bluuebunny/crossref_metadata_2025 huggingface dataset:
Change Detection in Synthetic Aperture Radar Images Based on Fuzzy Active Contour Models and Genetic Algorithms
Authors: Shi Jiao , Wu Jiaji , Paul Anand , Jiao Licheng , Gong Maoguo
Published: April 2014

This paper presents an unsupervised change detection approach for synthetic aperture radar images based on a fuzzy active contour model and a genetic algorithm. The aim is to partition the difference image which is generated from multitemporal satellite images into changed and unchanged regions. Fuzzy technique is an appropriate approach to analyze the difference image where regions are not always statistically homogeneous. Since interval type‐2 fuzzy sets are well‐suited for modeling various uncertainties in comparison to traditional fuzzy sets, they are combined with active contour methodology for properly modeling uncertainties in the difference image. The interval type‐2 fuzzy active contour model is designed to provide preliminary analysis of the difference image by generating intermediate change detection masks. Each intermediate change detection mask has a cost value. A genetic algorithm is employed to find the final change detection mask with the minimum cost value by evolving the realization of intermediate change detection masks. Experimental results on real synthetic aperture radar images demonstrate that change detection results obtained by the improved fuzzy active contour model exhibits less error than previous approaches.
Determinants of Disability in Multiple Sclerosis: An Immunological and MRI Study
Authors: Tortorella Paola , Laganà Maria Marcella , Saresella Marina , Tavazzi Eleonora , Preti Maria Giulia , Ricci Cristian , Baglio Francesca , Marventano Ivana , Piancone Federica , Baselli Giuseppe , Cecconi Pietro , Caputo Domenico , Clerici Mario , Rovaris Marco
Published: April 2014

Multiple sclerosis (MS) is characterized by a wide interpatient clinical variability and available biomarkers of disease severity still have suboptimal reliability. We aimed to assess immunological and MRI-derived measures of brain tissue damage in patients with different motor impairment degrees, forin vivoinvestigating the pathogenesis of MS-related disability. Twenty-two benign (B), 26 secondary progressive (SP), and 11 early, nondisabled relapsing-remitting (RR) MS patients and 37 healthy controls (HC) underwent conventional and diffusion tensor brain MRI and, as regards MS patients, immunophenotypic and functional analysis of stimulated peripheral blood mononuclear cells (PBMC). Corticospinal tract (CST) fractional anisotropy and grey matter volume were lower and CST diffusivity was higher in SPMS compared to RRMS and BMS patients. CD14+IL6+ and CD4+IL25+ cell percentages were higher in BMS than in SPMS patients. A multivariable model having EDSS as the dependent variable retained the following independent predictors: grey matter volume, CD14+IL6+ and CD4+IL25+ cell percentages. In patients without motor impairment after long-lasting MS, the grey matter and CST damage degree seem to remain as low as in the earlier disease stages and an immunological pattern suggestive of balanced pro- and anti-inflammatory activity is observed. MRI-derived and immunological measures might be used as complementary biomarkers of MS severity.
Culturable Aerobic and Facultative Anaerobic Intestinal Bacterial Flora of Black Cobra (Naja naja karachiensis) in Southern Pakistan
Authors: Iqbal Junaid , Sagheer Mehwish , Tabassum Nazneen , Siddiqui Ruqaiyyah , Khan Naveed Ahmed
Published: April 2014

Using morphological analysis and biochemical testing, here for the first time, we determined the culturable gut bacterial flora (aerobes and facultative anaerobes) in the venomous Black Cobra (Naja naja karachiensis) from South Asia. The findings revealed that these snakes inhabit potentially pathogenic bacteria including Serratia marcescens, Pseudomonas aeruginosa, Shewanella putrefaciens, Aeromonas hydrophila, Salmonella sp., Moraxella sp., Bacillus sp., Ochrobactrum anthropi, and Providencia rettgeri. These findings are of concern, as injury from snake bite can result in wound infections and tissue necrosis leading to sepsis/necrotizing fasciitis and/or expose consumers of snake meat/medicine in the community to infections.
Existence and Stability of Almost Periodic Solution for a Stochastic Cellular Neural Network with External Perturbation
Authors: Zhou Hui , Zhou Zongfu , Jiang Wei
Published: April 2014

A class of stochastic cellular neural networks with external perturbation is investigated. By employing fixed points principle and some stochastic analysis techniques, we establish some sufficient conditions for existence and exponential stability of a quadratic mean almost periodic solution of the model. The new criteria not only improve some classical results but also are applied in real problems due to the changes of external input.
Urinary Protein Biomarker Panel for the Detection of Recurrent Bladder Cancer
Authors: Rosser Charles J. , Chang Myron , Dai Yunfeng , Ross Shanti , Mengual Lourdes , Alcaraz Antonio , Goodison Steve
Published: April 2014

Background: Up to 70% of patients with non–muscle-invasive bladder cancer (NMIBC) experience disease recurrence, making it one of the most prevalent cancers in the United States. The purpose of this study was to test the performance of a multiplex urinary biomarker assay for the monitoring of voided urine for recurrent bladder cancer.

Methods: This retrospective, multicenter study included a total of 125 subjects with a history of bladder cancer. Voided urine specimens were collected before procedure from these subjects (53 with confirmed tumor recurrence and 72 with confirmed non-tumor recurrence) for analysis. A prediction rule generated from the performance characteristics of 10 single biomarkers (IL8, MMP9, MMP10, SERPINA1, VEGFA, ANG, CA9, APOE, SERPINE1, and SDC1) was measured using ELISA. The diagnostic performance of the biomarker panel was assessed using receiver operator curves (ROC) and descriptive statistical values (e.g., sensitivity and specificity).

Results: The combination of all 10 biomarkers outperformed any single biomarker with a calculated AUROC for the diagnostic panel of 0.904 [95% confidence interval (CI), 0.853–0.956]. The multiplex assay achieved an overall sensitivity of 79% and specificity of 88% for recurrent bladder cancer and significantly outperformed the Urovysion cytogenetic assay (sensitivity 42%, specificity 94%) and voided urinary cytology (sensitivity 33%, specificity 90%).

Conclusions: A diagnostic panel of 10 urinary biomarkers that accurately detects primary bladder cancer also performs well for the detection of recurrent bladder cancer.

Impact: The identification of a reliable urine-based surveillance and detection assay would be of benefit to both patients and the healthcare system. Cancer Epidemiol Biomarkers Prev; 23(7); 1340–5. ©2014 AACR.
Phase II Study of Cediranib in Patients with Advanced Gastrointestinal Stromal Tumors or Soft-Tissue Sarcoma
Authors: Judson Ian , Scurr Michelle , Gardner Kate , Barquin Elizabeth , Marotti Marcelo , Collins Barbara , Young Helen , Jürgensmeier Juliane M. , Leahy Michael
Published: April 2014

Purpose: Cediranib is a potent VEGF signaling inhibitor with activity against all three VEGF receptors and KIT. This phase II study evaluated the antitumor activity of cediranib in patients with metastatic gastrointestinal stromal tumor (GIST) resistant/intolerant to imatinib, or metastatic soft-tissue sarcomas (STS; ClinicalTrials.gov, NCT00385203).

Experimental Design: Patients received cediranib 45 mg/day. Primary objective was to determine the antitumor activity of cediranib according to changes in 2[18F]fluoro-2-deoxy-D-glucose positron emission tomography (18FDG-PET) tumor uptake in patients with GIST using maximum standardized uptake values (SUVmax). Secondary objectives included objective tumor response and tolerability in patients with GIST/STS.

Results: Thirty-four of 36 enrolled patients were treated (GIST n = 24; STS n = 10). At day 29, five patients had confirmed decreases in SUVmax (≥10% from day 8) and two had confirmed partial metabolic responses (≥25% decrease), but arithmetic mean percentage changes in SUVmax, averaged across the cohort, were not significant at day 8 [6.8%; 95% confidence interval (CI), 19.95–33.54) or day 29 (4.6%; 95% CI, 8.05–17.34). Eleven patients with GIST achieved a best objective tumor response of stable disease; eight achieved stable disease ≥16 weeks. In patients with STS, four of six with alveolar soft-part sarcoma (ASPS) achieved confirmed and durable partial responses. The commonest adverse events were diarrhea (85%), fatigue (74%), and hypertension (68%).

Conclusions: In patients progressing on imatinib/sunitinib, cediranib 45 mg/day demonstrated evidence of activity by 18FDG-PET, but did not reduce average SUVmax. Evidence of antitumor activity was seen in ASPS. Clin Cancer Res; 20(13); 3603–12. ©2014 AACR.
The Role of Relative Lymphocyte Count as a Biomarker for the Effect of Catumaxomab on Survival in Malignant Ascites Patients: Results from a Phase II/III Study
Authors: Heiss Markus M. , Ströhlein Michael A. , Bokemeyer Carsten , Arnold Dirk , Parsons Simon L. , Seimetz Diane , Lindhofer Horst , Schulze Elisabeth , Hennig Michael
Published: April 2014

Purpose: We report the role of relative lymphocyte count (RLC) as a potential biomarker with prognostic impact for catumaxomab efficacy and overall survival (OS) based on a post hoc analysis of the pivotal phase II/III study of intraperitoneal catumaxomab treatment of malignant ascites.

Experimental Design: The impact of treatment and RLC on OS was evaluated using multivariate Cox models. Kaplan–Meier and log-rank tests were used for group comparisons. Survival analyses were performed on the safety population [patients with paracentesis plus ≥1 dose of catumaxomab (n = 157) and paracentesis alone (n = 88)]. Determination of the optimal cutoff value for RLC was based on five optimality criteria.

Results: OS was significantly longer with catumaxomab versus paracentesis alone (P = 0.0219). The 6-month OS rate with catumaxomab was 28.9% versus 6.7% with paracentesis alone. RLC had a positive impact on OS and was an independent prognostic factor (P < 0.0001). In patients with RLC > 13% (n = 159: catumaxomab, 100 and control, 59), catumaxomab was associated with a favorable effect on OS versus paracentesis alone (P = 0.0072), with a median/mean OS benefit of 41/131 days and an increased 6-month survival rate of 37.0% versus 5.2%, respectively. In patients with RLC ≤ 13% at screening (n = 74: catumaxomab, 50 and control, 24), the median (mean) OS difference between the catumaxomab and the control group was 3 (16) days, respectively (P = 0.2561).

Conclusions: OS was significantly improved after catumaxomab treatment in patients with malignant ascites. An RLC > 13% at baseline was a significant prognostic biomarker. Clin Cancer Res; 20(12); 3348–57. ©2014 AACR.
Targetable Signaling Pathway Mutations Are Associated with Malignant Phenotype in IDH-Mutant Gliomas
Authors: Wakimoto Hiroaki , Tanaka Shota , Curry William T. , Loebel Franziska , Zhao Dan , Tateishi Kensuke , Chen Juxiang , Klofas Lindsay K. , Lelic Nina , Kim James C. , Dias-Santagata Dora , Ellisen Leif W. , Borger Darrell R. , Fendt Sarah-Maria , Vander Heiden Matthew G. , Batchelor Tracy T. , Iafrate A. John , Cahill Daniel P. , Chi Andrew S.
Published: April 2014

Purpose: Isocitrate dehydrogenase (IDH) gene mutations occur in low-grade and high-grade gliomas. We sought to identify the genetic basis of malignant phenotype heterogeneity in IDH-mutant gliomas.

Methods: We prospectively implanted tumor specimens from 20 consecutive IDH1-mutant glioma resections into mouse brains and genotyped all resection specimens using a CLIA-certified molecular panel. Gliomas with cancer driver mutations were tested for sensitivity to targeted inhibitors in vitro. Associations between genomic alterations and outcomes were analyzed in patients.

Results: By 10 months, 8 of 20 IDH1-mutant gliomas developed intracerebral xenografts. All xenografts maintained mutant IDH1 and high levels of 2-hydroxyglutarate on serial transplantation. All xenograft-producing gliomas harbored “lineage-defining” mutations in CIC (oligodendroglioma) or TP53 (astrocytoma), and 6 of 8 additionally had activating mutations in PIK3CA or amplification of PDGFRA, MET, or N-MYC. Only IDH1 and CIC/TP53 mutations were detected in non–xenograft-forming gliomas (P = 0.0007). Targeted inhibition of the additional alterations decreased proliferation in vitro. Moreover, we detected alterations in known cancer driver genes in 13.4% of IDH-mutant glioma patients, including PIK3CA, KRAS, AKT, or PTEN mutation or PDGFRA, MET, or N-MYC amplification. IDH/CIC mutant tumors were associated with PIK3CA/KRAS mutations whereas IDH/TP53 tumors correlated with PDGFRA/MET amplification. Presence of driver alterations at progression was associated with shorter subsequent progression-free survival (median 9.0 vs. 36.1 months; P = 0.0011).

Conclusion: A subset of IDH-mutant gliomas with mutations in driver oncogenes has a more malignant phenotype in patients. Identification of these alterations may provide an opportunity for use of targeted therapies in these patients. Clin Cancer Res; 20(11); 2898–909. ©2014 AACR.
Anetumab Ravtansine: A Novel Mesothelin-Targeting Antibody–Drug Conjugate Cures Tumors with Heterogeneous Target Expression Favored by Bystander Effect
Authors: Golfier Sven , Kopitz Charlotte , Kahnert Antje , Heisler Iring , Schatz Christoph A. , Stelte-Ludwig Beatrix , Mayer-Bartschmid Anke , Unterschemmann Kerstin , Bruder Sandra , Linden Lars , Harrenga Axel , Hauff Peter , Scholle Frank-Detlef , Müller-Tiemann Beate , Kreft Bertolt , Ziegelbauer Karl
Published: April 2014

Mesothelin is a tumor differentiation antigen frequently overexpressed in tumors such as mesothelioma, ovarian, pancreatic, and lung adenocarcinomas while showing limited expression in nonmalignant tissues. Mesothelin is therefore an attractive target for cancer therapy using antibody–drug conjugates (ADC). This study describes the detailed characterization of anetumab ravtansine, here referred to as BAY 94-9343, a novel ADC consisting of a human anti-mesothelin antibody conjugated to the maytansinoid tubulin inhibitor DM4 via a disulfide-containing linker. Binding properties of the anti-mesothelin antibody were analyzed using surface plasmon resonance, immunohistochemistry, flow cytometry, and fluorescence microscopy. Effects of BAY 94-9343 on cell proliferation were first studied in vitro and subsequently in vivo using subcutaneous, orthotopic, and patient-derived xenograft tumor models. The antibody binds to human mesothelin with high affinity and selectivity, thereby inducing efficient antigen internalization. In vitro, BAY 94-9343 demonstrated potent and selective cytotoxicity of mesothelin-expressing cells with an IC50 of 0.72 nmol/L, without affecting mesothelin-negative or nonproliferating cells. In vivo, BAY 94-9343 localized specifically to mesothelin-positive tumors and inhibited tumor growth in both subcutaneous and orthotopic xenograft models. In addition, BAY 94-9343 was able to induce a bystander effect on neighboring mesothelin-negative tumor cells. Antitumor efficacy of BAY 94-9343 correlated with the amount of mesothelin expressed and was generally superior to that of standard-of-care regimen resulting in complete tumor eradication in most of the models. BAY 94-9343 is a selective and highly potent ADC, and our data support its development for the treatment of patients with mesothelin-expressing tumors. Mol Cancer Ther; 13(6); 1537–48. ©2014 AACR.
Urologic Considerations of Placenta Accreta: A Contemporary Tertiary Care Institutional Experience
Authors: Woldu Solomon L. , Ordonez Maria A. , Devine Patricia C. , Wright Jason D.
Published: April 2014

Background: As the incidence of cesarean delivery has increased, we are experiencing a higher incidence of subsequent placenta accreta and the associated complications, including urologic complications. Methods: This is a retrospective review of all patients delivered from 2000 to 2011 with a histologically proven diagnosis of placenta accreta. Data were analyzed for baseline maternal characteristics, intraoperative and postoperative outcomes and complications. Results: 83 patients were included in the analysis. The depth of placenta accreta invasion varied in the cohort, with 48, 25 and 27% being classified as placenta accreta, placenta increta and placenta percreta, respectively. 88% of patients had had a previous cesarean delivery, and 58% had more than one prior operative delivery. Cystotomy was encountered in 27% of patients and ureteral injury occurred in 4%. Degree of placenta accreta invasion, number of prior cesarean deliveries and intraoperative blood loss were associated with a higher likelihood of urologic injury. Conclusions: Urologic injuries are among the most frequently encountered intraoperative complications of placenta accreta. Surgeons involved in these cases need to be aware of this risk and maintain a high level of surveillance intraoperatively.
Transumbilical Multiport Laparoscopic Nephrectomy with Specimen Extraction through the Vagina
Authors: Zou Xiaofeng , Zhang Guoxi , Xue Yijun , Yuan Yuanhu , Xiao Rihai , Wu Gengqing , Wang Xiaoning , Wu Yuting , Long Dazhi , Yang Jun , Xu Hui , Liu Folin , Liu Min
Published: April 2014

Objectives: To report our initial experience with transumbilical multiport laparoscopic nephrectomy (TMLN) with transvaginal specimen extraction. Patients and Methods: Between January and July 2010, 5 married and parous female patients were submitted to TMLN with transvaginal specimen extraction in our center. All data referring to patient demographics, surgery, pathology and perioperative outcomes were recorded. Sexual function was assessed with the Female Sexual Function Index questionnaire before and after surgery. The cosmetic result was investigated by administering the Patient Scar Assessment Questionnaire and Scoring System (PSAQ). Results: All procedures were completed successfully. The mean operative time was 136 min (range 110-160 min, standard deviation [SD] 20.7). The mean estimated blood loss was 66 ml (range 40-100 ml, SD 24.1). The mean postoperative hospitalization stay was 4.8 days (range 4-6 days, SD 0.8). All patients reported unaltered sexual function after surgery. The better cosmetic results were confirmed by the PSAQ score. Conclusions: TMLN with transvaginal specimen extraction is feasible and safe for married and parous female patients. This technique is a natural evolution towards natural orifice transluminal endoscopic surgery (NOTES). By acting as an intermediate-type procedure, it provides a bridge through which NOTES may ultimately gain clinical acceptance.
Innovating Aging: Promises and Pitfalls on the Road to Life Extension
Authors: Vijg Jan , de Grey Aubrey D.N.J.
Published: April 2014

One of the main benefits of the dramatic technological progress over the last two centuries is the enormous increase in human life expectancy, which has now reached record highs. After conquering most childhood diseases and a fair fraction of the diseases that plague adulthood, medical technology is now mainly preoccupied by age-related disorders. Further progress is dependent on circumventing the traditional medical focus on individual diseases and instead targeting aging as a whole as the ultimate cause of the health problems that affect humankind at old age. In principle, a major effort to control the gradual accumulation of molecular and cellular damage - considered by many as the ultimate cause of intrinsic aging - may rapidly lead to interventions for regenerating aged and worn-out tissues and organs. While considered impossible by many, there really is no reason to reject this as scientifically implausible. However, as we posit, it is not only scientific progress that is currently a limiting factor, but societal factors that hinder and may ultimately prevent further progress in testing and adopting the many possible interventions to cure aging.
Frequency and Severity of Semantic Deficits in a Consecutive Memory Clinic Cohort
Authors: Vogel Asmus , Johannsen Peter , Stokholm Jette , Jørgensen Kasper
Published: April 2014

Background/Aim: Semantic memory deficits have been shown in dementia and mild cognitive impairment (MCI) by group comparisons. The aim of this study is to investigate the frequency of impairments on tests with semantic content in patients with dementia, MCI (amnestic and non-amnestic) and affective disorders. Methods: A Famous faces test, Boston Naming Test and Category fluency were applied in 114 consecutive memory clinic patients and 95 healthy participants (all participants were 60 years old or older; dementia/MCI patients had Mini-Mental State Examination scores ≥20). Results: Fifty-three patients were classified with dementia, 36 with MCI (14 amnestic, 22 non-amnestic) and 25 with affective disorders. Dementia and MCI patients differed significantly from the control group on all tests. Patients with dementia and MCI had impairments in about 40% of the cases (on the most sensitive tests). However, patients with affective disorders also had mild impairments on tests tapping semantic memory (25% were impaired on the most sensitive tests). Impairments on the Famous faces test were more frequently found in dementia and MCI as compared to patients with affective disorders. Conclusion: Short tests with semantic memory content are sensitive to changes in dementia and MCI, but impairments on such tests may also be found in other diseases, e.g. affective disorders.
Accuracy of Prognostic and Predictive Markers in Core Needle Breast Biopsies Compared with Excisional Specimens
Authors: Motamedolshariati Mohammad , Memar Bahram , Aliakbaian Mohsen , Shakeri Mohammad T. , Samadi Mohammad , Jangjoo Ali
Published: April 2014

Background: Core needle biopsy (CNB) is widely accepted for preoperative diagnosis of breast cancer and sometimes can be the only way of providing a suitable specimen for prognostic and predictive marker studies prior to neoadjuvant treatment. The purpose of this study was to evaluate the accuracy of CNB by comparing histological tumor type and grade as well as estrogen receptor (ER), progesterone receptor (PR), p53, and HER2/neu status by immunohistochemistry in CNB and excisional surgical specimens. Patients and Methods: During a 2.5-year study period, we identified 30 patients with breast cancer, who underwent CNB and definitive surgery. To evaluate the accuracy of CNB, tumor grade, ER, PR, HER2, and p53 status were immunohistochemically determined in both the CNB and the surgical specimens, and concordance of results between the 2 specimens was assessed. Results: The concordance rate was 100% for histological type, 66.6% for histological grade, and 96.7, 90, 76.7 and 93.3% for ER, PR, p53 and HER2/neu, respectively. Conclusion: Our study showed that CNB has an excellent accuracy for tumor type, ER, and HER2/neu; however, it should be used cautiously for tumor grade, PR, and p53 status. Thus, excisional biopsy is recommended for the determination of these factors.
Insurance Status Is Associated With Acuity of Presentation and Outcomes for Thoracic Aortic Operations
Authors: Andersen Nicholas D. , Brennan J. Matthew , Zhao Yue , Williams Judson B. , Williams Matthew L. , Smith Peter K. , Scarborough John E. , Hughes G. Chad
Published: April 2014

Background—

Nonelective procedure status is the greatest risk factor for postoperative morbidity and mortality in patients undergoing thoracic aortic operations. We hypothesized that uninsured patients were more likely to require nonelective thoracic aortic operation due to decreased access to preventative care and elective surgical services.

Methods and Results—

An observational study of the Society of Thoracic Surgeons Database identified 51 282 patients who underwent thoracic aortic surgery between 2007 and 2011 at 940 North American centers. Patients were stratified by insurance status (private insurance, Medicare, Medicaid, other insurance, or uninsured) as well as age <65 or ≥65 years to account for differences in Medicare eligibility. The need for nonelective thoracic aortic operation was highest for uninsured patients (71.7%) and lowest for privately insured patients (36.6%). The adjusted risks of nonelective operation were increased for uninsured patients (adjusted risk ratio, 1.77; 95% confidence interval, 1.70–1.83 for age <65 years; adjusted risk ratio, 1.46; 95% confidence interval, 1.29–1.62 for age ≥65 years) as well as Medicaid patients aged <65 years (adjusted risk ratio, 1.18; 95% confidence interval, 1.10–1.26) when compared with patients with private insurance. The adjusted risks of major morbidity or mortality were further increased for all patients aged <65 years without private insurance (adjusted risk ratios between 1.13 and 1.27).

Conclusions—

Insurance status was associated with acuity of presentation and major morbidity and mortality for thoracic aortic operations. Efforts to reduce insurance-based disparities in the care of patients with thoracic aortic disease seem warranted and may reduce the incidence of aortic emergencies and improve outcomes after thoracic aortic surgery.
Fragmentation of Care and the Use of Head Computed Tomography in Patients With Ischemic Stroke
Authors: Bekelis Kimon , Roberts David W. , Zhou Weiping , Skinner Jonathan S.
Published: April 2014

Background—

Computed tomographic (CT) scans are central diagnostic tests for ischemic stroke. Their inefficient use is a negative quality measure tracked by the Centers for Medicare and Medicaid Services.

Methods and Results—

We performed a retrospective analysis of Medicare fee-for-service claims data for adults admitted for ischemic stroke from 2008 to 2009, with 1-year follow-up. The outcome measures were risk-adjusted rates of high-intensity CT use (≥4 head CT scans) and risk- and price-adjusted Medicare expenditures in the year after admission. The average number of head CT scans in the year after admission, for the 327 521 study patients, was 1.94, whereas 11.9% had ≥4. Risk-adjusted rates of high-intensity CT use ranged from 4.6% (Napa, CA) to 20.0% (East Long Island, NY). These rates were 2.6% higher for blacks than for whites (95% confidence interval, 2.1%–3.1%), with considerable regional variation. Higher fragmentation of care (number of different doctors seen) was associated with high-intensity CT use. Patients living in the top quintile regions of fragmentation experienced a 5.9% higher rate of high-intensity CT use, with the lowest quintile as reference; the corresponding odds ratio was 1.77 (95% confidence interval, 1.71–1.83). Similarly, 1-year risk- and price-adjusted expenditures exhibited considerable regional variation, ranging from $31 175 (Salem, MA) to $61 895 (McAllen, TX). Regional rates of high-intensity CT scans were positively associated with 1-year expenditures (
r
=0.56;
P
<0.01).

Conclusions—

Rates of high-intensity CT use for patients with ischemic stroke reflect wide practice patterns across regions and races. Medicare expenditures parallel these disparities. Fragmentation of care is associated with high-intensity CT use.
Hyponatremia Is an Independent Predictor of In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage
Authors: Kuramatsu Joji B. , Bobinger Tobias , Volbers Bastian , Staykov Dimitre , Lücking Hannes , Kloska Stephan P. , Köhrmann Martin , Huttner Hagen B.
Published: April 2014

Background and Purpose—

Hyponatremia is the most frequent electrolyte disturbance in critical care. Across various disciplines, hyponatremia is associated with increased mortality and longer hospital stay, yet in intracerebral hemorrhage (ICH) no data are available. This the first study that investigated the prevalence and clinical associations of hyponatremia in patients with ICH.

Methods—

This observational study included all consecutive spontaneous ICH patients (n=464) admitted during a 5-year period to the Department of Neurology. Patient characteristics, in-hospital measures, mortality, and functional outcome (90 days and 1 year) were analyzed to determine the effects of hyponatremia (Na <135 mEq/L). Multivariable regression analyses were calculated for factors associated with hyponatremia and predictors of in-hospital mortality.

Results—

The prevalence of hyponatremia on hospital admission was 15.6% (n=66). Normonatremia was achieved and maintained in almost all hyponatremia patients <48 hours. In-hospital mortality was roughly doubled in hyponatremia compared with nonhyponatremia patients (40.9%; n=27 versus 21.1%; n=75), translating into a 2.5-fold increased odds ratio (
P
<0.001). Multivariable analyses identified hyponatremia as an independent predictor of in-hospital mortality (odds ratio, 2.2; 95% confidence interval, 1.05–4.62;
P
=0.037). Within 90 days after ICH, hyponatremia patients surviving hospital stay were also at greater risk of death (odds ratio, 4.8; 95% confidence interval, 2.1–10.6;
P
<0.001); thereafter, mortality rates were similar.

Conclusions—

Hyponatremia was identified as an independent predictor of in-hospital mortality with a fairly high prevalence in spontaneous ICH patients. The presence of hyponatremia at hospital admission is related to an increased short-term mortality in patients surviving acute care, possibly reflecting a preexisting condition that is linked to worse outcome due to greater comorbidity. Correction of hyponatremia does not seem to compensate its influence on mortality, which strongly warrants future research.
Volume of Carotid Artery Ulceration as a Predictor of Cardiovascular Events
Authors: Kuk Mariya , Wannarong Thapat , Beletsky Vadim , Parraga Grace , Fenster Aaron , Spence J. David
Published: April 2014

Background and Purpose—

Previous studies have shown the presence of ulceration in atherosclerotic plaque either by categorizing the plaque as complex (irregular morphology with ulcers) or smooth or by quantifying the number of ulcers observed in a specific region of interest. The aim of this study was to quantify carotid total ulcer volume by 3-dimensional ultrasound to investigate the relationship of total ulcer volume to vascular events (strokes, transient ischemic attack, myocardial infarction, revascularization, or death because of cardiovascular reasons).

Methods—

In total, 349 at-risk subjects provided written informed consent to carotid 3-dimensional ultrasound and were analyzed for ulcerations. Ulcer volume was defined as a distinct discontinuity in an atherosclerotic plaque, with a volume ≥1.00 mm
3
as measured using manual segmentation. The sum of the volumes of all ulcers seen in both carotids was the total ulcer volume. Participants were monitored for ≤5 years for outcomes, including cardiovascular events and death.

Results—

Kaplan–Meier survival analysis showed that subjects with total ulcer volume ≥5 mm
3
experienced a significantly higher risk of developing stroke, transient ischemic attack, or death (
P
=0.009) and of developing stroke/transient ischemic attack/death/myocardial infarction/revascularization (
P
=0.017). Lower ulcer volumes did not predict events nor did ulcer depth.

Conclusions—

Volume of carotid ulceration on 3-dimensional ultrasound predicts cardiovascular events. In addition to improving risk stratification, ulceration is a potential therapeutic target.
Local–Global Linkages in Environmental Governance: The Case of Crop Genetic Resources
Authors: Aksoy Zuhre
Published: April 2014

The loss of biodiversity is a global environmental problem that poses important governance challenges. Effective governance of crop genetic resources as a component of biodiversity is essential, given that such resources are the building blocks of today's modern agriculture. This article examines the formal governance framework in place for crop genetic resources, as embodied in the Convention on Biological Diversity and the International Treaty on Plant Genetic Resources for Food and Agriculture, and compares this to alternative modes of governance proposed by peasants' organizations such as Via Campesina. The author argues that the existing formal governance framework falls short of providing an effective mechanism for the conservation of crop genetic resources. Alternative governance mechanisms may more effectively connect the local and the global in a way that recognizes the contributions of local communities to conserving genetic resources in centers of diversity, and re-embeds their control over agricultural production processes.
Frames of Climate Change in Side Events from Kyoto to Durban
Authors: Hjerpe Mattias , Buhr Katarina
Published: April 2014

Addressing climate change is challenging because of its diverse meanings regarding the implications of science, values, risk, and governance. Climate change frames are central organizing ideas that allow us to identify why climate change is a problem of global concern, who is responsible, and the ways in which and by whom it should be governed. UN climate change conferences gather diverse actors for debating climate policy, allowing us to study the frames they represent and how they evolve. They examine the official side events at these conferences, considering the topics of all 2,214 side events from 1997 through 2011. The results show a prominence of the action and conformity frames, indicating that actors reluctant to change have not been engaged; a tendency to favor the social progress frame over the economic frame; that topical changes were not solely the result of new organizations being admitted; a rise in non-climatic issues indicating large potential for bandwagoning; and a symbiotic relationship between negotiations and side events.
Athanasius in Syriac
Authors: ter Haar Romeny Bas
Published: April 2014

This paper discusses aspects of the reception of Athanasius in the Syriac-speaking churches. On the basis of a survey of the Syriac translations of Athanasius and references to him by a number of authors, it is argued that he was considered a very important Father by the Syriac Orthodox, the Melkites, as well as the East Syrians, even though most if not all of the translations were made by the Syriac Orthodox. His status was based not only on the fact that especially in matters of Christology he was considered the epitome of Orthodoxy by all parties, but also on the fact that his ascetic writings formed a major source of inspiration to monks. With the help of five examples the importance of the Syriac tradition for the establishment of critical texts of Athanasius’s writings is shown here to be considerable, even though there are very many issues and problems connected with the translations.
The Relevance of Athanasius in Dogmatics
Authors: van de Beek Abraham
Published: April 2014

This article deals with the reception of Athanasius in systematic theology. The first section focuses on quantitative data. It turns out that Athanasius, though often hailed as one of the greatest Church fathers, is not quoted very frequently when compared e.g. with Augustine. Major systematic works do not refer to him at all, or scarcely. The second part directs its attention to the content of the reception. The core of Athanasius’s importance is found in his Christology: God became human so that humans become God. Soteriology and Christology are one and the same and this can also get the face of pneumatology: participation in the Spirit of God. Other aspects of Athanasius work whereto is referred, are his list of canonical books and his view on theological epistemology. In the final section the author stresses once again the priority of Athanasius’s interpretation of the homoousios over any other Christological model.
On the identity of Cancer urania Herbst, 1801 (Crustacea: Decapoda: Brachyura: Leucosiidae)
Authors: NG Peter K.L. , TÜRKAY MICHAEL , GALIL BELLA S.
Published: April 2014

Cancer urania Herbst, 1801, is the type species of the leucosiid genus Coleusia Galil, 2006. Its identity has been a subject of confusion due to various taxonomical and nomenclatural issues. We redescribe the species, discuss its complex history and taxonomy, and a female syntype is designated as the lectotype of the species to clarify any lingering ambiguities concerning the type material of Cancer urania Herbst, 1801.
A Dynamical Model for the Leeuwin Undercurrent
Authors: Schloesser Fabian
Published: April 2014

Recently, Furue et al. explored analytic solutions to a dynamical model for the Leeuwin Current system (LCS) off the coast of Western Australia. Their linear, variable density, two-layer model reduces to a one-layer system near the coast. The circulation is determined by matching solutions in the coastal and offshore regions across the “grounding line” and displays many features observed in the LCS. However, it does not include a Leeuwin Undercurrent (LUC). Here, that model is extended considering an across-shore density gradient (front) caused by relatively light, tropical water being carried poleward by the Leeuwin Current (LC). As a result of including the front, the LCS circulation changes considerably; the LC deepens and strengthens significantly toward the pole, and the LCS now includes an equatorward LUC on the offshore edge of the LC. Differences in density and sea surface height across the front both contribute to the pressure gradient driving the LUC.
Assessment of CODAR SeaSonde and WERA HF Radars in Mapping Surface Currents on the West Florida Shelf*
Authors: Liu Yonggang , Weisberg Robert H. , Merz Clifford R.
Published: April 2014

Concurrently operated on the West Florida shelf for the purpose of observing surface currents are three long-range (4.9 MHz) Coastal Ocean Dynamics Applications Radar (CODAR) SeaSonde and two median-range (12.7 MHz) Wellen Radar (WERA) high-frequency (HF) radar systems. These HF radars overlook an array of moored acoustic Doppler current profilers (ADCPs), three of which are presently within the radar footprint. Analyzed herein are 3 months of simultaneous observations. Both the SeaSonde and WERA systems generally agree with the ADCPs to within root-mean-square differences (rmsd) for hourly radial velocity components of 5.1–9.2 and 3.8–6.5 cm s−1 for SeaSonde and WERA, respectively, and within rmsd for 36-h low-pass filtered radial velocity components of 2.8–6.0 and 2.2–4.3 cm s−1 for SeaSonde and WERA, respectively. The bearing offset and tidal and subtidal currents of total velocities are also assessed using the ADCP data. Despite differences in a variety of aspects between the direction-finding CODAR SeaSonde (long range, effective depth of 2.4 m, integration time of 4 h, and idealized antenna patterns) and the beam-forming WERA (median range, effective depth of 0.9 m, and integration time of 1 h), both HF radar systems demonstrated good surface current mapping capability. The differences between the velocities measured with the HF radar and the ADCP are sufficiently small in this low-energy shelf that much of these rmsd values may be accounted for by the expected measurement differences due to the horizontal, vertical, and temporal sampling differences of the ocean current observing systems used.
An Examination of the Feasibility of Linear Deterministic Sea Wave Prediction in Multidirectional Seas Using Wave Profiling Radar: Theory, Simulation, and Sea Trials
Authors: Belmont M. R. , Christmas J. , Dannenberg J. , Hilmer T. , Duncan J. , Duncan J. M. , Ferrier B.
Published: April 2014

For a number of maritime tasks there is a short time period, typically only a few tens of seconds, where a critical event occurs that defines a limiting wave height for the whole operation. Examples are the recovery of fixed and rotary winged aircraft, cargo transfers, final pipe mating in fluid transfer operations, and launch/recovery of small craft. The recovery of a 30-t rescue submersible onto a mother ship in the North Atlantic Treaty Organization (NATO) Submarine Rescue System is a prime example. In such applications short-term deterministic sea wave prediction (DSWP) can play a vital role in extending the sea states under which the system can be safely deployed. DSWP also has great potential in conducting experimental sea wave research at full scale. This report explores the feasibility of using data from an experimental wave profiling radar in achieving DSWP. The report includes theory, simulation, and field testing. Two forms of DSWP are employed: a fixed point system based upon a restricted set of wave directions from which some success is obtained and the other a fully two-dimensional technique that requires further development. The main finding is that using wave profiling radar for DSWP offers promise but requires improvements both to the spatial reliability and the resolution of the wave profiling radar and to the temporal resolution of its sweep before the technique can be considered to be viable as a usable tool.
Performance of Operational Model Precipitation Forecast Guidance during the 2013 Colorado Front-Range Floods*
Authors: Hamill Thomas M.
Published: April 2014

During the period 9–16 September 2013, more than 17 in. (~432 mm) of rainfall fell over parts of Boulder County, Colorado, with more than 8 in. (~203 mm) over a wide swath of Colorado’s northern Front Range. This caused significant flash and river flooding, loss of life, and extensive property damage. The event set a record for daily rainfall (9.08 in., or >230 mm) in Boulder that was nearly double the previous daily rainfall record of 4.8 in. (122 mm) set on 31 July 1919. The operational performance of precipitation forecast guidance from global ensemble prediction systems and the National Weather Service’s global and regional forecast systems during this event is documented briefly in the article and more extensively in online supplemental appendixes. While the precipitation forecast guidance uniformly depicted a much wetter-than-average period over northeastern Colorado, none of the global nor most of the regional modeling systems predicted precipitation amounts as heavy as analyzed. Notable exceptions to this were the Short-Range Ensemble Forecast (SREF) members that used the Advanced Research Weather Research and Forecasting Model (ARW-WRF) dynamical core. These members consistently produced record rainfall in the Front Range. However, the SREF’s record rainfall was also predicted to occur the day before the heaviest actual precipitation as well as the day of the heaviest precipitation.
The Multiple Facets of Influence
Authors: Dubois Elizabeth , Gaffney Devin
Published: April 2014

This study compares six metrics commonly used to identify influential players in two of Canada’s largest political Twitter communities based on the users, and ranking order of users, identified by each metric. All tweets containing the hashtag #CPC, representing the Conservative Party of Canada (government), and #NDP, representing the New Democratic Party of Canada (official opposition), were collected over a 2-week period in March 2013 and a follower network graph was created. Social network analysis and content analysis were employed to identify influentials. Kendall’s τ was the primary quantitative measure for comparison. Categorization of Twitter profiles of users found within the top 20 most influential lists, according to each metric of influence, made up the qualitative portion of analysis. The authors find that measures of centrality—indegree and eigenvector centrality—identify the traditional political elite (media outlets, journalists, politicians) as influential, whereas measures considering the quality of messages and interactions provide a different group of influencers, including political commentators and bloggers. Finally, the authors investigate the possibility of using the local clustering coefficient of nodes to identify those who are both aware of the traditional elite and embedded in tightly knit communities, similar to the “opinion leader,” described in the Two-Step Flow Hypothesis.
Overwork and the Slow Convergence in the Gender Gap in Wages
Authors: Cha Youngjoo , Weeden Kim A.
Published: April 2014

Despite rapid changes in women’s educational attainment and continuous labor force experience, convergence in the gender gap in wages slowed in the 1990s and stalled in the 2000s. Using CPS data from 1979 to 2009, we show that convergence in the gender gap in hourly pay over these three decades was attenuated by the increasing prevalence of “overwork” (defined as working 50 or more hours per week) and the rising hourly wage returns to overwork. Because a greater proportion of men engage in overwork, these changes raised men’s wages relative to women’s and exacerbated the gender wage gap by an estimated 10 percent of the total wage gap. This overwork effect was sufficiently large to offset the wage-equalizing effects of the narrowing gender gap in educational attainment and other forms of human capital. The overwork effect on trends in the gender gap in wages was most pronounced in professional and managerial occupations, where long work hours are especially common and the norm of overwork is deeply embedded in organizational practices and occupational cultures. These results illustrate how new ways of organizing work can perpetuate old forms of gender inequality.
Chylothorax diagnosis: can the clinical chemistry laboratory do more?
Authors: Gibbons Stephen M , Ahmed Farhan
Published: April 2014

Background

Chylothorax is a rare anatomical disruption of the thoracic duct associated with a significant degree of morbidity and mortality. Diagnosis usually relies upon lipid analysis and visual inspection of the pleural fluid. However, this may be subject to incorrect interpretation. The aim of this study was to compare pleural fluid lipid analysis and visual inspection against lipoprotein electrophoresis.

Methods

Nine pleural effusion samples suspected of being chylothorax were analysed. A combination of fluid lipid analysis and visual inspection was compared with lipoprotein electrophoresis for the detection of chylothorax.

Results

There was 89% concordance between the two methods. Using lipoprotein electrophoresis as gold standard, calculated sensitivity, specificity, negative predictive value and positive predictive value for lipid analysis/visual inspection were 83%, 100%, 100% and 75%, respectively.

Conclusion

Examination of pleural effusion samples by lipoprotein electrophoresis may provide important additional information in the diagnosis of chylothorax.
Comparison of BD Vacutainer® Rapid Serum Tube and plasma for haemolysis markers in the emergency department
Authors: Ryan JB , Stuart LA , Southby SJ , Than MP , Mackay R , Florkowski CM , George PM
Published: April 2014

Background

In recent years, a rapid-clotting serum tube, BD Vacutainer® Rapid Serum Tube (RST™), was introduced to improve turn-around times for serum samples. Previous studies reported reduced concentrations of some markers of haemolysis in RST specimens compared to other serum or plasma samples. We aimed to compare RST to plasma tubes for haemolysis markers in an emergency department (ED) setting, where increased rates of haemolysis are commonly seen.

Methods

Patients presenting to ED over an eight-day period had an RST, BD Vacutainer® PST™ II (plasma) Tube and BD Vacutainer® Heparin (non-gel, plasma) Tube collected. Blood was drawn from an intravenous cannula, and samples were promptly analysed for haemolysis index, potassium, phosphate, aspartate aminotrasferase (AST), magnesium and lactate dehydrogenase (LD).

Results

A total of 347 patient samples were included, and 9.2% of the PST samples were haemolysed. The RST tubes had small increases in all of the haemolysis markers compared to both plasma tubes ( P ≤ 0.005), except LD which was lower in the RST group. There were no significant differences in the proportion of results above the upper reference limit between the tubes, except for LD which had a lower proportion in RST samples ( P ≤ 0.002).

Conclusion

Compared to plasma, RST specimens show small increases in several haemolysis markers, consistent with known differences between serum and plasma, but the proportion of elevated haemolysis markers is similar to plasma. In a setting with a high haemolysis rate such as ED, RST specimens provide a non-inferior sample type for markers of haemolysis.