1996; by 2011, the number of clumps and proportion of cover had increased. Clump size was affected by distance from the glacier edge (i.e. till age) in areas of recent deglaciation but not in deglaciated areas >15 yr old. Monthly mean minimum temperature at Mt. Kenya increased by >2 °C from 1963 to 2011, and glacial retreat was related to increase in monthly mean minimum temperature.

Conclusion

The glaciers on Mt. Kenya have diminished rapidly in recent years, and pioneer plant species have advanced in response. The movements of some species do not appear to be directly spatially related to glacial retreat but may be related to increases in air temperature, soil development, seed dispersal limitation and interval of masting. Recent unusually high temperatures and precipitation also likely caused the blooming of some species during atypical seasons.
High levels of circulating HMGB1 as a biomarker of acute liver failure in patients with viral hepatitis E
Authors: Majumdar Manasi , Ratho Radhakanta , Chawla Yogesh , Singh Mini P.
Published: April 2013

Background

Viral hepatitis E clinically ranges between acute self‐limiting hepatitis (AVH) and acute liver failure (ALF). The varied clinical course of the disease possibly thought to be immune‐mediated. High‐mobility group box 1 (HMGB1) is a non‐histone chromosomal nuclear protein with recently discovered pro‐inflammatory and immunomodulatory action. Its presence in abundance within hepatocytes is thought provoking in patients with hepatitis.

Aim

The present study was designed to elucidate the role of circulating HMGB1 and its gene expression in patients with viral hepatitis E.

Methods

Blood samples were obtained from AVH (n = 38), ALF (n = 34) and healthy controls (HC, n = 30). The HMGB1 levels were estimated in serum by quantitative‐micro‐ELISA. Gene expression levels were studied in the patient's PBMCs by real‐time PCR. Lymphocyte proliferation was estimated by colorimetric‐MTT assay.

Results

Mean circulating HMGB1 levels in HC, AVH and ALF patients were found to be 12.04 ± 2.23, 112.6 ± 13.33 and 225.3 ± 15.04 ng/ml respectively. The levels were significantly higher in ALF than AVH and HC (P < 0.0001). Moreover, 88.2% of ALF patients with >250 ng/ml of circulating HMGB1 had a fatal outcome. The gene expression of HMGB1 in the PBMCs of ALF and AVH patients were comparable. A positive correlation was observed between HMGB1 level and INR. A significantly low lymphocyte proliferation was observed in ALF patients (P = 0.008).

Conclusion

Massive necrosis of hepatocytes in ALF patients might predispose to excessive accumulation of extracellular HMGB1 leading to suppression of T‐cell proliferation. Therefore, it is proposed that excessive circulating HMGB1 might play an important role in immunosuppression and fulminant course of the disease following HEV infection.
Charlson Co‐morbidity Index and albumin significantly associated with fracture risk in peritoneal dialysis patients
Authors: Ma Maggie KM , Yap Desmond YH , Yip Terence PS , Lui Sing Leung , Lo Wai Kei
Published: April 2013

Published literature on fracture in dialysis patients seldom addressed the effect of co‐morbidity and malnutrition. In this study, we reported the incidence and risk factors for fracture in peritoneal dialysis patients. Peritoneal dialysis patients who had fractures between 2006 and 2011 were recruited. Demographic data, details of fracture, Charlson Co‐morbidity Index (CCI) and biochemical parameters were also collected. Non‐fracture controls, matched for age, gender and duration of dialysis, were also recruited at ratio 1:1 for fracture risk analysis. The incidence of fracture was 1 in 37 patient‐years. The commonest site of fracture was neck of femur (n = 16, 55.2%). Twenty‐four patients (82.8%) developed fracture after slip and fall injury. Eight out of 17 self‐ambulatory patients (47.1%) became non‐ambulatory after fracture. Infection was the commonest complication during hospitalization. Univariant analysis demonstrated high CCI (P = 0.001), hypoalbuminaemia (P < 0.001), loss of self autonomy (P = 0.006) and non‐ambulatory state (P = 0.011) significantly associated with increased fracture risk. However, only CCI (odds ratio (OR) 1.373, P = 0.028) and albumin (OR 0.893, P = 0.025) increased fracture risk significantly on multivariant analysis. Bone profile and parathyroid hormone were not significant risk factors. To conclude, fracture associated with adverse outcome in peritoneal dialysis patients. High CCI score and hypoalbuminaemia significantly increase risk of fracture.
Validity and reliability of the scientific review process in nursing journals – time for a rethink?
Authors: Jasper Melanie , Vaismoradi Mojtaba , Bondas Terese , Turunen Hannele
Published: April 2013

As pressure to publish increases in the academic nursing world, journal submission numbers and rejection rates are soaring. The review process is crucial to journals in publishing high quality, cutting‐edge knowledge development, and to authors in preparing their papers to a high quality to enable the nursing world to benefit from developments in knowledge that affect nursing practice and patient outcomes and the development of the discipline. This paper does not intend to contribute to the debate regarding the ethics of reviewing, but rather seeks to explore notions of how the quality of the reviewing process can be enhanced to benefit authors, the reviewers, and the state of nursing knowledge. Furthermore, a call is made to editors to devise strategies for aiding reviewers to attain higher validity and reliability within the reviewing process by establishing clear standards and expectations and to ensure published work is judged against industry norms for quality.
Vasoactive intestinal polypeptide regulates barrier function via mast cells in human intestinal follicle‐associated epithelium and during stress in rats
Authors: Keita Å. V. , Carlsson A. H. , Cigéhn M. , Ericson A.‐C. , McKay D. M. , Söderholm J. D.
Published: April 2013

Background

Vasoactive intestinal polypeptide (VIP) has been implicated as a regulator of intestinal barrier function and inflammation. Our aim was to elucidate the role of VIP in follicle‐associated epithelium (FAE) and villus epithelium (VE) permeability following stress in rats and on human intestinal barrier function.

Methods

Rats were injected intraperitoneally (i.p.) with VIP receptor‐antagonists (anti‐VPACs), a mast cell stabilizer, doxantrazole (DOX), or NaCl, and submitted to acute water avoidance stress. Ileal segments were mounted in Ussing chambers to assess 51chromium‐edta (51Cr‐edta) and Escherichia (E.) coli (strain K‐12) permeability. Rat ileal and human ileal and colonic segments were exposed to VIP ± anti‐VPACs or DOX. An in vitro co‐culture model of human FAE was used to study epithelial‐VIP effects. VIP/VPACs distribution was assessed by microscopy.

Key Results

Stress increased 51Cr‐edta and E. coli permeability in VE and FAE. The increases were abolished by i.p. injection of DOX or anti‐VPACs. Ileal VIP‐exposure ex vivo increased bacterial passage and this was reduced by DOX. In human FAE ex vivo, VIP treatment doubled bacterial uptake, which was normalized by DOX or anti‐VPACs. No barrier effects were observed in human colonic tissue. VPACs were found in rat and human ileal follicles, with partial mast cell co‐localization. The co‐culture model confirmed VIP–mast cell–epithelial interactions in the regulation of barrier function.

Conclusions & Inferences

Stress affects the FAE barrier by mechanisms involving VIP and VPACs on mucosal mast cells. We suggest a regulatory role for VIP in the control of ileal permeability that may be relevant to bacterial–epithelial interactions in stress‐related intestinal disorders.
Free Will, Determinism, and the Possibility of Doing Otherwise
Authors: List Christian
Published: April 2013

I argue that free will and determinism are compatible, even when we take free will to require the ability to do otherwise and even when we interpret that ability modally, as the possibility of doing otherwise, and not just conditionally or dispositionally. My argument draws on a distinction between physical and agential possibility. Although in a deterministic world only one future sequence of events is physically possible for each state of the world, the more coarsely defined state of an agent and his or her environment can be consistent with more than one such sequence, and thus different actions can be “agentially possible”. The agential perspective is supported by our best theories of human behaviour, and so we should take it at face value when we refer to what an agent can and cannot do. On the picture I defend, free will is not a physical phenomenon, but a higher‐level one on a par with other higher‐level phenomena such as agency and intentionality.
For A New Bipolarity: China and Russia vs. America
Authors: XUETONG YAN
Published: April 2013

A great historical transition is underway from American‐led Globalization 1.0 to Globalization 2.0—the interdependence of plural identities where no one power or alliance of powers dominates.

The G‐20 is floundering as the immediate global financial crisis has receded. The United Nations and the old Bretton Woods institutions—the IMF, the World Bank and the WTO—have lost their vigor and are struggling to adjust to the global powershift with the rise of the emerging economies. While Europe is paralyzed as the historic project of integration stalls, the world's two largest economies—the United States and China—are as yet unable to figure out how to share power.

The danger now is that the geopolitical vacuum will invite assertions of national self‐interest that will unravel the rules‐based order that enabled stability and prosperity over recent decades.

America's leading geopolitical strategist, China's most outspoken strategic thinker and one of Asia's leading global thinkers from Singapore offer their reflections on this state of affairs.
The Great Convergence and the Logic of One World
Authors: MAHBUBANI KISHORE
Published: April 2013

A great historical transition is underway from American‐led Globalization 1.0 to Globalization 2.0—the interdependence of plural identities where no one power or alliance of powers dominates.

The G‐20 is floundering as the immediate global financial crisis has receded. The United Nations and the old Bretton Woods institutions—the IMF, the World Bank and the WTO—have lost their vigor and are struggling to adjust to the global powershift with the rise of the emerging economies. While Europe is paralyzed as the historic project of integration stalls, the world's two largest economies—the United States and China—are as yet unable to figure out how to share power.

The danger now is that the geopolitical vacuum will invite assertions of national self‐interest that will unravel the rules‐based order that enabled stability and prosperity over recent decades.

America's leading geopolitical strategist, China's most outspoken strategic thinker and one of Asia's leading global thinkers from Singapore offer their reflections on this state of affairs.
Modelling obesity outcomes: reducing obesity risk in adulthood may have greater impact than reducing obesity prevalence in childhood
Authors: Lhachimi S. K. , Nusselder W. J. , Lobstein T. J. , Smit H. A. , Baili P. , Bennett K. , Kulik M. C. , Jackson‐Leach R. , Boshuizen H. C. , Mackenbach J. P.
Published: April 2013

A common policy response to the rise in obesity prevalence is to undertake interventions in childhood, but it is an open question whether this is more effective than reducing the risk of becoming obese during adulthood. In this paper, we model the effect on health outcomes of (i) reducing the prevalence of obesity when entering adulthood; (ii) reducing the risk of becoming obese throughout adult life; and (iii) combinations of both approaches. We found that, while all approaches reduce the prevalence of chronic diseases and improve life expectancy, a given percentage reduction in obesity prevalence achieved during childhood had a smaller effect than the same percentage reduction in the risk of becoming obese applied throughout adulthood. A small increase in the probability of becoming obese during adulthood offsets a substantial reduction in prevalence of overweight/obesity achieved during childhood, with the gains from a 50% reduction in child obesity prevalence offset by a 10% increase in the probability of becoming obese in adulthood. We conclude that both policy approaches can improve the health profile throughout the life course of a cohort, but they are not equivalent, and a large reduction in child obesity prevalence may be reversed by a small increase in the risk of becoming overweight or obese in adulthood.
Prevalence of Candida spp., xerostomia, and hyposalivation in oral lichen planus – A controlled study
Authors: Artico G , Freitas RS , Santos Filho AM , Benard G , Romiti R , Migliari DA
Published: April 2013

Objective

To determine the frequency of Candida spp., xerostomia, and salivary flow rate (SFR) in three different groups: patients with OLP (OLP group), patients with oral mucosal lesions other than OLP (non‐OLP group), and subjects without oral mucosal lesions (control group).

Material and methods

Xerostomia as well as SFR was investigated in the three groups. Samples for isolation of Candida spp. were collected from OLP lesions (38 patients), non‐OLP lesions (28 patients), and healthy subjects (32 subjects).

Results

There was no statistically significant difference regarding the frequency of xerostomia and hyposalivation among the three groups (P > 0.05). A higher prevalence for colonization by Candida spp. was found in the healthy subject as compared to that of patients with OLP (P = 0.03) and non‐OLP (P = 0.02) groups. Low SFR was not a factor for colonization by Candida spp.

Conclusions

Xerostomia and hyposalivation occur with similar frequency in subjects with and without oral lesions; also, the presence of oral lesions does not increase the susceptibility to colonization by Candida spp. It seems that any study implicating Candida spp. in the malignant transformation of oral lesions should be carried out mostly on a biochemical basis, that is, by testing the capability of Candida spp. to produce carcinogenic enzyme.
QTLs for phosphorus deficiency tolerance detected in upland NERICA varieties
Authors: Koide Yohei , Pariasca Tanaka Juan , Rose Terry , Fukuo Ayumi , Konisho Kunihiko , Yanagihara Seiji , Fukuta Yoshimichi , Wissuwa Matthias
Published: April 2013

Phosphorous (P) deficiency is a major yield limiting factor in rice (Oryza sativa L.) production. The interspecific New Rice for Africa (NERICA) varieties combine general stress tolerance from African cultivated rice (Oryza glaberrima Steud) with characteristics associated with high yield from O. sativa. However, little is known about their ability to tolerate P deficiency. Here, we examined the variation for tolerance to P deficiency among the 18 upland NERICAs and their parents in multi‐year field experiments. The good performance under P deficiency of the O. glaberrima parent CG 14 and some NERICAs suggested that these tolerant NERICAs contain loci associated with P deficiency tolerance inherited from CG 14. Additionally, four QTL clusters for P deficiency tolerance were detected on chromosomes 4, 6 and 11 using F3 lines derived from the cross between the P deficiency tolerant variety NERICA10 and a Japonica‐type sensitive variety ‘Hitomebore’. These QTLs represent the first step in identifying stress tolerance genes from O. glaberrima that could subsequently be used to enhance P deficiency tolerance in O. sativa.
Effectiveness of selection at CIMMYT's main maize breeding sites in Mexico for performance at sites in Africa and vice versa
Authors: Kebede Aida Z. , Mahuku George , Burgueño Juan , Vicente Felix San , Cairns Jill E. , Das Biswanath , Makumbi Dan , Magorokosho Cosmos , Windhausen Vanessa S. , Melchinger Albrecht E. , Atlin Gary N.
Published: April 2013

The exchange of elite breeding materials across regions is an important way in which multinational maize breeding programmes access new genetic variation, improve efficiency and reduce costs. Our objectives were to examine whether CIMMYT's breeding programmes for tropical and subtropical environments in Mexico and Eastern and Southern Africa (ESA) can effectively share materials. Sets of selected and unselected lines were evaluated for per se and testcross performance in multiple environments in Mexico and ESA for grain yield, days to anthesis and plant height. Genotypic correlations between performance in Mexico and ESA as testcross and line per se were high (≥ 0.72) for all experiments, and indirect selection efficiency ranged from 67 to over 100% for all traits. Lines selected in ESA or Latin America performed equally well in each region, indicating selection was for broad rather than regional adaptation. Thus, breeding programmes of CIMMYT in both Mexico and ESA can benefit tremendously by exchanging breeding materials and test results, and elite selections from each region should be fast‐tracked for evaluation in the other.
Papular Epidermal Nevus with “Skyline” Basal Cell Layer (PENS) Following a Blaschko Linear Pattern
Authors: Faure Elisa , Tadini Gianluca , Brena Michela , Cassulini Lucia Restano
Published: April 2013

Papular epidermal nevus with “skyline” basal cell layer (PENS), a variant of epidermal nevi, has recently been described as a small, round or polygonal papule, visible at birth or shortly thereafter, with characteristic histopathologic features. It has been considered a separate entity from keratinocytic nevi because no lesion observed thus far has followed any of the known archetypical mosaic patterns. Here we describe for the first time a PENS lesion following a linear distribution pattern along Blaschko's lines.
Is theSECa learning regulator? Lessons from proxy access
Authors: Pichhadze Aviv
Published: April 2013

Analysis of theUS Securities andExchangeCommission's (SEC) treatment of the concept of ownership in the federal proxy rules, between 1934 and 2010, suggestsSECsystems and procedures may not employ optimal organizational learning. Addressing this,Idevelop theLearningRegulatorFramework, a normative model facilitating organizational learning and allowing regulatory agencies to maintain awareness of, and adaptation to, socio‐economic realities in regulated environments, thereby promoting reflective, responsive, relevant, and efficient regulatory frameworks. The relevance of the model to other institutional settings is also considered.
Technical systems and the architecture of transnational business governance interactions
Authors: Porter Tony
Published: April 2013

This article sets out the concept of a technical system and explores its ability to explain why some transnational regulatory domains are governed by a single transnational business governance (TBG) scheme, while in others there are many such schemes. By linking the numbers of TBG schemes that govern any particular transnational regulatory domain to technical systems in this way, important insights are provided into TBG interactions. Where technical systems are present, the TBG schemes that govern them will be specialized and complementary, rather than competitive. More generally, a technical systems approach illuminates the set of extended relationships that connect TBG schemes to the industry they seek to regulate. By tracing out these relationships we can reveal indirect interactions between TBG schemes that may be mediated through firms or market infrastructures. These indirect interactions can be obscured by approaches that only focus on the direct interactions among TBG schemes. The article analyzes two cases of TBG schemes in global finance. The first, derivatives, has a single overall TBG scheme. The second case, professional financial designations, has multiple competing TBG schemes.
Prognostic value of plasma N‐terminal pro B‐type natriuretic peptide levels in pneumonia patients requiring intensive care unit admission
Authors: Lin Shih‐Chang , Tsai Yi‐Ju , Huang Chun‐Ta , Kuo Yao‐Wen , Ruan Sheng‐Yuan , Chuang Yu‐Chung , Yu Chong‐Jen
Published: April 2013

Background and objective: 

Correct and early risk stratification for critically ill pneumonia patients remains an unmet medical need. This study aimed to test whether N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) can serve as a prognostic marker in this setting.

Methods

This prospective study enrolled 216 pneumonia patients admitted to intensive care unit. Plasma NT‐proBNP samples were obtained upon admission and primary outcome was all‐cause mortality at 30 days. Meanwhile, Acute Physiology and Chronic Health Evaluation (APACHE) II and Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) 2007 minor criteria were assessed.

Results

Overall 30‐day mortality was 30%. NT‐proBNP levels were significantly higher in nonsurvivors than survivors (11 938 ± 13 121 vs 5658 ± 9240 pg/mL, P = 0.001). Area under receiver operating characteristic curves of NT‐proBNP, APACHE II and IDSA/ATS 2007 minor criteria were not significantly different regarding prediction of mortality (0.715, 0.754 vs 0.654, P = 0.085). Adding NT‐proBNP to APACHE II significantly increased the area under receiver operating characteristic curve from 0.754 to 0.794 (P = 0.048). Receiver operating characteristic analysis revealed optimal NT‐proBNP and APACHE II cut‐offs of 2177.5 pg/mL and 25.5, respectively. In multivariate analysis, both NT‐proBNP and APACHE II values above cut‐offs had a significantly higher probability of death than those below cut‐offs. A categorical approach combining NT‐proBNP and APACHE II cut‐offs provides additional risk stratification over a single marker approach.

Conclusions

For pneumonia patients admitted to intensive care unit, NT‐proBNP strongly and independently predicts mortality, and its prognostic accuracy is comparable with APACHE II and IDSA/ATS 2007 minor criteria.
Structural Change and Growth in a NEG Model
Authors: Cerina Fabio , Mureddu Francesco
Published: April 2013

This paper presents a New Economic Geography model of structural change, agglomeration and growth. Assuming a non‐homothetic preference structure, our results show that a progressive reduction of trade costs allows the economy to pass from a pre‐industrialized to an industrialized stage and then, within the latter, from a dispersed to an urbanized regime. However, the introduction of capital accumulation and the dynamic setting of our model opens the door to a richer set of implications. First, an additional stage is introduced as, for some intermediate values of trade costs, a multiple equilibria regime emerges with simultaneously stable symmetric and core‐periphery equilibria. Second, the introduction of non‐homotheticity introduces a new channel through which growth is affected by trade costs and agglomeration. In particular, integration is always growth‐enhancing while agglomeration is growth‐detrimental.
On Footloose Industries and Labor Disputes with Endogenous Information Asymmetry
Authors: Chau Nancy H. , Kanbur Ravi
Published: April 2013

If capital becomes internationally mobile but labor does not, are outcomes of labor disputes tilted in favor of workers or employers? In this paper, we show that the answer depends critically on how the information structure of the dispute changes endogenously with capital mobility, and in addition, whether international investment incentives selectively favor the outflow of capital from the most or the least productive firms. In doing so, this paper brings together three strands of literature that are not often seen together—incentive compatible contracting, wage and unemployment outcomes of labor disputes, and international capital mobility with heterogeneous firms.
Liberalization and the Changing Inter‐industry Wage Structure of the Organized Manufacturing Sector in India, 1973/74–2003/04
Authors: Chatterji Monojit , Choudhury Homagni
Published: April 2013

This paper examines the inter‐industry wage structure of the organized manufacturing sector in India for the period 1973/74–2003/04 by estimating the growth of average real wages for production workers by industry. Using wage data on 51 three‐digit industries, our estimation procedure obtains estimates of growth of real wages per worker that are wholly deterministic in nature by accounting for any potential structural break(s) associated with the reforms. Our paper identifies three distinct regimes—pre‐reform, first phase reforms and second phase reforms, over which real wages have grown at varying rates for each industry. Our findings suggest that the inter‐industry wage differences have become more pronounced in the post‐reform periods. The paper provides new evidence from India on the need to consider seriously the hypothesis that industry affiliation is potentially an important determinant of wages when studying any relationship between reforms and wages.
Business Cycle Synchronization between Euro Area andCentral andEasternEuropeanCountries
Authors: Jiménez‐Rodríguez Rebeca , Morales-Zumaquero Amalia , Égert Balázs
Published: April 2013

We analyze the degree of co‐movements in real macroeconomic aggregates across selected euro area andCentral andEasternEuropean (CEE) countries applying a multi‐factor model. Our results suggest that the evolution of the globalEuropean factor matches well the narrative of main economic events between 1995 and 2011, capturing among others the recession during the recent global financial and economic crisis. This factor plays a central role in explaining real output growth variability in euro area and is negligible inCEEcountries. Furthermore, usingMarkov switching models and concordance indices, we shed light on an increase in business cycle synchronization, with the degree of concordance between country‐specific and European business cycles being high.
Precession‐scale cyclicity in the fluvial lower Eocene Willwood Formation of the Bighorn Basin, Wyoming (USA)
Authors: Abels Hemmo A. , Kraus Mary J. , Gingerich Philip D.
Published: April 2013

Little is known about controls on river avulsion at geological time scales longer than 104 years, primarily because it is difficult to link observed changes in alluvial architecture to well‐defined allogenic mechanisms and to disentangle allogenic from autogenic processes. Recognition of Milankovitch‐sale orbital forcing in alluvial stratigraphy would provide unprecedented age control in terrestrial deposits, and also exploit models of allogenic forcing enabling more rigorous testing of allocyclic and autocyclic controls. The Willwood Formation of the Bighorn Basin is a lower Eocene fluvial unit distinctive for its thick sequence of laterally extensive lithological cycles on a scale of 4 to 10 m. Intervals of red palaeosols that formed on overbank mudstones are related to periods of relative channel stability when gradients between channel belts and floodplains were low. The intervening drab, heterolithic intervals with weak palaeosol development are attributed to episodes of channel avulsion that occurred when channels became super‐elevated above the floodplain. In the Deer Creek Amphitheater section in the McCullough Peaks area, these overbank and avulsion deposits alternate with a dominant cycle thickness of ca 7·1 m. Using integrated stratigraphic age constraints, this cyclicity has an estimated period of ca 21·6 kyr, which is in the range of the period of precession climate cycles in the early Eocene. Previous analyses of three older and younger sections in the Bighorn Basin showed a similar 7 to 8 m spacing of red palaeosol clusters with an estimated duration close to the precession period. Intervals of floodplain stability alternating with episodes of large‐scale reorganization of the fluvial system could be entirely autogenic; however, the remarkable regularity and the match in time scales documented here indicate that these alternations were probably paced by allogenic, astronomically forced climate change.
Adolescent Suicidal Trajectories through Young Adulthood: Prospective Assessment of Religiosity and Psychosocial Factors among a Population‐Based Sample in the United States
Authors: Nkansah‐Amankra Stephen
Published: April 2013

The main objective was to identify distinct patterns of suicidal behaviors over the life course from adolescence to young adulthood and to determine influences of religiosity and other contextual factors on subgroup membership. Semiparametric growth mixture models were used to identify distinct clusters of suicide ideation and suicide attempt trajectories, and generalized estimating equations were used to assess individual and contextual characteristics predicting suicidal behaviors in adolescence and in young adulthood. Distinct trajectories of suicide ideation and suicide attempt were identified for the total sample and for the gender groups. Results showed marked gender differences in the trajectory of suicide ideation and attempt patterns. Religiosity effects on suicidality were prominent in adolescence but not in young adulthood. Analysis showed that an important window of opportunity for preventing the escalation of suicidality exists during the early adolescent period, an opportunity that should be emphasized in interventions on adolescence suicide prevention.
The value of obstetric surveillance systems within the National Health Service
Authors: Culshaw Nick , Pasupathy Dharmintra , Kyle Pippa
Published: April 2013

Key content

There are several obstetric surveillance systems currently used within the National Health Service (NHS).

These systems employ a variety of techniques to monitor a range of important health conditions and medical services.

Uses of surveillance data include monitoring disease, clinical audit, research and resource planning.

A surveillance system must be designed appropriately if it is to achieve its desired purpose and remain a justifiable use of public funds.

Learning objectives

To be able to identify the different surveillance system types currently employed within obstetrics and their appropriate uses.

To understand the advantages and limitations of surveillance system data in obstetrics.

To appreciate the importance of appropriate surveillance system design in generating useful data.

Ethical issues

Surveillance systems contain large volumes of personal data. Relevant legal permissions are required to collect, store and permit access to such data that is often collected without explicit consent.
Role of surgery to optimise outcome of assisted conception treatments
Authors: Suresh Yalanadu Narendra , Narvekar Nitish
Published: April 2013

Key content

Assisted conception technology such as in vitro fertilisation (IVF) is the first‐line treatment of many causes of female subfertility and surgery is offered primarily to optimise the outcome of such treatments.

An awareness and understanding of the evidence about the different surgical interventions used prior to assisted conception is essential in achieving the best possible outcome.

Learning objectives

To assess the fertility needs of women including the need for surgery.

To understand the role of different surgical interventions prior to assisted conception for the management of hydrosalpinx, uterine fibroids, uterine pathology such as a uterine septum and intrauterine adhesions, and the treatment of endometriosis and ovarian endometriomas.

Ethical issues

Women should be counselled about the benefits and risks of surgery including the risk of delay to their assisted conception.

A sympathetic approach is needed for women who are already emotionally and physically stressed.

There are financial implications involved in IVF treatment.

Psychosocial issues and anxiety require a multidisciplinary approach.
Management of menstrual problems in adolescents with learning and physical disabilities
Authors: Jeffery Elizabeth , Kayani Salma , Garden Anne
Published: April 2013

Key content

The onset of menarche in adolescents with disabilities can cause significant disruption to their lives.

Menstruation has an impact on the symptom control of various medical conditions.

Signs and symptoms of dysmenorrhoea, menorrhagia and cyclical behavioural disturbances are frequent and distressing.

There are parental and carer concerns regarding menstrual management and hygiene, vulnerability to sexual abuse and pregnancy, as well as inappropriate behaviour.

Research on managing the menstrual problems of adolescents with disabilities is limited; consequently there is little guidance to best practice.

Learning objectives

To recognise the behavioural and emotional changes associated with menstruation.

To be aware of the pros and cons of the different management options available for adolescents with disabilities.

To understand the legislature and the legal issues of consent.

Ethical issues

The role of surgical options for management of menstruation in the adolescent girl.

Informed counselling includes the short and long‐term effects of the disability on menstruation and vice versa, which influence decision‐making.

The contribution of multidisciplinary team in the decision‐making process involving the health and wellbeing of the adolescent.
Preventing recurrent miscarriage of unknown aetiology
Authors: Morley Lara , Shillito Jayne , Tang Thomas
Published: April 2013

Key content

One to three per cent of couples are affected by recurrent miscarriage (defined as more than three consecutive pregnancy losses).

Current interventions are centred on known causes of aetiology.

Recent research on miscarriage of unknown cause has investigated the requirements for successful embryo implantation.

Treatment of immunological risk factors with immunotherapy does not have a strong evidence base.

The overall evidence supporting the use of human chorionic gonadotrophin supplementation during pregnancy is inconclusive.

The efficacy of progesterone as an intervention remains empirical, with further trials under way.

Learning objectives

To understand the aetiology of recurrent miscarriage and patient risk factors.

To understand the theoretical pathophysiology underlying miscarriage of unknown aetiology.

To be aware of the potential agents of intervention for recurrent miscarriage and their efficacy.

Ethical issues

Treating patients with recurrent miscarriage can be emotive; should women be treated with interventions that have limited evidence‐based clinical efficacy?

How do we manage patients with the psychological impact of recurrent miscarriage?
Surrogate pregnancy: ethical and medico‐legal issues in modern obstetrics
Authors: Burrell Celia , O'Connor Hannah
Published: April 2013

Key content

This comprehensive literature review of the medico‐legal challenges of surrogacy in modern obstetrics, highlights recent changes in UK law, the limited guidelines and legislation available, and the legal requirements for parenthood and parental rights.

UK legislation involving surrogacy and the medico‐legal definition of parenthood is reviewed.

There is new UK surrogacy legislation affecting the parental order qualification, indicating that obstetricians will see more surrogate cases in the immediate future.

Conflicts can arise when surrogacy agreements are broken, since they are lawful but legally unenforceable in the UK.

There are ethical and legal dilemmas for healthcare professionals in managing surrogate pregnancies in the absence of professional guidance, and as a result the authors of this review introduced a practical guide and pro forma.

Learning objectives

To explain current legislation surrounding surrogacy in the UK.

To discuss ethical and moral concerns regarding the practice of surrogacy.

To apply medico‐legal principles in the management of surrogate pregnancy.

Ethical issues

The exploitation versus empowerment and autonomy of women participating in surrogacy.

The commodification of reproduction through surrogacy.

The validity of consent with the possible presence of emotional or financial coercion, and the unpredictability of outcomes in surrogacy arrangements.
Noninvasive methods for haemoglobin screening in prospective blood donors
Authors: Belardinelli A. , Benni M. , Tazzari P. L. , Pagliaro P.
Published: April 2013

Background and Objectives

The haemoglobin level of prospective blood donors is usually performed on blood obtained by from the finger pulp by fingerstick with a lancet and filling a capillary tube with a sample. New noninvasive methods are now available for rapid, noninvasive predonation haemoglobin screening.

Materials and Methods

Prospective blood donors at our blood centre were tested, in two different trials, as follows: by the NBM 200 (OrSense) test (n = 445 donors) and by the Pronto‐7 (Masimo) test (n = 463 donors). The haemoglobin values of each trial and the haemoglobin of finger pulp blood obtained by fingerstick with a lancet (HemoCue) were compared with the haemoglobin values obtained from a venous sample on a Cell Counter (Beckman Coulter).

Results

Comparison of Beckman Coulter Cell Counter and OrSense and results showed a bias of 0·29 g/dl, the standard deviation of the differences (SDD) of 0·98 and 95% limits of agreement from −1·64 to 2·21, using Bland and Altman statistical methodology. Comparison of Masimo and Beckman Coulter Cell Counter results showed a bias of −0·53 g/dl, SDD of 1·04 and 95% limits of agreement from −2·57 to 1·51. Cumulative analysis of all 908 donors, as tested by the usual fingerstick test showed a bias of 0·83 g/dl, SDD of 0·70 and 95% limits of agreement from −0·54 to 2·20 compared with the Coulter Cell Counter. Compared with the Coulter Counter, the specificity of the methods was 99·5% for fingerstick, 97% for OrSense and 83% for Massimo, and the sensitivity was 99, 98 and 93%, respectively.

Conclusions

Analysis of finger pulp blood by either direct sampling by fingerstick and Hemocue, or by noninvasive haemoglobin tests does not replicate the results of cell counter analysis of venous samples. Compared with fingerstick, noninvasive haemoglobin tests eliminate pain and reduce stress, but have a lower level of specificity and sensitivity.
A source model for modulated electron radiation therapy using dynamic jaw movements
Authors: Papaconstadopoulos Pavlos , Seuntjens Jan
Published: April 2013

Purpose:

The development of fast and accurate source models (SMs) might be of crucial importance for the future clinical implementation of modulated electron radiation therapy (MERT). In this study, a SM is presented for reconstructing phase‐space information of modulated electron beams using a few‐leaf electron collimator (FLEC) and the photon jaws.

Methods:

During a FLEC‐based delivery, two collimation devices (jaws and FLEC) modulate the electron beam characteristics dynamically. The SM separates the beam into a primary and a scattered component. The primary component is derived by a fast Monte Carlo (MC) transport calculation in air using the EGSnrc/BEAMnrc code. The scattered beam is modeled analytically. The accelerator was decomposed into its individual leaf components and the scattered beam was characterized at various levels of the accelerator. Scattered particles are assigned an energy and position by sampling pre‐calculated probability distributions. The direction is estimated by geometrical arguments. Particles were assumed to emerge from tunable virtual sources on the side of each collimator leaf. A leaf‐hit algorithm was developed to dynamically reject particles that are incident on any collimating leaf. Electron transport in air between the two collimation levels was calculated based on a MC‐modified version of the Fermi‐Eyges scattering theory. Correlations between direction and position were observed and taken into account at the final collimation level.

Results:

To validate the model, reconstructed phase‐space data were compared with the full accelerator MC phase‐space data. The model accurately reproduced the beam characteristics and preserved important correlations. Depth and profile dose distributions in water were derived for square, rectangular, and off‐axis field sizes and for a range of clinical energies. Discrepancies in the dose distributions and dose output were within 3% in all cases.

Conclusions:

Fast and accurate SMs open the possibility for fast treatment planning in MERT, based on an inverse optimization MC treatment planning scheme.