bluuebunny/crossref_metadata_2025 huggingface dataset:
Successful management of cervico‐isthmic pregnancy delivered at term
Authors: Sakai Atsuhiko , Fujita Yasuyuki , Yumoto Yasuo , Fukushima Kotaro , Kobayashi Hiroaki , Wake Norio
Published: July 2012

A 29‐year‐old woman was diagnosed with a cervico‐isthmic pregnancy based on ultrasound findings at 8 weeks of gestation. At 30 weeks of gestation, placenta previa was confirmed. During cesarean section at 37 weeks, the placenta did not spontaneously detach from the uterus; therefore, we decided to leave it in the uterus to avoid major hemorrhage. Blood loss was 775 mL and a healthy infant was delivered. After the operation, weekly methotrexate injection was initiated. Shortly after the eighth course of injection, massive vaginal bleeding suddenly occurred and bilateral uterine artery embolization was performed to control it. After the procedure, the retained placental tissue was removed and the patient was discharged with good general condition. Although a cervico‐isthmic pregnancy constitutes a high‐risk pregnancy, fertility‐sparing management without a hysterectomy or blood transfusion was possible by not removing the placenta manually during the operation.
The influence of bilingualism on speech production: A systematic review
Authors: Hambly Helen , Wren Yvonne , McLeod Sharynne , Roulstone Sue
Published: July 2012

Background

Children who are bilingual and have speech sound disorder are likely to be under‐referred, possibly due to confusion about typical speech acquisition in bilingual children.

Aims

To investigate what is known about the impact of bilingualism on children's acquisition of speech in English to facilitate the identification and treatment of bilingual children with speech sound disorder.

Methods & Procedures

A systematic review of studies from the last 50 years was conducted. Studies investigating speech acquisition in bilingual infants and children (where one language was English) were identified through searching seven electronic databases, bibliographies of relevant articles and e‐mailing authors. Sixty‐six studies investigating bilingual speech production met inclusion criteria, with 53 describing typically developing children and 13 describing children with speech sound disorder. The 66 studies were analysed thematically and summarized in terms of methods, key findings and underlying theories.

Main Contribution

There was limited evidence to suggest that bilingual children develop speech at a slower rate than their monolingual peers; however, there was evidence for qualitative differences and increased variation in speech production. Nearly all studies provide evidence for transfer between the two phonological and language structures, although the amount of transfer varied between studies. There was evidence of positive and negative transfer of features from the dominant language (L1) to the second language (L2) as well as from L2 to L1. Positive transfer became more evident with increased age and length of exposure to a second language. More recently researchers have moved away from investigating whether there are one or two phonological systems and accept that there are two systems that interact. Interest has shifted to examining how phonological systems interact and to identifying factors that influence interactions. The review revealed a number of inconsistencies in the findings of studies due to differences in methodology, languages investigated and degree of language exposure. Overall, measurement issues were addressed well but most studies provided limited sample information about language experience, schooling and socio‐economic status.

Conclusions & Implications

There are differences in speech sound acquisition between monolingual and bilingual children in terms of rate and patterns of error, with both positive and negative transfer occurring in bilingual children.
The importance of who infects whom: the evolution of diversity in host resistance to infectious disease
Authors: Boots Mike , White Andy , Best Alex , Bowers Roger
Published: August 2012

Variation for resistance to infectious disease is ubiquitous and critical to host and parasite evolution and to disease impact, spread and control. However, the processes that generate and maintain this diversity are not understood. We examine how ecological feedbacks generate diversity in host defence focussing on when polymorphism can evolve without co‐evolution of the parasite. Our key result is that when there is heritable variation in hosts in both their transmissibility and susceptibility along with costs to resistance, there is the possibility of the evolution of polymorphism. We argue that a wide range of behavioural or physiological mechanisms may lead to relationships between transmissibility and susceptibility that generate diversity. We illustrate this by showing that a tendency for higher contacts between related individuals leads to polymorphism. Only dimorphisms can evolve when infection is determined only by an individuals' susceptibility or when transmissibility and susceptibility are simply positively or negatively correlated.
Tagaturonate–fructuronate epimerase UxaE, a novel enzyme in the hexuronate catabolic network in Thermotoga maritima
Authors: Rodionova Irina A. , Scott David A. , Grishin Nick V. , Osterman Andrei L. , Rodionov Dmitry A.
Published: July 2012

Thermotoga maritima is a marine hyperthermophilic microorganism that degrades a wide range of simple and complex carbohydrates including pectin and produces fermentative hydrogen at high yield. Galacturonate and glucuronate, two abundant hexuronic acids in pectin and xylan, respectively, are catabolized via committed metabolic pathways to supply carbon and energy for a variety of microorganisms. By a combination of bioinformatics and experimental techniques we identified a novel enzyme family (named UxaE) catalysing a previously unknown reaction in the hexuronic acid catabolic pathway, epimerization of tagaturonate to fructuronate. The enzymatic activity of the purified recombinant tagaturonate epimerase from T. maritima was directly confirmed and kinetically characterized. Its function was also confirmed by genetic complementation of the growth of the Escherichia coli uxaB knockout mutant strain on galacturonate. An inferred novel galacturonate to mannonate catabolic pathway in T. maritima was reconstituted in vitro using a mixture of recombinant purified enzymes UxaE, UxaC and UxuB. Members of the newly identified UxaE family were identified in ∼ 50 phylogenetically diverse heterotrophic bacteria from aquatic and soil environments. The genomic context of respective genes and reconstruction of associated pathways suggest that UxaE enzymatic and biological function remains conserved in all of these species.
Effect of Coherin™ on intraocular pressure, pupil size and heart rate in the glaucomatous Beagle: a pilot study
Authors: MacKay Edward O. , Gelatt Kirk N.
Published: August 2012

Objective To evaluate effects of Coherin™ on intraocular pressure (IOP), pupil size (PS), and heart rate (HR) in glaucomatous Beagles in single‐dose studies in a pilot study.

Materials and methods Intraocular pressure, PS, and HR were measured in eight glaucomatous Beagles. One randomly chosen eye received single 50 μL doses of differing concentrations of Coherin™ (treated eye) or vehicle (placebo‐treated eye), and the fellow eye served as the untreated control. After the first measurements, a single dose of either Coherin™ or sterile water vehicle was instilled in the drug and placebo eyes, respectively.

Results The mean ± SEM diurnal changes in IOP after 0.005%, 0.01%, 0.2%, 0.284%, 1%, 2%, and 4% topical Coherin™ once daily were 7.6 ± 3.2 mmHg, 15.5 ± 5.3 mmHg, 11.2 ± 4.4 mmHg, 11.8 ± 4.4 mmHg, 19.1 ± 3.8 mmHg, 5.0 ± 1.8 mmHg, and 8.8 ± 2.8 mmHg, respectively. The declines in IOP were significantly different (P < 0.05) from the untreated control eyes with the 0.2% and 0.284% Coherin™‐treated eyes and suggestive for 1% Coherin™ concentrations. No signs of irritation, significant PS, and HR changes were detected in the Coherin™‐treated eyes.

Conclusion Of seven different concentrations, 2% and 0.248% Coherin™ produced significant declines in IOP in the glaucomatous beagle in single‐dose studies when compared to both untreated control and placebo‐treated eyes. One percent Coherin™ solution produced significant IOP decreases compared with the placebo‐treated eye but not the untreated control eyes. No local ocular irritation, PS and HR changes were observed in Coherin™‐treated eyes. This pilot study suggests that topical Coherin™ has potential as an ocular hypotensive agent.
The Wild Indian's Venison: Locke's Theory of Property and English Colonialism in America
Authors: Arneil Barbara
Published: July 2012

Locke's theory of property in the Two Treatises of Government is shaped by his deep involvement in the development of colonial policy, as secretary to both the Lord Proprietors of Carolina and the Council of Trade and Plantations. This article will demonstrate the extent to which chapter five of the Second Treatise mirrors the arguments made both by the ethical and economic defenders of the English plantation. By calling America vacant, by beginning property in land through enclosure and cultivation and limiting it to that which does not spoil, and by introducing money and international commerce as the means by which the spoilage proviso can be transcended, Locke incorporates both an ethical justification for taking Indian occupied land and economic reasons for favouring settled agrarian based colonies. Thus, embedded within Locke's theory of property is a vigorous economic and ethical defence of England's colonial activities in the new world.
Neoliberalization, Housing Institutions and Variegated Gentrification: How the ‘Third Wave’ Broke in Amsterdam
Authors: van Gent W.P.C.
Published: July 2012

Neil Smith argues that in the last two decades gentrification has become a generalized global urban phenomenon. His theory is at a high level of abstraction, as it links urban gentrification to globalization, financial capitalism and neoliberalization. With these global processes, all cities have experienced ‘third wave’ gentrification. The theory, however, leaves little room for variegations of gentrification, apart from characterizing geographical differences as idiosyncrasies or as minor variations. This downplays the role of intervening mechanisms that impinge upon the pursuit and social outcomes of gentrification. This article aims to amend abstract theory by looking at Amsterdam from a historical institutional perspective. In Amsterdam, gentrification was particularly made possible by a process of neoliberalization within the housing system. However, as institutional change is incremental and based on layering and conversion, many older institutional arrangements remain in place. These arrangements tend to slow gentrification and assuage social consequences. Nevertheless, neoliberal modifications to the housing system have been accelerating the pursuit of gentrification. Current policies will very likely lead to exclusionary displacement.
Urban Renewal in Istanbul: Reconfigured Spaces, Robotic Lives
Authors: Karaman Ozan
Published: July 2012

The article discusses Turkey's property‐led residential redevelopment model. This entails the demolition of an existing settlement, replacing it with blocks of apartments (usually constructed on the exact same site and at a higher density), some of which are then made available to displaced residents for purchase via mortgage loans with long maturities. While the authorities promote this model of urban renewal as an innovative public housing policy, I argue that, far from being an exception to market‐rate housing, the model is in fact a market‐disciplinary tool. It seeks to incorporate into the formal market not just spontaneously developed and only partially regulated spaces, but also the conduct of residents living in these informal neighborhoods. The article contributes to the immense literature on urban renewal and organized struggles around the right to housing by showing that urban renewal is not simply about dispossession and displacement. In the Turkish case, urban renewal does not necessarily seek to displace poor residents (even though it often ends up doing so), rather to incorporate them into a nascent mortgage origination market. The second half of the article introduces and elaborates on a case study in Istanbul.
Randomized Controlled Pilot Study of 2 Weeks' Treatment With High Cutoff Membrane for Hemodialysis Patients With Elevated C‐Reactive Protein
Authors: Fiedler Roman , Neugebauer Felix , Ulrich Christof , Wienke Andreas , Gromann Cora , Storr Markus , Böhler Torsten , Seibert Eric , Girndt Matthias
Published: July 2012

Chronic inflammation in hemodialysis (HD) patients is associated with cardiovascular complications and mortality. Circulating immune active proteins in the molecular range 15–45 kD that cannot be efficiently cleared by high‐flux (HF) dialysis may be causally involved. We intended to test the feasibility of using a high cutoff (HCO) dialyzer in chronic HD patients and its influence on inflammation and monocyte activation. The Gambro HCO1100 dialyzer was compared to a conventional HF membrane in a randomized double‐blind crossover trial in 19 chronic HD patients selected for the presence of elevated serum C‐reactive protein levels. Patients were treated for six consecutive dialysis sessions (2 weeks) with each membrane. Safety analysis recorded adverse events and albumin losses through the protein‐leaking membranes. Efficacy analysis observed reductions in the number of proinflammatory (CD14+CD16+) monocyte subpopulations in circulating blood. Treatment with the HCO membrane was well tolerated, although the number of adverse events was slightly higher. Despite significant serum albumin loss (from 34.1 ± 2.7 to 29.6 ± 3.0 g/L; P < 0.01), there was no need to supplement albumin, and rising activity of cholinesterase during HCO treatment indicated compensation by enhanced hepatic synthesis. The HCO membrane cleared high amounts of proinflammatory cytokines, but did not reduce predialysis inflammatory monocytes and markers. Although the time of HD session was extended, the study was hampered by a lower Kt/V in the HCO compared to the HF period. Treatment of chronic HD patients with this HCO dialyzer for 2 weeks is tolerable in terms of albumin loss and able to clear proinflammatory cytokines; however, this was not sufficient to decrease monocyte activation. Therefore, a more selective, less albumin‐leaking membrane is desirable to allow prolonged high‐efficient dialysis with more effective cytokine clearance.
Structural Change and the Environment
Authors: Lan Jun , Lenzen Manfred , Dietzenbacher Erik , Moran Daniel , Kanemoto Keiichiro , Murray Joy , Geschke Arne
Published: August 2012

We use the input‐output tables in constant prices extended with carbon dioxide (CO2) emissions for examining the development of China, a country undergoing rapid growth. We undertake this empirical analysis in terms of a new and therefore rarely applied methodology: instead of average coefficients characterizing the average (old) technology operating throughout a particular reporting year, we calculate marginal coefficients—in monetary and CO2 terms—that capture the additional (new) technology installed after that year. Marginal coefficients are increasingly recommended in the literature for applications such as consequential life cycle assessment, where they are supposed to lead to more realistic results, especially in prospective analyses. Our work provides a first, broad overview about the magnitude and distribution of these coefficients across recent years in China's rapidly growing economy for which marginal coefficients could be expected to differ greatly from average coefficients. We find that (1) marginal coefficients can differ substantially from average coefficients, thus lending support to the need expressed in the literature for coining consequential life cycle assessment (LCA) and similar prospective assessment in marginal rather than average terms; (2) marginal CO2 emissions coefficients differ more from their average counterparts than marginal monetary coefficients, showing that for China, within‐sector technological solutions to emissions abatement have played a more important role than the reorganization of supply structures; and (3) there exists considerable scatter and variation of marginal coefficients across years, which to a certain extent precludes the identification of clear temporal and sectoral trends.
Food, Fuel, and Climate Change
Authors: Silalertruksa Thapat , Gheewala Shabbir H.
Published: August 2012

This study evaluates the sustainability of biodiesel for transport in Thailand in terms of the availability of fresh fruit bunches (FFB) and crude palm oil (CPO) supply to satisfy the future demands for food and fuel, and the contribution of palm biodiesel to mitigating climate change if biodiesel induces land‐use change (LUC). Five land conversions including rubber, cassava, paddy field, set‐aside land, and forest land to oil palm are considered along with their displacement effects to other land types to evaluate the greenhouse gas (GHG) emissions associated with the direct and indirect land‐use impacts. The net feedstock balance reveals that the policy to expand 0.4 million hectare (Mha) for new oil palm plantations accompanied with an increase of FFB yield to 22 megagrams per hectare (Mg/ha) by 2012 would help avoid a CPO shortage; however, this increase in land use needs to be strongly encouraged. The GHG analyses show a wide range of net GHG balances compared to diesel depending on which type of land is converted and which options are used to treat the oil palm wastes. Except for forest land conversion, direct LUC emissions from converting other lands to oil palm will render benefit to the GHG balance of biodiesel. Indirect LUC emissions through crop displacements, however, will generally worsen the balance. Several recommendations are therefore suggested for sustainable palm biodiesel production in the future.
The Varying Effects of Family Relationships in Entrepreneurial Teams
Authors: Brannon David L. , Wiklund Johan , Haynie J. Michael
Published: July 2012

A majority of entrepreneurial teams contain family relations but little is known about the implications of such family relationships in the formative stages of new venture creation. We examine two distinct types of family relationships in these teams; romantic couples and biologically linked teams and how such relationships influence the probability of ever achieving first sales. Relying on social identity theory, and a longitudinal sample of 295 nascent teams, we find that these relationships matter in important ways. Our conceptualizations and results have implications for the entrepreneurial teams and family business literatures.
Acute and Long‐Term Clinical Outcome After Endoscopic Pulmonary Vein Isolation: Results from the First Prospective, Multicenter Study
Authors: METZNER ANDREAS , WISSNER ERIK , SCHMIDT BORIS , CHUN JULIAN , HINDRICKS GERHARD , PIORKOWSKI CHRISTOPHER , OUYANG FEIFAN , KUCK KARL‐HEINZ
Published: August 2012

Clinical Outcome After Endoscopic PVI. Introduction: The acute and long‐term outcome of pulmonary vein isolation (PVI) using an endoscopic ablation system (EAS) has only been reported in single‐center studies. The current prospective, multicenter study assessed the acute and 1‐year outcome following PVI using the EAS.

Methods and Results: Seventy‐two patients (34 female, mean age 58 ± 10 years) with a history (5 ± 6 years) of drug‐refractory paroxysmal atrial fibrillation (AF) were included. Endoscopic PVI was performed in all patients. Follow‐up was based on regular telephone interviews, Holter ECG, and transtelephonic ECG recordings. Recurrence was defined as a symptomatic and/or documented AF episode >30 seconds following a blanking period of 3 months. In 72 patients, a total of 281 pulmonary veins (PVs) were targeted and 277/281 (98.6%) PVs were isolated successfully using only the EAS. PV stenosis, thrombembolic events, pericardial effusion, pericardial tamponade, and phrenic nerve palsy occurred in 0 of 72, 0 of 72, 3 of 72 (4.2%), 4 of 72 (5.6%), and in 1 of 72 (1.4%) patients, respectively. Sixty‐seven of 72 (93.1%) patients completed a follow‐up of 365 days and 42 of 67 (62.7%) patients remained in stable sinus rhythm after a single procedure. A total of 13 of 25 (52%) patients suffering from AF recurrence consented to repeat PVI using conventional radiofrequency energy 221 ± 121 days after the index procedure. LA to PV reconduction was found in 30 of 45 (67%) previously isolated PVs.

Conclusions: A very high rate of acute electrical PVI is achieved using exclusively the EAS. The 1‐year single‐procedure success rate in patients with paroxysmal AF is comparable to conventional PVI. PV reconduction is the major determinant for AF recurrence. (J Cardiovasc Electrophysiol, Vol. 24, pp. 7‐13, January 2013)
“They want a different life”: Rural northern settlement dynamics and pathways to homelessness in Yellowknife and Inuvik, Northwest Territories
Authors: Christensen Julia
Published: July 2012

Visible homelessness in the Northwest Territories, Canada is often described as a recent phenomenon by policy makers and the popular media alike. Indeed, since the late 1990s, homeless shelters in Yellowknife and Inuvik report a steady increase in demand for beds and other support for homeless people. Homelessness in these two communities disproportionately affects Aboriginal northerners, however little is known about their individual pathways to homelessness. Moreover, homelessness in the Northwest Territories is often portrayed as an issue confined to larger “urbanizing” regional centres, yet many homeless Aboriginal northerners have originated from small, rural settlement communities. Despite this, little concern has been paid to how factors at the small community level intersect with more visible forms of homelessness in larger, urban centres, not to mention how these intersections shape a territorial geography of homelessness. In this article, I aim to uncover and explore the often hidden factors at the northern rural settlement level that ultimately contribute to more visible forms of homelessness in northern urban centres. I suggest that uneven and fragmented social, institutional, and economic geographies result in a unique landscape of vulnerability to homelessness in the Northwest Territories. This geography emerges through the production of particular dynamics between rural settlement communities and northern urban centres. In particular, four main factors represent these rural‐urban dynamics: 1) the attractions of opportunity in northern urban centres; 2) rural settlement‐urban institutional flows; 3) chronic housing need in the settlements; and, 4) disintegrating social relationships in the settlements. I explore the particular ways in which these factors influence rural‐urban migration among the homeless population and what roles this mobility plays in individual pathways to homelessness.
Mesoporous Metal Nitride Materials Prepared from Bulk Oxides
Authors: Yang Minghui , MacLeod Michelle J. , Tessier Franck , DiSalvo Francis J.
Published: July 2012

The preparation of metal nitride materials structured on the nano or mesoscale is challenging due to the need for high sintering temperatures and/or long reaction times. Here, we present a new and simple process for preparing mesoporous transition metal nitrides without the use of nanopatterning or other templating. Mesoporous VN, TiN, CrN, Ta3N5, TaN, NbN, WN, MoN, and Mo2N are obtained by the ammonolysis of bulk ternary oxides containing Zn. The products were characterized by Rietveld refinement of powder X‐ray diffraction (PXRD) patterns, scanning electron microscopy (SEM), and nitrogen adsorption/desorption analysis. Our results demonstrate that the pore sizes of these materials range from 10 to 50 nm. By varying the precursor stoichiometry, the transition metal, and processing conditions, many different mesoporous morphologies are obtained. These materials show high surface area and good electrical conductivity.
Irradiation by light‐emitting diode light as an adjunct to facilitate healing of experimental periodontitis in vivo
Authors: Chang P‐C. , Chien L‐Y. , Ye Y. , Kao M‐J.
Published: July 2012

Chang P‐C, Chien L‐Y, Ye Y, Kao M‐J. Irradiation by light‐emitting diode light as an adjunct to facilitate healing of experimental periodontitis in vivo. J Periodont Res 2013; 48: 135–143. © 2012 John Wiley & Sons A/S

Background and Objective:  This study evaluated the biostimulatory effect of 660 nm light‐emitting diode (LED) as an adjunct in the treatment of experimental periodontitis.

Material and Methods:  Ninety‐six Sprague‐Dawley rats underwent experimental periodontitis by placement of a silk ligature followed with or without additive Porphyromonas gingivalis lipopolysaccharide (Pg‐LPS) injection. Irradiation with LED light was performed at varying energy densities of 5, 10 and 15 J/cm2, 1 d after debridement and detoxification. Rats were killed at 3, 7 and 14 d after irradiation with LED light, and the effect of irradiation was evaluated by descriptive histology and quantitative measurements of periodontal bone loss, inflammatory infiltration and cellular proliferation.

Results:  Reduction of inflammation, accelerated collagen deposition and realignment was noted following irradiation with LED light at densities of 10 and 15 J/cm2, and temporary reduction of periodontal bone loss, as well as bundle bone apposition, was noted at day 3 in rats treated with 10 J/cm2 light. The biomodulatory effect was stronger in sites treated with Pg‐LPS injection. In sites without Pg‐LPS injection, temporary reduction of inflammation was noted in all LED light‐irradiated specimens at day 3. No significant change in cellular proliferation was noted in any LED light‐treated group.

Conclusions:  LED light (660 nm) with an energy density of 10 J/cm2 appeared suitable as an adjunct modality for periodontitis by temporarily reducing inflammation, facilitating collagen realignment and bundle bone deposition. Future studies will aim to amplify the biostimulatory effect of LED light by adding a supplementary medium or repeated irradiation.
High‐throughput phenotyping of avoidance learning in mice discriminates different genotypes and identifies a novel gene
Authors: Maroteaux G. , Loos M. , van der Sluis S. , Koopmans B. , Aarts E. , van Gassen K. , Geurts A. ,   The NeuroBSIK Mouse Phenomics Consortium, Largaespada D. A. , Spruijt B. M. , Stiedl O. , Smit A. B. , Verhage M.
Published: July 2012

Recognizing and avoiding aversive situations are central aspects of mammalian cognition. These abilities are essential for health and survival and are expected to have a prominent genetic basis. We modeled these abilities in eight common mouse inbred strains covering ∼75% of the species' natural variation and in gene‐trap mice (>2000 mice), using an unsupervised, automated assay with an instrumented home cage (PhenoTyper) containing a shelter with two entrances. Mice visited this shelter for 20–1200 times/24 h and 71% of all mice developed a significant and often strong preference for one entrance. Subsequently, a mild aversive stimulus (shelter illumination) was automatically delivered when mice used their preferred entrance. Different genotypes developed different coping strategies. Firstly, the number of entries via the preferred entrance decreased in DBA/2J, C57BL/6J and 129S1/SvImJ, indicating that these genotypes associated one specific entrance with the aversive stimulus. Secondly, mice started sleeping outside (C57BL/6J, DBA/2J), indicating they associated the shelter, in general, with the aversive stimulus. Some mice showed no evidence for an association between the entrance and the aversive light, but did show markedly shorter shelter residence times in response to illumination, indicating they did perceive illumination as aversive. Finally, using this assay, we screened 43 different mutants, which yielded a novel gene, specc1/cytospinB. This mutant showed profound and specific delay in avoidance learning. Together, these data suggest that different genotypes express distinct learning and/or memory of associations between shelter entrance and aversive stimuli, and that specc1/cytospinB is involved in this aspect of cognition.
An audit to assess the perspectives of US wound care specialists regarding the importance of proteases in wound healing and wound assessment
Authors: Snyder Robert J , Cullen Breda , Nisbet Lorraine T
Published: July 2012

Chronic wounds represent an aberrant biochemistry that creates a toxic proteolytic milieu which can be detrimental to the healing process. Rebalancing the wound microenvironment and addressing elevated protease activity (EPA) could therefore help facilitate healing. To understand how clinicians currently diagnose and manage excessive proteolytic activity, 183 survey responses from US wound specialists were collated and analysed to find out their perceptions on the role of proteases. The majority of respondents (>98%) believed proteases were important in wound healing and that a point‐of‐care (POC) protease test could be useful. This study yielded a low response rate (7·1%, n = 183); however, there were adequate data to draw significant conclusions. Specialists perceived that fibrin, slough, granulation tissue and rolled wound edges could indicate EPA. About 43% of respondents, however, failed to give a correct response when asked to review photographs to determine if excessive protease activity was present, and the perceived visual signs for EPA did not correlate with the wounds that had EPA; no statistical differences between professions were observed. Respondents chose debridement, wound cleansing and advanced therapies as important in reducing excessive protease activity. It was concluded that specialists have a need for POC diagnostic tests. On the basis of the responses to wound photos, it was determined that there were no visual cues clinicians could use in determining excessive protease activity. Additional research is recommended to evaluate the efficacy of a POC diagnostic test for protease activity and the treatments and therapies applied when EPA is found.
Berkeley on the Numerical Identity of What Several Immediately Perceive (Three Dialogues between Hylas and PhilonousIII 247–8)
Authors: Glauser Richard
Published: August 2012

Although several passages in Berkeley are related to the question whether two or more finite substances can simultaneously perceive numerically identical sensible ideas, it is only in TDHP (247–8) that he addresses the question explicitly and in some detail. Yet, Berkeley’s less than straightforward reply is notoriously difficult to pin down. Some commentators take Berkeley to be endorsing a clear‐cut positive reply, whereas others have him giving an emphatically negative one; others hold that for Berkeley there is no fact of the matter that determines an answer one way or the other. I argue that all three readings find some justification at one point or another in the passage, and all hold a kernel of truth. Yet, none of them can be taken unrestrictedly because Philonous’s considered position is disjunctive: either there is no problem at all, or, if there is one (thus warranting a negative reply to the public status of sensible ideas), it makes equally against ‘materialism’ and immaterialism. I argue that the passage can be given an overall interpretation that explains why Berkeley is entitled to hold that there is some truth in each direction. I propose answers to the questions (a) why Berkeley thinks there may nevertheless be a problem after all, and (b) if so, why he can yet legitimately feel entitled to let it rest, that is, why he remains confident, within the philosophical context of his day, that his philosophy does not lead to solipsism.
Inherited thrombocytopenias: an approach to diagnosis and management
Authors: Geddis A. E.
Published: July 2012

Inherited thrombocytopenias vary in their presentation, associated features, and molecular etiologies. An accurate diagnosis is important to provide appropriate therapy as well as counseling for the individual and their family members. As the genetic basis of more disorders is understood, it will be possible to diagnose a greater fraction of patients as well as learn more about the process of megakaryopoiesis and platelet production.
Experiences of patients called to hospital for a renal transplant
Authors: Noble Helen R.
Published: July 2012

When patients develop end stage renal failure (ESRF) the effects can be devastating. Patients perceive transplantation as a solution to their many problems and it is often the treatment of choice. The aim of this study was to examine the experiences of patients with ESRF when called to the hospital for a renal transplant. Semi‐structured interviews were taped, transcribed and a thematic data analysis carried out. Results demonstrated that patients felt they were given adequate support on arrival at hospital but they found the wait to determine if they were a suitable match for the kidney difficult. There was evidence that some patients coped with the situation by shutting out negative possibilities.
Immunoadsorption in systemic lupus erythematosus
Authors: Perniok A. , Schneider M.
Published: July 2012

Plasmapheresis and immunoadsorption (IA) have been introduced into the therapeutic strategy of patients with systemic lupus erythematosus (SLE) and severe organ involvement. Despite numerous reports about the clinical efficacy of extracorporeal treatments controlled studies have failed to show significant advantages compared with standard immunosuppressive treatment. We describe the historical development of plasmapheresis‐based IA‐techniques with special comments on substitution fluids and especially immunoglobuline (Ig) specific adsorption columns. In addition, an overview is given of our clinical experience with different columns and a new strategy of aggressive Ig lowering combined with standard cyclophosphamide pulse therapy in SLE patients with severe organ involvement.
Immunoadsorption in HLA‐sensitised renal patients
Authors: Bevan D.J. , Gallagher M.C. , Vaughan R.W. , Koffman C.G.
Published: July 2012

Kidney dialysis is a costly procedure both in monetary terms (£ 30,000/year/patient) and also in patient morbidity. Dialysis is capable of delivering about 10% of normal renal function in contrast to a transplanted kidney, which can provide up to 50%. Following renal transplantation the annual costs per year (after the first year) are in the region of £ 5,000 (per patient) and the transplant recipients enjoy a longer life. Not all patients who are suitable for transplantation can be easily transplanted. Dialysis‐dependent patients in end‐stage‐renal‐failure with high levels of HLA (human leukocyte antigen) specific antibodies, owing to previous blood transfusions, pregnancy or earlier failed organ transplants, have a greatly reduced likelihood of obtaining a suitable donor kidney. We have therefore developed a strategy to assist the transplantation of this disadvantaged group of patients, who constitute a significant proportion of adult renal patients on transplant waiting lists.
Daily dialysis and survival rates of vascular access
Authors: Rondini L. , Marilena L. , Pasticci F. , Quintaliani G. , Reboldi G. , Buoncristiani U.
Published: July 2012

A major cause of morbidity for haemodialysis patients is vascular access failure and/or occlusion. It is commonly believed that increased frequency of dialysis sessions, among other factors, might lead to higher rates of fistula complications. To evaluate if patients on daily haemodialysis carry a higher risk of vascular access occlusion, we examined the raw incidence rate of access occlusion and the survival function of native vascular access in patients undergoing daily dialysis (DD ‐ N. =24) as compared to patients on standard three times a week haemodialysis (TWD‐N. =198). The number of thrombotic events in the first group was 2 (8%) whereas in the second group we observed 76 (38%) access problems (8%) (p<0.008). The mean vascular access survival before occlusion was 1307 days in TWD and 1388 days in DD. Our data clearly shows that daily dialysis should not be considered a risk factor for access occlusion.
Factors influencing iron requirements in haemodialysis patients
Authors: Ochando A. , Zaleski M. , Andrea C. , Garvía R. , López D. , Pulido A. , Galera A.
Published: July 2012

It is well known that haemodialysis patients are prone to developing iron deficiency. Our study looks for data to establish the factors influencing the varying iron needs among these patients.
Practical initiatives in the prevention of cross infection
Authors: Vanpellicom J.
Published: July 2012

In Belgium Infection Control Nurses must register postoperative wound infections, sepsis and ventilation associated pneumonia. At the author's hospital, the incidence of pressure sores is scored four times a year and there is a register of new patients with M.R.S.A. (methicillin resistant staphylococcus aureus) and tuberculosis. Procedures for hospital hygiene can be consulted in order to see which patients must be isolated and what kind of precautions must be taken. The microorganisms and diseases are sorted alphabetically and the cause of cross‐infection, isolation procedure and duration of isolation are noted. These procedures must be translated to the different departments and individual patients. For instance a patient with M.R.S.A. is strictly isolated in the general hospital, but not in the psychiatric department. As far as the haemodialysis unit is concerned, patients with chronic renal disease are more sensitive to infections. For this reason correct hand hygiene is very important. Hand washing, hand desinfection techniques and the use of gloves must be promoted. A microbiological control of the hands of staff once a year, combined with an educational programme, can motivate staff in a positive way. Needle‐stick injuries present a serious occupational hazard for health care workers, especially those working in a haemodialysis unit. Information and needleless haemodialysis may reduce the risk of needle‐stick injuries and the risk of viral transmission.

Can a nurse, at risk of viral contamination and transmission, refuse to treat a patient? Is the use of hats, overshoes, glasses necessary? How many times are these materials changed, etc.?

This paper presents the data of 10 years of M.R.S.A. registration at the author's hospital. M.R.S.A. has become a serious problem in many hospitals since the mid 1970s. Strenuous efforts need to be taken to control its spread. Screening of the nose of patients and of staff can be helpful. The carriers can be treated with mupirocin ointment. Body washing with chlorhexidine is preferred. The use of vancomycin and teicoplanin is a decision for the physician.
Microbiological survey of dialysate: Vantage of use of sterile bag concentrate
Authors: Pansini S. , Degaetano R. , Boccassini D. , Turi E.
Published: July 2012

Haemodialysed patients are exposed to nearly 400 litres of dialysis water weekly. The bacterial contamination of treated dialysate and water induces acute pyrogenic reactions or chronic damage and cytokine activation.

The aim of this study was to value the microbiological parameters of dialysis water and dialysate of our monitors by bacterial culture (measured as colony forming units [CFU]) of water samples at 37 °C after 48 hours, at 22 °C after 72 hours and after seven days, and by measuring endotoxin levels (endotoxin units [EU]).

In our centre, there are 16 monitors (6 monitors use sterile dialysate fluid and 10 monitors use non sterile dialysate fluid). The chemicals used for disinfection are chlorine and paracetic acid. Water samples were taken under sterile procedures every three months for a year.

No bacteria were found in the samples of water of the dialysis ring; EU were lower than the limit value of 0.25 EU/ml fixed by the European Pharmacopoeia.

The concentration of CFU and EU of the dialysate, taken from monitors with a sterile bag, were lower than those of other monitors (p < 0.05 t Student test). However, the levels of CFU/ml and EU/ml of dialysate samples, taken from monitors with a non‐sterile bag, were lower than the guideline value of the European Pharmacopoeia (v.n. CFU < 50 CFU/ml and EU < 0,05 EU/ml).

Frequent examination of CFU and EU is essential to reduce the damage caused by the use of contaminated water, therefore the goal of future dialytic techniques will be the use of “sterile dialysate”.
Care of the geriatric patient in chronic renal failure
Authors: Bernaert P.
Published: July 2012

Currently, there are around one million chronic dialysis patients worldwide. More than half of these are older than 65. For various reasons this is a fast growing population.

When the indication is considered to start dialysis, a distinction must be made between biological age in the third and fourth decade on the one hand, and a specific geriatric profile on the other, which implies adequate gerontological knowledge.

Besides the patient‐directed choice of the best tolerated treatment technique, the specific treatment of age‐linked polypathology as well as the appropriate approach of inter‐ and intradialysis related problems regarding access and haemodynamics are the best guaranties of success in this highest age dialysis group. By means of a multidisciplinary geriatric assessment, which makes it possible to carry out an objective analysis and observation from the somatic, psychic and social points of view, an ultimate objective is achieved: the improvement of quality of life by means of rehabilitation.

The survival of elderly dialysis patients has favourably evolved since the 90's after the introduction of EPO, bicarbonate dialysate, the monitoring of dialysis adequacy and support of prognostic and comorbid factors.

The problems surrounding dialysis drop‐out is a sensitive and controversial matter in which well founded communication with the patient, the family, the dialysis team, domestic care and the general practitioner is vital. “Add life to years and not years to life” remains a challenge for every nephrologist.
Reduction of Kt/V by food intake during haemodialysis
Authors: Miguelsanz M. San Juan , Pilar S. Muñoz , De Pablos Santos , Prieto B. Bravo
Published: July 2012

Background: Urea kinetic modelling is a method for verifying that the amount of dialysis prescribed equals the amount of dialysis delivered. DOQI guidelines help to assess the causes of a low Kt/V: fistula integrity, treatment duration, methods of obtaining BUN samples, dialysis machine and patient specific variables.

Objective: To demonstrate the relation between food intake during HD and measurement of Kt/V.

Methods: Prospective study on 14 patients. We measured the amount of dialysis during the second week, with and without food intake during HD. HD prescription (blood flow, dialysate flow, dialyser, dry weight, heparin) was not changed.

Statistical analysis was performed using Paired T test.

Conclusions: 1. There was no significant change in protein catabolic rate, average urea concentration and intradialysis gain with food intake. 2. There was a significant change in levels of Kt/V using Gotch formula and Dugirdas formula with food intake.
Early management and prevention of Acute Renal Failure
Authors: Kalra P. A.
Published: July 2012

Despite major advances in nutritional support, membrane technology and dialytic techniques, the mortality of patients with acute renal failure (ARF) who require dialysis is still almost 50% (1). Increased patient age and co‐morbidity confer a poorer prognosis, and the condition is certainly commoner in this patient group. Hence, one study showed that the age‐related annual incidence of ARF increased from 17 per million in adults under 50 years to 949 per million in the 80–89 age group (2).

Over 60% of cases of ARF ultimately result from renal hypoperfusion and consequent intra‐renal ischaemic damage, which leads to acute tubular necrosis (ATN) (3). Ischaemic ARF may thus result from a diversity of systemic and intra‐renal circulatory stresses including acute losses of blood and extra‐cellular fluids, from low cardiac output states such as following ischaemic or toxic myocardial damage, and even from drug‐induced renal perfusion shutdown (ACE inhibitors, non‐steroidal anti‐inflammatory agents). Many cases of ARF have a multi‐factorial aetiology (e.g. post‐surgical sepsis with hypovolaemia, hypotension and injudicious antibiotic use), and these patients, who often have other organ failure, fit into the poorer prognostic category.

A large number of patients with ischaemic ARF pass through a phase of potentially reversible pre‐renal oliguria; early recognition and prompt, appropriate treatment of these pre‐renal factors can prevent progression to established ARF, with the genuine prospect of improved patient morbidity and mortality, and this is the main scope of this article. Early diagnosis in other patients with ARF, such as those with acute inflammatory renal disease (e.g. vasculitis) or urinary tract obstruction, will allow appropriate prompt treatment and the possibility for reversal of the ARF. The following account, which is composed of personal experience, that of colleagues, and the literature (1,4), is not intended to provide a comprehensive guide to the management of ARF, but seeks to highlight important common pitfalls and fundamental principles in the recognition and subsequent preventive treatment of these patients.
The effects of Acute Renal Failure on the family
Authors: Ashwanden C.
Published: July 2012

This paper will explore the effects of Acute Renal Failure (ARF) on the family of the patient. The patient's needs are the concern of the health care team and are more medically orientated than those of the family, whose needs are prevailingly social ones. However, the family's reactions do affect the patient and his/her response to their illness. The diagnosis of any major illness is devastating for the patient and his/her family, and in discussing ARF and its effects, it is possible to realise the common needs of the relatives of all acutely sick people. There is little written about the family's needs when ARF is diagnosed because of the commonalities with the diagnosis of any sudden critical illness. However it is in the relationships between the families and the specialist renal nurse where the differences lie. The partnership which develops in chronic renal care between the renal nurse and his/her patient translates onto the acute unit and makes the care that the specialist acute nurse provides different to other wards in a hospital. On diagnosis, the patient will be treated either on an Intensive Care Unit or in the acute haemodialysis unit depending on the causes of the renal failure and the co‐morbidities. The personnel treating the patient will differ depending where the treatment is delivered; but wherever the patient finds themselves the needs of the family are generally the same (1). There is much debate about where is the best place to treat people with ARF (2) but most patients are moved to the acute haemodialysis ward as soon as possible, where the specialist nursing staff have great influence over the treatment and care of the patient. It is here, where the expert nurse and his/her skills are most in evidence and the skills of the nurse are vital, as s/he will spend the most time with the patient (3). It is the time spent during treatment when the family can relate to one caregiver and relationships develop.