bluuebunny/crossref_metadata_2025 huggingface dataset:
Baseline Circulating Tumor Cell Counts Significantly Enhance a Prognostic Score for Patients Participating in Phase I Oncology Trials
Authors: Olmos David , Baird Richard D. , Yap Timothy A. , Massard Christophe , Pope Lorna , Sandhu Shahneen K. , Attard Gerhardt , Dukes Juliet , Papadatos-Pastos Dionysis , Grainger Philippa , Kaye Stan B. , de Bono Johann S.
Published: April 2011

Background: High circulating tumor cell (CTC) counts are associated with poor prognosis in several cancers. Enrollment of patients on phase I oncology trials requires a careful assessment of the potential risks and benefits. Many patients enrolled on such trials using established eligibility criteria have a short life expectancy and are less likely to benefit from trial participation. We hypothesized that the incorporation of CTC counts might improve patient selection for phase I trials.

Methods: This retrospective analysis evaluated patients who had baseline CTCs enumerated prior to their starting on a phase I trial. CTCs were enumerated using the CellSearch System.

Results: Between January 2006 and December 2009 a total of 128 patients enrolled in phase I trials had CTC counts evaluated. Higher CTC counts as a continuous variable independently correlated with risk of death in this patient population (P = 0.006). A multivariate point-based risk model was generated using CTCs as a dichotomous variable (≥3 or <3), and incorporated other established prognostic factors, including albumin <35 g/L, lactate dehydrogenase greater than upper limit of normal, and >2 metastatic sites. Comparison of receiver operating characteristic curves demonstrated that the addition of baseline CTC counts improved the performance of the prospectively validated Royal Marsden Hospital phase I prognostic score, which now identifies three risk groups (P < 0.0001): good prognosis [score 0–1, median overall survival (OS) 63.7 weeks], intermediate prognosis (score 2–3, median OS 37.3 weeks), and poor prognosis (score 4, median OS 13.4 weeks).

Conclusion: CTC enumeration improved the performance of a validated prognostic score to help select patients for phase I oncology trials. Clin Cancer Res; 17(15); 5188–96. ©2011 AACR.
Detection of Tumor DNA at the Margins of Colorectal Cancer Liver Metastasis
Authors: Holdhoff Matthias , Schmidt Kerstin , Diehl Frank , Aggrawal Nishant , Angenendt Philipp , Romans Katharine , Edelstein Daniel L. , Torbenson Michael , Kinzler Kenneth W. , Vogelstein Bert , Choti Michael A. , Diaz Luis A.
Published: April 2011

Purpose: Defining an adequate resection margin of colorectal cancer liver metastases is essential for optimizing surgical technique. We have attempted to evaluate the resection margin through a combination of histopathologic and genetic analyses.

Experimental Design: We evaluated 88 samples of tumor margins from 12 patients with metastatic colon cancer who each underwent partial hepatectomy of one to six liver metastases. Punch biopsies of surrounding liver tissue were obtained at 4, 8, 12, and 16 mm from the tumor border. DNA from these biopsies was analyzed by a sensitive PCR-based technique, called BEAMing, for mutations of KRAS, PIK3CA, APC, or TP53 identified in the corresponding tumor.

Results: Mutations were identified in each patient's resected tumor and used to analyze the 88 samples circumscribing the tumor-normal border. Tumor-specific mutant DNA was detectable in surrounding liver tissue in 5 of these 88 samples, all within 4 mm of the tumor border. Biopsies that were 8, 12, and 16 mm from the macroscopic visible margin were devoid of detectable mutant tumor DNA and of microscopically visible cancer cells. Tumors with a significant radiologic response to chemotherapy were not associated with any increase in mutant tumor DNA in beyond 4 mm of the main tumor.

Conclusions: Mutant tumor-specific DNA can be detected beyond the visible tumor margin, but never beyond 4 mm, even in patients whose tumors were larger prior to chemotherapy. These data provide a rational basis for determining the extent of surgical excision required in patients undergoing resection of liver metastases. Clin Cancer Res; 17(11); 3551–7. ©2011 AACR.
Effectiveness of Tyrosine Kinase Inhibitors on “Uncommon” Epidermal Growth Factor Receptor Mutations of Unknown Clinical Significance in Non–Small Cell Lung Cancer
Authors: Wu Jenn-Yu , Yu Chong-Jen , Chang Yeun-Chung , Yang Chih-Hsin , Shih Jin-Yuan , Yang Pan-Chyr
Published: April 2011

Purpose: Clinical features of epidermal growth factor receptor (EGFR) mutations, L858R, deletions in exon 19, T790M, and insertions in exon 20, in non–small cell lung cancer (NSCLC) are well known. The clinical significance of other uncommon EGFR mutations, such as their association with the effectiveness of EGFR tyrosine kinase inhibitors (TKI), is not well understood. This study aimed to improve the understanding of these uncommon EGFR mutations of unknown clinical significance.

Patients and Methods: Specimens from 1,261 patients were tested for EGFR mutations. We surveyed the clinical data and the effectiveness of gefitinib and erlotinib in NSCLC patients with uncommon EGFR mutations.

Results: Of the 1,261 patients, 627 (49.8%) had EGFR mutations. This included 258 patients with deletions in exon 19, 260 patients with L858R, 25 patients with insertions or duplications in exon 20, 6 patients with de novo T790M, and 78 (12.4%) patients with uncommon mutations. Of the 78 patients, 62 received either gefitinib or erlotinib treatment. The response rate of TKIs treatment was 48.4%, and the median progression-free survival (PFS) was 5.0 months. Mutations on G719 and L861 composed a major part (28 of 62) of uncommon mutations, and were associated with a favorable effectiveness of EGFR TKIs (response rate, 57.1%; median PFS, 6.0 months). Mutations other than G719 and L861 led to a worse response to EGFR TKIs (response rate, 20.0%; median PFS, 1.6 months).

Conclusions: Uncommon EGFR mutations constituted a distinct part of the whole group of EGFR mutations. Their composition was heterogeneous, and their associations with EGFR TKIs differed. Clin Cancer Res; 17(11); 3812–21. ©2011 AACR.
Antitumor and Antiangiogenic Activities of BMS-690514, an Inhibitor of Human EGF and VEGF Receptor Kinase Families
Authors: Wong Tai W. , Lee Francis Y. , Emanuel Stuart , Fairchild Craig , Fargnoli Joseph , Fink Brian , Gavai Ashvinikumar , Hammell Amy , Henley Benjamin , Hilt Christine , Hunt John T. , Krishnan Bala , Kukral Daniel , Lewin Anne , Malone Harold , Norris Derek , Oppenheimer Simone , Vite Gregory , Yu Chiang
Published: April 2011

Purpose: The extensive involvement of the HER kinases in epithelial cancer suggests that kinase inhibitors targeting this receptor family have the potential for broad spectrum antitumor activity. BMS-690514 potently inhibits all three HER kinases, and the VEGF receptor kinases. This report summarizes data from biochemical and cellular pharmacology studies, as well as antitumor activity of BMS-690514.

Experimental Design: The potency and selectivity of BMS-690514 was evaluated by using an extensive array of enzymatic and binding assays, as well as cellular assays that measure proliferation and receptor signaling. Antitumor activity was evaluated by using multiple xenograft models that depend on HER kinase signaling. The antiangiogenic properties of BMS-690514 were assessed in a matrigel plug assay, and effect on tumor blood flow was measured by dynamic contrast-enhanced MRI.

Results: BMS-690514 is a potent and selective inhibitor of epidermal growth factor receptor (EGFR), HER2, and HER4, as well as the VEGF receptor kinases. It inhibits proliferation of tumor cells with potency that correlates with inhibition of receptor signaling, and induces apoptosis in lung tumor cells that have an activating mutation in EGFR. Antitumor activity was observed with BMS-690514 at multiple doses that are well tolerated in mice. There was evidence of suppression of tumor angiogenesis and endothelial function by BMS-690514, which may contribute to its efficacy.

Conclusions: By combining inhibition of two receptor kinase families, BMS-690524 is a novel targeted agent that disrupts signaling in the tumor and its vasculature. Clin Cancer Res; 17(12); 4031–41. ©2011 AACR.
Molecular Chemotherapy and Chemotherapy: A New Front against Late-Stage Hormone-Refractory Prostate Cancer
Authors: Singh Preetiner Pal , Joshi Swapna , Russell Pamela J. , Verma Nirupama D. , Wang Xiaochun , Khatri Aparajita
Published: April 2011

Purpose: Stemming from its inherent heterogeneity, single-agent treatments are essentially ineffective against castration-resistant prostate cancer (CRPC). Thus, clinically relevant regimens that harness different modalities to maximize treatment efficacy without increasing cumulative toxicities are urgently needed. Based on this rationale, we investigated whether a novel combination of purine nucleoside phosphorylase–mediated, gene-directed enzyme-prodrug therapy (PNP-GDEPT) with docetaxel against CRPC has superior efficacy in comparison with individual treatments.

Methods: The in vitro cell growth inhibition in differentially treated murine and human CRPC cell lines was established using a cell-viability assay. The extent of synergy, additivity, or antagonism between treatments was evaluated using CalcuSyn statistical analyses. The local and systemic effects of docetaxel and/or PNP-GDEPT were tested in both immunodeficient and immunocompetent mice against human and murine CRPC tumors, respectively. Subsequently, immunohistochemical analyses and an evaluation of serum cytokine and serum toxicity profiles were conducted to characterize the differential host responses to treatment.

Results: The combined use of PNP-GDEPT and docetaxel led to strong synergistic cell killing in vitro. Compared with the individual modalities, a combination of the 2 led to a marked reduction in “local and distant” tumor growth in vivo, and importantly, with lowered doses and without additional toxicities. Immunomodulation was indicated by enhanced immune cell infiltration and altered serum cytokine levels. Furthermore, a lowering of T-helper type 2 cytokines, MCP-1, interleukin (IL)-4, IL-6, and IL-10 marked lower tumor burden and enhanced treatment efficacy.

Conclusion: PNP-GDEPT and docetaxel are a potent combination against CRPC in immunocompetent and immunodeficient settings; these outcomes have implications of translational potential for improved treatment and management of CRPC patients. Clin Cancer Res; 17(12); 4006–18. ©2011 AACR.
Ultrastructure of the Mantle of the Gastropod Haliotis asinina and Mechanisms of Shell Regionalization
Authors: McDougall Carmel , Green Kathryn , Jackson Daniel J. , Degnan Bernard M.
Published: April 2011

The ability of a biological system to drive the formation of a microstructure as complex and ordered as the molluscan shell is of immense interest to the fields of nanotechnology and biomedicine. Although recent studies have greatly expanded our knowledge of the genes involved in shell formation, the mechanism by which matrix proteins are regulated and directed to the appropriate region of the shell, a process critical for microstructure control, is still obscure. The formation of microstructure-specific compartments within the extrapallial cavity may be the outcome of precise regulation of the vesicle trafficking of shell components within secretory cells at the mineralization front and/or the overall organization and morphology of the mantle itself. Here, we investigate the ultrastructure of the mantle of the gastropod Haliotis asinina as current models put forward to describe molluscan shell formation are primarily based on observations from bivalves despite crystallographic and molecular studies indicating large differences between molluscan classes. We find that the H. asinina mantle is structurally complex and comprised of novel cells packed with a diversity of vesicle types consistent with a complex system to control the secretion of the shell matrix and associated factors.
A Duration Analysis of Democratic Transitions and Authoritarian Backslides
Authors: Alemán José , Yang David D.
Published: April 2011

Recent theories of political development have emphasized redistributive demands as the main drivers of democratic transitions and consolidation. The authors employ Cox duration models to evaluate a number of economic, institutionalist, and sociological theories of regime transition, using global data from 1970 to 1999. This study suggests that demands for redistribution are insufficient explanators of political transitions. The authors find that transitions to democracy depend primarily on a high level of oppositionist social mobilization and, secondarily, favorable patterns of economic distribution. On the other hand, a high level of socioeconomic development is by far the best guarantor of democratic resiliency, whereas mass political conflict endangers consolidation once democracy has been introduced. The study also reveals that institutionalist factors are less influential than socioeconomic characteristics in explaining regime transitions. This study highlights the contribution of social movement theory to the study of regime transitions.
The Only Thing We Have to Fear Is Fear Itself
Authors: Piquero Nicole Leeper
Published: April 2011

Criminologists have long been interested in understanding why people commit crime. Perhaps an even more interesting question is what accounts for the offending of individuals who occupy white-collar positions. Most explanations of white-collar offending have relied on extant criminological theories that have been developed to account for street or juvenile offending. One theoretical explanation that was specifically developed to explain white-collar crime is the fear of falling hypothesis or the notion that the motivation for crime is the fear of losing what one has worked so hard to obtain. This study presents the results of an original data-collection effort designed to test this hypothesis. Data collected among business-experienced adults indicate that the fear of falling is inversely related to intentions to price-fix but positively related to internal and legal constraints against price-fixing. Taken together, these results suggest that the fear of falling may serve as a reminder of the attainments that could be lost, should the illegality be committed.
Identification of Unrecognized Diabetes and Pre-diabetes in a Dental Setting
Authors: Lalla E. , Kunzel C. , Burkett S. , Cheng B. , Lamster I.B.
Published: April 2011

Many diabetic patients remain undiagnosed, and oral findings may offer an unrealized opportunity for the identification of affected individuals unaware of their condition. We recruited 601 individuals who presented for care at a dental clinic, were ≥ 40 years old, if non-Hispanic white, and ≥ 30 years old, if Hispanic or non-white, and had never been told they have pre-diabetes or diabetes. Those with at least one self-reported diabetes risk factor (N = 535) received a periodontal examination and a point-of-care hemoglobin A1c (HbA1c) test. A fasting plasma glucose (FPG) test was used as the study outcome, signifying potential diabetes or pre-diabetes. Performance characteristics of simple models of dysglycemia (FPG ≥ 100 mg/dL) identification were evaluated and optimal cut-offs identified. A model including only two dental variables had an estimated area under the receiver operating characteristic curve (AUC) of 0.65. The addition of a point-of-care HbA1c test improved the AUC to 0.79 (p < 0.001). The presence of ≥ 26% deep pockets or ≥ 4 missing teeth correctly identified 73% of true cases; the addition of an HbA1c ≥ 5.7% increased correct identification to 92%. Analysis of our data suggests that oral healthcare professionals have the opportunity to identify unrecognized diabetes and pre-diabetes in dental patients and refer them to a physician for further evaluation and care.
Mineral Trioxide Aggregate Inhibits Osteoclastic Bone Resorption
Authors: Hashiguchi D. , Fukushima H. , Yasuda H. , Masuda W. , Tomikawa M. , Morikawa K. , Maki K. , Jimi E.
Published: April 2011

Mineral trioxide aggregate (MTA), a commonly used endodontic repair material, is useful for both basic and clinical research, and the effect of MTA on osteoblast differentiation has been well-defined. However, the effects of MTA on osteoclastic bone resorption are not fully understood. Hence, the aim of this study is to examine the effect of MTA solution in the regulation of osteoclast bone-resorbing activity using osteoclasts formed in co-cultures of primary osteoblasts and bone marrow cells. MTA solution dose-dependently reduced the total area of pits formed by osteoclasts. The reduction of resorption induced by 20% MTA treatment was due to inhibition of osteoclastic bone-resorbing activity and had no effect on osteoclast number. A 20% MTA solution disrupted actin ring formation, a marker of osteoclastic bone resorption, by reducing phosphorylation and kinase activity of c-Src, and mRNA expressions of cathepsin K and mmp-9. A high concentration of MTA solution (50%) induced apoptosis of osteoclasts by increasing the expression of Bim, a member of the BH3-only (Bcl-2 homology) family of pro-apoptotic proteins. Taken together, our results suggest that MTA is a useful retrofilling material for several clinical situations because it both stimulates osteoblast differentiation and inhibits bone resorption.
Dendritic Cells, Antibodies Reactive with oxLDL, and Inflammation
Authors: Tew J.G. , El Shikh M.E. , El Sayed R.M. , Schenkein H.A.
Published: April 2011

Periodontitis appears to promote chronic inflammatory diseases, including atherosclerosis, but relevant mechanisms need clarification. Oral bacteria induce antibodies that bind not only bacteria, but also oxLDL. Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans induce remarkable IgG responses that are dominated by IgG2, and IgG2 is IFN-γ-dependent and is promoted by dendritic cells (DCs). LDL-reactive antibodies induced by P. gingivalis and A. actinomycetemcomitans include anti-phosphorylcholine (α-PC) and β2-glycoprotein-1-dependent anticardiolipin (α-CL), and these antibodies may link chronic inflammatory diseases at a mechanistic level. Antibody-mediated uptake of oxLDL or bacteria dramatically enhances DC-IL-12, and DC-IL-12 induces NK-cell-IFN-γ responses that promote Th-1 responses and sustained inflammation. DCs may be derived from monocytes, and this is striking in cultures of aggressive periodontitis (AgP) monocytes, where DC numbers are about double control levels. Moreover, serum α-CL levels in individuals with AgP are frequently elevated, and these antibodies promote atherosclerosis in persons with antiphospholipid syndrome. Elevated serum levels of soluble-intercellular adhesion molecule, soluble-vascular cell adhesion molecule, and soluble-E-selectin are atherosclerosis-associated indicators of vascular inflammation, and these markers are elevated in the subset of AgP patients with high α-CL. We reason that periodontitis patients with elevated antibodies reactive with oxLDL could be a subgroup at high risk for cardiovascular sequelae.
Exploring Parental Influences in the Theory of Normative Social Behavior
Authors: Jang Su Ahn , Rimal Rajiv N. , Cho NamAuk
Published: April 2011

The theory of normative social behavior (TNSB) suggests that injunctive norms, group identity, outcome expectations, and peer communication moderate this relation between descriptive norms and behavioral intentions. This article extends the TNSB by conceptualizing parental influences (parental monitoring and disapproval) as important moderators in the relationship between descriptive norms and Korean mid-adolescents’ prior drinking behaviors as well as their drinking intentions. A study was conducted among Korean high school students ( N = 538) to assess their normative perceptions, parental monitoring, parental disapproval of drinking, drinking intentions, and past alcohol use. The current study found a significant association between parental monitoring and disapproval, on the one hand, and drinking and intentions, on the other, after controlling for descriptive norms. The results revealed that the harmful effects of adolescents’ perceptions about the prevalence of alcohol consumption among their peers may be mitigated through active parental involvement. When adolescents believed that their parents closely monitored and expressed disapproval of their drinking, they were less likely to be influenced by the high-risk behaviors practiced by their peers.
Exploring Ethnic Variation in Preadolescent Aggressive Girls’ Social, Psychological, and Academic Functioning
Authors: Blake Jamilia J. , Lease A. Michele , Turner Terez L. , Outley Corliss
Published: April 2011

The authors examined whether the adjustment patterns of socially and overtly aggressive preadolescent girls, ages 9 to 11 years, from rural communities differed by ethnicity. Students were administered a series of questionnaires to assess the degree to which girls engaged in various forms of aggression and to assess aggressive girls’ social, psychological, and academic functioning. Four clusters of girls—nonaggressive, socially aggressive, and moderate and high mixed aggressive—were identified with cluster analysis based on cross-gendered peer nominations of social and overt aggression. Results indicated that ethnic variation exists in aggressive and nonaggressive girls’ attitudes toward school and satisfaction with their friendships, but no ethnic differences were found in aggressive girls’ social adjustment. Socially aggressive and nonaggressive African American girls endorsed greater feelings of disengagement from school than socially aggressive and nonaggressive European American girls. No ethnic differences were found in aggressive girls’ endorsement of internalizing symptoms. However, both nonaggressive and socially aggressive African American girls reported greater dissatisfaction with their interpersonal relationships than nonaggressive and socially aggressive European American girls.
From Airfield to Airport: An Institutionalist-Historical Approach to the Early Development of Amsterdam Airport Schiphol, 1916-1940
Authors: El Makhloufi Abdel , Kaal Harm
Published: April 2011

In this article, the development of Dutch airports during the antebellum period from military airfields to mixed-airfields and finally to a municipal airports is examined from an institutionalist-historical approach. Specific attention is given to the evolution of Amsterdam Airport Schiphol within a regional socioeconomic context and within a national context of local competition, particularly between the big cities in Randstad Holland. This article argues that the rise and development of Schiphol and its impact on the surrounding urban area (city and the region) can be characterized as a coevolutionary process involving different actors within various domains— economic, political, and institutional—and at different spatial levels. Airport development, therefore, has to be conceived as the result of a collective arrangement that has determined the spatial and economic development of the airport itself and the surrounding area.
Feet and Fabrication: Footbinding and Early Twentieth-Century Rural Women’s Labor in Shaanxi
Authors: Bossen Laurel , Wang Xurui  , Brown Melissa J. , Gates Hill
Published: April 2011

The early twentieth-century transformations of rural Chinese women’s work have received relatively little direct attention. By contrast, the former custom of footbinding continues to fascinate and is often used to illustrate or contest theories about Chinese women’s status. Arguing that for rural women at least, footbinding needs to be understood in relation to rural economic conditions, the authors focus on changes in textile production and in footbinding in two counties in Shaanxi province. Drawing on historical sources and their own interview data from rural women who grew up in this period, the authors find evidence that transformations in textile production undercut the custom of footbinding and contributed to its rapid demise.
Relationship Between Feeding Tube Site and Respiratory Outcomes
Authors: Metheny Norma A. , Stewart Barbara J. , McClave Stephen A.
Published: April 2011

Background: It is unclear if placing feeding tubes postpylorically to prevent respiratory complications is worth the extra effort. This study sought to determine the extent to which aspiration and pneumonia are associated with feeding site (controlling for the effects of severity of illness, degree of head‐of‐bed elevation, level of sedation, and use of gastric suction). Methods: A retrospective analysis was performed on a large data set gathered prospectively to evaluate aspiration in critically ill, mechanically ventilated patients. Feeding site was designated by attending physicians and confirmed by radiography. Each patient participated in the study for 3 consecutive days, with pneumonia assessed by the simplified Clinical Pulmonary Infection Score on the fourth day. Tracheal secretions were assayed for pepsin in a research laboratory; the presence of pepsin served as a proxy for aspiration. A total of 428 patients were included in the regression analyses performed to address the research objectives. Results: As compared with the stomach, the percentage of aspiration was 11.6% lower when feeding tubes were in the first portion of the duodenum, 13.2% lower when in the second/third portions of the duodenum, and 18.0% lower when in the fourth portion of the duodenum and beyond (all significant at P < .001). Pneumonia occurred less often when feedings were introduced at or beyond the second portion of the duodenum (P = .020). Conclusions: The findings support feeding critically ill patients with numerous risk factors for aspiration in the mid‐duodenum and beyond to reduce the risk of aspiration and associated pneumonia.
Sterility of Pediatric Lipid Emulsions Repackaged by an Automated Compounding Device
Authors: Ybarra Joseph V. , Rose Warren E. , Curtis Caitlin S. , Sacks Gordon S.
Published: April 2011

Background: The daily requirement of intravenous (IV) lipid in pediatric patients is often less than the volumes and sizes available in prepackaged, commercially available preparations. In clinical practice, IV lipid emulsions (IVLEs) have been repackaged into syringes to prevent infusions from exceeding 12 hours, to reduce waste, and to improve patient safety. Recent data suggest an increasing risk of contamination when these preparations are repackaged manually. This study investigates the sterility of small volumes of IVLE that have been repackaged into empty IV bags by means of an automated compounding device (ACD). Methods: A total of 152 IVLE bags were repackaged with an ACD in an International Standards Organization class 5 environment. IVLE repackaging was conducted over a period of 3 weeks (week 1, n = 52; week 2, n = 52; week 3, n = 48). Forty commercially available bags of IVLE served as controls. At 0, 24, 48, and 120 hours after repackaging, IVLEs were filtered and placed onto blood agar medium. Results: Microbial growth occurred in 12 of the 152 repackaged preparations compared with 0 of the 40 controls (7.9% vs 0%, P = .07). Positive cultures consisted of gram‐positive cocci (n = 5, 3.3%), gram‐positive rods (n = 5, 3.3%), and yeast (n = 2, 1.3%). There was no difference in positive bacterial or yeast growth between weeks 1, 2, and 3, suggesting an absence of outside contamination during preparation. Conclusions: The positive microbial growth suggests a concerning incidence of contamination of IVLEs repackaged with an ACD. Additional research is needed to further identify and validate the clinical impact of these preparations.
Albumin Synthesis Rates Are Not Responsive to Hyperglycemic Hyperinsulinemia in Postoperative Patients
Authors: Rittler Peter , Braun Susanne , Kuppinger David , Demmelmair Hans , Koletzko Berthold , Vogeser Michael , Jauch Karl‐Walter , Hartl Wolfgang H.
Published: April 2011

Background: Insulin regulates albumin synthesis in vitro and in various experimental models. The current study was undertaken to determine the effects of a physiologic hyperinsulinemia on albumin synthesis in postoperative patients in whom plasma albumin concentrations are decreased. Methods: Studies were performed in postabsorptive patients after major abdominal operations. Mass spectrometry techniques were used to directly determine the incorporation rate of 1‐[13C]‐leucine into albumin. Consecutive blood samples were taken during a continuous isotope (D‐Glc) infusion (0.16 µmol/kg/min). Isotopic enrichments were determined at baseline (period I) and after a 4‐hour D‐glucose (D‐Glc) infusion at currently recommended rates (170 mg/kg/h, n = 10) or after infusion of saline (control group, n = 8) (period II). Results: After D‐Glc infusion, plasma insulin concentrations increased significantly (period I, 6.6 ± 1.8 µU/mL; period II, 21.4 ± 2.1 µU/mL; P < .01). In contrast, plasma insulin concentration remained constant in control patients (period I, 3.8 ± 0.9 µU/mL−1; period II, 5.9 ± 1.1 µU/mL; not significant vs period I, but P < .005 vs the corresponding value at the end of period II in the control group). Hyperinsulinemia was without effect on fractional albumin synthesis (period I, 12.8% ± 1.9%/d; period II, 11.9% ± 1.9%/d; not significant), and synthesis rates corresponded to those measured in controls (period I, 13.0% ± 1.2%/d; period II, 12.1% ± 0.1%/d; not significant vs period I and vs D‐Glc infusion). Conclusions: A standard D‐Glc infusion is insufficient to increase albumin synthesis in postoperative patients.
Change in Academic Coauthorship, 1953–2003
Authors: O’Brien Timothy L.
Published: April 2011

Coauthored scholarship increased substantially across fields of science during the twentieth century, but it is unclear whether this growth reflects change in the behavior of individual scientists (i.e., career aging) or publishing differences between cohorts of researchers (i.e., cohort succession). I examine the publication records of an interdisciplinary sample of university scientists and find evidence of both career-aging and cohort-succession processes, although cohort differences are much more pronounced than individual changes. Specifically, scientists in this sample increased the percentage of their articles with coauthors by 0.63 percentage points annually. However, compared to those who received their PhDs between 1953 and 1962, scientists who entered the workforce between 1983 and 1991 coauthored approximately one third more of their early career articles (35.63 percentage points). Additionally, career-aging processes in coauthorship varied by PhD cohort, with earlier trained researchers increasing more rapidly. Overall, this article highlights cohort succession as a source of change in coauthorship, and underscores the importance of accounting for generational differences in studies of scientific careers.
A Diaspora Approach to Sport Tourism
Authors: Joseph Janelle
Published: April 2011

The concept of diaspora offers an alternative approach to understanding sport tourism. Sport-related travel is a powerful diasporic resource that permits migrants to connect simultaneously to their nation, region, or cultural heritage and to their dispersed peers. This ethnographic study of a Caribbean-Canadian group’s cricket tourism in St. Lucia, West Indies reveals that nostalgia sport tourists reminisce about their sporting heroes and regional histories, active sport tourists lime and reenact their homeland culture, and holiday sport tourists contribute to a broadly defined homeland through financial and material donations. These acts allow members of the Caribbean diaspora to rekindle their affiliation with their national and regional cultures, discover and express a sense of self as part of Caribbean histories, and foster a deterritorialized racial community.
Team Clinical Supervision in Acute Hospital Wards
Authors: O’Connell Bev , Ockerby Cherene M. , Johnson Susan , Smenda Helen , Bucknall Tracey K.
Published: April 2011

Clinical supervision provides a strategy to mitigate nurses’ workplace stress and enhance retention, but the literature provides little guidance about its implementation beyond mental health nursing. This study explored the feasibility of implementing and evaluating ward-based team clinical supervision for general nurses on two separate wards at one public and one private hospital. Nurses completed the Work Environment Questionnaire pre- ( n = 36) and postintervention ( n = 27), and focus groups ( n = 20) explored their perceptions of supervision. Staff were unfamiliar with clinical supervision, so information sessions were required. The questionnaire may not have been suitable to evaluate this type of intervention. Focus group findings revealed that team supervision improved communication, enhanced working relationships, and empowered nurses to challenge existing practices, which had a positive impact on their perceived stress. This study provides insights to guide implementation and evaluation of clinical supervision in acute settings.
Initial Impact of the Acute Otitis Externa Clinical Practice Guideline on Clinical Care
Authors: Bhattacharyya Neil , Kepnes Lynn J.
Published: April 2011

Objectives

Determine the influence of the acute otitis externa clinical practice guideline on clinical care.

Study Design

Cross‐sectional study with historical controls.

Setting

Outpatient departments in the United States.

Methods

Cases of acute otitis externa occurring in 2004‐2005 (before guideline publication) and 2007‐2008 (after guideline publication) were extracted from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Care Survey. Prescribing rates for ototopical medications, analgesic recommendations, and oral antibiotics were determined and compared before and after guideline publication and relative to guideline recommendations.

Results

An estimated 5.50 (standard error of the estimated mean, 0.38) million visits (mean age, 27.7 [1.7] years; 49.8% male) with a primary and singular coded diagnosis of acute otitis externa were studied (2.64 [0.26] million visits for 2004‐2005 and 2.86 [0.28] million visits for 2007‐2008). Prescribing rates for ototopical preparations were 67.2% (5.3%) and 67.6% (5.0%) before and after guideline publication, respectively (P =. 955). Recommendation rates for analgesics were 14.2% (3.3%) and 20.6% (3.9%), respectively (P =. 248). Prescription rates for oral antibiotics were 21.7% (4.8%) and 30.5% (3.6%), before and after, respectively (P =. 166).

Conclusion

Clinician behavior in the medical treatment of acute otitis externa has not significantly changed after guideline publication, despite clear, evidence‐based guideline recommendations. These data have important implications for performance measures based on the guideline. Further efforts toward guideline dissemination are likely needed.
Optimizing Statin Treatment Decisions for Diabetes Patients in the Presence of Uncertain Future Adherence
Authors: Mason Jennifer E. , England Darin A. , Denton Brian T. , Smith Steven A. , Kurt Murat , Shah Nilay D.
Published: April 2011

Background. Statins are an important part of the treatment plan for patients with type 2 diabetes. However, patients who are prescribed statins often take less than the prescribed amount or stop taking the drug altogether. This suboptimal adherence may decrease the benefit of statin initiation. Objective. To estimate the influence of adherence on the optimal timing of statin initiation for patients with type 2 diabetes. Method. The authors use a Markov decision process (MDP) model to optimize the treatment decision for patients with type 2 diabetes. Their model incorporates a Markov model linking adherence to treatment effectiveness and long-term health outcomes. They determine the optimal time of statin initiation that minimizes expected costs and maximizes expected quality-adjusted life years (QALYs). Results. In the long run, approximately 25% of patients remain highly adherent to statins. Based on the MDP model, generic statins lower costs in men and result in a small increase in costs in women relative to no treatment. Patients are able to noticeably increase their expected QALYs by 0.5 to 2 years depending on the level of adherence. Conclusions. Adherence-improving interventions can increase expected QALYs by as much as 1.5 years. Given suboptimal adherence to statins, it is optimal to delay the start time for statins; however, changing the start time alone does not lead to significant changes in costs or QALYs.
Does User-Charge Financing Reduce Expenditure Levels for the Charge-Financed Services?
Authors: Sun Rui , Jung Changhoon
Published: April 2011

Spurred by the tax and expenditure limitation movement of the late 1970s, user charges have grown to become a major source of revenue for local governments. Both theory and literature propose that a well-designed user-charge structure could reduce spending on the charge-financed services by strengthening the relationship between service and payment. This study empirically tests such a possibility by examining the level of expenditure for sewer and parks and recreation services. Using a panel of 686 American cities for the sewer services and 715 cities for the parks and recreation services between 1972 and 2004, this study finds evidence that greater reliance on user charges to finance government services leads to a reduction in municipal expenditures.
Sector Imprinting
Authors: Chen Chung-An
Published: April 2011

Social phenomena often involve long-term changes, but most organizational studies focusing on sector comparison have not illuminated the decisive role that time plays. I tested “sector imprinting,” the effect that occurs when an individual who has adapted to the norms of one sector, moves to another sector, by using a sample comprised of respondents from both public and nonprofit organizations. I found that in the public sector, individuals switching from business enterprises and nonprofit organizations perceive more formalized personnel rules and red tape than individuals who have not switched sectors. In the nonprofit sector, individuals switching from the government perceive lower levels of formalized rules and red tape as compared to nonswitchers and switchers from the private sector. Although unpleasant rules are critical sources of one’s turnover intention, individuals who switch into the public sector have longer current job tenure than nonswitchers. I argue that the theories of contrast effect, self-persuasion, extrinsic motivation, and public service motivation (PSM) help explain these findings.
Critical Questions for the Transition to Defined Contribution Pension Systems in the Public Sector
Authors: Frank Howard , Gianakis Gerasimos (Jerry) , Neshkova Milena I.
Published: April 2011

Unfunded liabilities of pension plans sponsored by state and local governments have drastically increased in the past few years. This article examines the potential challenges faced by states and municipalities in meeting their pension obligations and explores the cost and benefits of a switch from traditional defined benefit (DB) plans to defined contribution (DC) plans. The authors draw on the experience of the private sector to depict the potential cost savings for governments and the likely impacts on employees. The authors also identify several issues that are unique to governments if a shift in pension coverage plans is to occur. One of the attractions of public sector employment has been the generous benefits offered; the authors examine whether it will be harder to recruit people in the public sector if the government does not offer DB pensions. The authors explore equity issues and the effects of eroding political support for public sector DB systems in light of their demise in the private sector. The authors also address the issue of financial illiteracy in the work place and its impact on the human resource function in the context of DC plan implementation. Finally, the authors pose critical questions regarding DC plan rollout and its inherent difficulties.
Autologous Chondrocyte Implantation in the Adolescent Knee
Authors: Macmull Simon , (Ed) Michael T. R. Parratt , Bentley George , Skinner John A. , Carrington Richard W. J. , Morris Tim , Briggs Tim W. R.
Published: April 2011

Background

Autologous chondrocyte implantation (ACI) has been shown to have favorable results in the treatment of symptomatic chondral and osteochondral lesions. However, there are few reports on the outcomes of this technique in adolescents.

Purpose

The aim of this study was to assess pain relief and functional outcome in adolescents undergoing ACI.

Study Design

Case series; Level of evidence, 4.

Methods

Thirty-five adolescent patients undergoing ACI or matrix-assisted chondrocyte implantation (MACI) were identified from a larger cohort. Four patients were lost to follow-up, leaving 31 patients (24 ACI, 7 MACI). The mean age was 16.3 years (range, 14-18 years) with a mean follow-up of 66.3 months (range, 12-126 months). There were 22 male and 9 female patients. All patients were symptomatic; 30 had isolated lesions and 1 had multiple lesions. Patients were assessed preoperatively and post-operatively using the visual analog scale (VAS) score for pain, the Bentley Functional Rating Score, and the Modified Cincinnati Rating System. At 1 year postoperatively, patients were recalled for a diagnostic biopsy, which was successfully attained in 21 patients.

Results

The mean pain scores improved from 5 preoperatively to 1 postoperatively. The Bentley Functional Rating Score improved from 3 to 0, while the Modified Cincinnati Rating System improved from 48 preoperatively to 92 postoperatively with 84% of patients achieving excellent or good results. All postoperative scores exhibited significant improvement from preoperative scores. One patient underwent graft hypertrophy and 1 patient's graft failed and was revised. Biopsy results revealed hyaline cartilage in 24% of cases, mixed fibro/hyaline cartilage in 19%, and fibrocartilage in 57%.

Conclusion

Results show that, in this particular group who received ACI, patients experienced a reduction in pain and significant improvement in postoperative function after ACI or MACI. The authors believe that ACI is appropriate in the management of carefully selected adolescents with symptomatic chondral and osteochondral defects.
Role of Nutrition in Pediatric Chronic Liver Disease
Authors: Sultan Mutaz I. , Leon Carly D. G. , Biank Vincent F.
Published: April 2011

The liver plays a central role in energy and nutrient metabolism. Malnutrition is highly prevalent among patients with chronic liver disease and leads to increased morbidity and mortality rates. This review addresses the causes of malnutrition, methods used to assess nutrition status, and appropriate treatment strategies in pediatric patients with chronic liver disease.
Does Local Firm Ownership Matter?
Authors: Fleming David A. , Goetz Stephan J.
Published: April 2011

A data set for U.S. counties that includes residence status of firm owners is used to assess whether per capita density of locally owned businesses affects local economic growth, compared with nonlocal ownership. The database also permits stratification of firms across different employment size categories. Economic growth models that control for other relevant factors reveal a positive relationship between density of locally owned firms and per capita income growth but only for small (10-99 employees) firms, whereas the density of large (more than 500 workers) firms not owned locally has a negative effect. These results provide strong evidence that local ownership matters for economic growth but only in the small size category. Results are robust across rural and urban counties.
Transmitting Knowledge Across Generations: The Role of Management Accounting Practices
Authors: Giovannoni Elena , Maraghini Maria Pia , Riccaboni Angelo
Published: April 2011

This article aims to shed light on the distinguishing features of management accounting in family firms in relation to processes of professionalization and succession. The study combines insights offered by the debate on family businesses and management accounting with the empirical findings of a longitudinal case study (Monnalisa). By exploring the evolution of management accounting practices within the company and the processes of succession and professionalization, this article shows that management accounting can affect the transfer of knowledge across generations and between the owner family and the management team, thus representing and reproducing the priorities, values, and vision of the entrepreneur.
The Attitudes Toward Prostitutes and Prostitution Scale: A New Tool for Measuring Public Attitudes Toward Prostitutes and Prostitution
Authors: Levin Lia , Peled Einat
Published: April 2011

Contemporary developments in social attitudes toward prostitution and prostitutes influence both social policies and the social work profession. Understanding individuals’ attitudes toward these issues is necessary for the development of social interventions and policies aimed at reducing stigmata attached to them. This article describes a new research measure for the assessment of attitudes toward prostitutes and prostitution (the Attitudes toward Prostitutes and Prostitution Scale; APPS), and outlines its development process. Results from pilot studies using the APPS are presented, alongside detailed information regarding the measure’s psychometric properties. The article concludes with a review of possible uses and limitations of the APPS.
Small-Cell (Basaloid) Thyroid Carcinoma
Authors: Cruz João , Eloy Catarina , Aragüés José Maria , Vinagre João , Sobrinho-Simões Manuel
Published: April 2011

In the past, undifferentiated (anaplastic) carcinoma of the thyroid included a small-cell variant with either a diffuse or a compact morphology. After the mid-1980s, with the advance of immunohistochemistry, almost all those rare tumors with the former characteristic were reclassified as low-grade lymphomas and those with the latter characteristic as small-cell variants of medullary carcinoma and poorly differentiated (“insular”) carcinoma. Since then, no primary thyroid small-cell carcinoma has been reported in the literature, with the exception of a case of a small-cell (neuroendocrine) carcinoma, an exceedingly rare neoplasm akin to medullary carcinoma, with expression of neuroendocrine markers but lacking calcitonin immunoreactivity. Here, the authors report a primary small-cell carcinoma of the thyroid displaying a basaloid appearance and lacking any signs of neuroendocrine or C-cell differentiation.
Dedifferentiated Endometrioid Adenocarcinoma of the Uterus
Authors: Vita Giulia , Borgia Ludovica , Di Giovannantonio Luigina , Bisceglia Michele
Published: April 2011

Dedifferentiation confers more aggressive malignant behaviour than would be otherwise shown by the original tumor if present alone. This phenomenon has been described in several tumors, both mesenchymal and epithelial. Dedifferentiated endometrioid carcinoma either ovarian or endometrial is the latest addition to this family of tumors. Only 2 papers have appeared in the literature so far on the topic of dedifferentiated endometrioid carcinoma, both from the same institution. We report herein a case of endometrial dedifferentiated endometrioid carcinoma in a 45-year old lady with ovarian metastasis from the undifferentiated component. The primary endometrial tumor showed an undifferentiated component in an otherwise low grade endometrioid carcinoma. The undifferentiated component of these tumors can be misdiagnosed as the solid component of FIGO grade 3 in a pure endometrioid carcinoma. The recognition of an undifferentiated component in an otherwise low grade endometrioid carcinoma is very important, since dedifferentiated endometrioid adenocarcinoma has a worse prognosis when compared with FIGO grade 3 endometrioid carcinoma.