bluuebunny/crossref_metadata_2025 huggingface dataset:
Signet Ring Cell Carcinoma in Urine Cytology: Cytomorphologic Findings and Differential Diagnosis
Authors: Guan Hui , Tatsas Armanda D. , Ali Syed Z.
Published: February 2012

Background: Signet ring carcinoma is an exceedingly rare and aggressive variant of primary bladder carcinoma. The cytomorphologic features of this rare entity in urinary specimens have not been well characterized. Methods: Twenty-seven cases of signet ring cell carcinoma of the urinary bladder were identified from the pathology archives of The Johns Hopkins Hospital (1989–2011). Of these, 6 cases with prior urinary cytology specimens were studied. Results: There were 5 males and 1 female, with a mean age of 62 years. The presenting complaints included hematuria with or without symptoms of bladder irritation. Histopathologically, there were 5 cases of primary bladder carcinoma and 1 case of metastatic colonic signet ring cell carcinoma. The salient cytomorphologic features included scattered malignant epithelial cells, displaying distinct cell borders, abundant cytoplasm with a single large, discrete mucin vacuole, and eccentric irregular nuclei with prominent nucleoli. Primary adenocarcinoma additionally revealed a few intact malignant glandular epithelial fragments. Metastatic colonic signet ring cell carcinoma displayed predominantly singly dispersed malignant cells with eccentrically placed, oval nuclei with occasional small nucleoli and a moderate amount of vacuolated cytoplasm. Conclusion: Signet ring cell carcinomas are rarely encountered in urinary cytology. The differential diagnosis includes distended histiocytes or degenerated urothelial cells, primary signet ring cell carcinoma, and metastatic adenocarcinoma.
Implementing Human Papillomavirus Testing in a Public Health Hospital: Challenges and Opportunities
Authors: Beldi Mariana Carmezim , Tacla Maricy , Caiaffa-Filho Helio , Ab’saber Alexandre , Siqueira Sheila , Baracat Edmund Chada , Alves Venancio Avancini Ferreira , Longatto-Filho Adhemar
Published: February 2012

Objectives: Robust evidence now supports human papillomavirus (HPV) testing as a more effective option to screening and as more sensitive than cytology in detecting high-grade cervical intraepithelial neoplasia . Our goal was to analyze the performance of the Hybrid Capture II (HC2) assay for high-risk HPV (hrHPV) in women undergoing gynecological examination at a public health hospital as part of the evaluation of HPV screening as an alternative or complement to cytology. Study Design: This analysis is a subset of a cross-sectional study carried out at a large public hospital serving a predominantly low-resource population. A total of 705 women were enrolled; the sensitivity and specificity of each test were estimated and compared. Results: The analysis identified 272 hrHPV-positive women (mean age 36.3 years) and 433 hrHPV-negative women (mean age 41.2 years). HPV testing showed a significantly increased sensitivity of the HC2 assay versus cytology (84.5 vs. 69.7%; p < 0.0001) but a lower specificity (49.90 vs. 88.78%; p < 0.0001). Conclusion: The combination of both methods seems to be useful in improving detection of cervical lesions.
Clinical, Endoscopic and Histological Differentiations between Crohn’s Disease and Intestinal Tuberculosis
Authors: Yu Haisheng , Liu Ying , Wang Yadong , Peng Liang , Li Aimin , Zhang Yali
Published: February 2012

Background and Aim: Differentiating Crohn’s disease from intestinal tuberculosis often challenges clinicians in countries where tuberculosis and Crohn’s disease coexist. The aim of this study was to screen out clinical, endoscopic and histological features which may be helpful in distinguishing Crohn’s disease from intestinal tuberculosis. Methods: 43 patients with a confirmed diagnosis of intestinal tuberculosis and 53 patients with Crohn’s disease were recruited for this study. Their clinical, endoscopic and histological features were subjected to univariate and multivariate analyses. Results: On univariate analysis, the features of hematochezia, intestinal obstruction, fistula, oral ulcers, longitudinal ulcers, cobblestone appearance and pseudopolyps were more common in Crohn’s disease than in intestinal tuberculosis (p < 0.05). The features of night sweats, concomitant pulmonary tuberculosis, positive tuberculin skin test, positive antibody to tuberculosis, abdominal lymphadenopathy, ascites, transverse ulcers, patulous ileocecal valve, and granulomas were more common in intestinal tuberculosis than in Crohn’s disease (p < 0.05). Granulomas exceeding 300 µm in maximal diameter, more than five granulomas per section, and confluent granulomas were more frequently identified in intestinal tuberculosis than in Crohn’s disease (p < 0.05). On further multivariable logistic regression analysis, night sweats (OR 0.1, CI 0.02–0.1), longitudinal ulcers (OR 35.5, CI 1.8–683.2), and granulomas (OR 0.02, CI 0.002–0.2) were found to be significant predictors in differentiating Crohn’s disease from intestinal tuberculosis. Receiver-operating characteristic (ROC) analysis was performed on the scores of patients from the final multivariate logistic model, and the area under the ROC curve was 0.8642 (95% CI 0.79–0.94). Conclusions: Night sweats, longitudinal ulcers and granulomas were the most important features to differentiate Crohn’s disease from intestinal tuberculosis.
Ultrasound Gel Causes Fine Needle Aspiration Artifact? A Clear Choice
Authors: Royer Mark C. , Davidson Darrell D. , Dimitrov Rosen K. , Kuo Connie Y. , Kokoska Mimi S.
Published: February 2012

Objectives: Ultrasound-guided fine needle aspiration (FNA) is a commonly employed tool in cytopathologic practice. Artifacts resulting in misinterpretation of specimens have been noted with various ultrasound gel media. Our purpose was to perform a prospective human cadaveric study of this phenomenon to identify a low-cost solution that eliminates the artifact. Study Design: Three separate ultrasound-guided FNAs were performed on the thyroid and parotid glands in situ of a fresh human cadaver using three different types of ultrasound gel media. Slides were prepared in standard fashion (Quik-Diff and Papanicolaou stains). Two cytopathologists subsequently analyzed the slides for the presence of any artifact interfering with their ability to visualize and interpret the cellular aspirate material. Results: Two of the three gel media revealed significant artifacts mimicking apoptosis, necrosis or colloid, making it difficult to visualize the cellular components and differentiate the artifact from the thyroid colloid. One gel medium did not show any significant artifact, and there was no discernable difference in its quality with regard to the ultrasound image during FNA procedures. Conclusions: Ultrasound gels can be associated with a significant artifact in FNA specimens. To eliminate this artifact, which may alter the adequacy, diagnosis or cytologic appearance, we confirm a specific gel type that is useful for ultrasound-guided FNAs.
Value of Current Chemotherapy and Surgery in Advanced and Metastatic Bladder Cancer
Authors: Racioppi M. , D’Agostino D. , Totaro A. , Pinto F. , Sacco E. , D’Addessi A. , Marangi F. , Palermo G. , Bassi P.F.
Published: February 2012

The aim of the present paper was to review findings from the most relevant studies and to evaluate the value of current chemotherapy and surgery in advanced unresectable and metastatic bladder cancer. Studies were identified by searching the MEDLINE® and PubMed® databases up to 2011 using both medical subject heading (Mesh) and a free text strategy with the name of the known individual chemotherapeutic drug and the following key words: ‘muscle-invasive bladder cancer’, ‘chemotherapeutics agents’, and ‘surgery in advanced bladder cancer’. At the end of our literature research we selected 141 articles complying with the aim of the review. The results showed that it has been many years since the MVAC (methotrexate, vinblastine, adriamycin, cisplatin) regimen was first developed. The use of cisplatin-based combination chemotherapy is associated with significant toxicity and produces long-term survival in only approximately 15–20% of patients. Gemcitabine + cisplatin represents the gold standard in the treatment of metastatic bladder cancer. In conclusion, the optimal approach in the management of advanced urothelial cancer continues to evolve. Further progress relies on the expansion of research into tumor biology and an understanding of the underlying molecular ‘fingerprints’ that can be used to enhance diagnostic and therapeutic strategies. Cisplatin-based therapy has had the best track record thus far.
Predictors of Successful Decannulation Using a Tracheostomy Retainer in Patients with Prolonged Weaning and Persisting Respiratory Failure
Authors: Budweiser Stephan , Baur Tobias , Jörres Rudolf A. , Kollert Florian , Pfeifer Michael , Heinemann Frank
Published: February 2012

Background: For percutaneously tracheostomized patients with prolonged weaning and persisting respiratory failure, the adequate time point for safe decannulation and switch to noninvasive ventilation is an important clinical issue. Objectives: We aimed to evaluate the usefulness of a tracheostomy retainer (TR) and the predictors of successful decannulation. Methods: We studied 166 of 384 patients with prolonged weaning in whom a TR was inserted into a tracheostoma. Patients were analyzed with regard to successful decannulation and characterized by blood gas values, the duration of previous spontaneous breathing, Simplified Acute Physiology Score (SAPS) and laboratory parameters. Results: In 47 patients (28.3%) recannulation was necessary, mostly due to respiratory decompensation and aspiration. Overall, 80.6% of the patients could be liberated from a tracheostomy with the help of a TR. The need for recannulation was associated with a shorter duration of spontaneous breathing within the last 24/48 h (p < 0.01 each), lower arterial oxygen tension (p = 0.025), greater age (p = 0.025), and a higher creatinine level (p = 0.003) and SAPS (p < 0.001). The risk for recannulation was 9.5% when patients breathed spontaneously for 19–24 h within the 24 h prior to decannulation, but 75.0% when patients breathed for only 0–6 h without ventilatory support (p < 0.001). According to ROC analysis, the SAPS best predicted successful decannulation [AUC 0.725 (95% CI: 0.634–0.815), p < 0.001]. Recannulated patients had longer durations of intubation (p = 0.046), tracheostomy (p = 0.003) and hospital stay (p < 0.001). Conclusion: In percutaneously tracheostomized patients with prolonged weaning, the use of a TR seems to facilitate and improve the weaning process considerably. The duration of spontaneous breathing prior to decannulation, age and oxygenation describe the risk for recannulation in these patients.
The Effect of Exenatide and Erythromycin on Postprandial Symptoms and Their Relation to Gastric Functions
Authors: Yoon Seung Bae , Choi Myung-Gyu , Lim Chul-Hyun , Kim Jin Soo , Cho Yu Kyung , Park Jae Myung , Lee In Seok , Kim Sang Woo , Choi Kyu Yong , Chung In-Sik
Published: February 2012

Background: The relationship between abnormal gastric motor function and postprandial abdominal symptoms has not been fully clarified. The aim of the study was to investigate this relationship in response to mediators that affect gastric function. Methods: Ten healthy volunteers participated in a 3-way cross-over study of treatment with placebo, exenatide and erythromycin. The studies were performed at 1-week intervals. Each subject underwent 3-dimensional single photon emission computed tomography to measure fasting and postprandial gastric volumes. A combined nutrient drink test and cutaneous electrogastrography (EGG) were performed on the next day. Results: Erythromycin reduced postprandial symptoms compared with placebo. The postprandial gastric volume after exenatide was greater than after placebo and erythromycin treatment. Exenatide did not aggravate postprandial symptoms compared with placebo. The ratio of postprandial over fasting gastric volume was inversely correlated with the total postprandial symptom score after placebo, exenatide and erythromycin treatment. The postprandial symptom score of the normal EGG group was significantly lower than that of the abnormal group, considering overall treatments. Conclusions: Erythromycin reduced postprandial symptoms, whereas exenatide did not aggravate postprandial symptoms, possibly due to its enhancement of gastric accommodation. An abnormal EGG rhythm was associated with postprandial symptoms.
Bilateral Nephrectomy as a Rescue Therapy for Hemodialyzed Patient with Malignant Hypertension – Case Report
Authors: Macsim Lucian Stefan , Stróżecki Paweł , Miśkowiec-Wiśniewska Ilona , Kardymowicz Anna , Manitius Jacek
Published: February 2012

We present the case of a 64-year-old male patient in whom malignant phase of hypertension developed during dialysis therapy. Hypertension was resistant to pharmacological therapy with seven antihypertensive drugs and dialysis therapy with ultrafiltration. In this patient bilateral nephrectomy was performed as a rescue therapy. It led to better control of blood pressure and allowed to reduce the number and dosage of antihypertensive medications.
Thioredoxin-Interacting Protein Mediates Nuclear–to–Plasma Membrane Communication
Authors: Spindel Oded N. , Yan Chen , Berk Bradford C.
Published: February 2012

Objective—

Thioredoxin-interacting protein (TXNIP) and poly-ADP-ribose polymerase 1 (PARP1) are both regulated by changes in cellular reduction-oxidation (redox) state and localize to the nucleus basally in human umbilical vein endothelial cells (HUVEC). Previously we showed a novel mechanism for PARP1 inhibition–mediated HUVEC survival through activation of vascular endothelial growth factor receptor 2 (VEGFR2) signaling in response to stress-induced apoptosis. In addition, we showed TXNIP translocation to the plasma membrane (PM) and activation of VEGFR2 in response to physiological stimuli. Because TXNIP is an α-arrestin that regulates VEGFR2 signaling, we hypothesized that PARP1 regulates TXNIP localization and function that might affect HUVEC stress-induced apoptosis.

Methods and Results—

HUVEC treated with 10 μmol/L PARP1 inhibitor (PJ34) were protected from TNF (10 ng/mL) or H
2
O
2
(300 μmol/L) mediated cell death. HUVEC transfected with TXNIP siRNA lost the protective effect of PARP1 inhibition, suggesting a protective role for TXNIP. Using immunofluorescence, cell fractionation analysis, and plasma membrane sheet assay, TXNIP was shown to translocate to the plasma membrane after PARP1 inhibition. TXNIP translocation was associated with activation of VEGFR2 signaling. Functionally, TXNIP-PARP1 interaction was decreased on PJ34 treatment, suggesting PARP1 as a novel regulator of TXNIP localization and function.

Conclusion—

These findings demonstrate a novel regulatory mechanism of TXNIP by PARP1 to mediate activation of plasma membrane signaling and cell survival.
Everolimus Triggers Cytokine Release by Macrophages
Authors: Martinet Wim , Verheye Stefan , De Meyer Inge , Timmermans Jean-Pierre , Schrijvers Dorien M. , Van Brussel Ilse , Bult Hidde , De Meyer Guido R.Y.
Published: February 2012

Objective—

Stent-based delivery of the mammalian target of rapamycin (mTOR) inhibitor everolimus is a promising strategy for the treatment of coronary artery disease. We studied potential adverse effects associated with mTOR inhibition.

Methods and Results—

Macrophages in culture were either treated with everolimus or starved to inhibit mTOR. Everolimus led to inhibition of protein translation, activation of p38 MAPK, and the release of proinflammatory cytokines (eg, IL-6, TNFα) and chemokines (eg, MCP1, Rantes) before induction of autophagic death. These effects were also observed with rapamycin, but not after starvation. Everolimus-induced cytokine release was similar in macrophages lacking the essential autophagy gene Atg7 but was inhibited when macrophages were cotreated with p38 MAPK inhibitor SB202190 or the glucocorticoid clobetasol. Combined stent-based delivery of clobetasol and everolimus in rabbit plaques downregulated TNFα expression as compared with everolimus-treated plaques but did not affect the ability of everolimus to induce macrophage clearance.

Conclusion—

mTOR inhibition by everolimus triggers cytokine release in macrophages through inhibition of protein translation and p38 activation. These findings provide a rationale for combined local treatment of atherosclerotic plaques with everolimus and an anti-inflammatory agent.
Asialoerythropoietin, a Nonerythropoietic Derivative of Erythropoietin, Displays Broad Anti-Heart Failure Activity
Authors: Takeyama Toshiaki , Takemura Genzou , Kanamori Hiromitsu , Kawaguchi Tomonori , Ogino Atsushi , Watanabe Takatomo , Morishita Kentaro , Tsujimoto Akiko , Goto Kazuko , Maruyama Rumi , Ushikoshi Hiroaki , Kawasaki Masanori , Yamada Kazunari , Nikami Hideki , Fujiwara Takako , Fujiwara Hisayoshi , Minatoguchi Shinya
Published: February 2012

Background—

We investigated the effects of asialoerythropoietin (asialoEPO), a nonerythrogenic erythropoietin derivative, on 3 murine models of heart failure with different etiologies.

Methods and Results—

Doxorubicin (15 mg/kg) induced heart failure within 2 weeks (toxic cardiomyopathy). Treatment with asialoEPO (6.9 μg/kg) for 2 weeks thereafter attenuated the associated left ventricular dysfunction and dilatation. In addition, the asialoEPO-treated heart showed less myocardial fibrosis, inflammation, and oxidative damage, and diminished atrophic cardiomyocyte degeneration, which was accompanied by restored expression of GATA-4 and sarcomeric proteins. Mice with large 6-week-old myocardial infarctions exhibited marked left ventricular dysfunction with adverse remodeling (ischemic cardiomyopathy). AsialoEPO treatment for 4 weeks significantly mitigated progression of the dysfunction and remodeling and reduced myocardial fibrosis, inflammation, and oxidative damage. Finally, 25-week-old δ-sarcoglycan-deficient mice (genetic cardiomyopathy) were treated with asialoEPO for 5 weeks. AsialoEPO mitigated the progressive cardiac remodeling and dysfunction through cardiomyocyte hypertrophy, and upregulated expression of GATA-4 and sarcomeric proteins. AsialoEPO appears to act by altering the activity of the downstream erythropoietin receptor signals extracellular signal-regulated protein kinase, Akt, signal transducer, and activator of transcription 3 and 5 in a model-specific manner.

Conclusions—

The findings suggest that asialoEPO exerts broad cardioprotective effects through distinct mechanisms depending on the model, which are independent of the erythrogenic action. This compound may be promising for the treatment of heart failure of various etiologies.
Absence of Type VI Collagen Paradoxically Improves Cardiac Function, Structure, and Remodeling After Myocardial Infarction
Authors: Luther Daniel J. , Thodeti Charles K. , Shamhart Patricia E. , Adapala Ravi K. , Hodnichak Cheryl , Weihrauch Dorothee , Bonaldo Paolo , Chilian William M. , Meszaros J. Gary
Published: February 2012

Rationale:

We previously reported that type VI collagen deposition increases in the infarcted myocardium in vivo. To date, a specific role for this nonfibrillar collagen has not been explored in the setting of myocardial infarction (MI).

Objective:

To determine whether deletion of type VI collagen in an in vivo model of post-MI wound healing would alter cardiac function and remodeling in the days to weeks after injury.

Methods and Results:

Wild-type and
Col6a1
−/−
mice were subjected to MI, followed by serial echocardiographic and histological assessments. At 8 weeks after MI, infarct size was significantly reduced, ejection fraction was significantly preserved (43.9%±3.3% versus 29.1%±4.3% for wild-type), and left ventricular chamber dilation was attenuated in the
Col6a1
−/−
MI group (25.8%±7.9% increase versus 62.6%±16.5% for wild-type). The improvement in cardiac remodeling was evident as early as 10 days after MI in the
Col6a1
−/−
mice. Myocyte apoptosis within the infarcted zones was initially greater in the
Col6a1
−/−
group 3 days after MI, but by day 14 this was significantly reduced. Collagen deposition also was reduced in the infarcted and remote areas of the
Col6a1
−/−
hearts. The reductions in chronic myocyte apoptosis and fibrosis are critical events leading to improved long-term remodeling and functional outcomes.

Conclusions:

These unexpected results demonstrate for the first time that deletion of type VI collagen in this knockout model plays a critical protective role after MI by limiting infarct size, chronic apoptosis, aberrant remodeling, and fibrosis, leading to preservation of cardiac function.
Topographic Location of Acute Pontine Infarction Is Associated With the Development of Progressive Motor Deficits
Authors: Oh Semi , Bang Oh Young , Chung Chin-Sang , Lee Kwang Ho , Chang Won Hyuk , Kim Gyeong-Moon
Published: February 2012

Background and Purpose—

Motor weakness progression is relatively common in acute pontine infarction and frequently associated with increased functional disability. We designed this study to identify the predictors of progression of motor weakness in patients with pontine infarction during the acute phase.

Methods—

We identified consecutive patients with acute ischemic stroke in the pons. Patients were defined as having progressive motor deficits (PMD) if their motor National Institutes of Health Stroke Scale scores increased by ≥1 unit between the maximal and initial neurological deficits. To define the predictors of PMD in patients with a pontine infarct, clinical, laboratory, diffusion-weighted imaging lesion location, and magnetic resonance angiographic variables were investigated.

Results—

A total of 190 patients (male:female=112:78, 66.4±10.6) were identified, and 49 (25.8%) patients were diagnosed with progressive motor deficits. Logistic multiple regression analysis identified lesion involvement of the lower pons (odds ratio, 3.768; 95% confidence interval, 1.696–8.371) as an independent risk factor contributing to motor progression. Although 34 patients (17.9%) had significant basilar artery stenosis, there was no relationship between PMD in pontine infarct patients and the presence of basilar artery stenosis. Additionally, female and previous hypertension were associated with PMD (odds ratio, 2.651, 95% confidence interval, 1.211–5.802; odds ratio, 3.051, 95% confidence interval, 1.087–9.673).

Conclusions—

Our results suggest that lower pons lesions may contribute to progressive motor deficits in patients with isolated acute pontine infarction. Infarct topography is therefore a potential prognostic factor of PMD, because the location of the infarct can affect the extent of ischemic degeneration of the corticospinal tract.
A Simple, Assumption-Free, and Clinically Interpretable Approach for Analysis of Modified Rankin Outcomes
Authors: Howard George , Waller Jennifer L. , Voeks Jenifer H. , Howard Virginia J. , Jauch Edward C. , Lees Kennedy R. , Nichols Fenwick T. , Rahlfs Volker W. , Hess David C.
Published: February 2012

Background and Purpose—

There is debate regarding the approach for analysis of modified Rankin scale scores, the most common functional outcome scale used in acute stroke trials.

Methods—

We propose to use tests to assess treatment differences addressing the metric, “if a patient is chosen at random from each treatment group and if they have different outcomes, what is the chance the patient who received the investigational treatment will have a better outcome than will the patient receiving the standard treatment?” This approach has an associated statement of treatment efficacy easily understood by patients and clinicians, and leads to statistical testing of treatment differences by tests closely related to the Mann-Whitney
U
test (Wilcoxon Rank-Sum test), which can be tested precisely by permutation tests (randomization tests).

Results—

We show that a permutation test is as powerful as are other approaches assessing ordinal outcomes of the modified Rankin scores, and we provide data from several examples contrasting alternative approaches.

Discussion—

Whereas many approaches to analysis of modified Rankin scores outcomes have generally similar statistical performance, this proposed approach: captures information from the ordinal scale, provides a powerful clinical interpretation understood by both patients and clinicians, has power at least equivalent to other ordinal approaches, avoids assumptions in the parameterization, and provides an interpretable parameter based on the same foundation as the calculation of the probability value.
Microembolic Signals in Acute Posterior Circulation Cerebral Ischemia
Authors: Hwang Jaechun , Kim Suk Jae , Hong Ji Man , Bang Oh Young , Chung Chin-Sang , Lee Kwang Ho , Kim Gyeong-Moon
Published: February 2012

Background and Purpose—

The clinical significance of microembolic signals (MES) in the posterior circulation remains unclear. The aim of this study was to investigate the sources and consequences of MES in acute posterior circulation cerebral ischemia.

Methods—

We evaluated a total of 140 consecutive patients (93 males, mean age 62.9 years) who had acute posterior circulation cerebral ischemia. The MES monitoring was conducted at the basilar artery through the suboccipital window for a 30-minute period.

Results—

MES were detected in 18 (12.9%) of the 140 patients. Clinical characteristics and laboratory data did not differ between the MES-positive and MES-negative groups. Intracranial vertebrobasilar artery (VBA) stenosis was independently associated with the presence of MES (odds ratio, 9.85; 95% confidence interval, 1.22–79.48;
P
=0.032), whereas the patients with vertebral artery stenosis that was limited to the extracranial portion did not show an association. Microembolic signals occurred significantly more frequently in patients with severe degree of VBA stenosis compared to those with nonsignificant stenosis (odds ratio, 9.88; 95% confidence interval, 1.23–79.07;
P
=0.031). In a subgroup analysis of the 79 patients who had lesions on diffusion-weighted images and relevant VBA stenosis, the MES-positive group showed more frequent embolic infarction (
P
=0.010) and multiple lesion patterns (
P
=0.007) than single perforating infarctions.

Conclusions—

In acute posterior circulation cerebral ischemia, intracranial and severe VBA stenosis is associated with MES and may be its root causes. The presence of MES in VBA stenosis suggests that multiple and embolic type infarctions are the mechanisms of stroke.
Novel MRI Approaches for Assessing Cerebral Hemodynamics in Ischemic Cerebrovascular Disease
Authors: Donahue Manus J. , Strother Megan K. , Hendrikse Jeroen
Published: February 2012

Changes in cerebral hemodynamics underlie a broad spectrum of ischemic cerebrovascular disorders. An ability to accurately and quantitatively measure hemodynamic (cerebral blood flow and cerebral blood volume) and related metabolic (cerebral metabolic rate of oxygen) parameters is important for understanding healthy brain function and comparative dysfunction in ischemia. Although positron emission tomography, single-photon emission tomography, and gadolinium-MRI approaches are common, more recently MRI approaches that do not require exogenous contrast have been introduced with variable sensitivity for hemodynamic parameters. The ability to obtain hemodynamic measurements with these new approaches is particularly appealing in clinical and research scenarios in which follow-up and longitudinal studies are necessary. The purpose of this review is to outline current state-of-the-art MRI methods for measuring cerebral blood flow, cerebral blood volume, and cerebral metabolic rate of oxygen and provide practical tips to avoid imaging pitfalls. MRI studies of cerebrovascular disease performed without exogenous contrast are synopsized in the context of clinical relevance and methodological strengths and limitations.
Grading Carotid Stenosis Using Ultrasonic Methods
Authors: von Reutern Gerhard-Michael , Goertler Michael-Wolfgang , Bornstein Natan M. , Sette Massimo Del , Evans David H. , Goertler Michael-Wolfgang , Hetzel Andreas , Kaps Manfred , Perren Fabienne , Razumovky Alexander , Shiogai Toshiyuki , Titianova Ekaterina , Traubner Pavel , Venketasubramanian Narayanaswamy , Wong Lawrence K.S. , Yasaka Masahiro
Published: February 2012

The controversy as to whether Doppler ultrasonic methods should play a role in clinical decision-making in the prevention of stroke is attributable to reported disagreement between angiographic and ultrasonic results and the lack of internationally accepted ultrasound criteria for describing the degree of stenosis. Foremost among the explanations for both is the broad scatter of peak systolic velocities in the stenosis, the criterion that has so far received most attention. Grading based on a set of main and additional criteria can overcome diagnostic errors. Morphological measurements (B-mode images and color flow imaging) are the main criteria for low and moderate degrees of stenosis. Increased velocities in the stenosis indicate narrowing, but the appearance of collateral flow and decreased poststenotic flow velocity prove a high degree stenosis (≥70%), additionally allowing the estimation of the hemodynamic effect in the category of high-degree stenosis. Additional criteria refer to the effect of a stenosis on prestenotic flow (common carotid artery), the extent of poststenotic flow disturbances, and derived velocity criteria (diastolic peak velocity and the carotid ratio). This multiparametric approach is intended to increase the reliability and the standard of reporting of ultrasonic results for arteriosclerotic disease of the carotid artery.
Using the Sensitivity of Large-Eddy Simulations to Evaluate Atmospheric Boundary Layer Models
Authors: Bellon Gilles , Stevens Bjorn
Published: February 2012

A simple framework to study the sensitivity of atmospheric boundary layer (ABL) models to the large-scale conditions and forcings is introduced. This framework minimizes the number of parameters necessary to describe the large-scale conditions, subsidence, and radiation. Using this framework, the sensitivity of the stationary ABL to the large-scale boundary conditions [underlying sea surface temperature (SST) and overlying humidity and temperature in the free troposphere] is investigated in large-eddy simulations (LESs). For increasing SST or decreasing free-tropospheric temperature, the LES exhibits a transition from a cloud-free, well-mixed ABL stationary state, through a cloudy, well-mixed stationary state and a stable shallow cumulus stationary state, to an unstable regime with a deepening shallow cumulus layer. For a warm SST, when increasing free-tropospheric humidity, the LES exhibits a transition from a stable shallow cumulus stationary state, through a stable cumulus-under-stratus stationary state, to an unstable regime with a deepening, cumulus-under-stratus layer. For a cool SST, when increasing the free-tropospheric humidity, the LES stationary state exhibits a transition from a cloud-free, well-mixed ABL regime, through a well-mixed cumulus-capped regime, to a stratus-capped regime with a decoupling between the subcloud and cloud layers.

This dataset can be used to evaluate other ABL models. As an example, the sensitivity of a bulk model based on the mixing-line model is presented. This bulk model reproduces the LES sensitivity to SST and free-tropospheric temperature for the stable and unstable shallow cumulus regimes, but it is less successful at reproducing the LES sensitivity to free-tropospheric humidity for both shallow cumulus and well-mixed regimes.
The Political Effectiveness of Terrorism Revisited
Authors: Abrahms Max
Published: February 2012

Terrorists attack civilians to coerce their governments into making political concessions. Does this strategy work? To empirically assess the effectiveness of terrorism, the author exploits variation in the target selection of 125 violent substate campaigns. The results show that terrorist campaigns against civilian targets are significantly less effective than guerrilla campaigns against military targets at inducing government concessions. The negative political effect of terrorism is evident across logit model specifications after carefully controlling for tactical confounds. Drawing on political psychology, the author concludes with a theory to account for why governments resist compliance when their civilians are targeted.
The Career Experiences of Male-to-Female Transsexuals
Authors: Brown Chris , Dashjian Lauren T. , Acosta Taryn J. , Mueller Conrad T. , Kizer Bobby E. , Trangsrud Heather B.
Published: February 2012

To understand the career experiences of adult transsexual women, we conducted a qualitative study on a sample of 9 predominately White male-to-female (MTF) transsexuals who were mostly middle-aged ( M = 33.8, SD = 15.4) and had been on hormone therapy for an average of 20.7 months ( SD = 22.5). Results of the interview data highlighted participants’ initial choice of traditionally male-dominated occupations in an attempt to prove or reinforce a masculine persona. Following their decision to transition, participants expressed interest in furthering their education and pursuing careers that are female dominated or in the helping profession. Implications for counseling are discussed.
Auditory Perception of Motor Vehicle Travel Paths
Authors: Ashmead Daniel H. , Grantham D. Wesley , Maloff Erin S. , Hornsby Benjamin , Nakamura Takabun , Davis Timothy J. , Pampel Faith , Rushing Erin G.
Published: February 2012

Objective: These experiments address concerns that motor vehicles in electric engine mode are so quiet that they pose a risk to pedestrians, especially those with visual impairments.

Background: The “quiet car” issue has focused on hybrid and electric vehicles, although it also applies to internal combustion engine vehicles. Previous research has focused on detectability of vehicles, mostly in quiet settings. Instead, we focused on the functional ability to perceive vehicle motion paths.

Method: Participants judged whether simulated vehicles were traveling straight or turning, with emphasis on the impact of background traffic sound.

Results: In quiet, listeners made the straight-or-turn judgment soon enough in the vehicle’s path to be useful for deciding whether to start crossing the street. This judgment is based largely on sound level cues rather than the spatial direction of the vehicle. With even moderate background traffic sound, the ability to tell straight from turn paths is severely compromised. The signal-to-noise ratio needed for the straight-or-turn judgment is much higher than that needed to detect a vehicle.

Conclusion: Although a requirement for a minimum vehicle sound level might enhance detection of vehicles in quiet settings, it is unlikely that this requirement would contribute to pedestrian awareness of vehicle movements in typical traffic settings with many vehicles present.

Application: The findings are relevant to deliberations by government agencies and automobile manufacturers about standards for minimum automobile sounds and, more generally, for solutions to pedestrians’ needs for information about traffic, especially for pedestrians with sensory impairments.
Between a Rock and a Hard Place
Authors: Staniland Paul
Published: February 2012

Ethnic insurgents sometimes defect to join forces with the state during civil wars. Ethnic defection can have important effects on conflict outcomes, but its causes have been understudied. Using Sunni defection in Iraq as a theory-developing case, this article offers a theory of “fratricidal flipping” that identifies lethal competition between insurgent factions as an important cause of defection. It examines the power of the fratricidal-flipping mechanism against competing theories in the cases of Kashmir and Sri Lanka. These wars involve within-conflict variation in defection across groups and over time. A detailed study of the empirical record, including significant fieldwork, suggests that fratricide was the dominant trigger for defection, while government policy played a secondary role in facilitating pro-state paramilitarism. Deep ideological disagreements were surprisingly unimportant in driving defection. The argument is probed in other wars in Asia. The complex internal politics of insurgent movements deserve careful attention.
Accession Rules for International Institutions
Authors: Schneider Christina J. , Urpelainen Johannes
Published: February 2012

Powerful states often accept unanimity voting on accession to international institutions, even though this enables weak states to blackmail powerful states into providing costly side payments. Whereas the literature attributes this choice mainly to efforts to bolster the legitimacy of international institutions, the authors demonstrate that the choice of unanimity also has a strategic component. The authors formally show that unanimous accession rules can profit powerful states by creating uncertainty as to the minimal level of reform that enables accession. If accession is valuable enough and the membership candidate is uncertain about the resolve of weak states, it plays safe by implementing ambitious reforms that improve the efficacy of the international institution. In this case, a legitimacy-efficacy trade-off does not exist: the unanimity rule enhances legitimacy while allowing powerful states to induce significant reforms by applicants to the benefit of current members.
Equality Matters
Authors: Albin Cecilia , Druckman Daniel
Published: February 2012

This article explores relationships between procedural justice (PJ) in the negotiation process, distributive justice (DJ) in the terms of negotiated agreements, and their durability in cases of civil war. Adherence to PJ principles was found to correlate strongly with agreements based specifically on the DJ principle of equality. Agreements were also found to be more durable when based on equality, but not when based on other DJ principles. The equality principle accounted for the relationship between PJ and durability irrespective of differences between the parties in power. Further examination suggested that two types of equality in particular—equal treatment and equal shares—were associated with forward-looking agreements and high durability. The findings suggest that durability is served by including equality in the terms of agreements, and that PJ helps (but does not guarantee) achieving such agreements.
Gender Differences in Immigrant Health
Authors: Read Jen’nan Ghazal , Reynolds Megan M.
Published: February 2012

This article draws on theories of gender inequality and immigrant health to hypothesize differences among the largest immigrant population, Mexicans, and a lesser known population of Middle Easterners. Using data from the 2000-2007 National Health Interview Surveys, we compare health outcomes among immigrants to those among U.S.-born whites and assess gender differences within each group. We find an immigrant story and a gender story. Mexican and Middle Eastern immigrants are healthier than U.S.-born whites, and men report better health than women regardless of nativity or ethnicity. We identify utilization of health care as a primary mechanism that contributes to both patterns. Immigrants are less likely than U.S.-born whites to interact with the health care system, and women are more likely to do so than men. Thus, immigrant and gender health disparities may partly reflect knowledge of health status rather than actual health.
An Analysis of the Ratings and Interrater Reliability of High School Band Contests
Authors: Hash Phillip M.
Published: February 2012

The purpose of this study was to examine procedures for analyzing ratings of large-group festivals and provide data with which to compare results from similar events. Data consisted of ratings from senior division concert band contests sponsored by the South Carolina Band Directors Association from 2008 to 2010. Three concert-performance and two sight-reading judges evaluated each band to determine a final rating. Research questions examined (a) frequency distributions of ratings; (b) interrater reliability as measured by Spearman correlation of individual judges’ ratings, internal consistency (α), and two forms of interrater agreement (IRA); and (c) differences in mean ratings among individual adjudicators, contest sites, years, and classifications. The average final rating for all bands ( N = 353) was 1.73, with 86.7% ( n = 306) earning a I/Superior or II/Excellent. Interrater correlation, IRA, and internal consistency were higher for sight-reading versus concert performance. Each of these measures rose above the .80 benchmark for good reliability, except interrater correlation and average pairwise IRA in the concert portion of the contest. Data indicated significant differences in 8 out of 18 judging panels, in contest sites in 2010, and among ensemble classifications. In this study, the author demonstrated an effective procedure for analyzing ratings of large-group festivals and identified implications for improving these events.
The fictitious notch rounding approach applied to V-notches with root holes subjected to mode I loading
Authors: Berto Filippo , Zappalorto Michele
Published: February 2012

The fictitious notch rounding concept is applied here to V-shaped notches with root holes subjected to mode I loading. The fictitious notch radius ρf is determined as a function of the real notch radius ρ, the microstructural support length ρ* and the notch opening angle 2α, at first using the normal stress criterion. Two analytical methods have been developed resulting in closed-form expressions for the multiaxiality factor s in the well-known relationship ρf = ρ + sρ*. The first method expresses the notch stress averaged over the microstructural support length at pointed V-notches by the maximum notch stress of fictitiously rounded V-notches (with root hole), taking advantage of a newly developed analytical solution. The second method considers V-notches with root holes both in the real and in the fictitious configuration. It uses a procedure given by Neuber. Finally, different failure criteria are considered using the first method. Plane stress and plane strain conditions, respectively, are evaluated.
The influence of multimodal behavioral treatment on the consumption of acute migraine drugs: a randomized, controlled study
Authors: Hedborg Kerstin , Muhr Carin
Published: February 2012

Objectives: To characterize overall drug use in migraine in conjunction with multimodal behavioral treatment (MBT).

Methods: Seventy-six adults reporting at least two monthly migraine attacks underwent a randomized, controlled, 24-week MBT intervention. Migraine drugs and symptoms were registered in an Internet-based diary.

Results: During 4256 days of baseline registration, 859 drug doses were taken during 655 of the 856 days with migraine headache. Triptans and analgesics constituted 56.7 and 38.3% of all doses with efficacy ratios of 0.41 and 0.20, respectively. Men displayed significantly lower drug efficacy ( p = 0.001), and used triptans significantly less ( p < 0.001) and analgesics significantly more ( p < 0.001) than women. At the end of the MBT, total drug consumption decreased by 22% ( p = 0.029), corresponding to 27% fewer days with migraine headache. Drug efficacy increased during MBT from 0.30 to 0.52 ( p < 0.001), mainly explained by an increased proportion of mild attacks, which also was the attack category that displayed the largest increase in drug efficacy.

Conclusions: Triptans were the most used and efficient drugs. MBT led to decreased and more efficient drug consumption. Men used triptans less frequently.
Building Bridges to Safety and Justice: Stories of Survival and Resistance
Authors: Pyles Loretta , Katie M. , Mariame B. , Suzette G. , DeChiro Jaclyn
Published: February 2012

The authors offer three narratives of women survivors who are engaged in organizing around issues of gender-based violence. Common themes include experiences of the cycle of violence, a wide range of control tactics used by abusers, the difficulties of breaking free, economic injustice, the complexities that children bring to leaving, and multiple barriers in community and public services, particularly for low-income and immigrant women. The narratives also demonstrate how the survivors found their voices and stand in solidarity with other survivors. The stories are analyzed from a policy perspective using a capabilities lens.
Ageing, skills and participation in work-related training in Britain: assessing the position of older workers
Authors: Canduela Jesus , Dutton Matthew , Johnson Steve , Lindsay Colin , McQuaid Ronald W , Raeside Robert
Published: February 2012

Policy makers have introduced a number of measures to encourage older workers to stay in the labour market, with improving access to training a particular priority. Policy action appeared justified by evidence that older workers are less likely to participate in training, and more likely to have never been offered training by employers – a key finding of Taylor and Urwin’s (2001) review of Labour Force Survey (LFS) data from 1997. This article models LFS data from 2007 to assess whether age remained a predictor of inequalities in training. It finds that men over 50 remained among those least likely to have been offered training by employers. There were other significant inequalities in participation, suggesting a polarization in access to jobs that offer opportunities for training and progression. The article concludes that policies promoting ‘active ageing’ need to challenge negative employer attitudes and acknowledge fundamental inequalities in access to skills.
The back office goes global: exploring connections and contradictions in shared service centres
Authors: Howcroft Debra , Richardson Helen
Published: February 2012

This article explores a neglected aspect of IT-enabled service work: the back office. The fieldwork study reveals how back office service work has been identified as suitable for ongoing reorganization and reconfiguration as firms respond to the pressures of contemporary capitalism. The article focuses on standardization as a means of facilitating organizational restructuring into shared service centres as highly skilled back office work is reframed as routine service work. Standardization is the vehicle that drives the commodification of the labour process as tasks are fragmented, quantified and traded in the global sourcing of services, allowing work to be lifted out of traditional organizational structures and placed elsewhere, or outsourced to other service providers. The study shows how this ongoing process is fraught with contradictions, problematically rendering people and place ancillary.
‘Monday will never be the same again’: the transformation of employment and work in a public-private partnership
Authors: Smith Andrew
Published: February 2012

Under the public-private partnership (PPP) programme, private sector finance, management expertise and innovation are used in ‘partnership’ to modernize public services. However, advocates fail to account for the differing aims and responsibilities of the public and private sectors, in that private companies plan to make a profit out of non-profit public sector organizations. There is a paucity of critical empirical research into new ‘partnership’ forms of privatization and the implications that these have for employment and work. This article will examine the PPP of National Savings and Investments (NS&I) and some of the initiatives introduced and problems encountered, which resulted in the creation of a multi-tier workforce, together with the insourcing, outsourcing and the first ever offshoring of UK Government work to India.