bluuebunny/crossref_metadata_2025 huggingface dataset:
Infiltrative Cutaneous Hemangiolipoma in a Goat
Authors: Collier Jessica R. , Byers Stacey R. , Schaffer Paula A. , Worley Deanna R. , Ehrhart E. J. , Duncan Colleen G. , Grossman Alicia N. , Holt Timothy , Callan Robert J.
Published: July 2013

An approximately 4-year-old castrated male, Saanen cross goat presented to the Colorado State University Veterinary Teaching Hospital for evaluation and removal of a 22 cm × 22 cm, dark red, thickened, and crusted cutaneous lesion along the left ventrolateral thorax. An initial incisional biopsy performed approximately 8 weeks earlier was suspicious for cutaneous hemangiosarcoma. Surgical excision was deemed to be the most appropriate treatment option for this goat. A complete physical exam, complete blood count, and chemistry profile were performed and results were within normal limits. Thoracic radiographs and abdominal ultrasound were performed to rule out metastatic disease and comorbid conditions; no metastatic lesions or other abnormalities were observed. En bloc surgical excision of the affected skin was performed and the entire tissue was submitted for histopathology. A final diagnosis of cutaneous hemangiolipoma was reached upon extensive sectioning and histologic examination of the larger tissue specimen. The goat recovered well from surgery and has had no further complications up to 9 months postoperatively. To our knowledge, this is the first case report of a hemangiolipoma in a goat and surgical excision for such lesions appears to be a viable treatment method.
Management of Globus Pharyngeus
Authors: Kortequee S. , Karkos P. D. , Atkinson H. , Sethi N. , Sylvester D. C. , Harar R. S. , Sood S. , Issing W. J.
Published: July 2013

Globus pharyngeus is a common ENT condition. This paper reviews the current evidence on globus and gives a rational guide to the management of patients with globus. The aetiology of globus is still unclear though most ENT surgeons believe that reflux whether acidic or not plays a significant role. Though proton pump inhibitors are used extensively in practice, there is little evidence to support their efficacy. Most patients with globus can be discharged after simple office investigations. The role of pepsin-induced laryngeal injury is an exciting concept that needs further study. Given the benign nature of globus pharyngeus, in most cases, reassurance rather than treatment or extensive investigation with rigid oesophagoscopy or contrast swallows is all that is needed. We need more research into the aetiology of globus.
Investigation into Structural Changes of the Copper Binding Site in Lysyl Oxidase upon Substrate and Inhibitor Docking
Authors: Lynch M. , Ryvkin F.
Published: July 2013

The present paper reports a computational investigation of potential communication between the lysine tyrosylquinone (LTQ) and copper cofactors within lysyl oxidase (LOX). Various substrates and inhibitors of LOX were docked into the active site in our computer generated model of the enzyme. Conformational changes in the vicinity of the copper site as well as changes in the electrostatic environment were identified. The appearance of a canal-like structure involving tyrosine 35 (TYR35) and glutamine 104 (GLN104) residues was shown to be consistent upon docking of a variety of different compounds. Interactions between LOX and its natural substrate, collagen, were also explored through molecular dynamic simulations. The possibility of communication between the organic and inorganic cofactors in LOX was proposed, aiding the ongoing debate regarding the role of copper in the catalytic mechanism of this important enzyme.
Benzyl Isothiocyanate: Double Trouble for Breast Cancer Cells
Authors: Rao Chinthalapally V.
Published: July 2013

An inverse association between dietary intake of cruciferous vegetables and cancer risk has been established for different types of malignancies, including breast cancer. The anticarcinogenic effect of cruciferous vegetables has been attributed to chemicals with an isothiocyanate (ITC) functional moiety. Research over the past three decades has provided extensive preclinical evidence for the efficacy of various ITCs against cancer in preclinical models. Benzyl isothiocyanate (BITC) is one such compound with the ability to inhibit chemically induced cancer, oncogenic-driven tumor formation, and human tumor xenografts in rodent cancer models. Prior work also has established that BITC has the ability to influence carcinogen metabolism and signaling pathways relevant to tumor progression and invasion. In this issue, Kim and colleagues show that BITC inhibits breast cancer stem cell growth, both in vitro and in vivo, in association with suppression of the full-length receptor tyrosine kinase RON as well as its activated truncated form (sfRon), both of which seem to drive stemness in breast cancer cells. Overexpression of RON or sfRon prevented the BITC effect. These data complement prior work from this group showing elimination of mammary tumor cells via tumor cell apoptosis by BITC administration. The inhibition of breast cancer stem cells is observed at pharmacologic concentrations of BITC. This perspective briefly reviews epidemiologic evidence, preclinical efficacy data, and molecular and cellular mechanistic attributes of BITC. Critical issues relevant to clinical development of BITC are discussed briefly. Cancer Prev Res; 6(8); 760–3. ©2013 AACR.
Not Expecting the Unexpected: Diacylglycerol Kinase Alpha as a Cancer Target
Authors: Bhat Krishna P.L. , Aldape Kenneth
Published: July 2013

Summary: In this issue of Cancer Discovery, Dominguez and colleagues identify diacylglycerol kinase alpha (DGKα), an enzyme that converts the membrane lipid diacylglycerol to phosphatidic acid, as a central node upstream of mTOR and other oncogenic pathways. Importantly, targeting DGKα causes apoptosis in cancer cells and tumor growth inhibition in mice with no overt toxicity, implicating DGKα as a novel cancer-specific target. Cancer Discov; 3(7); 726–7. ©2013 AACR.

See related article by Dominguez et al., p. 782
The Sensitivity and Specificity of Subjective Memory Complaints and the Subjective Memory Rating Scale, Deterioration Cognitive Observee, Mini-Mental State Examination, Six-Item Screener and Clock Drawing Test in Dementia Screening
Authors: Ramlall S. , Chipps J. , Bhigjee A.I. , Pillay B.J.
Published: July 2013

Background: The effectiveness of dementia screening depends on the availability of suitable screening tools with good sensitivity and specificity to confidently distinguish normal age-related cognitive decline from dementia. The aim of this study was to evaluate the discriminant validity of 7 screening measures for dementia. Methods: A sample of 140 participants aged ≥60 years living in a residential facility for the aged were assessed clinically and assigned caseness for dementia using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revised diagnostic criteria. Sensitivity and specificity of a selection of the following screening measures were tested using receiver operating characteristic (ROC) analysis for individual and combined tests: the Mini-Mental State Examination (MMSE), Six-Item Screener (SIS), Subjective Memory Complaint, Subjective Memory Complaint Clinical (SMCC), Subjective Memory Rating Scale (SMRS), Deterioration Cognitive Observee (DECO) and the Clock Drawing Test (CDT). Results: Using ROC analyses, the SMCC, MMSE and CDT were found to be ‘moderately accurate' in screening for dementia with an area under the curve (AUC) >0.70. The AUCs for the SIS (0.526), SMRS (0.661) and DECO (0.687) classified these measures as being ‘less accurate'. At recommended cutoff scores, the SMCC had a sensitivity of 90.9% and specificity of 45.7%; the MMSE had a sensitivity of 63.6% and a specificity of 76.0%, and the CDT had a sensitivity of 44.4% and a specificity of 88.9%. Combining the SMCC and MMSE did not improve their predictive power except for a modest increase when using the sequential rule. Conclusion: The SMCC is composed of valid screening questions that have high sensitivity, are simple to administer and ideal for administration at the community or primary health care level as a first level of ‘rule-out' screening. The MMSE can be included at a second stage of screening at the general hospital level and the CDT in specialist clinical settings. Sequential use of the SMCC and MMSE will improve the specificity of the former and the sensitivity of the latter.
Gastrointestinal Adverse Events after Dual Antiplatelet Therapy: Clopidogrel Is Safer than Ticagrelor, but Prasugrel Data Are Lacking or Inconclusive
Authors: Serebruany Victor L. , DiNicolantonio James J. , Can Mehmet Mustafa , Pershukov Igor V. , Kuliczkowski Wiktor
Published: July 2013

Current guidelines offer a choice of P2Y12 receptor antagonist among clopidogrel, prasugrel or ticagrelor on top of aspirin (ASA) for dual antiplatelet therapy (DAPT) in patients after acute coronary syndromes (ACS). However, the comparative risks of gastrointestinal (GI) adverse events during DAPT are not clear. Two large ACS trials (TRITON and PLATO) provide a valuable opportunity to directly match the risks of GI complications among current antiplatelet regimens. We compared the rates of GI adverse events after prasugrel and ticagrelor versus clopidogrel based on the Food and Drug Administration (FDA) clinical safety reviews. When compared with ticagrelor, clopidogrel is safer with regard to GI-related risks including fewer overall GI/anal bleeding events and spontaneous GI hemorrhagic episodes, less nausea, vomiting, dyspepsia and diarrhea, and a lower rate of presence of Helicobacter pylori. Among GI symptoms, only constipation was more common after clopidogrel than following ticagrelor. There were extrahepatic risks observed with ticagrelor but not with prasugrel when compared to clopidogrel. Prasugrel unquestionably caused more bleeding from the GI tract and GI malignancies than clopidogrel. However, the entire spectrum of GI effects of prasugrel is much less well known and mostly based on sponsor analysis rather than FDA-verified numbers. Among 3 DAPT options on top of ASA, clopidogrel seems to represent the safest alternative, although comprehensive data on direct prasugrel-associated GI effects are lacking or inconclusive.
Fine-Needle Aspiration Cytology of Breast Lesions with Spontaneous Infarction: A Five-Year Study
Authors: Agnihotri Mona , Naik Leena , Kothari Kanchan , Fernandes Gwendolyn , Ojha Sandeep
Published: July 2013

Objective: To put forth the cytological features and diagnostic pitfalls of spontaneously infarcted breast lesions on fine-needle aspiration cytology (FNAC). Study Design: We present 19 cases of spontaneously infarcted breast lesions encountered on FNAC over a 5-year period. Histological follow-up was correlated wherever available. Results: The majority of cases were seen in the second decade of life. The smears in all 19 cases were cellular. The cytomorphologic findings were scattered dyscohesive cells (n = 16), ghost cells (n = 11) and necrosis (n = 10). The dyscohesive cells were small and had a normal nuclear cytoplasmic ratio with pyknotic nuclei. The presence of viable epithelial cells or stromal fragments helped in the diagnosis of the primary breast lesion and was seen in all 19 cases. Cytology diagnoses were infarcted fibroadenoma (n = 11), infarcted breast lesion (n = 3), Phyllodes tumor (n = 2), papillary lesion (n = 2) and infarcted benign breast lesion (n = 1). Histopathology was available in 13 cases, 12 were concordant and 1 was inadequate for primary diagnosis. Conclusion: An infarcted breast lesion poses diagnostic difficulties on cytology. It needs to be differentiated from inflammatory lesions and malignancy. A cytopathologist should be aware of the entity and recognize its cytomorphologic features.
When Do Essential Tremor Patients Develop Head Tremor Influences of Age and Duration and Evidence of a Biological Clock
Authors: Louis Elan D.
Published: July 2013

Background: Essential tremor (ET) is a chronic, progressive neurological disease. Head (neck) tremor may eventually develop in as many as 30-60% of patients, yet it is unclear why. Is its appearance merely a function of advancing disease duration? Alternatively, is patient age a primary factor? The latter would argue for the presence of a biological clock that is important for the expression of this clinical feature of ET. Methods: A total of 363 ET patients were enrolled in a cross-sectional, clinical-epidemiological study. Each ET patient underwent a 20-min videotaped neurological examination which included an assessment of the presence/absence of head tremor. Results: Head tremor was present on examination in 140 (38.6%) patients. Young patients, even with longer-duration tremor, rarely had head tremor: 2/27 (7.4%) patients <40 years old with tremor duration ≥10 years had head tremor versus 121/283 (42.8%) older patients (>60 years old) with tremor duration ≥10 years (p < 0.001). In a multivariate logistic regression analysis, while head tremor was associated with age (p < 0.001) it was not independently associated with tremor duration (p = 0.26); interestingly, it was associated with gender in that model (p < 0.001). With the exception of 1 patient, head tremor did not begin before the age of 36. Conclusions: Data suggest that the appearance of head tremor in ET depends on a biological factor that is intrinsic to the patient (i.e. age) and is not a clear consequence of advancing disease duration.
Activation of Gq Proteins Coupled with 5-HT2 Receptors in Rat Cerebral Cortical Membranes Assessed by Antibody-Capture Scintillation Proximity Assay/[35S]GTPγS Binding
Authors: Odagaki Yuji , Toyoshima Ryoichi
Published: July 2013

Background/Aims: Functional activation of Gq coupled with 5-HT2 receptors was investigated in rat cerebral cortical membranes. Methods: Antibody-capture scintillation proximity assay (SPA)/[35S]GTPγS binding with anti-Gαq antibody was performed. Results: The specific [35S]GTPγS binding to Gαq was increased by 5-hydroxytryptamine (5-HT) in a concentration-dependent but unsaturable manner. The increase elicited by micromolar concentrations of 5-HT was inhibited completely by ketanserin, whereas it inhibited the response by submillimolar to millimolar concentrations of 5-HT only partially. Analysis of the concentration-dependent increases by 5-HT in the absence and presence of ketanserin, methiothepin, WAY100635, and pirenzepine clearly indicates that there are two distinct components of 5-HT-stimulated [35S]GTPγS binding, one of which is a pharmacologically relevant increase elicited by lower concentrations (-30 μmol/l) of 5-HT mediated through 5-HT2 receptors and the other is pharmacologically undefined stimulation by higher concentrations of 5-HT. When 5-HT and carbachol were added simultaneously, there was apparently lack of additivity. Conclusion: It is concluded that by means of antibody-capture SPA/[35S]GTPγS binding it is possible to detect two distinct components of 5-HT-elicited activation of Gq shared by M1 muscarinic receptors, one of which is mediated through 5-HT2 receptors and the other is derived from unknown origin in rat cerebral cortical membranes.
A Social Cognitive Perspective on ‘Understanding' and ‘Explaining'
Authors: Vogeley Kai
Published: July 2013

One essential methodological dichotomy introduced by Karl Jaspers into the field of psychopathology is the difference between ‘understanding' (‘Verstehen') and ‘explaining' (‘Erklären'). Jaspers emphasizes a critical epistemological divide between both methods: whereas ‘explaining' relates to the attempt to consider mental disorders as consequences of impersonal natural laws, ‘understanding' refers to the empathic appreciation of conflicts, hopes, and desires of an individual person. This distinction is related to the difference between ‘persons' and ‘things' according to Fritz Heider, founder of the so-called ‘attribution theory' in social psychology that deals with our ability to ascribe mental states to others. Whereas the behavior of persons is based on psychological rules that are inherently characterized by ambiguity and uncertainty and are thus only partly predictable, the behavior of things is based on natural laws and is therefore fully predictable. This suggests a close resemblance of both accounts where ‘understanding' is related to the domain of persons and ‘explaining' is related to the domain of things or physical objects. Recently, understanding others has also become a central topic of modern cognitive neuroscience, constituting ‘social neuroscience' targeted at explaining our human capacity of ascribing mental states to others. This shows that this distinction introduced by Jaspers still is an important and fundamental differentiation for various research fields dealing with communication and interaction between persons.
Anticoagulation in patients with atrial fibrillation undergoing coronary stent implantation
Authors: Bernard Anne , Pellegrin Céline , Clementy Nicolas , Etienne Christophe Saint , Banerjee Amitava , Naudin Djedjiga , Angoulvant Denis , Fauchier Laurent
Published: July 2013

In patients with atrial fibrillation (AF) undergoing coronary stent implantation, the optimal antithrombotic strategy is unclear. We evaluated whether use of oral anticoagulation (OAC) was associated with any benefit in morbidity or mortality in patients with AF, high risk of thromboembolism (TE) (CHA2DS2-VASC score ≥2) and coronary stent implantation. Among 8,962 unselected patients with AF seen between 2000 and 2010, a total of 2,709 (30%) had coronary artery disease and 417/2,709 (15%) underwent stent implantation while having CHA2DS2-VASC score ≥2. During follow-up (median=650 days), all TE, bleeding episodes, and major adverse cardiac events (i.e. death, acute myocardial infarction, target lesion revascularisation) were recorded. At discharge, 97/417 patients (23%) received OAC, which was more likely to be prescribed in patients with permanent AF and in those treated for elective stent implantation. The incidence of outcome event rates was not significantly different in patients treated and those not treated with OAC. However, in multivariate analysis, the lack of OAC at discharge was independently associated with increased risk of death/stroke/systemic TE (relative risk [RR] =2.18, 95% confidence interval [CI] 1.02-4.67, p=0.04), with older age (RR =1.12, 1.04-1.20, p=0.003), heart failure (RR =3.26, 1.18-9.01, p=0.02), and history of stroke (RR =18.87, 3.11-111.11, p=0.001). In conclusion, in patients with AF and high thromboembolic risk after stent implantation, use of OAC was independently associated with decreased risk of subsequent death/stroke/systemic TE, suggesting that OAC should be systematically used in this patient population.
Validity of Negative High-Resolution Diffusion-Weighted Imaging in Transient Acute Cerebrovascular Events
Authors: Hotter Benjamin , Kufner Anna , Malzahn Uwe , Hohenhaus Marc , Jungehülsing Gerhard J. , Fiebach Jochen B.
Published: July 2013

Background and Purpose—

A significant amount of strokes are reported to be diffusion-weighted imaging (DWI) negative in acute imaging. We attempted to quantify the rate of false-negative high-resolution (hr) DWI and to identify a valid screening tool to guide follow-up MRI to diagnose infarction initially not visible on hrDWI.

Methods—

An a priori–defined post hoc analysis of a prospective 3T MRI cohort of acute cerebrovascular events imaged within 24 hours of ictus. Basic demographics, risk factors, National Institute of Health Stroke Scale, and imaging parameters were recorded.

Results—

Of 151 patients with negative acute hrDWI, 63 received follow-up scans depicting infarction in 7 cases (11.1%). Persistence of clinical symptoms as established by National Institute of Health Stroke Scale on the following day was strongly associated with infarction on follow-up MRI (odds ratios, 17.5; 95% confidence interval, 2.83–108.12). Negative predictive value of follow-up National Institute of Health Stroke Scale was 0.96.

Conclusions—

Infarcts are frequently invisible on initial hrDWI, but we may well trust in negative hrDWI in completely transient cerebrovascular events.
La place de la coutume internationale en droit public français
Authors: Stirn Bernard
Published: July 2013

Abstract

Bernard Stirn’s presentation examines the status of international custom in French public law. He notes that international custom may be considered as covered by the reference in the preamble of the Constitution to the rules of public international law. He underlines the increased effects of international custom in the French domestic legal order as enshrined in the latest developments of the case-law of the Conseil d’Etat. He stresses that whilst French administrative judges may set aside a law in the event of a conflict with the provisions of an international treaty, they do not possess a similar power in the case of a conflict with a rule of customary international law. He concludes by citing cases in which the French constitutional court has made reference to international custom.
Synonymical and nomenclatural notes on Trachyderini (Coleoptera, Cerambycidae, Cerambycinae)
Authors: MONNÉ MARCELA L. , MONNÉ MIGUEL A.
Published: July 2013

Megaderus is reinstated and attributed to Germar, 1824 and not to Rafinesque, 1815 or Dejean, 1821; Neomegaderus Monné, 2006 is an unnecessary replacement name; Purpuricenus brasiliensis Schaufuss, 1871 is a synonym of Eriphus purpuratus Chevrolat, 1862; Panchylissus Waterhouse, 1880 is a synonym of Galissus Dupont, 1840 and G. rubiventris Martins & Galileo, 2010 a synonym of G. cyaneipennis (Waterhouse, 1880), comb. nov.; Panchylissus nigriventris Lane, 1965 is transferred to Galissus; a key to the species of Galissus is provided; the female of Poecilopeplus fontanieri (Lucas, 1857) is described; Ischnotes Newman, 1840 currently in Trachyderini, Ancylocerini is transferred to incertae sedis of Cerambycinae.
The Impact of the North Atlantic Oscillation on Renewable Energy Resources in Southwestern Europe
Authors: Jerez S. , Trigo R. M. , Vicente-Serrano S. M. , Pozo-Vázquez D. , Lorente-Plazas R. , Lorenzo-Lacruz J. , Santos-Alamillos F. , Montávez J. P.
Published: July 2013

Europe is investing considerably in renewable energies for a sustainable future, with both Iberian countries (Portugal and Spain) promoting significantly new hydropower, wind, and solar plants. The climate variability in this area is highly controlled by just a few large-scale teleconnection modes. However, the relationship between these modes and the renewable climate-dependent energy resources has not yet been established in detail. The objective of this study is to evaluate the impact of the North Atlantic Oscillation (NAO) on the interannual variability of the main and primary renewable energy resources in Iberia. This is achieved through a holistic assessment that is based on a 10-km-resolution climate simulation spanning the period 1959–2007 that provides physically consistent data of the various magnitudes involved. A monthly analysis for the extended winter (October–March) months shows that negative NAO phases enhance wind speeds (10%–15%) and, thereby, wind power (estimated around 30% at typical wind-turbine altitudes) and hydropower resources (with changes in precipitation exceeding 100% and implying prolonged responses in reservoir storage and release throughout the year), while diminishing the solar potential (10%–20%). Opposite signals were also sporadically identified, being well explained when taking into account the orography and the prevailing wind direction during both NAO phases. An additional analysis using real wind, hydropower, and solar power generation data further confirms the strong signature of the NAO.
New Hailstone Physics. Part II: Interaction of the Variables
Authors: List Roland
Published: July 2013

The reduction of parameter dimensions in Part I is complemented by the compaction of parameter space in Part II. The range of diameters is 0.5 ≤ D ≤ 8 cm, and the assumed liquid water content varies within 1 ≤ Wf ≤ 3 for dry growth and Wf ≤ 6 g m−3 for shedding. Entirely new data throw new light onto HMT and growth.

Results are as follows: (i) dry growth is unimportant, since most hailstones grow spongy; (ii) radial growth is slow for dry and fast for spongy growth because less latent heat of freezing needs to be discarded if a smaller portion of the accreted water is frozen: this growth with shedding is particularly effective if the product Y of the net collection efficiency and ice mass fraction of the deposit is 0.2 ≤ Y ≤ 0.6; (iii) the lowest possible surface temperature tS for dry growth is −32.3°C. For water-skin-covered, spongy particles tS > −5°C, and tS > −0.55°C for shedding from wet surfaces without water skins; and (iv) the interplay between water-skin thickness and surface temperature allows interconnection of all variables. However, new icing experiments are necessary to prove the proposed sphere growth by special gyration, to quantify the components of Y, and to address water-skin properties and growth.

Radically redesigned dynamic cloud models need to incorporate hail packaging and rain spectra evolution in clouds. The latter will connect hailstone shedding with a warm rain process that is parallel to and interacts with hail formation.
Assessment of the Performance of CORDEX Regional Climate Models in Simulating East African Rainfall
Authors: Endris Hussen Seid , Omondi Philip , Jain Suman , Lennard Christopher , Hewitson Bruce , Chang'a Ladislaus , Awange J. L. , Dosio Alessandro , Ketiem Patrick , Nikulin Grigory , Panitz Hans-Jürgen , Büchner Matthias , Stordal Frode , Tazalika Lukiya
Published: July 2013

This study evaluates the ability of 10 regional climate models (RCMs) from the Coordinated Regional Climate Downscaling Experiment (CORDEX) in simulating the characteristics of rainfall patterns over eastern Africa. The seasonal climatology, annual rainfall cycles, and interannual variability of RCM output have been assessed over three homogeneous subregions against a number of observational datasets. The ability of the RCMs in simulating large-scale global climate forcing signals is further assessed by compositing the El Niño–Southern Oscillation (ENSO) and Indian Ocean dipole (IOD) events. It is found that most RCMs reasonably simulate the main features of the rainfall climatology over the three subregions and also reproduce the majority of the documented regional responses to ENSO and IOD forcings. At the same time the analysis shows significant biases in individual models depending on subregion and season; however, the ensemble mean has better agreement with observation than individual models. In general, the analysis herein demonstrates that the multimodel ensemble mean simulates eastern Africa rainfall adequately and can therefore be used for the assessment of future climate projections for the region.
Simulated Changes in Northwest U.S. Climate in Response to Amazon Deforestation*
Authors: Medvigy David , Walko Robert L. , Otte Martin J. , Avissar Roni
Published: July 2013

Numerical models have long predicted that the deforestation of the Amazon would lead to large regional changes in precipitation and temperature, but the extratropical effects of deforestation have been a matter of controversy. This paper investigates the simulated impacts of deforestation on the northwest United States December–February climate. Integrations are carried out using the Ocean–Land–Atmosphere Model (OLAM), here run as a variable-resolution atmospheric GCM, configured with three alternative horizontal grid meshes: 1) 25-km characteristic length scale (CLS) over the United States, 50-km CLS over the Andes and Amazon, and 200-km CLS in the far-field; 2) 50-km CLS over the United States, 50-km CLS over the Andes and Amazon, and 200-km CLS in the far-field; and 3) 200-km CLS globally. In the high-resolution simulations, deforestation causes a redistribution of precipitation within the Amazon, accompanied by vorticity and thermal anomalies. These anomalies set up Rossby waves that propagate into the extratropics and impact western North America. Ultimately, Amazon deforestation results in 10%–20% precipitation reductions for the coastal northwest United States and the Sierra Nevada. Snowpack in the Sierra Nevada experiences declines of up to 50%. However, in the coarse-resolution simulations, this mechanism is not resolved and precipitation is not reduced in the northwest United States. These results highlight the need for adequate model resolution in modeling the impacts of Amazon deforestation. It is concluded that the deforestation of the Amazon can act as a driver of regional climate change in the extratropics, including areas of the western United States that are agriculturally important.
The Spatial Structure of Tidal and Mean Circulation over the Inner Shelf South of Martha's Vineyard, Massachusetts
Authors: Kirincich Anthony R. , Lentz Steven J. , Farrar J. Thomas , Ganju Neil K.
Published: July 2013

The spatial structure of the tidal and background circulation over the inner shelf south of Martha's Vineyard, Massachusetts, was investigated using observations from a high-resolution, high-frequency coastal radar system, paired with satellite SSTs and in situ ADCP velocities. Maximum tidal velocities for the dominant semidiurnal constituent increased from 5 to 35 cm s−1 over the 20-km-wide domain with phase variations up to 60°. A northeastward jet along the eastern edge and a recirculation region inshore dominated the annually averaged surface currents, along with a separate along-shelf jet offshore. Owing in part to this variable circulation, the spatial structure of seasonal SST anomalies had implications for the local heat balance. Cooling owing to the advective heat flux divergence was large enough to offset more than half of the seasonal heat gain owing to surface heat flux. Tidal stresses were the largest terms in the mean along- and across-shelf momentum equations in the area of the recirculation, with residual wind stress and the Coriolis term dominating to the west and south, respectively. The recirculation was strongest in summer, with mean winds and tidal stresses accounting for much of the differences between summer and winter mean circulation. Despite the complex bathymetry and short along-shelf spatial scales, a simple model of tidal rectification was able to recreate the features of the northeastward jet and match an estimate of the across-shelf structure of sea surface height inferred from the residual of the momentum analysis.
Modeling anesthesia and pavilion surgical units in a Chilean hospital with Specification and Description Language
Authors: Leiva Jorge , Fonseca i Casas Pau , Ocaña Jordi
Published: July 2013

This paper addresses the problem of formally modeling processes related to the operation of surgical pavilions and an anesthesia unit in a Chilean hospital. To perform this modeling, we used Specification and Description Language (SDL), which resulted in a graphic layout consisting of one system, 11 blocks, 52 processes, 135 channels of communication, and 137 information signals. The model includes as system environment to the emergency units, clinical services, and support units. The model was created to document and understand the tacit knowledge of the personnel working in the anesthesia and pavilion surgical units. The aim of the proposed methodology was to design a model that can represent the system in a modular and standard way and that will also assist with hospital management and facilitate simulation.
Surgical off-pump closure of perimembranous ventricular septal defects
Authors: Omelchenko Alexander Y , Zhuang Zhongyun , Schreiber Christian , Gorbatykh Yuriy N , Arkhipov Alexey N , Malakhova Oksana Y , Zaitsev Gregory S
Published: July 2013

Objective

To present our first experience in perventricular closure of ventricular septal defect, which is in our opinion, an important adjunct to current ventricular septal defect treatment options.

Background

Surgical closure under cardiopulmonary bypass is the treatment of choice for a perimembranous ventricular septal defect. Percutaneous techniques have technical limitations. To date, an off-pump approach and device deployment through the wall of the right ventricle is not widespread and has only been reported from China and Germany. We think this approach is promising in selected patients.

Methods

In July 2012, 7 pediatric patients with an isolated perimembranous ventricular septal defect (age range, 4 months to 8 years, mean 2.5 years, all female) with a body weight of 5 to 27 kg, mean 12.7 kg, underwent minimally invasive perventricular device closure.

Results

In all patients, the ventricular septal defect was occluded successfully based on transesophageal echocardiographic confirmation. There were no cases of occluder dislocation noted in the operating room or in the postoperative period. No residual shunts were observed. There was no transient or persistent rhythm disorder in any of the patients. All patients were discharged 4–5 days postoperatively, in excellent physical condition.

Conclusions

The described off-pump approach showed excellent results. It offers such advantages as avoidance of the morbidity associated with cardiopulmonary bypass, significantly shorter hospital stay and therefore reduced costs, and a cosmetic advantage.
From punched cards to apps and iPads
Authors: Clark Andrew , Körner Claudia , Nielsen Henning P.
Published: July 2013

The Pharma Documentation Ring (P-D-R) has gone from strength to strength in the 55 years that it has existed. A leading think tank of industry professionals representing some top 20 pharmaceutical companies, the P-D-R has adapted to the challenging and changing environments in which information professionals in today’s environment have to work and has been influential in educating information providers as the sector has evolved. Knowledge, insight, collaboration, innovative technologies, new and emerging trends are key strengths of the P-D-R and this article takes a journey from the very first days when the association was formed to the innovative, influential and growing organization it is today.
Attempts to create an Inter-ethnic and Inter-generational ‘National Culture’ in Kenya
Authors: Presbey Gail
Published: July 2013

The challenges of building community based on a common identity that also respects differences has two different kinds of chasms to cross. There is the division of ethnic groups, and there is also the generational gap. Given recent problems of ethnic violence that broke out during the December 2007 elections, can contemporary Kenyans build community, coming to common understanding with others on issues such as value and identity? This is not a new problem. It has often been expressed as the need to develop a common Kenyan “national culture.” After a survey including Okot p’Bitek, Frantz Fanon, Bethwell Ogot and Ngugi wa Thiong’o’s contribution to the topic in the context of the 1960s and 70s, I will then go on to discuss the contribution of Kenyan Philosophy professor Henry Odera Oruka, who was greatly influenced by the ongoing discussions regarding national culture when he began his sage philosophy project – a project he clearly described as being able to play a role in the creation of Kenyan national culture. I explore some of Odera Oruka’s unpublished work on this topic. Chaungo Barasa has continued this project. I move on to survey how current academics in Kenya are working to describe and forge national values as a meaningful alternative to Kenyan government ongoing endeavors to promote culture as a tourist commodity.
Solving the correspondence problem in stereo vision by internal simulation
Authors: Kaiser Alexander , Schenck Wolfram , Möller Ralf
Published: July 2013

We present a computational model for object matching in a pair of stereo images based on internal sensorimotor simulation. In our study, we use pairs of retinal images, i.e. the resolution is higher towards the image center and low in the periphery, which stem from two cameras, each one mounted on a pan–tilt unit (PTU). The internal simulation is driven by two internal models: a saccade controller (SC) which generates a fixation movement to a certain point in either image, and a visual forward model (VFM) that models the effect on camera movements (by the PTU) onto the image. The SC takes as sensory input the current position of a salient point (in image coordinates) and generates a motor command that would lead to the fixation of that point. The VFM takes as sensory input a current camera image and a motor command, i.e. a saccade, and generates an image that appears as if the saccade was executed. By using the internal models, the salient objects are virtually fixated in both images. These fixated views are matched against each other using a simple difference-based matching approach. The performance of the model is evaluated through a large number of experiments on an image database and compared to a widely used approach from computer vision. In addition, a comparison on a commonplace scene is presented.
Why WIC Women Stop Breastfeeding?
Authors: Tenfelde Sandi , Zielinski Ruth , Heidarisafa Rebecca L.
Published: July 2013

Women who receive benefits from Women, Infants, and Children (WIC) are not meeting the recommendations for breastfeeding duration. The purpose of this descriptive correlational study was to examine maternal sociodemographic and time factors related to the reason for discontinuing breastfeeding for 238 WIC participants who initiated breastfeeding. This study is a secondary data analysis of existing longitudinal survey and administrative data from a Chicago-area community health center and WIC clinic. The average length of breastfeeding within this sample was 16 weeks. Women in this sample reported a perception of insufficient milk (PIM; 46%), returning to work/school (13%), and other maternal problems (13%) as the main reasons for discontinuing breastfeeding. Within the first 16 weeks, 65% of the women who discontinued breastfeeding cited PIM as the main reason, with 2 distinct time points at 5 weeks and 13 weeks. Women of Hispanic descent were more likely than non-Hispanic women to report this perception (odds ratio 2.66, P = .01, 95% confidence interval = 1.21-5.83). Although these women initiated breastfeeding, the national recommendation for breastfeeding duration was not met in this population. Additionally, many women stopped breastfeeding early due to PIM. There are distinct time points where culturally tailored interventions may be most effective.
Nutrition Management of the Critically Ill Pediatric Patient
Authors: Abad-Jorge Ana
Published: July 2013

Provision of optimal nutritional support to children in the pediatric intensive care unit (PICU) is important for optimizing nutritional management, yet challenging because of a variety of factors. Previous nutritional status, degree of malnutrition, and variability in disease states differ significantly among PICU patients. Although there are numerous benefits for enteral nutrition (EN) in critically ill children, obstacles exist within the PICU that prevent the initiation and delivery of appropriate EN and parenteral nutritional (PN) support. Evidence-based nutrition care guidelines have been established to promote optimal nutrition support practice in PICU patients, including identification of those at greatest nutritional risk, initiating EN or PN in a timely manner, and providing EN as the preferred nutrition support modality for children with a functioning gastrointestinal tract. Strategies can be implemented to minimize avoidable delays or interruptions to the optimal delivery of PN and EN, including establishing nutrition support guidelines to promote consistency in practice, promoting clear and consistent communication among the PICU team via direct communication, unit rounds, and the medical record. The education of frontline PICU staff by trained professionals such as pediatric registered dietitians board certified in pediatric nutrition or nutrition support practice can also help promote improved nutritional support practice and outcomes. Specific strategies to optimize nutritional support and EN initiation and delivery at the author’s institution are also presented.
Higher Birth Weight Improves Rates of Exclusive Breastfeeding Through 3 Months
Authors: Flaherman Valerie J. , McKean Michelle , Cabana Michael D.
Published: July 2013

Background. Exclusive breastfeeding through 3 months is a Healthy People 2020 goal, yet most US infants who initiate breastfeeding receive formula before 3 months. The effect of birth weight on exclusive breastfeeding has not been previously studied. Methods. We analyzed data from a randomized trial of probiotics for healthy infants to determine the effect of birth weight and other predictors available at birth on any breastfeeding and exclusive breastfeeding through 3 months. We used backward stepwise logistic regression to examine the effect of maternal age, education, feeding plan, delivery method, and parity and infant birth weight and gestational age on the outcomes of any and exclusive breastfeeding through 3 months. Results. Birth weight was strongly associated with exclusive breastfeeding through 3 months (odds ratio = 6.23 [95% confidence interval = 2.27-17.1] per kilogram birth weight), adjusting for maternal college education and maternal plan to breastfeed exclusively. However, birth weight was not associated with any breastfeeding at 3 months when adjusting for the same predictors. Discussion. Smaller newborns were more likely to receive formula before 3 months in this study population. Educating mothers of smaller babies and their physicians about normal newborn growth patterns might reduce unnecessary formula use for smaller newborns.
Does Celiac Disease Ever Travel Alone?
Authors: Swanson Jamie , John Rita Marie
Published: July 2013

Celiac disease is a genetic disease that can affect many different organs in susceptible individuals. It is a common digestive disease with an incidence of 1% in the general population. Celiac disease has a wide variety of gastrointestinal as well as extraintestinal signs and symptoms. The disease is unrecognized or undiagnosed in 75% to 90% of cases because of subclinical or unusual symptoms. Many nonmalignant and malignant complications have been associated with celiac disease, the most common of which are associated autoimmune disorders, altered liver and thyroid function, and lymphoma. The risk of developing complications from celiac disease is much higher with adult-onset disease. Most of the associated complications are related to the chronic inflammation that occurs with continued gluten exposure. A strict gluten-free diet is advised for patients with celiac disease. However, the risk of malignancy associated with celiac disease is not high enough to warrant mass screening of all individuals.
Breastfeeding in the Workplace
Authors: Gettas Marina , Morales Adriana
Published: July 2013

The purpose of this article is to describe the need for the federal government to pass Bill S 1463, The Breastfeeding Promotion Act of 2011. When this bill is passed, it will allow working lactating women to breastfeed (pump) while at the workplace by requiring reasonable work breaks and space. The first year of a child’s life is the most crucial, and allowing this bill to pass will encourage working mothers to give their baby one of the best gifts a mother can give her child—a healthier life. Not only will it benefit mothers and children, when this bill is passed it will also benefit employers. Employers will save in health care costs and absenteeism costs. The Breastfeeding Promotion Act must be passed immediately so that our mothers, children, and employers can benefit from the many benefits that this bill will provide.
Treatment of cancer-associated thrombosis
Authors: Lee Agnes Y. Y. , Peterson Erica A.
Published: July 2013

Therapeutic options for the management of venous thromboembolism (VTE) in patients with cancer remain very limited. Although low-molecular-weight heparin monotherapy has been identified as a simple and efficacious regimen compared with an initial parenteral anticoagulant followed by long-term therapy with a vitamin K antagonist, many clinical questions remain unanswered. These include optimal duration of anticoagulant therapy, treatment of recurrent VTE, and the treatment of patients with concurrent bleeding or those with a high risk of bleeding. Treatment recommendations from consensus clinical guidelines are largely based on retrospective reports or extrapolated data from the noncancer population with VTE, as randomized controlled trials focused on cancer-associated thrombosis are sorely lacking. Furthermore, with improvements in imaging technology and extended survival duration of patients with cancer, we are encountering more unique challenges, such as the management of incidental VTE. Clinicians should be aware of the limitations of the novel oral anticoagulants and avoid the use of these agents because of the paucity of evidence in the treatment of cancer-associated thrombosis.
Derivation and validation of a simple, accurate and robust prediction rule for risk of mortality in patients with Clostridium difficile infection
Authors: Butt Emma , Foster Jane AH , Keedwell Edward , Bell Julia EA , Titball Richard W , Bhangu Aneel , Michell Stephen L , Sheridan Ray
Published: July 2013

Background

Clostridium difficile infection poses a significant healthcare burden. However, the derivation of a simple, evidence based prediction rule to assist patient management has not yet been described.

This study aimed to identify such a prediction rule to stratify hospital inpatients according to risk of all-cause mortality, at initial diagnosis of infection.

Method

Univariate, multivariate and decision tree procedures were used to deduce a prediction rule from over 186 variables; retrospectively collated from clinical data for 213 patients. The resulting prediction rule was validated on independent data from a cohort of 158 patients described by Bhangu et al. (Colorectal Disease, 12(3):241-246, 2010).

Results

Serum albumin levels (g/L) (P = 0.001), respiratory rate (resps /min) (P = 0.002), C-reactive protein (mg/L) (P = 0.034) and white cell count (mcL) (P = 0.049) were predictors of all-cause mortality. Threshold levels of serum albumin ≤ 24.5 g/L, C- reactive protein >228 mg/L, respiratory rate >17 resps/min and white cell count >12 × 103 mcL were associated with an increased risk of all-cause mortality. A simple four variable prediction rule was devised based on these threshold levels and when tested on the initial data, yield an area under the curve score of 0.754 (P < 0.001) using receiver operating characteristics. The prediction rule was then evaluated using independent data, and yield an area under the curve score of 0.653 (P = 0.001).

Conclusions

Four easily measurable clinical variables can be used to assess the risk of mortality of patients with Clostridium difficile infection and remains robust with respect to independent data.