bluuebunny/crossref_metadata_2025 huggingface dataset:
Randomized and prospective trial comparing tract creation using plasma vaporization with balloon dilatation in percutaneous nephrolithotomy
Authors: Chiang Po Hui , Su Hsin Hao
Published: October 2012

What's known on the subject? and What does the study add?

Use of balloon dilatation leads to less blood transfusion rates than metallic dilators. Plasma vaporization leads to less blood loss than balloon dilatation in this study.

The study evaluates a novel technique for the creation of a nephrostomy tract for PCNL. Compared with other techniques, plasma vaporization is a safer procedure that causes lesser blood loss, requires a shorter hospital stay, causes less radiation exposure, and enables easier nephrostomy tract creation for PCNL.

Objective

To evaluate the efficacy and safety of plasma vaporization for tract creation in percutaneous nephrolithotomy (PCNL).

Patients and Methods

In this randomized prospective trial we enrolled 65 patients and assigned each to one of two groups: 33 patients were randomly scheduled to undergo plasma vaporization and 32 were scheduled to undergo balloon dilatation for tract creation.

A bipolar resectoscope mounted with a plasma vaporization button electrode or a traditional balloon dilator were used to create the nephrostomy tract.

Results

The mean blood loss, mean length of hospital stay and mean operating time, stone‐free rates and postoperative complications in the two groups were compared using the t‐test or chi‐squared test (Fisher's exact test).

The plasma vaporization group had a significantly lower mean (SD) decrease in haematocrit level (3.5 [2.8]% vs 6.6 [3.3]%; P = 0.02) and a shorter mean (SD) hospital stay (2.6 [1.2] days vs 5.3 [3.4] days; P = 0.0).

There were no significant differences in the operating time, stone‐free rate or cases of postoperative fever between the two groups.

Conclusion

The plasma vaporization technique is safe, leads to less blood loss than the other techniques, and is a simple solution for creating the nephrostomy tract for PCNL.
RESIDENTIAL PHOTOVOLTAIC ENERGY SYSTEMS IN CALIFORNIA: THE EFFECT ON HOME SALES PRICES
Authors: HOEN BEN , WISER RYAN , THAYER MARK , CAPPERS PETER
Published: October 2012

Relatively little research exists estimating the marginal impacts of photovoltaic (PV) energy systems on home sale prices. Using a large data set of California homes that sold from 2000 through mid‐2009, we find strong evidence, despite a variety of robustness checks, that existing homes with PV systems sold for a premium over comparable homes without PV systems, implying a near full return on investment. Premiums for new homes are found to be considerably lower than those for existing homes, implying, potentially, a trade‐off between price and sales velocity. The results have significant implications for homeowners, builders, appraisers, lenders, and policymakers. (JEL R31, D12, C33)
Tourism, leisure and work in an east African pastoral society (Respond to this article at http://www.therai.org.uk/at/debate)
Authors: Régi Tamás
Published: October 2012

This article investigates what happens with leisure experience between cultures when the Mursi of southwestern Ethiopia meet with international tourists. I propose that instead of regarding leisure as a fixed human condition within one society, it might fruitfully be approached as a process that evolves when different societies meet, i.e. as a constantly emerging (and disappearing) practice in cross‐cultural encounters. Tourism, studied broadly from an anthropological point of view, offers an excellent field for this investigation. The Western ideology of leisure, mobilized by tourists in non‐Western settings, is a good entry point to make tangible how societies understand leisure pursuits in intercultural encounters.
The Party Politics of Englishness
Authors: Mycock Andrew , Hayton Richard
Published: October 2012

Research Highlights and Abstract

provides one of the first assessments of how British multi-national and English political parties have responded to existing and emergent identity tensions in England whilst continuing to defend the concept of the post-devolution British union-state. extends debates about multi-level party political systems in multi-national states which have typically focused on Scotland, Wales and, to a lesser extent, Northern Ireland. considers the potential that debates about English national identity could morph into a party politics of Englishness. assesses the potential for nascent English nationalism to encourage divergent party political responses to questions of English governance, citizenship and nation identity.

This article assesses how the main British multi-national parties, whilst retaining an attachment of one form or another to the concept of the Union-state, have responded to existing and emergent identity tensions. Through examination of Labour, the Conservatives and the Liberal Democrats, with brief discussion of the BNP, UKIP and the English Democrats, it will consider the impact of devolution and the threat of separatist nationalism on party approaches and policy choices concerning English identity construction and governance. It will also explore the extent to which devolution has compromised the ability of UK politicians to ‘speak of Britain’ (they rarely use the term UK) and the four composite nations. By comparing and contrasting the narratives articulated by parties at different levels of governance it will ask whether a nascent ‘party politics of Englishness’ has emerged which can accommodate these challenges.
Action Imitation at 1½ Years Is Better Than Pointing Gesture in Predicting Late Development of Language Production at 3 Years of Age
Authors: Zambrana Imac M. , Ystrom Eivind , Schjølberg Synnve , Pons Francisco
Published: October 2012

This study examined whether poor pointing gestures and imitative actions at 18 months of age uniquely predicted late language production at 36 months, beyond the role of poor language at 18 months of age. Data from the Norwegian Mother and Child Cohort Study were utilized. Maternal reports of the children's nonverbal skills and language were gathered for 42,517 children aged 18 months and for 28,107 of the same children at 36 months. Panel analysis of latent variables revealed that imitative actions, language comprehension, and language production uniquely contributed to predicting late development of language production, while pointing gestures did not. It is suggested that the results can be explained by underlying symbolic representational skills at 18 months.
Living with side effects from cancer treatment – a challenge to target information
Authors: Pedersen Birgith , Koktved Dorte P. , Nielsen Lene L.
Published: October 2012

Background

Patients with cancer experience side effects related to their antineoplastic treatment. Demands for efficiency limit the time patients spend with health professionals. This requires that professionals are able to offer adequate support to patients in coping with side effects of treatment in everyday life. However, it appears that the level of information about and support in living with side effects may be insufficient.

Objective

To explore patients' experiences of how side effects from chemotherapy and radiotherapy impact everyday life as well as the information needs in coping with these side effects.

Methods

Nine patients' experiences were analysed and interpreted using a phenomenological‐hermeneutical approach. Data were collected through semi‐structured interviews.

Findings

The patients are deeply impacted by side effects in their everyday life. They struggle to take power but experience loss of control. They feel inexperienced without knowledge in an ‘ongoing system', and because of lack of continuity, they do not come up with their real needs. To avoid pitfalls in the information, the patients need individualized support from the professionals.

Conclusion

If the patients have to be supported during everyday life with side effects from cancer treatment in an individualized way, the professional must be aware that the patients risk adapting to the busy healthcare system. To empower the patient, the professional must be able to sense the patients' appeal for help and enter into caring relationships.

Implications for practice

To ensure targeted information, the relationship between nurse and patient must build on nursing values including the patients' illness – perspective. However, the professionals must take a critical look at how they provide information and how they act to empower the patients.
Diversity of mucosal immune responses in upper respiratory airways and the suitability of mucosal vaccines
Authors: Kurono Y. , Nagano H. , Umakoshi M. , Makise T.
Published: October 2012

Mucosal vaccines are considered to be a promising strategy for preventing upper airway infections. As immunization routes to induce mucosal immune responses, oral, intranasal and sublingual immunizations have been proposed for clinical application. Recently, it was reported that transcutaneous immunization (TC) is also capable of inducing mucosal as well as systemic immune responses. However, it remains unclear which route is most effective for inducing mucosal immune responses in upper respiratory airways. In this study, the mucosal immune responses against phosphorylcholine (PC), a structural component of a wide variety of Gram‐positive and ‐negative bacteria, were investigated after intranasal, sublingual, or TC. Female BALB/c mice were immunized intranasally, sublingually, or transcutaneously with PC and cholera toxin. For the TC, the dorsal region was shaved and a cotton patch soaked with the antigen was attached. Nasal wash, saliva and serum samples were collected at 7 days after the final immunization, and examined for their PC‐specific antibody activities using ELISA. Phosphorylcholine‐specific antibodies in serum and PC‐specific IgA in nasal washes and saliva were detected in mice after intranasal and sublingual immunization with PC. Although salivary IgA was higher following intranasal immunization, nasal wash IgA was significantly higher after sublingual immunization. Furthermore, significantly increased IgA in vaginal washes and remarkably decreased serum IgE production were observed after sublingual immunization. TC increased PC‐specific IgA in faecal samples, but not in saliva. The PC antigen can induce mucosal as well as systemic immune responses when administered via intranasal, sublingual and transcutaneous routes. Sublingual immunization is superior to intranasal immunization in terms of safety for inducing mucosal immune responses. Although TC might be an alternative way to induce mucosal immune responses, further investigation is needed for its application as a vaccine route to prevent upper airway infection.
New approach for improving the safety of oral immunotherapy for food allergy
Authors: Urisu A. , Tanaka K. , Ogura K. , Naruse N. , Hirata N. , Nakajima Y. , Inuo C. , Suzuki S. , Ando H. , Kondo Y. , Tsuge I. , Yamada K. , Kimura M.
Published: October 2012

Avoidance of causative foods is the mainstay of therapy for food allergy. This therapy places a burden, to a greater or lesser extent, on food‐allergic patients and their parents if they are children. They always face the probable risk of an unexpected accident resulting from intake of a causative food. Allergen‐specific immunotherapy for pollinosis and bee‐venom allergy has been proven efficient and common in clinical practice. Recently, reports on oral immunotherapy (OIT) for food allergy have been increasing, and OIT has drawn attention as a therapy with the possibility of providing a cure for food allergy. Initially, we review the present status of oral antigen‐specific immunotherapy for food allergy. Overall, OIT for food allergy is promising with regard to an increase in tolerance to causative foods. However, several concerns regarding safety remain. Subsequently, we review new approaches for improving the safety of OIT, including sublingual immunotherapy and modified antigens for OIT. We briefly summarize our study on OIT using heated and ovomucoid‐reduced egg white as an example of a hypoallergenic antigen for safer OIT.
Biology of Asphondyliini (Diptera: Cecidomyiidae)
Authors: TOKUDA Makoto
Published: October 2012

The family Cecidomyiidae (Diptera) including about 6100 described species displays diverse feeding habits. The tribe Asphondyliini is a well‐circumscribed monophyletic group of Cecidomyiidae and all species are known as gall inducers. Species belonging to this tribe exhibit fascinating ecological traits such as host alternation, polyphagy, extended diapause, induction of dimorphic galls and association with fungal symbionts. For these reasons, biogeographical and phylogenetic studies of Asphondyliini are of interest in elucidating the evolution of these traits, and particularly the processes of host‐range expansion, host‐plant shift and shifts in gall‐bearing organs. In order to facilitate further evolutionary studies of Asphondyliini, I review studies of systematics, biogeography, phylogeny, speciation, cytology, behavior, ecology, physiology, biological interaction and economic importance in this tribe.
Assessment of Undergraduate Clinical Reasoning in Geriatric Medicine: Application of a Script Concordance Test
Authors: Piovezan Ronaldo D. , Custódio Osvladir , Cendoroglo Maysa S. , Batista Nildo A. , Lubarsky Stuart , Charlin Bernard
Published: October 2012

A challenging aspect of geriatric practice is that it often requires decision‐making under conditions of uncertainty. The Script Concordance Test (SCT) is an assessment tool designed to measure clinical data interpretation, an important element of clinical reasoning under uncertainty. The purpose of this study was to develop and analyze the validity of results of an SCT administered to undergraduate students in geriatric medicine. An SCT consisting of 13 cases and 104 items covering a spectrum of common geriatric problems was designed and administered to 41 undergraduate medical students at a medical school in São Paulo, Brazil. A reference panel of 21 practicing geriatricians contributed to the test's score key. The responses were analyzed, and the psychometric properties of the tool were investigated. The test's internal consistency and discriminative capacity to distinguish students from experienced geriatricians supported construct validity. The Cronbach alpha for the test was 0.84, and mean scores for the experts were found to be significantly higher than those of the students (80.0 and 70.7, respectively; P < .001). This study demonstrated robust evidence of reliability and validity of an SCT developed for use in geriatric medicine for assessing clinical reasoning skills under conditions of uncertainty in undergraduate medical students. These findings will be of interest to those involved in assessing clinical competence in geriatrics and will have important potential application in medical school examinations.
Chewing Ability and Tooth Loss: Association with Cognitive Impairment in an Elderly Population Study
Authors: Lexomboon Duangjai , Trulsson Mats , Wårdh Inger , Parker Marti G.
Published: October 2012

Objectives

To determine whether there is an association between tooth loss, chewing ability, and cognitive function in a general elderly population.

Design

Data from the Panel Study of Living Conditions of the Oldest Old in 2002 were analyzed. Stepwise logistic regression analyses were used to examine the relationship between cognitive function and tooth loss and chewing ability.

Participants

Five hundred fifty‐seven persons who were nationally representative of the Swedish population aged 77 and older.

Measurements

Cognitive function was measured using the abridged version of the Mini‐Mental State Examination. Information on dental status and chewing difficulty was obtained according to self‐assessment.

Results

Persons with multiple tooth loss and persons with difficulty chewing hard food had significantly higher odds of cognitive impairment. When adjusted for sex, age, and education, the odds of cognitive impairment were not significantly different between persons with natural teeth and with multiple tooth loss, but the odds of impairment remained significantly higher for persons with chewing difficulty even when adjusted for sex, age, education, depression, and mental illness.

Conclusion

Sex, age, education, and certain illnesses do not explain the association between cognition and chewing ability. Whether elderly persons chew with natural teeth or prostheses may not contribute significantly to cognitive impairment as long as they have no chewing difficulty. The results add to the evidence of the association between chewing ability and cognitive impairment in elderly persons.
Older Adults with Biliary Tract Cancer: Treatment and Prognosis
Authors: Lee Ban S. , Hwang Jin‐Hyeok , Lee Sang H. , Jang Sang E. , Ahn Dong‐Won , Hwang Dae W. , Cho Jai Y. , Yoon Yoo‐Seok , Han Ho‐Seong , Ahn Soyeon
Published: October 2012

Objectives

To compare survival in older (≥65) and younger (<65) individuals with biliary tract cancer (BTC) and to determine whether treatment efficacy varies according to age.

Design

Retrospective cohort study and nested case–control study.

Setting

Tertiary referral center in Korea.

Participants

Five hundred thirty–one individuals diagnosed with BTC from 2003 to 2011.

Measurements

Demographic and clinical characteristics of 326 older (≥65) and 205 younger (<65) individuals with BTC were compared. Differences in survival were also assessed after matching according to propensity score.

Results

There were no significant differences in sex, symptoms and signs, tumor histology, stage, or surgery between the two groups, but older participants had more comorbidities and poorer performance status and underwent less chemotherapy and radiotherapy (P < .05). Survival of the two groups was compared. After adjustment for baseline characteristics using the propensity score method, survival was still comparable (P = .72). When survival of older participants in the treatment group (TG, those who underwent surgery, chemotherapy, or radiotherapy) was compared with that of those in the supportive care group (SCG, those who received only supportive care), those in the TG had a longer survival time than those in the SCG (P < .001). This result was confirmed in the propensity analysis (including individuals undergoing surgery, P < .001; excluding individuals undergoing surgery, P < .001). In the multivariable Cox analysis, surgical resection and chemotherapy were significantly associated with longer survival, and advanced tumor stage, lower baseline serum albumin level, and greater comorbidity were found to significantly predict poor survival. Age was not associated with survival in individuals with BTC (P = .33).

Conclusion

Older age was not associated with poor survival in BTC, and treated individuals had longer survival in the older BTC population. Therefore, treatment should not be restricted on the basis of age.
Effect of Coexisting Chronic Obstructive Pulmonary Disease and Cognitive Impairment on Health Outcomes in Older Adults
Authors: Chang Sandy S. , Chen Shu , McAvay Gail J. , Tinetti Mary E.
Published: October 2012

Objectives

To determine the extent to which the co‐occurrence of chronic obstructive pulmonary disease (COPD) and cognitive impairment affect adverse health outcomes in older adults.

Design

Multicenter longitudinal cohort study.

Setting

California, Pennsylvania, Maryland, and North Carolina.

Participants

Three thousand ninety‐three community‐dwelling adults aged 65 and older from the Cardiovascular Health Study. Four hundred thirty‐one had chronic obstructive pulmonary disease (COPD) at study baseline.

Measurements

Follow‐up began at the second CHS visit and continued for 3 years. Spirometric criteria for airflow limitation served to establish COPD using the Lambda‐Mu‐Sigma method, which accounts for age‐related changes in lung function. Cognitive impairment was evaluated using the modified Mini‐Mental State Examination and claims data. Outcomes were respiratory‐related and all‐cause hospitalizations and death.

Results

Participants with coexisting COPD and cognitive impairment had the highest rates of respiratory‐related (adjusted hazard ratio (aHR) = 4.10, 95% confidence interval (CI) = 1.86–9.05) and all‐cause hospitalizations (aHR = 1.34, 95% CI = 1.00–1.80) and death (aHR = 2.29, 95% CI = 1.18–4.45). In particular, individuals with both conditions had a 48% higher rate of all‐cause hospitalizations (adjusted synergy index (aSI) = 1.48, 95% CI = 0.19–11.31) and a rate of death nearly three times as high (aSI = 2.74, 95% CI = 0.43–17.32) as the sum of risks for each respective outcome associated with having COPD or cognitive impairment alone. Nevertheless, tests for interaction were not statistically significant for the presence of synergism between the two conditions contributing to each of the outcomes. Therefore, it cannot be concluded that the combined effect of COPD and cognitive impairment is greater than additive.

Conclusion

Coexisting COPD and cognitive impairment have an additive effect on respiratory‐related and all‐cause hospitalizations and death. Optimizing outcomes in older adults with COPD and cognitive impairment will require that how to improve concurrent management of both conditions be determined.
A mathematical modeling approach to quantify the role of phlebotomy losses and need for transfusions in neonatal anemia
Authors: Rosebraugh Matthew R. , Widness John A. , Nalbant Demet , Veng‐Pedersen Peter
Published: October 2012

BACKGROUND: Very preterm infants commonly develop anemia requiring multiple red blood cell transfusions (RBCTx). This is in part attributable to heavy laboratory phlebotomy loss. Quantification of the extent to which laboratory blood loss contributes to anemia sufficient to prompt RBCTx has not been examined.

STUDY DESIGN AND METHODS: Twenty‐six preterm infants weighing less than 1500 g at birth requiring ventilator support who received one or more RBCTx were intensively studied during the first month of life. Hemoglobin (Hb) loss via laboratory blood loss and RBC senescence and Hb gain from RBCTx were precisely accounted for in a Hb mass balance mathematical model developed to assess the impact of phlebotomy on RBCTx when restrictive RBCTx criteria were applied.

RESULTS: Study subjects had a birth weight of 880 ± 240 g (mean ± SD) and a Hb level of 14.4 ± 2.4 g/dL at birth and received 3.81 ± 2.15 RBCTx during the study period. Modeling indicated that even with the total elimination of laboratory phlebotomy loss, a reduction of 41% to 48% in RBCTx was achievable.

CONCLUSION: The present modeling results indicate that while phlebotomy reduction can significantly decrease the number of RBCTx administered to preterm infants, total elimination of all RBCTx will likely require other approaches, for example, stimulation of erythropoiesis with erythropoiesis‐stimulating agents.
Residual risk of transfusion‐transmitted hepatitis B virus (HBV) infection caused by blood components derived from donors with occult HBV infection in Japan
Authors: Taira Rikizo , Satake Masahiro , Momose Shun'ya , Hino Satoru , Suzuki Yoshiharu , Murokawa Hiroyuki , Uchida Shigeharu , Tadokoro Kenji
Published: October 2012

BACKGROUND: Nucleic acid amplification testing (NAT) for hepatitis B virus (HBV) during blood screening has helped to prevent transfusion‐transmitted HBV infection (TT‐HBV) in Japan. Nevertheless, 4 to 13 TT‐HBV infections arise annually.

STUDY DESIGN AND METHODS: The Japanese Red Cross (JRC) analyzed repository samples of donated blood for TT‐HBV that was suspected through hemovigilance. Blood donations implicated in TT‐HBV infections were categorized as either window period (WP) or occult HBV infection (OBI) related. In addition, we analyzed blood from 4742 donors with low antibody to hepatitis B core antigen (anti‐HBc) and antibody to hepatitis B surface antigen (anti‐HBs) titers using individual‐donation NAT (ID‐NAT) to investigate the relationship between anti‐HBc titer and proportion of viremic donors.

RESULTS: Introduction of a more sensitive NAT method for screening minipools of 20 donations increased the OBI detection rate from 3.9 to 15.2 per million, while also the confirmed OBI transmission rate increased from 0.67 to 1.49 per million. By contrast the WP transmission rate decreased from 0.92 to 0.46 per million. Testing repository samples of donations missed by minipools of 20 donations NAT showed that 75 and 85% of TT‐HBV that arose from WP and OBI donations, respectively, would have been interdicted by ID‐NAT. The ID‐NAT trial revealed that 1.94% of donations with low anti‐HBc and anti‐HBs titers were viremic and that anti‐HBc titers and the frequency of viremia did not correlate.

CONCLUSIONS: The JRC has elected to achieve maximal safety by discarding all units with low anti‐HBc and anti‐HBs titers that account for 1.3% of the total donations.
Terrorism Risks and Cost‐Benefit Analysis of Aviation Security
Authors: Stewart Mark G. , Mueller John
Published: October 2012

We evaluate, for the U.S. case, the costs and benefits of three security measures designed to reduce the likelihood of a direct replication of the 9/11 terrorist attacks. To do so, we assess risk reduction, losses, and security costs in the context of the full set of security layers. The three measures evaluated are installed physical secondary barriers (IPSB) to restrict access to the hardened cockpit door during door transitions, the Federal Air Marshal Service (FAMS), and the Federal Flight Deck Officer (FFDO) Program. In the process, we examine an alternate policy measure: doubling the budget of the FFDO program to $44 million per year, installing IPSBs in all U.S. aircraft at a cost of $13.5 million per year, and reducing funding for FAMS by 75% to $300 million per year. A break‐even cost‐benefit analysis then finds the minimum probability of an otherwise successful attack required for the benefit of each security measures to equal its cost. We find that the IPSB is costeffective if the annual attack probability of an otherwise successful attack exceeds 0.5% or one attack every 200 years. The FFDO program is costeffective if the annual attack probability exceeds 2%. On the other hand, more than two otherwise successful attacks per year are required for FAMS to be costeffective. A policy that includes IPSBs, an increased budget for FFDOs, and a reduced budget for FAMS may be a viable policy alternative, potentially saving hundreds of millions of dollars per year with consequences for security that are, at most, negligible.
Bioimpedance analysis and cardiovascular status in pediatric patients on chronic hemodialysis
Authors: Paglialonga Fabio , Ardissino Gianluigi , Galli Maria A. , Scarfia Rosalia V. , Testa Sara , Edefonti Alberto
Published: October 2012

Bioimpedance analysis (BIA) is reported to be useful in assessing dry weight (DW) in patients on hemodialysis (HD), but its exact role has never been clearly defined. We reviewed our experience of using the BIA measure of reactance (Xc) in pediatric patients on chronic HD. Our approach is currently based on identifying a range of patient‐specific Xc values at which a child can be considered at DW according to a multidisciplinary assessment. Values lower than the patient‐specific limit suggests the need for a reduction in DW, whereas values higher than the limit suggest that DW should be increased. The accuracy of our approach was retrospectively assessed by analyzing the left ventricular mass index (LVMI) and the incidence of pulmonary edema (PE) in two groups: The first consisted of 13 patients (median age 15.6 years) on dialysis in 2007, before the introduction of the BIA‐based approach; the second included 18 patients (median 14.8 years) on dialysis in 2011. In 2007, three children experienced four episodes of PE, whereas no PE occurred in 2011. The median LVMI was 56.8 g/m2.7 in 2007, and 44.5 g/m2.7 in 2011 (P < 0.05). The percentage of patients with LV hypertrophy (LVMI>38.5 g/m2.7) was 92.3% in 2007 and 61.1% in 2011 (P < 0.05). There were no between‐group differences in terms of blood pressure, antihypertensive medications, percentage of symptomatic sessions, or biochemistry. In conclusion, a simple approach based on BIA may be useful in assessing DW in pediatric patients on HD, and thus improve their cardiovascular status.
Home hemodialysis: A successful option for obese and bariatric people with end‐stage kidney disease
Authors: Batt Jeni , Linton Kerry , Bennett Paul N.
Published: October 2012

The increasing prevalence of obesity in developed countries is reflected in the chronic kidney disease, dialysis, and transplant populations. The added risk factor of obesity increases the risk of vascular events, inflammation, insulin resistance, blood pressure, dyslipidemia, and mortality risk. Nephrology center policies may exclude obese people from transplantation programs resulting in many years of dialysis. The case of a 215‐kg Australian male who has successfully dialyzed at home for more than 8 years will be used to illustrate the important considerations and clinical support that these people require for successful home dialysis treatment. The aim of this paper is to report on a program that has successfully trained 23 obese (body mass index >30) people who commenced on home hemodialysis between 2001 and 2009. Body weight ranged between 94.0 and 215 kg (mean 126, SD 26.19) and body mass index ranged between 34.9 and 71 (mean 43.38, SD 9.99) at the start of home training. During the 8.5 years of follow‐up, average time on home dialysis was 43.7 months. Home hemodialysis is a feasible treatment for obese people to facilitate longer and more frequent dialysis, resulting in improved hemodynamic stability and improved quality of life. For obese people with end‐stage kidney disease, home hemodialysis has shown to be cost‐effective and can result in greater treatment efficacy than in‐center hospital dialysis.
Predictors of Parent Satisfaction in Pediatric Laceration Repair
Authors: Lowe David A. , Monuteaux Michael C. , Ziniel Sonja , Stack Anne M.
Published: October 2012

ACADEMIC EMERGENCY MEDICINE 2012; 19:1166–1172 © 2012 by the Society for Academic Emergency Medicine

Objectives:  Patient and parent satisfaction are important measures of quality of care. Data are lacking regarding satisfaction with emergency procedures, including laceration repair. The objective was to define the elements of care that are important to parents during a pediatric laceration repair and to determine the predictors of excellent parent satisfaction.

Methods:  This was a cross‐sectional observational study of a convenience sample of patients younger than 18 years of age presenting for laceration repair to an urban tertiary care children’s hospital emergency department (ED). At the end of the ED visit, parents completed a survey developed for this study assessing ratings of their experience and their perception of how their child experienced the repair. Exploratory factor analysis was used to derive the factors comprising parents’ perception of the laceration repair process. A separate factor analysis was performed for the 0‐ to 4‐years age subgroup. Multivariate logistic regression was used to determine which of these factors predicted excellent parent satisfaction with the visit, and also satisfaction with the procedure itself, adjusting for sociodemographic factors.

Results:  A total of 408 parents returned completed surveys (response rate = 76%). Factor analysis revealed that three factors provided a summary of the 16 survey items. They were labeled “provider performance,”“anxiety and pain,” and “cosmetic appearance,” based on factor loading patterns. Provider performance was the only predictor of satisfaction with the visit (adjusted odds ratio [OR] = 11.6; 95% confidence interval [CI] = 6.2 to 21.6). Provider performance (adjusted OR = 4.7; 95% CI = 3.1 to 7.2) and cosmetic appearance (adjusted OR 2.7; 95% CI = 1.7 to 4.2) predicted satisfaction with the procedure. Anxiety and pain did not predict either outcome.

Conclusions:  Provider performance, which comprises the elements of physician communication, caring attitude, confidence, and hygiene, is the strongest predictor of excellent parent satisfaction for pediatric patients with ED visits for laceration repair.
Report of Findings in a DSM-5 Field Trial for Hypersexual Disorder
Authors: Reid Rory C. , Carpenter Bruce N. , Hook Joshua N. , Garos Sheila , Manning Jill C. , Gilliland Randy , Cooper Erin B. , McKittrick Heather , Davtian Margarit , Fong Timothy
Published: October 2012

Introduction

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for hypersexual disorder (HD) have been proposed to capture symptoms reported by patients seeking help for out-of-control sexual behavior. The proposed criteria created by the DSM-5 Work Group on Sexual and Gender Identity Disorders require evaluation in a formal field trial.

Aim

This DSM-5 Field Trial was designed to assess the reliability and validity of the criteria for HD in a sample of patients seeking treatment for hypersexual behavior, a general psychiatric condition, or a substance-related disorder.

Method

Patients (N = 207) were assessed for psychopathology and HD by blinded raters to determine inter-rater reliability of the HD criteria and following a 2-week interval by a third rater to evaluate the stability of the HD criteria over time. Patients also completed a number of self-report measures to assess the validity of the HD criteria.

Main Outcome Measures

HD and psychopathology were measured by structured diagnostic interviews, the Hypersexual Behavior Inventory, Sexual Compulsivity Scale, and Hypersexual Behavior Consequences Scale. Emotional dysregulation and stress proneness were measured by facets on the NEO Personality Inventory—Revised.

Results

Inter-rater reliability was high and the HD criteria showed good stability over time. Sensitivity and specificity indices showed that the criteria for HD accurately reflected the presenting problem among patients. The diagnostic criteria for HD showed good validity with theoretically related measures of hypersexuality, impulsivity, emotional dysregulation, and stress proneness, as well as good internal consistency. Patients assessed for HD also reported a vast array of consequences for hypersexual behavior that were significantly greater than those diagnosed with a general psychiatric condition or substance-related disorder.

Conclusions

The HD criteria proposed by the DSM-5 Work Group on Sexual and Gender Identity Disorders appear to demonstrate high reliability and validity when applied to patients in a clinical setting among a group of raters with modest training on assessing HD.
Prevalence and Factors Associated with Condom Use Among Chinese Monogamous Female Patients with Sexually Transmitted Infection in Hong Kong
Authors: Yan Jin , Lau Joseph T.F. , Tsui Hi-Yi , Gu Jing , Wang Zixin
Published: October 2012

Introduction

Monogamous female sexually transmitted infection (STI) patients are at high risk of recurrent STI, but there is no study investigating their risk behaviors.

Aim

We investigated the prevalence of male condom use and associated factors among monogamous STI female patients.

Main Outcome Measures

Independent variables included socio-demographic characteristics, STI history, nature of relationship, and cognitions (Health Belief Model). Dependent variables included the use of male condoms in the past two months and intention to use male condoms consistently in the future 6 months.

Methods

A cross-sectional survey using a structured questionnaire was conducted among STI female patients with only one male sex partner in the last 12 months and attended a major government STI clinic in Hong Kong.

Results

Among the 538 participants, 25.1% used condoms consistently (every time) during sex in the past 2 months, while 35.2% intended to do so in the next 6 months. A multiple stepwise logistic regression model identified three statistically significant factors associated with lower likelihoods of consistent condom use in the past 2 months: type of sole sex partner (cohabitant vs. husband: OR = 0.29, 95% CI = 0.12 to 0.70; regular boyfriend vs. husband: OR = 0.52, 95% CI = 0.30 to 0.91), being financially dependent (OR = 0.45, 95% CI = 0.27 to 0.75), and partner’s dislike of condom use (OR = 0.23, 95% CI = 0.15 to 0.39). In a similar model, the same three factors were found to be significantly associated with the intention to use condoms consistently in the next 6 months. The low prevalence of intention to use condoms consistently in the future suggested that our study population might be victimized again. The impact of financially dependent relationships and men’s dislike of using condoms on condom use may operate through imbalanced gender power.

Conclusion

Interventions are greatly warranted and should increase risk awareness and empower this vulnerable population.
Tape Casting of Anode Supports for Solid Oxide Fuel Cells at Forschungszentrum Jülich
Authors: Schafbauer Wolfgang , Menzler, Norbert H. , Buchkremer Hans P.
Published: October 2012

This contribution describes the development of tape casting for solid oxide fuel cells (SOFCs) anode supports starting with the characterization of the powders and ending with manufacturing of cells for stack testing. After casting the support, full cells were prepared by screen printing and sintering of the functional layers. The results of single‐cell and stack tests of the novel SOFC will be discussed. The new cell showed excellent electrochemical performance in single‐cell tests with more than 1.5 A/cm2 (800°C, 0.7 V). Furthermore, stack tests showed no significant difference from earlier standard cells when operated at 800°C with a current density of 0.5 A/cm2.
Follow‐up study comparing necropsy rates and discrepancies between clinical and pathologic diagnoses at a veterinary teaching hospital: 2009 versus 1989 and 1999
Authors: Dank G. , Segev G. , Moshe D. , Kent M. S.
Published: October 2012

OBJECTIVES

A follow‐up, retrospective study to determine whether the proportion of discrepancies between clinical and pathological diagnoses made during 2009, 1999 and 1989 and the proportion of dogs necropsied have changed.

METHODS

Medical records of 148 hospitalised dogs that died or were euthanased in a veterinary medical teaching hospital during 2009 were reviewed. Clinical and pathological diagnoses were recorded, categorised and compared to historical controls using a data set of 623 dogs from a previous study.

RESULTS

The proportion of discrepancies was significantly (P<0·001) lower in 2009 (14·9%), compared to both 1999 (37%) and 1989 (39·8%). There was also a significant (P<0·001) decrease in the number of necropsies performed during 2009 (21·4%) compared to both 1999 (48·4%) and 1989 (58·9%).

CLINICAL SIGNIFICANCE

There was a marked improvement in the ante‐mortem diagnosis of patients in 2009 compared with both 1989 and 1999 as evidenced by the decrease in the proportion of discrepancies between the clinical and pathological diagnoses. Necropsies should still be regarded as a vital tool for teaching, determining the pathological basis of disease, identification of new and emerging diseases, and for an individual animal determining the cause of death.
Transient responses of fished populations to marine reserve establishment
Authors: White J. Wilson , Botsford Louis W. , Hastings Alan , Baskett Marissa L. , Kaplan David M. , Barnett Lewis A.K.
Published: October 2012

Implementation of no‐take marine reserves is typically followed by monitoring to ensure that a reserve meets its intended goal, such as increasing the abundance of fished species. The factors affecting whether abundance will increase within a reserve are well characterized; however, those results are based on long‐term equilibria of population models. Here we use age‐structured models of a generic fish population to analyze the short‐term transient response. We show that it may take decades for a fished population to reach postreserve equilibrium. In the meantime, short‐term transient dynamics dominate. During the transient phase, population abundance could either remain unchanged, decrease, or exhibit single‐generation oscillations, regardless of the eventual long‐term result. Such transient dynamics are longer and more oscillatory for populations with heavier fishing, older ages at maturity, lower natural mortality rates, and lower larval connectivity. We provide metrics based on demographic data to describe the important characteristics of these postreserve transient dynamics.
Role of particle beam therapy in a trimodality approach to locally advanced non‐small cell lung cancer
Authors: Kesarwala Aparna H. , Grover Surbhi , Rengan Ramesh
Published: October 2012

Lung cancer accounts for nearly one‐fifth of all cancer deaths worldwide and is the most common cause of cancer‐related death in the United States. Outcomes for locally advanced non‐small cell lung cancer remain extremely poor with regards to both local control and overall survival. Modest gains in local control were obtained with the incorporation of multimodality treatment, including preoperative chemotherapy followed by surgical resection; combination chemoradiotherapy also improved survival, secondary to improved local control. While the natural progression to trimodality therapy resulted in superior local control, it did not translate to improved overall survival, secondary to increased toxicity. The additional morbidity is likely from radiation toxicity, the minimization of which will be crucial to the future success of trimodality therapy. One strategy to decrease toxicity is to utilize charged particles, such as protons, which deposit a high dose at the Bragg peak with a minimal dose beyond the peak, thereby reducing the dose to distal normal tissues. Trimodality therapy incorporating preoperative proton radiation therapy and chemotherapy, followed by surgery, is currently being evaluated as a potential strategy to achieve improved local control and overall survival in locally advanced non‐small cell lung cancer.
Involvement of gangliosides in the process of Cbp/PAG phosphorylation by Lyn in developing cerebellar growth cones
Authors: Sekino‐Suzuki Naoko , Yuyama Kohei , Miki Toshiaki , Kaneda Mizuho , Suzuki Hidenori , Yamamoto Naomasa , Yamamoto Tadashi , Oneyama Chitose , Okada Masato , Kasahara Kohji
Published: October 2012

The association of gangliosides with specific proteins in the central nervous system was examined by coimmunoprecipitation with an anti‐ganglioside antibody. The monoclonal antibody to the ganglioside GD3 (R24) immunoprecipitated the Csk (C‐terminal src kinase)‐binding protein (Cbp). Sucrose density gradient analysis showed that Cbp of rat cerebellum was detected in detergent‐resistant membrane (DRM) raft fractions. R24 treatment of the rat primary cerebellar cultures induced Lyn activation and tyrosine phosphorylation of Cbp. Treatment with anti‐ganglioside GD1b antibody also induced tyrosine phosphorylation. Furthermore, over‐expressions of Lyn and Cbp in Chinese hamster ovary (CHO) cells resulted in tyrosine 314 phosphorylation of Cbp, which indicates that Cbp is a substrate for Lyn. Immunoblotting analysis showed that the active form of Lyn and the Tyr314‐phosphorylated form of Cbp were highly accumulated in the DRM raft fraction prepared from the developing cerebellum compared with the DRM raft fraction of the adult one. In addition, Lyn and the Tyr314‐phosphorylated Cbp were highly concentrated in the growth cone fraction prepared from the developing cerebellum. Immunoelectron microscopy showed that Cbp and GAP‐43, a growth cone marker, are localized in the same vesicles of the growth cone fraction. These results suggest that Cbp functionally associates with gangliosides on growth cone rafts in developing cerebella.
1α,25‐Dihydroxyvitamin D3‐liganded vitamin D receptor increases expression and transport activity of P‐glycoprotein in isolated rat brain capillaries and human and rat brain microvessel endothelial cells
Authors: Durk Matthew R. , Chan Gary N.Y. , Campos Christopher R. , Peart John C. , Chow Edwin C. Y. , Lee Eason , Cannon Ronald E. , Bendayan Reina , Miller David S. , Pang K. Sandy
Published: October 2012

Induction of the multidrug resistance protein 1 (MDR1)/P‐glycoprotein (P‐gp) by the vitamin D receptor (VDR) was investigated in isolated rat brain capillaries and rat (RBE4) and human (hCMEC/D3) brain microvessel endothelial cell lines. Incubation of isolated rat brain capillaries with 10 nM of the VDR ligand, 1α,25‐dihydroxyvitamin D3 [1,25(OH)2D3] for 4 h increased P‐gp protein expression fourfold. Incubation with 1,25(OH)2D3 for 4 or 24 h increased P‐gp transport activity (specific luminal accumulation of NBD‐CSA, the fluorescent P‐gp substrate) by 25–30%. In RBE4 cells, Mdr1b mRNA was induced in a concentration‐dependent manner by exposure to 1,25(OH)2D3. Concomitantly, P‐gp protein expression increased 2.5‐fold and was accompanied by a 20–35% reduction in cellular accumulation of the P‐gp substrates, rhodamine 6G (R6G), and HiLyte Fluor 488‐labeled human amyloid beta 1‐42 (hAβ42). In hCMEC/D3 cells, a 3 day exposure to 100 nM 1,25(OH)2D3 increased MDR1 mRNA expression (40%) and P‐gp protein (threefold); cellular accumulation of R6G and hAβ42 was reduced by 30%. Thus, VDR activation up‐regulates Mdr1/MDR1 and P‐gp protein in isolated rat brain capillaries and rodent and human brain microvascular endothelia, implicating a role for VDR in increasing the brain clearance of P‐gp substrates, including hAβ42, a plaque‐forming precursor in Alzheimer's disease.
Incidence rates and trends of lip, oral and oro‐pharyngeal cancers in Portugal
Authors: Monteiro Luís S. , Antunes Luís , Bento Maria J. , Warnakulasuriya Saman
Published: October 2012

Objectives

To analyse the trends and patterns of lip, oral and oro‐pharyngeal cancer incidence in Portugal between 1998 and 2007.

Patients and Methods

Data on lip, oral and oro‐pharyngeal cancers was collected from the databases maintained at the three main Regional Cancer Registries of Portugal (1998–2007). The data were analysed by gender, age and by site. Incidence rates were age standardized by the direct method, and joinpoint regression was used to estimate trends in incidence.

Results

During this 10‐year period, a total of 9623 cases of lip, oral and oropharynx cancers were reported, 7565 (78.6%) in males and 2058 (21.4%) in females. There was an increase in the age‐standardized incidence of oral cancers by 1.96% per year for both sexes grouped together and an increase of 4.34% per year for the female group. Oro‐pharyngeal cancer showed an increase incidence trend of 3.49% per year for both sexes grouped together and an increase of 3.49% per year for male group among the sites analysed. Lip cancer showed a decrease in its incidence rate.

Conclusion

In view of rising trends, it is necessary to implement policies on oral cancer control by initiating campaigns on oral cancer awareness and screening and to harness political measures on tobacco and alcohol control for the Portuguese population.