bluuebunny/crossref_metadata_2025 huggingface dataset:
A Decrease in the Density of HLA-DR-Positive Cells Occurs Faster in Corneas Stored in Organ Culture than under Hypothermic Conditions
Authors: Al-Fakih Aref , Faltus Vaclav , Jirsova Katerina
Published: June 2011

Aims: To compare the number of antigen-presenting cells (APC) at various locations in fresh human corneoscleral disks and in those that are stored for grafting under hypothermic conditions or in organ culture (OC) with the aim of determining the conditions under which the decline in APC numbers is most substantial. Methods: Cryosections obtained from fresh corneoscleral disks and disks stored under hypothermic (Optisol-GS) or OC conditions were used. The density of HLA-DR-positive cells was determined on cross sections using enzyme immunohistochemistry (alkaline phosphatase-antialkaline phosphatase technique). Longitudinal sections were used for detecting ATPase activity. Results: The densities of HLA-DR-positive cells in both the epithelium and stroma increased from the central (3.79 and 0.61/mm2) to the peripheral cornea (5.56 and 1.35/mm2) as well as to the limbus and conjunctiva. A marked decrease in the number of HLA-DR-positive cells occurred after 7 days of storage in all corneal areas, the limbus and conjunctiva, compared to fresh tissue. No positive cells were found in the epithelium of corneas after 14 days in OC and after 21 days in hypothermic storage. Twenty-eight days of storage in OC led to the complete absence of HLA-DR-positive cells in the epithelium of the limbus and conjunctiva, and to a significant reduction in the stroma. Conclusion: Corneas stored in OC longer than 14 days are likely to be less immunogenic than corneas stored under hypothermic conditions, thus resulting in a possible positive effect on prolonging graft survival.
Nutrition of Preterm Infants after Discharge
Authors: Cooke Richard
Published: June 2011

The fundamental principle underlying nutritional support is that intake meets needs thereby ensuring the best outcome, which, in the case of the preterm infant, is optimal growth and development. Achieving this goal is problematic. Most, if not all, very-low-birth-weight infants (VLBWI) are undernourished and under-grown when they are first discharged from the hospital. This has important implications for the nutritional care of preterm, particularly the breast-fed, VLBWI after hospital discharge.
Long-Term Outcomes after Robotic Sacrocolpopexy in Pelvic Organ Prolapse: Prospective Analysis
Authors: Moreno Sierra Jesús , Ortiz Oshiro Elena , Fernandez Pérez Cristina , Galante Romo Isabel , Corral Rosillo Javier , Prieto Nogal Sara , Castillon Vela Ignacio T. , Silmi Moyano Angel , Alvarez Fernandez-Represa J.
Published: June 2011

Objective: To evaluate the feasibility and long-term outcomes of our initial series of robot-assisted laparoscopic sacrocolpopexy. Methods: We conducted a prospective analysis of our series of robotic sacrocolpopexy. Inclusion criteria: patients with grades III and IV cystocele and or other symptomatic pelvic organ prolapse. We performed a transperitoneal four-trocar technique with the Da Vinci robotic system using two polypropylene meshes for fixation to the sacral promontory. The primary outcome was recurrence; secondary outcomes included operating room time, blood loss, conversion to open surgery, complications and length of stay. Results: 31 consecutive procedures were included. Mean patient age was 65.2 (50–81) years. Mean operating room time was 186 (150–230) min. We converted 1 case to laparoscopy (3.2%). There were two major complications (1 acute myocardial infarction and 1 reoperation for excess tension with syncopes), two minor complications (1 wound infection and 1 ileus) and no recurrences at a mean follow-up of 24.5 (16–33) months. Conclusions: Robotic sacrocolpopexy could possibly improve with experience after overcoming the learning curve. There is no doubt it is a reproducible technique, but its safety and efficacy still need to be proven. Our initial series demonstrated good outcomes and no recurrences at 24.5 months of follow-up.
Long-Term Survival in a Patient with Node-Positive Adult-Onset Xp11.2 Translocation Renal Cell Carcinoma
Authors: Aoyagi Toshiki , Shinohara Nobuo , Kubota-Chikai Kanako , Kuroda Naoto , Nonomura Katsuya
Published: June 2011

Adult-onset Xp11.2 translocation renal cell carcinoma is a rare malignancy that has an aggressive clinical course and poor prognosis. The reasons for this include the fact that most patients have an advanced clinical stage at diagnosis and also that there is a lack of effective systemic therapy. We herein present the case of a 32-year-old woman suffering from node-positive Xp11.2 translocation renal cell carcinoma who underwent radical nephrectomy with an extensive retroperitoneal lymph node dissection, followed by two times of surgical resection for recurrent nodal disease. The patient has experienced no recurrent disease 4.5 years after the last operation and remains free of disease. Surgical approach to recurrent disease, if the recurrent site can be judged to be limited, might be one of the feasible treatment options in patients with Xp11.2 translocation renal cell carcinoma.
Impact of Clinical Parameters on the Diagnostic Accuracy of Endorectal Coil MRI for the Detection of Prostate Cancer
Authors: Colleselli Daniela , Hennenlotter Jörg , Schilling David , Krueger Stefan A. , Roethke Mathias , Lichy Mathias P. , Vogel Ullrich , Kuehs Ursula , Schlemmer Heinz-Peter , Stenzl Arnulf , Schwentner Christian
Published: June 2011

Objectives: Endorectal coil MRI (endoMRI) of the prostate is useful to evaluate tumor localization. There is little evidence on patient characteristics affecting its diagnostic performance. We evaluate the influence of clinical and histological parameters on the accuracy of endoMRI. Methods: Sixty-nine patients with prostate cancer were included. After virtually dividing the prostate into pixels of 1 cm2, results of endoMRI were compared with those from prostatectomy specimens’ whole-mount sections. Univariate and multivariate analyses were performed to calculate the impact of clinical and histological parameters on the number of appropriately described pixels. Results: In 9, no tumor could be demonstrated by endoMRI. 48.3% of patients were staged correctly, 23.3% were over- and 28.3% understaged. Mean rates of correctly labeled pixels were 0.44 (± 0.04 SEM) for tumor and 0.90 (± 0.01) for benign segments. In univariate analysis, the rate of correctly labeled tumor segments showed significant positive correlations with Gleason score ≧7 and negative correlations with prostate weight and multifocality. The rate of correctly labeled benign segments showed significant negative correlation with tumor weight. All factors were independent variables in multivariate analysis. Conclusions: The reliability of endoMRI depends on clinical parameters. Higher Gleason scores, unifocal tumors and smaller prostate volumes ameliorate endoMRI performance.
The Association between Erection Hardness Grading Scale and International Index of Erectile Function in Men with Erectile Dysfunction Treated with Sildenafil Citrate
Authors: Aslan Yilmaz , Tuncel Altug , Aydin Omur , Balci Melih , Karabulut Erdem , Atan Ali
Published: June 2011

Introduction: To evaluate the association between the first 5-item version of the International Index of Erectile Function (IIEF-5) and Erection Hardness Grading Scale (EHGS) scores in patients who received sildenafil citrate treatment due to erectile dysfunction (ED). Patients and Methods: A total of 81 men with ED lasting for 6 months or longer were included in this study. Mean age was 51 years (range 21–75). All patients were given 50 mg sildenafil citrate (Viagra®) 4 times a week during an 8-week period and they were asked to attempt sexual intercourse when they used the drug. Results: The mean pretreatment IIEF-5 and EHGS scores were 6.7 ± 2.5 and 1.7 ± 0.5, respectively. These values were 15.3 ± 5.1 and 2.8 ± 0.6 after the treatment, respectively. There were statistically significant differences in all scores between before and after treatment for IIEF-5 and EHGS scores (p < 0.001). We found a very strong association between IIEF-5 and EHGS scores in the pretreatment period (gamma = 0.916, p < 0.001). However, there was a fair agreement between IIEF-5 and EHGS scores (kappa coefficient: 0.375). Conclusions: Our experience showed that there was no significant agreement between the IIEF-5 and EHGS scores in patients treated with sildenafil citrate.
Role of Preoperative and Intraoperative Factors in Mediating Infection Complication following Percutaneous Nephrolithotomy
Authors: Lojanapiwat B. , Kitirattrakarn P.
Published: June 2011

Objective: To identify the pre- and intraoperative factors that affect the development of postoperative systemic inflammatory response syndrome (SIRS) following percutaneous nephrolithotomy (PCNL). Patients and Methods: A total of 200 patients were treated with PCNL, 56 of which developed postoperative SIRS (group I) and 144 did not (group II). For these 2 groups, the patient factor, operative factor, preoperative urine culture, pelvic urine culture, and stone culture were compared. Results: Average age, stone size, operative time, success rate, and number of tubeless PCNL were not significantly different between the 2 groups. However, preoperative urine culture, pelvic urine culture, and stone culture, respectively, were positive in 66.1, 46.4 and 48.2% of the patients in group I, but only 10.4, 3.5 and 3.5% for the corresponding specimens in group II. In addition, 5 patients in group I developed clinical septic shock, 4 of which were positive for all cultures and 1 positive only for stone culture. Conclusion: Infection following PCNL is common, but only a few cases progress to septic shock. Positive preoperative urine, intraoperative pelvic urine and stone cultures are important factors indicating the development of postoperative SIRS. Intraoperative cultures are important for decision-making about the treatment of postoperative infection complications.
Variability of Influenza AH1N1 Infections in a Neonatal Unit in Spain
Authors: Calvo Cristina , Gonzalez-Carrasco Ersilia , Quevedo Sergio , García-García Maria Luz , Rando Alvaro , Ledesma Juan , Calderon Ana , Pozo Francisco , Pérez-Breña Pilar , Casas Inmaculada
Published: June 2011

We describe three positive influenza AH1N1 cases in a neonatal unit during the influenza pandemic in Spain. One term baby presented with an upper respiratory tract infection, another preterm infant with an apnea episode following nosocomial infection, and thirdly, a term infant of a mother with influenza AH1N1 had severe respiratory distress and pneumothoraces needing high-frequency ventilation.
Managing Mesh Erosion after Abdominal Pelvic Organ Prolapse Repair: Ten Years’ Experience in a Single Center
Authors: Costantini Elisabetta , Zucchi Alessandro , Lazzeri Massimo , Del Zingaro Michele , Vianello Alberto , Porena Massimo
Published: June 2011

Objective: To report conservative and surgical strategies for treatment of mesh erosion after pelvic organ prolapse (POP) repair. Methods: Between 1998 and 2008, 179 patients underwent integral pelvic floor reconstruction for advanced POP in our tertiary urogynecological unit. Patients’ charts and follow-up data were entered into a computerized database and data analysis performed to search for mesh erosion/complications/surgery. Results: 12 patients were diagnosed and treated for mesh erosion: in 10 of 179, surgery was performed in our department and the mesh used was polypropylene (PP): 3 after colposacropexy (CSP) (5.5%), 5 after CSP + hysterectomy (Hys) (6.5%), and 2 after hysterosacropexy (HSP) (3.9%); in 1 case, Gore-tex mesh was used, and another case had undergone CSP in another hospital using PP mesh. Time to mesh erosion ranged from 2 to 66 months (mean 22.9), with 4 erosions (33%) within 6 months of POP repair. In 4 asymptomatic patients (33%) erosion was incidentally discovered during clinical check-ups at 4, 31, 36 and 66 months. Five cases (41%) presented with occasional vaginal bleeding, associated with dyspareunia in 2. Treatments were individualized but in all cases conservative treatment was unable to resolve the complications and surgery was needed. At a mean follow-up of 57 months (range 18–120) after surgical treatment all patients were asymptomatic and free from erosions. Conclusions: The surgeon who approaches management of complications after abdominal/laparoscopic sacropexy should possess a comprehensive understanding of pelvic floor anatomy and surgical skills in order to individualize the management of such complications.
Surgical Repair and Analysis of Penile Fracture Complications
Authors: Moreno Sierra Jesús , Garde Garcia Hector , Fernandez Perez Cristina , Galante Romo Isabel , Chavez Roa Cesar , Senovilla Perez Jose Luis , Silmi Moyano Angel
Published: June 2011

Background: The objective of this study is to describe and analyze the experience over a period of 10 years at our center through a retrospective study of a series of diagnosed and treated cases of penile fracture. Material and Methods: From 2005 to 2009 the Urology Department of the Hospital Clínico San Carlos of Madrid carried out a retrospective case study of a total of 15 cases of penile fracture. The diagnosis was reached through physical exploration of the patient aided by a penile ultrasound; the immediate treatment performed on the patients was emergency surgical repair. Results: From the total in the series (n = 15), only 1 case was associated with a complete urethral fracture (6.6%). Surgical repair was performed in all cases; the average hospital stay was 2.6 days (range 1–5), and the most frequent long-term complication was erectile dysfunction in 3 of 15 cases (20%). Conclusions: A penis fracture diagnosis is mostly clinical; complementary tests, such as ultrasound, are helpful but not definitive. Surgical treatment consists of an incision that allows adequate exposure of the corpora cavernosa and urethra to repair the suspected lesions found upon diagnosis. Ambulatory follow-up is essential to diagnose and treat possible complications.
Clinical Characteristics and Outcomes of Patients with Primary Signet-Ring Cell Carcinoma of the Urinary Bladder
Authors: Wang Jue , Wang Fen Wei
Published: June 2011

Objective: The aim of this study was to examine the epidemiology, natural history, treatment pattern and predictors of long-term survival of patients with signet-ring cell carcinoma (SRCC) of the urinary bladder based on the analysis of the national Surveillance, Epidemiology, and End Results (SEER) database. Methods and Results: In total, 230 patients with pathologically confirmed SRCC of the urinary bladder were identified between 1973 and 2004. The mean age was 65 ± 13 years. Overall, 75.7% of the patients had a poorly differentiated or undifferentiated histology grade, 26.5% presented with metastatic disease, 59 (25.7%) underwent transurethral resection for bladder tumor only and 107 (46.5%) had partial or radical cystectomy. The 1-, 3- and 10-year cancer-specific survival rates were 66.8, 40.6 and 25.8%, respectively. Using multivariable Cox proportional hazard model, age (HR 1.024; p = 0.004), stage (distant vs. local, HR 6.2; p < 0.001) and cystectomy (HR 0.53; p = 0.002) were identified as independent predictors for cancer-specific survival. Conclusions: Receipt of cystectomy was strongly associated with improved survival in the patients with SRCC of urinary bladder. However, many patients with localized tumors did not receive potentially curative cystectomy. Further studies to address the barriers to the delivery of appropriate care to these patients are warranted.
Urodynamic Parameters Development and Complications of Clean Intermittent Self-Catheterization in Chinese Schoolchildren with Neurogenic Underactive Bladder
Authors: Wang Qing Wei , Song Dong Kui , Zhang Xue Pei , Wu Yu Dong , Zhang Rui Li , Wei Jin Xing , Wen Jian Guo
Published: June 2011

Objective: To evaluate the urodynamic parameters, development of bladder function and complications of clean intermittent self-catheterization (CIC) in Chinese schoolchildren with neurogenic underactive bladder. Methods: Ninety-three children with neurogenic underactive bladder were successfully treated with CIC or combined with oxybutynin for two years follow-up. According to bladder compliance before CIC, they were subdivided into a normal bladder compliance (NBC) group and a low bladder compliance (LBC) group. Urodynamic parameters and complications were recorded. Results: At follow-up, the incidence of neurogenic detrusor overactivity was found to have significantly decreased in both groups. Moreover, maximum cystometric capacity (CC) and relatively safe CC in the NBC group was significantly higher than those before CIC. However, relatively safe CC was significantly lower than that before CIC, and detrusor leakage point pressure was significantly higher than that before CIC in the LBC group. The incidences of bacteriuria, vesicureteral reflux (VUR), febrile urinary tract infections (UTI) and macroscopic hematuria were, respectively, 62, 13, 25 and 15%, and those of VUR and febrile UTI in the LBC group were significantly higher than those in the NBC group. Conclusion: For these cases, the complications of CIC are rare, and bladder compliance seems to be correlated with the development of bladder function and complications during CIC.
Decorin and Colchicine as Potential Treatments for Post-Haemorrhagic Ventricular Dilatation in a Neonatal Rat Model
Authors: Hoque Nicholas , Thoresen Marianne , Aquilina Kristian , Hogan Sarah , Whitelaw Andrew
Published: June 2011

Background: Post-haemorrhagic ventricular dilatation (PHVD) after intraventricular haemorrhage (IVH) remains a significant problem in preterm infants. Due to serious disadvantages of ventriculoperitoneal shunt dependence, there is an urgent need for non-surgical interventions. Considerable experimental and clinical evidence implicates transforming growth factor β (TGFβ) in the pathogenesis of PHVD. Colchicine and decorin are both compounds with anti-TGFβ properties. The former downregulates TGFβ production and is in clinical use for another fibrotic disease, and the latter inactivates TGFβ. Objectives: We hypothesized that administration of decorin or colchicine, which both have anti-TGFβ properties, would reduce ventricular dilatation in a model of PHVD. Methods: 142 rat pups underwent intraventricular blood injection on postnatal days (PN) 7 and 8. Sixty-nine pups were randomized to colchicine 20 and 50 µg/kg/day or water by gavage for 13 days. Seventy were randomized to decorin 4 mg/kg or saline by intraventricular injection on PN8 and PN13. At PN21, the ventricular area was measured on coronal brain sections. Negative geotaxis was tested at PN14 in controls and in the decorin study group. Results: Ventricular size was not different between animals receiving either drug or water/saline. Intraventricular blood impaired neuromotor performance, but decorin had no effect. Conclusion: Two drugs that block TGFβ by different mechanisms do not reduce ventricular dilatation in this model. Together with our previous work on losartan and pirfenidone, we conclude that blocking TGFβ alone does not prevent the development of PHVD.
Vladimir Mikhailovic Bekhterev (1857–1927): Strange Circumstances Surrounding the Death of the Great Russian Neurologist
Authors: Kesselring Jürg
Published: June 2011

The famous Russian neurologist Vladimir Mikhailovic Bekhterev (1857–1927) was ordered to examine Josef Stalin in December 1927 during the First All-Russian Neurological Congress in Moscow. Returning to the Congress after his consultation he told some colleagues that he had ‘examined a paranoiac with a dry, small hand’. The next day, Bekhterev died and only his brain was examined postmortem, the body being cremated the same day.
How Much Can A Priori Hydrologic Model Predictability Help in Optimal Merging of Satellite Precipitation Products?
Authors: Gebregiorgis Abebe , Hossain Faisal
Published: June 2011

In this study, the authors ask the question: Can a more superior precipitation product be developed by merging individual products according to their a priori hydrologic predictability? The performance of three widely used high-resolution satellite precipitation products [Tropical Rainfall Measuring Mission (TRMM) real-time precipitation product 3B42 (3B42-RT), the NOAA/Climate Prediction Center morphing technique (CMORPH), and Precipitation Estimation from Remotely Sensed Information using Artificial Neural Networks-Cloud Classification System (PERSIANN-CCS)] was evaluated in terms streamflow predictability for the entire Mississippi River basin using the Variable Infiltration Capacity (VIC) macroscale hydrologic model. A merging concept that was not based on a single universal merging formula for the whole basin but rather used a “localized” (grid box by grid box) approach for merging precipitation products was then explored. In this merging technique, the a priori (historical) hydrologic predictive skill of each product for each grid box was first identified. Prior to streamflow routing, the corresponding accuracy of the spatially distributed simulations of soil moisture and runoff were used as proxy for weights in merging the precipitation products. It was found that the merged product derived on the basis of runoff predictability outperformed its counterpart merged product derived on the basis of soil moisture simulation. Results indicate that such a grid box by grid box merging concept that leverages a priori information on predictability of individual products has the potential to yield a more superior product for streamflow prediction than what the individual products can deliver for hydrologic prediction.
Visual Search Asymmetries in Heavy Clutter: Implications for Display Design
Authors: Yamani Yusuke , McCarley Jason S.
Published: June 2011

Objective: An experiment aimed to test whether design of symbology to produce visual search asymmetries might facilitate target detection in cluttered displays.

Background: A visual search asymmetry exists between two stimuli when a target of one type is found efficiently among distractors of the second type but a target of the second type is found with difficulty among distractors of the first type. Asymmetries have generally been studied within relatively sparse displays. In the present study, the authors tested whether an asymmetry driven by stimulus familiarity persists within heavily cluttered imagery.

Method: In this study, 10 participants performed a visual search task using stimuli (canonical vs. reversed Ns) known to produce a search asymmetry. Search stimuli were embedded within geospatial images containing either low or high levels of clutter. A decision theoretic index of sensitivity served as the dependent measure.

Results: The search asymmetry was robust against the presence of heavy display clutter. Specifically, sensitivity was greater when the target was a reversed N rather than an N, and this pattern remained within cluttered displays. Time-accuracy analysis revealed that the search asymmetry increased the rate of information accumulation roughly equally within low- and high- clutter images.

Conclusion: Search asymmetries are robust against heavy, spatially continuous visual clutter.

Application: Design of display symbology to produce visual search asymmetries can offset the costs of visual clutter, maximizing detectability of task-critical information in complex displays.
Hybrid model of evaluation of underground lead—zinc mine capacity expansion project using Monte Carlo simulation and fuzzy numbers
Authors: Gligoric Zoran , Beljic Cedomir , Gluscevic Branko , Jovanovic Sasa
Published: June 2011

Large capital intensive projects, such as those in the mineral resource industry, are often associated with diverse sources of both endogenous and exogenous risks and uncertainties. These risks can greatly influence the project profitability. Having the ability to plan for these uncertainties is increasingly recognized as critical to long-term mining project success. In the mining industry in particular, the relationships between input variables that are controllable, and those that are not, and the physical and economic outcomes are complex and often nonlinear. The value of managerial flexibility is assessed using data on prices, costs, discount rates, grades, ore extraction, and metal output. Monte Carlo simulation of the mean reversion process is used to forecast revenue data based on an initial metal price, by using annualized volatility. Monte Carlo simulation of the Geometric Brownian Motion is used to forecast operating costs. To quantify the uncertainty in the parameters within a project such as capital investment, ore grade, and mill recovery, we used triangular, uniform, and normal statistical distribution, respectively. To decrease uncertainty related to selection of the appropriate discount rate, we have applied the concept of fuzzy sets theory. The result is a Net Present Value (NPV) based on the cash flows generated by the simulation over the timeframe of the project. When using fuzzy numbers, the fuzzy NPV itself is the payoff distribution from the project. The model explains investment behavior satisfactorily, both from a statistical and from an economic point of view.
‘Creative Industry Clusters’ and the ‘Entrepreneurial City’ of Shanghai
Authors: Zheng Jane
Published: June 2011

This article evaluates the impact of ‘creative industry clusters’ on urban entrepreneurialism in Shanghai. It aims to introduce the concept of ‘creative industry clusters’ into the discussion of the ‘entrepreneurial city’ in China by testing two main arguments regarding the role of creative industry clusters, and to develop the concept of entrepreneurial city in China. The major argument is that, although these clusters are playing an important role in upgrading the city’s entrepreneurial features particularly in attracting business, they have made a limited contribution to fostering talent or boosting creative industry entrepreneurship. Three features of the entrepreneurial city of Shanghai are: the government’s stance of attracting capital and professionals; the continuation of urban commodification in character; and, the innovativeness of diversified forms of urban commodities within current urban policies. Such new forms of commodities, however, do not serve as new strategies designed specifically for creative industries.
Transport Impacts of Clustered Development in Beijing: Compact Development versus Overconcentration
Authors: Yang Jiawen , Shen Qing , Shen Jinzhen , He Canfei
Published: June 2011

This research aims to inform the compact city discussion with a case study of Beijing, where urban planning has emphasised clustered suburban development in the past half-century. It uses three decades of census data to describe Beijing’s spatial development trajectory and a household survey to assess its transport impacts. The research reveals an overconcentration of urban activities as a result of the featureless expansion of the central built-up area and the absorption of the suburban clusters; and, a lengthened commuting time stemming from the observed spatial development pattern. Beijing’s experience adds to the existing literature by informing the search for good city forms in urban areas of high density. It is essential to differentiate compact development from overconcentration when combating sprawling development. Developing and maintaining suburban nodal characteristics around public transit can reduce travel in high-density urban areas.
Forward into History
Authors: Buxton Julia
Published: June 2011

The 2008 presidential campaign in the United States raised expectations that the election of the Democratic Party candidate Barack Obama would lead to substantive change in the direction and execution of U.S. foreign policy. This has proved not to be the case. In relation to Obama’s Latin American policy, it is possible to speak of an entrenchment rather than a revision of George W. Bush’s strategy and assumptions. Examination of the complex of historical and institutional factors that constrain changes in modes and mechanisms of U.S. engagement suggests that the sclerosis that has characterized Obama’s conduct of hemispheric relations will compound the challenges faced by the United States on issues such as drugs, poverty, and immigration while deepening U.S. isolation and ideological distance from Latin American countries. At a theoretical level, Obama’s policy linearity with Bush calls into question assumed distinctions between Democratic and Republican Party approaches while highlighting the limited space for policy reform in the U.S. political system.
Obama and the Bolivarian Agenda for the Americas
Authors: Hellinger Daniel
Published: June 2011

President Barack Obama’s campaign rhetoric suggested a significant shift away from the militarist intervention practiced by U.S. administrations since the Reagan presidency, and his emphasis on multilateral diplomacy was endorsed by some key foreign policy elites. Focusing on home-grown obstacles to the hoped-for change in Latin American policy, such as domestic ideologies and narrow corporate interests, may underestimate the role of Latin American resistance and of the global shifts that have presented alternatives to the multilateral diplomacy of the OAS and the regional economic integration of the proposed Free Trade Area of the Americas. The Bolivarian agenda offers a direct challenge to neoliberal globalization as promoted by the United States under presidents of both parties. While for a number of reasons it is unlikely to bring U.S. hegemony in Latin America to an end, it has facilitated alternative forms of cooperation for economic integration and security, and this poses a significant dilemma for the Obama administration.
President Obama, the Crisis, and Latin America
Authors: Gandásegui Marco A.
Published: June 2011

Since his election in 2008, President Barack Obama has tried without success to disguise U.S. military initiatives and the neoconservative milieu inherited from George W. Bush without changing any of the government’s strategic goals. He has developed an economic plan similar to that of his predecessor, merely replacing fundamentalist neoliberals with pragmatic ones. More broadly, Latin America has practically been erased from the map in the White House. In particular, his administration has failed to deliver in three areas: ending the Cuban embargo, respecting democratic institutions in Venezuela, Bolivia, and Ecuador, and abandoning its military agenda (the Colombia Plan, the Mérida Initiative, the Fourth Fleet). Whatever changes Obama’s presence may have introduced into the White House, Latin America remains forgotten.
Promoting positive emotional health of children of transient armed forces families
Authors: Eodanable Miranda , Lauchlan Fraser
Published: June 2011

The focus of this research was to promote emotional health in a small primary school ( n = 180), with a highly transient pupil population of armed forces children (Service children). Negative effects of pupil mobility have been found to relate to academic attainment (Dobson, Henthorne, & Lynas, 2000; Mott, 2002), but its effect on social and emotional development is less specific. A multi-stranded approach to intervention was used, which included the delivery of pilot curricular materials on emotional literacy to two classes in the school, an educational programme (Seasons for Growth) delivered to a smaller group of pupils and the development of a specific critical incident policy in the event of a casualty notification. Post-intervention, evaluation measures did not point to increases in pupils’ emotional literacy scores but the qualitative data indicated that the emotional literacy curriculum did receive positive ratings by pupils and staff. Findings suggest the importance of an emotional health curriculum for a mobile school community and the role of parental involvement to sustain curricular interventions. Further research could investigate the extent of behavioural and emotional difficulties for mobile pupils across primary and secondary schools and the effect of a whole school approach to emotional literacy for this group of pupils. Implications for Educational Psychologists’ (EP) practice indicate an increasing role in psycho-education and integrated work with health agencies.
What triggers the establishment of a works council?
Authors: Mohrenweiser Jens , Marginson Paul , Backes-Gellner Uschi
Published: June 2011

This article analyses events that trigger the establishment of a works council and the actor or agent who triggers it. The article extends previous research in two dimensions. First, it examines specific events that motivate workers to establish a works council, such as a change of owner, founding a spin-off, a firm acquisition or a radical restructuring. These events express protection against uncertainty as workers’ primary motivation for establishing a works council. Second, the article analyses the actor or agent who triggers the establishment of a works council and shows that management is involved in one-third of all cases and has, in a minority of cases, motivated workers to establish a works council. Managerial involvement in the process of establishment reveals a positive managerial response to worker representation.
How Organizations Engage with External Complexity: A Political Action Perspective
Authors: Child John , Rodrigues Suzana B.
Published: June 2011

This paper offers a new insight into how organizations engage with external complexity. It applies a political action perspective that draws attention to the hitherto neglected question of how the relative power organizational leaders enjoy within their environments is significant for the actions they can take on behalf of their organizations when faced with external complexity. It identifies cognitive and relational complexity as two dimensions of the environment with which organizations have to engage. It proposes three modes whereby organizations may engage with environmental complexity that are conditioned by an organization’s power within its environment. It also considers the intention associated with each mode, as well as the implications of these modes of engagement for how an organization can learn about its environment and for the use of rationality and intuition in its strategic decision-making. The closing discussion considers how this analysis integrates complexity and political action perspectives in a way that contributes to theoretical development and provides the basis for a dynamic political co-evolutionary approach.
Disjunctured narratives: rethinking reconciliation and conflict transformation
Authors: Little Adrian
Published: June 2011

Reconciliation has been a notable part of discourses of conflict management and transitional justice in a number of conflictual situations around the world. This article examines the recent emergence of critical theories of reconciliation with particular reference to processes of conflict transformation in Northern Ireland. It evaluates the ways in which conflict transformation in Northern Ireland is specific to that context and the variations in the usage of discourses of reconciliation compared with other ‘post-conflict’ societies. The article highlights critical theories of reconciliation which, although largely supportive of the potential of reconciliation, tend to highlight the arguments and conflicts that notions of reconciliation can generate. By examining the ways in which reconciliation is articulated in Northern Ireland through interviews with representatives of the main political parties, the article contends that narrative approaches are best suited to analysis of the issues in Northern Irish politics. The argument developed here suggests that reconciliation in Northern Ireland is part of a ‘disjunctured synthesis’ whereby the main political parties become locked into narratives of reconciliation based on opposition to the perceived position of the other.
End-of-life care in hospitalized adults with complex congenital heart disease: care delayed, care denied
Authors: Tobler Daniel , Greutmann Matthias , Colman Jack M , Greutmann-Yantiri Mehtap , Librach Lawrence S , Kovacs Adrienne H
Published: June 2011

Adults with congenital heart disease represent a growing patient population. Notwithstanding dramatic improvements in survival and life expectancy over recent decades, many of these patients remain at risk of premature death from progressive heart disease and would benefit from the principles of palliative and end-of-life care. Data on end-of-life care in this patient group are, however, lacking. We report a retrospective study of 48 patients with congenital heart disease who died while admitted to our hospital (mean age at death 37 ± 14 years). We describe circumstances of death, end-of-life discussions, and the provision of end-of-life care. The majority of patients had complex congenital heart disease and were considered to be in the end stage of their disease. Despite this, only a minority of patients had documented end-of-life discussions prior to their terminal admission and most received continuing aggressive medical treatment up to their demise. Advanced palliative and end-of-life care strategies should be developed for and provided to this group of patients, with the dual aims of reduction of unwarranted therapies and enhancement of the quality of death and dying.
Are we heading in the same direction? European and African doctors’ and nurses’ views and experiences regarding outcome measurement in palliative care
Authors: Daveson BA , Simon ST , Benalia H , Downing J , Higginson IJ , Harding R , Bausewein C ,   on behalf of PRISMA
Published: June 2011

Objective: To examine and compare doctors’ and nurses’ views and experiences regarding outcome measurement in palliative care, including patient-reported outcome measures (PROMs).

Methods: A web-based survey developed through expert review and piloting was conducted in Europe and Africa with palliative care professionals working in clinical care, audit and research.

Results: The overall participation rate was 42% (663/1592) and the overall completion rate was 59% (392/663). Of these respondents, 196 were doctors (51% male, mean 47 years) and 104 were nurses (84% female, mean 45 years). Doctors’ most common reported reasons for not using tools were time constraints followed by lack of training. For nurses, it was lack of training followed by time constraints. Provision of information and guidance influenced willingness to use measures. For those that used tools, most reported favourable outcome measurement experiences. Both prioritized brief PROMs, and measures that included physical and psychological domains. For clinical purposes, the main advantage for doctors was assessment/screening, and clinical decision making for nurses. For research, doctors were most influenced by a measure’s comparability with national/international literature followed by its validation in palliative care. For nurses, validation in palliative care was followed by tool access.

Conclusion: Overall these respondents shared similar views and experiences, and both were influenced by similar factors. Multidisciplinary outcome measurement education and training is feasible and required. Multidimensional and brief PROMs that include physical and psychological domains need to be prioritized, and access to freely available, validated and translated tools is needed to ensure cross-national comparisons and coordination of international research.
What is the methodological rigour of palliative care research in long-term care facilities in Europe? A systematic review
Authors: Albers Gwenda , Harding Richard , Pasman H Roeline W , Onwuteaka-Philipsen Bregje D , Hall Sue , Toscani Franco , Ribbe Miel W , Deliens Luc ,   On behalf of PRISMA
Published: June 2011

Background:

The European population is rapidly ageing, resulting in increasing numbers of older people dying in long-term care facilities. There is an urgent need for palliative care in long-term care facilities.

Aim:

The aim of this study was to systematically review the literature on palliative care research in long-term care facilities in Europe with respect to how the palliative care populations were described, and to determine the study designs and patient outcome measures utilized.

Methods:

We used a systematic literature review. The search strategy included searches of PubMed, Embase and PsychINFO databases from 2000 up to May 2010, using search terms related to ‘palliative care’ and ‘end-of-life care’ combined with search terms related to ‘long-term care’. We selected articles that reported studies on patient outcome data of palliative care populations residing in a long-term care facility in Europe.

Results:

This review demonstrated that there are few, and mainly descriptive, European studies on palliative care research in long-term care facilities. Fourteen studies were retained in the review, of which eight were conducted in the Netherlands. None of these studies described their study population specifically as a palliative care or end-of-life care population. Retrospective and prospective designs were applied using many different measurement instruments. Most instruments were proxy ratings. Symptom (management) was the most frequently measured outcome.

Conclusion:

To improve future research on palliative care in long-term care facilities, agreement on what can be considered as palliative care in long-term care facilities and, the availability of well-developed and tested measurement instruments is needed to provide more evidence, and to make future research more comparable.
An uncertain future: The unchanging views of care home residents about living and dying
Authors: Mathie Elspeth , Goodman Claire , Crang Clare , Froggatt Katherine , Iliffe Steve , Manthorpe Jill , Barclay Stephen
Published: June 2011

Background:

Older people living in a care home have a limited life expectancy, and care homes are an important setting for end-of-life care provision.

Aim:

This research aimed to explore the views, experiences and expectations of end-of-life care among care home residents to understand if key events or living in a residential environment influenced their views.

Design:

The research used a prospective design. The paper draws on the qualitative interviews of 63 care home residents who were interviewed up to three times over a year. This was a sub-sample of the larger data set of 121 care home residents.

Setting/Participants:

The residents were recruited from six care homes (providing personal care with no on-site nursing) in the UK. Results: Four main themes were identified; Living in the Past, Living in the Present, Thinking about the Future and Actively Engaged with planning the future. Many residents said they had not spoken to the care staff about end-of-life care; many assumed their family or General Practitioner would take responsibility.

Conclusions:

Core to the older person’s ability to discuss end-of-life care is their acceptance of being in a care home, the involvement of family members in making decisions and the extent to which they believed they could influence decision making within their everyday lives. Advance care plans should document ongoing dialogue. These findings can inform how primary health and palliative care services introduce, discuss and tailor existing frameworks and programmes of end-of-life care.
Law machines: Scale models, forensic materiality and the making of modern patent law
Authors: Pottage Alain
Published: June 2011

Early US patent law was machine made. Before the Patent Office took on the function of examining patent applications in 1836, questions of novelty and priority were determined in court, within the forum of the infringement action. And at all levels of litigation, from the circuit courts up to the Supreme Court, working models were the media through which doctrine, evidence and argument were made legible, communicated and interpreted. A model could be set on a table, pointed at, picked up, rotated or upended so as to display a point of interest to a particular audience within the courtroom, and, crucially, set in motion to reveal the ‘mode of operation’ of a machine. The immediate object of demonstration was to distinguish the intangible invention from its tangible embodiment, but models also ‘machined’ patent law itself. Demonstrations of patent claims with models articulated and resolved a set of conceptual tensions that still make the definition and apprehension of the invention difficult, even today, but they resolved these tensions in the register of materiality, performativity and visibility, rather than the register of conceptuality. The story of models tells us something about how inventions emerge and subsist within the context of patent litigation and patent doctrine, and it offers a starting point for renewed reflection on the question of how technology becomes property.
Mubarak's nemesis
Authors: Eissa Ibrahim
Published: June 2011

Egypt’s leading independent editor, Ibrahim Eissa, talks to Index about freedom of the press, revolution and the fight for democracy
Symptom Prevalence in Advanced Cancer
Authors: Kirkova Jordanka , Rybicki Lisa , Walsh Declan , Aktas Aynur
Published: June 2011

Age, gender, and performance status (PS) are important patient characteristics which might influence to cancer symptom profile. We conducted a secondary analysis of a symptom database to examine any interaction of these factors on symptom prevalence. 38 symptoms were assessed in 1000 consecutive patients with advanced cancer. The association of the three demographic factors with each symptom was examined using logistic regression analysis. Eight symptoms were associated with more than one of the three factors. Model-based estimates of symptom prevalence were calculated for 30 groups based on combinations of age, gender, and ECOG PS (0-4). Prevalence differences between various groups >10% were empirically classified as clinically relevant. The frequency of all eight symptoms (pain, constipation, sleep problems, nausea, anxiety, vomiting, sedation, and blackouts) was associated with more than one of the demographic characteristics of age, gender, and PS level. The prevalence of all eight decreased with older age. Females had more nausea, anxiety, and vomiting than males; males greater sleep problems. The prevalence of constipation, sedation, and blackouts was higher with worse PS, whereas pain and anxiety became less common with worse PS. Age, gender, and PS appeared to be associated with variations in the prevalence of eight gastrointestinal and neuropsychological symptoms in cancer patients. They should be included as important variables in clinical practice symptom research data.
Plants: Adaptive behavior, root-brains, and minimal cognition
Authors: Calvo Garzón Paco , Keijzer Fred
Published: June 2011

Plant intelligence has gone largely unnoticed within the field of animal and human adaptive behavior. In this context, we will introduce current work on plant intelligence as a new set of relevant phenomena that deserves attention and also discuss its potential relevance for the study of adaptive behavior more generally. More specifically, we first give a short overview of adaptive behavior in plants to give some body to the notion of plants as acting creatures. Second, we focus on ‘‘plant neurobiology’’ and introduce the resurfacing of Darwin’s idea that plants have a control center for behavior dispersed across the root tips (a root-brain). We then discuss minimal forms of cognition, and consider motility and having a dedicated sensorimotor organization as key features for designating the domain of minimal cognition. We conclude that plants are minimally cognitive, and close by discussing some of the implications and challenges that plant intelligence provide for the study of adaptive behavior and embodied cognitive science more generally.