bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliability, construct validity and measurement potential of the ICF comprehensive core set for osteoarthritis
Authors: Kurtaiş Yeşim , Őztuna Derya , Küçükdeveci Ayşe A , Kutlay Şehim , Hafiz Meliha , Tennant Alan
Published: November 2011

Background

This study aimed to investigate the reliability and construct validity of the International Classification of Functioning, Disability and Health (ICF) Comprehensive Core Set for osteoarthritis (OA) in order to test its possible use as a measuring tool for functioning.

Methods

100 patients with OA (84 F, 16 M; mean age 63 yr) completed forms including demographic and clinical information besides the Short Form (36) Health Survey (SF-36®) and the Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC). The ICF Comprehensive Core Set for OA was filled by health professionals. The internal construct validities of "Body Functions-Body structures" (BF-BS), "Activity" (A), "Participation" (P) and "Environmental Factors" (EF) domains were tested by Rasch analysis and reliability by internal consistency and person separation index (PSI). External construct validity was evaluated by correlating the Rasch transformed scores with SF-36 and WOMAC.

Results

In each scale, some items showing disordered thresholds were rescored, testlets were created to overcome the problem of local dependency and items that did not fit to the Rasch model were deleted. The internal construct validity of the four scales (BF-BS 16 items, A 8 items, P 7 items, EF 13 items) were good [mean item fit (SD) 0.138 (0.921), 0.216 (1.237), 0.759 (0.986) and -0.079 (2.200); person item fit (SD) -0.147 (0.652), -0.241 (0.894), -0.310 (1.187) and -0.491 (1.173) respectively], indicating a single underlying construct for each scale. The scales were free of differential item functioning (DIF) for age, gender, years of education and duration of disease. Reliabilities of the BF-BS, A, P, and EF scales were good with Cronbach's alphas of 0.79, 0.86, 0.88, and 0.83 and PSI's of 0.76, 0.86, 0.87, and 0.71, respectively. Rasch scores of BF-BS, A, and P showed moderate correlations with SF-36 and WOMAC scores where the EF had significant but weak correlations only with SF36-Social Functioning and SF36-Mental Health.

Conclusion

Since the four different scales derived from BF-BS, A, P, and EF components of the ICF core set for OA were shown to be valid and reliable through a combination of Rasch analysis and classical psychometric methods, these might be used as clinical assessment tools.
Factors associated with use of community mental health services by schizophrenia patients using multilevel analysis
Authors: Moreno-Küstner Berta , Mayoral Fermín , Rivas Fabio , Angona Pedro , Requena Javier , García-Herrera José M , Navas Desiree , Moreno Patricia , Serrano-Blanco Antoni , Bellón Juan A
Published: November 2011

Background

Persons with schizophrenia and related disorders may be particularly sensitive to a number of determinants of service use, including those related with illness, socio-demographic characteristics and organizational factors. The objective of this study is to identify factors associated with outpatient contacts at community mental health services of patients with schizophrenia or related disorders.

Methods

This cross-sectional study analyzed 1097 patients. The main outcome measure was the total number of outpatient consultations during one year. Independent variables were related to socio-demographic, clinical and use of service factors. Data were collected from clinical records.

Results

The multilevel linear regression model explained 46.35% of the variance. Patients with significantly more contacts with ambulatory services were not working and were receiving welfare benefits (p = 0.02), had no formal education (p = 0.02), had a global level of severity of two or three (four being the most severe) (p < 0.001), with one or more inpatient admissions (p < 0.001), and in contact with both types of professional (nurses and psychiatrists) (p < 0.001). The patients with the fewest ambulatory contacts were those with diagnoses of persistent delusional disorders (p = 0.04) and those who were attended by four of the 13 psychiatrists (p < 0.001).

Conclusions

As expected, the variables that explained the use of community service could be viewed as proxies for severity of illness. The most surprising finding, however, was that a group of four psychiatrists was also independently associated with use of ambulatory services by patients with schizophrenia or related disorders. More research is needed to carefully examine how professional support networks interact to affect use of mental health.
CD200-CD200R dysfunction exacerbates microglial activation and dopaminergic neurodegeneration in a rat model of Parkinson's disease
Authors: Zhang Shi , Wang Xi-Jin , Tian Li-Peng , Pan Jing , Lu Guo-Qiang , Zhang Ying-Jie , Ding Jian-Qing , Chen Sheng-Di
Published: November 2011

Background

Increasing evidence suggests that microglial activation may participate in the aetiology and pathogenesis of Parkinson's disease (PD). CD200-CD200R signalling has been shown to be critical for restraining microglial activation. We have previously shown that expression of CD200R in monocyte-derived macrophages, induced by various stimuli, is impaired in PD patients, implying an intrinsic abnormality of CD200-CD200R signalling in PD brain. Thus, further in vivo evidence is needed to elucidate the role of malfunction of CD200-CD200R signalling in the pathogenesis of PD.

Methods

6-hydroxydopamine (6-OHDA)-lesioned rats were used as an animal model of PD. CD200R-blocking antibody (BAb) was injected into striatum to block the engagement of CD200 and CD200R. The animals were divided into three groups, which were treated with 6-OHDA/Veh (PBS), 6-OHDA/CAb (isotype control antibody) or 6-OHDA/BAb, respectively. Rotational tests and immunohistochemistry were employed to evaluate motor deficits and dopaminergic neurodegeneration in animals from each group. HPLC analysis was used to measure monoamine levels in striatum. Morphological analysis and quantification of CD11b- (or MHC II-) immunoreactive cells were performed to investigate microglial activation and possible neuroinflammation in the substantia nigra (SN). Finally, ELISA was employed to assay protein levels of proinflammatory cytokines.

Results

Compared with 6-OHDA/CAb or 6-OHDA/Veh groups, rats treated with 6-OHDA/BAb showed a significant increase in counts of contralateral rotation and a significant decrease in TH-immunoreactive (TH-ir) neurons in SN. A marked decrease in monoamine levels was also detected in 6-OHDA/BAb-treated rats, in comparison to 6-OHDA/Veh-treated ones. Furthermore, remarkably increased activation of microglia as well as up-regulation of proinflammatory cytokines was found concomitant with dopaminergic neurodegeneration in 6-OHDA/BAb-treated rats.

Conclusions

This study shows that deficits in the CD200-CD200R system exacerbate microglial activation and dopaminergic neurodegeneration in a 6-OHDA-induced rat model of PD. Our results suggest that dysfunction of CD200-CD200R signalling may be involved in the aetiopathogenesis of PD.
Effect of additional treatment with EXenatide in patients with an Acute Myocardial Infarction (EXAMI): study protocol for a randomized controlled trial
Authors: Scholte Martijn , Timmers Leo , Bernink Flip JP , Denham Robert N , Beek Aernout M , Kamp Otto , Diamant Michaela , Horrevoets Anton JG , Niessen Hans WM , Chen Weena JY , van Rossum Albert C , van Royen Niels , Doevendans Pieter A , Appelman Yolande
Published: November 2011

Background

Myocardial infarction causes irreversible loss of cardiomyocytes and may lead to loss of ventricular function, morbidity and mortality. Infarct size is a major prognostic factor and reduction of infarct size has therefore been an important objective of strategies to improve outcomes. In experimental studies, glucagon-like peptide 1 and exenatide, a long acting glucagon-like peptide 1 receptor agonist, a novel drug introduced for the treatment of type 2 diabetes, reduced infarct size after myocardial infarction by activating pro-survival pathways and by increasing metabolic efficiency.

Methods

The EXAMI trial is a multi-center, prospective, randomized, placebo controlled trial, designed to evaluate clinical outcome of exenatide infusion on top of standard treatment, in patients with an acute myocardial infarction, successfully treated with primary percutaneous coronary intervention. A total of 108 patients will be randomized to exenatide (5 μg bolus in 30 minutes followed by continuous infusion of 20 μg/24 h for 72 h) or placebo treatment. The primary end point of the study is myocardial infarct size (measured using magnetic resonance imaging with delayed enhancement at 4 months) as a percentage of the area at risk (measured using T2 weighted images at 3-7 days).

Discussion

If the current study demonstrates cardioprotective effects, exenatide may constitute a novel therapeutic option to reduce infarct size and preserve cardiac function in adjunction to reperfusion therapy in patients with acute myocardial infarction.

Trial registration

ClinicalTrials.gov: NCT01254123
Bacterial and fungal microflora in surgically removed lung cancer samples
Authors: Apostolou Panagiotis , Tsantsaridou Aggeliki , Papasotiriou Ioannis , Toloudi Maria , Chatziioannou Marina , Giamouzis Gregory
Published: November 2011

Background

Clinical and experimental data suggest an association between the presence of bacterial and/or fungal infection and the development of different types of cancer, independently of chemotherapy-induced leukopenia. This has also been postulated for the development of lung cancer, however the prevalence and the exact species of the bacteria and fungi implicated, have not yet been described.

Aim

To determine the presence of bacterial and fungal microflora in surgically extracted samples of patients with lung cancer.

Materials and methods

In this single-center prospective, observational study, tissue samples were surgically extracted from 32 consecutive patients with lung cancer, and reverse-transcription polymerase chain reaction (RT-PCR) was used to identify the presence of bacteria and fungi strains.

Results

The analysis of the electrophoresis data pointed out diversity between the samples and the strains that were identified. Mycoplasma strains were identified in all samples. Strains that appeared more often were Staphylococcus epidermidis, Streptococcus mitis and Bacillus strains, followed in descending frequency by Chlamydia, Candida, Listeria, and Haemophilus influenza. In individual patients Legionella pneumophila and Candida tropicalis were detected.

Conclusions

A diversity of pathogens could be identified in surgically extracted tissue samples of patients with lung cancer, with mycoplasma strains being present in all samples. These results point to an etiologic role for chronic infection in lung carcinogenesis. Confirmation of these observations and additional studies are needed to further characterize the etiologic role of inflammation in lung carcinogenesis.
Mucopolysaccharidosis type II: European recommendations for the diagnosis and multidisciplinary management of a rare disease
Authors: Scarpa Maurizio , Almássy Zsuzsanna , Beck Michael , Bodamer Olaf , Bruce Iain A , De Meirleir Linda , Guffon Nathalie , Guillén-Navarro Encarna , Hensman Pauline , Jones Simon , Kamin Wolfgang , Kampmann Christoph , Lampe Christina , Lavery Christine A , Leão Teles Elisa , Link Bianca , Lund Allan M , Malm Gunilla , Pitz Susanne , Rothera Michael , Stewart Catherine , Tylki-Szymańska Anna , van der Ploeg Ans , Walker Robert , Zeman Jiri , Wraith James E
Published: November 2011

Mucopolysaccharidosis type II (MPS II) is a rare, life-limiting, X-linked recessive disease characterised by deficiency of the lysosomal enzyme iduronate-2-sulfatase. Consequent accumulation of glycosaminoglycans leads to pathological changes in multiple body systems. Age at onset, signs and symptoms, and disease progression are heterogeneous, and patients may present with many different manifestations to a wide range of specialists. Expertise in diagnosing and managing MPS II varies widely between countries, and substantial delays between disease onset and diagnosis can occur. In recent years, disease-specific treatments such as enzyme replacement therapy and stem cell transplantation have helped to address the underlying enzyme deficiency in patients with MPS II. However, the multisystem nature of this disorder and the irreversibility of some manifestations mean that most patients require substantial medical support from many different specialists, even if they are receiving treatment. This article presents an overview of how to recognise, diagnose, and care for patients with MPS II. Particular focus is given to the multidisciplinary nature of patient management, which requires input from paediatricians, specialist nurses, otorhinolaryngologists, orthopaedic surgeons, ophthalmologists, cardiologists, pneumologists, anaesthesiologists, neurologists, physiotherapists, occupational therapists, speech therapists, psychologists, social workers, homecare companies and patient societies.

Take-home message

Expertise in recognising and treating patients with MPS II varies widely between countries. This article presents pan-European recommendations for the diagnosis and management of this life-limiting disease.
Fast marine CSEM inversion in the CMP domain using analytical derivatives
Authors: Silva Crepaldi João Lucas , Pereira Buonora Marco Polo , Figueiredo Irineu
Published: November 2011

Utilization of the marine controlled-source electromagnetic method (mCSEM) as a means to reduce risks in the exploration of hydrocarbons has been gradually growing; however, the interpretation of the rendered data is still a challenge for the oil industry. This 1D inversion method is an alternative to the high computational costs of 2D and 3D inversions, as well as their complex implementations and the lack of information provided by anomaly profiles and maps. This method uses a set of algorithms to compose an mCSEM inversion workflow, which inverts data in the common midpoint (CMP) domain as a set of 1D models that correspond to their respective CMP cells. Moreover, these 1D models are laterally constrained so as to provide a georesistivity section with geological meaning. In addition, the presented analytical derivatives of the electromagnetic field responses for 1D models with respect to their resistivities, apart from making the 1D inversion an order of magnitude faster, the expressions developed in this study can be used to clarify some aspects of the electromagnetic methods in stratified medium. This workflow was applied to simulated and field data, wherein geoelectrical sections with resistive bodies at the correct positions and well-estimated background resistivities were recovered in only a few minutes. These results demonstrate the value of this routine as a useful tool for mCSEM data interpretation.
Wait-and-See Policy for Clinical Complete Responders After Chemoradiation for Rectal Cancer
Authors: Maas Monique , Beets-Tan Regina G.H. , Lambregts Doenja M.J. , Lammering Guido , Nelemans Patty J. , Engelen Sanne M.E. , van Dam Ronald M. , Jansen Rob L.H. , Sosef Meindert , Leijtens Jeroen W.A. , Hulsewé Karel W.E. , Buijsen Jeroen , Beets Geerard L.
Published: November 2011

Purpose

Neoadjuvant chemoradiotherapy for rectal cancer can result in complete disappearance of tumor and involved nodes. In patients without residual tumor on imaging and endoscopy (clinical complete response [cCR]) a wait-and-see-policy (omission of surgery with follow-up) might be considered instead of surgery. The purpose of this prospective cohort study was to evaluate feasibility and safety of a wait-and-see policy with strict selection criteria and follow-up.

Patients and Methods

Patients with a cCR after chemoradiotherapy were prospectively selected for the wait-and-see policy with magnetic resonance imaging (MRI) and endoscopy plus biopsies. Follow-up was performed 3 to 6 monthly and consisted of MRI, endoscopy, and computed tomography scans. A control group of patients with a pathologic complete response (pCR) after surgery was identified from a prospective cohort study. Functional outcome was measured with the Memorial Sloan-Kettering Cancer Center (MSKCC) bowel function questionnaire and Wexner incontinence score. Long-term outcome was estimated by using Kaplan-Meier curves.

Results

Twenty-one patients with cCR were included in the wait-and-see policy group. Mean follow-up was 25 ± 19 months. One patient developed a local recurrence and had surgery as salvage treatment. The other 20 patients are alive without disease. The control group consisted of 20 patients with a pCR after surgery who had a mean follow-up of 35 ± 23 months. For these patients with a pCR, cumulative probabilities of 2-year disease-free survival and overall survival were 93% and 91%, respectively.

Conclusion

A wait-and-see policy with strict selection criteria, up-to-date imaging techniques, and follow-up is feasible and results in promising outcome at least as good as that of patients with a pCR after surgery. The proposed selection criteria and follow-up could form the basis for future randomized studies.
The Folklorization of French Farming: Marketing Luxury Wine in the Interwar Years
Authors: Laferté Gilles
Published: November 2011

Late nineteenth-century tourists looked to nature for beauty, so Burgundy, with its industrial and agricultural landscapes, was perceived as a region of historical interest but not as picturesque. Yet as tourist interests after the Great War encompassed folklore and gastronomy, the region’s image came to be promoted through its food industry. The earlier aristocratic image of its wines was superseded by one of growers engaged in a labor of love. The wine-producing economy became emblematic of Burgundy. Since scenery was a prerequisite of regional identity, it was the vineyard, the theater in which Burgundy’s luxury output was crafted, that came to typify the area.

Fin dix-neuvième, pour les touristes, seuls les sites naturels à l’exclusion des espaces industriels et agricoles constituent des paysages, faisant de la Bourgogne une région historique sans paysage. La rénovation des objets du tourisme après guerre incluant le folklore et la gastronomie permet à la région de se constituer une image valorisant son industrie alimentaire et renverse l’imaginaire aristocratique des vins bourguignons, pour un univers vigneron. La stéréotypisation de la Bourgogne se fait autour de son économie viticole. Le paysage typique élément de la check-list identitaire régionaliste devient viticole, espace productif désormais distinctif comme mise en scène artisanale de la production de luxe.
Marcel Aymé and the Moral Economy of Penury in Occupied France
Authors: Mouré Kenneth
Published: November 2011

Marcel Aymé paid more attention than any other contemporary French novelist to economic behavior during the Second World War. His war fiction highlights French adaptation to economic hardship, with a particular sensitivity to the moral confusion generated by conflict between state economic regulations and individual economic needs. Aymé was acutely aware of the ambiguities, inequities, vulnerabilities, and compromises of life under the German Occupation. His work shows both the moral conflicts for individuals and the larger failure of Vichy aspirations to establish a new moral order in France. This article draws on Aymé’s fiction as a point of departure to examine economic adaptation to scarcity, community mobilization to protest food shortages during and after the Occupation, and the fears that behaviors adopted during the Occupation would produce a long-term moral decline.

Plus qu’aucun autre romancier de son époque, Marcel Aymé nous offre une vue privilégiée des comportements économiques des Français au cours de la Deuxième Guerre mondiale. Ses romans et nouvelles ayant pour objet la période de la guerre nous donnent un témoignage précieux sur l’adaptation des Français aux difficultés économiques, et sur les dilemmes moraux provoqués par les contradictions entre les réglementations imposées par l’Etat à des fins de régulation et les besoins particuliers. Aymé était sensible aux ambiguïtés, aux inégalités, aux vulnérabilités et aux compromis que l’Occupation a fait surgir dans la vie quotidienne. Son œuvre montre non seulement les conflits moraux à l’échelle individuelle, mais aussi plus largement l’échec des aspirations plus importantes du régime de Vichy à établir un nouvel ordre moral en France. A partir de la fiction d’Aymé, cet article permet d’étudier les adaptations économiques à la disette, les mobilisations sociales contre les conditions du ravitaillement sous l’Occupation et après celleci, et la crainte que ces différents comportements ne conduisent au déclin moral de la population française.
Hedgehog and retinoic acid signaling cooperate to promote motoneurogenesis in zebrafish
Authors: Mich John K. , Chen James K.
Published: November 2011

The precise requirements of Hedgehog (Hh) pathway activity in vertebrate central nervous system development remain unclear, particularly in organisms with both maternally and zygotically derived signaling. Here we describe the motoneural phenotype of zebrafish that lack maternal and zygotic contributions of the Hh signaling transducer Smoothened (MZsmo mutants) and therefore are completely devoid of ligand-dependent pathway activation. Some functional primary motoneurons (PMNs) persist in the absence of Hh signaling, and we find that their induction requires both basal Gli transcription factor activity and retinoic acid (RA) signaling. We also provide evidence that RA pathway activation can modulate Gli function in a Hh ligand-independent manner. These findings support a model in which Hh and RA signaling cooperate to promote PMN cell fates in zebrafish.
A conserved PTEN/FOXO pathway regulates neuronal morphology duringC. elegansdevelopment
Authors: Christensen Ryan , de la Torre-Ubieta Luis , Bonni Azad , Colón-Ramos Daniel A.
Published: November 2011

The phosphatidylinositol 3-kinase (PI3K) signaling pathway is a conserved signal transduction cascade that is fundamental for the correct development of the nervous system. The major negative regulator of PI3K signaling is the lipid phosphatase DAF-18/PTEN, which can modulate PI3K pathway activity during neurodevelopment. Here, we identify a novel role for DAF-18 in promoting neurite outgrowth during development in Caenorhabditis elegans. We find that DAF-18 modulates the PI3K signaling pathway to activate DAF-16/FOXO and promote developmental neurite outgrowth. This activity of DAF-16 in promoting outgrowth is isoform-specific, being effected by the daf-16b isoform but not the daf-16a or daf-16d/f isoform. We also demonstrate that the capacity of DAF-16/FOXO in regulating neuron morphology is conserved in mammalian neurons. These data provide a novel mechanism by which the conserved PI3K signaling pathway regulates neuronal cell morphology during development through FOXO.
Exploratory and Exploitative Learning in New Product Development: A Social Capital Perspective on New Technology Ventures in China
Authors: Atuahene-Gima Kwaku , Murray Janet Y.
Published: November 2011

The authors examine the differential effects of the structural, relational, and cognitive dimensions of social capital on exploratory and exploitative learning in new product development in new ventures in China. In addition to investigating the potential nonlinear relationships between exploratory and exploitative learning and new product performance, the authors examine the relationship between the interaction of the two types of learning and new product performance. The findings suggest that different dimensions of social capital are indeed significantly related to the level of exploratory and exploitative learning. The results also support the argument that firms need a balance of exploratory and exploitative learning to enhance performance. The findings draw the attention of managers from multinational firms operating in China to the important role of social capital in enhancing new product performance.
Antibiotic Prescribing in Ambulatory Pediatrics in the United States
Authors: Hersh Adam L. , Shapiro Daniel J. , Pavia Andrew T. , Shah Samir S.
Published: November 2011

BACKGROUND:

Antibiotics are commonly prescribed for children with conditions for which they provide no benefit, including viral respiratory infections. Broad-spectrum antibiotic use is increasing, which adds unnecessary cost and promotes the development of antibiotic resistance.

OBJECTIVE:

To provide a nationally representative analysis of antibiotic prescribing in ambulatory pediatrics according to antibiotic classes and diagnostic categories and identify factors associated with broad-spectrum antibiotic prescribing.

PATIENTS AND METHODS:

We used the National Ambulatory and National Hospital Ambulatory Medical Care surveys from 2006 to 2008, which are nationally representative samples of ambulatory care visits in the United States. We estimated the percentage of visits for patients younger than 18 years for whom antibiotics were prescribed according to antibiotic classes, those considered broad-spectrum, and diagnostic categories. We used multivariable logistic regression to identify demographic and clinical factors that were independently associated with broad-spectrum antibiotic prescribing.

RESULTS:

Antibiotics were prescribed during 21% of pediatric ambulatory visits; 50% were broad-spectrum, most commonly macrolides. Respiratory conditions accounted for >70% of visits in which both antibiotics and broad-spectrum antibiotics were prescribed. Twenty-three percent of the visits in which antibiotics were prescribed were for respiratory conditions for which antibiotics are not clearly indicated, which accounts for >10 million visits annually. Factors independently associated with broad-spectrum antibiotic prescribing included respiratory conditions for which antibiotics are not indicated, younger patients, visits in the South, and private insurance.

CONCLUSIONS:

Broad-spectrum antibiotic prescribing in ambulatory pediatrics is extremely common and frequently inappropriate. These findings can inform the development and implementation of antibiotic stewardship efforts in ambulatory care toward the most important geographic regions, diagnostic conditions, and patient populations.
Patients’ Narratives of Chronic Illnesses and the Notion of Biographical Disruption
Authors: Delbene Roxana
Published: November 2011

Bury's (1982) argument that the onset of a chronic illness represents a biographical disruption has become paradigmatic in the sociology of illness studies. More recently Bury (1991, 1997) himself, Williams (2000) and other medical sociologists have argued that the notion of illness as biographical disruption needs re-examination. Following a phenomenological approach, in this paper the author draws on different narrative models (Labov and Waletzky 1967 and Ricoeur 1980) to analyze how patients orient to the onset of chronic illness as the complicating action. The data comprise eight narratives collected in South America: three correspond to patients with renal failure, and five to patients with HIV/AIDS disease. It is observed that in some cases, patients’ complicating actions are rather oriented to experiences of poverty, drug addiction, and criminality that took place prior to their onset of their illnesses. These experiences, instead of the onset of their illnesses, occupy the place of the complicating action in these patients’ narratives. The author discusses that in the studies of illness narratives, it is difficult to operate from a different paradigm, but argues that conflating the onset of chronic illness with a biographical disruption may confuse the episodic dimension of narrative with the configurational dimension.
Combining Interdisciplinary and International Medical Graduate Perspectives to Teach Clinical and Ethical Communication Using Multimedia
Authors: Woodward-Kron Robyn , Flynn Eleanor , Delany Clare
Published: November 2011

In Australia, international medical graduates (IMGs) play a crucial role in addressing workforce shortages in healthcare. Their ability to deliver safe and effective healthcare in an unfamiliar cultural setting is intrinsically tied to effective communication. Hospital based medical clinical educators, who play an important role in providing communication training to IMGs, would benefit from practical resources and an understanding of the relevant pedagogies to address these issues in their teaching. This paper aims to examine the nature of an interdisciplinary collaboration to develop multimedia resources for teaching clinical and ethical communication to IMGs. We describe the processes and dynamics of the collaboration, and outline the methodologies from applied linguistics, medical education, and health ethics that we drew upon. The multimedia consist of three video clips of challenging communication scenarios as well as experienced IMGs talking about communication and ethics. The multimedia are supported by teaching guidelines that address relevant disciplinary concerns of the three areas of collaboration. In the paper's discussion we point out the pre-conditions that facilitated the interdisciplinary collaboration. We propose that such collaborative approaches between the disciplines and participants can provide new perspectives to address the multifaceted challenges of clinical teaching and practice.
Periosteal Distraction Osteogenesis and Barrier Membrane Application: An Experimental Study in the Rat Calvaria
Authors: Saulacic Nikola , Schaller Benoit , Bosshardt Dieter D. , Buser Daniel , Jaun Pascal , Haeniwa Hideya , Iizuka Tateyuki
Published: November 2011

Background: Distraction of the periosteum results in the formation of new bone in the gap between the periosteum and the original bone. We postulate that the use of a barrier membrane would be beneficial for new bone formation in periosteal distraction.

Methods: To selectively influence the contribution of the periosteum, a distraction plate with perforations was used alone or covered by a collagen barrier membrane. All animals were subjected to a 7‐day latency period and a 10‐day distraction period with a rate of 0.1 mm/day. Four animals per group with or without a barrier membrane were sacrificed at 2, 4, and 6 weeks after the end of the distraction. The height of new bone generated relative to the areas bound by the parent bone and the periosteum was determined by histomorphometric methods.

Results: New bone was found in all groups. At the periphery of the distraction plate, significant differences in bone height were found between the hinge and the distraction screw for the group without barrier membrane at 2 weeks (0.39 ± 0.19 mm) compared to 4 weeks (0.84 ± 0.44 mm; P = 0.002) and 6 weeks (1.06 ± 0.39 mm; P = 0.004). Differences in maximum bone height with and without a barrier membrane were observed laterally to the distraction plate at 2 weeks (1.22 ± 0.64 versus 0.55 ± 0.14 mm; P = 0.019) and 6 weeks (1.61 ± 0.56 versus 0.73 ± 0.33 mm; P = 0.003) of the consolidation period.

Conclusion: Within the limitations of the present study, the application of a barrier membrane may be considered beneficial for new bone formation induced by periosteal distraction.
Right-sided aortic arch with anomalous origin of the left subclavian artery: Case report
Authors: Vucurevic Goran , Tanaskovic Slobodan , Ilijevski Nenad , Kovacevic Vladimir , Kecmanovic Vladimir , Radak Djordje
Published: November 2011

Introduction. A right-sided aortic arch is a rare congenital defect of the
aorta with incidence of 0.05% to 0.1% reported in published series. Usually
it is associated with congenital heart anomalies and esophageal and tracheal
compression symptoms. We present a case of a right-sided aortic arch of
anomalous left subclavian artery origin, accidentally revealed during
multislice CT (MSCT) supraaortic branches angiography. Case Outline. A
53-year-old female patient was examined at the Outpatients? Unit of the
Vascular Surgery University Clinic for vertigo, occasional dizziness and
difficulty with swallowing. Physical examination revealed a murmur of the
left supraclavicular space, with 15 mmHg lower rate of arterial tension on
the left arm. Ultrasound of carotid arteries revealed 60% stenosis of the
left subclavian artery and bilateral internal carotid artery elongation. MSCT
angiography revealed a right-sided aortic arch with aberrant separation of
the left subclavian artery that was narrowed 50%, while internal carotid
arteries were marginally elongated. There was no need for surgical treatment
or percutaneous interventions, so that conservative treatment was indicated.
Conclusion. A right-sided aortic arch is a very rare anomaly of the location
and branching of the aorta. Multislice CT angiography is of great importance
in the diagnostics of this rare disease.
Radioactivity of phosphate mineral products
Authors: Mitrovic Branislava , Vitorovic Gordana , Stojanovic Mirjana , Vitorovic Dusko
Published: November 2011

The phosphate industry is one of the biggest polluters of the environment
with uranium. Different products are derived after processing phosphoric ore,
such as mineral and phosphate fertilizers and phosphate mineral supplements
(dicalcium-and monocalcium phosphate) for animal feeding. Phosphate mineral
additives used in animal food may contain a high activity of uranium.
Research in this study should provide an answer to the extent in which
phosphate mineral products (phosphate fertilizer and phosphate mineral feed
additives) contribute to the contamination of soil, plants and animals.
Gray Markets and Multinational Transfer Pricing
Authors: Autrey Romana L. , Bova Francesco
Published: November 2011

Gray markets arise when a manufacturer's products are sold outside of its authorized channels, for instance when goods designated by a multinational firm for sale in a foreign market are resold domestically. One method multinationals use to combat gray markets is to increase transfer prices to foreign subsidiaries in order to increase the gray market's cost base. We illustrate that, when a gray market competitor exists, the optimal transfer price to a foreign subsidiary exceeds marginal cost and is decreasing in the competitiveness of the domestic market. However, a multinational's discretion in setting transfer prices may be limited by mandatory arm's length transfer pricing rules. Provided gray markets exist, we characterize when mandating arm's length transfer pricing lowers domestic social welfare relative to unrestricted transfer pricing. We also demonstrate that gray markets can lead to higher domestic tax revenues, even when gray market firms do not pay taxes domestically.
Wittgenstein, von Wright and the Myth of Progress
Authors: Bouveresse Jacques
Published: November 2011

The Viennese satirist Karl Kraus called progress a ‘standpoint that looks like movement’ and a ‘mobile decoration’: a politically useful slogan devoid of content. Despite his tendency to think in the revolutionary mode of the tabula rasa, Ludwig Wittgenstein was a cultural conservative, sceptical of progress. He shares this pessimistic scepticism with some, but not all, of the early twentieth-century Viennese writers he read enthusiastically (strong sceptics include Kraus but not Robert Musil). It would, however, be too simple to claim that Wittgenstein did not believe in the possibility of progress. Rather, he thought it mistaken to confuse progress with continued movement in one direction. Georg Henrik von Wright, Wittgenstein's student and successor at Cambridge, has discussed the ‘myth of progress’ in Wittgenstinian terms; the relevance of these analyses of progress in contemporary political discourse is examined.
Coronary Artery Anomalies Presenting with St-segment Elevation Myocardial Infarction
Authors: Marchesini Jlenia , Campo Gianluca , Righi Riccardo , Benea Giorgio , Ferrari Roberto
Published: November 2011

ST-segment elevation MI (STEMI) is a rare presentation in patients with coronary artery anomalies. In these patients, the identification of the culprit lesion and its treatment may be difficult, particularly in the emergency setting of primary percutaneous coronary intervention (PCI). From January 2008 to April 2011, 1015 STEMI patients received coronary artery angiography and primary PCI in our centre. Of these, 5 (0.4%) patients showed a coronary artery anomaly. In this paper we reported two rare cases: i) the first is a single coronary artery originating from right sinus of Valsalva; ii) the second is a separate origin of 3 coronary arteries originating from the right sinus of Valsalva. In conclusion, coronary artery anomalies presenting with STEMI are really uncommon, but often are a challenge. The integration between traditional coronary artery angiography and multidetector computerized tomography is crucial to optimize the interventional and medical management of these patients.
Current Approaches to the Treatment of Non-Hodgkin's Lymphoma
Authors: Gisselbrecht Christian
Published: November 2011

Chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) has long been a standard treatment for lymphoma. Improvements to the efficacy of this regimen can be made by increasing the doses of doxorubicin and cyclophosphamide, as in the chemotherapeutic regimen of doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone (ACVBP), and by reducing the standard dosing interval, as seen with the CHOP-14 regimen. Adding the immunotherapeutic agent rituximab (R) to either CHOP or ACVBP has been shown to improve outcomes significantly, such that six cycles of R-CHOP plus two cycles of rituximab are as effective as eight cycles of R-CHOP, and R-CHOP-21 appears to be at least as effective as the more dose-intense R-CHOP-14. In patients who have several adverse prognostic factors, RACVBP plus autologous stem-cell transplantation has been shown to produce good treatment outcomes. The use of positron emission tomography scanning before and early in treatment should allow prediction of long-term outcomes, and therefore the adaptation of treatment to individual prognosis and treatment needs. In patients with follicular lymphoma, rituximab has been shown to improve the efficacy of conventional chemotherapies. In addition, rituximab alone or yttrium-90-ibritumomab tiuxetan are effective maintenance therapies in this condition.
SIOG (International Society of Geriatric Oncology) Recommendations for Anthracycline Use in the Elderly
Authors: Aapro Matti
Published: November 2011

A taskforce of the International Society of Geriatric Oncology (SIOG) has recently submitted recommendations on the use of anthracyclines in elderly patients. Despite the aging of the population and the high proportion of elderly individuals in the population of patients with non-Hodgkin’s lymphoma, the development of specialist expertise in the treatment of elderly patients with cancer is relatively recent. Treatment of the elderly is complex because they are a highly heterogeneous population, with large variations in health status, comorbidities and life expectancy. In addition, these patients are generally more susceptible than young patients to the cardiotoxic effects of anthracyclines. Strategies for assessing elderly patients with cancer, reducing the risk of congestive heart failure, and assessing the cardiotoxic effects of treatments are discussed. In addition, a summary of the SIOG recommendations is presented.
Influence of parents’ and caregivers’ characteristics on the outcomes of antiretroviral treatment in Ugandan children
Authors: Malangu Ntambwe
Published: November 2011

Background: The purpose of this study was to investigate whether there was an association between characteristics of parents and caregivers, and the outcomes of antiretroviral treatment in children younger than 6 years treated at Mildmay Centre in Uganda. Methods: This study was a cross-sectional study based on the review of records. The records of children treated from January 2000 to July 2005 were included in the analysis as part of a larger study. Descriptive and inferential statistics were used in the analysis of data.Results: Of the 179 children, 57.3% were male, 53.4% were 4–5 years, and their median age was 4 years. The majority of children were cared for, in descending order, by their mothers, aunts, grandmothers, and fathers. Whilst 16.0% were orphans of both parents, 56.9% had one of their parents still alive. With regard to outcomes of antiretroviral treatment, it was found that a CD4 count of less than 15% was the most significant predictor of death, when treatment was initiated only at that late stage. When the influence of caregivers’ and parents’ characteristics on the outcomes of treatment were considered, the only factor that was associated significantly with clinical improvement was the ‘father’s unknown human immunodeficiency virus (HIV) status’. The data show that when the father was alive, as well as when both parents were alive, the children had a better chance of survival.Conclusion: The nature of the relationship between caregivers and children on antiretroviral treatment, as well as the HIV and living status of their parents seem to have little positive influence on the clinical, immunological, and survival outcomes of the children on treatment. More studies are needed to investigate other characteristics and relationships that may influence the outcomes of treatment.
Entrepreneurial education’s and entrepreneurial role models’ influence on career choice
Authors: Muofhe Nnditsheni J. , Du Toit Willem F.
Published: November 2011

Orientation: Little research has been done into the impact of entrepreneurial education and entrepreneurial role models on entrepreneurship as a career choice, especially in developing countries.Research purpose: The purpose of the study is to firstly explore the differences in entrepreneurial intentions between entrepreneurship students and non-entrepreneurship students, and secondly to investigate the relationship between entrepreneurial education and entrepreneurial intentions as well as between role models and entrepreneurial intentions.Motivation for the study: There is a need for stakeholders, such as training authorities and training providers, to understand the influence of entrepreneurship education and role models on entrepreneurial career choice. Knowing this could assist in developing and implementing more effective entrepreneurial education programmes.Research design, approach and method: The study was conducted amongst a convenience sample of 269 final-year students, of which 162 (60.2%) were entrepreneurship and 107 (39.8%) non-entrepreneurship students from a higher education institution in Johannesburg. The entrepreneurial intentions of entrepreneurship students were compared with those of non-entrepreneurship students. The findings of the study suggest that entrepreneurship students have stronger entrepreneurial intentions than non-entrepreneurship students, and that there is a positive relationship between entrepreneurship education and entrepreneurial intentions and between role models and entrepreneurial intentions respectively.Practical/managerial implications: Entrepreneurship stakeholders can use the findings of the study to improve curriculum design, delivery methods and assessment strategies in their efforts to advance entrepreneurship.Contribution/value-add: The findings of the study suggest that entrepreneurship education and role models can influence students’ entrepreneurial intentions in a developing country.
Effectiveness of an Integrated Handwriting Program for First-Grade Students: A Pilot Study
Authors: Case-Smith Jane , Holland Terri , Bishop Beth
Published: November 2011

We developed and piloted a program for first-grade students to promote development of legible handwriting and writing fluency. The Write Start program uses a coteaching model in which occupational therapists and teachers collaborate to develop and implement a handwriting–writing program. The small-group format with embedded individualized supports allows the therapist to guide and monitor student performance and provide immediate feedback. The 12-wk program was implemented with 1 class of 19 students. We administered the Evaluation of Children’s Handwriting Test, Minnesota Handwriting Assessment, and Woodcock–Johnson Fluency and Writing Samples test at baseline, immediately after the Write Start program, and at the end of the school year. Students made large, significant gains in handwriting legibility and speed and in writing fluency that were maintained at 6-mo follow-up. The Write Start program appears to promote handwriting and writing skills in first-grade students and is ready for further study in controlled trials.
Influence of intense scavenging on Pa-Th fractionation in the wake of Kerguelen Island (Southern Ocean)
Authors: Venchiarutti C. , Roy-Barman M. , Freydier R. , van Beek P. , Souhaut M. , Jeandel C.
Published: November 2011

Abstract. Dissolved and particulate excess 230Th and 231Pa concentrations (noted 230Thxs and 231Paxs respectively) and 231Paxs/230Thxs activity ratios were investigated on and out of the Kerguelen plateau (Southern Ocean) in the framework of the Kerguelen Ocean and Plateau compared Study project in order to better understand the influence of particle flux and particle chemistry and advection on the scavenging of 231Pa. In the wake of Kerguelen, particulate 231Paxs is relatively abundant compared to its content in the dissolved phase. This, together with the low fractionation observed between 230Th and 231Pa (FTh/Pa ranging from 0.06 ± 0.01 to 1.6 ± 0.2) reflects the domination of the biogenic silica in the particle pool. Along the eastern escarpment of the Kerguelen plateau, the strong 231Paxs horizontal gradient in the deep waters highlights the intense removal of 231Pa at depth, as already observed for 230Thxs. This local boundary scavenging was attributed to re-suspension of opal-rich particles by nepheloid layers, resulting in fractionation factors FTh/Pa ≤ 1 along the Kerguelen plateau slope. Therefore, both the composition (biogenic opal) and the flux (intense along the margin) of particles control the scavenging of the two radionuclides in the Kerguelen wake. The modelling of 231Pa distribution with an advection-scavenging model demonstrates that lateral advection of open ocean water on the Kerguelen plateau could supply most of the 231Pa, which is then efficiently scavenged on the highly productive plateau, as previously proposed for 230Thxs. It stresses that lateral advection can play a significant role in the overall budget of particle reactive trace elements in a coastal-open ocean system.
The Middle Miocene climate as modelled in an atmosphere-ocean-biosphere model
Authors: Krapp M. , Jungclaus J. H.
Published: November 2011

Abstract. We present simulations with a coupled atmosphere-ocean-biosphere model for the Middle Miocene 15 million years ago. The model is insofar more consistent than previous models because it captures the essential interactions between ocean and atmosphere and between atmosphere and vegetation. The Middle Miocene topography, which alters both large-scale ocean and atmospheric circulations, causes a global warming of 0.7 K compared to present day. Higher than present-day CO2 levels of 480 and 720 ppm cause a global warming of 2.8 and 4.9 K. The associated water vapour feedback enhances the greenhouse effect which leads to a polar amplification of the warming. These results suggest that higher than present-day CO2 levels are necessary to drive the warm Middle Miocene climate, also because the dynamic vegetation model simulates a denser vegetation which is in line with fossil records. However, we do not find a flatter than present-day equator-to-pole temperature gradient as has been suggested by marine and terrestrial proxies. Instead, a compensation between atmospheric and ocean heat transport counteracts the flattening of the temperature gradient. The acclaimed role of the large-scale ocean circulation in redistributing heat cannot be supported by our results. Including full ocean dynamics, therefore, does not solve the problem of the flat temperature gradient during the Middle Miocene.