bluuebunny/crossref_metadata_2025 huggingface dataset:
Case presentation of moderate‐severe psoriasis
Authors: Salmhofer W.
Published: July 2012

The use of biologic agents has greatly improved psoriasis treatment. However, some individuals fail to respond to treatment or loose initial efficacy, and it may be difficult to find the optimal treatment for these patients. We present a patient with long‐standing, moderate–severe plaque psoriasis, who had received UVB therapy as well as classical systemic therapies without sufficient response previously. Alefacept only gave a moderate response with quick recurrence after the end of treatment. Adalimumab was working for some time, but finally the patient experienced a slow loss of efficacy and was especially hampered by severe involvement of his hands. This caused him great distress as his work involved a high level of customer contact. The decision was taken to change therapy to ustekinumab. After one injection of ustekinumab psoriasis was greatly improved and it was almost completely resolved after the second injection, and arthritis was no longer active. The efficacy of ustekinumab treatment could be maintained up to now; there is only minimal disease activity and the patient is extremely satisfied. In conclusion, the decision to change to another biologic with different mode of action proved to be successful, and it helped the patient to forget his disease for most of the time and to fulfil the responsibilities of his job.
Two novel mutations of the NCSTN gene in Chinese familial acne inverse
Authors: Zhang C. , Wang L. , Chen L. , Ren W. , Mei A. , Chen X. , Deng Y.
Published: July 2012

Background  Acne inversa (AI; MIM 142690), or hidradenitis suppurativa (HS), is a type of autosomal‐dominant genodermatosis caused by mutations in γ‐secretase. The complex of γ‐secretase is a transmembrane protease that catalyses the cleavage of a set of membrane proteins and is comprised of four subunits encoded by four genes, including PSEN1, PSENEN, NCSTN and APH1. However, mutations associated with AI vary significantly, and it is important to define the specific mutation with a particular AI patient.

Objective  To determine specific mutations in the γ‐secretase gene associated with two Chinese AI families.

Methods  Two families of three generations with apparent AI symptoms were examined through proband analysis. Genomic DNAs of the family members and a cohort of 100 healthy individuals were isolated and subjected to polymerase chain reaction (PCR) and direct DNA sequencing.

Results  Two heterozygous missense mutations, c.647A>C (p.Q216P) in the exon 6, and c.223G>A (p.V75I) in the exon 3 of the NCSTN gene, were identified in the two families respectively. No mutations were found in 100 healthy individuals.

Conclusions  We have identified two novel mutations within the NCSTN gene associated with AI.
High discordance between punch biopsy and excision in establishing basal cell carcinoma subtype: analysis of 500 cases
Authors: Wolberink E.A.W. , Pasch M.C. , Zeiler M. , van Erp P.E.J. , Gerritsen M.J.P.
Published: July 2012

Background  Basal cell carcinoma (BCC) is the most frequently occurring cancer in humans. Worldwide incidences rise about 10% each year, increasing the burden on dermatologists, general practitioners and pathologists as well as increasing costs for the health care system. Increasingly non‐surgical treatment options are used in the treatment of BCC, without histological confirmation of BCC subtype, potentially resulting in under‐treatment.

Objective  We evaluated the diagnostic accuracy of a punch biopsy for the BCC histological subytpe in a primary BCC and the prevalence of biopsy‐based under‐diagnosis of aggressive subtypes. Accuracy of a punch biopsy was defined as concordance of the diagnosis of subtype of BCC at punch biopsy and excision.

Methods  A retrospective chart‐review was performed of primary BCC, which were proven by punch biopsy and subsequently treated by excision. The first 100 consecutive BCCs per year during the years 2004–2009 were included, yielding a total of 500 evaluated BCCs.

Results  The overall accuracy of punch biopsy for BCC subtype at excision was 69%, in single‐type BCC 83% (n = 343) and in mixed‐type BCC 37% (n = 157). Accuracy varied substantially according to BCC subtype, being highest in the superficial subtype (84%) and subsequently in infiltrative (69%), nodular (63%) and micronodular subtype (38%). In 11% of all cases, an unsuspected more aggressive subtype was present.

Conclusion  Punch biopsy has a high accuracy in single‐type BCCs and a considerably lower accuracy in mixed‐type BCCs for establishing BCC subtype compared to excision. The presence of an unsuspected aggressive subtype could explain therapy failure of non‐surgical treatments like imiquimod or photodynamic therapy.
Quality of life in alopecia areata: a disease‐specific questionnaire
Authors: Fabbrocini G. , Panariello L. , De Vita V. , Vincenzi C. , Lauro C. , Nappo D. , Ayala F. , Tosti A.
Published: July 2012

Background  Alopecia areata (AA) is an autoimmune disease affecting about 2% of the population, which has a considerable impact on quality of life (QoL). There are no disease‐specific questionnaires to assess QoL in patients suffering from AA.

Objective  To validate a new disease‐specific questionnaire for AA, named AA‐QLI, and to compare the consequent Quality of Life Index (QLI) with the commonly known Dermatology Life Quality Index (DLQI) to verify if it can provide a more comprehensive tool for patients.

Methods  A total of 50 patients affected by AA were administered both the AA‐QLI, created by us, and the well‐known DLQI. With the aim to detect suitable QLI, we propose to use two multivariate analyses:

 a principal component analysis approach on the data collected with both questionnaires to compare their capability to measure the QoL;

 a structural equation modelling on our AA‐QLI to identify which category of symptoms mostly affects the QoL.

Results  The scores of both the questionnaires are quite close, except for a few cases. Statistical analysis shows a higher specificity of the AA‐QLI for evaluating QoL. Among the three areas in which AA‐QLI is divided, ‘Relationship’ has a major impact on the QLI, followed by ‘Subjective symptoms’; ‘Objective signs’ has a lower weight on the QLI.

Conclusion  AA‐QLI is a good instrument to evaluate the real impact of AA on QoL. It can be helpful both for the physician and for the patient.
Nasal septal and craniofacial form in European‐ and African‐derived populations
Authors: Holton Nathan E. , Yokley Todd R. , Figueroa Aaron
Published: July 2012

As a component of the chondrocranium, the nasal septum influences the anteroposterior dimensions of the facial skeleton. The role of the septum as a facial growth center, however, has been studied primarily in long‐snouted mammals, and its precise influence on human facial growth is not as well understood. Whereas the nasal septum may be important in the anterior growth of the human facial skeleton early in ontogeny, the high incidence of nasal septal deviation in humans suggests the septum’s influence on human facial length is limited to the early phases of facial growth. Nevertheless, the nasal septum follows a growth trajectory similar to the facial skeleton and, as such, its prolonged period of growth may influence other aspects of facial development. Using computed tomography scans of living human subjects (n = 70), the goal of the present study is to assess the morphological relationship between the nasal septum and facial skeleton in European‐ and African‐derived populations, which have been shown to exhibit early developmental differences in the nasal septal–premaxillary complex. First we assessed whether there is population variation in the size of the nasal septum in European‐ and African‐derived samples. This included an evaluation of septal deviation and the spatial constraints that influence variation in this condition. Next, we assessed the relationship between nasal septal size and craniofacial shape using multivariate regression techniques. Our results indicate that there is significant population variation in septal size and magnitude of septal deviation, both of which are greater in the European‐derived sample. While septal deviation suggests a disjunction between the nasal septum and other components of the facial skeleton, we nevertheless found a significant relationship between the size of the nasal septum and craniofacial shape, which appears to largely be a response to the need to accommodate variation in nasal septal size.
Predictive modelling of leopard predation using contextual Global Positioning System cluster analysis
Authors: Pitman R. T. , Swanepoel L. H. , Ramsay P. M.
Published: July 2012

Apex predators are essential for the viability of healthy ecosystems. By studying carnivoran feeding ecology, we can obtain a better understanding of the ecological limits, resilience and predator–prey dynamics that govern these populations. However, monitoring elusive predators – like the leopard Panthera pardus – is often fraught with logistical and financial constraints, particularly in inaccessible terrain.

In this study, we identified clusters of Global Positioning System (GPS) points from four GPS‐collared leopards and investigated them in the field for potential kills. Environmental data from cluster sites were gathered alongside spatial and temporal data collected via GPS cluster analysis to develop statistical models capable of predicting the occurrence of leopard predatory events.

Our results demonstrate that leopard predation can be accurately modelled either by using a combination of field data (i.e. collected at cluster sites) and remote data (i.e. obtained via GPS analysis), or simply remote data alone. Kills were more likely to be present at clusters where leopards exhibited longer handling times, at sites with dense vegetation cover, when leopards were more active 12 h before the cluster than 12 h after, where more tree refugia were present, in areas of higher elevation, at sites containing low levels of shrub cover, and when clusters began during diurnal or crepuscular hours.

By using this modelling approach, comprehensive predation studies are not only efficient and cost‐effective but also logistically feasible across a range of different habitats and may even be applied to other carnivorans. It provides a detailed analytical means of studying broader aspects of carnivoran feeding ecology, such as predation habits, carrying capacity, ecological hunting requirements and species interactions, which are important aspects of carnivoran management.
Dynamical patterns of human postural responses to emotional stimuli
Authors: Perakakis Pandelis E. , Idrissi Sofia , Vila Jaime , Ivanov Plamen CH.
Published: July 2012

Postural displacements in response to emotional activation have recently been proposed as a direct and objective index of approach–avoidance behavior in humans. Here, we present the results of an experiment designed to assess spontaneous postural responses to discrete affective pictures, briefly presented in random order of valence. Our findings question the interpretation of phasic postural responses to emotional stimuli as approach–avoidance behavior. Further, we identify a robust dynamical pattern, characterized by specific features indicating that attentional processes may play a role in human postural responses to emotional stimuli.
Pakistani labour migration and masculinity: industrial working life, the body and transnationalism
Authors: QURESHI KAVERI
Published: July 2012

In this article, I examine the narratives of migrant Pakistani men in their fifties and sixties, who became chronically ill over the course of their working lives in London. The men's life histories show that the body, and in particular the labouring body, needs more sustained attention in migration studies. Their narratives tell of how the physical toll of industrial labour resulted in chronic ill health, unemployment and various forms of ‘redundant masculinities’. Moreover, the impoverishment that frequently followed from ill health ate away at local social status and transnational relationships. I argue that the existing work on transnationalism has normalized the experiences of an entrepreneurial migrant elite and obscured those of migrants who are bound to one place by force of circumstance. Chronic ill health is not merely the experience of a minority who fall between the cracks of epidemiological studies on ‘healthy migrants’, as some have recently suggested, but rather, common to industrial labour migration.
Transnational issue networks in real and virtual space: the case of women, peace and security
Authors: CARPENTER R. CHARLI , JOSE BETCY
Published: July 2012

To what extent do online issue networks serve as a proxy for their real‐space counterparts in structure and substance? This question is significant because a number of scholars have begun to study transnational advocacy networks through their representations online. We explored whether this assumption is valid by comparing the network composition and agenda composition of the advocacy network around ‘women, peace and security’, as operationalized through a web‐based survey of actual activists, and the network's online representations of itself, as measured through advocacy websites. Two specific concerns drove the study. First, how closely does the structure of issue networks, as represented on the World Wide Web, correspond with actual advocates' understanding of the players within a specific issue domain? Second, to what extent does the online issue agenda correlate with the most prominent issues described by real‐space advocates within a transnational network? Our findings yielded a high correlation between the online issue agenda and activists’ interpretations of the agenda. However, we found that while hyperlink analysis is an effective tool for identifying the ‘hubs’ or ‘gatekeepers’ within a specific issue network, the nature of the World Wide Web makes it is a blunt tool with which to capture the broader network. This suggests that while the web poses important opportunities as a data source, scholars of transnational networks must pay closer attention to the methodological assumptions implicit in their reliance on this and other new media.
Transnational mobility and rootedness: the upper middle classes in European cities
Authors: ANDREOTTI ALBERTA , LE GALÈS PATRICK , MORENO FUENTES FRANCISCO JAVIER
Published: July 2012

Some authors argue that ‘mobilities’ form the distinctive feature of late modern societies and represent a new social cleavage between cosmopolitan mobile élites and urban residents more rooted in their local neighbourhoods. One assumption in contemporary discourses of rootedness is that this new transnational or global society entails an ongoing process of uprooting individuals and a mainly mobile élite packing up and relocating. In this article, we draw on empirical comparative research to examine the patterns and dynamics of mobility and belonging across European borders among upper‐middle‐class managers in four cities – Paris, Madrid, Milan and Lyon. We suggest that these new urban upper‐middle‐class managers display flight responses, or ‘partial exit’ strategies, which operate at various levels to enable them to protect and control their interests while holding onto the reins of power in their local communities. Our study adopts a micro‐level perspective to explore individual experiences, strategies, motivations and values based on interviews with 480 managers in these cities.
Transforming polygamy: migration, transnationalism and multiple marriages among Muslim minorities
Authors: CHARSLEY KATHARINE , LIVERSAGE ANIKA
Published: July 2012

In Europe, polygamy is often portrayed as emblematic of unchanging patriarchal traditions among Muslims. In contrast, based on research with Pakistanis in Britain and Turks in Denmark, we explore ways in which polygamy is transformed in the context of migration and transnationalism. Migration‐related polygamy features in accounts of the pioneer generations of Pakistani and Turkish migrants to Europe, but there is also evidence of great variety in contemporary practices of multiple marriage, and new permutations of polygamy arising due to the specific conditions of transnational migration. Coexisting legal systems within and between nations; the opportunities of spousal settlement; multiple marital aspirations; and both transnational connections and geographical distance combine to create opportunities and motivations for a range of polygamous situations, including some in which ‘technical’ polygamy masks monogamy in practice.
Long‐term environmental monitoring in the UK: origins and achievements of the Plynlimon catchment study
Authors: Robinson M , Rodda J C , Sutcliffe J V
Published: July 2012

The Plynlimon catchments are the UK’s most intensively studied long‐term research basins, with 40 years of hydrological and hydrochemical observations. Used to study the impacts of land cover, their establishment, progress and achievements is a complex story of scientific advances in response to national needs, set against a background of academic controversy and competing stakeholder pressures, that remains relevant today. Established to answer the important practical question ‘Do forests use more water than grassland in our climate?’, these research basins helped to revolutionise our fundamental understanding of forest hydrology in Britain, and became a multi‐disciplinary ‘outdoor laboratory’ encompassing floods and droughts, acidification and water chemistry, process studies and climate change used by many universities and research organisations. The findings of the studies there have been widely published, with over 500 papers in refereed journals, and the measurements shared with the international research community. Nevertheless, many data users remain unaware of how and why the catchments were established, the challenges that were overcome, and the ways in which the research programme evolved to meet changing needs. As the study enters its fifth decade, this paper takes the opportunity to look back at its establishment, assess the outputs and offer guidance to other researchers wishing to embark on new catchment or observatory studies.
Esophageal foreign bodies in dogs: 34 cases (2004–2009)
Authors: Thompson Holly C. , Cortes Yonaira , Gannon Kristi , Bailey Dennis , Freer Sean
Published: July 2012

Objective

To characterize the clinical and radiographic signs, endoscopic findings, treatment, and outcome for dogs that present with esophageal foreign bodies (EFBs), and to identify factors associated with the severity of secondary esophagitis and length of hospitalization (LOH).

Design

Retrospective case series.

Setting

Private referral veterinary center.

Animals

Client‐owned dogs.

Interventions

None.

Measurements

Medical records for 34 client‐owned dogs withEFBs that had esophageal radiographs and that had undergone esophagoscopy were evaluated retrospectively. Information regarding clinical history, radiographic signs, findings at esophagoscopy, and outcome were recorded.

Results

The most commonEFBs were bone (29.7%) and rawhides (29.7%). The median duration of clinical signs prior to initial presentation was 2.75 hours. Radiographically,EFBs were identified definitively in 30 dogs and questionably in 1. The most common location was in the caudal esophagus (59.3%). Esophagitis was not identified in 6 dogs; and was assessed as mild in 14, moderate in 9, and severe in 4. In 1 dog the degree of esophagitis could not be determined due to the presence of contrast agent. Dogs with longer duration of clinical signs and longer anesthesia times were more likely to have moderate or severe esophagitis. MedianLOHwas 19 hours. Dogs with longer duration of clinical signs,EFBs located in the caudal esophagus, and moderate or severe esophagitis had longer hospital stays. No dogs experienced long‐term complications. Complication rate was 82.5% with 8 patients having more than 1 complication.

Conclusions

While long‐term prognosis is excellent, early intervention helps reduce short‐term esophagitis andLOH.
Updates in theAmericanHeartAssociation guidelines for cardiopulmonary resuscitation and potential applications to veterinary patients
Authors: Maton Barbara L. , Smarick Sean D.
Published: July 2012

Objective

To review the updates in theAmericanHeartAssociation (AHA) guidelines for cardiopulmonary resuscitation (CPR) and identify potential applications to veterinary patients.

Etiology

Cardiopulmonary arrest is common in veterinary emergency and critical care, and consensus guidelines are lacking. Human resuscitation guidelines are continually evolving as new clinical and experimental studies support updated recommendations. Synthesis of human, experimental animal model, and veterinary literature support the potential for updates and advancement in veterinaryCPRpractices.

Therapy

This review serves to highlight updates in theAHAguidelines forCPRand evaluate their application to small animal veterinary patients. Interventions identified will be evaluated for trans‐species potential, raise questions regarding best resuscitation recommendations, and offer opportunities for further research to continue to advance veterinaryCPR.

Prognosis

The prognosis for any patient undergoing cardiopulmonary arrest remains guarded.
A comparison of 3 anesthetic protocols for 24 hours of mechanical ventilation in cats
Authors: Boudreau Ainsley E. , Bersenas Alexa M.E. , Kerr Carolyn L. , Holowaychuk Marie K. , Johnson Ron J.
Published: July 2012

Objective

To compare the recovery times, recovery quality, and cardiovascular (CV) effects of 3 anesthetic protocols during 24 hours of mechanical ventilation (MV) in healthy cats.

Design

Prospective, randomized, crossover study.

Setting

Research laboratory at a veterinary teaching hospital.

Animals

Six healthy intact male purpose‐bred cats.

Interventions

Each cat was randomly assigned to receive 3 anesthetic protocols for 24 hours of MV; Protocol K consisted of ketamine, Protocol P, propofol; and Protocol PK, propofol plus fixed‐rate low‐dose ketamine. Each infusion drug dose was adjusted using a sedation scoring system. All protocols included fixed doses of fentanyl (10 μg/kg/h) and midazolam (0.5 mg/kg/h).

Measurements and Main Results

Drug doses and recovery times were recorded. Recovery quality was scored. Blood gas results, CV parameters, and frequency of bradycardia or hypotension requiring interventions were recorded. The mean d dose ± standard error of K was 81.3 ± 3.3 μg/kg/m. The median dose (95% cardiac index) of propofol (μg/kg/m) in PK was 16.0 (13.1, 19.6) and in P was 48.1 (39.3, 58.9). P necessitated significantly more propofol than PK (P< 0.05). Protocol K (35.6 ± 3.2 hours) had significantly longer times to full recovery compared to P (18.2 ± 3.2 hours). Protocol K had significantly longer times to head up, crawling, and standing compared to P and PK. Cats sedated with PK (2.33 ± 0.47) required significantly more interventions for hypotension than K (0.50 ± 0.47). Protocol P (3.2 ± 0.4) and PK (1.4 ± 0.3) required significantly more interventions for bradycardia compared to K (0.8 ± 0.3). When comparing protocol K to P and PK, significant differences in blood pressure, lactate, oxygen delivery, and oxygen consumption were noted.

Conclusions

Cats anesthetized with P had shorter times to full recovery compared to K. Cats anesthetized with K required fewer interventions for bradycardia or hypotension but had longer recovery times compared to P or PK. Protocol PK reduced the propofol dose required to maintain optimal anesthesia.
Mechanisms of injury and emergency care of acute spinal cord injury in dogs and cats
Authors: Park Edward H. , White George A. , Tieber Lisa M.
Published: July 2012

Objectives

To review the literature in regards to the pathophysiology of acute spinal cord injury, and to describe current concepts in regards to patient assessment, diagnostic, and therapeutic measures with a special emphasis on emergency and critical care considerations.

Etiology

Acute spinal cord injury occurs in 2 phases. The primary injury occurs at the time of initial injury and may include intervertebral disk herniation, vertebral fracture or luxation, penetrating injury, and vascular anomalies such as fibrocartilaginous embolic myelopathy. Secondary injury occurs following primary injury and is multifactorial encompassing numerous biochemical and vascular events that result in progression of injury.

Diagnosis

The diagnosis is based on history and physical examination findings. A neurologic examination should be performed following initial patient assessment and stabilization. Further diagnostics to characterize acute spinal injury include radiographs and advanced imaging modalities such as myelography, computed tomography, or magnetic resonance imaging.

Therapy

Initial treatment should focus on addressing the patient's cardiovascular and respiratory system. Supportive measures to support systemic perfusion are vital to minimizing secondary injury. Specific therapy toward minimizing secondary injury in veterinary medicine remains controversial, especially in regards to the utilization of methylprednisolone. Other therapies are either in need of additional research or have failed to document clinical difference.

Prognosis

The prognosis for acute spinal injury is varied and is dependent upon the presence of concurrent trauma, location, and type of primary injury sustained, and extent of neurologic impairment at the time of initial presentation. The etiology of the underlying trauma is of great importance in determining prognosis and outcome. Loss of deep pain is generally accepted as a poor prognostic indicator; however, even these patients can recover depending on their response to treatment.
Severe burn injury, burn shock, and smoke inhalation injury in small animals. Part 1: Burn classification and pathophysiology
Authors: Vaughn Lindsay , Beckel Nicole
Published: July 2012

Objective

To review the literature related to severe burn injury (SBI), burn shock, and smoke inhalation injury in domestic animals. Current animal‐ and human‐based research and literature were evaluated to provide an overview of thermal burn classification and the pathophysiology of burn shock and smoke inhalation injury.

Etiology

Severe burn injury, burn shock, and smoke inhalation injury may be encountered as a result of thermal injury, radiation injury, chemical injury, or electrical injury.

Diagnosis

Burns can be subdivided based on the amount of total body surface area (TBSA) involved and the depth of the burn. Local burn injuries involve <20% of the TBSA whereas SBI involves >20–30% of the TBSA. The modern burn classification system classifies burns by increasing depth: superficial, superficial partial‐thickness, deep partial‐thickness, and full‐thickness.

Local burn injury rarely leads to systemic illness whereas SBI leads to significant metabolic derangements that require immediate and intensive management. SBI results in a unique derangement of cardiovascular dysfunction known as “burn shock.” The physiologic changes that occur with SBI can be divided into 2 distinct phases; the resuscitation phase and the hyperdynamic hypermetabolic phase. The resuscitation phase occurs immediately following SBI and lasts for approximately 24–72 hours. This period of hemodynamic instability is characterized by the release of inflammatory mediators, increased vascular permeability, reduced cardiac output, and edema formation. The hyperdynamic hypermetabolic phase begins approximately 3–5 days after injury. This phase is characterized by hyperdynamic circulation and an increased metabolic rate that can persist up to 24 months post burn injury in people.
Development of a limited‐sampling model for prediction of doxorubicin exposure in dogs
Authors: Wittenburg L. A. , Thamm D. H. , Gustafson D. L.
Published: July 2012

Understanding the relationship between drug dose and exposure (pharmacokinetics, PK) and the relationship between exposure and effect (pharmacodynamics) is an important component of pharmacology when attempting to predict clinical effects of anticancer drugs. PK studies can provide a better understanding of these relationships; however, they often involve intensive sampling over an extended period of time, resulting in increased cost and decreased compliance. Doxorubicin (DOX), one of the most widely used antineoplastic agents in veterinary cancer therapy, is characterized by large interpatient variability in overall drug exposure and the development and degree of myelosuppression following equivalent dosages. We have developed and validated a limited‐sampling strategy forDOX, in which three blood samples are obtained over 1 h post‐treatment, that accurately predicts patient exposure. This strategy could allow for refining of dosing variables and utilization of therapeutic drug monitoring to ensure optimized dosing.
Characteristics, Interventions, and Outcomes of Women Who Used a Birthing Pool: A Prospective Observational Study
Authors: Burns Ethel E. , Boulton Mary G. , Cluett Elizabeth , Cornelius Victoria R. , Smith Lesley A.
Published: July 2012

Background

Birthing pools are integrated into maternity care in the United Kingdom and are a popular care option for women in midwifery‐led units and at home. The objective of this study was to describe and compare maternal characteristics, intrapartum events, interventions, and maternal and neonatal outcomes by planned place of birth for women who used a birthing pool.

Methods

A total of 8,924 women at low risk of childbirth complications were recruited from care settings in England, Scotland, and Northern Ireland. Descriptive analysis was performed.

Results

Overall, 7,915 (88.9%) women had a spontaneous birth (5,192, 58.3% water births), of whom 4,953 (55.5%) were nulliparas. Fewer nulliparas whose planned place of birth was the community (freestanding midwifery unit or home) had labor augmentation by artificial membrane rupture (149, 11.3% [95% CI: 9.6–13.1]), compared with an alongside midwifery unit (271, 22.7% [95% CI: 20.3–25.2]), or obstetric unit (639, 26.3% [95% CI: 24.5–28.1]). Results were similar for epidural analgesia and episiotomy. More community nulliparas had spontaneous birth (1,172, 88.9% [95% CI: 87.1–90.6]), compared with birth in an alongside midwifery unit (942, 79% [95% CI: 76.6–81.3]) and obstetric unit (1,923, 79.2% [95% CI: 77.5–80.8]); and fewer required hospital transfer (265, 20% [95% CI: 17–22.2]) compared with those in an alongside midwifery unit (370, 31% [95% CI: 28.3–33.7]). Results for multiparas and newborns were similar across care settings. Twenty babies had an umbilical cord snap, 18 (90%) of which occurred during water birth.

Conclusions

Birthing pool use was associated with a high frequency of spontaneous birth, particularly among nulliparas. Findings revealed differences in midwifery practice between obstetric units, alongside midwifery units, and the community, which may affect outcomes, particularly for nulliparas. No evidence was found for a difference across care settings in interventions or outcomes in multiparas or in outcomes for newborns. During water birth, it is important to prevent undue traction on the cord as the baby is guided to the surface. (BIRTH 39:3 September 2012)
Physical Health and Recovery in the First 18 Months Postpartum: Does Cesarean Section Reduce Long‐Term Morbidity?
Authors: Woolhouse Hannah , Perlen Susan , Gartland Deirdre , Brown Stephanie J.
Published: July 2012

Background

Research examining long‐term health outcomes for women after childbirth has been limited. The objective of this study was to investigate the natural history of common morbidities in the 18 months after the birth of a first child, and to explore the hypothesis that women who have a cesarean section for a first birth experience less overall morbidity in the postnatal period.

Methods

A prospective nulliparous pregnancy cohort study was conducted of 1,507 women recruited in early pregnancy from six public hospitals in Melbourne, Australia (mean gestation 15 weeks). Follow‐up questionnaires at 3, 6, 12, and 18 months postpartum included standardized measures of urinary and fecal incontinence, and a symptom checklist asking about common physical health problems.

Results

At 6, 12, and 18 months postpartum, no statistically significant differences were found in the proportion of women reporting three or more health problems by method of birth. Compared with women who had a spontaneous vaginal birth, women who had a cesarean section were more likely to report extreme tiredness at 6 months postpartum (adjusted OR: 1.39; 95% CI: 1.07–1.82) and at 12 months postpartum (adjusted OR: 1.40; 95% CI: 1.05–1.85), and were more likely to report back pain at 6 months postpartum (adjusted OR: 1.37; 95% CI: 1.06–1.77) and at 12 months postpartum (adjusted OR: 1.41; 95% CI: 1.06–1.87). Women who had a cesarean section were less likely to report urinary incontinence at 3, 6, and 12 months postpartum, respectively (adjusted OR: 0.26; 95% CI: 0.19–0.36; adjusted OR: 0.36; 95% CI: 0.25–0.52; adjusted OR: 0.48; 95% CI: 0.33–0.68). For all other physical health problems the pattern of morbidity did not differ between cesarean section and spontaneous vaginal birth.

Conclusions

Physical health problems commonly persist or recur throughout the first 18 months postpartum, with potential long‐term consequences for women's health. Cesarean section does not result in women experiencing less overall morbidity in the postpartum period compared with women who have a spontaneous vaginal birth. (BIRTH 39:3 September 2012).
Perceived Alcohol Stigma: Factor Structure and Construct Validation
Authors: Glass Joseph E. , Kristjansson Sean D. , Bucholz Kathleen K.
Published: July 2012

Introduction

There has been an increasing interest in studying the stigma of alcohol use disorders (AUDs) yet scant research has evaluated the conceptualization and measurement of alcohol stigma. This study examined the measurement properties (i.e., factor structure) and validity of the alcohol‐adapted Perceived Devaluation‐Discrimination scale (PDD), which assesses the construct of perceived alcohol stigma (PAS).

Methods

Our sample included 34,386 respondents from the Wave 2 assessment in the National Epidemiologic Survey on Alcohol and Related Conditions, a population‐representative survey of noninstitutionalized U.S. adults. Analytic procedures included confirmatory factor analysis and structural equation modeling.

Results

One‐factor (perceived devaluation–discrimination) and 2‐factor (perceived devaluation, perceived discrimination) confirmatory factor analytic models fit the data well (Comparative Fit Index = 0.958, Tucker‐Lewis Index = 0.942, Root Mean Square Error of Approximation = 0.056; Comparative Fit Index = 0.962, Tucker‐Lewis Index = 0.946, Root Mean Square Error of Approximation = 0.054; respectively) when adjusting for item wording effects with a latent method factor. Despite having a better fit to the data, χ2 (1) = 542, p < 0.0001, the 2 factors were highly correlated (r = 0.90), which led us to favor a 1‐factor model. Structural equation models found that the inverse relationship between PAS and perceived interpersonal social support was strongest for persons with a stigmatized labeling status. The same was not true in analyses predicting social network involvement.

Conclusions

A 1‐factor solution of PAS had superior parsimony. The alcohol‐adapted PDD appears to be a psychometrically sound measure and exhibits relationships that are consistent with modified labeling theory.
Surgical Treatment of an Intracranial Epidermoid Cyst in a Dog
Authors: De Decker Steven , Davies Emma , Benigni Livia , Wilson Helen , Pelligand Ludovic , Rayner Emma L. , Shihab Nadia , Volk Holger A.
Published: July 2012

Objective

To report challenges and complications associated with surgical intracranial epidermoid cyst removal from the fourth ventricle of a dog.

Study Design

Clinical report.

Animal

Labrador retriever (7 years old) with focal seizures.

Methods

Magnetic resonance imaging (MRI) revealed an oval lesion in the fourth ventricle. This lesion was heterogeneously hyperintense onT2‐weighted and fluid attenuation inversion recovery (FLAIR) images and hypointense onT1‐weighted images. Dilatation of the ventricular system was present. A ventriculoperitoneal shunt (VPS) was placed and the fourth ventricle was approached by suboccipital craniectomy. An oval, white mass was identified in the fourth ventricle. Subtotal removal of the mass was performed.

Results

On the day after surgery, neurologic deterioration was observed. The dog had severe cerebellar and brainstem dysfunction. Histopathologic examination of the removed tissue revealed an epidermoid cyst. The dog experienced gradual neurologic improvement; however, neurologic deterioration beginning at 6 months resulted in euthanasia 8 months after surgery. On necropsy, epidermoid cyst tissue was identified in the fourth ventricle.

Conclusion

Surgical removal of an intracranial epidermoid cyst may be complicated by adhesions between the cyst capsule and surrounding neurovascular structures, causing postoperative morbidity and eventual recurrence of clinical signs. These observations should be taken into account when considering surgical removal of an intracranial epidermoid cyst.
Fracture of the Patella after TPLO in 6 Dogs
Authors: Rutherford Scott , Bell Jonathan C. , Ness Malcolm G.
Published: July 2012

Objective

To describe the clinical findings of dogs that sustained patellar fractures after tibial plateau leveling osteotomy (TPLO).

Study Design

Retrospective case series.

Animals

Dogs with patellar fractures that occurred after TPLO surgery (n = 6).

Methods

Medical records (November 1, 2008–October 31, 2010) were reviewed to identify dogs with patellar fracture occurring after TPLO.

Results

Six of 305 (2%) dogs had a patellar fracture after TPLO; 5 dogs were clinically lame when the fracture was diagnosed and all had radiographic evidence of patellar tendon thickening. All dogs were treated nonsurgically. In 2 dogs where follow‐up radiographs were available there was no evidence of fracture union. No dog had a persistent lameness.

Conclusion

Fracture of the patella is an uncommon complication of TPLO surgery. Nonsurgical management can provide a satisfactory functional outcome.
The Florida Shock Anxiety Scale (FSAS) for Patients with Implantable Cardioverter Defibrillators: Testing Factor Structure, Reliability, and Validity of a Previously Established Measure
Authors: FORD JESSICA , FINCH JOHN F. , WOODROW LAWRENCE K. , CUTITTA KATHERINE E. , SHEA JULIE , FISCHER AVI , HAZELTON GARRETT , SEARS SAMUEL F.
Published: July 2012

Background: The implantable cardioverter defibrillator (ICD) reduces mortality in patients at risk for life‐threatening arrhythmias via high energy shock. The Florida Shock Anxiety Scale (FSAS) was developed to measure ICD patient shock‐related anxiety. Initial psychometric evaluation revealed good reliability and validity. The purpose of this study was to examine the psychometrics of the FSAS in a large US sample of ICD patients.

Methods: Participants were recruited via e‐mail and the survey was completed online. Ultimately, 443 ICD patients (359 male and 421 White) completed the 10‐item FSAS.

Results: Means for FSAS were comparable to previously published data (M = 15.18, SD = 6.5). Interitem reliability was good (Cronbach's α= 0.89). The FSAS was negatively correlated with single‐item measures of emotional well‐being (r =–0.378, P < 0.01), sense of security (r =–0.365, P < 0.01), perceived general health (r =–0.185, P < 0.01), and quality of life (r =–0.216, P < .01), demonstrating discriminant validity. Convergent validity was supported through significant correlations with number of shocks (r = 0.464, P < 0.01) and reported disruptiveness of shock (r = 0.484, P < 0.01). Confirmatory factor analysis revealed that a single (second‐order) factor model (χ2 [34] = 75.34, P < 0.05, comparative fit index = 0.98, root mean‐square error of approximation = 0.05) had the best fit.

Conclusions: Shock anxiety as a construct can be measured in a reliable and valid method by the FSAS. These nationally representative data suggest that a single score for shock anxiety is an easy to use and appropriate method of assessment. (PACE 2012; 35:1146–1153)
Comparative Study of Same Sitting Hybrid Coronary Artery Revascularization versus Off‐Pump Coronary Artery Bypass in Multivessel Coronary Artery Disease
Authors: BACHINSKY WILLIAM B. , ABDELSALAM MURAD , BOGA GOUTHAMI , KILJANEK LUKASZ , MUMTAZ MUBASHIR , MCCARTY CHRISTINE
Published: July 2012

Objective:
 We compared the outcomes of same sitting robotic‐assisted hybrid coronary artery revascularization (HCR) with off‐pump coronary artery bypass grafting (OPCABG) in similar patients with multivessel coronary artery disease.

Background:
 HCR is a novel procedure in selected patients with multivessel coronary artery disease (CAD). Although there are some data on staged HCR, the data on same sitting HCR are limited.

Methods:
 We conducted a prospective study comparing same sitting robotic‐assisted HCR patients (n = 25) to a group of consecutive low to moderate risk OPCABG patients (n = 27) during the study period. HCR patients underwent robotic internal mammary artery takedown followed by OPCABG via minithoracotomy. After confirming graft patency, immediate percutaneous coronary intervention on the nonbypass arteries was performed. Comparative analyses were performed on in‐hospital and 30 day outcomes.

Results:
 The baseline characteristics were similar for both groups including the severity of CAD (Syntax score 33.5+/−8.2 vs. 34.9+/−8.2, P = 0.556). Overall MACE was similar between both groups; however, the HCR group showed improved hospital outcomes with lower need for postoperative transfusions (12% vs. 67%, P < 0.001), and shorter length of hospital stay (5.1+/−2.8 vs. 8.2+/−5.4 days, P < 0.01). Despite lower postoperative costs, the HCR group had higher overall hospital costs due to higher procedural costs ($33,984 +/−$4,806 vs. $27,816+/−$11,172, P < 0.0001). Propensity model analysis showed similar findings. The HCR group showed improved quality of life measures with shorter time to return to work (5.3+/−3.0 vs. 8.2+/− 4.6 weeks, P = 0.01).

Conclusions:
 Same sitting HCR appears to be feasible and may offer superior outcomes to standard OPCABG, further studies are warranted. (J Interven Cardiol 2012;25:460–468)
Measuring State Environmental Policy
Authors: Konisky David M. , Woods Neal D.
Published: July 2012

Studies of environmental policy employ various empirical strategies for measuring state environmental effort. The majority of these strategies can be divided into four categories: indices of state programmatic indicators, government expenditures, pollution abatement costs, and regulatory enforcement actions. In this article, we argue that these measures are empirically distinct, capture different attributes of state environmental policy, and are correlated with different intrastate factors. Thus, the choice among environmental policy measures is substantively important for researchers to consider, and we conclude by providing advice to scholars concerning choosing among these measures.
The Role of Experts in the European Union's Research Policy
Authors: Tamtik Merli , Sá Creso M.
Published: July 2012

This research analyzes the role of experts in the European Union's policy‐making process. Focusing on the field of research policy, this study seeks to probe how expert participation in the Open Method of Coordination informs policy decisions. The paper reports on an analysis of the expert group in the European Internationalization Strategy in Science and Technology. Our analysis reveals the dynamics of expert participation at the micro level, as it identifies who these experts are, how they are appointed, and in what ways expert knowledge gets used in policy making.
The Shale Gas Revolution: U.S. and EU Policy and Research Agendas
Authors: Boersma Tim , Johnson Corey
Published: July 2012

The “shale gas revolution” raises a host of questions for policy makers and researchers on both sides of the Atlantic. We provide a brief overview of the regulatory environment as it relates to hydraulic fracturing for natural gas in the United States and the European Union. We then pose a set of open questions, which we believe should shape policy and research agendas surrounding shale gas wherever the development of this resource is being pursued or considered.
Relaxor to Ferroelectric Transitions in (Bi1/2Na1/2)TiO3–Bi(Zn1/2Ti1/2)O3Solid Solutions
Authors: Patterson Eric A. , Cann David P.
Published: July 2012

Recently, (Bi1/2Na1/2)TiO3 solid solutions have been found to exhibit excellent dielectric and piezoelectric properties. In this study, the dielectric and ferroelectric properties of (1–x)(Bi1/2Na1/2)TiO3–xBi(Zn1/2Ti1/2)O3 (BNT–BZT) solid solutions were investigated. Up to a solubility limit of 8% BZT, distortions to the parent cubic perovskite phase were observed in the diffraction data through splitting of the (001), (011), and (111) reflections. At low concentrations of BZT, the material behaved very much like a conventional ferroelectric, with well‐saturated loops with high remanent polarization (Pr ~ 35 μC/cm2). As the BZT content increased, the dielectric behavior displayed characteristics of relaxor behavior. Polarization hysteresis data at elevated temperatures and a thermal hysteresis in the dielectric maximum were evidence for a relaxor to ferroelectric transition.
A High‐Temperature‐Capacitor Dielectric Based on K0.5Na0.5NbO3‐Modified Bi1/2Na1/2TiO3–Bi1/2K1/2TiO3
Authors: Dittmer Robert , Anton Eva‐Maria , Jo Wook , Simons Hugh , Daniels John E. , Hoffman Mark , Pokorny Jan , Reaney Ian M. , Rödel Jürgen
Published: July 2012

A high‐temperature dielectric, (1–x)(0.6Bi1/2Na1/2TiO3–0.4Bi1/2K1/2TiO3)–xK0.5Na0.5NbO3, off the morphotropic phase boundary of the parent matrix 0.8Bi1/2Na1/2TiO3–0.2Bi1/2K1/2TiO3, has been developed for application as a high‐temperature capacitor. In addition to temperature‐dependent permittivity and dielectric loss, DC conductivity and field‐dependent permittivity are reported. These properties are correlated with temperature‐dependent structure data measured at different length scales using Raman spectroscopy and neutron diffraction. It is suggested that all materials investigated are ergodic relaxors with two types of polar nanoregions providing different relaxation mechanisms. The most attractive properties for application as high‐temperature dielectrics are obtained in a material with x = 0.15 at less than 10% variation of relative permittivity of about 2100 between 54°C and 400°C.
TEM and SAED Characterization of Metakaolin. Pozzolanic Activity
Authors: Trusilewicz L. , Fernández‐Martínez F. , Rahhal V. , Talero R.
Published: July 2012

The present study deals with a characterization of metakaolin pozzolanic activity and its chemical character exhibited in the Ordinary Portland Cement (OPC) blends by means of Transmission Electron Microscopy (TEM) and Selected‐Area Electron Diffraction (SAED) techniques principally. Metakaolin sample was prepared by calcination of kaolin rock (Guadalajara, Spain) at 780°C. Two OPC of different chemical composition from the tricalcium aluminate content point of view were chosen and Portland cement blends series elaborated and then submitted to the pozzolanic activity test (EN 196‐5 or Frattini test). The main mineralogical components of the metakaolin are determined qualitatively: χ‐alumina and quartz. The chemical character of the metakaolin is described because of its final composition as well as due to its Al atoms possible coordination. The crystalline order of the material is found to be of both amorphous and polycrystalline, being an intimate amorphous mixture of alumina and silica. Finally, all the alumina capable of reacting chemically is denominated and classified as reactive alumina component, Al2O3r−, of pozzolans, as well as the aluminic chemical character of metakaolin in OPC blends is once again proved and exhibited by means of Friedel's salt formation studied already at 4 h‐age.