bluuebunny/crossref_metadata_2025 huggingface dataset:
Justification of allocation scheme and the ratio of sieves in screen shoes
Authors: Гиевский  , Gievskiy Aleksey , Чернышов  , Chernyshov Aleksey , Оробинский  , Orobinskiy Vladimir
Published: December 2013

The results of the feasibility studies of allocation scheme of sieves in the screen shoe to improve performance are given. Inves-tigations were carried out in a pilot plant consisting of two-aspiration pneumatic sys-tem and screen shoe with a ball-cleaning of sieves, controlled vibration frequency and location in one tier of up to three sieves with a length of 0.99 m. Permissible unit stress were obtained for grains and sorting sieve for cleaning piles of winter wheat at the mill vibration amplitude of 0.03 m in and a frequency of 350 min-1.
Analysis and synthesis of automatic control systems of pneumatic transport and technological chips account
Authors: Петровский  , Petrovskiy Vladislav , Щедрин  , Shchedrin Sergey
Published: December 2013

The article shows the task solution of mass accounting, volume of pneumatically transported chips per time unit by measuring the pressure drop for the pneumatic transport conveying flow after the feeder. This system has been tested at Bratsk FIC and its implementation was based on the calibration of the measurement system, which takes into account the mathematical relationship of chipping flow per unit of time and reducing the pressure of pneumatic transport.
Phantom Public
Authors: Fiel Wolfgang
Published: December 2013

In 2008 tat ort inhabited a flat for a sustained period of two months in the Siedlung an der Ach/Estate on the Ach, located in the small city of Bregenz in Vorarlberg, Austria. The project was the pilot to an open-ended series of self-organized artist residencies, with the aim of looking into the immediate living conditions of segregated, dense and highly conflict-laden social housing estates. This is an account of the theory and practice that formed a strategy to unlock a wealth of information that all too often is neglected by official bodies, governments or other representational organizations. By rendering this tremendous expertise visible, tat ort are able to reveal how a specific apparatus emerges, how to describe or interpret it adequately, and – if necessary – how to foster or reinvigorate its underlying dynamic with the catalysing spirit and playful dexterity of genuine artistic creation.
When art is a form of behaviour …
Authors: Aga B.
Published: December 2013

Roy Ascott’s influence is pervasive, through his pedagogy (the ‘Ground Course’ and the ‘Planetary Collegium’) and through the telematics works in the 1980s and 1990s. In the early 1960s, Ascott lit the slow burning fuse of a mind-bomb that, rather than shattering the fabric of the art world, slowly dissolved its materiality. As telematic shrapnel penetrate its vital organs, the object d’art staggers on, zombie like, curators wheeling over head, picking over the corpse. Rather than try to resuscitate the remains, there are those who prefer to surf the shockwave of this legacy in the hope that the future will catch up.
Focus on form as a joint accomplishment: An attempt to bridge the gap between focus on form research and conversation analytic research on SLA
Authors: Fasel Lauzon Virginie , Pekarek Doehler Simona
Published: December 2013

Several debates have recently addressed complementarities and/or (in)compatibilities between two lines of research concerned with second language interactions: Focus on Form research and conversation analytic work on repair in second language interactions. While our expertise primarily lies in the latter, we follow up on recent calls emanating from the former for more qualitatively oriented analysis. In this paper, we report on a study of correction in naturally occurring French L2 classroom interaction addressing the following question: how is attention focus on form distributed among the participants and interactionally organized across the temporal unfolding of talk? We show the analytic difficulty of determining precisely whose focus we observe in focus on form episodes. The findings substantiate an understanding of attention focus – along with the cognitive orientations of participants – as a process that is interactionally occasioned and organized, and the transformation of which into joint focus hinges on the local contingencies of talk.
Point of view in British Sign Language and spoken English narrative discourse: the example of “The Tortoise and the Hare”
Authors: Earis Helen , Cormier Kearsy
Published: December 2013

This paper discusses how point of view (POV) is expressed in British Sign Language (BSL) and spoken English narrative discourse. Spoken languages can mark changes in POV using strategies such as direct/indirect discourse, whereas signed languages can mark changes in POV in a unique way using “role shift”. Role shift is where the signer “becomes” a referent by taking on attributes of that referent, e.g. facial expression. In this study, two native BSL users and two native British English speakers were asked to tell the story “The Tortoise and the Hare”. The data were then compared to see how point of view is expressed and maintained in both languages. The results indicated that the spoken English users preferred the narrator's perspective, whereas the BSL users preferred a character's perspective. This suggests that spoken and signed language users may structure stories in different ways. However, some co-speech gestures and facial expressions used in the spoken English stories to denote characters' thoughts and feelings bear resemblance to the hand movements and facial expressions used by the BSL storytellers. This suggests that while approaches to storytelling may differ, both languages share some gestural resources which manifest themselves in different ways across different modalities.
One word at a time: Mental representations of object shape change incrementally during sentence processing
Authors: Sato Manami , Schafer Amy J. , Bergen Benjamin K.
Published: December 2013

We report on two experiments that ask when and under what linguistic conditions comprehenders construct detailed shape representations of mentioned objects, and whether these can change over the course of a sentence when new information contradicts earlier expectations. We used Japanese because the verb-final word order of Japanese presented a revealing test case where information about objects can radically change with a subsequent verb. The results show that language understanders consistently generate a distinct and detailed shape for an object by integrating the semantic contributions of different sentential elements. These results first confirm that the tendency to generate specific shape information about objects that are involved in described events is not limited to English, but is also present in Japanese, a typologically and genetically distinct language. But more importantly, they shed light on the processing mechanism of object representation, showing that mental representations are initiated sentence medially, and are rapidly revised if followed by a verb that implies a change to an object shape. This work contributes to ongoing research on incremental language processing – comprehenders appear to construct extremely detailed semantic representations early in a sentence, and modify them as needed.
Diet-induced macrophage inhibitory cytokine 1 promotes prostate cancer progression
Authors: Huang Mingguo , Narita Shintaro , Inoue Takamitsu , Tsuchiya Norihiko , Satoh Shigeru , Nanjo Hiroshi , Sasaki Takehiko , Habuchi Tomonori
Published: December 2013

Recent studies have indicated that a high-fat diet (HFD) plays an important role in prostate cancer (PCa) progression. Palmitic acid (PA) is one of the most abundant saturated free fatty acids (FAs) and is associated with carcinogenesis. In this study, we investigated the mechanism underlying the association of dietary fat, including PA, with PCa progression. In four PCa cell lines,in vitroPA administration stimulated the expression of macrophage inhibitory cytokine 1 (MIC1), which is a divergent member of the transforming growth factor-β family.In vivo, LNCaP xenograft tumor growth, serum MIC1 levels, and FA levels in xenograft tumors were significantly higher in mice receiving an HFD containing high amounts of PA than in those receiving a low-fat diet (LFD). In addition, tumor cells with high MIC1 expression invaded to venules and lymph vessels in the LNCaP xenograft.In vitrostudies showed that proliferation and invasive capacity were significantly higher in PCa cells cultured with serum from HFD-fed mice than in those cultured with the serum from LFD-fed mice. This effect was attenuated by the addition of neutralizing antibodies against MIC1, but not by isotype control antibodies. Clinically, serum MIC1 levels were significantly higher in PCa patients than in healthy controls, and higher levels were associated with higher pathological grade and obesity. In conclusion, our results indicate that an HFD containing PA may promote growth and invasiveness of PCa cells through the upregulation of MIC1 expression.
Health Care Worker Exposures to Pertussis: Missed Opportunities for Prevention
Authors: Kuncio Danica E. , Middleton Maria , Cooney Mary G. , Ramos Mark , Coffin Susan E. , Feemster Kristen A.
Published: December 2013

OBJECTIVE:

Pediatric health care workers (HCWs) are at particular risk for pertussis exposure, infection, and subsequent disease transmission to susceptible patients. This cross-sectional study describes the epidemiology of occupational exposures to pertussis and identifies factors that may inform interventions to promote effective implementation of infection prevention and control (IPC) guidelines.

METHODS:

We abstracted data from occupational health (OH) and IPC records for pertussis cases that resulted in an exposure investigation in a large quaternary pediatric care network, January 1, 2002 to July 18, 2011. We calculated the frequency of occupational exposures and measured associated characteristics. To assess the frequency of potential missed exposures, we reviewed electronic health record (EHR) data identifying laboratory-confirmed pertussis cases not documented in OH or IPC records.

RESULTS:

A total of 1193 confirmed HCW pertussis exposures were associated with 219 index cases during the study period. Of these, 38.8% were infants <6 months old and 7 were HCWs. Most (77.5%) of exposures occurred in the emergency department or an ambulatory site; 27.0% of exposures occurred after documented initiation of IPC precautions. We identified 450 laboratory-confirmed pertussis cases through EHR review, of which 49.8% (N = 224) had no OH or IPC investigation. The majority of uninvestigated cases (77.2%) were from ambulatory sites.

CONCLUSIONS:

Occupational exposures to pertussis occur frequently in pediatric health care settings despite appropriate IPC guidelines. Interventions are needed to ensure consistent implementation of IPC practices and timely identification and reporting of pertussis index cases to prevent HCW exposures and potential transmission to patients.
Decreasing Hypothermia During Delivery Room Stabilization of Preterm Neonates
Authors: Pinheiro Joaquim M.B. , Furdon Susan A. , Boynton Susan , Dugan Robin , Reu-Donlon Christine , Jensen Sharon
Published: December 2013

BACKGROUND AND OBJECTIVE:

Hypothermia during delivery room stabilization of very low birth weight (VLBW) newborns is independently associated with mortality, yet it occurred frequently both in collaborative networks and at our institution. We aimed to attain admission temperatures in the target range of 36°C to 38°C in ≥90% of inborn VLBW neonates through implementation of a thermoregulation bundle.

METHODS:

This quality improvement project extended over 60 consecutive months, using sequential plan–do–check–act cycles. During the 14 baseline months, we standardized temperature measurements and developed the Operation Toasty Tot thermoregulation bundle (including consistent head and torso wrapping with plastic, warmed blankets, and a closed stabilization room). We introduced this bundle in month 15 and added servo-controlled, battery-powered radiant warmers for stabilization and transfer in month 21. We provided results and feedback to staff throughout, using simple graphics and control charts.

RESULTS:

There were 164 inborn VLBW babies before and 477 after bundle implementation. Introduction and optimization of the bundle decreased the incidence of hypothermia, with rates remaining in the target range for the last 13 study months. The incidence of temperatures >38°C was ∼2% both before and after bundle implementation.

CONCLUSIONS:

This thermoregulation bundle resulted in sustained improvement in normothermia rates during delivery room stabilization of VLBW newborns. Our benchmark goal of ≥90% admission temperatures above 36°C was met without increasing hyperthermia rates. Because these results compare favorably with those of recently published research or improvement collaboratives, we aim to maintain our performance through routine surveillance of admission temperatures.
Acute and Chronic Effects of Sleep Duration on Blood Pressure
Authors: Au Chun Ting , Ho Crover Kwok Wah , Wing Yun Kwok , Lam Hugh Simon , Li Albert Martin
Published: December 2013

OBJECTIVE:

To evaluate the association between ambulatory blood pressure (ABP) and sleep duration as measured by 7-day sleep diary and nocturnal polysomnography in normal-weight adolescents without significant obstructive sleep apnea.

METHODS:

Subjects aged 10 to 17.9 years with an obstructive apnea hypopnea index <5 underwent polysomnography for 9.5 hours and 24-hour ABP monitoring commencing at noon on the same day. ABP was divided into prepolysomnography, in bed during polysomnography, and postpolysomnography periods for separate analyses. Sleep duration (SpD7) was obtained from a 7-day sleep diary, reflecting the sleep pattern in the week before admission. Total sleep time (TST) and sleep efficiency (SpE) were obtained from polysomnography.

RESULTS:

A total of 143 adolescents participated. SpD7 was inversely associated with systolic blood pressure (SBP) in prepolysomnography, in-bed, and postpolysomnography periods (all β = −2 mm Hg) and with diastolic blood pressure (DBP) in prepolysomnography and in-bed periods (all β = −1 mm Hg). TST was inversely associated with SBP in the postpolysomnography period (β = −1.5 mm Hg). SpE was inversely associated with SBP in in-bed period (β = −0.1 mm Hg) and with DBP in in-bed (β = −0.1 mm Hg) and postpolysomnography (β = −0.2 mm Hg) periods. Neither TST nor SpE was associated with SBP and DBP in prepolysomnography period.

CONCLUSIONS:

Short sleep duration as reflected by 7-day sleep diary was associated with higher blood pressure in normal-weight adolescents. Occasional adequate sleep may partially ameliorate the risk of high blood pressure but may not completely reverse the effect of long-term sleep insufficiency.
7% Hypertonic Saline in Acute Bronchiolitis: A Randomized Controlled Trial
Authors: Jacobs Jonathan D. , Foster Megan , Wan Jim , Pershad Jay
Published: December 2013

BACKGROUND:

Research suggests that hypertonic saline (HS) may improve mucous flow in infants with acute bronchiolitis. Data suggest a trend favoring reduced length of hospital stay and improved pulmonary scores with increasing concentration of nebulized solution to 3% and 5% saline as compared with 0.9% saline mixed with epinephrine. To our knowledge, 7% HS has not been previously investigated.

METHODS:

We conducted a prospective, double-blind, randomized controlled trial in 101 infants presenting with moderate to severe acute bronchiolitis. Subjects received either 7% saline or 0.9% saline, both with epinephrine. Our primary outcome was a change in bronchiolitis severity score (BSS), obtained before and after treatment, and at the time of disposition from the emergency department (ED). Secondary outcomes measured were hospitalization rate, proportion of admitted patients discharged at 23 hours, and ED and inpatient length of stay.

RESULTS:

At baseline, study groups were similar in demographic and clinical characteristics. The decrease in mean BSS was not statistically significant between groups (2.6 vs 2.4 for HS and control groups, respectively). The difference between the groups in proportion of admitted patients (42% in HS versus 49% in normal saline), ED or inpatient length of stay, and proportion of admitted patients discharged at 23 hours was not statistically significant.

CONCLUSIONS:

In moderate to severe acute bronchiolitis, inhalation of 7% HS with epinephrine does not appear to confer any clinically significant decrease in BSS when compared with 0.9% saline with epinephrine.
Exacerbations of COPD and symptoms of gastroesophageal reflux: a systematic review and meta-analysis
Authors: Sakae Thiago Mamoru , Pizzichini Marcia Margaret Menezes , Teixeira Paulo Jose Zimermann , Silva Rosemeri Maurici da , Trevisol Daisson Jose , Pizzichini Emilio
Published: December 2013

OBJECTIVE: To examine the relationship between gastroesophageal reflux (GER) and COPD exacerbations. METHODS: We conducted a systematic search of various electronic databases for articles published up through December of 2012. Studies considered eligible for inclusion were those dealing with COPD, COPD exacerbations, and GER; comparing at least two groups (COPD vs. controls or GER vs. controls); and describing relative risks (RRs) and prevalence ratios-or ORs and their respective 95% CIs (or presenting enough data to allow further calculations) for the association between GER and COPD-as well as exacerbation rates. Using a standardized form, we extracted data related to the study design; criteria for GER diagnosis; age, gender, and number of participants; randomization method; severity scores; methods of evaluating GER symptoms; criteria for defining exacerbations; exacerbation rates (hospitalizations, ER visits, unscheduled clinic visits, prednisone use, and antibiotic use); GER symptoms in COPD group vs. controls; mean number of COPD exacerbations (with symptoms vs. without symptoms); annual frequency of exacerbations; GER treatment; and severity of airflow obstruction. RESULTS: Overall, GER was clearly identified as a risk factor for COPD exacerbations (RR = 7.57; 95% CI: 3.84-14.94), with an increased mean number of exacerbations per year (mean difference: 0.79; 95% CI: 0.22-1.36). The prevalence of GER was significantly higher in patients with COPD than in those without (RR = 13.06; 95% CI: 3.64-46.87; p < 0.001). CONCLUSIONS: GER is a risk factor for COPD exacerbations. The role of GER in COPD management should be studied in greater detail.
Risk factors for infection with multidrug-resistant bacteria in non-ventilated patients with hospital-acquired pneumonia
Authors: Seligman Renato , Ramos-Lima Luis Francisco , Oliveira Vivian do Amaral , Sanvicente Carina , Sartori Juliana , Pacheco Elyara Fiorin
Published: December 2013

OBJECTIVE: To identify risk factors for the development of hospital-acquired pneumonia (HAP) caused by multidrug-resistant (MDR) bacteria in non-ventilated patients. METHODS: This was a retrospective observational cohort study conducted over a three-year period at a tertiary-care teaching hospital. We included only non-ventilated patients diagnosed with HAP and presenting with positive bacterial cultures. Categorical variables were compared with chi-square test. Logistic regression analysis was used to determine risk factors for HAP caused by MDR bacteria. RESULTS: Of the 140 patients diagnosed with HAP, 59 (42.1%) were infected with MDR strains. Among the patients infected with methicillin-resistant Staphylococcus aureus and those infected with methicillin-susceptible S. aureus, mortality was 45.9% and 50.0%, respectively (p = 0.763). Among the patients infected with MDR and those infected with non-MDR gram-negative bacilli, mortality was 45.8% and 38.3%, respectively (p = 0.527). Univariate analysis identified the following risk factors for infection with MDR bacteria: COPD; congestive heart failure; chronic renal failure; dialysis; urinary catheterization; extrapulmonary infection; and use of antimicrobial therapy within the last 10 days before the diagnosis of HAP. Multivariate analysis showed that the use of antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria (OR = 3.45; 95% CI: 1.56-7.61; p = 0.002). CONCLUSIONS: In this single-center study, the use of broad-spectrum antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria in non-ventilated patients with HAP.
Performance comparison between the mycobacteria growth indicator tube system and Löwenstein-Jensen medium in the routine detection of Mycobacterium tuberculosis at public health care facilities in Rio de Janeiro, Brazil: preliminary results of a pragmatic clinical trial
Authors: Moreira Adriana da Silva Rezende , Huf Gisele , Vieira Maria Armanda , Fonseca Leila , Ricks Monica , Kritski Afranio Lineu
Published: December 2013

In view of the fact that the World Health Organization has recommended the use of the mycobacteria growth indicator tube (MGIT) 960 system for the diagnosis of tuberculosis and that there is as yet no evidence regarding the clinical impact of its use in health care systems, we conducted a pragmatic clinical trial to evaluate the clinical performance and cost-effectiveness of the use of MGIT 960 at two health care facilities in the city of Rio de Janeiro, Brazil, where the incidence of tuberculosis is high. Here, we summarize the methodology and preliminary results of the trial. (ISRCTN.org Identifier: ISRCTN79888843 [http://isrctn.org/])
Smoke inhalation injury during enclosed-space fires: an update
Authors: Antonio Ana Carolina Pecanha , Castro Priscylla Souza , Freire Luiz Octavio
Published: December 2013

In view of the tragic fire at a nightclub in the city of Santa Maria, Brazil, which culminated in the sudden death of 232 young people, we decided to review the literature regarding smoke inhalation injury caused by enclosed-space fires, which can be divided into direct thermal damage, carbon monoxide poisoning, and cyanide poisoning. Such injuries often call for immediate orotracheal intubation, either due to acute airway obstruction or due to a reduced level of consciousness. The diagnosis and the severity of the thermal injury can be determined by fiberoptic bronchoscopy. The levels of gases and gas by-products in the bloodstream should be assessed as rapidly as possible, even while still at the scene of the incident. First responders can also treat carbon monoxide poisoning, with immediate administration of oxygen at 100%, as well as cyanide poisoning, with oxygen therapy and hydroxocobalamin injection
Congenital lobar emphysema: 30-year case series in two university hospitals
Authors: Cataneo Daniele Cristina , Rodrigues Olavo Ribeiro , Hasimoto Erica Nishida , Schmidt Jr Aurelino Fernandes , Cataneo Antonio Jose Maria
Published: December 2013

OBJECTIVE: To review the cases of patients with congenital lobar emphysema (CLE) submitted to surgical treatment at two university hospitals over a 30-year period. METHODS: We reviewed the medical records of children with CLE undergoing surgical treatment between 1979 and 2009 at the Botucatu School of Medicine Hospital das Clínicas or the Mogi das Cruzes University Hospital. We analyzed data regarding symptoms, physical examination, radiographic findings, diagnosis, surgical treatment, and postoperative follow-up. RESULTS: During the period studied, 20 children with CLE underwent surgery. The mean age at the time of surgery was 6.9 months (range, 9 days to 4 years). All of the cases presented with symptoms at birth or during the first months of life. In all cases, chest X-rays were useful in defining the diagnosis. In cases of moderate respiratory distress, chest CT facilitated the diagnosis. One patient with severe respiratory distress was misdiagnosed with hypertensive pneumothorax and underwent chest tube drainage. Only patients with moderate respiratory distress were submitted to bronchoscopy, which revealed no tracheobronchial abnormalities. The surgical approach was lateral muscle-sparing thoracotomy. The left upper and middle lobes were the most often affected, followed by the right upper lobe. Lobectomy was performed in 18 cases, whereas bilobectomy was performed in 2 (together with bronchogenic cyst resection in 1 of those). No postoperative complications were observed. Postoperative follow-up time was at least 24 months (mean, 60 months), and no late complications were observed. CONCLUSIONS: Although CLE is an uncommon, still neglected disease of uncertain etiology, the radiological diagnosis is easily made and surgical treatment is effective.
Reliability of the Brazilian Portuguese version of the fatigue severity scale and its correlation with pulmonary function, dyspnea, and functional capacity in patients with COPD
Authors: Valderramas Silvia , Camelier Aquiles Assuncao , Silva Sinara Alves da , Mallmann Renata , Paulo Hanna Karine de , Rosa Fernanda Warken
Published: December 2013

OBJECTIVE: To describe the intra-rater and inter-rater reliability of the Brazilian Portuguese version of the fatigue severity scale (FSS) in patients with COPD and to identify the presence of its association with parameters of pulmonary function, dyspnea, and functional capacity. METHODS: This was an observational cross-sectional study involving 50 patients with COPD, who completed the FSS in interviews with two researchers in two visits. The FSS scores were correlated with those of the Medical Research Council (MRC) scale, as well as with FEV1, FVC, and six-minute walk distance (6MWD). RESULTS: The mean age of the patients was 69.4 ± 8.23 years, whereas the mean FEV1 was 46.5 ± 20.4% of the predicted value. The scale was reliable, with an intraclass correlation coefficient of 0.90 (95% CI, 0.81-0.94; p < 0.01). The FSS scores showed significant correlations with those of MRC scale (r = 0.70; p < 0.01), as well as with 6MWD (r = –0.77; p < 0.01), FEV1 (r = –0.38; p < 0.01), FVC (r = –0.35; p < 0.01), and stage of the disease in accordance with the Global Initiative for Chronic Obstructive Lung Disease criteria (r = 0.37; p < 0.01). CONCLUSIONS: The Brazilian Portuguese version of the FSS proved reliable for use in COPD patients in Brazil and showed significant correlations with sensation of dyspnea, functional capacity, pulmonary function, and stage of the disease.
Pseudomonas aeruginosa infection in patients with cystic fibrosis: scientific evidence regarding clinical impact, diagnosis, and treatment
Authors: Silva Filho Luiz Vicente Ribeiro Ferreira da , Ferreira Flavia de Aguiar , Reis Francisco Jose Caldeira , Britto Murilo Carlos Amorim de , Levy Carlos Emilio , Clark Otavio , Ribeiro Jose Dirceu
Published: December 2013

Evidence-based techniques have been increasingly used in the creation of clinical guidelines and the development of recommendations for medical practice. The use of levels of evidence allows the reader to identify the quality of scientific information that supports the recommendations made by experts. The objective of this review was to address current concepts related to the clinical impact, diagnosis, and treatment of Pseudomonas aeruginosa infections in patients with cystic fibrosis. For the preparation of this review, the authors defined a group of questions that would be answered in accordance with the principles of PICO–an acronym based on questions regarding the Patients of interest, Intervention being studied, Comparison of the intervention, and Outcome of interest. For each question, a structured review of the literature was performed using the Medline database in order to identify the studies with the methodological design most appropriate to answering the question. The questions were designed so that each of the authors could write a response. A first draft was prepared and discussed by the group. Recommendations were then made on the basis of the level of scientific evidence, in accordance with the classification system devised by the Oxford Centre for Evidence-Based Medicine, as well as the level of agreement among the members of the group.
Transdiaphragmatic intercostal hernia: imaging aspects in three cases
Authors: Macedo Ana Carolina Sandoval , Kay Fernando Uliana , Terra Ricardo Mingarini , Campos Jose Ribas Milanez de , Aranha Andre Galante Alencar , Funari Marcelo Buarque de Gusmao
Published: December 2013

Transdiaphragmatic intercostal hernia is uncommon and mostly related to blunt or penetrating trauma. We report three similar cases of cough-induced transdiaphragmatic intercostal hernia, highlighting the anatomic findings obtained with different imaging modalities (radiography, ultrasonography, CT, and magnetic resonance) in each of the cases.
Delayed diagnosis of sarcoidosis is common in Brazil
Authors: Rodrigues Mauri Monteiro , Coletta Ester Nei Aparecida Martins , Ferreira Rimarcs Gomes , Pereira Carlos Alberto de Castro
Published: December 2013

OBJECTIVE: To determine the frequency of and the factors related to delayed diagnosis of sarcoidosis in Brazil. METHODS: We evaluated patients with a biopsy-proven diagnosis of sarcoidosis, using a questionnaire that addressed the following: time since symptom onset and since the first medical visit; and the number and specialty of the physicians visited. We divided the patients by the timeliness of the diagnosis-timely (< 6 months) and delayed (≥ 6 months)-comparing the two groups in terms of systemic and pulmonary symptoms; extrathoracic involvement; spirometric data; radiological staging; level of education; income; and tuberculosis (diagnosis and treatment). RESULTS: We evaluated 100 patients. The median number of physicians consulted was 3 (range, 1-14). In 11 cases, sarcoidosis was diagnosed at the first visit. In 54, the first physician seen was a general practitioner. The diagnosis of sarcoidosis was timely in 41 patients and delayed in 59. The groups did not differ in terms of gender; race; type of health insurance; level of education; income; respiratory/systemic symptoms; extrathoracic involvement; and radiological staging. In the delayed diagnosis group, FVC was lower (80.3 ± 20.4% vs. 90.5 ± 17.1%; p = 0.010), as was FEV1 (77.3 ± 19.9% vs. 86.4 ± 19.5%; p = 0.024), misdiagnosis with and treatment for tuberculosis (≥ 3 months) also being more common (24% vs. 7%, p = 0.032, and 20% vs. 0%; p = 0.002, respectively). CONCLUSIONS: The diagnosis of sarcoidosis is often delayed, even when the imaging is suggestive of sarcoidosis. Delayed diagnosis is associated with impaired lung function at the time of diagnosis. Many sarcoidosis patients are misdiagnosed with and treated for tuberculosis.
The influence of leptin on Th1/Th2 balance in obese children with asthma
Authors: Youssef Doaa Mohammed , Elbehidy Rabab Mohamed , Shokry Dina Mahamoud , Elbehidy Eman Mohamed
Published: December 2013

OBJECTIVE: In individuals with asthma, obesity induces the production of leptin and is associated with disease severity. Our objective was to evaluate the levels of serum leptin and their effect on Th1/Th2 balance in obese and non-obese children with asthma, as well as to investigate the association between serum leptin levels and clinical outcomes. METHODS: We evaluated 50 atopic children with physician-diagnosed moderate-to-severe persistent asthma and 20 controls. The children with asthma were divided into two groups, by body mass index percentile: obese (n = 25) and non-obese (n = 25). From all subjects, we collected peripheral blood samples in order to determine the levels of leptin, IFN-γ, and IL-4. Asthma severity was assessed by an asthma symptom score, and the results were correlated with the parameters studied. RESULTS: Serum leptin levels were significantly higher in the obese asthma group than in the non-obese asthma group, as well as being significantly higher in the children with asthma than in the controls, whereas IFN-γ levels were significantly higher and IL-4 levels were significantly lower in the obese asthma group than in the non-obese asthma group. In addition, the obese asthma group showed higher asthma symptom scores and significantly lower FEV1 (% of predicted) than did the non-obese asthma group. There was a significant positive correlation between leptin and IFN-γ levels only in the obese asthma group. CONCLUSIONS: Although leptin is involved in the pathogenesis of asthma in obese and non-obese children, its effect is more pronounced in the former. In the presence of high leptin levels, only obese children with asthma exhibited Th1 polarization, with higher IFN-γ levels and greater asthma severity.
Prevalence of and factors influencing smoking among medical and non-medical students in Tbilisi, Georgia
Authors: Chkhaidze Ivane , Maglakelidze Nino , Maglakelidze Tamaz , Khaltaev Nikolai
Published: December 2013

OBJECTIVE: Smoking is a serious problem that has a devastating impact on health. The objective of this study was to describe the prevalence of and factors influencing smoking among medical and non-medical students in Tbilisi, Georgia, as well as to determine whether medical education has an impact on smoking. METHODS: A cross-sectional study was carried out at Tbilisi State Medical University and Tbilisi State University, both of which are located in Tbilisi, Georgia. A total of 400 4th-year students (200 students at each university) were asked to complete standardized questionnaires. RESULTS: Of the sample as a whole, 48.75% were identified as smokers and 51.25% were identified as nonsmokers. The mean age was 20.24 years among smokers and 20.26 years among nonsmokers. Of the medical students, 49.5% were smokers, as were 48.0% of the non-medical students. The male-to-female ratio in the study population was 0.9:1.1. Smoking was found to have a strong relationship with gender, males accounting for 65% of all smokers. Of the smokers, 56.9% stated that they would like to quit smoking (for health or financial reasons). Of the medical students, 59.5% expressed a willingness to quit smoking, as did 54.2% of the non-medical students. CONCLUSIONS: There is a need to improve smoking education for undergraduate students. Special attention should be given to the inclusion of anti-smoking education in undergraduate curricula, as well as to the implementation of smoking prevention campaigns at institutions of higher education. However, such measures will be effective only if tobacco control policies are strictly enforced on the national level as well.
Obstructive sleep apnea and asthma
Authors: Salles Cristina , Terse-Ramos Regina , Souza-Machado Adelmir , Cruz Alvaro A
Published: December 2013

Symptoms of sleep-disordered breathing, especially obstructive sleep apnea syndrome (OSAS), are common in asthma patients and have been associated with asthma severity. It is known that asthma symptoms tend to be more severe at night and that asthma-related deaths are most likely to occur during the night or early morning. Nocturnal symptoms occur in 60-74% of asthma patients and are markers of inadequate control of the disease. Various pathophysiological mechanisms are related to the worsening of asthma symptoms, OSAS being one of the most important factors. In patients with asthma, OSAS should be investigated whenever there is inadequate control of symptoms of nocturnal asthma despite the treatment recommended by guidelines having been administered. There is evidence in the literature that the use of continuous positive airway pressure contributes to asthma control in asthma patients with obstructive sleep apnea and uncontrolled asthma.
Cryptococcosis, silicosis, and tuberculous pseudotumor in the same pulmonary lobe
Authors: Silva Geruza Alves da , Brandao Daniel Ferracioli , Vianna Elcio Oliveira , Sa Filho Joao Batista Carlos de , Baddini-Martinez Jose
Published: December 2013

Tuberculosis and cryptococcosis are infectious diseases that can result in the formation of single or multiple nodules in immunocompetent patients. Exposure to silica is known to raise the risk of infection with Mycobacterium tuberculosis. We report the case of an elderly man with no history of opportunistic infections and no clinical evidence of immunodeficiency but with a six-month history of dry cough and nocturnal wheezing. A chest X-ray revealed a mass measuring 5.0 × 3.5 cm in the right upper lobe. The diagnostic approach of the mass revealed tuberculosis. The histopathological analysis of the surrounding parenchyma reveled silicosis and cryptococcosis. Cryptococcosis was also found in masses identified in the mediastinal lymph nodes. The surgical approach was indicated because of the degree of pleuropulmonary involvement, the inconclusive results obtained with the invasive and noninvasive methods applied, and the possibility of malignancy. This case illustrates the difficulty inherent to the assessment of infectious or inflammatory pulmonary pseudotumors, the differential diagnosis of which occasionally requires a radical surgical approach. Despite the presence of respiratory symptoms for six months, the first chest X-ray was performed only at the end of that period. We discuss the possible pathogenic mechanisms that might have led to the combination of three types of granulomatous lesions in the same lobe, and we emphasize the need for greater awareness of atypical presentations of pulmonary tuberculosis.
Managing Downy Brome (Bromus tectorum) in the Central Rockies: Land Manager Perspectives
Authors: Kelley Windy K. , Fernandez-Gimenez Maria E. , Brown Cynthia S.
Published: December 2013

Successful management of downy brome (also known as cheatgrass) requires understanding land managers' perceptions and decisions about whether to invest in its control. We investigated ranchers' and natural resource professionals' (NRPs) perceptions and knowledge about downy brome ecology and its impacts, their current downy brome management practices and satisfaction with those practices, and their information and technical needs using focus groups and a mail survey of ranchers and NRPs in Colorado and Wyoming. Both groups thought downy brome was a problem, and perception of the severity of downy brome corresponded to the level of infestation in the respondent's region. NRPs identified downy brome as a bigger problem than did ranchers from the same area in all but one region. Ranchers were most likely to use early spring grazing to control downy brome, and NRPs were most likely to use seeding, imazapic herbicide, or a combination of methods. Both groups reported that the primary constraint to controlling downy brome was that other weeds were a higher priority. Ranchers and NRPs wanted more information about the control methods they were already likely to use as well as other downy brome control methods. Our findings suggest that (1) listing a species as a noxious weed may provide an important incentive to control it, but trade-offs among control efforts for different species must be carefully considered; (2) managers need to know more about low-cost, low-labor strategies for managing downy brome; and (3) some managers need to be informed about how to identify downy brome, its potential negative effects, and how to prevent its spread. Better quantification of the economic and ecological impacts of downy brome in the Central Rocky Mountains, continued development of effective and economically viable management methods, and improvement in the dissemination of that information to land managers are necessary for successful control of downy brome.
Comparing Effectiveness and Impacts of Japanese Barberry (Berberis thunbergii) Control Treatments and Herbivory on Plant Communities
Authors: Ward Jeffrey S. , Williams Scott C. , Worthley Thomas E.
Published: December 2013

Two factors that can degrade native plant community composition and structure, and hinder restoration efforts, are invasive species and chronic overbrowsing by ungulates such as white-tailed deer. Beginning in 2007, the effectiveness, costs, and impacts of Japanese barberry control treatments and herbivory on nonnative and native plant communities was examined at eight study areas over 4 to 5 yr. Prescribed burning and mechanical mowing by wood shredder or brush saw were utilized as initial treatments to reduce the aboveground portion of established barberry and were equally effective. Without a follow-up treatment, barberry had recovered to 56 to 81% of pretreatment levels 50 to 62 mo after initial treatment. Follow-up treatments in mid-summer to kill new sprouts included directed heating and foliar herbicide applications. Relative to untreated controls, follow-up treatments lowered barberry cover 50 to 62 mo after initial treatment by at least 72%. Although all follow-up treatments were equally effective, the labor cost of directed heating was four times higher than for herbicide applications. Follow-up treatment type (directed heating vs. herbicide) had minimal impact on species other than barberry. White-tailed deer herbivory had a larger impact on other species than did barberry control treatments. Native grass and fern cover was higher outside of exclosures. Areas inside exclosures had higher cover of Oriental bittersweet and multiflora rose, but not Japanese barberry. Thus, recovery of native communities will require more than simply removing the dominant invasive species where deer densities are high. Excellent reduction of Japanese barberry cover can be achieved using either directed heating or herbicides as follow-up treatments in a two-step process, but other invasive plants may become a problem when barberry is removed if deer populations are low.
Soil characterisation of South Pars field, Persian Gulf
Authors: Ebrahimian Babak , Movahed Vahid , Nazari Aida
Published: December 2013

South Pars, located in the Persian Gulf, southwest of Iran, is one of the largest offshore gas fields in the world. During the past decade, numerous geotechnical investigations have been carried out in this area for designing deep foundations of offshore oil- and gas-extraction facilities. Generally, such geotechnical site investigations consist of various in situ and laboratory tests. Downhole piezocone penetration tests are widely performed in this area up to a depth of about 130 m below the seabed. Shear strengths of different soil layers are evaluated using various in situ and laboratory methods including unconsolidated undrained triaxial, pocket penetrometer, torvane, and miniature vane tests. In this paper, local geotechnical site characterisation of the South Pars field is presented based on a large amount of data collected from developed phases of the field. This research is particularly focused on the cone factor, which relates the undrained shear strength of soil to the cone tip resistance of the cone penetration test (CPT). The variation of the cone factor within the South Pars field is presented based on CPT results. The deformation characteristics and the stress history parameters have also been evaluated for marine clays of the field. The influence of stress state on cone factors has been studied as well.
A study on electrokinetic dewatering of oil sands tailings
Authors: Guo Yu , Shang Julie Q.
Published: December 2013

Oil sands tailings (mature fine tailing (MFT)) are the final product of oil sands processing and are in the form of slurry with a very low solid content. After sedimentation, due to a low hydraulic conductivity of the tailings, dewatering and consolidating the tailings is difficult. Since electrokinetics (EK) has been successfully applied on dewatering and consolidation of low permeability soils, this study is carried out to assess the effectiveness and efficiency of EK dewatering of MFT, a man-made geomaterial. Two series of tests were conducted in this study. In the first series, four EK cell tests were performed on oil sands tailings to measure the electroosmotic permeability, ke, which is the key parameter for assessment of the EK treatment. In the second series, the model tests were designed and carried out to investigate the feasibility of EK dewatering on oil sands tailings. The performance of the EK dewatering was compared under two conditions — under a surcharge load of 5 kPa for consolidation, followed by EK dewatering and under simultaneous treatment of a surcharge load of 5 kPa and EK treatment. The final water content, undrained shear strength and plasticity of MFT were measured after all tests. It was observed that the EK dewatering model tests resulted in significant overall increases in the undrained shear strength and reductions in the water content of tailings samples, along with significant changes of the tailings plasticity.
Factors Associated With Implementation of the POLST Paradigm: Results From a Survey of Florida Physicians
Authors: Matthews Juliana J. , Souther Carly Elizabeth
Published: December 2013

Objectives: To investigate physicians’ awareness and attitudes regarding the Physician Orders for Life-Sustaining Treatment (POLST) concept and to identify barriers and opportunities for its expansion.

Design: Cross-sectional questionnaire, using electronic survey instrument.

Setting: Community.

Patients: 212 physicians from three Florida medical associations and the Florida State University College of Medicine clinical faculty responded to the survey. Of those, 67.9% were familiar with the concept of POLST.

Measurements and Main Results: Data were collected using a web-based survey, completed in June–July 2012, consisting of qualitative and quantitative questions. Most (95.8%) agreed or strongly agreed that it was a physician’s responsibility to discuss end-of-life care and treatment options with patients. Satisfaction with current advanced directives was highly variable. However, a consensus about potential benefits of POLST exists, including assisting the discussion of end-of-life care, decreasing unwanted treatment, and lowering costs. More than 70% of respondents reported they would be more likely to use the POLST form if provided civil and criminal immunity; however, data analysis rendered the apparent association statistically insignificant. Qualitative data were also collected in the form of respondents’ recommendations and additional comments.

Conclusions: Physicians vary in their knowledge and opinions regarding the POLST paradigm. Broad opportunities may exist to improve physician knowledge and attitudes toward POLST. Dissemination of educational materials to physicians involved in the end-of-life planning process may increase physician support and use of POLST.
Measures to improve angiotensin receptor blocker prescribing efficiency in the UK: findings and implications
Authors: Martin Andrew , Godman Brian , Miranda Jamilette , Tilstone Jeanette , Saleem Nigget , Olsson Erika , Acosta Angela , Restrepo Luis , Bennie Marion
Published: December 2013

Background:
Generic losartan provides an opportunity to enhance angiotensin receptor blocker (ARB) prescribing efficiency, with all ARBs essentially being similar. Initially, there was limited activity in NHS Bury (UK). This changed in March 2011 with therapeutic switching and other measures encouraging the prescribing of losartan following generics to enhance its utilization versus patented ARBs.
Aim:
This study aims to assess the impact of multiple measures on losartan utilization, its price and total ARB expenditure.
Methods:
An interrupted time series analysis was performed. Utilization was measured as prescription items dispensed, typically 28 days.
Results:
No immediate change in losartan utilization was observed following generics. This changed after the multiple initiatives with losartan accounting for 65% of all single ARB items dispensed by the study end. ARB expenditure was 59% below prestudy levels by the study end, which was helped by a 92% reduction in expenditure per item for losartan. Annual net savings from the program were estimated at just under GB£290,000, which is over eight-times the cost of implementation.
Conclusion:
Multiple measures can enhance prescribing efficiency. Health authorities cannot rely on a ‘spillover’ effect from other classes in order to affect changes in physician prescribing habits.