bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis and treatment of lingual thyroglossal duct cyst in newborns
Authors: Bai Weiliang , Ji Wenyue , Wang Liping , Song Yan
Published: March 2009

Background:  The objective of this study was to explore the diagnosis and treatment method of lingual thyroglossal duct cyst in newborns.

Method:  The clinical data of nine newborns who were diagnosed as lingual thyroglossal duct cyst were retrospectively analyzed.

Results:  One lingual thyroglossal duct cyst was found when the tongue was pressed with a spatula. The other eight lingual thyroglossal duct cysts were found with a laryngoscope. Three‐dimensional computed tomography showed that the cysts were located at the base of tongue, which was round and smooth. Six of nine patients were treated with the puncture method. The fluid was drawn out, and the average volume was 1.4 mL. Follow‐up survey lasted for 1 year or more and 33.3% (2/6) of the cases recurred. For the recurrence, the two patients underwent another operation in which most of the cyst walls were removed and they had no recurrence after another year of follow‐up survey. Three of the nine patients were treated with the excision method, and they had no recurrence after 1 year of follow‐up survey.

Conclusions:  The laryngoscope and three‐dimensional computed tomography examinations are important for the diagnosis of lingual thyroglossal duct cyst. Surgical removal serves as a radical cure for lingual thyroglossal duct cyst.
Two Japanese infants with congenital generalized lipodystrophy due to BSCL2 mutations
Authors: Nishiyama Atsushi , Yagi Mariko , Awano Hiroyuki , Okizuka Yo , Maeda Taro , Yoshida Shinsaku , Takeshima Yasuhiro , Matsuo Masafumi
Published: March 2009

Background:  Congenital generalized lipodystrophy (CGL), Berardinelli‐Seip syndrome, is a rare autosomal recessive disorder characterized by the generalized absence of adipose tissue at birth, severe insulin resistance early in life, hypertriglyceridemia, hepatomegaly, and the development of diabetes mellitus during puberty. Recently, two genes, BSCL2 and AGPAT2, were identified as causative genes for CGL. It has been reported that patients with BSCL mutations present with more severe clinical findings than those with AGPAT2 mutations. However, the clinical course of CGL caused by BSCL2 mutations in infancy has not been fully elucidated.

Methods:  Two Japanese infantile patients with CGL from independent families were examined and underwent an oral glucose tolerance test. Insulin resistance and insulin secretion were estimated using the homeostasis model assessment for insulin resistance and the insulinogenic index, respectively. Sequence analysis of the entire coding region of BSCL2 and AGPAT2 was performed.

Results:  Both CGL patients presented with normal glycemic profiles after oral glucose tolerance tests; however, the values from the homeostasis model assessment of insulin resistance were elevated and well above the cut‐off point for diagnosis of infant insulin resistance in both patients. One patient possessed a known homozygous nonsense mutation in exon 8 (c.823C>T) of BSCL2; the other had a novel homozygous missense mutation in exon 5 (c.560A>G) of BSCL2.

Conclusion:  Japanese CGL patients with BSCL2 mutations presented with severe insulin resistance, even during infancy, prior to the development of diabetes mellitus.
Bacteriophages drive strain diversification in a marine Flavobacterium: implications for phage resistance and physiological properties
Authors: Middelboe Mathias , Holmfeldt Karin , Riemann Lasse , Nybroe Ole , Haaber Jakob
Published: March 2009

Genetic, structural and physiological differences between strains of the marine bacterium Cellulophaga baltica MM#3 (Flavobacteriaceae) developing in response to the activity of two virulent bacteriophages, ΦSM and ΦST, was investigated during 3 weeks incubation in chemostat cultures. A distinct strain succession towards increased phage resistance and a diversification of the metabolic properties was observed. During the incubation the bacterial population diversified from a single strain, which was sensitive to 24 tested Cellulophaga phages, into a multistrain and multiresistant population, where the dominant strains had lost susceptibility to up to 22 of the tested phages. By the end of the experiment the cultures reached a quasi steady state dominated by ΦST‐resistant and ΦSM + ΦST‐resistant strains coexisting with small populations of phage‐sensitive strains sustaining both phages at densities of > 106 plaque forming units (pfu) ml−1. Loss of susceptibility to phage infection was associated with a reduction in the strains' ability to metabolize various carbon sources as demonstrated by BIOLOG assays. This suggested a cost of resistance in terms of reduced physiological capacity. However, there was no direct correlation between the degree of resistance and the loss of metabolic properties, suggesting either the occurrence of compensatory mutations in successful strains or that the cost of resistance in some strains was associated with properties not resolved by the BIOLOG assay. The study represents the first direct demonstration of phage‐driven generation of functional diversity within a marine bacterial host population with significant implications for both phage susceptibility and physiological properties. We propose, therefore, that phage‐mediated selection for resistant strains contributes significantly to the extensive microdiversity observed within specific bacterial species in marine environments.
Prospective assessment of systemic therapy followed by surgical removal of metastases in selected patients with renal cell carcinoma
Authors: Daliani Danai D. , Tannir Nizar M. , Papandreou Christos N. , Wang Xuemei , Swisher Stephen , Wood Christopher G. , Swanson David A. , Logothetis Christopher J. , Jonasch Eric
Published: March 2009

OBJECTIVE

To prospectively establish objective selection criteria for metastasectomy in patients with metastatic renal cell carcinoma (mRCC).

PATIENTS AND METHODS

Between 1991 and 1999, 38 patients with mRCC with responsive or stable disease after initial systemic therapy, and with potentially resectable disease, were enrolled. Patients had a metastasectomy with curative intent and received consolidative adjuvant systemic therapy.

RESULTS

Of the patients enrolled, 79% had stable disease after initial systemic therapy and 21% had a partial or complete response. Most (84%) had metastasectomy of one organ site. There was surgically no evidence of disease (sNED) in 76%. Operative morbidity and mortality were acceptable and 90% of the patients received adjuvant systemic therapy. The median (95% confidence interval) survival was 4.7  (3.0–7.8) years, and the median time to progression was 1.8 (0.8–3.1) years. Eight of 38 patients (21%) remained free of disease by the end of the study. Significant predictors of outcome were lack of sNED after metastasectomy, and the presence of pulmonary metastases. The median overall survival for those who had sNED was 5.6 years, vs 1.4 years for those who did not (P < 0.001).

CONCLUSIONS

Metastasectomy in patients with mRCC not progressing after systemic therapy is feasible, with acceptable morbidity. Predictive factors for long‐term outcome include pulmonary metastases and sNED. Future work evaluating treatments that can convert patients into surgical candidates will increase the cure rate of patients with mRCC.
Comparison of intravesical botulinum toxin type A injections plus hydrodistention with hydrodistention alone for the treatment of refractory interstitial cystitis/painful bladder syndrome
Authors: Kuo Hann‐Chorng , Chancellor Michael B.
Published: March 2009

OBJECTIVE

To compare the clinical effectiveness of botulinum toxin type A (BoNT‐A) injections followed by hydrodistention (HD) with HD alone in patients with interstitial cystitis/painful bladder syndrome (IC/PBS).

PATIENTS AND METHODS

A prospective, randomized study was performed in a urological referral centre. In all, 67 patients with IC/PBS who had failed conventional treatments were enrolled. Of these, 44 patients received suburothelial injection with 200 U (15) or 100 U (29) of BoNT‐A followed by cystoscopic HD 2 weeks later (BoNT‐A groups). The control group (23 patients) received the identical HD procedure with no BoNT‐A injection. All patients remained on baseline medications of pentosan polysulphate throughout the study. Bladder pain visual analogue scale (VAS), O’Leary‐Sant symptom and problem indexes, functional bladder capacity (FBC) and urodynamic variables were measured at baseline and after treatment. Global response assessment was used to evaluate successful treatment response.

RESULTS

The IC/PBS symptom score significantly decreased in all three groups, but VAS reduction, FBC and cystometric bladder capacity increases were significant only in the BoNT‐A groups at 3 months. Of the 44 patients in the BoNT‐A group 31 (71%) had a successful result at 6 months. A successful result at 12 and 24 months was reported in 24 (55%) and 13 (30%) patients in BoNT‐A group, respectively, compared with only six (26%) and four (17%) in the control group (P = 0.002).

CONCLUSION

Intravesical injections of BoNT‐A followed by HD produced significantly better clinical results than HD alone in patients with IC/PBS.
TRADE LIBERALIZATION AND THE EXTENSIVE MARGIN
Authors: Mukerji Purba
Published: March 2009

Trade barriers can lead to the disappearance of products and impose huge costs. Allowing for the realistic possibility that imported products are substituted by domestic varieties this paper finds that the cost of protection that allows for disappearance of products, the ‘Romer cost,’ is higher below a tariff threshold. This threshold depends on the substitutability of domestic for foreign products. This is important for developing countries where inferior technology leads to poor substitutability and traditional calculations underestimate the cost. Analysis of new varieties trade after the Indian liberalization supports the findings in the context of a developing country.
PENSION FUNDING IN A UNIONIZED ECONOMY
Authors: Adam Antonis , Moutos Thomas
Published: March 2009

This paper analyzes the effects of pension funding for a small open economy in which wages are subject to bargaining. Using an overlapping‐generations framework, we show that a reform away from a Pay‐As‐You‐Go towards a funded pension system will be Pareto improving only if the reform results in a reduction in the steady‐state unemployment rate. However, the reduction in the unemployment rate is by no means warranted: although for pension systems which involve a limited amount of intra‐generational redistribution this is likely, for systems displaying a high degree of intra‐generational redistribution the unemployment rate may well rise thus preventing the realization of welfare gains.
WHEN DO SOCIAL NORMS REPLACE STATUS‐SEEKING CONSUMPTION? AN APPLICATION TO THE CONSUMPTION OF CLEANLINESS
Authors: Woersdorfer Julia Sophie
Published: March 2009

Interdependencies in consumer behavior stem from either status‐seeking consumption or compliance with social norms. This paper analyzes how a consumption act changes from a means to signal the consumer's status to a means of norm compliance. It is shown that such a transformation can only be understood when consumer motivations other than social recognition are taken into account. We depict norm emergence as a learning process based on changing associations between a specific consumption act and widely shared, non‐subjectivist consumer needs. Our conjectures are illustrated by means of a case study: the emergence of the cleanliness norm in the 19th century.
Prevalence and clinical features of LRRK2 mutations in patients with Parkinson’s disease in southern Spain
Authors: Gao L. , Gómez‐Garre P. , Díaz‐Corrales F. J. , Carrillo F. , Carballo M. , Palomino A. , Díaz‐Martín J. , Mejías R. , Vime P. J. , López‐Barneo J. , Mir P.
Published: March 2009

Background and purpose:  Mutations in leucine‐rich repeat kinase 2 (LRRK2) gene are associated with both familial and idiopathic Parkinson’s disease (PD), whereas mutations in PARK2 (PARKIN) gene result in early onset recessive PD. Here, the objectives were to determine the frequency of LRRK2 G2019S and R1441G mutations in a PD population from southern Spain; to search for LRRK2 mutations in familial PD cases and to study the effect of PARKIN mutations on clinical features of LRRK2‐associated; PD.

Methods:  We included 187 PD patients (172 idiopathic, 15 familial) and 287 control subjects from southern Spain. LRRK2 and PARKIN mutations were screened, and clinical features of LRRK2‐associated PD were examined.

Results:  Three (1.7%) idiopathic PD patients carried the G2019S, whereas another three (1.7%) had the R1441G. A novel polymorphism D1420N was found in two (13.3%) familial PD patients. One G2019S carrier also had a homozygous PARKIN deletion, who had early onset PD with clinical symptoms similar to those with PARKIN‐associated PD. The remaining LRRK2‐asscociated patients had clinical manifestations similar to those with idiopathic PD.

Conclusions:  G2019S and R1441G are common LRRK2 mutations in PD patients in this region. PARKIN mutations override clinical features in LRRK2‐associated PD.
Personal values and the ‘country‐of‐origin effect’: the moderating role of consumers' demographics
Authors: De Moura Engracia Giraldi Janaina , Ikeda Ana Akemi
Published: March 2009

This article has addressed the following research problem: what consumers' personal values most influence the country‐of‐origin effect? Furthermore, it has verified whether there are differences on this influence, in terms of consumers' demographic characteristics such as gender, age and country familiarity. A descriptive and quantitative empirical research has been used to analyse the product category of Chinese home appliances, using a sample of Brazilian executives. Results have shown that consumers' personal values exert different influences on the evaluation of foreign products. Most influences of personal values on the country‐of‐origin effect are negative; the more important the personal values, the more negative the products are evaluated. Exceptions are for women. With the results of this research, marketing professionals and theoreticians may better manage the use of a product's country of origin as a marketing tool in international marketing activities.
Urologist Ownership of Ambulatory Surgery Centers and Urinary Stone Surgery Use
Authors: Hollingsworth John M. , Ye Zaojun , Strope Seth A. , Krein Sarah L. , Hollenbeck Ann T. , Hollenbeck Brent K.
Published: March 2009

Objectives. To understand how physician ownership of ambulatory surgery centers (ASCs) relates to surgery use.

Data Source. Using the State Ambulatory Surgery Databases, we identified patients undergoing outpatient surgery for urinary stone disease in Florida (1998–2002).

Study Design. We empirically derived a measure of physician ownership and externally validated it through public data. We employed linear mixed models to examine the relationship between ownership status and surgery use. We measured how a urologist's surgery use varied by the penetration of owners within his local health care market.

Principal Findings. Owners performed a greater proportion of their surgeries in ASCs than nonowners (39.6 percent versus 8.0 percent, p<.001), and their utilization rates were over twofold higher ( p<.001). After controlling for patient differences, an owner averaged 16.32 (95 percent confidence interval [CI], 10.98–21.67; p<.001) more cases annually than did a nonowner. Further, for every 10 percent increase in the penetration of owners within a urologist's local health care market, his annual caseload increased by 3.32 (95 percent CI, 2.17–4.46; p<.001).

Conclusions. These data demonstrate a significant association between physician ownership of ASCs and increased surgery use. While its interpretation is open to debate, one possibility relates to the financial incentives of ownership. Additional work is necessary to see if this is a specialty‐specific phenomenon.
The reliability of romantic love: A reliability generalization meta‐analysis
Authors: GRAHAM JAMES M. , CHRISTIANSEN KENAN
Published: March 2009

The present study is a reliability‐generalization meta‐analysis of 5 commonly used measures of romantic love: Rubin’s Loving and Liking scales, the Love Attitudes Scale, the Love Attitudes Scale–Short Form, the Passionate Love Scale, and the Triangular Love Scale. Data from 127 studies representing 38,132 participants provided internal consistency reliability estimates. The studies provide information on the average score reliability across studies and the effect of sample characteristics on score reliability across measures. The reliability of scores from several measures proved to be susceptible to the influence of sample characteristics, most notably, the ethnicity of the sample. The discussion provides recommendations to researchers and focuses on the ramifications of score reliability on love research.
Assessing the health of a dyadic relationship in heterosexual and same‐sex partners
Authors: KURDEK LAWRENCE A.
Published: March 2009

The purpose of this study was to assess characteristics of a measure of monitoring the health of a dyadic relationship based on data from self‐report surveys completed by both partners from dating heterosexual, married heterosexual, cohabiting gay male, and cohabiting lesbian couples from the United States (Ns = 127, 46, 81, and 224, respectively). Covariation among the measure’s 7 items conformed to 1 latent factor. Intraclass correlations between partners from the same couple were positive. Gender effects occurred only for married couples, with wives having higher scores than husbands. One’s own and one’s partner’s monitoring accounted for unique variance in one’s own commitment, even with controls for other variables. Monitoring buffered the negative effects of neuroticism on commitment.
Outcomes for 236 patients from a 2‐year early intervention in psychosis service
Authors: Turner M. A. , Boden J. M. , Smith‐Hamel C. , Mulder R. T.
Published: March 2009

Objective:  To examine: i) changes in key outcome measures over time in treatment in a representative first‐episode psychosis treatment cohort and ii) baseline predictors of service disengagement.

Method:  Baseline characteristics of 236 patients were examined for associations with outcomes over time using generalized estimating equation models. The data on disengagement were analysed using logistic regression.

Results:  After controlling for admission scores, patients showed consistently improved outcomes while in treatment on functional recovery (unemployment, P < 0.01; HoNOS, P < 0.001; the Quality of Life Scale, P < 0.001; GAF, P < 0.05) but not symptomatology (as assessed by the PANSS and substance abuse). The 64 (33%) who disengaged were more likely to be unemployed (P < 0.01) and have higher HoNOS (P < 0.01) and GAF (P < 0.05) scores at baseline.

Conclusion:  This evaluation has shown significant improvements in psychosocial functioning but not psychopathology during treatment at an Early Intervention for Psychosis Service. Despite attempts to retain patients, there is a high rate of treatment discontinuation.
Periodontitis and nosocomial lower respiratory tract infection: preliminary findings
Authors: Gomes‐Filho Isaac Suzart , Santos Carla M. L. , Cruz Simone S. , Passos Johelle de S. , Cerqueira Eneida de M. M. , Costa Maria da Conceição N. , Santana Teresinha C. , Seymour Gregory J. , Santos Carlos Antonio de S. T. , Barreto Maurício L.
Published: March 2009

Aim: To evaluate the possible association between periodontitis and nosocomial lower respiratory tract infection (LRTI).

Material and Methods: A case–control study was conducted at a General Hospital in Feira de Santana, Bahia, Brazil. The sample consisted of 103 individuals: 22 cases (presence of nosocomial LRTI) and 81 controls (absence of nosocomial LRTI). The diagnosis of periodontitis was based on probing depth, gingival recession, clinical attachment loss and bleeding on probing. The diagnosis of nosocomial LRTI was made in accordance with established medical criteria.

Results: Invasive ventilation was much more frequent in cases (95.5%) than in controls (7.4%). An orotracheal tube was used in 81.8% of cases and in 7.4% of controls; bronchoaspiration was suspected in 81.8% of cases and in 6.2% of controls. There was no statistically significant difference in any of the clinical periodontal parameters between cases and controls. The crude odds ratio (OR) value for individuals with periodontitis having LRTI was not statistically significant [ORcrude=1.70; 95% confidence interval:(0.60–4.87)]. After including age, smoking and duration of hospitalization in the logistic regression, the adjusted OR for individuals with periodontitis having LRTI was statistically significant [ORadjusted=3.67 (1.01–13.53); p=0.049].

Conclusions: A marginal association between periodontitis and LRTI was found when smoking, age and length of hospitalization were included as covariates. Patients with LRTI had a high frequency of suspected bronchoaspiration and this could explain the possible association of periodontal disease and LRTI found in this and other studies. Additional studies are needed to further clarify the possible relationship between periodontal disease and LRTI.
Coexpression of the melatonin receptor 1 and nestin in human breast cancer specimens
Authors: Rögelsperger O. , Ekmekcioglu C. , Jäger W. , Klimpfinger M. , Königsberg R. , Krenbek D. , Sellner F. , Thalhammer T.
Published: March 2009

Abstract:  Activation of the G‐protein‐coupled receptor (GPCR) for melatonin (MT1) suppresses breast cancer cell growth in experimental models. To elucidate whether MT1 might play a role in cancer cells positive for the stem cell marker nestin, we assessed paired carcinomatous (Ca) and adjacent noncancerous (NCa) samples from 42 patients with primary breast cancer for MT1 and nestin by double immunofluorescence staining and quantitative image analysis with Tissue‐Quest® software. MT1 was located in luminal and myoepithelial cells in milk ducts and in tumor cells in 40/42 and 39/42 of NCa and Ca specimens, respectively, independent of hormone receptor and HER‐2 status. Nestin was located together with MT1 in myoepithelial cells in 38 NCa specimens (total n = 42) and in 18 Ca specimens with intact milk ducts. Quantitative evaluation of selected 16 NCa and Ca samples revealed that MT1 levels were higher in invasive Ca sections than in NCa specimens in eight and lower in six cases. Specimens from higher tumor stages (TII/III) with a higher risk of relapse were associated with MT1/nestin co‐staining in more than 10% of tumor cells, whereas a lack of co‐staining correlated with lower tumor stages. Abundant expression of MT1 and, particularly, coexpression of MT1 with nestin in invading tumor cells in more advanced tumors suggest an important role for this GPCR in the pathogenesis of breast cancer.
Demonstratives in Philosophy and Linguistics
Authors: Wolter Lynsey
Published: March 2009

Demonstrative noun phrases (e.g., that guy, this) are of interest to philosophers of language and semanticists because they are sensitive to demonstrations or speaker intentions. The interpretation of a demonstrative therefore sheds light on the role of the context in natural language semantics. This survey reviews two types of approaches to demonstratives: Kaplan's direct reference treatment of demonstratives and other indexicals, and recent challenges to Kaplan's approach that focus on less obviously context‐sensitive uses of demonstratives. The survey then covers selected research on demonstratives in linguistics. This research offers new empirical puzzles and contrasting theoretical approaches to demonstratives.
Intelligent Design
Authors: Hasker William
Published: March 2009

The intelligent design movement aspires to create a new scientific paradigm which will replace the existing Darwinian paradigm of evolution by random mutation and natural selection. However, the creation of such a paradigm is hampered by the fact that the movement pursues a ‘big tent’ strategy that refuses to make a choice between young‐earth creationism, old‐earth (progressive) creationism, and divinely directed natural selection. The latter two options are discussed in some detail, and it becomes apparent that either one presents difficult challenges that the movement shows no signs of overcoming. It is concluded that there are not good prospects for the creation of an alternative paradigm in the foreseeable future.
Do International Medical Graduates (IMGs) “Fill the Gap” in Rural Primary Care in the United States? A National Study
Authors: Thompson Matthew J. , Hagopian Amy , Fordyce Meredith , Hart L. Gary
Published: March 2009

ABSTRACT: 
Context: The contribution that international medical graduates (IMGs) make to reducing the rural‐urban maldistribution of physicians in the United States is unclear. Quantifying the extent of such “gap filling” has significant implications for planning IMG workforce needs as well as other state and federal initiatives to increase the numbers of rural providers. Purpose: To compare the practice location of IMGs and US medical graduates (USMGs) practicing in primary care specialties. Methods: We used the 2002 AMA physician file to determine the practice location of all 205,063 primary care physicians in the United States. Practice locations were linked to the Rural‐Urban Commuting Areas, and aggregated into urban, large rural, small rural, and isolated small rural areas. We determined the difference between the percentage of IMGs and percentage of USMGs in each type of geographic area. This was repeated for each Census Division and state. Findings: One quarter (24.8% or 50,804) of primary care physicians in the United States are IMGs. IMGs are significantly more likely to be female (31.9% vs 29.9%, P < .0001), older (mean ages 49.7 and 47.1 year, P < .0001), and less likely to practice family medicine (19.0% vs 38%, P < .0001) than USMGs. We found only two Census Divisions in which IMGs were relatively more likely than USMGs to practice in rural areas (East South Central and West North Central). However, we found 18 states in which IMGs were more likely, and 16 in which they were less likely to practice in rural areas than USMGs. Conclusions: IMGs fill gaps in the primary care workforce in many rural areas, but this varies widely between states. Policies aimed to redress the rural‐urban physician maldistribution in the United States should take into account the vital role of IMGs.
Rurality and Birth Outcomes: Findings From Southern Appalachia and the Potential Role of Pregnancy Smoking
Authors: Bailey Beth A. , Cole Laura K. Jones
Published: March 2009

ABSTRACT: 
Context: Rates of preterm birth (PTB) and low birth weight (LBW) vary by region, with disparities particularly evident in the Appalachian region of the South. Community conditions related to rurality likely contribute to adverse birth outcomes in this region. Purpose: This study examined associations between rurality and related community conditions, and newborn outcomes in southern Appalachia, and explored whether pregnancy smoking explained such associations. Methods: Data for all births in a southern Appalachian county over a 2‐year period were extracted from hospital records. Findings: Data were available for 4,144 births, with 45 different counties of residence. Babies born to women from completely rural counties, on average, weighed 700 g less, were 1.5 inches shorter, and were born over 3 weeks earlier than less rural infants. In addition, these babies were 4.5 times more likely to be LBW, 4 times more likely to be PTB, and 5 times more likely to be admitted to the neonatal intensive care unit (NICU). Effects were also found for per capita income, poverty rate, and unemployment rate, all of which were associated with rurality. Some, but not all of the association was explained by elevated rates of pregnancy smoking. Conclusions: Babies born to women residing in rural and economically depressed counties in southern Appalachia are at substantially increased risk for poor birth outcomes. Improving these outcomes in the rural South will likely require addressing access to health services and information, health care provider retention, transportation services, employment opportunities, and availability of public health services including smoking cessation assistance.
Bypassing the Local Rural Hospital for Outpatient Procedures
Authors: Saunders Charles , Bellamy Gail R. , Menachemi Nir , Chukmaitov Askar S. , Brooks Robert G.
Published: March 2009

ABSTRACT: 
Purpose: To assess the amount of local rural hospital outpatient department (HOPD) bypass for outpatient procedures. Methods: We analyzed data on colonoscopies and upper gastrointestinal endoscopies performed in the state of Florida over the period 1997‐2004. Findings: Approximately, 53% of colonoscopy and 45% of upper gastrointestinal endoscopy patients bypassed their local rural hospital for treatment at either a free‐standing ambulatory surgical center (ASC) or a nonlocal hospital outpatient department. Independent predictors of bypass included risk‐adjusted severity of the patient's medical condition, insurance status, and race. Patients treated in ASCs were predominately healthier, white and commercially insured. Nonlocal HOPDs tend to treat a sicker cohort of patients who were publicly insured or under managed care. Conclusions: The results indicate that patients who bypass their local HOPD to an ASC differ from those bypassing to a nonlocal HOPD, and that patient factors influencing bypass for outpatient procedures differ from those influencing inpatient bypass. From a policy perspective, as procedures continue to migrate from the inpatient to the outpatient setting, bypassing the local rural hospital for treatment elsewhere could create conditions that negatively impact rural hospital operations.
Emergency Department Coverage by Primary Care Physicians in a Rural Practice‐Based Research Network: Incentives, Confidence, and Training
Authors: Lew Edward , Fagnan Lyle J. , Mattek Nora , Mahler Jo , Lowe Robert A.
Published: March 2009

ABSTRACT: 
Context: In rural areas of the United States, emergency departments (EDs) are often staffed by primary care physicians, as contrasted to urban and suburban hospitals where ED coverage is usually provided by physicians who are residency‐trained in emergency medicine. Purpose: This study examines the reasons and incentives for rural Oregon primary care physicians to cover the ED and their reported measures of confidence and priorities for additional training. Methods: We conducted a cross‐sectional survey of primary care physicians in rural Oregon who are members of the Oregon Rural Practice‐Based Research Network (ORPRN). The survey was sent to 70 primary care physicians in 27 rural Oregon practices. Findings: Fifty‐two of 70 (74%) ORPRN physicians representing 24 practices returned the questionnaire. Nineteen of the 52 responding physicians reported covering the ED. The majority (75%) of physicians covering the ED did so as a requirement for practice employment and/or hospital privileges. Physicians covering the ED reported low confidence in pediatric emergencies and expressed the need for additional training in pediatric emergencies as their top priority. Conclusions: Almost two fifths of surveyed primary care physicians in a rural practice‐based research network provide ED coverage. Based on these physicians' low levels of confidence and desire for additional training in pediatric emergencies, effective education models are needed for physicians covering the ED at their rural hospitals.
Extra‐Individual Correlates of Physical Activity Attainment in Rural Older Adults
Authors: Shores Kindal A. , West Stephanie T. , Theriault Daniel S. , Davison Elizabeth A.
Published: March 2009

ABSTRACT: 
Context: Challenged with a higher incidence of disease, reduced social support, and less access to physical activity facilities and services, rural older adults may find healthy active living a challenge. Despite these challenges, some rural older adults manage to achieve active lifestyles. Purpose: This study investigates the relative importance of 4 extra‐individual correlates of physical activity to physical activity achievement in rural seniors. Methods: Data were drawn from mail questionnaires completed by 454 adults age 65 and over in 7 rural North Carolina counties. Findings: Results from an analysis of covariance indicate that respondents who approached CDC/ACSM recommended levels of physical activity were significantly more likely to report that they lived within walking distance to parks, perceived they had transportation to physical activity areas, had a partner with whom to be active, and felt activity facilities were safe. Next, 7 extra‐individual correlates of physical activity were entered into a backward logistic regression. The resultant model predicting physical activity achievement among rural older adults included social support for physical activity, a safe environment for physical activity, and reported ability to walk to a local park. Conclusions: Interventions designed to provide social support, heighten safety at activity areas and improve park infrastructure may provide opportunities to increase physical activity among seniors.
Creating Reference Datasets for Systems Biology Applications Using Text Mining
Authors: Krallinger Martin , Rojas Ana María , Valencia Alfonso
Published: March 2009

High‐throughput experimental techniques are generating large data collections with the aim of identifying novel entities involved in fundamental cellular processes as well as drawing a systematic picture of the relationships between individual components. Determining the accuracy of the resulting data and the selection of a subset of targets for more careful characterizations often requires relying on information provided by manually annotated data repositories. These repositories are incomplete and cover only a small fraction of the knowledge contained in the literature. We propose in this paper the use of text‐mining technologies to extract, organize, and present information relevant for a particular biological topic. The aims of the resulting approach are (1) to enable topic‐centric biological literature navigation, (2) to assist in the construction of manually revised data repositories, (3) to provide prioritization of biological entities for experimental studies, and (4) to enable human interpretation of large‐scale experiments by providing direct links of bio‐entities to relevant descriptions in the literature.
Reverse‐Engineering Transcriptional Modules from Gene Expression Data
Authors: Michoel Tom , De Smet Riet , Joshi Anagha , Marchal Kathleen , Van de Peer Yves
Published: March 2009

“Module networks” are a framework to learn gene regulatory networks from expression data using a probabilistic model in which coregulated genes share the same parameters and conditional distributions. We present a method to infer ensembles of such networks and an averaging procedure to extract the statistically most significant modules and their regulators. We show that the inferred probabilistic models extend beyond the dataset used to learn the models.
Definition of Arousal and Mechanistic Studies in Intact and Brain‐Damaged Mice
Authors: Arrieta‐Cruz Isabel , Pfaff Donald W.
Published: March 2009

The existence of a primitive, elemental form of CNS arousal, “generalized arousal,” has been hypothesized; it has been given an operational definition, and a high throughput assay has been assayed for it in mice. Many of the ascending and descending neuroanatomical pathways are fairly well understood. To begin experiments that might have potential implications for therapeutic measures, mice were rendered anoxic and it was shown that the assay can demonstrate behavioral abnormalities not detected with a standard neurological screen. These behavioral deficiencies are reminiscent of “sundowning,” a form of dementia seen in hospitalized elderly patients. Electrical stimulation of neurons in medial thalamic cell groups can increase activity in the generalized arousal assay. Current studies include attempts to achieve temporal patterns of electrical stimulation that would take advantage of nonlinear properties of ascending arousal pathways.
Simultaneous Electroencephalography and Functional Magnetic Resonance Imaging of General Anesthesia
Authors: Purdon Patrick L. , Pierce Eric T. , Bonmassar Giorgio , Walsh John , Harrell P. Grace , Kwo Jean , Deschler Daniel , Barlow Margaret , Merhar Rebecca C. , Lamus Camilo , Mullaly Catherine M. , Sullivan Mary , Maginnis Sharon , Skoniecki Debra , Higgins Helen‐Anne , Brown Emery N.
Published: March 2009

It has been long appreciated that anesthetic drugs induce stereotyped changes in electroencephalogram (EEG), but the relationships between the EEG and underlying brain function remain poorly understood. Functional imaging methods including positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), have become important tools for studying how anesthetic drugs act in the human brain to induce the state of general anesthesia. To date, no investigation has combined functional MRI with EEG to study general anesthesia. We report here a paradigm for conducting combined fMRI and EEG studies of human subjects under general anesthesia. We discuss the several technical and safety problems that must be solved to undertake this type of multimodal functional imaging and show combined recordings from a human subject. Combined fMRI and EEG exploits simultaneously the high spatial resolution of fMRI and the high temporal resolution of EEG. In addition, combined fMRI and EEG offers a direct way to relate established EEG patterns induced by general anesthesia to changes in neural activity in specific brain regions as measured by changes in fMRI blood oxygen level dependent (BOLD) signals.
Exploring Altered Consciousness States by Magnetic Resonance Imaging in Brain Injury
Authors: Lescot Thomas , Galanaud Damien , Puybasset Louis
Published: March 2009

Traumatic brain injury (TBI) occurs abruptly, involves multiple specialized teams, calls on the health‐care system in its emergency dimension, and engages the well‐being of the patient and his relatives for a lifetime period. Clinicians in charge of these patients are faced with issues of uppermost importance: medical issues such as predicting the long‐term neurological outcome of the comatose patient; ethical issues because of the influence of intensive care on the long‐term survival of patients in a vegetative and minimally conscious state; legal issues because of the law that has set the concept of proportionality of care as the legal rule; and social issues as the result of the very high cost of these pathologies. Today's larger availability of magnetic resonance imaging (MRI) in ventilated patients and the recent improvements in hardware and in imaging techniques that have made the last‐developed imaging techniques such as diffusion tensor imaging and magnetic resonance spectroscopy available in brain‐trauma patients, are changing the paradigm in neurointensive care regarding outcome prediction. The old paradigm that no individual prognosis could be made at the subacute phase in TBI patients does not hold true anymore. This major change opens new challenging ethical questions. This review focuses on the brain explorations that are required, such as MRI, magnetic resonance spectroscopy, and diffusion tensor imaging, to provide the clinician with a multimodal assessment of the brain state to predict outcome of coma. Such an assessment will become mandatory in the near future to answer the crucial question of proportionality of care in these patients.
Being Conscious of Their Burden
Authors: Fins Joseph J.
Published: March 2009

Writing 50 years after the publication of C. P. Snow's Two Cultures and The Scientific Revolution, this paper considers the many cultures that have to intersect to sustain and deepen the advances in the diagnosis and treatment of patients with disorders of consciousness. To bridge this “two‐culture divide,” the paper contextualizes scientific developments in this field within work in medical ethics and the humanities. The author asserts that this line of inquiry cannot go forward responsibly absent input from the humanities and an appreciation of the lived experiences of patients and families who confront the quotidian and existential challenges of severe brain injury.
Sacred Space in the Ancient Near East
Authors: Wasilewska Ewa
Published: March 2009

The focus of this article is to demonstrate how sacred space in the ancient Near East manifested itself, that is, how it was chosen and used; how it was differentiated from profane areas; and how viable it was for adaptation to socio‐political and socio‐religious changes. Due to the massive amount of available data on sacral places from ancient Anatolia, Egypt, Iran, Mesopotamia, and Syria‐Palestine only selected examples of temples and/or sanctuaries are discussed in general, sparing the reader their detailed descriptions but setting them up within an appropriate cultural context.
Gorham's disease: a case report and literature review
Authors: Patel R.M. , Ward D. , Moran N.
Published: March 2009

Background:  Gorham's disease is an extremely rare disorder of unknown aetiology. The disease is characterised by spontaneous and progressive osteolysis of one or more skeletal bones. Occurrence in the maxillofacial region is rare with fewer than 40 reported cases affecting the facial and jawbones.

Case report:  A 4‐year‐old child was admitted to a district general hospital with a 7‐day history of fever, sore throat, cough and pain in the left face and ear. Three months previously the patient had presented to a local dental hospital complaining of ‘tooth pain’. There was tenderness on examination of the temporomandibular joints and cervical spine, and marked trismus. The teeth were very mobile with extensive gingivitis present. The child was referred to Great Ormond Street Hospital for Sick Children where he received cytotoxic therapy. The patient deteriorated and succumbed to the disease at 6 years of age.

Discussion:  Prognosis of the disease is dependent on which structures are involved. Mandibular involvement is considered high‐risk. The presentation of generalised tooth pain and mobility in a child should raise the suspicion of a systemic disorder affecting the jaws. Gorham's disease is one such condition to consider.
Diffuse peripheral odontogenic fibroma
Authors: Ide F. , Shimoyama T. , Horie N.
Published: March 2009

This report describes the case of a 12‐year‐old girl who presented with diffuse enlargements of the anterior gingiva in both jaws. The clinical diagnosis was an inflammatory hyperplasia, but gingivectomy samples from all involved sites showed similar histological features consistent with odontogenic fibroma. Another peculiar finding was generalised mottled enamel. This is the fifth case of a diffuse clinical variant of peripheral odontogenic fibroma documented in the literature.
Castleman's disease presenting within the cheek of a child
Authors: Katti S. , Bussell M.A. , Najran P. , ElRasheed A. , Prescott R.J. , Smith J.G.
Published: March 2009

A case is presented of an 11‐year‐old male with an eventual diagnosis of extranodal Castleman's disease (hyaline vascular type). This was difficult to diagnose as attempts were made to remove what was believed to be a haematoma, and then a reactive lymph node within the left cheek. Subsequent histopathology revealed the true nature of this swelling.
Glandular odontogenic cyst: a case report
Authors: De Castro J.F.L. , Henriques Á.C.G. , Medeiros M.D. , Montenegro L.T. , Cazal C.
Published: March 2009

The glandular odontogenic cyst (GOC) is a rare developmental lesion considered a distinct entity because of its uncommon histopathological characteristics. It has morphological similarities to other lesions, which makes its histopathological diagnosis challenging for some pathologists. This lesion can involve either jaws, but the anterior region of the mandible is the most affected area. It strikes distinct age groups, with an average patient age of 50 years. It can exhibit a tendency towards recurrence when conservative treatment is administered. It is believed that the low prevalence of GOC in the literature is because of not only its rarity, but principally to the fact that its main characteristics are also found in other pathological entities, thereby generating controversial diagnoses. The aim of the present article is to report a case of GOC in a 40‐year‐old female patient exhibiting an intrabone cyst in the anterior mandibular region. The initial diagnostic hypothesis by means of radiographic imaging was of a traumatic bone cyst. After histological analysis, the lesion was diagnosed as GOC. The specimen was stained with haematoxylin and eosin, and then with the Periodic Acid Schiff (PAS) method. Through immunohistochemical analysis, the cyst tested positively for the Ki‐67 and p53 antibodies as well as high molecular pan‐cytokeratin.
Acute leukaemia masquerading as lower third molar pericoronitis
Authors: Collin J. , Anand P. , McLennan A.
Published: March 2009

We report a case of acute lymphoblastic leukaemia that presented with trismus and swelling, mimicking lower wisdom tooth pericoronitis. This case highlights the importance of clinical vigilance and thorough history taking to exclude haematological malignancy in patients presenting with head and neck swellings.
Prediction of subclinical regional lymph node metastasis in stage I/II squamous cell carcinoma of the oral tongue based on clinical findings
Authors: Nakamori K. , Miyazaki A. , Tomihara K. , Sogabe Y. , Imai T. , Yamamoto T. , Hiratsuka H.
Published: March 2009

Background:  Although tumour depth appears to be a powerful predictor of regional lymph node metastasis in squamous cell carcinoma of the oral tongue, measurement is usually based on histological findings following surgical resection. The predictive value of clinical findings on lymph node metastasis in the absence of surgical intervention is unclear.

Methods:  We retrospectively evaluated 90 previously untreated cases of stage I/II squamous cell carcinoma of the oral tongue to analyse the relationship between greatest dimension, growth pattern, depth of tumour and regional lymph node metastasis.

Results:  Lymph node metastasis was recognised in 15 of 90 cases. A positive correlation between greatest dimension and tumour depth was seen for endophytic‐type tumours only. Logistic regression analysis revealed that growth pattern was an independent predictor of lymph node metastasis (P = 0.0014).

Conclusion:  Combination analysis of tumour growth pattern and greatest dimension may predict lymph node metastasis of squamous cell carcinoma of the oral tongue.
Ulcerated palatal canalicular adenoma: a case series and review of the literature
Authors: Handley T.P.B. , Markose G. , Hunter K.D. , Currie W.J.R.
Published: March 2009

Canalicular adenoma is a benign minor salivary gland neoplasm, which most commonly occurs in or near the upper lip. We present three cases of palatal canalicular adenoma that presented with mucosal ulceration, highlighting diagnosis, treatment and follow up, with a review of the current literature.