bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating the impact of training influence on employee retention in small and medium enterprises: a regression‐type classification and ranking believe simplex analysis on sparse data
Authors: Beynon Malcolm James , Jones Paul , Pickernell David , Packham Gary
Published: February 2014

This study investigates the impact of available training alternatives (TAs) on employee retention in small and medium enterprises (SMEs). A noticeable problem with this research issue is that individual SMEs may utilize different combination of TAs. The considered survey questionnaire allowed respondent SME owners/managers the option to gauge the level of satisfaction of a TA or to indicate that they did not use it. It follows, therefore, that the survey‐based data set is sparse, in the sense that the ‘did not use’ option infers that a form of missing value is present (Likert‐scale‐based satisfaction value present if a TA was used). To facilitate an effective analysis of the considered sparse data set, because the missing values have meaning, the nascent regression‐type classification and ranking believe simplex (RCaRBS) technique is employed. As a development of the CaRBS technique, this technique is able to undertake multivariate regression‐type analysis on sparse data, without the need to manage the missing values in any way. Results are presented from the RCaRBS analyses relating to SME owner/managers' satisfactions with TAs and their impact on two employee retention facets, namely greater employee loyalty and, conversely, losing an employee to a competitor. Emphasis here is on the graphical elucidation of findings in regard to model fit and TA contribution. The pertinence of the study is the inclusiveness of the data considered (a novel approach to analysing sparse data), and the comparisons between these associated issues of TA satisfaction and employee retention.
Modifying the PEG model for Mediterranean lakes – no biological winter and strong fish predation
Authors: Moustaka‐Gouni Maria , Michaloudi Evangelia , Sommer Ulrich
Published: February 2014

The widely cited Plankton Ecology Group (PEG) model of plankton seasonal succession is often used as a template to explain the seasonal changes in plankton communities outside the cold temperate zone, where it was developed, but this may be inappropriate for lower‐latitude lakes.

Lower‐latitude lakes have high light availability in winter and less pronounced seasonal variations in fish predation on zooplankton. We might therefore expect higher phytoplankton crops in winter and much more predation on zooplankton by fish than in colder lakes. This might lead to less grazing in summer and relatively higher phytoplankton crops.

We compared data on phytoplankton biovolume, zooplankton biomass and body size from 18 German and 6 Greek lakes to test these hypotheses.
Major surgery in severe haemophilia A with inhibitors using a recombinant factor VIIa and activated prothrombin complex concentrate hybrid regimen
Authors: van Veen J. J. , Maclean R. M. , Hampton K. K. , Hamer A. , Makris M.
Published: February 2014

Major surgery in persons with haemophilia A and inhibitors is increasingly being performed. Both recombinant activated factor VII (rFVIIa) and activated prothrombin complex concentrate (APCC) are used to cover surgery but it remains unclear what the optimal dosing schedules are. We describe the use of a hybrid regimen in four inhibitor patients undergoing eight major surgical procedures using rFVIIa in the initial 2–6 postoperative days followed by FEIBA® for the remaining period. All patients were also treated with tranexamic acid while receiving rFVIIa. We performed six major orthopaedic procedures, one emergency orchidectomy and one open appendectomy. The dosing schedules were at the higher end of those described in the literature but within the recommendations of the summary of product characteristics. Despite this, we encountered non‐surgical bleeding in four of eight episodes. Three of these occurred in one individual suggesting a patient factor. The overall outcome was good for all episodes. The hybrid regimen combines flexibility of dose and dosing frequency of rFVIIa in the immediate postoperative setting with the advantage of a reduced dosing frequency with FEIBA® in the subsequent days. This study also emphasizes that surgical procedures in this patient group remain a challenge.
Diagnosis and management challenges in patients with mild haemophilia A and discrepant FVIII measurements
Authors: Trossaert M. , Lienhart A. , Nougier C. , Fretigny M. , Sigaud M. , Meunier S. , Fouassier M. , Ternisien C. , Negrier C. , Dargaud Y.
Published: February 2014

Thirty per cent of patients with mild haemophilia A (MHA) present markedly different FVIII: C level when assayed by one‐stage clotting and two‐stage chromogenic assays. It is, therefore, a real clinical challenge to predict the individual bleeding risk of these patients. The aim of the present work was to study the relationship between the bleeding tendency of these patients with the results of a panel of phenotypic and genotypic tools. Thirty‐six patients with MHA were included in this multicentre prospective clinical study. The severity of bleeding symptoms was evaluated using the ISTH/SSC score. FVIII:C levels were measured using an activated partial thromboplastin time‐based one‐stage FVIII assay (FVIII: C1) and three commercial chromogenic kits (FVIII:CR). FVIII antigen levels, thrombin generation measurement and FVIII gene mutation analysis were also performed. Our results showed that a one‐stage FVIII: C assay cannot rule out the diagnosis of MHA, a combined use of FVIII:C1 with a FVIII:CR is suitable for detecting MHA. We observed that FVIII:CR results better reflected the clinical bleeding tendency of patients compared to FVIII:C1. We also observed a relationship between thrombin generation (TG) capacity and FVIII:CR of these patients. FVIII gene mutation analysis showed mutations previously reported in MHA patients with discrepant FVIII:C measurements, but with no predictive value of the individual bleeding phenotype of patients. Overall, we observed a relationship between chromogenic FVIII:C results, TG assay and bleeding tendency of patients with discrepant FVIII:C measurements, while FVIII:C1 was not well correlated with clinical bleeding phenotype in this particular population.
Triptan Education and Improving Knowledge for Optimal Migraine Treatment: An Observational Study
Authors: Baron Eric P. , Markowitz Shira Y. , Lettich Alyssa , Hastriter Eric , Lovell Brigitte , Kalidas Kavita , Dodick David William , Schwedt Todd J. ,   American Headache Society Headache Fellows Research Consortium
Published: February 2014

Background

It is generally felt that patient education and patient knowledge regarding triptan use for acute migraine management are important for successful and safe treatment. It is unclear how knowledgeable triptan users are regarding their triptan, how much education occurs when triptans are prescribed, and the impact patient education has on actual patient knowledge regarding triptan use.

Objective

The primary objective was to compare triptan users' self‐perceived knowledge and actual knowledge about triptans in patients who report having received triptan education vs patients who report not having received triptan education.

Methods

This was a multicenter prospective observational study of 207 migraine patients who were using triptans for abortive therapy and who were being evaluated as new patients at academic headache specialty clinics in the United States. Patients completed standardized questionnaires regarding their self‐perceived knowledge about triptans, their actual knowledge regarding triptans, and the perceived education about the triptan that they had received at the time of prescription.

Results

Although greater than 80% of the subjects reported receiving education about when to take the triptan and the number of doses they could take for headache, only 71.5% reported receiving education about triptan side effects, 64% for the number of triptan doses they could take each week/month, 64% for taking other medications with the triptan, and 49% for medical contraindications to triptan use. Compared with subjects who did not recall receiving education about when to take their triptan, subjects who recalled such education had a statistically significant greater actual knowledge for taking the triptan immediately after a headache begins (91% vs 77%, P = .049; confidence interval [CI]: 0.00–0.33), treating when pain is mild (75% vs 50%, P = .009; CI: 0.04–0.45), understanding that they do not need to fail treatment with over‐the‐counter medications before taking a triptan (74% vs 42%, P = .001; CI: 0.11–0.51), and recognizing that coronary artery disease is a contraindication to triptan use (40% vs 19%, P = .001; CI: 0.09–0.34).

Conclusion

This study provides evidence that patients who recall having received education at the time of triptan prescribing have greater knowledge regarding optimal triptan use. Triptan users who recalled having received this education had greater recognition of the importance of taking the triptan immediately at the onset of a headache, treating when pain is mild, not needing to fail treatment with over‐the‐counter medications before taking a triptan, and understanding that coronary artery disease is a contraindication to triptan use.
The Surgical Treatment of Headache
Authors: Hong Jennifer , Roberts David W.
Published: February 2014

Medically refractory headache is an uncommon but difficult‐to‐treat clinical problem. Patients who fail maximal medical management may be candidates for invasive treatment. In this review, we critically examine the literature on the range of surgical treatments currently available for migraine, trigeminal autonomic cephalalgias, idiopathic intracranial hypertension and Chiari malformation type 1, with particular attention to patient selection, treatment efficacy, and complications.
Obesity and Headache: Part II – Potential Mechanism and Treatment Considerations
Authors: Chai Nu Cindy , Bond Dale S. , Moghekar Abhay , Scher Ann I. , Peterlin B. Lee
Published: February 2014

Obesity and headache are both associated with a substantial personal and societal impact, and epidemiologic studies have consistently identified a positive association between obesity and headache in general, as well as obesity and migraine specifically (see part I). In the current manuscript, we will discuss the potential mechanisms for the migraine–obesity association, with a focus on the central and peripheral pathophysiological pathways which overlap between migraine and those modulating the drive to feed. We then discuss surgical, behavioral, and pharmacological treatment considerations for overweight and obese migraineurs as well as for those with idiopathic intracranial hypertension. We close by briefly discussing where future research may be headed in light of this data.
Vascular Risk in Migraineurs: Interaction of Endothelial and Cortical Excitability Factors
Authors: Murinova Natalia , Krashin Daniel L. , Lucas Sylvia
Published: February 2014

Background

Migraine is a common primary headache disorder occurring predominantly in a young, relatively healthy population.

Results

There is a growing literature on associations between migraine, especially migraine with aura, and ischemic stroke as well as other vascular events. Migraine as a risk factor for vascular disease and connections between migraine and endothelial, structural, and genetic risk are reviewed.

Conclusion

There may be an interaction between endothelial dysfunction and cortical spreading depression affecting risk. Patient education and treatment of modifiable risk factors may decrease future vascular events.
Transient CNS Deficits and Migrainous Auras in Individuals Without a History of Headache
Authors: Naeije Gilles , Gaspard Nicolas , Legros Benjamin , Mavroudakis Nicolas , Pandolfo Massimo
Published: February 2014

Objective

To demonstrate that benign transient focal neurological symptoms represent equivalents of migraine auras without headache.

Background

Benign focal neurological symptoms suggesting cerebral dysfunction are common and usually prompt an extensive diagnostic workup, but their etiology is often not elucidated. We hypothesized that benign transient focal neurological symptoms represent equivalents of migraine auras without headache, even in subjects who have never experienced migraine headaches.

Methods

We led a cross‐sectional study and identified individuals who presented at least 1 episode of unexplained transient focal neurological symptoms suggestive of cerebral dysfunction, but no history of migraine headache, among physicians and inpatients of an academic hospital. Cortical hyperexcitability, assessed by occipital transcranial magnetic stimulation (oTMS), was used as a marker of possible migraine auras without headache.

Results

Frequency of transient focal neurological symptoms suggestive of cerebral dysfunction among the physicians who responded was 9% (21/233), vs 0.09% (6/690) of inpatients. Most episodes resembled typical visual migrainous auras. Motor, sensory, and language dysfunction were more common among inpatients than among physicians. oTMS induced phosphenes in 12/16 (75%) subjects and in none of 10 controls.

Conclusion

Benign focal neurological symptoms were common in our population and likely represent migraine aura without headache. Non‐visual symptoms are less common and lead to medical consultation. oTMS is abnormal in most cases, supporting the diagnosis of migraine aura without headache and helping separate this benign condition from transient ischemic attacks.
Healthcare pathway and biopsychosocial impact of persistent dentoalveolar pain disorder: a qualitative study
Authors: Durham J. , Nixdorf D. R.
Published: February 2014

Aim

To examine persistent dentoalveolar pain disorder (PDAP) patients' reported experiences of the biopsychosocial impacts of the condition and its healthcare pathway.

Methods

Qualitative semi‐structured interviews were conducted with a university‐based cohort of PDAP patients. One interviewer used an open‐ended, evolving, topic guide, and all interviews were recorded and transcribed verbatim. Data collection and analysis continued until saturation (n = 20). The principles of the constant comparative method were followed, and frameworks were used to help organize and analyse the data.

Results

PDAP exerts significant biopsychosocial impacts on the individual. These impacts occur across a wide variety of everyday activities including employment, personal relationships and social activities. The conceptualization and acceptance of PDAP are difficult for patients given the reinforcement of multiple ineffective dental treatments perceived as targeting the source of their pain.

Conclusion

There is an urgent need for earlier identification of PDAP cases in order to minimize the negative biopsychosocial effects of multiple dental interventions incorrectly applied to treat the symptom of pain.
C‐reactive protein is essential for innate resistance to pneumococcal infection
Authors: Paul Simons J. , Loeffler Jutta M. , Al‐Shawi Raya , Ellmerich Stephan , Hutchinson Winston L. , Tennent Glenys A. , Petrie Aviva , Raynes John G. , de Souza J. Brian , Lawrence Rachel A. , Read Kevin D. , Pepys Mark B.
Published: February 2014

No deficiency of human C‐reactive protein (CRP), or even structural polymorphism of the protein, has yet been reported so its physiological role is not known. Here we show for the first time that CRP‐deficient mice are remarkably susceptible to Streptococcus pneumoniae infection and are protected by reconstitution with isolated pure human CRP, or by anti‐pneumococcal antibodies. Autologous mouse CRP is evidently essential for innate resistance to pneumococcal infection before antibodies are produced. Our findings are consistent with the significant association between clinical pneumococcal infection and non‐coding human CRP gene polymorphisms which affect CRP expression. Deficiency or loss of function variation in CRP may therefore be lethal at the first early‐life encounter with this ubiquitous virulent pathogen, explaining the invariant presence and structure of CRP in human adults.
The Canine Orthopedic Index. Step 1: Devising the Items
Authors: Brown Dorothy Cimino
Published: February 2014

Objective

To develop questions for an owner‐completed outcome assessment instrument for dogs with orthopedic disease.

Study Design

Focus groups, key‐informant interviews, surveys.

Sample Population

Owners of dogs with osteoarthritis (OA).

Methods

Audio recorded focus groups were transcribed. Descriptive statistics around discussed topics were calculated. A list of frequently discussed behaviors underwent discrimination and frequency endorsement analysis and was circulated for refinement among veterinarians experienced in treating dogs with orthopedic disease. The final list of behaviors was transformed into a series of questions and organized as the preliminary instrument for testing in further studies.

Results

Owners (n = 27) participated in 4 focus groups. Based on the frequency of comments generated during focus groups and key‐informant interviews, 30 behaviors were further screened by discrimination analysis and endorsement frequency in an additional cohort of 60 owners. No behaviors were classified as “good” for discriminating between front and hind limb disease so a single, non‐limb‐specific instrument was developed. Four behaviors had an endorsement frequency ≤33% and were not considered further for inclusion in the preliminary instrument. Twenty‐one questions associated with the remaining behaviors were used to create the preliminary Canine Orthopedic Index (COI) for psychometric testing in further studies.

Conclusions

A 21‐question owner‐completed COI was successfully developed in preparation for psychometric testing studies.
Assessing sperm chromatin and DNA damage: clinical importance and development of standards
Authors: Zini A. , Albert O. , Robaire B.
Published: February 2014

Over the past 20 years, numerous new methods have been developed to identify changes in the organization and composition of sperm chromatin as well as to determine the extent of DNA damage in the nuclei of spermatozoa. Although these methods are being used effectively in assessing how toxicants act on sperm chromatin quality in agricultural settings, their use as complementary biomarkers of sperm quality in assessing male fertility remains controversial. We review some key aspects of the assessment of sperm chromatin quality and DNA damage and identify some of the most widely used tests to monitor these endpoints. An approach to validate three tests by standardizing methodology and determining interlaboratory variation for each test using a standard set of samples is outlined.
Parent Report of Conversations with Their Adolescents with Intellectual Disability
Authors: Jones Jennifer L. , Oseland Lauren M. , Morris Kathryn L. , Larzelere Robert E.
Published: February 2014

Background

The purpose of this study was to examine parent report of conversations about difference and disability in families of adolescents with intellectual disability.

Materials and Methods

Participants included 50 parents (44 mothers, four fathers, and two other caregivers) and their adolescents with intellectual disability (M age = 15.9). Parents provided written responses to open‐ended questions regarding conversations with their adolescent. Adolescents completed measures of self‐concept and self‐determination.

Results

The majority (66%) of parents reported talking to their adolescent about difference and/or disability. Consistent with previous research, some of these conversations were in response to social exclusion (e.g. child was bullied). Parents who knew the aetiology of their child's disability were significantly more likely to talk with their child about his or her disabling condition.

Conclusions

Parents' narratives illustrate their struggle to explain disability to their adolescent. Professionals are challenged to consider how to promote proactive conversations between parents and adolescents.
Comparison of multiplicative heterogeneous variance adjustment models for genetic evaluations
Authors: Márkus Sz. , Mäntysaari E.A. , Strandén I. , Eriksson J‐Å. , Lidauer M.H.
Published: February 2014

Two heterogeneous variance adjustment methods and two variance models were compared in a simulation study. The method used for heterogeneous variance adjustment in the Nordic test‐day model, which is a multiplicative method based on Meuwissen (J. Dairy Sci., 79, 1996, 310), was compared with a restricted multiplicative method where the fixed effects were not scaled. Both methods were tested with two different variance models, one with a herd‐year and the other with a herd‐year‐month random effect. The simulation study was built on two field data sets from Swedish Red dairy cattle herds. For both data sets, 200 herds with test‐day observations over a 12‐year period were sampled. For one data set, herds were sampled randomly, while for the other, each herd was required to have at least 10 first‐calving cows per year. The simulations supported the applicability of both methods and models, but the multiplicative mixed model was more sensitive in the case of small strata sizes. Estimation of variance components for the variance models resulted in different parameter estimates, depending on the applied heterogeneous variance adjustment method and variance model combination. Our analyses showed that the assumption of a first‐order autoregressive correlation structure between random‐effect levels is reasonable when within‐herd heterogeneity is modelled by year classes, but less appropriate for within‐herd heterogeneity by month classes. Of the studied alternatives, the multiplicative method and a variance model with a random herd‐year effect were found most suitable for the Nordic test‐day model for dairy cattle evaluation.
Experimental peri‐implant mucositis at different implant surfaces
Authors: Schwarz Frank , Mihatovic Ilja , Golubovic Vladimir , Eick Sigrun , Iglhaut Theresa , Becker Jürgen
Published: February 2014

Objectives

To histologically and immunologically assess experimental peri‐implant mucositis at surface enhanced modified (mod) hydrophilic titanium implants.

Materials and Methods

In a split‐mouth design (n = 6 foxhounds), four different implants were inserted on each side of the maxilla: three titanium‐zirconium alloy implants (TiZr) with either modSLA (sand‐blasted, acid etched and chemically mod), modMA (machined, acid etched and chemically mod), or M (machined) surfaces in the transmucosal portion, and one titanium implant with a machined transmucosal portion (TiM). Experimental mucositis was induced at one randomly assigned side (NPC), whereas the contra‐lateral maxillary side received mechanical plaque removal three times per week (PC). At 16 weeks, tissue biopsies were processed for histological (primary outcome: apical extension of the inflammatory cell infiltrate measured from the mucosal margin – PM‐aICT) and immunohistochemical (CD68 antigen reactivity) analyses. Peri‐implant sulcus fluid was analysed for interleukin (IL)‐1β, IL‐8, matrix metalloproteinase (MMP)‐8 and myeloperoxidase (MPO).

Results

Mean PM‐aICT values varied between 1.86 (TiZrmodSLA) and 3.40 mm (TiM) in the UPC group, and between 0.88 (TiZrmodSLA) and 2.08 mm (TiZrM) in the PC group. Mean CD68, IL‐1β, IL‐8, MMP‐8 and MPO values were equally distributed between mod‐ and control implants in both NPC and PC groups.

Conclusions

The progression of experimental mucositis was comparable at all implant surfaces investigated.
Chemical Offense by Means of Toxicysts in the Freshwater Ciliate, Coleps hirtus
Authors: Buonanno Federico , Anesi Andrea , Guella Graziano , Kumar Santosh , Bharti Daizy , La Terza Antonietta , Quassinti Luana , Bramucci Massimo , Ortenzi Claudio
Published: February 2014

Coleps hirtus is a small common freshwater ciliate belonging to the protostomatid group, its body covered by calcified plates assembled to form an armor. Coleps feeds on bacteria, algae, flagellates, living and dead ciliates, animal and plant tissues. To assist its carnivorous feeding the ciliate is equipped with offensive extrusomes (toxicysts), clustering mainly in and around its oral aperture. In this study, we isolated the discharge of the toxicysts from living cells, evaluating its cytotoxic effects against various ciliate species, and demonstrating that it is essential for the effectiveness of Coleps’ predatory behavior. The analysis of the toxicyst discharge performed by liquid chromatography‐electrospray‐mass spectrometry and gas chromatography‐mass spectrometry, revealed the presence of a mixture of 19 saturated, monounsaturated and polyunsaturated free fatty acids with the addition of a minor amount of a diterpenoid (phytanic acid).
A capture–recapture model of amphidromous fish dispersal
Authors: Smith W. E. , Kwak T. J.
Published: February 2014

Adult movement scale was quantified for two tropical Caribbean diadromous fishes, bigmouth sleeper Gobiomorus dormitor and mountain mullet Agonostomus monticola, using passive integrated transponders (PITs) and radio‐telemetry. Large numbers of fishes were tagged in Río Mameyes, Puerto Rico, U.S.A., with PITs and monitored at three fixed locations over a 2·5 year period to estimate transition probabilities between upper and lower elevations and survival probabilities with a multistate Cormack–Jolly–Seber model. A sub‐set of fishes were tagged with radio‐transmitters and tracked at weekly intervals to estimate fine‐scale dispersal. Changes in spatial and temporal distributions of tagged fishes indicated that neither G. dormitor nor A. monticola moved into the lowest, estuarine reaches of Río Mameyes during two consecutive reproductive periods, thus demonstrating that both species follow an amphidromous, rather than catadromous, migratory strategy. Further, both species were relatively sedentary, with restricted linear ranges. While substantial dispersal of these species occurs at the larval stage during recruitment to fresh water, the results indicate minimal dispersal in spawning adults. Successful conservation of diadromous fauna on tropical islands requires management at both broad basin and localized spatial scales.
Skin immune response in the zebrafish, Danio rerio (Hamilton), to Aeromonas hydrophila infection: a transcriptional profiling approach
Authors: Lü A‐J , Hu X‐C , Wang Y , Zhu A‐H , Shen L‐L , Tian J , Feng Z‐Z , Feng Z‐J
Published: February 2014

Skin plays an important role in innate immune responses to bacterial infection, but its molecular mechanism remains unclear in fish. The transcriptional profiling of the skin immune response to Aeromonas hydrophila infection of the zebrafish, Danio rerio (Hamilton), was performed by Affymetrix microarray analysis. The results showed that 538 genes were differentially expressed, of which 388 genes were up‐regulated and 150 genes were down‐regulated. The expression patterns for 106 representative genes were observed to be up‐regulated in zebrafish skin at 24 and 36 h post‐infection, and gene expression changes were clearly greater at 36 h. Gene Ontology classification indicated that 222 genes were significantly associated with the skin immunity, including complement activation, acute‐phase response, stress response, chemotaxis and apoptosis. Further Kyoto Encyclopedia of Genes and Genomes analysis showed that the significant pathways included MAPK, p53, Wnt, TGF‐β, Notch, ErbB, JAK‐STAT, VEGF, mTOR and Calcium signalling in skin immune responses, and several genes (e.g. akt2l, frap1, nras, rac1, xiap) were found to be involved in signalling networks. Moreover, expression changes in nine selected genes were verified by real‐time qPCR analysis. This is the first known report on transcriptome analysis in the skin of zebrafish against the pathogen A. hydrophila.
Laparoscopic versus open liver resection for elderly patients with malignant liver tumors: A single‐center experience
Authors: Chan Albert C Y , Poon Ronnie T P , Cheung Tan To , Chok Kenneth S H , Dai Wing Chiu , Chan See Ching , Lo Chung Mau
Published: February 2014

Background

Laparoscopic liver resection is associated with less perioperative blood loss, shorter hospital stay, and fewer postoperative complications in younger patients. However, it remains unclear if these short‐term benefits could also be applicable to elderly patients with medical comorbidities.

Aim

To evaluate the perioperative outcomes of laparoscopic liver resection in patients with advanced age.

Materials and Methods

Patients aged ≥ 70 years old who received liver resections for malignant liver tumors between January 2002 and December 2012 were included. The perioperative outcomes of 17 patients with laparoscopic approach were matched and compared with 34 patients with conventional open approach in a 1:2 ratio.

Results

There was no significant difference with regard to age, gender, incidence of comorbid illness, hepatitis B positivity, and Child grading of liver function. The median tumor size was 3 cm for both groups. The types of liver resection were similar between the two groups with no significant difference in the duration of operation (laparoscopic: 195 min vs open: 210 min, P = 0.436). The perioperative blood loss was 150 mL in the laparoscopic group and 330 mL in the open group (P = 0.046) with no significant difference in the number of patients with blood transfusion. The duration of hospital stay was 6 days (3–15 days) for the laparoscopic group and 8 days (5–105 days) for the open group (P = 0.005).

Conclusion

Laparoscopic liver resection is safe and feasible for elderly patients. The short‐term benefits of laparoscopic approach continued to be evident for geriatric oncological liver surgery.
Clinical outcomes and prognostic factors of patients with advanced hepatocellular carcinoma treated with sorafenib as first‐line therapy: A Korean multicenter study
Authors: Lee Sangheun , Kim Beom Kyung , Kim Seung Up , Park Soo Young , Kim Ja Kyung , Lee Hyun Woong , Park Jun Yong , Kim Do Young , Ahn Sang Hoon , Tak Won Young , Kweon Young Oh , Lee Jung Il , Lee Kwan Sik , Kim Hyung Joon , Han Kwang‐Hyub
Published: February 2014

Background and Aim

Sorafenib is recommended as a standard treatment for advanced hepatocellular carcinoma (HCC). The efficacy and safety of sorafenib as a first‐line therapy in Korean patients with advanced HCC were investigated.

Methods

From 2007 to 2012, 86 patients with advanced HCC (Barcelona Clinic Liver Cancer stage C) treated with sorafenib as a first‐line therapy were enrolled from five tertiary hospitals. Predictors of overall survival (OS) and progression‐free survival (PFS) were analyzed.

Results

The median age was 59.5 years, and 71 (82.6%) were males; 57 (66.3%) patients were in Child–Pugh class A. The median OS and PFS were 5.0 (range 4.0–5.9) and 3.2 (range 2.6–3.7) months, respectively. Regarding OS, Child–Pugh class A (6.0 vs 2.8 months), tumor diameter < 5 cm (6.0 vs 4.3 months), baseline α‐fetoprotein < 200 ng/mL (5.8 vs 4.1 months), and the advent of hand‐foot‐skin reaction of ≥ grade 2 (5.9 vs 4.0 months) were independent favorable predictors (all P < 0.05). Similarly, regarding PFS, Child–Pugh class A (4.3 vs 2.1 months), tumor diameter < 5 cm (3.9 vs 2.8 months), baseline α‐fetoprotein < 200 ng/mL (5.6 vs 2.8 months), and the advent of hand‐foot‐skin reaction of ≥ grade 2 (4.5 vs 2.6 months) were independent favorable predictors (all P < 0.05). All toxicities during sorafenib treatment were manageable.

Conclusions

Because the efficacy of sorafenib seems marginal in Korean patients with treatment‐naïve HCC, how to select candidates with favorable outcomes should be further investigated.
Regulation of T cell recruitment and inflammation in the human immunodeficiency virus/hepatitis C virus coinfected liver
Authors: Nguyen Nam , Hampartzoumian Taline , Cameron Barbara , Palmer Clovis , O'Toole Sandra , Post Jeffrey , Zekry Amany , Lloyd Andrew
Published: February 2014

Background and Aim

Patients coinfected with both hepatitis C virus (HCV) and human immunodeficiency virus (HIV) have accelerated liver disease compared with HCV mono‐infected patients. In chronic HCV infection, it is known that chemokines play a key role in T cell recruitment and in determining the extent of hepatic injury.

Methods

In this study, we determined by quantitative real‐time reverse transcriptase polymerase chain reaction and immunohistochemistry the intrahepatic phenotype of the cellular infiltrate and its associated chemokine profile and localization in a cohort of relatively immune competent coinfected HIV/HCV subjects.

Results

Increased lobular expression of CD8+ cytotoxic T cells was found in the coinfected liver in conjunction with increased expression of the T cell chemoattractant, chemokine (C‐C motif) ligand (CCL)5, compared with the HCV mono‐infected liver. Furthermore, the number of lobular‐infiltrating CD8+ T cells was positively correlated with the expression of CCL5. Immunohistochemical staining of CCL5 showed it to primarily localize to the hepatocytes. Within the inflammatory infiltrate, proliferating (Ki‐67+) and apoptotic terminal deoxynucleotidyl transferase 2′‐deoxyuridine 5′‐triphosphate nick end labeling + (TUNEL)+ cells were sparse.

Conclusions

Collectively, the data suggest that even in the setting of relatively immune competent coinfected subjects, a pro‐inflammatory milieu exists ,which can potentially drive the increased T cell recruitment found in the HIV/HCV coinfected liver. This profile is likely to contribute to the accelerated progression of liver disease observed in HIV/HCV coinfection.
A Tale of Two Methods: Chart and Interview Methods for Identifying Delirium
Authors: Saczynski Jane S. , Kosar Cyrus M. , Xu Guoquan , Puelle Margaret R. , Schmitt Eva , Jones Richard N. , Marcantonio Edward R. , Wong Bonnie , Isaza Ilean , Inouye Sharon K.
Published: February 2014

Objectives

To compare chart‐ and interview‐based methods for identification of delirium.

Design

Prospective cohort study.

Setting

Two academic medical centers.

Participants

Individuals aged 70 and older undergoing major elective surgery (N = 300) (majority orthopedic surgery).

Measurements

Participants were interviewed daily during hospitalization for delirium using the Confusion Assessment Method (CAM; interview‐based method), and their medical charts were reviewed for delirium using a validated chart‐review method (chart‐based method). Rate of agreement of the two methods and characteristics of those identified using each approach were examined. Predictive validity for clinical outcomes (length of stay, postoperative complications, discharge disposition) was compared. In the absence of a criterion standard, predictive value could not be calculated.

Results

The cumulative incidence of delirium was 23% (n = 68) according to the interview‐based method, 12% (n = 35) according to the chart‐based method, and 27% (n = 82) according to the combined approach. Overall agreement was 80%; kappa was 0.30. The methods differed in detection of psychomotor features and time of onset. The chart‐based method missed delirium in individuals that the CAM identified who were lacking features of psychomotor agitation or inappropriate behavior. The CAM‐based method missed chart‐identified cases occurring during the night shift. The combined method had high predictive validity for all clinical outcomes.

Conclusions

Interview‐ and chart‐based methods have specific strengths for identification of delirium. A combined approach captures the largest number and broadest range of delirium cases.
Epidemiology of Restricting Fatigue in Older Adults: The Precipitating Events Project
Authors: de Rekeneire Nathalie , Leo‐Summers Linda , Han Ling , Gill Thomas M.
Published: February 2014

Objectives

To estimate the rate of restricting fatigue in community‐living older adults and to determine whether the rates differ according to age, sex, race, physical frailty, and depression.

Design

Prospective cohort study.

Setting

Greater New Haven, Connecticut.

Participants

Nondisabled community‐living older men and women aged 70 and older (N = 754).

Measurements

Restricting fatigue was defined as staying in bed for at least half the day and/or cutting down on one's usual activities because of fatigue for 3 consecutive months or longer. Physical frailty was defined on the basis of slow gait speed, and depression was assessed using the Center for Epidemiologic Studies Depression Scale.

Results

During a median follow‐up of 111 months, the cumulative incidence of restricting fatigue was 31.1% for men and 42.1% for women. The overall incidence rate of restricting fatigue was 6.7 per 1,000 person‐months (7.8 for women and 4.4 for men, P < .001), which did not differ according to race. Rates were higher in persons who were physically frail than those who were not (P < .001), in those who were depressed than those who were not (P < .001), and in persons aged 75 to 79 and 80 to 84 than those aged 70 to 74 (both P < .01) but not in those aged 85 and older. Of the 459 episodes of restricting fatigue, the median duration was 3 months, which did not differ according to age, sex, race, physical frailty, or depression.

Conclusion

Restricting fatigue is common in community‐living older adults. Women, individuals aged 75 to 84, and individuals with physical frailty or depression had higher rates of restricting fatigue than their respective counterparts.
Depressive Symptoms and Hospital Readmission in Older Adults
Authors: Albrecht Jennifer S. , Gruber‐Baldini Ann L. , Hirshon Jon M. , Brown Clayton H. , Goldberg Richard , Rosenberg Joseph H. , Comer Angela C. , Furuno Jon P.
Published: February 2014

Objectives

To quantify the risk of 30‐day unplanned hospital readmission in adults aged 65 and older with depressive symptoms.

Design

Prospective cohort study.

Setting

University of Maryland Medical Center.

Participants

Individuals aged 65 and older admitted between July 1, 2011, and August 9, 2012, to the general medical and surgical units and followed for 31 days after hospital discharge (N = 750).

Measurements

Primary exposure was depressive symptoms at admission, defined as a score of 6 or more on the 15‐item Geriatric Depression Scale. Primary outcome was unplanned 30‐day hospital readmission, defined as an unscheduled overnight stay at any inpatient facility not occurring in the emergency department.

Results

Prevalence of depressive symptoms was 19% and incidence of 30‐day unplanned hospital readmission was 19%. Depressive symptoms were not significantly associated with hospital readmission (relative risk (RR) = 1.20, 95% confidence interval (CI) = 0.83–1.72). Age, Charlson Comorbidity Index score, and number of hospitalizations within the past 6 months were significant predictors of unplanned 30‐day hospital readmission.

Conclusion

Although not associated with hospital readmission, depressive symptoms were associated with other poor outcomes and may be underdiagnosed in hospitalized older adults. Hospitals interested in reducing readmission should focus on older adults with more comorbid illness and recent hospitalizations.
Delirium Risk Prediction, Healthcare Use and Mortality of Elderly Adults in the Emergency Department
Authors: Kennedy Maura , Enander Richard A. , Tadiri Sarah P. , Wolfe Richard E. , Shapiro Nathan I. , Marcantonio Edward R.
Published: February 2014

Objectives

To create a risk prediction rule for delirium in elderly adults in the emergency department (ED) and to compare mortality and resource use of elderly adults in the ED with and without delirium.

Design

Prospective observational study.

Setting

Urban tertiary care ED.

Participants

Individuals aged 65 and older presenting for ED care (N = 700).

Measurements

A trained research assistant performed a structured mental status assessment and attention tests, after which delirium was determined using the Confusion Assessment Method. Data were collected on participant demographics, comorbidities, medications, ED course, hospital and intensive care unit (ICU) admission, length of stay, hospital charges, 30‐day rehospitalization, and mortality.

Results

Nine percent of elderly study participants had delirium. Using logistic regression, a delirium prediction rule consisting of older age, prior stroke or transient ischemic attack, dementia, suspected infection, and acute intracranial hemorrhage was created had good predictive accuracy (area under the receiver operating characteristic curve = 0.77). Admitted participants with ED delirium had longer median lengths of stay (4 vs 2 days) and were more likely to require ICU admission (13% vs 6%) and to be discharged to a new long‐term care facility (37% vs 9%) than those without. In all participants, ED delirium was associated with higher 30‐day mortality (6% vs 1%) and 30‐day readmission (27% vs 13%).

Conclusion

This risk prediction rule may help identify a group of individuals in the ED at high risk of developing delirium who should undergo screening, but it requires external validation. Identification of delirium in the ED may enable physicians to implement strategies to decrease delirium duration and avoid inappropriate discharge of individuals with acute delirium, improving outcomes.
Resource Use in Small Island States
Authors: Krausmann Fridolin , Richter Regina , Eisenmenger Nina
Published: February 2014

Iceland and Trinidad and Tobago are small open, high‐income island economies with very specific resource‐use patterns. This article presents a material flow analysis (MFA) for the two countries covering a time period of nearly five decades. Both countries have a narrow domestic resource base, their economy being largely based on the exploitation of one or two key resources for export production. In the case of Trinidad and Tobago, the physical economy is dominated by oil and natural gas extraction and petrochemical industries, whereas Iceland's economy for centuries has been based on fisheries. More recently, abundant hydropower and geothermal heat were the basis for the establishment of large export‐oriented metal processing industries, which fully depend on imported raw materials and make use of domestic renewable electricity. Both countries are highly dependent on these natural resources and vulnerable to overexploitation and price developments. We show how the export‐oriented industries lead to high and growing levels of per capita material and energy use and carbon dioxide emissions resulting from large amounts of processing wastes and energy consumption in production processes. The example of small open economies with an industrial production system focused on few, but abundant, key resources and of comparatively low complexity provides interesting insights of how resource endowment paired with availability or absence of infrastructure and specific institutional arrangements drives domestic resource‐use patterns. This also contributes to a better understanding and interpretation of MFA indicators, such as domestic material consumption.
Outcomes of Nulliparous Women With Spontaneous Labor Onset Admitted to Hospitals in Preactive Versus Active Labor
Authors: Neal Jeremy L. , Lamp Jane M. , Buck Jacalyn S. , Lowe Nancy K. , Gillespie Shannon L. , Ryan Sharon L.
Published: February 2014

Introduction

The timing of when a woman is admitted to the hospital for labor care following spontaneous contraction onset may be among the most important decisions that labor attendants make because it can influence care patterns and birth outcomes. The aims of this study were to estimate the percentage of low‐risk, nulliparous women at term who are admitted to labor units prior to active labor and to evaluate the effects of the timing of admission (ie, preactive vs active labor) on labor interventions and mode of birth.

Methods

Data from low‐risk, nulliparous women with spontaneous labor onset at term gestation were merged from 2 prospective studies conducted at 3 large Midwestern hospitals. Baseline characteristics, labor interventions, and outcomes were compared between groups using Fisher's exact and Mann‐Whitney U tests, as appropriate. Likelihoods for oxytocin augmentation, amniotomy, and cesarean birth were assessed by logistic regression.

Results

Of the sample of 216 low‐risk nulliparous women, 114 (52.8%) were admitted in preactive labor and 102 (47.2%) were admitted in active labor. Women who were admitted in preactive labor were more likely to undergo oxytocin augmentation (84.2% and 45.1%, respectively; odds ratio [OR], 6.5; 95% confidence interval [CI], 3.43–12.27) but not amniotomy (55.3% and 61.8%, respectively; OR, 0.8; 95% CI, 0.44–1.32) when compared to women admitted in active labor. The likelihood of cesarean birth was higher for women admitted before active labor onset (15.8% and 6.9%, respectively; OR, 2.6; 95% CI, 1.02–6.37).

Discussion

Many low‐risk nulliparous women with regular, spontaneous uterine contractions are admitted to labor units before active labor onset, which increases their likelihood of receiving oxytocin and giving birth via cesarean. An evidence‐based, standardized approach for labor admission decision making is recommended to decrease inadvertent admissions of women in preactive labor. When active labor cannot be diagnosed with relative certainty, observation before admission to the birthing unit is warranted.
Intravascular Ultrasound Analysis to Determine the Relationship between High‐Density Lipoprotein Cholesterol and Lesion Characteristics in Patients with Coronary Artery Disease
Authors: KITABATA HIRONORI , LOH JOSHUA P. , PENDYALA LAKSHMANA K. , OMAR ALFAZIR , MAGALHAES MARCO A. , TORGUSON REBECCA , CHEN FANG , PICHARD AUGUSTO D. , BREWER H. BRYAN , WAKSMAN RON
Published: February 2014

Objectives

This study utilized grayscale intravascular ultrasound (IVUS) to explore the relationship between high‐density lipoprotein cholesterol (HDL‐C) levels and culprit lesion characteristics in patients with coronary artery disease.

Background

Low HDL‐C is associated with an increased risk of cardiovascular events. Previous IVUS studies have suggested a significant association between lesion characteristics and cardiovascular events.

Methods

According to HDL‐C levels, 120 patients who underwent IVUS for native, de novo coronary lesions before any intervention were divided into a low HDL‐C group (<40 mg/dL, n = 60) and a high HDL‐C group (≥40 mg/dL, n = 60). Quantitative and qualitative IVUS analyses were performed to compare lesion characteristics.

Results

Quantitative IVUS measurements showed no significant differences between the 2 groups. HDL‐C level was not significantly correlated with remodeling index (r = 0.03, P = 0.78). However, attenuated plaque was more frequent in the low HDL‐C group (48.3% vs. 28.3%, P = 0.02) and a greater percentage of attenuated plaque was found in this group (32.5 ± 21.3% vs. 21.0 ± 11.0%, P = 0.02). Moreover, when categorized into 4 groups according to HDL‐C levels, the proportion of attenuated plaque (64.7% in group with <30 mg/dL, 41.9% in group with 30–39 mg/dL, 36.4% in group with 40–59 mg/dL, and 6.3% in group with ≥60 mg/dL; P = 0.001 for trend) was significantly different among groups. On multivariate analysis, only HDL‐C and male gender were independently associated with the presence of attenuated plaque at the culprit lesions.

Conclusions

Patients with low levels of HDL‐C may be at increased risk of having a higher incidence of attenuated plaques. (J Interven Cardiol 2014;27:325–333)