bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic significance of global grading system of Gleason score in patients with prostate cancer with bone metastasis
Authors: Kambara Tsunehito , Oyama Tetsunari , Segawa Atsuki , Fukabori Yoshitatsu , Yoshida Ken‐Ichiro
Published: November 2009

Study Type – Prognosis (case series) Level of Evidence 4

OBJECTIVE

To investigate the influence of the revised Gleason grading system (GGS, revised at a consensus conference organized by the International Society of Urological Pathology in 2005) on prediction of prognosis for patients with prostate cancer with bone metastasis.

PATIENTS AND METHODS

Prostatic needle biopsy specimens from 113 patients with prostate cancer with bone metastasis were scored using the conventional GGS (CGGS), modified global GGS (MGGGS), and modified highest GGS (MHGGS). The patients were divided into two groups (Gleason score ≤7 and ≥8) using each grading system. Prostate‐specific antigen failure‐free survival after hormone therapy (HT) was estimated retrospectively. The Cox proportional hazard method was used for univariate and multivariate analysis.

RESULTS

Patients with a Gleason score of ≤7 had a significantly longer remission than patients with a score of ≥8 according to each GGS. However, the better prognosis patients were detected more precisely by the CGGS and MGGGS than the MHGGS. Multivariate analysis showed that the CGGS and MGGGS were significant prognostic indicators for the outcome of HT after adjustment for other prognostic factors.

CONCLUSIONS

These results suggest that the CGGS and MGGGS are more useful than the MHGGS as prognostic indicators for HT. Further evaluation in larger series is needed to define its clinical usefulness.
Parental Reports of Children’s Scale Errors in Everyday Life
Authors: Rosengren Karl S. , Gutiérrez Isabel T. , Anderson Kathy N. , Schein Stevie S.
Published: November 2009

Scale errors refer to behaviors where young children attempt to perform an action on an object that is too small to effectively accommodate the behavior. The goal of this study was to examine the frequency and characteristics of scale errors in everyday life. To do so, the researchers collected parental reports of children’s (age range = 13–21 months at onset) scale errors over a 6‐month period. All but 1 of the parents (N = 30) reported at least 1 scale error with an average of 3.2 scale errors per child. These results suggest that most, if not all, children commit scale errors during early childhood.
Are Gains in Decision‐Making Autonomy During Early Adolescence Beneficial for Emotional Functioning? The Case of the United States and China
Authors: Qin Lili , Pomerantz Eva M. , Wang Qian
Published: November 2009

This research examined the role of children’s decision‐making autonomy in their emotional functioning during early adolescence in the United States and China. Four times over the 7th and 8th grades, 825 American and Chinese children (M = 12.73 years) reported on the extent to which they versus their parents make decisions about issues children often deem as under their authority. Children also reported on their emotional functioning. American children made greater gains over time in decision‐making autonomy than did Chinese children. Initial decision‐making autonomy predicted enhanced emotional functioning similarly among American and Chinese children. However, gains over time in decision‐making autonomy predicted enhanced emotional functioning more in the United States (vs. China) where such gains were normative.
Letter Names and Alphabet Book Reading by Senior Kindergarteners: An Eye Movement Study
Authors: Evans Mary Ann , Saint‐Aubin Jean , Landry Nadine
Published: November 2009

The study monitored the eye movements of twenty 5‐year‐old children while reading an alphabet book to examine the manner in which the letters, words, and pictures were fixated and the relation of attention to print to alphabetic knowledge. Children attended little to the print, took longer to first fixate print than illustrations, and labeled fewer letters than when presented with letters in isolation. After controlling for receptive vocabulary, regressions revealed that children knowing more letters were quicker to look at the featured letter on a page and spent more time looking at the featured letter, the word, and its first letter. Thus, alphabet books along with letter knowledge may facilitate entrance into the partial alphabetic stage of word recognition.
Exploratory Study of Organizational Creativity in Creative Organizations
Authors: Moultrie James , Young Alasdair
Published: November 2009

The creative industries represent an important and growing sector of the UK economy. This paper explores organizational creativity in firms within the creative industries. A questionnaire based on both Amabile's ‘Organizational Creativity’ model and Ekvall's ‘Creative Climate’ model was completed in ten firms in different sectors of the creative industries. Follow‐up interviews with five firms were also conducted, to compare the outputs from each model as well as the variation in responses from firms in different sectors. The results indicate that both models of organizational creativity are complementary, although not necessarily fully applicable in the creative industries. Specific differences between firms in the graphic design/branding sector and firms in product design were also observed.
Innovation Labs: An Examination into the Use of Physical Spaces to Enhance Organizational Creativity
Authors: Magadley Wissam , Birdi Kamal
Published: November 2009

Recent years have seen an increase in the number of innovation labs, purpose‐built physical facilities designed to enhance and support creativity and innovation in organizations. This rising phenomenon may be driven by the increasing emphasis placed on innovation as the key to the survival of modern day organizations. Innovation labs are attracting greater attention from organizations, yet little is known about their effectiveness. Using a mixed‐method approach this paper aims to evaluate the effectiveness of a major UK‐based facility in enhancing creativity and to explore users' attitudes towards this rising organizational phenomenon. The findings have implications for the management of existing innovation labs and those in the planning.
Towards a More Realistic Creative Problem Solving Approach
Authors: Buijs Jan , Smulders Frido , Van Der Meer Han
Published: November 2009

This paper takes a closer look at the existing multi‐step diamond shaped models for creative problem solving (CPS). A case history of a real‐life technical problem in which CPS techniques were used is our source of inspiration for some new ideas about approaching CPS. We propose three concurrent processes: Content finding, Acceptance finding and Information finding. In concrete in‐company projects, these three processes need to be managed simultaneously, which leads to a fourth overarching process: project management. Content finding is concerned with the process the creative session members are going through based on people's own active knowledge and ideas and on sharing their mental models to get new ideas. Acceptance finding is concerned with the co‐creation of new and additional mental systems that are needed for bringing new ideas into good currency within the existing organization and goes beyond agreement on implementation plans. Information finding is concerned with gathering additional knowledge on the ideas that are not readily available during the session. Finally, Project management is concerned with organizing and leading the creative session and in the embedding of the project into the larger organization.
Guanxi Networks and Creativity in Taiwanese Project Teams
Authors: Chen Ming‐Huei
Published: November 2009

Personal connections, also called guanxi in Chinese culture, are embedded within a network of interdependent social exchanges, providing access to resources, information and supports, therefore facilitating performance. Building guanxi networks means building social networks. Project teams are commonly used as fundamental units in organizations, partly in order to generate more creative ideas, and so this paper evaluates how project teams use their guanxi networks within and outside of their teams and across boundaries to stimulate their creative performance. Fifty‐four product development project teams with 293 members from high‐tech Taiwanese firms participated in this study. Findings suggested that, in a guanxi culture such as Taiwan's, in order to facilitate a project team's creative performance, the most important task is to develop a more cohesive social unit before the team extends its external networks, since Chinese culture regards people first as members of groups, and secondly as individuals.
‘We want you! But . . .’ Recruiting Migrants and Encouraging Transnational Migration Through Progressive Inclusion
Authors: Farahat Anuscheh
Published: November 2009

The article submits a proposal for outlining the present body of legal norms in the field of European migration and immigration law. To this end, it suggests understanding European migration and integration law as shaped by two principles: the principle of congruence between a state's territory, authority and citizenry and the principle of progressive inclusion. According to the established principle of congruence, the granting of rights to third‐country nationals (TCNs) is always geared to the ideal image that the persons permanently living on a territory are—in reality—part of the citizenry of that state and subject to the state's authority. According to the more recent principle of progressive inclusion, TCNs are to be gradually included into the host country's society by approximating their rights progressively to the rights of citizens. There are potential tensions between the two principles, which can be explained by the diverging philosophical and political concerns that they follow and the conceptions of migration that each uses. The article then goes on to explore the influence of both principles in current European migration and integration law. It brings forward the argument that current European migration and integration law is structured as much by the ‘older’ principle of congruence as by the principle of progressive inclusion. This assumption will be illustrated by the examples of the Long‐term Residents Directive (LTR Directive). Important provisions of the proposal for a framework directive intended to guarantee TCNs' equal treatment with EU citizens in social matters (Draft Framework Directive) and the directive on the highly skilled migrant workers (Blue Card Directive) will also be taken into account. Against the background of the highly contested legal field of migration and integration law, using the language of principles provides a useful tool not only for better grasping the current shape of this legal field, but even more for the legal discourse on the future development of European migration and integration law.
Outcome of intracerebral haemorrhage patients pre‐treated with statins
Authors: Gomis M. , Ois A. , Rodríguez‐Campello A. , Cuadrado‐Godia E. , Jiménez‐Conde J. , Subirana I. , Dávalos A. , Roquer J.
Published: November 2009

Background:  Statins treatment may have potential clinical impact in vascular disease beyond cholesterol lowering. Its benefits have been documented in cerebral ischaemia and in subarachnoid haemorrhage. In intracerebral haemorrhage (ICH), experimental models in statin‐treated animals have better outcome than non‐treated ones, but in humans the relationship is unclear. We investigated whether patients treated with statins before the onset of intracerebral haemorrhage have a better outcome at 3 months than patients without statins pre‐treatment.

Methods:  Retrospective review of primary intracerebral haemorrhage case series from a prospective stroke register. We recorded demographics, vascular risk factors, previous statin treatment, Glasgow coma scale (GCS) at onset, ICH scale, hematoma volume and location, ventricular extension of the hematoma, and functional outcome at 3 months. The effect of prior statin treatment on good outcome (modified Rankin scale [mRS] 0 to 2) was analysed by logistic regression analysis.

Results:  We included 269 patients (age 71.9 ± 12.4, mean ± SD, 152 males). Thirty‐four patients (12.6%) were on prior statin treatment when admitted. There were no differences in fasting serum cholesterol and triglycerides levels between the statin pre‐treated groups and the group without statin pre‐treatment. Multivariate regression analysis showed a significant association between age (OR: 0.95; CI 0.92–0.97), ICH volume (OR: 0.96; CI 0.94–0.98), GCS (OR: 1.55; CI 1.21–1.98), pre‐treatment with statins (OR: 4.21; CI 1.47–12.17; P = 0.008), and good outcome at 3 months.

Conclusions:  Statins pre‐treatment of patients with intracerebral haemorrhage may provide better functional outcome at 3 months of acute onset.
Influence of antiplatelet pre‐treatment on the risk of intracranial haemorrhage in acute ischaemic stroke after intravenous thrombolysis
Authors: Dorado L. , Millán M. , De La Ossa N. Pérez , Guerrero C. , Gomis M. , López‐Cancio E. , Ricciardi A. C. , Dávalos A.
Published: November 2009

Background:  Pre‐treatment with antiplatelet agents (AP) is present amongst 30% of acute stroke patients. Previous studies have shown conflicting results on the effect of these drugs regarding haemorrhagic transformation after thrombolytic therapy. The hypothesis that pre‐treatment with AP may increase the risk of cerebral haemorrhage (ICH) after intravenous tissue plasminogen activator (tPA) was assessed.

Methods:  Retrospective study of consecutive prospectively registered patients with acute ischaemic stroke treated with iv tPA (n = 235) in the last 5 years. Baseline characteristics and prior AP therapy were registered on admission. Computed tomography (CT) scan was performed on admission and 24–36 h after tPA. ICH was classified according to the ECASS II criteria into haemorrhagic infarction and parenchymal haematoma (PH). Symptomatic intracerebral haemorrhage (SICH) was defined as a worsening of ≥ 4 points in the NIHSS score during the first 36 h in any haemorrhage subtype.

Results:  Seventy‐two (30.6%) patients were pre‐treated with AP (55 aspirin, 14 clopidogrel, 2 aspirin + clopidogrel, 1 triflusal). PH was observed in 33 (14.1%) patients (PH1 13, PH2 12, PHr 8) of whom 16 were symptomatic. Male gender (78.8% vs. 21.2%, P = 0.036), prior AP therapy (54.5% vs. 26.9%, P = 0.001), stroke severity (median NIHSS, 17 vs. 12, P = 0.005) and early CT signs of infarction (12.5% vs. 2.1%, P = 0.004) were associated with PH. The adjusted odds ratios of PH for patients pre‐treated with AP therapy was 3.5 (1.5–7.8, P = 0.002) and for SICH 1.9 (0.6–5.9, P = 0.2).

Conclusions:  Pre‐treatment with AP is associated with an increased risk of PH after intravenous thrombolysis in patients with acute ischaemic stroke.
Expression of clock genes Per1 and Bmal1 in total leukocytes in health and Parkinson’s disease
Authors: Cai Y. , Liu S. , Sothern R. B. , Xu S. , Chan P.
Published: November 2009

Background:  There is a growing number of clinical studies that revealed a variety of behavioral and physiological desynchronies in patients with Parkinson’s disease (PD). However, these desynchronies have not been defined at the molecular level.

Methods:  Using real‐time RT‐PCR assay, we analyzed the expression profiles of two principle clock genes, PER1 and BMAL1, in total leukocytes for 12 h during the evening, overnight and morning in subjects with PD and age/sex‐matched healthy controls.

Results:  A difference in the expression pattern of BMAL1 but not PER1 was apparent during the dark span, where the relative abundance of BMAL1 was significantly lower in PD patients versus control subjects at 21:00, 00:00 and 06:00 h. Furthermore, expression levels of BMAL1 in PD patients correlated with their United Parkinson’s Disease Rating Scale score at 06:00, 09:00 h, and with Pittsburgh Sleep Quality Index score at 06:00 h.

Conclusion:  These results suggest that a peripheral molecular clock, as reflected in the dampened expression of the clock genes BMAL1 in total leukocytes, is altered in PD patients. In addition, the relative BMAL1 levels correlate positively with PD severity, which could provide a molecular basis to help monitor disease progression and response to investigational drugs.
Conservation genetics of a critically endangered Iberian minnow: evidence of population decline and extirpations
Authors: Sousa V. , Penha F. , Pala I. , Chikhi L. , Coelho M. M.
Published: November 2009

The endangered minnow Iberochondrostoma almacai is an endemic Iberian cyprinid with a restricted and fragmented distribution. Here, we describe the genetic structure of the species and infer its demographic history from six nuclear‐encoded microsatellite loci and mitochondrial cytochrome b sequences. Genetic diversity was low (microsatellite He<0.45; mtDNA π<0.0015), and both markers resolved two groups: one from the northern Mira drainage and one from the Arade and Bensafrim drainages. The relatively low differentiation between these groups (0.09<FST<0.29; 0.31< ΦST <0.57) suggests past headwater captures and/or that populations were large until recently. The genetic diversity and differentiation estimates were compared with those for other three endangered cyprinids inhabiting similar intermittent rivers. Microsatellite data indicate a population decrease in the last 100–2400 years, probably as a result of anthropogenic disturbance. Human activities together with an intermittent flow of these rivers apparently led to local extinctions with consequent fragmentation and contraction in range. We recognize two management units corresponding to the two genetic groups identified. To maintain/increase genetic diversity, we recommend habitat restoration actions and measures to increase gene flow within and/or between the two units, under controlled reproductive programmes. Ecological experiments should be performed to ensure the success of supplementation among the two units. Moreover, the reintroductions in unoccupied drainages are suggested if further data confirm the presence of I. almacai in the recent past.
Platelet aggregation responses are critically regulated in vivo by endogenous nitric oxide but not by endothelial nitric oxide synthase
Authors: Tymvios C , Moore C , Jones S , Solomon A , Sanz‐Rosa D , Emerson M
Published: November 2009

Background and purpose:  Although exogenous nitric oxide (NO) clearly modifies platelet function, the role and the source of endogenous NO in vivo remain undefined. In addition, endothelial NO synthase (NOS‐3) critically regulates vessel tone but its role in modulating platelet function is unclear. In this paper we have investigated the roles of endogenous NO and NOS‐3 in regulating platelet function in vivo and determined the functional contribution made by platelet‐derived NO.

Experimental approach:  We used a mouse model for directly assessing platelet functional responses in situ in the presence of an intact vascular endothelium with supporting in vitro and molecular studies.

Key results:  Acute NOS inhibition by Nω‐nitro‐L‐arginine methyl ester hydrochloride (L‐NAME) enhanced platelet aggregatory responses to thrombin and platelets were shown to be regulated primarily by NO sources external to the platelet. Elevation of endogenous NOS inhibitors to mimic effects reported in patients with cardiovascular diseases did not enhance platelet responses. Platelet responsiveness following agonist stimulation was not modified in male or female NOS‐3−/− mice but responses in NOS‐3−/− mice were enhanced by L‐NAME.

Conclusions and implications:  Platelets are regulated by endogenous NO in vivo, primarily by NO originating from the environment external to the platelet with a negligible or undetectable role of platelet‐derived NO. Raised levels of endogenous NOS inhibitors, as reported in a range of diseases were not, in isolation, sufficient to enhance platelet activity and NOS‐3 is not essential for normal platelet function in vivo due to the presence of bioactive NO following deletion of NOS‐3.
Negotiation for Action: English Language Learning in Game‐Based Virtual Worlds
Authors: ZHENG DONGPING , YOUNG MICHAEL F. , WAGNER MANUELA MARIA , BREWER ROBERT A.
Published: November 2009

This study analyzes the user chat logs and other artifacts of a virtual world, Quest Atlantis (QA), and proposes the concept of Negotiation for Action (NfA) to explain how interaction, specifically, avatar‐embodied collaboration between native English speakers and nonnative English speakers, provided resources for English language acquisition. Iterative multilayered analyses revealed several affordances of QA for language acquisition at both utterance and discourse levels. Through intercultural collaboration on solving content‐based problems, participants successfully reached quest goals during which emergent identity formation and meaning making take place. The study also demonstrates that it is in this intercultural interaction that pragmatics, syntax, semantics, and discourse practices arose and were enacted. The findings are consistent with our ecological psychology framework, in that meaning emerges when language is used to coordinate in‐the‐moment actions.
Finding Middle Ground in Second Language Reading: Pedagogic Modifications That Increase Comprehensibility and Vocabulary Acquisition While Preserving Authentic Text Features
Authors: O'DONNELL MARY E.
Published: November 2009

Using a quantitative approach, this study explores the use of textual elaboration as a modification option for literary texts in an intermediate‐level Spanish as a second language (L2) course. The results suggest that, with elaborative modifications, literary texts could have an expanded role in L2 instruction for lower proficiency students, thus representing a compromise between those who advocate the exclusive use of authentic reading materials and those who suggest that pedagogically modified texts are more appropriate for this level student. The findings indicate that the L2 readers who read short literary texts that had been modified elaboratively were able to recall more information about the texts and could identify more vocabulary that appeared within the texts. However, the level of text difficulty played a pivotal role in relation to the effectiveness of elaborative modifications. In terms of comprehension, students who read unmodified texts that were relatively easy to comprehend benefited the least from these modifications.
Argumentation and Debate in Foreign Language Instruction: A Case for the Traditional Classroom Facilitating Advanced‐Level Language Uptake
Authors: BROWN N. ANTHONY
Published: November 2009

In response to a growing demand for highly proficient speakers of foreign languages, both from private and government sectors, an added emphasis has been placed on immersion‐type programs that offer extensive contact time in a target language. Although time in a target language certainly plays a valuable and needed role, this research demonstrates that innovative curricular design and development in the university foreign language classroom can equal if not exceed uptake that occurs in extended immersion environments. A thorough description of the research design is provided, including the application of “memory box” items, laboratory self‐recordings, listening, reading, and written exercises, and in‐class practicum in the target language involving British parliamentary‐style debate and Model United Nations. Preliminary findings based on certified pre‐ and post‐Oral Proficiency Interview and Written Proficiency Test ratings suggest that such an approach yields significant gain. Vygotsky's (1978) idea of the Zone of Proximal Development serves as a useful framework for explaining a high percentage of gain at the Advanced‐high/Superior threshold in oral proficiency, whereas native‐speaker written corrective recasts followed by revision and resubmission of written assignments offer a useful paradigm for facilitating threshold gain across a range of proficiency levels for all participants involved.
Don Quixote Meets Ser and Estar: Multiple Perspectives on Language Learning in Spanish Literature Classes
Authors: POLIO CHARLENE , ZYZIK EVE
Published: November 2009

This multiple case study examines language‐focused instruction in 3 university Spanish literature classes to examine the students’ and instructors’ perspectives on language learning in this context. The classes were studied for a semester through observations, instructor interviews and stimulated recalls, and student questionnaires. Among the findings were that although both the instructors and the students had concerns about students’ language ability, the instructors had minimal language‐related goals for their classes, and language issues were dealt with mostly incidentally. In addition, several themes emerged from both groups of participants: language learning as an incidental activity, problems with students’ oral proficiency and the role of study abroad in improving it, the importance of vocabulary, and the difficulties of reading complex texts. Changes in instruction and curriculum are suggested to better meet the needs and goals of both the students and the instructors.
Self‐Regulatory Strategies and Agency in Self‐Instructed Language Learning: A Situated View
Authors: BOWN JENNIFER
Published: November 2009

Individualized instruction, a form of materials‐centered self‐instruction, has a long, undocumented history in the United States. The context of individualized instruction requires learners to regulate their own learning processes, including their emotional responses to learning. This study offers a situated view of the processes and strategies learners use to manage the self‐instructional process. Findings of this study suggest that contextual factors such as learners' self‐beliefs and social support influence the kinds of strategies that learners employ. Moreover, self‐regulation of learning in this context required that learners (a) structure the learning environment to meet their needs and (b) manage their emotional responses to individualized language learning.
Family–Business Meta–Identity, Institutional Pressures, and Ability to Respond to Entrepreneurial Opportunities
Authors: Reay Trish
Published: November 2009

This commentary extends the theoretical model developed by Shepherd and Haynie by examining the relationship between the central construct of their model—the family–business meta–identity—and the institutional environment. Using the characteristics of identity (central, distinctive, and enduring) I explain how consideration of institutional pressures may modify predictions in the model.
Triggering Pulmonary Veins: A Paradoxical Predictor for Atrial Fibrillation Recurrence After PV Isolation
Authors: DE GREEF YVES , TAVERNIER RENE , VANDEKERCKHOVE YVES , DUYTSCHAEVER MATTIAS
Published: November 2009

Triggering Pulmonary Veins and Recurrence After Ablation. Purpose: To identify procedural parameters predicting recurrence of atrial fibrillation (AF) after a first circumferential pulmonary vein isolation (CPVI).

Methods:
One hundred seventy‐one patients undergoing CARTO‐guided CPVI for recurrent AF with a left atrial (LA) diameter <45 mm were studied. Follow‐up (symptoms and 7‐day Holter) was performed at 1 and 3 months and every 3 months thereafter. Clinical and procedural characteristics between successful patients and patients undergoing repeat ablation were compared. In addition, procedural parameters of the first procedure were compared with parameters during repeat ablation.

Results:
After first CPVI, 80% of patients were free of AF without antiarrhythmic drugs after a follow‐up (FU) of 28 ± 11 months (N = 136). Thirty‐five patients (20%) had recurrence of AF of which 25 underwent repeat ablation (N = 25). Clinical characteristics did not differ between the successful and repeat group. A triggering vein during the index procedure was significantly more observed in the repeat group (56% vs 11%, P < 0.001). At repeat ablation, 2.6 ± 1.2 veins per patient were reconnected. Whereas there was no preferential reconnecting PV, all PVs triggering at index were reconnected (100%).

Conclusions:
(1) In patients with symptomatic recurrent AF, the presence of a triggering pulmonary vein during ablation is a paradoxical predictor for AF recurrence after PV isolation. (2) The consistent finding of reconnection of the triggering PV at repeat ablation, suggests that, in these patients, the triggering PV is the culprit vein and that reconnection invariably results in clinical AF recurrence. (3) The present study advocates a strategy of even more stringent PV isolation in case of a triggering PV. (J Cardiovasc Electrophysiol, Vol. 21, pp. 381–388, April 2010)
What You See (Sonographically) Is What You Get: Vein and Patient Characteristics Associated With Successful Ultrasound‐guided Peripheral Intravenous Placement in Patients With Difficult Access
Authors: Panebianco Nova L. , Fredette Jenna M. , Szyld Demian , Sagalyn Emily B. , Pines Jesse M. , Dean Anthony J.
Published: November 2009

Objectives:  Ultrasound (US) has been shown to facilitate peripheral intravenous (IV) placement in emergency department (ED) patients with difficult IV access (DIVA). This study sought to define patient and vein characteristics that affect successful US‐guided peripheral IV placement.

Methods:  This was a prospective observational study of US‐guided IV placement in a convenience sample of DIVA patients in an urban, tertiary care ED. DIVA patients were defined as having any of the following: at least two failed IV attempts or a history of difficult access plus the inability to visualize or palpate any veins on physical exam. Patient characteristics (demographic information, vital signs, and medical history) were collected on enrolled patients. The relationships between patient characteristics, vein depth and diameter, US probe orientation, and successful IV placement were analyzed.

Results:  A total of 169 patients were enrolled, with 236 attempts at access. Increasing vessel diameter was associated with a higher likelihood of success (odds ratio [OR] = 1.79 per 0.1‐cm increase in vessel diameter, 95% confidence interval [CI] = 1.37 to 2.34). Increasing vessel depth did not affect success rates (OR = 0.96 per 0.1‐cm increase of depth, 95% CI = 0.89 to 1.04) until a threshold depth of 1.6 cm, beyond which no vessels were successfully cannulated. Probe orientation and patient characteristics were unrelated to success.

Conclusions:  Success was solely related to vessel characteristics detected with US and not influenced by patient characteristics or probe orientation. Successful DIVA was primarily associated with larger vessel, while vessel depth up to >1.6 cm and patient characteristics were unrelated to success. Clinically, if two vessels are identified at a depth of <1.6 cm, the larger diameter vessel, even if comparatively deeper, should yield the greatest likelihood of success.
Effect of an Independent‐capacity Protocol on Overcrowding in an Urban Emergency Department
Authors: Cha Won Chul , Shin Sang Do , Song Kyoung Jun , Jung Sung Koo , Suh Gil Joon
Published: November 2009

Objectives:  The authors hypothesized that a new strategy, termed the independent‐capacity protocol (ICP), which was defined as primary stabilization at the emergency department (ED) and utilization of community resources via transfer to local hospitals, would reduce ED overcrowding without requiring additional hospital resources.

Methods:  This is a before‐and‐after trial that included all patients who visited an urban, tertiary care ED in Korea from July 2006 to June 2008. To improve ED throughput, introduction of the ICP gave emergency physicians (EPs) more responsibility and authority over patient disposition, even when the patients belonged to another specific clinical department. The ICP utilizes the ED as a temporary, nonspecific place that cares for any patient for a limited time period. Within 48 hours, EPs, associated specialists, and transfer coordinators perform secondary assessment and determine patient disposition. If the hospital is full and cannot admit these patients after 48 hours, the EP and transfer coordinators move the patients to other appropriate community facilities. We collected clinical data such as sex, age, diagnosis, and treatment. The main outcomes included ED length of stay (LOS), the numbers of admissions to inpatient wards, and the mortality rate.

Results:  A total of 87,309 patients were included. The median number of daily patients was 114 (interquartile range [IQR] = 104 to 124) in the control phase and 124 (IQR = 112 to 135) in the ICP phase. The mean ED LOS decreased from 15.1 hours (95% confidence interval [CI] = 14.8 to 15.3) to 13.4 hours (95% CI = 13.2 to 13.6; p < 0.001). The mean LOS in the emergency ward decreased from 4.5 days (95% CI = 4.4 to 4.6 days) to 3.1 days (95% CI = 3.0 to 3.2 days; p < 0.001). The percentage of transfers from the ED to other hospitals decreased from 3.5% to 2.5% (p < 0.001). However, transfers from the emergency ward to other hospitals increased from 2.9% to 8.2% (p < 0.001). Admissions to inpatient wards from the ED were significantly reduced, and admission from the emergency ward did not change. The ED mortality and hospital mortality rates did not change (p = 0.15 and p = 0.10, respectively).

Conclusions:  After introduction of the ICP, ED LOS decreased without an increase in hospital capacity.
Predictors of response to immunosuppressive therapy with antithymocyte globulin and cyclosporine and prognostic factors for survival in patients with severe aplastic anemia
Authors: Chang Myung H. , Kim Kyoung H. , Kim Hyo S. , Jun Hyun J. , Kim Dong H. , Jang Jun H. , Kim Kihyun , Jung Chul W.
Published: November 2009

Background:  Immunosuppressive therapy (IST) with antithymocyte globulin (ATG) plus cyclosporine (CSA) is standard therapy in patients with severe aplastic anemia (SAA) who do not have an available HLA‐matched sibling donor.

Methods and patients:  The current study aimed to determine the predictive factors for response to IST in patients with SAA and to identify prognostic factors following IST. A total of 62 patients diagnosed with SAA who received IST with either rabbit ATG (n = 33) or horse ATG (n = 29) plus CSA between October 1994 and December 2007 were included.

Results:  With a median follow‐up duration of 60.5 months, complete response and overall response were estimated to be 31% and 53%, respectively. The 4 yr overall survival rate was 75 ± 6%. In terms of predicting the response to IST, neutrophil counts above 0.3 × 109/L prior to IST were the only significant predictive factor (P = 0.02). Survival following IST was significantly different in favor of both the group showing high absolute reticulocyte counts (ARC) above 10.9 × 109/L prior to IST (P = 0.004) and the group achieving any response following IST (P = 0.002).

Conclusions:  Pre‐IST neutrophil counts might predict the response to IST, while absolute ARCs prior to IST and response status after IST could be prognostic factors following IST.
Distribution and structure of the initial dental enamel formed in incisors of young wild‐type and Tabby mice
Authors: Sehic Amer , Peterkova Renata , Lesot Hervé , Risnes Steinar
Published: November 2009

Mouse incisor enamel can be divided into four layers: an inner prism‐free layer; an inner enamel with prism decussation; outer enamel with parallel prisms; and a superficial prism‐free layer. We wanted to study how this complex structural organization is established in the very first enamel formed in wild‐type mice and also in Tabby mice where enamel coverage varies considerably. Unworn incisors from young female wild‐type and Tabby mice were ground, etched, and analyzed using scanning electron microscopy. In both wild‐type and Tabby mice, establishment of the enamel structural characteristics in the initially formed enamel proceeded as follows, going from the incisal tip in an apical direction: (i) a zone with prism‐free enamel, (ii) a zone with occasional prisms most often inclined incisally, and (iii) a zone where prism decussation was gradually established in the inner enamel. The distribution of enamel in Tabby mice exhibited considerable variability. The sequence of initial enamel formation in mouse incisors mimics development from a primitive (prism‐free) structure to an evolved structure. It is suggested that genes controlling enamel distribution are not associated with genes controlling enamel structure. The control of ameloblast configuration, life span, organization in transverse rows, and movement is important for establishing the characteristic mature pattern of mouse incisor enamel.
Effect of denture base‐resin with prereacted glass‐ionomer filler on dentin demineralization
Authors: Mukai Yoshiharu , Kamijo Kazuko , Fujino Fukue , Hirata Yukio , Teranaka Toshio , Ten Cate Jacob M
Published: November 2009

The demineralization of dentin was studied when placed adjacent to one of four experimental denture base‐resins. These experimental resins contained polymethylmethacrylate (PMMA) and 0, 5, 10, 20 or 30 wt% surface reaction‐type prereacted glass‐ionomer (S‐PRG) filler, respectively. A dentin thin‐section was sandwiched between these resins and subjected to demineralization for 1 wk. Microradiographic analyses showed that the mineral vol% of the surface was increased, and lesion formation was inhibited, in a dose–response relationship with the amount of S‐PRG filler. Moreover, the mineral loss decreased, by up to 60%, with an increasing amount of filler. These results indicate that denture base‐resins containing S‐PRG filler possess a substantial inhibition capability against demineralization, and this may thereby assist in preventing root caries of abutment teeth.
Forebrain projections to brainstem nuclei involved in the control of mandibular movements in rats
Authors: Mascaro Marcelo B. , Prosdócimi Fábio C. , Bittencourt Jackson C. , Elias Carol F.
Published: November 2009

Mandibular movements occur through the triggering of trigeminal motoneurons. Aberrant movements by orofacial muscles are characteristic of orofacial motor disorders, such as nocturnal bruxism (clenching or grinding of the dentition during sleep). Previous studies have suggested that autonomic changes occur during bruxism episodes. Although it is known that emotional responses increase jaw movement, the brain pathways linking forebrain limbic nuclei and the trigeminal motor nucleus remain unclear. Here we show that neurons in the lateral hypothalamic area, in the central nucleus of the amygdala, and in the parasubthalamic nucleus, project to the trigeminal motor nucleus or to reticular regions around the motor nucleus (Regio h) and in the mesencephalic trigeminal nucleus. We observed orexin co‐expression in neurons projecting from the lateral hypothalamic area to the trigeminal motor nucleus. In the central nucleus of the amygdala, neurons projecting to the trigeminal motor nucleus are innervated by corticotrophin‐releasing factor immunoreactive fibers. We also observed that the mesencephalic trigeminal nucleus receives dense innervation from orexin and corticotrophin‐releasing factor immunoreactive fibers. Therefore, forebrain nuclei related to autonomic control and stress responses might influence the activity of trigeminal motor neurons and consequently play a role in the physiopathology of nocturnal bruxism.
Regulation of bite force increase during splitting of food
Authors: Svensson Krister G. , Trulsson Mats
Published: November 2009

The purpose of the study was to analyze how increases in the bite force, during the splitting of food morsels of different hardness, are modulated, and to evaluate the role of periodontal mechanoreceptors in this control. Fifteen subjects were instructed to hold and split food morsels of different hardness (peanuts and biscuits) between a pair of opposing central incisors before and during anesthesia of the teeth. The split occurred at an average bite force of 9 N for biscuits and at an average bite force of 18 N for peanuts. The duration of the split phase was longer, and the split force rate higher, for peanuts compared with biscuits. Furthermore, a steeper force trajectory was observed for the peanut. During anesthesia of the teeth, the duration of the split phase increased and the mean split force rate decreased for peanuts. Force trajectories for peanuts and biscuits were indistinguishable during anesthesia. The present results show that when higher bite forces are needed to split a morsel, both the duration and the rate of the bite force produced is increased. Furthermore, adaptation of the bite force rate to the hardness of the food is dependent on information from periodontal mechanoreceptors.
History of Sexual and Physical Abuse in Women with Dyspareunia: Association with Pain, Psychosocial Adjustment, and Sexual Functioning
Authors: Leclerc Bianca , Bergeron Sophie , Binik Yitzchak M. , Khalifé Samir
Published: November 2009

Aim

Dyspareunia is a women’s sexual health problem that still often goes undiagnosed despite its high prevalence and its detrimental impact on sexual, relationship, and psychological adjustment. Although sexual and physical abuse may constitute risk factors for the development of dyspareunia, the effects of past abuse on current pain and associated sexual and psychosocial impairments have never been examined. Thus, the aim of this study is to determine the relation between a history of sexual and physical abuse and a series of pain, psychological, dyadic, and sexual functioning variables in a sample of women with dyspareunia.

Methods

A hundred and fifty-one women took part in the study via health professional referrals and advertisements in local newspapers. Each participant underwent a standardized gynecological examination and a structured interview in order to confirm the diagnosis of dyspareunia. They also completed self-report questionnaires investigating past sexual and physical abuse, in addition to current pain, psychosocial adjustment, and sexual functioning. Dependent measures included: (i) The Brief Symptom Inventory; (ii) the Sexual History Form; and (iii) the Locke-Wallace Marital Adjustment Scale. Pain was assessed via the McGill Pain Questionnaire and a visual analogue scale.

Results

Results revealed that a history of sexual abuse involving penetration was associated with poorer psychological adjustment and sexual functioning. Additionally, findings showed that women who perceived a link between their dyspareunia and their past sexual abuse reported worse sexual functioning than those who did not. Finally, the experience of sexual abuse was not associated with pain intensity and physical abuse was not associated with any of the outcome measures.

Conclusions

Findings suggest that the presence of a sexual abuse history in women with dyspareunia is associated with increased psychological distress and sexual impairment, although there is no relation between a history of physical abuse and these outcomes.
The ACTIV Study: Acupuncture Treatment in Provoked Vestibulodynia
Authors: Curran Stephanie , Brotto Lori A. , Fisher Harris , Knudson Gail , Cohen Trevor
Published: November 2009

Introduction

Provoked vestibulodynia (PVD) is a distressing genital pain condition affecting 12% of women. Treatment modalities vary and although vestibulectomy has the highest efficacy rates, it is usually not a first-line option. Acupuncture has a long history in the traditional Chinese medicine (TCM) system and operates on the premise that pain results from the blockage or imbalance of important channels. The main principle of treatment is to move Qi and blood to cease genital pain.

Aim

To explore effect sizes and feasibility in a pilot study of acupuncture for women with PVD.

Methods

Eight women with PVD (mean age 30 years) underwent 10 1-hour acupuncture sessions. Specific placement of the needles depended on the woman’s individual TCM diagnosis. TCM practitioners made qualitative notes on participants’ feedback after each session.

Main Outcome Measures

Self-reported pain (investigator-developed), pain-associated cognitions (Pain Catastrophizing Scale [PCS], Pain Vigilance and Awareness Questionnaire), and sexual response (Female Sexual Function Index) were measured before and after treatment sessions 5 and 10. Qualitative analyses of TCM practitioner notes were performed along with one in-depth case report on the experience of a participant.

Results

A repeated measures analysis of variance revealed significant decreases in pain with manual genital stimulation and helplessness on the PCS. An examination of effect sizes also revealed strong (though nonsignificant) effects for improved ability to have intercourse and sexual desire. Qualitative analyses were overall more positive and revealed an improvement in perceived sexual health, reduced pain, and improved mental well-being in the majority of participants.

Conclusions

Effect sizes and qualitative analyses of practitioner-initiated interviews showed overall positive effects of acupuncture, but there were statistically significant improvements only in pain with manual genital stimulation and helplessness. These findings require replication in a larger, controlled trial before any definitive conclusions on the efficacy of acupuncture for PVD can be made.
A Cross-Sectional Study for the Analysis of Clinical, Sexual and Laboratory Conditions Associated to Peyronie’s Disease
Authors: Rhoden Ernani Luis , Riedner Charles Edison , Fuchs Sandra , Ribeiro Eduardo Porto , Halmenschlager Graziele
Published: November 2009

Introduction

Although Peyronie’s Disease (PD) was first described over 250 years ago, its precise etiology remains obscure.

Aim

Analyze a variety of potential associated factors with PD, including erectile dysfunction.

Materials and Methods

This cross-sectional study included 83 consecutive men with PD and 252 age-matched controls. All men completed the International Index of Erectile Function (IIEF) and were evaluated regarding their clinical and demographic characteristics, comorbidities, and used medications. Anthropometric measures included body mass index and waist circumference (WC). Fasting blood glucose, lipid profile, total testosterone, and dehydroepiandrosterone-sulfate were determined.

Main Outcome Measures

Clinical and laboratory characteristics associated to PD.

Results

The mean age was 59.2 ± 10 years in the cases and 59.7 ± 12 years in the controls. Marital status, current smoking, and excessive consumption of alcoholic beverages were similar between groups (P > 0.05). PD was more common among white skin color males (P = 0.001). The mean score for each IIEF domain and the androgen levels were similar in the two groups. Thiazides were the only medication associated to PD (P = 0.03). Dupuytren’s disease was more frequent among individuals with PD (P = 0.001). The distribution of all other comorbidities investigated was similar between groups (P > 0.05). The characteristics WC > 102 cm and levels of low-density lipoprotein (LDL) > 130 mg/dL were more prevalent in the controls (P <0.05). After multivariate analysis, white skin color (OR: 8.47, 95%CI: 1.98–36.24) and thiazide use (OR: 2.29, 95%CI: 1.07–4.90) were associated to PD, and LDL > 130 mg/dL (OR: 0.55, 95%CI: 0.32–0.92) and WC > 102 cm (OR: 0.53, 95%CI: 0.29–0.96) were inversely associated to PD.

Conclusions

In this study, PD was more common among white skin colored males. An inverse relationship with the presence of elevated serum levels of LDL and WC was observed. We found no association with medications other than thiazides and comorbidities other than Dupuytren’s disease. Androgen serum levels and sexual dysfunction had also no association to PD.