bluuebunny/crossref_metadata_2025 huggingface dataset:
Antithrombotic Therapy After Acute Ischemic Stroke in Patients With Atrial Fibrillation
Authors: McGrath Emer R. , Kapral Moira K. , Fang Jiming , Eikelboom John W. , ó Conghaile Aengus , Canavan Michelle , O’Donnell Martin J.
Published: November 2014

Background and Purpose—

For patients with atrial fibrillation and ischemic stroke (IS), current guidelines recommend oral anticoagulation (OAC) alone for secondary prevention of IS. In a large prospective cohort of patients with acute IS and atrial fibrillation, we determine the association between antithrombotic regimen on discharge and risk of major vascular events.

Methods—

Prospective cohort of consecutive patients included in the Ontario Stroke Registry. Multivariable Cox proportional hazard models were used to determine the association between antithrombotic regimen on discharge and time to death or admission for recurrent IS, myocardial infarction, or major bleeding.

Results—

Two thousand one hundred sixty-two patients were hospitalized atrial fibrillation and acute IS. At discharge, 8.0% were prescribed no antithrombotic therapy, 21.6% antiplatelet therapy alone, 39.3% OAC (warfarin) alone, and 31.1% combination OAC and antiplatelet therapy. Compared with OAC alone (hazard ratio [HR], 1.0), no antithrombotic therapy (HR, 1.51; 95% confidence interval, 1.23–1.86) and antiplatelet therapy (HR, 1.31; 95% confidence interval, 1.14–1.50) were associated with an increased risk of the primary composite outcome, whereas combination OAC and antiplatelet therapy was associated with a trend toward a reduced risk (HR, 0.91; 95% confidence interval, 0.80–1.04 overall and HR, 0.79; 95% confidence interval, 0.61–1.02 in those with coronary heart disease). Results were consistent in those with severe stroke: HR 1.58 (95% CI, 1.21–2.06), 1.34 (95% CI, 1.09–1.63), and 0.91 (95% CI, 0.74–1.11), respectively.

Conclusions—

Contrary to current guidelines, 30% of patients with atrial fibrillation and recent IS are not prescribed any OAC therapy on discharge, whereas a further 30% are prescribed combination OAC and antiplatelet therapy. Combination OAC and antiplatelet therapy in patients at high cardiovascular risk requires evaluation in clinical trials, particularly with the newer OACs, given their more favorable risk–benefit ratio compared with warfarin.
Cerebral Venous Thrombosis in the Absence of Headache
Authors: Coutinho Jonathan M. , Stam Jan , Canhão Patricia , Barinagarrementeria Fernando , Bousser Marie-Germaine , Ferro José M.
Published: November 2014

Background and Purpose—

Although headache is the most common symptom in cerebral venous thrombosis, 5% to 30% of patients do not report headache at baseline. Characteristics of these patients have not been investigated.

Methods—

In post hoc analysis of the International Study on Cerebral Vein and Dural Sinus Thrombosis study, patients who might not have been able to report headache (aphasia, stupor, coma, or mental status disorder) were excluded.

Results—

Three hundred eighty-two of the original 624 patients (61%) were included, of whom 38 (10%) did not report headache at baseline. Patients without headache were older (mean age, 45 versus 37;
P
=0.001) and less often female (63% versus 77%;
P
=0.06). Paresis (42% versus 27%;
P
=0.05) and seizures (58% versus 32%;
P
=0.001) were more common in patients without headache, whereas papilledema was less common (8% versus 35%;
P
=0.001). Isolated cortical vein thrombosis (16% versus 2%;
P
=0.001), brain parenchymal lesions (66% versus 46%;
P
=0.02), and malignancies (18% versus 6%;
P
=0.009) were more common among patients without headache. Outcome at last follow-up was worse in patients without headache (modified Rankin Scale, 0–1; 76% versus 89%;
P
=0.04; mortality, 13% versus 5%;
P
=0.05), but after adjustment for prognostic variables, headache was not an independent predictor of outcome.

Conclusions—

Patients with cerebral venous thrombosis but without headache are a heterogeneous subgroup, in which older patients, men, and some associated conditions are over-represented. Patients without headache had a worse clinical outcome, but after adjustment for imbalances, headache was not an independent predictor of outcome.
Amplification of Regulatory T Cells Using a CD28 Superagonist Reduces Brain Damage After Ischemic Stroke in Mice
Authors: Na Shin-Young , Mracsko Eva , Liesz Arthur , Hünig Thomas , Veltkamp Roland
Published: November 2014

Background and Purpose—

Neuroinflammation plays an important role in ischemic brain injury. Regulatory T cells (Treg) are important endogenous immune modulators. We tested the hypothesis that Treg amplification with a CD28 superagonistic monoclonal antibody (CD28SA) reduces brain damage in murine cerebral ischemia.

Methods—

Cerebral ischemia was induced by coagulation of the distal middle cerebral artery or by 60 minutes filament occlusion of the proximal middle cerebral artery in C57BL6 mice. 150 μg CD28SA was injected intraperitoneally 3 or 6 hours after ischemia onset. Outcome was determined by infarct volumetry and behavioral testing. Brain-infiltrating leukocyte subpopulations were analyzed by flow cytometry and immunohistochemistry 3 and 7 days after middle cerebral artery occlusion.

Results—

CD28SA reduced infarct size in both models and attenuated functional deficit 7 days after stroke induction. Mice treated with CD28SA increased numbers of Treg in spleen and brain. Tregs were functionally active and migrated into the brain where they accumulated and proliferated in the peri-infarct area. More than 60% of brain infiltrating Treg produced interleukin-10 in CD28SA compared with 30% in control.

Conclusions—

In vivo expansion and amplification of Treg by CD28SA attenuates the inflammatory response and improves outcome after experimental stroke.
Internal and External Relative Clauses in Ancient Greek
Authors: Fauconnier Stefanie
Published: November 2014

In this paper I argue that Ancient Greek has two distinct strategies for relative clause formation, corresponding to what is known in typology as externally and internally headed relative clauses. Furthermore, I explore two differences between these constructions. First, in comparison with their external counterparts, internal constructions are more restricted semantically. They can only be interpreted as restrictive relative clauses, while external constructions can also be interpreted as non-restrictive. Second, internal constructions are more restricted syntactically, given that they are not used when the domain nominal is subject in the relative clause. For external constructions there is no such syntactic restriction. Finally, I point out a number of convergences between internal relative clauses and noun phrases with an attributive participle. The findings presented in this paper are based on a study of Xenophon.
New species of Pheretima (Oligochaeta: Megascolecidae) from the Mt. Malindang Range, Mindanao Island, Philippines
Authors: ASPE NONILLON M. , JAMES SAMUEL W.
Published: November 2014

We provide descriptions, with illustrations of internal structures, for 18 new species of Pheretima from Mt. Malindang, Misamis Occidental Province, Mindanao Island, Philippines. Among the 18 species, 11 belong to the P. sangirensis species group, characterized by having a pair of spermathecal pores in the intersegmental furrow of 7/8 and lacking penial sheaths in the copulatory bursae: P. maculodorsalis n. sp., P. tigris n. sp., P. immanis n. sp., P. lago n. sp., P. nunezae n. sp., P. boniaoi n. sp., P. malindangensis n. sp., P. misamisensis n. sp., P. wati n. sp., P. longiprostata n. sp., and P. nolani n. sp. One species, P. longigula n. sp., belongs to the P. montana species group, characterized by having a pair of spermathecal pores in the intersegmental furrow of 7/8 and penial sheaths in the copulatory bursae. Two species, P. vergrandis n. sp. and P. concepcionensis n. sp., are monothecal. Three species, P. adevai n. sp., P. lluchi n. sp., and P. potonganensis n. sp., belong to the P. darnleiensis species group, characterized by having either four or five pairs of spermathecae from vi to ix, with a fifth pair variably present in segment v. One species, P. subanensis n. sp., is athecate. All species described here from the Mt. Malindang Range are probably native rather than introduced, and probably do not represent range extensions of species known from neighboring islands in Southeast Asia. We provide an identification key to the Pheretima species from Mt. Malindang.
Fitting and Analyzing LES Using Multiple Trivariate Gaussians
Authors: Firl Grant J. , Randall David A.
Published: November 2014

Assumed-PDF methods for the parameterization of subgrid-scale processes in atmospheric models provide many benefits. Many currently used assumed-PDF schemes reconcile the high number of required PDF parameters with the relative paucity of input moments by employing simplifying assumptions that are difficult to test. This paper explores the possibility of constructing a trivariate double-Gaussian PDF from the first three orders of moments without simplifying assumptions and proves that no unique solution exists. In an effort to provide a path for future improvement of current assumed-PDF schemes, the expectation maximization (EM) algorithm for Gaussian mixture models is used with LES output of shallow cumulus, stratocumulus, and deep convection cases to determine “best fit” PDFs using from one through four Gaussian clusters. The EM PDFs are evaluated using PDF-diagnosed higher-order moments, PDF-diagnosed cloud statistics, and the Akaike information criterion. It was found that two Gaussian clusters were almost always adequate to represent both higher-order moments and cloud statistics like cloud fraction, water content, and vertical fluxes of cloud water and buoyancy in layered clouds such as stratocumulus and deep convective anvils. However, higher-order moments and higher-order cloud statistics were only properly represented when three or four Gaussians were used in the upper regions of shallow cumulus layers and throughout the active portion of deep convection. Evidence is also provided that several common assumptions employed to diagnose trivariate double-Gaussian PDFs from a minimum number of input moments are weak.
Oceanic Boundary Conditions for Jakobshavn Glacier. Part I: Variability and Renewal of Ilulissat Icefjord Waters, 2001–14
Authors: Gladish Carl V. , Holland David M. , Rosing-Asvid Aqqalu , Behrens Jane W. , Boje Jesper
Published: November 2014

Jakobshavn Glacier, west Greenland, has responded to temperature changes in Ilulissat Icefjord, into which it terminates. This study collected hydrographic observations inside Ilulissat Icefjord and from adjacent Disko Bay between 2001 and 2014. The warmest deep Disko Bay waters were blocked by the entrance sill and did not reach Jakobshavn Glacier. In the fjord basin, the summer mean temperature was 2.8°C from 2009 to 2013, excluding 2010, when it was 1°C cooler. Despite this variability, summer potential densities in the basin were in the narrow range of 27.20 ≤ σθ ≤ 27.31 kg m−3, and basin water properties matched those of Disko Bay in this layer each summer. This relation has likely held since at least 1980. Basin waters from 2009 and 2011–13 were therefore similar to those in 1998/99, when Jakobshavn Glacier began to retreat, while basin waters in 2010 were as cool as in the 1980s. The 2010 basin temperature anomaly was advected into Disko Bay, not produced by local atmospheric variability.

This anomaly also shows that Ilulissat Icefjord basin waters were renewed annually or faster. Time series fragments inside the fjord did not capture the 2010 anomaly but show that the basin temperatures varied little subannually, outside of summer. Fjord velocity profiles from summer 2013 implied a basin renewal time scale of about 1 month. In model simulations of the fjord circulation, subglacial discharge from Jakobshavn Glacier could drive renewal of the fjord basin over a single summer, while baroclinic forcing from outside the fjord could not, because of the sill at the mouth.
Network Ecology and Adolescent Social Structure
Authors: McFarland Daniel A. , Moody James , Diehl David , Smith Jeffrey A. , Thomas Reuben J.
Published: November 2014

Adolescent societies—whether arising from weak, short-term classroom friendships or from close, long-term friendships—exhibit various levels of network clustering, segregation, and hierarchy. Some are rank-ordered caste systems and others are flat, cliquish worlds. Explaining the source of such structural variation remains a challenge, however, because global network features are generally treated as the agglomeration of micro-level tie-formation mechanisms, namely balance, homophily, and dominance. How do the same micro-mechanisms generate significant variation in global network structures? To answer this question we propose and test a network ecological theory that specifies the ways features of organizational environments moderate the expression of tie-formation processes, thereby generating variability in global network structures across settings. We develop this argument using longitudinal friendship data on schools (Add Health study) and classrooms (Classroom Engagement study), and by extending exponential random graph models to the study of multiple societies over time.
Suspending Progress
Authors: Perry Brea L. , Morris Edward W.
Published: November 2014

An influential literature in criminology has identified indirect “collateral consequences” of mass imprisonment. We extend this criminological perspective to the context of the U.S. education system, conceptualizing exclusionary discipline practices (i.e., out-of-school suspension) as a manifestation of intensified social control in schools. Similar to patterns of family and community decline associated with mass incarceration, we theorize that exclusionary discipline policies have indirect adverse effects on non-suspended students in punitive schools. Using a large hierarchical and longitudinal dataset consisting of student and school records, we examine the effect of suspension on reading and math achievement. Our findings suggest that higher levels of exclusionary discipline within schools over time generate collateral damage, negatively affecting the academic achievement of non-suspended students in punitive contexts. This effect is strongest in schools with high levels of exclusionary discipline and schools with low levels of violence, although the adverse effect of exclusionary discipline is evident in even the most disorganized and hostile school environments. Our results level a strong argument against excessively punitive school policies and suggest the need for alternative means of establishing a disciplined environment through social integration.
Registered Sex Offenders and Reported Sex Offenses
Authors: Stucky Thomas D. , Ottensmann John R.
Published: November 2014

Geographic restrictions on registered sex offenders (RSOs) have become commonplace. Such policies generally assume that sex offenses are likely to be higher near RSOs. Yet, few ecological studies have examined this question empirically. The current study examines whether incidences of reported sex offenses are higher in proximity to the addresses of RSOs. Specifically, we examine whether there is a relationship between the number of reported sex offenses and the number of RSOs living in square grid cells (and in 1,000, 1,500, and 2,500 ft radii of the cell centroid) in Indianapolis. Count models indicate that the number of RSOs in an area is not a robust predictor of reported sex offenses, net of controls.
Warm, cold, competent or incompetent? An empirical assessment of public perceptions of the higher and less educated
Authors: Spruyt Bram , Kuppens Toon
Published: November 2014

Growing educational differentials in different domains have made some scholars wonder whether these differences have the potential to grow into an educational conflict and associated education-based group consciousness. In this article that question is contrasted with a body of literature which considers educational credentials a form of symbolic capital, that is, institutionalized social status. Theoretical insights derived from the social psychological stereotype content model are used to disentangle this apparent paradox. In the empirical section survey data from Flanders (the Dutch speaking part of Belgium; N = 1967) are used to assess the perceptions held by the public at large about the higher and less educated. A within-subject design whereby respondents rated the less and higher educated in terms of traits related to warmth and competence shows that indications of legitimate status differences but also intergroup conflict can be found depending on the dimension on which higher and less educated people are compared. In addition, the study demonstrates that higher and less educated groups use a different stereotype dimension to differentiate educational groups. The conclusion elaborates on the implications of these findings.
Kids, Groups, and Crime
Authors: Zimring Franklin E. , Laqueur Hannah
Published: November 2014

Objectives:

The objective of this analysis is to address the data and conclusions of Lisa Stolzenberg and Stewart D’Alessio in their article “Co-offending and the Age-crime Curve,” published in The Journal of Research in Crime and Delinquency in 2008. The authors analyze National Incident–based Reporting System (NIBRS) 2002 arrests from seven states and conclude that most arrests at all ages involve only one offender, and therefore group offending is of little etiological significance.

Methods:

To test their claims, we conduct offense-specific analyses of single and multiple arrests using the full 2002 NIBRS arrest data set.

Results:

After disaggregating the data by type of offense, we find group involvement among young offenders dominates the arrest statistics for all serious crimes other than rape and aggravated assault.

Conclusions:

Contrary to the conclusions of Stolzenberg and D’Alessio, co-offending does appear to have a substantial impact on young offenders. The extent of adolescent crime as group behavior may be a cliché in criminological circles, but this is because the empirical evidence for it is substantial.
Gentrifying the peri-urban: Land use conflicts and institutional dynamics at the frontier of an Indonesian metropolis
Authors: Hudalah Delik , Winarso Haryo , Woltjer Johan
Published: November 2014

This paper aims to specify the meaning of gentrification in rapidly peri-urbanising metropolitan regions in the context of Indonesia’s rapid transition to decentralisation and democracy. It discusses a case study of conflict over an environmental revitalisation project in a peri-urban area of Bandung City. The analysis focuses on the political processes, tactics and strategies supporting and opposing peri-urban gentrification and their consequences. The analysis illustrates how these political dynamics mediate the interaction between the movement of capital and the spatial reorganisation of social classes. It is argued that in the context of a peri-urbanising metropolis, gentrification needs to be narrated less in terms of class-based neighbourhood succession and more in terms of competing cross-class coalitions emerging at local and regional levels.
Socioeconomic Contexts of Government Expenditure Across OECD Countries
Authors: Yoo Taeyoung , Jho Whasun
Published: November 2014

In contrast to the literature which analyzes government size using contingent factors, this article proposes that socioeconomic traditions, such as trust and state–business relations (SBR), complement the explanations of government size in an economy. Using 29 Organization for Economic Co-Operation and Development (OECD) countries from 1995 to 2008, this study shows that a high level of trust is negatively related to government expenditure, whereas tight SBRs are positively related to it even under the decreasing trend of government expenditure. We suggest that attention should be paid to the societal contexts of an economy in addition to its contingent factors, when analyzing changes in political economic activities.
A Monte Carlo–Based Bayesian Approach for Measuring Agreement in a Qualitative Scale
Authors: Calle-Alonso Fernando , Pérez Sánchez Carlos Javier
Published: November 2014

Agreement analysis has been an active research area whose techniques have been widely applied in psychology and other fields. However, statistical agreement among raters has been mainly considered from a classical statistics point of view. Bayesian methodology is a viable alternative that allows the inclusion of subjective initial information coming from expert opinions, personal judgments, or historical data. A Bayesian approach is proposed by providing a unified Monte Carlo–based framework to estimate all types of measures of agreement in a qualitative scale of response. The approach is conceptually simple and it has a low computational cost. Both informative and non-informative scenarios are considered. In case no initial information is available, the results are in line with the classical methodology, but providing more information on the measures of agreement. For the informative case, some guidelines are presented to elicitate the prior distribution. The approach has been applied to two applications related to schizophrenia diagnosis and sensory analysis.
Retrieving haystacks: a data driven information needs model for faceted search
Authors: Cleverley Paul Hugh , Burnett Simon
Published: November 2014

The research aim was to develop an understanding of information need characteristics for word co-occurrence-based search result filters (facets). No prior research has been identified into what enterprise searchers may find useful for exploratory search and why. Various word co-occurrence techniques were applied to results from sample queries performed on industry membership content. The results were used in an international survey of 54 practising petroleum engineers from 32 organizations. Subject familiarity, job role, personality and query specificity are possible causes for survey response variation. An information needs model is presented: Broad, Rich, Intriguing, Descriptive, General, Expert and Situational (BRIDGES). This may help professionals to more effectively meet their information needs and stimulate new needs, improving a system’s ability to facilitate serendipity. This research has implications for faceted search in enterprise search and digital library deployments.
Hybrid string matching algorithm with a pivot
Authors: Al-Ssulami Abdulrakeeb M.
Published: November 2014

Pattern matching is important in text processing, molecular biology, operating systems and web search engines. Many algorithms have been developed to search for a specific pattern in a text, but the need for an efficient algorithm is an outstanding issue. In this paper, we present a simple and practical string matching algorithm. The proposed algorithm is a hybrid that combines our modification of Horspool’s algorithm with two observations on string matching. The algorithm scans the text from left to right and matches the pattern from right to left. Experimental results on natural language texts, genomes and human proteins demonstrate that the new algorithm is competitive with practical algorithms.
Building between past and future
Authors: Ingram Callum
Published: November 2014

To balance radical changes in the built environment that accompany urban renewal, many cities deploy historical design elements to provoke a sense of physical and temporal continuity. By examining the theory and practice of nostalgia in renewal projects, I argue that this strategic deployment of historical signifiers is more complex and normatively problematic than it first appears. Analysing the design and construction of Baltimore’s Oriole Park at Camden Yards through Walter Benjamin’s theories of cultural production and historical succession, I show the problematic political effect of such image-led regeneration projects. The stadium exemplifies a system of urban and historical design and construction that uses material artifice to make totalizing political claims, deploying specific historical signifiers as a means to silence others. Drawing from Benjamin’s materialist historiography, I conclude with a survey of the resources that remain for the practice of an architecture of memory in light of my critique.
When is it legitimate to use images in moral arguments? The use of foetal imagery in anti-abortion campaigns as an exemplar of an illegitimate instance of a legitimate practice
Authors: Kelland Lindsay , Macleod Catriona
Published: November 2014

We aim to interrogate when the use of images in moral persuasion is legitimate. First, we put forward a number of accounts which purport to show that we can use tools other than logical argumentation to convince others, that such tools evoke affective responses and that these responses have authority in the moral domain. Second, we turn to Sarah McGrath’s account, which focuses on the use of imagery as a means to morally persuade. McGrath discusses 4 objections to the use of imagery, and outlines responses that may be used to legitimate the use of imagery in moral arguments. Assuming that we accept her account and that the invocation of affect has authority in the moral domain, we, using McGrath’s responses, examine whether the use of foetal imagery in anti-abortion campaigns is a legitimate instance of this practice.
Is meaningful work available to all people?
Authors: Veltman Andrea
Published: November 2014

In light of the impact of work on human flourishing, an intractable problem for political theorists concerns the distribution of meaningful work in a community of moral equals. This article reviews a number of partial solutions that a well-ordered society could draw upon to provide equality of opportunity for eudemonistically meaningful work and to minimize the impact of bad work upon those who perform it. Even in view of these solutions, however, it is not likely that opportunities for meaningful work can be guaranteed for all people, which carries an implication that, even in well-ordered societies, it is likely that not all people will flourish. The author argues that the limitedness of meaningful work is not a reason to reject the normative claim that meaningful work is integral in flourishing, nor is it a reason against working to transform social and political institutions to increase opportunities for meaningful work.
A Breathing Space for Aesthetics and Politics: An Introduction to Jacques Rancière
Authors: Papastergiadis Nikos
Published: November 2014

Jacques Rancière is one of the central figures in the contemporary debates on aesthetics and politics. This introduction maps the shift of focus in Rancière’s writing from political theory to contemporary art practice and also traces the enduring interest in ideas on equality and creativity. It situates Rancière’s rich body of writing in relation to key theorists such as the philosopher Alain Badiou, art historian Terry Smith and anthropologist George E. Marcus. I argue that Rancière offers a distinctive approach in this broad field by clarifying the specificity of the artist’s task in the production of critical and creative transformation, or what he calls the ‘distribution of the sensible’. In conclusion, I complement Rancière’s invocation to break out of the oppositional paradigm in which the political and aesthetic are usually confined by outlining some further methodological techniques for addressing contemporary art.
Dangerous surgical scavenger hunt: the complicated course of a patient with left ventricular assist device and end-stage renal disease undergoing reconstructive flap surgery
Authors: Freundt M , Haneya A , Schmid C , Hirt S
Published: November 2014

Patients with left ventricular assist devices (LVADs) who develop stage IV sacral pressure sores (SPS) have an increased procedural risk. We present the complications, including severe intra- and postoperative bleeding, diarrhea with metabolic acidosis, volume loss and acute on chronic renal failure, flap dehiscence and late LVAD outflow cannula thrombosis, in a 54-year-old male who underwent diverting ileostomy (DI) and subsequent fasciocutaneous flap (FCF) surgery for stage IV SPS while supported with an LVAD. Our experience suggests that, despite continuous heparinization, life-threatening thrombotic complications, such as device clotting, can occur. Therefore, the benefit of intervention has to outweigh the risk of bleeding, which should be managed with meticulous surgical technique and substitution of red blood cells rather than the reversal of heparinization or the substitution of clotting factors. Continuation of double anti-platelet therapy should also be considered.
Entrepreneurial woman and territory: A cross-sectoral analysis
Authors: Marino Vittoria , Montera Raffaella
Published: November 2014

This paper aims to outline the role of territory in international expansion, styles of command and innovative approaches of women business proprietorships operating in various economic sectors. The exploratory investigation uses a three-dimensional ILI (Internationalization–Leadership–Innovation) model. This model is validated through a qualitative survey conducted on a convenience sample. The primary data are collected using the focus group technique. This work shows that territory influences internationalization, leadership and innovation of women business proprietorships in the different economic sectors. Moreover, it also leads to a new taxonomy of women business proprietorships that are linked to the divinities of Greek and Roman mythology. This taxonomy can contribute to the understanding of the interconnections and interdependencies between business and territory.
Doctors and Numbers
Authors: Caverly Tanner J. , Prochazka Allan V. , Combs Brandon P. , Lucas Brian P. , Mueller Shane R. , Kutner Jean S. , Binswanger Ingrid , Fagerlin Angela , McCormick Jacqueline , Pfister Shirley , Matlock Daniel D.
Published: November 2014

Background. Risk interpretation affects decision making. Yet, there is no valid assessment of how clinicians interpret the risk data that they commonly encounter. Objective. To establish the reliability and validity of a 20-item test of clinicians’ risk interpretation. Methods. The Critical Risk Interpretation Test (CRIT) measures clinicians’ abilities to 1) modify the interpretation based on meaningful differences in the outcome (e.g., disease specific v. all-cause mortality) and time period (e.g., lifetime v. 10-year mortality), 2) maintain a stable interpretation for different risk framings (e.g., relative v. absolute risk), and 3) correctly interpret how diagnostic testing modifies risk. There were 658 clinicians and medical trainees who participated: 116 nurse practitioners (NPs) at a national conference, 273 medical students at 1 institution, 148 residents in internal medicine at 2 institutions, and 121 internists at 1 institution. Participants completed a self-administered paper test during educational conferences. Seventeen evidence-based medicine experts took the test online and formally assessed content validity. Eighteen second-year medical students were recruited to take the test and a retest 3 weeks later to explore test-retest correlation. Results. Expert review supported test clarity and content validity. Factor analysis supported that the CRIT identifies at least 3 separable areas of clinician knowledge. Test-retest correlation was fair (intraclass correlation coefficient = 0.65; standard error = 0.15). Scores on our test correlated with other tests of related abilities. Mean test scores varied among groups, with differences in prior evidence-based medicine training and experience (93 for NPs, 101 for medical students, 101 for residents, 103 for academic internists, and 110 for physician experts; P < 0.001). Conclusions. Our results provide supporting evidence for the reliability and validity of the CRIT as an index of critical risk interpretation abilities, which is acceptable and feasible to administer in an educational setting.
Introduction to the Special Issue
Authors: Prothero Andrea , McDonagh Pierre
Published: November 2014

This preview article introduces the second installment of a double special issue on “Sustainability as Megatrend” and presents a summary of the research. Connections are made with the first special issue published in September 2014, and the authors conclude with a special thank you to the authors, reviewers, and Editor-in-Chief for their roles in the preparation of the two special issues.
Glutathione S-transferase M1 and glutathione S-transferase T1 genotype in chronic pancreatitis: A meta-analysis
Authors: Zhong Yanjun , Zou Runmei , Cao Jie , Peng Mou
Published: November 2014

Objective

A meta-analysis to determine the association between chronic pancreatitis and glutathione-S transferase (GST) mu 1 ( GSTM1) and theta 1 ( GSTT1) deletions.

Methods

Case–control studies concerning the relationship between chronic pancreatitis and GSTM1 or GSTT1 deletions were identified (up to October 2013). Meta-analyses of the association between GSTM1 and GSTT1 genotype and chronic pancreatitis or alcoholic chronic pancreatitis (ACP) were performed.

Results

Seven studies were included in the meta-analysis (650 patients/1382 controls for GSTM1 and 536 patients/1304 controls for GSTT1). There were no significant relationships between GSTM1/GSTT1 and chronic pancreatitis or GSTT1 and ACP. There was a significant association between GSTM1 null genotype and ACP (odds ratio 1.16, 95% confidence intervals 1.03, 1.30).

Conclusion

The GSTM1 null genotype was significantly associated with ACP risk.
Acute and Chronic Erysipelothrix rhusiopathiae Infection in Lambs
Authors: Ersdal C. , Jørgensen H. J. , Lie K.-I.
Published: November 2014

Polyarthritis caused by Erysipelothrix rhusiopathiae is a relatively common infection in lambs characterized by low mortality and high morbidity. E. rhusiopathiae is a ubiquitous Gram-positive bacterium that is both a commensal and a pathogen of vertebrates. The disease was studied during an outbreak in a Norwegian Spæl sheep flock. In the acute phase, 48 of 230 (20%) lambs developed clinical signs and 4 died (1.7%). One acute case was necropsied and E. rhusiopathiae was cultured from all major organs investigated and from joints. There was a fibrinous polyarthritis, increased presence of monocytes in vessels, and necrosis of Purkinje cells. Sixteen of the diseased animals (33%) developed a chronic polyarthritis. Eight of these lambs were necropsied; all had lesions in major limb joints, and 3 of 8 also had lesions in the atlanto-occipital joint. At this stage, E. rhusiopathiae was cultured only from the joints in 7 of 8 (87.5%) lambs, but by real-time polymerase chain reaction, we showed persistence of the bacterium in several organs. Pulsed-field gel electrophoresis typing of the bacterial isolates indicated that the same strain caused the acute and chronic disease. Five of 6 (83%) chronically affected animals had amyloidosis of the spleen, and 6 of 8 (75%) had amyloidosis of the liver. All chronically affected animals had a glomerulonephritis, and 6 of 8 (75%) had sparse degeneration in the brain. Ceruloplasmin and haptoglobin were significantly increased in the chronically diseased lambs. These results show that chronic ovine erysipelas is not restricted to joints but is a multisystemic disease.
Return to Play and Recurrent Instability After In-Season Anterior Shoulder Instability
Authors: Dickens Jonathan F. , Owens Brett D. , Cameron Kenneth L. , Kilcoyne Kelly , Allred C. Dain , Svoboda Steven J. , Sullivan Robert , Tokish John M. , Peck Karen Y. , Rue John-Paul
Published: November 2014

Background:

There is no consensus on the optimal treatment of in-season athletes with anterior shoulder instability, and limited data are available to guide return to play.

Purpose:

To examine the likelihood of return to sport and the recurrence of instability after an in-season anterior shoulder instability event based on the type of instability (subluxation vs dislocation). Additionally, injury factors and patient-reported outcome scores administered at the time of injury were evaluated to assess the predictability of eventual successful return to sport and time to return to sport during the competitive season.

Study Design:

Cohort study (prognosis); Level of evidence, 2.

Methods:

Over 2 academic years, 45 contact intercollegiate athletes were prospectively enrolled in a multicenter observational study to assess return to play after in-season anterior glenohumeral instability. Baseline data collection included shoulder injury characteristics and shoulder-specific patient-reported outcome scores at the time of injury. All athletes underwent an accelerated rehabilitation program without shoulder immobilization and were followed during their competitive season to assess the success of return to play and recurrent instability.

Results:

Thirty-three of 45 (73%) athletes returned to sport for either all or part of the season after a median 5 days lost from competition (interquartile range, 13). Twelve athletes (27%) successfully completed the season without recurrence. Twenty-one athletes (64%) returned to in-season play and had subsequent recurrent instability including 11 recurrent dislocations and 10 recurrent subluxations. Of the 33 athletes returning to in-season sport after an instability event, 67% (22/33) completed the season. Athletes with a subluxation were 5.3 times more likely (odds ratio [OR], 5.32; 95% CI, 1.00-28.07; P = .049) to return to sport during the same season when compared with those with dislocations. Logistic regression analysis suggests that the Western Ontario Shoulder Instability Index (OR, 1.05; 95% CI, 1.00-1.09; P = .037) and Simple Shoulder Test (OR, 1.03; 95% CI, 1.00-1.05; P = .044) administered after the initial instability event are predictive of the ability to return to play. Time loss from sport after a shoulder instability event was most strongly and inversely correlated with the Simple Shoulder Test ( P = .007) at the time of initial injury.

Conclusion:

In the largest prospective study evaluating shoulder instability in in-season contact athletes, 27% of athletes returned to play and completed the season without subsequent instability. While the majority of athletes who return to sport complete the season, recurrent instability events are common regardless of whether the initial injury was a subluxation or dislocation.
Effect of Accelerated Weightbearing After Matrix-Associated Autologous Chondrocyte Implantation on the Femoral Condyle
Authors: Wondrasch Barbara , Risberg May-Arna , Zak Lukas , Marlovits Stefan , Aldrian Silke
Published: November 2014

Background:

Long-term effects of different weightbearing (WB) modalities after matrix-associated autologous chondrocyte implantation (MACI) on changes in knee articular cartilage and clinical outcomes are needed to establish more evidence-based recommendations for postoperative rehabilitation.

Hypothesis:

There will be no differences between accelerated WB compared with delayed WB regarding knee articular cartilage or patient self-reported knee function or activity level 5 years after MACI. Furthermore, significant correlations between magnetic resonance imaging (MRI)–based outcomes and patient-reported outcome measures 5 years postoperatively will exist.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

After MACI, 31 patients (23 male, 8 female) were randomly assigned to the accelerated WB group (AWB group) or to the delayed WB group (DWB group). With the exception of time and increase to full WB, both groups underwent the same rehabilitation program. The AWB group was allowed full WB after 6 weeks and the DWB group after 10 weeks. Assessments were performed 3 months, 2 years, and 5 years postoperatively, but this long-term follow-up study only included changes from 2 to 5 years postoperatively. The magnetic resonance observation of cartilage repair tissue (MOCART) score (primary outcome), the MRI-based variables of bone edema and effusion, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Tegner scale were included. In addition, the association between MRI-based outcomes and the KOOS at 5 years postoperatively was investigated.

Results:

There was a significant decrease in the MOCART score and a significant increase in bone edema 2 and 5 years postoperatively but no significant group differences. The only significant correlation between the MRI-based variables and the KOOS was found for bone edema and the KOOS subscale of pain ( r = −0.435, P < .05) at 5-year follow-up.

Conclusion:

There were no significant differences in the MRI-based or clinical outcomes between the AWB group and DWB group 5 years after MACI. While the clinical outcomes remained stable, a decline of the MRI-based findings was observed between 2 and 5 years postoperatively. Furthermore, a significant association between bone edema and pain was found. No occurrence of unintended effects was observed.
Buckling of rectangular composite plates with restrained edges subjected to axial loads
Authors: Kollár László P
Published: November 2014

Explicit expressions are developed for the buckling analyses of rectangular plates subjected to uniaxial loads when the unloaded edges are rotationally constrained. Three types of constraints (and their combinations) are considered: rotational springs, stiffeners with torsional stiffness and stiffeners with warping stiffness. The results can be applied for the stability analysis of the webs of thin-walled I or C beams.
Tribological and mechanical behavior of particulate aluminum matrix composites
Authors: Sharma Pardeep , Khanduja Dinesh , Sharma Satpal
Published: November 2014

Aluminum and its alloy are light in weight, ductile, strong and long lasting, having high corrosion resistance, good conductor of heat and electricity and are 100% recyclable. Despite all these good qualities, it has low wear resistance. But some applications entail high hardness and tensile strength, high modulus of elasticity than the conventional aluminum alloy with good tribological properties. Keeping in view the enhancement of mechanical as well as tribological properties with reduction in weight, the aluminum alloy is reinforced with a second phase which is hard and brittle, and the newly formed material has better mechanical and tribological properties. The paper reviews the various manufacturing processes of aluminum matrix composites, and it was found that the mechanical and tribological properties of the single reinforcement composites are better as compared to pure aluminum and its alloys irrespective of the aluminum matrix composites manufacturing process. Further, it was found that most of the hybrid composites exhibit better mechanical and tribological properties as compared to single reinforcement composites.
Bioplastic based on starch and cellulose nanocrystals from rice straw
Authors: Agustin Melissa B , Ahmmad Bashir , Alonzo Shanna Marie M , Patriana Famille M
Published: November 2014

Bioplastic based on starch as the matrix and cellulose nanocrystals from rice straw as reinforcing filler were prepared in this study. The isolation of cellulose nanocrystal (CNC) followed a series of steps: delignification, sulfuric acid hydrolysis, and sonication. The process afforded short, rod-like CNCs with particle diameter ranging from 10 to 12 nm and crystallinity index of 76.1%. Fourier transform infrared analysis of the CNCs also confirmed absorption patterns typical of cellulose and the removal of silica. Bioplastic with different starch-to-CNC ratios were prepared by solution casting and evaporation method. Scanning electron micrographs of the films showed uniform dispersion of CNC in the starch matrix. Mechanical tests revealed that both tensile strength and modulus significantly increased with increasing CNC load while percent elongation decreased. The moisture uptake of the films reinforced with CNC also decreased an indication of improvement in water resistance. However, the thermal stability of the films decreased by the addition of CNC.
Fortifying Leisure
Authors: McGovern Rachel A. , Taniguchi Stacy , Hite Julie M. , Hite Steven J. , Widmer Mark , Mugimu Christopher B. , Nsubuga Yusuf K.
Published: November 2014

This study examined family leisure patterns and meanings of family leisure from the perspective of adolescents living in the Mukono District of Uganda. Sixty-eight secondary students were interviewed. Results indicate Ugandan adolescent definitions of leisure reflect leisure as free time and leisure as a means to an end. Students mentioned three primary family leisure outcomes (enjoyment/fun, personal development, and family development) that point toward a core theme. Fortifying describes the importance Ugandan youth place upon family leisure outcomes that strengthen the individual to overcome inevitable challenges they will face throughout their lives and enable them to succeed, especially through family socializing activities, such as discussion and storytelling.
Growth Failure and Nutrition Considerations in Chronic Childhood Wasting Diseases
Authors: Kyle Ursula G. , Shekerdemian Lara S. , Coss‐Bu Jorge A.
Published: November 2014

Growth failure is a common problem in many children with chronic diseases. This article is an overview of the most common causes of growth failure/growth retardation that affect children with a number of chronic diseases. We also briefly review the nutrition considerations and treatment goals. Growth failure is multifactorial in children with chronic conditions, including patients with cystic fibrosis, chronic kidney disease, chronic liver disease, congenital heart disease, human immunodeficiency virus, inflammatory bowel disease, short bowel syndrome, and muscular dystrophies. Important contributory factors to growth failure include increased energy needs, increased energy loss, malabsorption, decreased energy intake, anorexia, pain, vomiting, intestinal obstruction, and inflammatory cytokines. Various metabolic and pathologic abnormalities that are characteristic of chronic diseases further lead to significant malnutrition and growth failure. In addition to treating disease‐specific abnormalities, treatment should address the energy and protein deficits, including vitamin and mineral supplements to correct deficiencies, correct metabolic and endocrinologic abnormalities, and include long‐term monitoring of weight and growth. Individualized, age‐appropriate nutrition intervention will minimize the malnutrition and growth failure seen in children with chronic diseases.