bluuebunny/crossref_metadata_2025 huggingface dataset:
Three Layer Interlocking
Authors: Kaya Ercan , Cingi Cemal , Olgun Yüksel , Soken Hakan , Pinarbasli Özgür
Published: September 2014

Objective:

Many techniques to repair a septal perforation using local flaps with or without an interpositioning graft with various rates of success have been described. Our aim was to describe a new and relatively easy technique for repairing these perforations.

Methods:

Twenty-two patients with nasal septal perforations smaller than 2 cm in diameter were operated on between 2010 and 2012 at Eskişehir Osmangazi University. The described 3-layer interlocking method was applied to repair the septal perforation in all of the cases.

Results:

Twenty-two patients were operated on using this technique. The follow-up time ranged from 30 months to 10 months, with a mean follow-up time of 20.9 months. In 19 of the 22 patients, complete closure of the perforation was achieved (86.3%). We did not encounter any early or late postoperative complications.

Conclusion:

A novel technique that uses a temporalis fascia-conchal cartilage complex as an interpositioning material to repair septal perforations is described. This complex was endoscopically introduced to the perforation after elevating the edges of the perforation. We concluded that the low morbidity, short operating time, and high success rate make this technique a good choice for repairing small- to medium-sized perforations.
Greece
Authors: Kiratli Osman Sabri
Published: September 2014

This paper investigates the change in the Greek position from an ardent critic to an enthusiastic supporter of supranational cooperation in the Common Foreign and Security Policies of the European Union (EU) during the negotiation process (2003–2004) for the Constitutional Treaty. It proposes that the change was largely due to the imminent security threat perceived from its neighbour, Turkey. As unilateralist, confrontational responses, which had been in effect since Turkey’s Cyprus intervention in 1974, had largely failed to curb the level of threats perceived from the eastern side of the Aegean, Greek policy-makers started to develop a radically new security strategy based on a cooperative and integrationist partnership with the EU.
India’s Soft Power in South Asia
Authors: Kugiel Patryk
Published: September 2014

Asymmetrical power relations and India’s contested leadership in South Asia are two major impediments to ensuring peace and stability in, and integration of, the region. After having unsuccessfully tested the hard power approach to impose its will in the region, India has turned towards soft power. It now tries to rebuild its positive image in the region and attract more neighbours into a vision of shared prosperity and peace through soft power. This essay presents an overview of the most recent initiatives aimed at improving India’s soft power in its neighbourhood and attempts to evaluate the effectiveness of this strategy. It finds that despite some flaws in this approach, it could bring tangible positive effects and has the potential to transform relations in South Asia in the long run.
Libya’s Arab Spring
Authors: Sadiki Larbi
Published: September 2014

This article presents a critical account of Libya’s incipient democratization, contextualizing it within the Arab Spring élan. This first line of inquiry is twofold: it critically assesses the meaning of democratization in the context of the Arab Middle East (AME), and briefly considers issues related to democratic knowledge and the Orientalist–Occidentalist inputs into this debate. Then, it situates this debate within the ‘Arab Spring’, looking at Western negative impressions of Arab revolts. A second line of inquiry is also twofold: While assessing the steps taken on the road to democratic reconstruction, it offers an unorthodox perspective on the North African country’s transition. To this end, the article concludes that even violence is part and parcel of the process of power redistribution and reconstitution of a new polity. From this angle, whilst Libya’s first election in nearly 50 years represents a step in the right direction along the path of political renewal, forms of unruliness—regional, religious or tribal—challenge Euro-American views of democracy as a single and fixed type of regime that precludes forms of disorder. In fact, unruliness has accompanied Libya’s long and arduous process of ousting Gaddafi from power; this continues and will mark the transition process for sometime in the foreseeable future.
Anti-Semitism, Unhappy Consciousness and the Social Construction of the Palestinian Nakba
Authors: Halabi Yakub
Published: September 2014

The history of Zionism is composed of two narratives: One is the history of anti-Semitism that begot Zionism, and the other is the history of the Zionist–Palestinian conflict that begot the Palestinian refugee problem (the Nakba). So far, these two narratives have been investigated in parallel and, thus, they were kept artificially disconnected from each other. The history of the Palestinian catastrophe has been examined mainly in the light of the 1947–1949 events that culminated in the 1948 War and the birth of the Nakba. This narrative ignores the identity of the Zionists, especially the link between anti-Semitism and the Nakba. Many Israeli scholars claim that the territorial demands of the two groups had ushered in the 1948 War, the outcome of which was determined by the balance of power between the Zionist forces and the Arabs. Based on theories of social constructivism, this essay claims, however, that the Nakba and the establishment of the state of Israel are a socially constructed enterprise that reflected the shared ideas, the collective unhappy consciousness and the identity of Zionists and their protracted history in Europe. Anti-Semitism shaped the world views of Zionists and their desire to establish a Jewish state on the total area of mandatory Palestine—the area west of the Jordan River under British administration—in which the Jews aspired to live alone with themselves. Finally, in order to uproot the ‘diaspora mentality’ from the Jewish newcomers to Palestine and to construct a Jewish nationality, the Zionists had excluded the Palestinians from the Hebrew labour market.
John Mackay’s Missional Vision
Authors: Guder Darrell L.
Published: September 2014

Although the language of “missional church” emerges in American missiological discussion at the turn of the twentieth to the twenty-first century, its basic themes and concerns are anticipated in diverse ways by John Mackay, from the 1920s onward. Drawing from the rich but controversial tradition of the modern missionary movement, Mackay broadened and deepened the theological discussion of the church’s mission by positing the centrality of “ecumenics” as the study of Christianity as a global movement. Both his theological work and his practical engagement contribute constructively today to the missional initiatives that are seeking to address the challenges of God’s mission in post-Christian cultures of the West. As a theological educator, his pioneering work continues both to profoundly inform as well as provocatively critique the leadership formation undertaken by contemporary seminaries.
Emotions and Identity Nonverification
Authors: Stets Jan E. , Burke Peter J.
Published: September 2014

When individuals’ identities are not verified, most theories and research suggest that they feel bad when others evaluate them more negatively than how they see themselves. It is less clear whether they feel good or bad when others evaluate them more positively than how they see themselves. We examine people’s emotional reactions to nonverifying feedback across seven studies that include both a survey and a laboratory component. In the survey, individuals feel a little better when others slightly overrate them (an enhancement effect). In both the survey and laboratory, individuals also feel bad for being highly overrated (a consistency effect), and this consistency effect overpowers the enhancement effect. The consistency effect emerges when we measure: (1) individuals’ identity meanings, (2) their responses to how they think others see them (reflected appraisals), and (3) the meanings in the situation that are relevant to an individual’s identity (identity-relevant situational meanings).
Parental Incarceration and Intergenerational Transfers to Young Adults
Authors: Siennick Sonja E.
Published: September 2014

This study extended work on the consequences of incarceration for families by linking parents’ incarcerations to their material support of children entering adulthood. It examined two categories of support, parental transfers of cash and shared housing, that are known deficits among young children of incarcerated parents and that play important roles in young adult attainment and well-being. Propensity score analyses of data from the National Longitudinal Study of Adolescent Health ( N [Wave3] = 14,023; N [Wave4] = 14,361) revealed that previously incarcerated mothers were less likely to give money and housing support to young adult children, as were previously incarcerated fathers. Some evidence of cross-parent effects was found; a given parent’s incarceration may increase the odds of the other parent’s financial support and decrease the odds of their housing support. The study confirms that the impact of parental incarceration extends beyond childhood and may disadvantage youths during the transition to adulthood.
Parent Predictors of Adolescents’ Explanatory Style
Authors: Vélez Clorinda E. , Krause Elizabeth D. , Brunwasser Steven M. , Freres Derek R. , Abenavoli Rachel M. , Gillham Jane E.
Published: September 2014

The current study tested the prospective relations (6-month lag) between three aspects of the parent-child relationship at Time 1 (T1) and adolescents’ explanatory styles at Time 2 (T2): caregiving behaviors, parents’ explanatory style for their own negative events, and parents’ explanatory style for their children’s negative events. The sample included 129 adolescents aged 11 to 14 years at baseline and their parents. Adolescents reported on their own explanatory style and their parents’ caregiving behaviors; parents self-reported on their caregiving behaviors and their explanatory style for their own and their children’s events. Regression analyses identified maternal acceptance as a significant predictor of T2 adolescents’ explanatory style. Marginal effects emerged for fathers’ psychological control and fathers’ explanatory style for their children’s events. Findings suggest that the ways parents—especially mothers—interact with their children may play a role in adolescents’ cognitive vulnerability to depression.
Ghrelin and obestatin plasma levels and ghrelin/obestatin prepropeptide gene polymorphisms in small for gestational age infants
Authors: Zhang Shulian , Zhai Guanpeng , Zhang Jinping , Zhou Jianguo , Chen Chao
Published: September 2014

Objectives

To investigate plasma ghrelin and obestatin levels, and ghrelin/obestatin prepropeptide gene polymorphisms, in sequentially enrolled small for gestational age (SGA) infants.

Methods

Neonates were sequentially enrolled into this study and were then subdivided into different groups, according to different study aims and availability of study materials. Consequently, plasma ghrelin and obestatin levels were measured in term SGA, term appropriate for gestational age (AGA), term large for gestational age (LGA), preterm SGA and preterm AGA neonates. Levels of both peptides were also measured in AGA infants of different gestational ages, and in term AGA neonates at different days following birth. Three ghrelin/obestatin prepropeptide gene single nucleotide polymorphisms (SNPs), Arg51Gln, Leu72Met, and Gln90Leu, were measured in neonates.

Results

The study involved a total cohort of 581neonates. Out of 150 neonates (30 term AGA, 30 term SGA, 30 term LGA, 30 preterm AGA, and 30 preterm SGA), plasma obestatin levels were significantly higher in term SGA versus term LGA neonates (0.21 ± 0.02 ng/ml versus 0.17 ± 0.01 ng/ml, respectively). Out of a wider cohort, there were no significant differences in genotypes and allele frequencies of Arg51Gln, Leu72Met, and Gln90Leu SNPs between term SGA and AGA neonates, or between preterm SGA and AGA neonates.

Conclusions

Ghrelin/obestatin prepropeptide polymorphisms were not found to be associated with SGA status in neonates; however, ghrelin and obestatin levels may be involved in growth and development. Further studies are required to understand the relationship between ghrelin, obestatin and prenatal development.
Knotted Versus Knotless Suture Bridge Repair of the Achilles Tendon Insertion
Authors: Cox Joseph T. , Shorten Peter L. , Gould Gregory C. , Markert Ronald J. , Barnett Michael D. , Laughlin Richard T.
Published: September 2014

Background:

Surgical treatment of insertional Achilles tendinopathy often involves detachment and debridement of the Achilles tendon insertion. A recent study has shown that knotted suture bridge fixation of the Achilles to the calcaneus is biomechanically superior to single-row fixation, but there is an absence of literature on the use of different suture bridge constructs to repair the Achilles tendon.

Hypothesis:

There will be no significant difference in the load to failure, mode of failure, tendon strain, tendon stiffness, repair site gapping, or footprint size when comparing knotted suture bridge repair to knotless suture bridge repair of the Achilles tendon after detachment for insertional Achilles tendinopathy.

Study Design:

Controlled laboratory study.

Methods:

A single specimen from each pair of 10 cadaveric Achilles tendons was randomized to 1 of 2 Achilles insertion repair groups: knotted (n = 10) or knotless (n = 10) suture bridge repair. Repaired footprint size was measured, and then cyclic testing from 10 to 100 N for 2000 cycles was performed. This was followed by measurement of tendon strain, repair site displacement, load to failure, and tendon stiffness.

Results:

The knotted suture bridge repair had a significantly higher load to failure compared with the knotless suture bridge (mean ± SD, 317.8 ± 93.6 N vs 196.1 ± 12.1 N, respectively; P = .001). All constructs failed at the tendon-suture interface. Tendon strain after cyclic testing was significantly greater in the knotless (1.20 ± 1.05) compared with the knotted (0.39 ± 0.4) suture repair groups ( P = .011). There was no significant difference in footprint size between the knotted (230.3 ± 63.3 mm2) and knotless (248.5 ± 48.8 mm2) groups ( P = .40). There was also no significant difference in stiffness (knotted = 76.4 ± 8.0 N/mm; knotless = 69.6 ± 10.9 N/mm; P = .17) and repair site displacement after cyclic testing (knotted = 2.8 ± 1.2 mm; knotless = 3.6 ± 1.1 mm; P = .17).

Conclusion:

During suture bridge repair of the Achilles tendon after detachment, knots at the proximal suture anchors significantly improve the biomechanical strength of the repair.

Clinical Relevance:

This study demonstrated that the knotless suture bridge repair had a significantly lower load to failure than the knotted suture bridge. Surgeons should be aware of these biomechanical differences, as they influence the postoperative rehabilitation protocol and may lead to higher surgical complication rates.
Biomechanical Comparison of Arthroscopic Repair Constructs for Meniscal Root Tears
Authors: Anz Adam W. , Branch Eric A. , Saliman Justin D.
Published: September 2014

Background:

Complete meniscal root tears render the meniscus nonfunctional. Repair constructs have been presented and tested; however, prior studies have evaluated suture patterns placed ex vivo without simulating an in vivo surgical setting. This study introduces a new double-locking loop suture pattern and compares its biomechanical properties and execution time with commonly used suture patterns. All constructs were performed using an all-inside arthroscopic technique.

Hypothesis:

Complex suture repair constructs have higher failure loads, stiffness, and execution times compared with simple constructs.

Study Design:

Controlled laboratory study.

Methods:

Sutures were placed arthroscopically into the posterior horn root region of the medial and lateral menisci in 21 cadaveric knees. Four repair constructs were evaluated: 2 simple sutures (2SS), 1 inverted mattress suture (1MS), 1 double-locking loop suture (1DLS), and 2 double-locking loop sutures (2DLS). In total, 40 posterior meniscal roots were tested, with 10 trials for each construct. After arthroscopic placement of the root repair constructs, each meniscus was explanted and tested to failure on a uniaxial materials testing machine. The Kruskal-Wallis test was used to evaluate for the significance of maximum failure loads and stiffness between groups.

Results:

The mean maximum failure loads were 137 ± 49 N (2SS), 126 ± 44 N (1MS), 186 ± 43 N (1DLS), and 368 ± 76 N (2DLS). Interconstruct comparison revealed a statistical difference between 2DLS and all 3 remaining constructs ( P < .01) and 1DLS when compared with 2SS and 1MS ( P < .01 for both). Statistical significance was not found between 2SS and 1MS ( P = .8). The mean times for repair of the 4 fixation techniques were 1.8 ± 0.9 minutes (2SS), 2.4 ± 1.9 minutes (1MS), 4.7 ± 2.0 minutes (1DLS), and 5.4 ± 0.6 minutes (2DLS).

Conclusion:

The double-locking loop suture repair technique had significantly higher failure loads compared with the 3 other methods tested. As the complexity of repair constructs increases, failure loads and surgical times increase.

Clinical Relevance:

Complex suture patterns can be placed via an all-inside arthroscopic technique delivering higher failure loads for meniscal root repair with little increase in surgical time.
Measuring political violence in Pakistan: Insights from the BFRS Dataset
Authors: Bueno de Mesquita Ethan , Fair C. Christine , Jordan Jenna , Rais Rasul Bakhsh , Shapiro Jacob N.
Published: September 2014

This article presents the BFRS Political Violence in Pakistan dataset addressing its design, collection and utility. BFRS codes a broad range of information on 28,731 incidents of political violence from January 1988 to November 2011. For each incident we record the location, consequences, cause, type of violence and party responsible as specifically as possible. These are the first data to systematically record all different kinds of political violence in a country for such an extended period, including riots, violent political demonstrations, terrorism and state violence, as well as asymmetric and symmetric insurgent violence. Similar datasets from other countries tend to focus on one kind of violence—such as ethnic riots, terrorism or combat—and therefore do not allow scholars to study how different forms of violence interact or to account for tactical and strategic substitution between methods of contestation. To demonstrate the utility of the dataset, first we examine how patterns of tactical substitution vary over time and space in Pakistan, showing that they differ dramatically, and discuss implications for the study of political violence more broadly. Second, we show how these data can help illuminate ongoing debates in Pakistan about the causes of the increase in violence in the last 10 years. Both applications demonstrate the value of disaggregating violence within countries and are illustrative of the potential uses of these data.
Management of Complications of End-Stage Liver Disease in the Intensive Care Unit
Authors: DellaVolpe Jeffrey D. , Garavaglia Jeffrey M. , Huang David T.
Published: September 2014

The management of critically ill patients with end-stage liver disease can be challenging due to the vulnerability of this population and the wide-ranging complications of the disease. This review proposes an approach based on the major organ systems affected, to provide a framework for managing the most common complications. Although considerable practice variation exists, a focus on the evidence behind the most common practices will ensure the development of the optimal skillset to appropriately manage this disease.
Polymer nanocomposites part 1
Authors: Awad A , Abou-Kandil Ahmed I , Elsabbagh I , Elfass M , Gaafar M , Mwafy E
Published: September 2014

Zinc oxide (ZnO) is a very important compound used in different industries. Several methods are currently used to synthesize ZnO. In this study, we discuss a novel chemical route used to synthesize and purify ZnO in the nanometer scale, with full control on the particle size. The resultant product is chemically and physically characterized using high-resolution X-ray diffraction, thermal analysis, spectral analysis, and ultrasonic measurements in order to determine the crystallite size and the chemical composition of the product as well as to confirm the absence of impurities. Electron microscopy (scanning and transmission) is used to confirm the particle size of the resultant material and confirm particle size uniformity and absence of agglomeration.
Public policy discourses on childhood during Chilean post-authoritarian democracy: A case of discursive colonization by the language of the free market
Authors: Vergara del Solar Ana
Published: September 2014

Based on the approach to language of Critical Discourse Analysis, this article explores the discursive construction of childhood in public policies during post-authoritarian Chilean democracy. Focusing on a key goal-setting policy document, the study notes how past and present discourses, including elements of the classical evolutionist view of childhood, the more historically recent children’s rights perspective, and that of the social investment in children, are combined. The social investment perspective tends to predominate, as part of the ‘colonization’ of discourses regarding childhood by the language of the free market.
The effect of job insecurity and employability on preferences for redistribution in Western Europe
Authors: Marx Paul
Published: September 2014

This article sheds light on the so far under-researched effect of subjective job insecurity on social policy preferences and the moderating role of employability. Using pooled individual-level data from the European Social Survey for workers from 11 Western European countries, it shows that subjective job insecurity does increase demand for redistribution. This effect is conditional upon employability perceptions, that is, expectations about future employment prospects. The impact of job insecurity on redistribution is strongest for workers who fear long-term unemployment. The findings do not seem to be driven by underlying political belief systems as they are robust in a reduced sample of centrist non-partisan workers. While the results confirm the hypothesised repercussions of labour-market flexibility on the individual level, aggregate effects should not be exaggerated, since the segment of workers exposed to job insecurity and low employability at the same time is rather small.
Institutions, employment insecurity and polarization in support for unemployment benefits
Authors: Paskov Marii , Koster Ferry
Published: September 2014

Research has shown that workers’ support for public unemployment benefits (UB) depends on their level of employment insecurity: the insecure workers are more supportive of benefits than the secure workers. It can also be hypothesized that this polarization in support for UB is increased or decreased by the institutional settings of a country. We are particularly interested in two types of institutional conditions: the level of employment protection and the generosity of unemployment benefits. We discuss how public provision of social protection in terms of job security and income might motivate the subjectively secure and insecure workers in different ways and thereby polarize or unite support for unemployment benefits. We find that protection of temporary job contracts and generous unemployment benefits bring the attitudes of the secure and insecure closer together. We argue that the convergence of attitudes can be explained by the distribution of underlying social risks and existing social norms about solidarity.
Contraception in patients with systemic lupus erythematosus and antiphospholipid syndrome
Authors: Sammaritano LR
Published: September 2014

Contraceptive choice in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) is challenging but important. Long-acting forms of contraception such as the progesterone intrauterine device (IUD) or subdermal implant are preferable for most patients. Estrogen-containing hormonal contraceptives may be used in stable, inactive SLE patients but are contraindicated in patients with positive antiphospholipid antibodies (aPL). The levonorgestrel IUD is a good alternative for many APS patients and often decreases menstrual blood loss. It is prudent to avoid depot medroxyprogesterone acetate (DMPA) in corticosteroid-treated or other patients at risk for osteoporosis because of the inhibition of ovulation. Effective and safe contraception in patients with SLE and APS permits planning for pregnancy during inactive disease and while on pregnancy-compatible medications, preventing a poorly timed pregnancy that may jeopardize maternal and/or fetal health.
Antiphospholipid antibodies and infertility
Authors: Chighizola CB , de Jesus GR
Published: September 2014

Since the late 1980s some publications have proposed that antiphospholipid antibodies (aPL) may have some relationship with infertility, considering reported deleterious effects that aPL exert on trophoblast proliferation and growth. Although not included in current classification criteria for antiphospholipid syndrome, many physicians investigate for aPL in patients with a history of infertility, including antibodies not listed in classification criteria, and most of those patients will receive anticoagulant therapy if any of those antibodies have a result considered positive. A review of literature was conducted searching for studies that investigated the association of aPL and infertility and if aPL positivity alters in vitro fertilization (IVF) outcome. The definition of infertility, routine work-up to exclude other causes of infertility, definition of IVF failure as inclusion criteria and control populations were heterogeneous among studies. Most of them enrolled women over 40 years of age, and exclusion of other confounding factors was also inconsistent. Of 29 studies that assessed aPL positivity rates in infertile women, the majority had small sample sizes, implying a lack of power, and 13 (44.8%) reported higher frequency of aPL in infertile patients compared to controls, but most of them investigated a panel of non-criteria aPL tests, whose clinical significance is highly controversial. Only two studies investigated all three criteria tests, and medium-high titer of anticardiolipin cut-off conforming to international guidelines was used in one study. Considering IVF outcome, there was also disparity in this definition: few studies assessed the live birth rate, others the implantation rate. Of 14 publications that addressed the relationship between aPL and IVF outcome, only two described a detrimental effect of these autoantibodies. In conclusion, available data do not support an association between aPL and infertility, and aPL positivity does not seem to influence IVF outcome. Well-designed clinical studies recruiting women with a clear diagnosis of infertility and a high-risk aPL profile should be performed to test whether clinically relevant aPL do—or not—exert an effect on human fertility.
The use of angiogenic and antiangiogenic factors in the differential diagnosis of pre-eclampsia, antiphospholipid syndrome nephropathy and lupus nephritis
Authors: de Jesus GR , de Jesus NR , Levy RA , Klumb EM
Published: September 2014

Pre-eclampsia (PE) is a major cause of maternal mortality and morbidity, perinatal deaths, preterm birth and intrauterine growth restriction. Differential diagnosis with antiphospholipid syndrome (APS) nephropathy and systemic lupus erythematosus (SLE) nephritis during pregnancy is difficult, if not sometimes impossible, as all three diseases may present hypertension and proteinuria. Improvement in diagnosis of PE has also offered new paths for differential diagnosis with other conditions and the analysis of angiogenic (vascular endothelial growth factor, placental growth factor) and antiangiogenic factors (serum soluble fms-like tyrosine kinase 1, soluble endoglin) is promising for differentiation between PE, APS nephropathy and SLE nephritis. This article reviews published studies about those factors in non-pregnant and pregnant patients with APS and SLE, comparing with patterns described in PE.
Pre-eclampsia as a manifestation of antiphospholipid syndrome: assessing the current status
Authors: Gibbins KJ , Ware Branch D
Published: September 2014

The presence of antiphospholipid antibodies is considered a risk factor for pre-eclampsia. Two meta-analyses and a number of case-control and cohort studies have found associations between pre-eclampsia and lupus anticoagulant, anticardiolipin, and/or anti-β2 glycoprotein I. However, existing literature is inconsistent, with varying severity of pre-eclampsia phenotype examined, differing aPL titer cutoffs used to define positive status, and an overwhelming lack of repeat confirmatory aPL testing. This calls into question the link between aPLs and pre-eclampsia, or at least makes it less well defined. There is evidence for a mechanistic pathway between aPLs and adverse pregnancy outcomes (APOs) including pre-eclampsia via the complement pathway. Complement appears to be overactive in pregnancies affected by APOs. A mouse model has show that the fetal wastage caused by treatment with human aPLs can be salvaged by either creating genetic knockouts along the complement, TNF-alpha, and tissue factor pathways or be treating mice with monoclonal antibodies blocking key complement factors. Thus, this is worth further investigation to clarify the likely association of aPLs and pre-eclampsia in humans, as well is to further evaluate the interaction with complement in human pregnancies.
Multiple antiphospholipid antibodies positivity and antiphospholipid syndrome criteria re-evaluation
Authors: Forastiero R
Published: September 2014

The antiphospholipid syndrome (APS) is characterized by the presence of aPL and thrombosis and/or pregnancy morbidity. The last APS laboratory classification criteria include the presence of at least one of the antiphospholipid antibodies (aPL) [lupus anticoagulant (LA), anticardiolipin (aCL) and/or anti-β2 glycoprotein I antibodies (aβ2GPI)] and introduced the concept of subclassification of APS patients into two different categories of aPL assay positivity (combination or single aPL). Several studies have recently shown that the risk for thrombosis increases with each additional aPL detected. We found that the presence of IgG antibodies to β2GPI and/or prothrombin increased thrombotic risk in patients with LA and/or aCLin a prospective study. Various studies have recently demonstrated that patients with triple positivity (LA, aCL and aβ2GPI) are at the highest risk for venous and arterial thrombosis and for obstetric complications. In retrospective but also in prospective studies the rate of thrombotic recurrence was high in subjects with triple positivity even while on anticoagulant therapy. In addition, the occurrence of a first thrombotic event in asymptomatic carriers of triple positivity was higher than in those with single aPL positivity. The inclusion of the detection of antibodies against domain I of β2GPI and/or antibodies to prothrombin would probably help to further identify more clinically relevant aPL. Based on the last findings, there are some proposals to consider only patients with triple positivity as definite APS (thrombotic and obstetric).
Autoantibody profiling in APS
Authors: Roggenbuck D , Somma V , Schierack P , Borghi MO , Meroni PL
Published: September 2014

The international consensus for the classification of antiphospholipid syndrome (APS) requires clinical and laboratory criteria to be considered at an equal level for diagnosing APS. Thus, detection of antiphospholipid antibodies (aPL) being a hallmark of APS has been the object of intensive investigation over the past 40 years. However, appropriate detection of aPL still remains a laboratory challenge due to their heterogeneity comprising autoantibodies reactive to different phospholipid-binding plasma proteins, such as beta-2 glycoprotein I (β2GPI) and prothrombin. The relevance of aPL interacting with phospholipids other than cardiolipin (CL, diphosphatidylglycerol), such as phosphatidylserine (PS), remains elusive with regard to the diagnosis of APS. Recently, the concept of aPL profiling has been introduced to assess the risk of thrombotic complications in patients with APS. New assay techniques, apart from enzyme-linked immunosorbent assays (ELISAs) recommended by the international consensus for the classification of APS, have been proposed for multiplexing of aPL testing. Line immunoassays (LIAs) employing a novel hydrophobic solid phase for the simultaneous detection of different aPL seem to be an intriguing alternative. We evaluated a novel multiplex LIA employing a hydrophobic membrane coated with different phospholipid (PL)-binding proteins or PLs. The performance characteristics of this new multiplexing assay technique demonstrated its usefulness for aPL profiling.
Identification and treatment of APS renal involvement
Authors: Tektonidou MG
Published: September 2014

Renal involvement in antiphospholipid syndrome (APS), either primary or systemic lupus erythematosus (SLE)-related APS, includes renal artery stenosis or thrombosis, renal infarction, renal vein thrombosis and a small-vessel vaso-occlusive nephropathy defined as “antiphospholipid antibody (aPL)-associated nephropathy.” aPL-associated nephropathy is characterized by acute lesions, thrombotic microangiopathy, and chronic lesions such as fibrous intimal hyperplasia, organizing thrombi with or without recanalization, fibrous occlusions of arteries or arterioles and focal cortical atrophy. Systemic hypertension, hematuria, proteinuria (ranging from mild to nephrotic level) and renal insufficiency represent the major clinical manifestations associated with aPL-associated nephropathy. Similar renal histologic and clinical characteristics have been described among all different groups of patients with positive aPL (primary APS, SLE-related APS, catastrophic APS and SLE/non-APS with positive aPL). In patients with aPL-associated nephropathy lesions in the absence of other causes associated with similar histological characteristics, aPL testing needs to be considered.
Antiphospholipid syndrome and the relevance of antibodies to negatively charged phospholipids in diagnostic evaluation
Authors: Tebo AE
Published: September 2014

The presence of lupus anticoagulant, moderate-to-high levels of IgG and/or IgM antibodies to beta-2 glycoprotein I or cardiolipin in association with at least one of the two major clinical manifestations (thrombosis and/or pregnancy-related morbidity) are required for a diagnosis of definite antiphospholipid syndrome (APS). The realization that certain negatively charged phospholipid (PL) autoantibodies broadly react with antibodies directed against cardiolipin and may be more reliable and specific markers for APS has led to the search for diagnostic assays with greater predictability for disease evaluation and management. This review focuses on the state-of-the-art analytical and clinical performance of IgG and IgM antibodies directed against negatively charged PLs, specifically phosphatidic acid (aPA), phosphatidylinositol (aPI), and phosphatidylserine (aPS), as well as the APhL assay, which contains a proprietary mixture of phospholipid antigens.
Reclaiming nuclear politics? Nuclear realism, the H-bomb and globality
Authors: van Munster Rens , Sylvest Casper
Published: September 2014

As nuclear weapons are again becoming the subject of critical scholarship and progressive activism, this article seeks to widen the perspective of critical security studies in relation to nuclear weapons and to provide a better understanding of the historical precursors of current ambitions. We do so by focusing on the central decade of the thermonuclear revolution (ca 1952–1963) and on a body of thought we term ‘nuclear realism’. Nuclear realists were united by the central conviction that liberal modernity could survive collective suicide only by radically rethinking and transforming its foundations. Günther Anders, John Herz, Lewis Mumford and Bertrand Russell take centre stage, and we highlight that the central pillars in their project of nuclear critique was a dissection of the legacy of the Enlightenment and an incisive examination of its implications for (international) politics in the nuclear age. These dimensions came together in their critique of the prevailing concept of deterrence. In an attempt to reclaim nuclear politics for a wider public, nuclear realists stressed the absolute centrality of imagination as a strategy for unmasking the power and rationality of a growing national security establishment, on the one hand, and bringing a distinct, alternative vision of global politics and security into view, on the other. This comprehensive yet multifaceted project, while afflicted by its own challenges, is deeply relevant for today’s nuclear politics.
Development and Validation of Women’s Satisfaction With Hospital-Based Intrapartum Care Scale in Jordan
Authors: Shaban Insaf , Mohammad Khitam , Homer Caroline
Published: September 2014

Background: Measuring satisfaction with care during labor is an important way to improve maternity services for women. This study was undertaken to develop an instrument to measure women’s satisfaction with intrapartum hospital-based care. Method: A multidimensional instrument was initially developed, using three core aspects identified from the literature. An expert panel was convened to further modify the instrument. Finally, a total of 300 low-risk women who gave birth in the past 2 months were asked to complete the instrument to assess validity and reliability. Findings: The 14-item instrument was found to have content and construct validity as well as a high level of reliability (α = .88). Conclusions: This new instrument is a valid and reliable measure of satisfaction with intrapartum care in a Jordanian setting. The instrument can provide valuable information on the quality of services and on future planning for maternity services.
Aggressive Attitudes in Middle Schools
Authors: Huang Francis L. , Cornell Dewey G. , Konold Timothy R.
Published: September 2014

Student attitudes toward aggression have been linked to individual aggressive behavior, but the relationship between school-wide normative beliefs about aggression and aggressive behavior poses some important measurement challenges that have not been adequately examined. The current study investigated the factor structure, measurement invariance, and criterion-related validity of a six-item Aggressive Attitudes scale using a large sample of seventh- and eighth-grade students ( n = 39,364) from 423 schools. Analytic procedures accounted for the frequently ignored modeling problems of clustered and ordinal data to provide more reliable and accurate model estimates and standard errors. The resulting second-order factor structure of the Aggressive Attitudes scale demonstrated measurement invariance across gender, grade, and race/ethnicity groups. Criterion-related validity was supported with eight student- and school-level indices of aggressive behavior.
Parenteral Anticoagulants Use in General Practice
Authors: Courrier Vincent , Fournier Jean-Pascal , Sommet Agnès , Montastruc Jean-Louis , Poutrain Jean-Christophe
Published: September 2014

Using parenteral anticoagulants in compliance with their summaries of product characteristics (SPCs) and consensus guidelines is associated with decreased rates of adverse drug reactions. The objectives were to assess compliance of parenteral anticoagulants use with SPCs and 4 consensus guidelines in outpatients of general practice. A descriptive cross-sectional study was conducted among 112 teaching general practitioners’ offices, from May to October 2011. Among the 332 adult outpatients consecutively included, 108 (32.5%) had a parenteral anticoagulant therapy complying with SPCs for both indication and regimen. The rate of compliance increased when considering consensus guidelines (159 patients, 47.9%). Rate of adverse events was 5.4%, including 0.6% of serious adverse events. This study showed that the use of parenteral anticoagulants complies with indications and regimens of SPCs in only 1 of the 3 outpatients. Further studies should be conducted in primary care to explore reasons for such low compliance rates.
Tales of the unexpected: Discussing improvisational learning
Authors: Cunha Miguel Pina e , Neves Pedro , Clegg Stewart R , Rego Arménio
Published: September 2014

Improvisation has been treated largely as if it were a conceptual monolith: all improvisations are similar. We challenge this theorizing by distinguishing forms of improvisation in organizations (semi-structured, episodic, subversive, resistive) and by exploring ways in which these forms interrelate in improvisational sequences. Improvisation is not just something individuals do; it is a learned capacity that organizations can manage. We introduce the dimension of improvisational formality and informality, adding a political dimension to the study of the topic. By combining forms in process sequences, we organize the existing literature under a systematic perspective facilitating theory development via an integrative understanding of how improvisation produces learning.
Experience with subcutaneous abatacept for rheumatoid arthritis: an update for clinicians
Authors: Khraishi Majed M.
Published: September 2014

Abatacept is recommended by several expert consensus groups including the 2013 update of the EULAR recommendations for the pharmacologic management of rheumatoid arthritis (RA), as a potential choice for biologic therapy for patients with RA. Initially developed, studied, and approved as an intravenous (IV) formulation, abatacept is now also available as a subcutaneous (SC) injection. Having both options available makes abatacept a particularly versatile agent for the management of RA, greatly expanding the population of patients who could benefit from this treatment. This review provides a summary of the most important clinical trials that have investigated this molecule in both of its formulations, with a focus on the more recent trials evaluating the SC formulation, specifically the AMPLE study, the first major trial evaluating two biologic agents (abatacept and the tumor necrosis factor (TNF)-inhibitor adalimumab) in a head-to-head manner. In that study, SC abatacept was found to have an efficacy profile similar to that of SC adalimumab, both in combination with methotrexate.
Whole‐liver CT texture analysis in colorectal cancer: Does the presence of liver metastases affect the texture of the remaining liver?
Authors: Rao Sheng-Xiang , Lambregts Doenja MJ , Schnerr Roald S , van Ommen Wenzel , van Nijnatten Thiemo JA , Martens Milou H , Heijnen Luc A , Backes Walter H , Verhoef Cornelis , Zeng Meng-Su , Beets Geerard L , Beets-Tan Regina GH
Published: September 2014

Background

Liver metastases limit survival in colorectal cancer. Earlier detection of (occult) metastatic disease may benefit treatment and survival.

Objective

The objective of this article is to evaluate the potential of whole‐liver CT texture analysis of apparently disease‐free liver parenchyma for discriminating between colorectal cancer (CRC) patients with and without hepatic metastases.

Methods

The primary staging CT examinations of 29 CRC patients were retrospectively analysed. Patients were divided into three groups: patients without liver metastases (n  = 15), with synchronous liver metastases (n  = 10) and metachronous liver metastases within 18 months following primary staging (n  = 4). Whole‐liver texture analysis was performed by delineation of the apparently non‐diseased liver parenchyma (excluding metastases or other focal liver lesions) on portal phase images. Mean grey‐level intensity (M), entropy (E) and uniformity (U) were derived with no filtration and different filter widths (0.5 = fine, 1.5 = medium, 2.5 = coarse).

Results

Mean E1.5 and E2.5 for the whole liver in patients with synchronous metastases were significantly higher compared with the non‐metastatic patients (p  = 0.02 and p  = 0.01). Mean U1.5 and U2.5 were significantly lower in the synchronous metastases group compared with the non‐metastatic group (p  = 0.04 and p  = 0.02). Texture parameters for the metachronous metastases group were not significantly different from the non‐metastatic group or synchronous metastases group (p  > 0.05), although – similar to the synchronous metastases group – there was a subtle trend towards increased E1.5, E2.5 and decreased U1.5, U2.5 values. Areas under the ROC curve for the diagnosis of synchronous metastatic disease based on the texture parameters E1.5,2.5 and U1.5,2.5 ranged between 0.73 and 0.78.

Conclusion

Texture analysis of the apparently non‐diseased liver holds promise to differentiate between CRC patients with and without metastatic liver disease. Further research is required to determine whether these findings may be used to benefit the prediction of metachronous liver disease.
Glenoid Bone Loss Measurement in Recurrent Shoulder Dislocation
Authors: Friedman Lisa G.M. , Ulloa Sergio A. , Braun David T. , Saad Hussein A. , Jones Morgan H. , Miniaci Anthony A.
Published: September 2014

Background:

Shoulder instability can cause both soft tissue injury and bone defects, requiring both computed tomography (CT) and magnetic resonance imaging (MRI) for a thorough workup, which results in high patient costs and radiation exposure. Prior studies in cadaveric and nonclinical models have shown promise in assessing preoperative bone loss utilizing MRI.

Purpose:

To evaluate the utility of MRI in detecting and evaluating glenoid bone defects in a clinical setting. The aim was to establish whether similar information could be determined by utilizing MRI and CT in a population with recurrent instability.

Study Design:

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

Methods:

CT and MRI scans of 22 shoulders were read by 4 orthopaedic surgeons. The CT images were obtained on a 2-dimensional CT scanner. Vertical measurements were taken from the superior glenoid tubercle and directed inferiorly along the glenoid; horizontal measurements were taken across the widest part of the face of the glenoid and were perpendicular within one-half of 1° to the vertical measurement. The same protocol was followed for MRI measurements. An intraclass correlation coefficient (ICC) was calculated.

Results:

There was a moderate amount of agreement between examiners for the height measurements on MRI (ICC, 0.53) and a substantial agreement for the CT images (ICC, 0.64). The width measurements for MRI had a moderate amount of agreement (ICC, 0.41), while the CT images had a fair agreement (ICC, 0.39). The height measurements between the measurements of MRI and CT images had an overall ICC of 0.43, while the width measurements had an overall ICC of 0.41, both of which were considered a moderate amount of agreement.

Conclusion:

There is moderate correlation between MRI and CT scans when measuring the glenoid, indicating that taking the length-to-height ratio measurements across the glenoid is a promising way to estimate the glenoid defect. At present, a complete workup of a patient with shoulder instability includes both a CT scan and an MRI. Future research that establishes precisely how MRI misestimates CT measurements of the glenoid can perhaps obviate the need for 2 scans.