bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of pelvic and para‐aortic lymphadenectomy in endometrial cancer: Current evidence
Authors: Bogani Giorgio , Dowdy Sean C. , Cliby William A. , Ghezzi Fabio , Rossetti Diego , Mariani Andrea
Published: January 2014

The aim of the present review is to summarize the current evidence on the role of pelvic and para‐aortic lymphadenectomy in endometrial cancer. In 1988, the International Federation of Obstetrics and Gynecology recommended surgical staging for endometrial cancer patients. However, 25 years later, the role of lymph node dissection remains controversial. Although the findings of two large independent randomized trials suggested that pelvic lymphadenectomy provides only adjunctive morbidity with no clear influence on survival outcomes, the studies have many pitfalls that limit interpretation of the results. Theoretically, lymphadenectomy may help identify patients with metastatic dissemination, who may benefit from adjuvant therapy, thus reducing radiation‐related morbidity. Also, lymphadenectomy may eradicate metastatic disease. Because lymphatic spread is relatively uncommon, our main effort should be directed at identifying patients who may potentially benefit from lymph node dissection, thus reducing the rate of unnecessary treatment and associated morbidity. This review will discuss the role of lymphadenectomy in endometrial cancer, focusing on patient selection, extension of the surgical procedure, postoperative outcomes, quality of life and costs. The need for new surgical studies and efficacious systemic drugs is recommended.
Bupropion effects on high-fat diet-induced steatohepatitis and endothelial dysfunction in rats: role of tumour necrosis factor-alpha
Authors: Ahmed Mai , El-Bakly Wesam M , Zaki Ahmed M , abd Alzez Lobna F , El serafi Osama
Published: January 2014

Objectives

This study aimed to elucidate the effect of bupropion (BUP) on high-fat diet (HFD)-treated rats that is to say the action of BUP on diabetes and hyperlipidemia with its consequences on liver and endothelial function.

Methods

Male Wistar rats were fed HFD or normal chow for 15 weeks then given either BUP (50 mg/kg) or distilled water by gavage for 4 weeks. The effect of BUP on diabetes, hyperlipidemia, hepatic and vascular functions as well as tumour necrosis factor-alpha (TNF)-α were assessed. The intima-media thickness of the aorta was evaluated.

Key findings

BUP significantly decreased serum lipid, liver enzyme, homeostasis model assessment for insulin resistance (HOMA-IR), serum TNF-α and the impaired glucose tolerance. Liver from rats with non-alcoholic steatohepatitis (NASH) demonstrated significant higher TNF-α level, inflammatory cell infiltration, ballooning and steatosis which significantly ameliorated by BUP treatment. Neither intima/media ratio nor vascular reactivity to acetylcholine is improved by BUP treatment.

Conclusions

NASH induced by a HFD was associated with hyperlipidemia, insulin resistance, endothelial dysfunction and increase in liver TNF-α. All of these may contribute to the pathogenesis of NASH. BUP has potential role in improving metabolic and hepatic function with negative vascular effect. Since BUP is a well-known antidepressant, it will be a candidate drug in treatment of depression in hepatic diseased or metabolic disturbed patients.
Propagule limitation and competition with nitrogen fixers limit conifer colonization during primary succession
Authors: Titus Jonathan H. , Bishop John G.
Published: January 2014

Questions

Is conifer colonization on primary successional sites limited by propagule availability or environmental filters? How do nitrogen‐fixing pioneer species (Lupinus lepidus and Alnus viridis) affect conifer emergence and establishment?

Location

Mount St. Helens, Washington State, USA.

Methods

We planted seeds of Pseudotsuga menziesii in four habitat types – barrens, young and old Lupinus patches and Alnus thickets – in a partial factorial cross with shade and soil disturbance treatments in 2002, 2003 and 2004, and monitored survival through 2006. We compared experimental results with surveys of natural establishment in 2007 and 2010.

Results

Pseudotsuga menziesii emergence and survival were highest in barren and young Lupinus sites and low in old Lupinus and Alnus patches, but varied greatly among cohorts. In barrens, nearly 50% of germinated seedlings of the 2002 cohort survived year 1 and 25% through year 4, compared to 10% (year 1) and ~0% (to year 4) survival in other habitats. Survival rates were lower in subsequent cohorts. Emergence and establishment were enhanced by shade and initial soil disturbance in barren sites and young Lupinus patches. Soil moisture was higher in barren and young Lupinus habitats. Post‐experiment surveys indicated older trees were six times more abundant on sites with old Lupinus patches and Alnus thickets, consistent with earlier colonization at those sites driven by seed availability, but total tree density increased more rapidly in sites with barren and young Lupinus habitats, surpassing older sites by 2010, as predicted from experimental results.

Conclusion

Increased seedling survival in barren and young Lupinus sites and under shade was attributable to decreased competition for soil moisture in those sites, possibly combined with apparent competition in old Lupinus and Alnus sites via seed and seedling predators. Overall, high emergence and survival rates in low‐density habitats suggest that P. menziesii colonization is strongly propagule limited, and that survival of seeds that successfully arrive and germinate is more strongly affected by competition in early succession than by soil N. This conclusion is supported by evidence for decreased recruitment over time in old Lupinus patches and Alnus thickets and accelerating recruitment in areas with less developed vegetation.
Teachable Moments, Learnable Moments: Medical Rounds as a Paradigm for Education
Authors: de Luise Vincent P.
Published: January 2014

The medical profession has for almost a century employed various types of “Rounds” as pedagogical tools to engage physicians, physicians‐in‐training, and their health care teams in the clinical diagnosis and treatment of patients. More recently, this validated paradigm of medical rounds (MR) has been extended to the field of education, where it is being used as an effective strategy for administrators to better understand their own domain. There are four distinct types of MR which can be further analyzed to find commonalities and parallels with the domain of education. The four types of MR are (1) Morning Rounds, (2) Chart Rounds, (3) Grand Rounds, and (4) Ongoing Collaborations—each have unique pedagogical characteristics and serve different functions. They are, however, unified by common threads of dynamic and interpersonal interactions wherein teacher (physician) and learner (physician‐in‐training) share learning and fluidly exchange roles in the pedagogy. MR models supplant the now outmoded theory of the “empty vessel” and corroborate the concept of the teaching brain. A formal analysis of MR underscores its ongoing utility in education both for its pedagogical innovations and for the Interactive and inherently human attributes that are required between teacher and learner for its efficacy.
Evolutionary Perspectives on Mind, Brain, and Education
Authors: Howard‐Jones Paul A.
Published: January 2014

Understanding about human origins informs our understanding of what it means to be human. It is reasonable, therefore, to consider that an evolutionary perspective can provide insight into the nature and processes of human learning and education. This article reviews how ideas about evolution have influenced educational thinking in the past. It then considers how understanding of brain development and function is helping to inspire “new thinking” about evolution. The review converges on a range of benefits that may arise from the inclusion of evolutionary concepts within the field of mind, brain, and education. These benefits include scrutiny of evolutionary neuromyth, reconsideration of the cultural and political status of education, insight into notions of individual difference, and help with stimulating and directing research efforts aimed at improving educational outcomes.
An unusual repressor controls the expression of a crucial nicotine‐degrading gene cluster in Pseudomonas putida S16
Authors: Wang Lijuan , Tang Hongzhi , Yu Hao , Yao Yuxiang , Xu Ping
Published: January 2014

Transcriptional factors that contain helix–turn–helix (HTH) DNA‐binding domains are widespread in bacteria for regulating gene expression on demand, and function as homodimers that bind a palindromic DNA segment. Here, we show that an HTH‐containing transcriptional regulator, NicR2, in Pseudomonas putida S16 plays a critical role in controlling the expression of a crucial gene cluster (nic2) in nicotine degradation, and NicR2 binds DNA in a manner different from most other DNA‐binding proteins that use HTHs for recognition. Electrophoretic mobility shift assay (EMSA) and DNase I footprinting indicate that NicR2 directly interacts with a 28 bp inverted repeat (IR) in the nic2 promoter region. Using EMSA with synthetic DNA fragments, we found that both NicR2 dimer and tetramer can bind to the half‐site of the IR. This is confirmed independently by biolayer interferometry and cross‐linking experiments. Our results indicate that two NicR2 dimers bind to the IR cooperatively through protein–protein interactions, with each dimer binding the half‐site of the IR. Thus, NicR2 appears to be an unusual regulator, which uses HTH for recognition and displays the binding characteristics of some regulators that use β‐sheets. The transcriptional regulation of nicotine degradation in Pseudomonas highlights a new level of complexity in prokaryotic transcriptional regulation.
Efficacy of deep brain stimulation in an adolescent patient with DYT11 myoclonus‐dystonia
Authors: Kimura Yasuyoshi , Mihara Masahito , Kawarai Toshitaka , Kishima Haruhiko , Sakai Norio , Takahashi Masanori P. , Mochizuki Hideki
Published: January 2014

Myoclonus‐dystonia is a movement disorder characterized by myoclonic jerks and dystonia. We herein report the case of an 18‐year‐old Japanese male patient with DYT11 myoclonus‐dystonia who developed myoclonic jerks at 2 years‐of‐age. He harbored a novel heterozygous mutation in the major responsible gene, ε‐sarcoglycan. As medication was ineffective and the myoclonus had become disabling, deep brain stimulation of the bilateral globus pallidus internus was carried out. After surgery, his symptoms showed overt improvement. Although reports of deep brain stimulation treatment in children or adolescents with myoclonus‐dystonia are scarce, the treatment should be considered when symptoms, particularly myoclonus, become refractory, sustained and disabling.
Strengthening systems for integrated early childhood development services: a cross‐national analysis of governance
Authors: Britto Pia Rebello , Yoshikawa Hirokazu , van Ravens Jan , Ponguta Liliana Angelica , Reyes Maria , Oh Soojin , Dimaya Roland , Nieto Ana María , Seder Richard
Published: January 2014

While there has been substantial growth in early childhood development (ECD) services in low‐ and middle‐income countries (LMICs), there is considerable inequity in their distribution and quality. Evidence‐based governance strategies are necessary, but currently they are insufficient for widespread, quality implementation. In particular, there is a limited understanding of the use of systems approaches for the analysis of ECD services as they go to scale. The aim of this paper is to present findings from four countries, using a cross‐national case study approach to explore governance mechanisms required to strengthen national systems of ECD services. While different sets of governance strategies and challenges were identified in each country, overarching themes also emerged with implications for systems strengthening. Study results focus on local, mid‐level and central governance, with recommendations for effective coordination and the integration of ECD services in LMICs.
Cost–benefit analysis of a micronutrient supplementation and early childhood stimulation program in Nicaragua
Authors: Boo Florencia Lopez , Palloni Giordano , Urzua Sergio
Published: January 2014

This paper estimates the cost–benefit ratio for an integrated early childhood development program in Nicaragua (PAININ). Using longitudinal data, we estimate the average treatment effects of PAININ including micronutrient sprinkles on the prevalence of anemia and hemoglobin levels among disadvantaged children aged 6–36 months. We also estimate the effects of PAININ excluding sprinkles on cognitive outcomes among children aged 2.5–5 years. In the younger age group the program reduced anemia by 4 percentage points after 8 months and nearly 6 percentage points after 1 year; the latter is a 26% decrease in anemia. In the older age group, the program improved verbal and numeric memory after a year and a half, but the effects were modest (0.13 SD). When analyzing its potential impact on earnings, we conclude that the discounted annual costs of the program per child are less than the discounted annual increase in beneficiary earnings. Specifically, we estimate a cost–benefit ratio of 1.50 from the PAININ plus sprinkles package. Our sensitivity analysis suggests a range for this ratio between 1.30 and 2.30.
Drought stress provokes the down‐regulation of methionine and ethylene biosynthesis pathways in Medicago truncatula roots and nodules
Authors: LARRAINZAR ESTÍBALIZ , MOLENAAR JOHANNA A. , WIENKOOP STEFANIE , GIL‐QUINTANA ERENA , ALIBERT BÉNÉDICTE , LIMAMI ANIS M. , ARRESE‐IGOR CESAR , GONZÁLEZ ESTHER M.
Published: January 2014

Symbiotic nitrogen fixation is one of the first physiological processes inhibited in legume plants under water‐deficit conditions. Despite the progress made in the last decades, the molecular mechanisms behind this regulation are not fully understood yet. Recent proteomic work carried out in the model legume Medicago truncatula provided the first indications of a possible involvement of nodule methionine (Met) biosynthesis and related pathways in response to water‐deficit conditions. To better understand this involvement, the drought‐induced changes in expression and content of enzymes involved in the biosynthesis of Met, S‐adenosyl‐L‐methionine (SAM) and ethylene in M. truncatula root and nodules were analyzed using targeted approaches. Nitrogen‐fixing plants were subjected to a progressive water deficit and a subsequent recovery period. Besides the physiological characterization of the plants, the content of total sulphur, sulphate and main S‐containing metabolites was measured. Results presented here show that S availability is not a limiting factor in the drought‐induced decline of nitrogen fixation rates in M. truncatula plants and provide evidences for a down‐regulation of the Met and ethylene biosynthesis pathways in roots and nodules in response to water‐deficit conditions.
Herbivore‐induced volatile emission in black poplar: regulation and role in attracting herbivore enemies
Authors: CLAVIJO MCCORMICK ANDREA , IRMISCH SANDRA , REINECKE ANDREAS , BOECKLER G. ANDREAS , VEIT DANIEL , REICHELT MICHAEL , HANSSON BILL S. , GERSHENZON JONATHAN , KÖLLNER TOBIAS G. , UNSICKER SYBILLE B.
Published: January 2014

After herbivory, plants release volatile organic compounds from damaged foliage as well as from nearby undamaged leaves that attract herbivore enemies. Little is known about what controls the volatile emission differences between damaged and undamaged tissues and how these affect the orientation of herbivore enemies. We investigated volatile emission from damaged and adjacent undamaged foliage of black poplar (Populus nigra) after herbivory by gypsy moth (Lymantria dispar) caterpillars and determined the compounds mediating the attraction of the gypsy moth parasitoid Glyptapanteles liparidis (Braconidae). Female parasitoids were more attracted to gypsy moth‐damaged leaves than to adjacent non‐damaged leaves. The most characteristic volatiles of damaged versus neighbouring undamaged leaves included terpenes, green leaf volatiles and nitrogen‐containing compounds, such as aldoximes and nitriles. Electrophysiological recordings and olfactometer bioassays demonstrated the importance of nitrogenous volatiles. Under field conditions, parasitic Hymenoptera were more attracted to traps baited with these substances than most other compounds. The differences in volatile emission profiles between damaged and undamaged foliage appear to be regulated by jasmonate signalling and the local activation of volatile biosynthesis. We conclude that characteristic volatiles from damaged black poplar foliage are essential cues enabling parasitoids to find their hosts.
A case of diffuse infiltrating gastrointestinal stromal tumor of sigmoid colon with perforation
Authors: Yamashita Daisuke , Usami Yu , Toyosawa Satoru , Hirota Seiichi , Imai Yukihiro
Published: January 2014

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, and typically present as discrete well‐circumscribed but non‐encapsulated tumor masses. In this report, we describe a case of colonic perforation caused by an unusual form of GIST. A 72‐year‐old Japanese woman presented to the emergency department with acute abdominal pain. Under the provisional diagnosis of sigmoid colon perforation, a laparoscopic sigmoidectomy was performed. Although the tumor mass was undetectable during the preoperative examination, a spindle cell lesion with a diffuse longitudinal growth pattern replacing the muscularis propria was revealed by microscopic examination. The spindle cell lesion was exposed at the perforation, suggesting a causal relationship between the lesion and the perforation. The spindle cell lesion was KIT‐positive and had a mutation in the C‐KIT gene at exon 11. We diagnosed it as diffuse infiltrating GIST. We consider that the lesion would be a cause of the colonic perforation, and emphasize the importance of accurate diagnosis of the lesion by histological, immunohistochemical and genetic examinations.
Muse cells, newly found non‐tumorigenic pluripotent stem cells, reside in human mesenchymal tissues
Authors: Wakao Shohei , Akashi Hideo , Kushida Yoshihiro , Dezawa Mari
Published: January 2014

Mesenchymal stem cells (MSCs) have been presumed to include a subpopulation of pluripotent‐like cells as they differentiate not only into the same mesodermal‐lineage cells but also into ectodermal‐ and endodermal‐lineage cells and exert tissue regenerative effects in a wide variety of tissues. A novel type of pluripotent stem cell, Multilineage‐differentiating stress enduring (Muse) cells, was recently discovered in mesenchymal tissues such as the bone marrow, adipose tissue, dermis and connective tissue of organs, as well as in cultured fibroblasts and bone marrow‐MSCs. Muse cells are able to differentiate into all three germ layers from a single cell and to self‐renew, and yet exhibit non‐tumorigenic and low telomerase activities. They can migrate to and target damaged sites in vivo, spontaneously differentiate into cells compatible with the targeted tissue, and contribute to tissue repair. Thus, Muse cells may account for the wide variety of differentiation abilities and tissue repair effects that have been observed in MSCs. Muse cells are unique in that they are pluripotent stem cells that belong in the living body, and are thus assumed to play an important role in ‘regenerative homeostasis’ in vivo.
Diaporthe sclerotioides exhibits no host specificity among cucurbit species
Authors: Shishido M. , Ohashi T. , Momma N.
Published: January 2014

Plant–fungal specificity between cucurbitaceous crops and Diaporthe sclerotioides, the causal agent of black root rot, was studied using cucumbers (Cucumis sativa), melons (Cucumis melo), pumpkins (Cucurbita maxima), watermelons (Citrullus lanatus) and bottlegourd (Lagenaria siceraria var. gourda). Twelve D. sclerotioides isolates from these cucurbit species were cross‐inoculated. The virulence of the isolates was evaluated as the area under the disease progress curve (AUDPC). All cucurbit species were susceptible to each isolate, but AUDPCs were significantly different among the hosts, with the order of greatest to least being melon, cucumber, watermelon, bottlegourd and finally, pumpkin. The infectiveness of isolates was assessed as the quantity of D. sclerotioides DNA detected in the hypocotyls of seedlings 2 weeks after inoculation using a real‐time PCR protocol. The fungal DNA quantities varied among the species in the same order as the AUDPCs. Whilst there were statistically significant correlations between the virulence and infectiveness of D. sclerotioides isolates in cucumbers, melons and bottlegourds, their coefficients of determination were not high (r2 < 0·6). Orthogonal contrasts indicated no specificity in either the fungal virulence or infectiveness between D. sclerotioides isolates and the cucurbit hosts from which these isolates originated. Thus, although the degree of host susceptibility to D. sclerotioides varies among cucurbit species, the absence of specificity to the host species in either virulence or infectiveness suggests the pathogen may spread via various cucurbit crops, irrespective of their original host species.
High prevalence of malignancy in HIV‐positive patients with mediastinal lymphadenopathy: A study in the era of antiretroviral therapy
Authors: Alçada Joana , Taylor Magali N. , Shaw Penny J. , Janes Sam M. , Navani Neal , Miller Robert F.
Published: January 2014

Background and objective

Mediastinal lymphadenopathy (MLN) in human immunodeficiency virus (HIV) infection has a wide spectrum of aetiologies with different prognoses and treatments. The decision to pursue a histopathological diagnosis represents a clinical challenge as patients present with non‐specific symptoms. This study aimed to determine the aetiology and predictive factors of MLN in a cohort of HIV‐infected patients in the combination antiretroviral therapy (cART) era.

Methods

Single‐centre retrospective cohort study of 217 consecutive HIV‐infected patients who underwent computed tomography (CT) of the chest between January 2004 and December 2009. Fifty‐two patients were identified to have MLN (>10 mm in short axis). CT images were re‐reviewed by an independent radiologist blinded to the clinical information. Final diagnoses of MLN were obtained from clinical records. Multivariate analysis was performed to identify predictors of aetiology of MLN.

Results

Seventeen patients (33%) had a diagnosis of malignancy. Consolidation on CT was associated with a reduced likelihood of malignancy odds ratio (OR) 0.03 (95% confidence interval 0.002–0.422), and larger lymph nodes were associated with an increase in the odds of malignancy (OR 2.89; 95% confidence interval 1.24–6.71). CD4 count was found not to be a predictor of aetiology of MLN.

Conclusions

In the era of combination cART, opportunistic infections and malignancy remain to be the frequent causes of MLN in HIV‐positive patients, but the prevalence of non‐HIV related malignancy has increased compared with previous studies. Although certain findings are predictors of non‐malignant disease, pathological diagnosis of MLN in HIV‐positive patients should be pursued whenever possible.
Unravelling the influence of water depth and wave energy on the facies diversity of shelf carbonates
Authors: Purkis Sam J. , Rowlands Gwilym P. , Kerr Jeremy M.
Published: January 2014

Carbonate sequence stratigraphy is founded on the principle that changes in relative sea‐level are recorded in the rock record by the accumulation of sediment with relative water depth‐dependent attributes. While at the scale of a shelf to basin transect, facies clearly arrange by water depth, the relation blurs for depths <40 m, the most vigorous zone of carbonate production. The reason for this change in behaviour is two‐fold. Firstly, in shallow water, the intrinsic processes of storm and wave reworking influence the seabed through submarine erosion and sediment redistribution. Secondly, facies diversity tends to be greater in shallow water than deep water because of a greater diversity in grain producers. Remote sensing imagery, field observations and hydrodynamic models for two reef‐rimmed shore‐attached carbonate platforms in the Red Sea show neither water depth nor energy regime to be reliable indicators of facies type when considered in isolation. Considered together, however, the predictive power of the two variables rises significantly. The results demonstrate it to be an oversimplification to assume a direct link between palaeo‐water depth and depositional diversity of subtidal lithofacies, while highlighting the importance of hydrodynamics in directing the accumulation of carbonate sediments in the shallow photic zone. While the size distributions of facies extents in the two focus areas follow power laws, no direct relation between the lateral continuity of the facies belts and water depth or wave height is reported. The work is relevant for the interpretation of metre‐scale subtidal carbonate cycles throughout the geological record by demonstrating how caution must be applied when inferring palaeo‐water depths from depositional facies.
The Scandinavian athlete's heart; echocardiographic characteristics of male professional football players
Authors: Gjerdalen G. F. , Hisdal J. , Solberg E. E. , Andersen T. E. , Radunovic Z. , Steine K.
Published: January 2014

This investigation explores the cardiac four‐chamber remodeling response to training in male players in Norwegian professional football league, and ethnicity as determinants in the development of athlete's heart. Standard 2D echocardiographic examination and analysis of all four cavities were performed in 504 football players of Caucasian origin, 49 of African origin, and 47 matched Caucasian controls (<3 h training /week). All results were indexed to body surface area (BSA). Most athletes exhibited BSA‐indexed values within normal ranges. Left ventricle (LV) mass was equally enlarged in both groups of athletes, but LV relative wall thickness and right ventricular (RV) relative wall thickness were increased in Africans compared with Caucasian athletes (0.37 ± 0.06 vs 0.33 ± 0.06 and 0.25 ± 0.06 vs 0.22 ± 0.04, respectively). Both LV and RV were smaller in Africans than in Caucasian athletes (67.8 ± 12.0 ml/m2 vs 73.6 ± 13.2 ml/m2 and 12.8 ± 2.1 vs 13.7 ± 2.4 cm2/m2, respectively, both P < 0.05), while left and right atria increased similarly. This first large‐scale echocardiographic survey of elite football players in a Scandinavian league suggests use of BSA‐indexed upper normal limits for both LV and RV in athletes. African athletes had significantly more concentric remodeled LV and RV than the Caucasian athletes.
Including the Tukey Mean‐Difference (Bland–Altman) Plot in a Statistics Course
Authors: Kozak Marcin , Wnuk Agnieszka
Published: January 2014

The Tukey mean‐difference plot, also called the Bland–Altman plot, is a recognized graphical tool in the exploration of biometrical data. We show that this technique deserves a place on an introductory statistics course by encouraging students to think about the kind of graph they wish to create, rather than just creating the default graph for the variables types they have. This graphical technique is described, and two examples are presented: one dealing with official agricultural data of Poland and the other one with an experiment on anorexia. Our opinion is that the plot is so easy and yet efficient in visualizing paired data that it should be included in statistics courses to support understanding and interpretation of data and their analysis. © 2014 The Authors. Teaching Statistics © 2014 Teaching Statistics Trust
Reduction in red blood cell transfusion associated with engagement of the ordering physician
Authors: Tavares Maria M. , Diquattro Pamela J. , Sweeney Joseph D.
Published: January 2014

Background

Data on red blood cell (RBC) transfusion in the United States show variation in practice and overprescribing or overdosing is considered to be prevalent. Education or restrictive interventions could modify practice.

Study Design and Methods

RBC transfusion and mortality rates were recorded in a single institution over a 15‐year period. The first 3 years were used as a baseline. Education measures were used to influence practice for 3 years followed by a 9‐year period when questionable RBC orders in nonbleeding inpatients resulted in prospective physician notification for potential modification. Physician notification was done by blood bank technologists with transfusion medicine physician support, if needed. Pretransfusion hemoglobin levels of more than 9 g/dL were recommended for cancellation and levels between 8 and 9 g/dL advised for a single unit, if 2 or more units were requested. RBC transfusion rates were described as inpatient units per 1000 discharges to allow for interyear comparison.

Results

A downward trend in RBC transfusion was noted for the intervention period. Comparison of the baseline period with the past 3 years of the intervention period showed an approximate 33% decrease, which was highly significant (508 ± 66 vs. 341 ± 32, p < 0.01). Inpatient mortality rates declined over this period.

Conclusion

Physician education in appropriate transfusion practice is desirable but may not greatly impact RBC use. Engagement of physicians who prescribe RBCs that appear inappropriate for indication or dose was associated with a significant decline in RBC use without evidence of a change in mortality.
Turbocharger Synchronous Vibration Control on High Speed Balancer: Test and Prediction
Authors: Gjika Kostandin , Mahadevan Pradeep , Costeux Antoine
Published: January 2014

Current trends for advanced automotive engines focusing on downsizing, better fuel efficiency, and lower emissions have led to several changes in turbocharger bearing systems design, and technology. Automotive turbochargers are running faster under high engine vibration level. Vibration control is becoming a real critical issue and turbocharger manufacturers are focusing more and more on new and improved balancing technology. This paper deals with turbocharger synchronous vibration control on high speed balancers. In a first step the synchronous rotordynamics behavior is identified. The developed fluid bearing code predicts bearing rotational speed (in case of fully floating design), operating inner and outer bearing film clearances and bearing force coefficients. A rotordynamics code uses this input to predict the synchronous lateral dynamic response of the rotor-bearing system by converging with bearing eccentricity ratio. The rotor-bearing system model is validated by shaft motion test data on high speed balancer (HSB). It shows that only one of the peaks seen on the synchronous G level plot collected in a high speed balancer can be explained by rotordynamics physics. A step-by-step structural dynamics model and analysis validated by experimental frequency response functions provides robust explanations for the other G level peaks. The synchronous vibration response of the system “turbocharger-HSB fixture” is predicted by integrating the predicted rotordynamics rotational bearing loads on the structural dynamics model. Numerous test data show very good correlation with the prediction, which validates the developed analytical model. The “rotordynamics—structural dynamics model” allows deep understanding of turbocharger synchronous vibration control, as well as optimization of the high speed balancer tooling.
Experimental Study of Sand Particle Concentration Profiles in Straight and Pipe Elbow for Horizontal Multiphase Flows
Authors: Kesana N. R. , Vieira R. , McLaury B. S. , Shirazi S. A.
Published: January 2014

Sand production is one of the major concerns for oil and gas producers. If production fluid velocities are not controlled properly, the produced sand may erode the pipelines which may result in pipe failures and halt the production causing economical losses as well as environmental issues. In order to better understand the erosion mechanism and improve current erosion models, it would be beneficial to identify the distribution of sand flowing inside the pipe. Therefore, sand sampling was performed at five different locations inside a 0.0732 m (3 in.) diameter horizontal pipe at L/D ∼ 150 using a pitot-style tube 6.35 mm (0.25 in.) in diameter. The probe was moved transversely from the top of the pipe and the face of the probe is facing the fluid flow to achieve sampling close to isokinetic conditions. Additionally, sampling experiments were conducted using the fixed mounted ports at the pipe wall. Using the fixed mounted ports, sampling is conducted both in a straight pipe section and elbow section. Experiments were performed in two different multiphase flow patterns (slug and wavy-annular) using two different particle sizes (150 μm and 300 μm) and three different liquid viscosities (1 cP, 10 cP, 40 cP). The influence of particle diameter, liquid viscosity, and the flow pattern on the sand distribution profiles will be discussed. From the experimental data, the recommended approaches for flowing concentration measurements are discussed. Finally, the implications of the sand concentration measurements on erosion are mentioned.
Anterior Instability of the Shoulder: Effect of Arm Position and Relative Contributions of Bony Bankart and Hill-Sachs Defects
Authors: Walia Piyush , Miniaci Anthony , Jones Morgan H. , Fening Stephen D.
Published: January 2014

Shoulder stability can be significantly reduced in the presence of bony defects. Bony Bankart and Hill-Sachs lesions are known causes for recurrent shoulder dislocation. It has been shown in literature that often these defects are present together during cases of recurrent dislocation. 1 However, past studies have only analyzed the effects of isolated bony Bankart or Hill-Sachs lesions. 2, 3 Recent studies have stated that a Hill-Sachs lesion that “engages” the anterior glenoid has a critical impact on shoulder stability. 4 It is important to understand the relationship between these two bony defects, as this would lead to better management of the shoulders’ instability.
Expediting Spinal Cord Stimulation Lead Design With Anatomical Bench Modeling
Authors: Wang Ling , Zhang Haitao , Noel Gary
Published: January 2014

A new testing method with an anatomic bench model was developed to replace cadaver studies as a means to validate lead design/development. The test methodology was verified with cadaver study results and physician feedback. Four different lead designs were characterized through this methodology. The methodology could save one year of lead development time and $60k in costs.
Comparison of Mechanical Variable Identifiers of Brain Injury
Authors: Qidwai Siddiq M. , Kota Nithyanand , Leung Alan C. , Bagchi Amit
Published: January 2014

Multiple mechanical variables have been used to describe the occurrence of brain injury in impact modeling of the human head [1, 2]. The validity of these variables for this purpose is usually established separately through the following process. First, a loading test is performed on an animal. Location, type and spatial extent of injury on the brain are measured upon or after loading. Subsequently, computational simulation is performed based on a particular constitutive model of the brain. Mechanical variables such as pressure or effective stress are plotted for the region of interest. The magnitude of the mechanical variable that results in a contour of the same size as the observed extent of experimental injury is declared as the critical value for that type of injury. The choice of mechanical variable itself could be based on conventional wisdom, precedence, or experience of the researcher. Another, much simpler variable-injury correlation process, which does not rely upon simulations, uses the ex vivo failure response of brain tissue as the criterion. For example, the uniaxial failure strain of the tissue may be taken as the critical value for injury.
Modeling Finger Capabilities for Use in Assessment and Monitoring of Hand Rehabilitation
Authors: Leitkam Sam , Bush Tamara Reid
Published: January 2014

Rehabilitation of the hand is often necessary for individuals to regain function following events such as a stroke, injury, or surgery [1]. To understand whether function is being restored with rehabilitation, measures of function must be quantified and presented in a manner that shows the current level of progress in comparison with the initial and potential abilities. The model presented in this research represents a unique way to view and interpret functional abilities and limitations of the hand prior to, during, and after rehabilitation.
Cost Optimization of a Multilayer Microchannel Dialyzer
Authors: Mohammadi Mahshid , Sharp Kendra V.
Published: January 2014

A microchannel-based hemodialyzer offers a novel approach to hemodialysis practice and holds many promises to improve kidney patients’ life quality and dialysis treatment efficiency. The hallow fiber hemodialyzer, a conventional dialysis device, has certain limitations including non-uniformity of the dialysate flow path which necessitates the use of a high dialysate flow rate. The microchannel-based hemodialyzer with flat membranes remarkably improves the mass transfer characteristics and enables the design of a smaller and less expensive unit with lower dialysate-to-blood flow rate ratios [1, 2]. In the microchannel-based design, successive stacked layers alternate between blood flow and dialysate flow. A porous membrane between these layers allows for the transport of toxins from blood side to dialysis fluid side. A schematic view of a single layer is shown in Fig. 1.
Cell Adhesion on a Wavy Surface
Authors: Hu Jia , Liu Yaling
Published: January 2014

The ability to control the position of cells in an organized pattern on a substrate has become increasingly important for biosensing and tissue engineering applications [1–3]. With the advent of nanofabrication techniques, a number of researchers have studied the effects of nano-scale grooves on cell spreading, migration, morphology, signaling and orientation [4–6]. Recent studies have shown that cell adhesion/spreading can be influenced by a nanostructured surface [7]. In most current studies, the pattern dimensions are much smaller than the size of a cell. In this paper, we focus on studying cell response to micro scale patterns instead of nano-scale patterns.
Validation of a Novel
In-Vitro Simulator for Real-Time Control of Active Shoulder Movements in Various Planes of Motion
Authors: Giles J. W. , Ferreira L. M. , Athwal G. S. , Johnson J. A.
Published: January 2014

In-vitro simulation of active shoulder joint motion is critical to gaining an understanding of the effects of surgical procedures and implant designs. However, development of systems for the accurate simulation of active shoulder motion has lagged well behind those implemented for the lower limb and elbow, which have used principles of closed-loop joint angle control 1,4. In contrast, active shoulder motion has been confined to simulators that can hold static joint angles through the application of loads based on computer model outputs 2, or that use constant velocity of the middle deltoid while using open-loop control to apportion other muscle loads as a function of a-priori physiologic loading ratios 3. Neither of these schemes utilizes real-time feedback of kinematic data in order to follow smooth, predefined profiles. The lack of more refined shoulder simulators, based on control theory, can primarily be attributed to the complexity of shoulder motion and the number of degrees of freedom (DOFs) ( i.e. plane of abduction, abduction angle, and axial rotation) which must be controlled.
Elastin Contributes to the Tensile Response of Medial Collateral Ligament
Authors: Henninger Heath B. , Underwood Clayton J. , Romney Steven J. , Davis Grant L. , Weiss Jeffrey A.
Published: January 2014

Elastin provides a restorative force after deformation, stretching and recoiling through both entropic and hydrophobic mechanisms.[1, 2] Selective degradation with elastase cleaves tropoelastin, creating a fragmented network with segments that vary in size and number of crosslinks.[3] Fragments may contribute to the tissue response, so degradation level may incrementally affect the mechanics of the tissue.
Stroke Rehabilitation Enhancement With DVD-Guided Visualization
Authors: Fischer Kenneth J. , Liu Wen , Wauneka Clayton , Bani-Ahmed Ali , Kluding Patricia
Published: January 2014

Stroke is a disorder that affects over 700,000 of people each year, with nearly 500,000 will be left with some sort of long-term disability. While the underlying cause is neurological disability in the region of the brain where the stroke occurred, the functional problem is most often physical disability. Many stroke patients can no longer use their extremities. Lower extremity deficit causes problems with walking and balance, while upper extremity deficit represents significant challenges with common activities of daily living (1). Stoke is considered one of the leading causes of disability in adults (2)! It can also have a tremendous impact on activities of daily living, and may result in dependence on a caregiver. Treatment for stroke has improved, and early detection and treatment can often mitigate the effects and prevent the sequelae of a stroke. Still nearly half a million stroke patients experience some level of physical dysfunction each year. Clearly physical dysfunction due to stroke is an enormous medical problem, and research to improve prevention, treatment and rehabilitation related to stroke is very important.
Integrating qPLM and Biomechanical Test Data With an Anisotropic Fiber Distribution Model and In Vitro Regulation of Articular Cartilage Fiber Modulus
Authors: Stender Michael E. , Raub Christopher B. , Yamauchi Kevin A. , Shirazi Reza , Vena Pasquale , Sah Robert L. , Hazelwood Scott J. , Klisch Stephen M.
Published: January 2014

Articular cartilage (AC) metabolism and mechanical properties are regulated by in vitro culture with transforming growth factor–beta 1 (TGF-β1) and insulin-like growth factor–1 (IGF-1) [1]. In general, TGF-β1 maintains tissue size accompanied by a maintenance or increase in tensile and compressive moduli and a maintenance or decrease of compressive Poisson’s ratios while IGF-1 produces significant tissue expansion at the expense of reduced tensile and compressive moduli and increased compressive Poisson’s ratios [1,2]. The goal of this study was to integrate experimental data including AC mechanical properties, biochemical contents including overall collagen (COL) volume fraction, and micro structural measures of COL fiber distribution with a continuum mixture model to predict how COL fiber modulus changes in vitro with TGF-β1 and IGF-1 treatment.
Comparative Studies of Axial Ventricular Assist Devices (VAD) and the Effect of Outflow Cannulation
Authors: Chiu Wei-Che , Alemu Yared , Lynch Bryan , Einav Shmuel , Slepian Marvin , Bluestein Danny
Published: January 2014

Congestive heart failure has reached epidemic proportions in the United States with more than 5.7 million patients suffering from it annually ( 1). Due to the limited availability of donor hearts, patients in their late stage heart failure who may require cardiac transplantation are dying while waiting for a matched heart. Mechanical circulatory support devices (MCS), such as ventricular assist devices (VAD), are utilized as a bridge to transplantation, and recently as destination therapy for extending the life of these patients. Continuous-flow VAD offer a surgical advantage over older generation pulsatile-flow VAD due to their compact design; however, due to the high RPM these VADs are operated with and the non-physiological blood flow patterns they generates, VADs are burdened with high incidence of thromboembolic events, and antiplatelet/anticoagulation regimens are mandated for the device recipients.
On the Microcirculation in the Human Conjunctiva
Authors: Dow William , Jacobitz Frank , Chen Peter
Published: January 2014

The microcirculation includes the smallest arterioles, capillaries, and venules with vessel diameters ranging from 8 to 150 μm and it represents a region where active and passive exchanges of nutrients and gasses take place. The microvessels’ rheological properties differ from large arteries: they are less viscous, and demonstrate autoregulation [3]. Epidemiologists study the microcirculation in detail and have identified associations between microvascular disorder and organ damage. The organization of the microvascular network can be different in different sites but the networks serve the common function in the delivery of nutrients to the surrounding tissues. This is controlled by a distribution of blood flow based on local metabolic needs. Under challenge or in the development of diseases, the microcirculation responds by selectively regulating blood flow. A comparison between healthy and diseased states may lead to the identification of changes in the microcirculation that can be used as diagnosis for a variety of vascular related disorders [4, 5].
Gratings on a Dish: A Scalable Cell Alignment Substrate on Optical Media
Authors: Anene-Nzelu Chukwuemeka G. , Choudhury Deepak , Li Huipeng , Toh Yi-Chin , Ng Gary Sum Huan , Liang Leo Hwa , Yu Hanry
Published: January 2014

Cell alignment by underlying topographical cues has been shown to affect important biological processes such as differentiation and functional maturation in vitro. However, the routine use of cell culture substrates with micro/nano-topographies is currently hampered by the high cost and specialized facilities required to produce these substrates. Here we present commercially available optical media as substrates for aligning cells in culture. These optical media, including CD-R, DVD-R and optical grating, allow different cell types to attach, align and grow on them. This cytoskeletal reorganization enhanced the differentiation of cardiac (H9C2), and skeletal muscle (C2C12) cell lines. These low-cost commercially available optical media can serve as scalable substrates for research or drug safety screening applications.
Duration of Nerve Root Compressive Trauma Modulates the Subsequent Thermal Hyperalgesia and Spinal Expression of the Glutamate Transporter, GLT1
Authors: Nicholson Kristen J. , Gilliland Taylor M. , Winkelstein Beth A.
Published: January 2014

Mechanical compression of the cervical nerve roots is a common injury modality [1] and a frequent source of neck pain, affecting 30–50% of adults each year [2]. Since the nerve root is viscoelastic in compression (Fig. 1) [3,4], its response to loading from different injury scenarios is also likely a function of the duration of the applied tissue insult, which varies with the type of injury. For example, the nerve root undergoes brief periods of compression during sports and auto-related trauma, whereas a more prolonged compression occurs for a bulging disc or foraminal stenosis [1]. Similarly, mechanical sensitivity (i.e. pain) after root compression is has been shown to be duration-dependent [3,4]. Compression of the cervical nerve root is only sufficient to induce mechanical sensitivity in a rat model if the compression is applied for more than 3 minutes [3]. Yet, mechanical sensitivity is only one behavioral sequelae of radicular pain and it is not known whether the duration dependent response is similar for other types of evoked pain, such as thermal sensitivity.