bluuebunny/crossref_metadata_2025 huggingface dataset:
Early experience and operative technique of robotic‐assisted partial nephrectomy
Authors: Kucharczyk John R. , Basto Marnique , Landau Adam , Graves Reid , Everaerts Wouter , Birch Emma , Murphy Declan , Moon Daniel
Published: May 2014

Background

The adoption of robotic‐assisted partial nephrectomy (RAPN) is increasing in Australia; however, to date no Australian RAPN series has been reported. This paper describes a single‐surgeon initial experience with RAPN and evaluates perioperative, pathological and oncological outcomes.

Methods

Data on the first 50 consecutive patients to undergo RAPN by a single surgeon were reviewed. Demographic, perioperative, tumour characteristics and Clavien complications were collected in addition to oncological follow‐up and renal function monitoring.

Results

Mean age was 58.2 ± 10.4 years, body mass index was 28.8 ± 4.5 kg/m2 and Charlson Co‐morbidity Index was 4.6 ± 1.2. Tumour diameter was 31 ± 13 mm and RENAL score was 6.8 ± 1.5. Average total operative time was 151 ± 32.7 min, estimated blood loss was 171.1 ± 185.8 mL, warm ischaemia time was 17.8 ± 6.7 min and length of hospital stay was 3 ± 0.9 days. There were seven Clavien complications and no deaths. Estimated glomerular filtration rate did not decrease significantly post‐operatively (P = 0.8); and there was 14.6% upstaging of chronic kidney disease scoring although no patient required dialysis. There were no positive malignant surgical margins, and to date no patient has evidence of disease recurrence. Of 50 patients, 54% had a minimum follow‐up of 6 months and 28% had a minimum follow‐up of 1 year.

Conclusion

We report the largest RAPN study in Australia or New Zealand to date. Initial results suggest that RAPN can be safely introduced into the Australian public and private health systems, and has been effective in oncologic control and renal function preservation.
Initial oxygen saturation values can predict the need to hospitalise children with mild wheezing
Authors: Pruikkonen H , Uhari M , Dunder T , Pokka T , Renko M
Published: May 2014

Aim

Mild wheezing during respiratory infections is a common cause of paediatric hospital admissions. This study aimed to identify factors predicting this condition in children over six months of age.

Methods

We reviewed the medical records of 539 children, aged 6 months to 16 years, who visited the emergency department because of wheezing during respiratory infection. Mild disease was defined as hospital stays of less than 48 h and severe disease was staying at least 48 h or being treated in intensive care. Patients with an initial oxygen saturation value (SaO2) below 90% were analysed separately.

Results

Most (87%) of the 539 patients had mild disease, 6% had a severe disease and 7% had an initial SaO2 below 90%. The area under the receiver operating characteristic (ROC) curve for the initial SaO2 predicting mild disease was 0.75 (95% CI 0.53–0.97), and the optimal cut‐off value was 93%. An initial SaO2 >93% had a negative predictive value of 93%. Although 270 patients (50%) were hospitalised, only 140 (26%) would have been admitted using an optimal cut‐off of SaO2 ≤93%.

Conclusion

An initial SaO2 >93% reflects a mild course of acute wheezing and using this cut‐off point could have almost halved hospital admissions.
Alterations of calcium homoeostasis in cultured rat astrocytes evoked by bioactive sphingolipids
Authors: Stenovec M. , Trkov S. , Kreft M. , Zorec R.
Published: May 2014

Aim

In the brain, alterations in sphingolipid metabolism contribute to several neurological disorders; however, their effect on astrocytes is largely unknown. Here, we identified bioactive sphingolipids that affect intracellular free calcium concentration ([Ca2+]i), mobility of peptidergic secretory vesicles, signalling pathways involved in alterations of calcium homoeostasis and explored the relationship between the stimulus‐evoked increase in [Ca2+]i and attenuation of vesicle mobility.

Methods

Confocal time‐lapse images were acquired to explore [Ca2+]i signals, the mobility of fluorescently tagged peptidergic vesicles and the structural integrity of the microtubules and actin filaments before and after the addition of exogenous sphingolipids to astrocytes.

Results

Fingolimod (FTY720), a recently introduced therapeutic for multiple sclerosis, and sphingosine, a releasable constituent of membrane sphingolipids, evoked long‐lasting increases in [Ca2+]i in the presence and absence of extracellular Ca2+; the evoked responses were diminished in the absence of extracellular Ca2+. Activation of phospholipase C and inositol‐1,4,5‐triphosphate receptors was necessary and sufficient to evoke increases in [Ca2+]i as revealed by the pharmacologic inhibitors; Ca2+ flux from the extracellular space intensified these responses several fold. The lipid‐evoked increases in [Ca2+]i coincided with the attenuated vesicle mobility. High and positive correlation between increase in [Ca2+]i and decrease in peptidergic vesicle mobility was confirmed independently in astrocytes exposed to evoked, transient Ca2+ signalling triggered by purinergic and glutamatergic stimulation.

Conclusion

Exogenously added cell‐permeable sphingosine‐like lipids exert complex, Ca2+‐dependent effects on astrocytes and likely alter their homeostatic function in vivo.
Children's judgements and emotions about social exclusion based on weight
Authors: Nguyen Christine , Malti Tina
Published: May 2014

This study examined children's judgements and emotions associated with weight‐based social exclusion using an ethnically diverse sample of one hundred and seventeen 9‐ and 13‐year‐old children. Children were interviewed about three scenarios depicting weight‐based exclusion in athletic, academic, and social contexts. Children's judgements of exclusion, emotions attributed to the excluder and excluded targets, and justifications for judgements and emotions were examined. Overall, children judged weight‐based exclusion to be wrong for moral reasons. However, they viewed weight‐based exclusion in athletic contexts as less wrong compared with academic contexts, and they used more social‐conventional reasoning to justify judgements and emotions attributed to excluders in athletic contexts compared with academic and social contexts. Children also expected excluded targets to feel negative emotions, whereas a range of positive and negative emotions was attributed to excluders. In addition, older children were more accepting of weight‐based exclusion in athletic contexts than in academic and social contexts. We discuss the results in relation to the development of children's understanding of, and emotions associated with, exclusion based on weight.
Electromechanical and atrial and ventricular antiarrhythmic actions of CIJ‐3‐2F, a novel benzyl‐furoquinoline vasodilator in rat heart
Authors: Chang Gwo‐Jyh , Yeh Yung‐Hsin , Lin Tsung‐Pin , Chang Chi‐Jen , Chen Wei‐Jan
Published: May 2014

Background and Purpose

This study was designed to examine the antiarrhythmic efficacy and the underlying mechanisms of the benzyl‐furoquinoline vasodilator, CIJ‐3‐2F, in rat cardiac preparations.

Experimental Approach

Conduction electrograms and left ventricular pressure were determined in Langendorff‐perfused hearts. Action potentials were assessed with microelectrode techniques, calcium transients by fura‐2 fluorescence and ionic currents by whole‐cell patch‐clamp techniques.

Key Results

In isolated hearts, CIJ‐3‐2F prolonged sinus cycle length, QT interval, Wenckebach cycle length, atrio‐His bundle and His bundle‐ventricular conduction intervals, refractory periods in atrium, AV node, His‐Purkinje system and ventricle, and also increased left ventricular pressure. CIJ‐3‐2F reduced the incidences of both ischaemic and reperfusion‐induced ventricular arrhythmias and prevented the induction of atrial tachyarrhythmias. In both atrial and papillary muscles, CIJ‐3‐2F decreased upstroke velocity and prolonged duration of the action potential. In ventricular myocytes, CIJ‐3‐2F moderately increased the amplitude of [Ca2+]i transients and cell shortening. CIJ‐3‐2F inhibited the transient outward K+ current (Ito) (IC50 = 4.4 μM) with accelerated inactivation, a slower rate of recovery from inactivation and use‐dependency. CIJ‐3‐2F also suppressed the steady‐state outward K+ current (Iss, IC50 = 3.6 μM, maximum inhibition = 65.7%) and both the inward Na+ current (INa, IC50 = 2.8 μM) and L‐type Ca2+ current (ICa,L, IC50 = 4.9 μM, maximum inhibition = 69.4%).

Conclusions and Implications

CIJ‐3‐2F blocked Na+ and Ito channels and, to some extent, also blocked Ca2+ and Iss channels, modifying cardiac electromechanical function. These effects are likely to underlie its antiarrhythmic properties.
Overcoming barriers to effective early parenting interventions for attention‐deficit hyperactivity disorder (ADHD): parent and practitioner views
Authors: Smith E. , Koerting J. , Latter S. , Knowles M. M. , McCann D. C. , Thompson M. , Sonuga‐Barke E. J.
Published: May 2014

Background

The importance of early intervention approaches for the treatment of attention‐deficit hyperactivity disorder (ADHD) has been increasingly acknowledged. Parenting programmes (PPs) are recommended for use with preschool children with ADHD. However, low ‘take‐up’ and high ‘drop‐out’ rates compromise the effectiveness of such programmes within the community.

Methods

This qualitative study examined the views of 25 parents and 18 practitioners regarding currently available PPs for preschool children with ADHD‐type problems in the UK. Semi‐structured interviews were undertaken to identify both barriers and facilitators associated with programme access, programme effectiveness, and continued engagement.

Results and conclusions

Many of the themes mirrored previous accounts relating to generic PPs for disruptive behaviour problems. There were also a number of ADHD‐specific themes. Enhancing parental motivation to change parenting practice and providing an intervention that addresses the parents' own needs (e.g. in relation to self‐confidence, depression or parental ADHD), in addition to those of the child, were considered of particular importance. Comparisons between the views of parents and practitioners highlighted a need to increase awareness of parental psychological barriers among practitioners and for better programme advertising generally. Clinical implications and specific recommendations drawn from these findings are discussed and presented.
Increased miR-223 expression in T cells from patients with rheumatoid arthritis leads to decreased insulin-like growth factor-1-mediated interleukin-10 production
Authors: Lu M-C , Yu C-L , Chen H-C , Yu H-C , Huang H-B , Lai N-S
Published: May 2014

We hypothesized that the aberrant expression of microRNAs (miRNAs) in rheumatoid arthritis (RA) T cells was involved in the pathogenesis of RA. The expression profile of 270 human miRNAs in T cells from the first five RA patients and five controls were analysed by real-time polymerase chain reaction. Twelve miRNAs exhibited potentially aberrant expression in RA T cells compared to normal T cells. After validation with another 22 RA patients and 19 controls, miR-223 and miR-34b were over-expressed in RA T cells. The expression levels of miR-223 were correlated positively with the titre of rheumatoid factor (RF) in RA patients. Transfection of Jurkat cells with miR-223 mimic suppressed insulin-like growth factor-1 receptor (IGF-1R) and transfection with miR-34b mimic suppressed cAMP response element binding protein (CREB) protein expression by Western blotting. The protein expression of IGF-1R but not CREB was decreased in RA T cells. The addition of recombinant IGF-1-stimulated interleukin (IL)-10 production by activated normal T cells, but not RA T cells. The transfection of miR-223 mimic impaired IGF-1-mediated IL-10 production in activated normal T cells. The expression levels of SCD5, targeted by miR-34b, were decreased in RA T cells after microarray analysis. In conclusion, both miR-223 and miR-34b were over-expressed in RA T cells, but only the miR-223 expression levels were correlated positively with RF titre in RA patients. Functionally, the increased miR-223 expression could impair the IGF-1-mediated IL-10 production in activated RA T cells in vivo, which might contribute to the imbalance between proinflammatory and anti-inflammatory cytokines.
Blood pressure, fludrocortisone dose and plasma renin activity in children with classic congenital adrenal hyperplasia due to 21‐hydroxylase deficiency followed from birth to 4 years of age
Authors: Bonfig Walter , Schwarz Hans Peter
Published: May 2014

Introduction

Infants with congenital adrenal hyperplasia (CAH) require higher doses of fludrocortisone (FC) due to physiological mineralocorticoid resistance. The adequacy of mineralocorticoid replacement should be closely monitored to avoid hypertension.

Objective

To evaluate blood pressure (BP) in infants with CAH due to 21‐hydroxylase deficiency.

Patients and Methods

Thirty‐three patients (18f/15 m) diagnosed by newborn screening were followed until the age of 4 years. Mean start of HC and FC treatment was day 9·8 ± 9·2 postnatally. Mean daily HC dose ranged from 8·6 to 12·3 mg/m2/day.

Results

During the first year of life prevalence of systolic hypertension was up to 45·5%. At 12 and at 18 months, BP was highest. Prevalence of systolic hypertension was up to 57·6% at 18 months of age. After 24 months BP levels were lower and at 48 months prevalence of hypertension decreased to 15·2%. Systolic and diastolic BP correlated significantly with the administered fludrocortisone dose (r = 0·3, P = 0·005), but not with body mass index. Hypertensive children received significantly higher FC doses and had significantly lower plasma renin activity during the study period.

Conclusion

High prevalence of transient, most likely FC induced hypertension was found in young children with classic CAH diagnosed by newborn screening. The changing mineralocorticoid sensitivity in infants is a risk factor for the development of hypertension in patients with CAH, who are treated with FC. Therefore suppressed plasma renin activity should be avoided to prevent arterial hypertension.
Short‐term changes in bone formation markers following growth hormone (GH) treatment in short prepubertal children with a broad range of GH secretion
Authors: Andersson Björn , Swolin‐Eide Diana , Magnusson Per , Albertsson‐Wikland Kerstin
Published: May 2014

Objectives

Growth hormone (GH) promotes longitudinal growth and bone modelling/remodelling. This study investigated the relationship between levels of bone formation markers and growth during GH treatment in prepubertal children with widely ranging GH secretion levels.

Methods

The study group comprised 113 short prepubertal children (mean age ± SD, 9·37 ± 2·13 years; 99 boys) on GH treatment (33·0 ± 0·06 μg/kg/day) for 1 year. Blood samples were taken at baseline and 1 and 2 weeks, 1 and 3 months, and 1 year after treatment start. Intact amino‐terminal propeptide of type I procollagen (PINP), bone‐specific alkaline phosphatase (BALP) and osteocalcin were measured using an automated IDS‐iSYS immunoassay system.

Results

Intact amino‐terminal propeptide of type I procollagen (PINP), BALP and osteocalcin, increased in the short‐term during GH treatment. PINP after 1 week (P = 0·00077), and BALP and osteocalcin after 1 month (P < 0·0001 and P = 0·0043, respectively). PINP levels at 1 and 3 months correlated positively, and osteocalcin levels at 1 week and percentage change after 1 month correlated negatively, with first year growth response. No significant correlations were found between BALP and first year growth. Multiple regression analysis showed that bone marker levels together with auxological data and insulin‐like growth factor binding protein‐3 explained the variation in first year growth response to 36% at start, 32% after 2 weeks and 48% at 3 months.

Conclusion

Short‐term increases in levels of the bone formation markers PINP, BALP and osteocalcin showed different temporal patterns, but all correlated with first year growth response during GH treatment. These markers may be a useful addition to existing prediction models for growth response.
Socio‐economic status and incident diabetes mellitus among employees in Denmark: a prospective analysis with 10‐year follow‐up
Authors: Cleal B. , Hannerz H. , Poulsen K. , Andersen L. L.
Published: May 2014

Aims

To contribute to the research on diabetes and social inequality by presenting national data on incident diabetes mellitus, stratified according to socio‐economic status.

Methods

National registers were combined, linking socio‐economic status with incident diabetes over a 10‐year period (2001–2010). The study population comprised employees in Denmark aged 20–59 years at baseline. Poisson regression analysis was used to estimate socio‐economic rate ratios. Excess fraction analysis was used to determine the proportion of cases that would not have occurred if morbidity rates in each socio‐economic group had been as low as those in the reference group. Monte Carlo simulation was used to calculate 95% CIs for excess fraction estimates

Results

A total of 1 005 572 men and 951 039 women were included in the analysis. The follow‐up yielded 43 439 cases in 9 533 199 person‐years at risk among men and 29 266 cases in 9 163 405 person‐years at risk among women. Using ‘professionals’ as a reference group, higher levels of relative risk were observed among every other socio‐occupational group. The excess fraction was, 0.342 (95% CI 0.329–0.354) among men and 0.359 (95% CI 0.349–0.369) among women.

Conclusions

Excess fraction analysis suggests that more than a third of cases of diabetes could be prevented if all employees were exposed to the same working conditions as the reference population. Acknowledging potential confounders, the observed levels of incident diabetes among the workforce highlight the potential gains to be had by better use of the workplace as an arena for prevention. Greater integration of occupational health and general healthcare is required to achieve this.
Peri‐Aortic Fluid: A Critical Finding in Acute Aortic Syndrome
Authors: Barake Walid , Oqab Zardasht , Najib Syed Samir , Hamilton Andrew , Johri Amer M.
Published: May 2014

Mini‐Abstract

A case of acute aortic syndrome (AAS) in a 70‐year‐old patient is described. Peri‐aortic fluid on echocardiography was a key for early diagnosis and surgical intervention. Peri‐aortic fluid, even in the absence of dissection on imaging, is a critical finding in AAS which has been underappreciated in the literature.
Insect herbivory and vertebrate grazing impact food limitation and grasshopper populations during a severe outbreak
Authors: BRANSON DAVID H. , HAFERKAMP MARSHALL A.
Published: May 2014

1. Competition between herbivores often plays an important role in population ecology and appears strongest when densities are high or plant production is low. Phytophagous insects are often highly abundant, but relatively few experiments have examined competition between vertebrates and phytophagous insects.

2. In grassland systems worldwide, grasshoppers are often the dominant phytophagous insect, and livestock grazing is a dominant land use. For this study, a novel experiment was conducted examining competition between vertebrates and invertebrates, where both grasshopper densities and sheep grazing were manipulated inside 10‐m2 caged mesocosms during a grasshopper outbreak. We examined how grasshopper densities and the timing of vertebrate herbivory affected grasshopper densities, if the effects of vertebrates on survival and reproduction changed with grasshopper density, and how a naturally occurring grasshopper outbreak affected grasshopper populations in the following year.

3. Densities of grasshoppers at the site peaked at 130 m–2. Food‐limited competition was stronger in treatments with higher grasshopper densities and repeated or late livestock herbivory, leading to reduced survival, femur length, and functional ovarioles, a measure of future reproduction. Strong food‐limited density‐dependent reproduction and survival led to reduced hatching densities in 2001.

4. As competition was typically stronger with high grasshopper densities than with livestock grazing, competition from vertebrates could be relatively less important for phytophagous insect population dynamics during outbreaks. The experiment provides insights into how competition between insect and vertebrate herbivores influences insect population dynamics, and indicates that severe outbreaks can rapidly subside with strong competition from vertebrate and insect herbivores.
Growth of common carp Cyprinus carpio in Anatolia (Turkey), with a comparison to native and invasive areas worldwide
Authors: Vilizzi Lorenzo , Ekmekçi F. Güler , Tarkan Ali Serhan , Jackson Zachary J.
Published: May 2014

Common carp Cyprinus carpio occurs in several non‐native areas worldwide, where it is generally regarded as either naturalised or invasive. Anatolia (Turkey) represents a unique region for evaluating common carp growth, due both to its location at the southernmost range of expansion of the species' wild form and to most of its water bodies having been stocked with domesticated strains. Based on a review of length‐at‐age data for common carp stocks from 45 water bodies sampled between 1953 and 2007, regional patterns in growth across climates, water body types, scalation variants and sexes, along with altitudinal gradients in growth performance and mortality, were investigated. Growth rates were lower in cold and arid relative to temperate climates, and also under hot or dry summers; this was true also of the mirror relative to the scale variant, males to females, but not of water body types (i.e., man‐made reservoirs, natural lakes, water courses). Growth performance and mortality decreased with increasing altitude and decreasing temperature, likely due to optimisation of resource allocation between growth and reproduction. Growth rate of common carp from Anatolia was consistently lower compared to its native (Eurasian) and, especially, invasive (North American) counterparts, which reflected an opportunistic life‐history strategy. Lower growth rates in Anatolia were ascribed to lower resilience of the widespread mirror variant together with limited habitat for spawning in man‐made reservoirs. Better knowledge of common carp growth in Anatolia will improve stock management and conservation efforts. Further studies will help clarify the mechanisms responsible for evolutionary genotype–phenotype inter‐relationships.
A newly discovered role of evolution in previously published consumer–resource dynamics
Authors: Hiltunen Teppo , Hairston Nelson G. , Hooker Giles , Jones Laura E. , Ellner Stephen P.
Published: May 2014

Consumer–resource interactions are fundamental components of ecological communities. Classic features of consumer–resource models are that temporal dynamics are often cyclic, with a ¼‐period lag between resource and consumer population peaks. However, there are few published empirical examples of this pattern. Here, we show that many published examples of consumer–resource cycling show instead patterns indicating eco‐evolutionary dynamics. When prey evolve along a trade‐off between defence and competitive ability, two‐species consumer–resource cycles become longer and antiphase (half‐period lag, so consumer maxima coincide with minima of the resource species). Using stringent criteria, we identified 21 two‐species consumer–resource time series, published between 1934 and 1997, suitable to investigate for eco‐evolutionary dynamics. We developed a statistical method to probe for a transition from classic to eco‐evolutionary cycles, and find evidence for eco‐evolutionary type cycles in about half of the studies. We show that rapid prey evolution is the most likely explanation for the observed patterns.
Rising sea level, temperature, and precipitation impact plant and ecosystem responses to elevated CO2 on a Chesapeake Bay wetland: review of a 28‐year study
Authors: Drake Bert G.
Published: May 2014

An ongoing field study of the effects of elevated atmospheric CO2 on a brackish wetland on Chesapeake Bay, started in 1987, is unique as the longest continually running investigation of the effects of elevated CO2 on an ecosystem. Since the beginning of the study, atmospheric CO2 increased 18%, sea level rose 20 cm, and growing season temperature varied with approximately the same range as predicted for global warming in the 21st century. This review looks back at this study for clues about how the effects of rising sea level, temperature, and precipitation interact with high atmospheric CO2 to alter the physiology of C3 and C4 photosynthetic species, carbon assimilation, evapotranspiration, plant and ecosystem nitrogen, and distribution of plant communities in this brackish wetland. Rising sea level caused a shift to higher elevations in the Scirpus olneyi C3 populations on the wetland, displacing the Spartina patens C4 populations. Elevated CO2 stimulated carbon assimilation in the Scirpus C3 species measured by increased shoot and root density and biomass, net ecosystem production, dissolved organic and inorganic carbon, and methane production. But elevated CO2 also decreased biomass of the grass, S. patens C4. The elevated CO2 treatment reduced tissue nitrogen concentration in shoots, roots, and total canopy nitrogen, which was associated with reduced ecosystem respiration. Net ecosystem production was mediated by precipitation through soil salinity: high salinity reduced the CO2 effect on net ecosystem production, which was zero in years of severe drought. The elevated CO2 stimulation of shoot density in the Scirpus C3 species was sustained throughout the 28 years of the study. Results from this study suggest that rising CO2 can add substantial amounts of carbon to ecosystems through stimulation of carbon assimilation, increased root exudates to supply nitrogen fixation, reduced dark respiration, and improved water and nitrogen use efficiency.
The Dynamic Effects of Entrepreneurship on Regional Economic Growth: Evidence from Canada
Authors: Matejovsky Lukas , Mohapatra Sandeep , Steiner Bodo
Published: May 2014

Facilitating entrepreneurship to address regional income disparity continues to be a major concern of policy makers across the globe. This study explores the temporal pattern of income disparity for Canadian provinces in two estimation steps. First, an econometric growth regression model is applied to identify the impact of entrepreneurship on regional economic growth. The estimation results suggest that entrepreneurship, measured in terms of the self‐employment rate, plays a pivotal role in determining regional development in Canada. Second, a dynamic vector autoregression model is employed to simulate long‐run regional growth effects that result from policy shocks affecting entrepreneurship. Compared to other growth drivers, entrepreneurship is found to have more pronounced and long‐term stimulative effects on regional development for the period of 1987–2007.
The Disconnect Between Principles and Practice: Rural Policy Reviews of OECD Countries
Authors: Freshwater David , Trapasso Raffaele
Published: May 2014

Following the publication of the New Rural Paradigm (NRP) in 2006, the Organisation for Economic Co‐operation and Development (OECD) undertook a number of national rural policy reviews for member countries between 2006 and 2009. These reviews were paid for by the nation being reviewed and were structured to assess how well the national policy followed the guidelines of the NRP. International agencies, including the OECD, are seen as being well positioned to encourage policy transfer, and one might think that countries wishing to be reviewed would have adopted the NRP. We examine the set of reviews to determine which elements of the NRP were commonly adopted and which were not. While it may seem that the interval between 2006 and the time of the reviews is too short to expect much change, the ideas underpinning the NRP have their origins in OECD rural policy analysis that began in the late 1980s.

Over 20 years, the OECD philosophy of rural development has evolved to parallel the academic research literature in endorsing “bottom‐up” investment‐oriented policies that engage a broad set of actors. Yet, just as academic research seems to have little impact on actual rural policy, so too there is limited evidence that countries fully adopt the NRP. Explaining why this lack of impact is the case is beyond the scope of the paper, but our results reinforce the challenges facing any effort to alter current rural policy.
Home hemodialysis: Beliefs, attitudes, and practice patterns
Authors: Jayanti Anuradha , Morris Julie , Stenvinkel Peter , Mitra Sandip
Published: May 2014

There is increasing interest of the worldwide kidney community in home hemodialysis (HHD). This is due to emerging evidence of its superiority over conventional hemodialysis (HD), largely attributed to improved outcomes on intensive schedule HD, best deployed in patient's own homes. Despite published work in this area, universal uptake remains limited and reasons are poorly understood. All those who provide HD care were invited to participate in a survey on HHD, initiated to understand the beliefs, attitudes, and practice patterns of providers offering this therapy. The survey was developed and posted on the Nephrology Dialysis Transplantation‐Educational (NDT‐E) website. Two hundred and seventy‐two responses were deemed suitable for complete analysis. It is apparent from the survey that there is great variability in the prevalence of HHD. Physicians have a great deal of interest in this modality, with majority viewing home as being the ideal location for the offer of intensive HD schedules (55%). A significant number (21%) feel intensive HD may be offered even outside the home setting. Those who offer this therapy do not see a financial disadvantage in it. Many units identify lack of appropriately trained personnel (35%) and funding for home adaptation (50.4%) as key barriers to widespread adoption of this therapy. Despite the interest and belief in this therapy among practitioners, HHD therapy is still not within reach of a majority of patients. Modifiable organizational, physician, and patient factors exist, which could potentially redefine the landscape of HHD provision. Well‐designed systematic research of national and local barriers is needed to design interventions to help centers facilitate change.
Physicians' perceptions of the value of prognostic models: the benefits and risks of prognostic confidence
Authors: Hallen Sarah A. M. , Hootsmans Norbert A. M. , Blaisdell Laura , Gutheil Caitlin M. , Han Paul K. J.
Published: May 2014

Background

The communication of prognosis in end‐of‐life (EOL) care is a challenging task that is limited by prognostic uncertainty and physicians' lack of confidence in their prognostic estimates. Clinical prediction models (CPMs) are increasingly common evidence‐based tools that may mitigate these problems and facilitate the communication and use of prognostic information in EOL care; however, little is known about physicians' perceptions of the value of these tools.

Objective

To explore physicians' perceptions of the value of CPMs in EOL care.

Design

Qualitative study using semi‐structured individual interviews which were analysed using a constant comparative method.

Setting and participants

Convenience sample of 17 attending physicians representing five different medical specialties at a single large tertiary care medical centre.

Results

Physicians perceived CPMs as having three main benefits in EOL care: (i) enhancing their prognostic confidence; (ii) increasing their prognostic authority; and (iii) enabling patient persuasion in circumstances of low prognostic and therapeutic uncertainty. However, physicians also perceived CPMs as having potential risks, which include producing emotional distress in patients and promoting prognostic overconfidence in EOL care.

Discussion and conclusions

Physicians perceive CPMs as a potentially valuable means of increasing their prognostic confidence, communication and explicit use of prognostic information in EOL care. However, physicians' perceptions of CPMs also indicate a need to establish broad and consistent implementation processes to engage patients in shared decision making in EOL care, to effectively communicate uncertainty in prognostic information and to help both patients and physicians manage uncertainty in EOL care decisions.
Barriers to patient portal access among veterans receiving home‐based primary care: a qualitative study
Authors: Mishuris Rebecca G. , Stewart Max , Fix Gemmae M. , Marcello Thomas , McInnes D. Keith , Hogan Timothy P. , Boardman Judith B. , Simon Steven R.
Published: May 2014

Background

Electronic, or web‐based, patient portals can improve patient satisfaction, engagement and health outcomes and are becoming more prevalent with the advent of meaningful use incentives. However, adoption rates are low, particularly among vulnerable patient populations, such as those patients who are home‐bound with multiple comorbidities. Little is known about how these patients view patient portals or their barriers to using them.

Objective

To identify barriers to and facilitators of using My HealtheVet (MHV), the United States Department of Veterans Affairs (VA) patient portal, among Veterans using home‐based primary care services.

Design

Qualitative study using in‐depth semi‐structured interviews. We conducted a content analysis informed by grounded theory.

Participants

Fourteen Veterans receiving home‐based primary care, surrogates of two of these Veterans, and three home‐based primary care (HBPC) staff members.

Key Results

We identified five themes related to the use of MHV: limited knowledge; satisfaction with current HBPC care; limited computer and Internet access; desire to learn more about MHV and its potential use; and value of surrogates acting as intermediaries between Veterans and MHV.

Conclusions

Despite their limited knowledge of MHV and computer access, home‐bound Veterans are interested in accessing MHV and using it as an additional point of care. Surrogates are also potential users of MHV on behalf of these Veterans and may have different barriers to and benefits from use.
Measuring the quality of surgical decisions for Latina breast cancer patients
Authors: Sepucha Karen , Feibelmann Sandra , Chang Yuchiao , Hewitt Sarah , Ziogas Argyrios
Published: May 2014

Background

A high‐quality decision for breast cancer surgery requires that patients are well informed, meaningfully involved in decision making, and receive treatments that match their goals. There is little in the existing literature that examines a comprehensive measure of decision quality for Latina breast cancer patients.

Objective

To examine the quality of surgical decisions among Latina breast cancer survivors and explore factors associated with decision quality and decision regret.

Design

Cross‐sectional mailed survey.

Main outcome measures

English and certified Spanish translations of Breast Cancer Surgery Decision Quality Instrument (BCS‐DQI), Short Acculturation Scale for Hispanics (SASH) and decision regret.

Participants and setting

Ninety‐seven breast cancer survivors of Hispanic or Spanish descent identified through the cancer registry from Orange or San Diego Counties in California.

Results

The 97 respondents were on average 55.7 years old, 39.1% had high school diploma or more education, and 62.9% had low acculturation (SASH scores < 2.99). The average knowledge score was 48.2%, the average decision process score was 67.5%, and many (77.3%) received treatments that matched their goals. In multivariable models, there were no significant associations with education, age, acculturation and any aspect of decision quality or decision regret in this sample. Respondents who had higher decision process scores, indicating more involvement in decision making, had significantly lower decision regret.

Conclusions

The BCS‐DQI may require some adaptation for Latina populations to improve acceptability. The different aspects of decision quality, including knowledge, decision process and concordance, did not vary by level of acculturation.
Refusal strategies in Persian
Authors: Izadi Ahmad , Zilaie Farzaneh
Published: May 2014

This study investigates how Iranian speakers of Persian realize the speech act of refusals to the initiating acts of offers, suggestions, invitations and requests. Two hundred and eight acts of refusals were naturally collected and classified according to the refusal classification scheme proposed by Beebe, Takahashi, and Uliss‐Weltz. The results showed that Iranian Persian speakers employ indirect strategies and a combination of direct and indirect strategies more than direct ones in refusals, in communication with the interactants with whom they have ongoing relationship. ‘Reason’ and ‘gratitude’ were the most frequent strategies in the data. Returning the act was found to be a new strategy. Finally, the socio‐cultural implications of the variety in the production of refusals are discussed.
A novel external catheter fixation method for chemotherapy using inferior epigastric arterial catheterization for cervical cancer
Authors: Chen Bo‐Lin , Li Jie , Chen Yong‐Yi , Tang Xin‐Hui , Li Xu‐Ying , Lin Xiao‐Ping , Yang Nong , Sui Hong‐yin , Ye Sha , Huang Jing
Published: May 2014

The aim of this randomized controlled study was to investigate the effects of a novel external catheter fixation method for chemotherapy using inferior epigastric arterial catheterization for cervical cancer.Patients diagnosed with cervical cancer were randomly divided into a control group (n = 32) and a treatment group (n = 33). Patients in the control group underwent a traditional fixation method using a haemostat, elastic band and abdominal bandage. Patients in the treatment group underwent an improved fixation method using an indwelling needle and membrane cover. We used a visual analogue scale (VAS) to evaluate each patient's comfort score and also recorded the incidence of needlestick injury and the length of injection time in each group. The VAS scores measured before and after chemotherapy in the treatment group were lower than in the control group. The incidence of needlestick injury in the treatment group was significantly lower than in the control group. The length of injection time in treatment group was significantly lower than in the control group. Compared with the traditional fixation method, the improved fixation method not only increased patient comfort but also reduced both the risk of needlestick injury and the length of injection time. This improved technique deserves increased clinical use.
Emotional needs of Aboriginal foster parents
Authors: Brown Jason D. , Ivanova Viktoria , Mehta Nisha , Skrodzki Donna , Rodgers Julie
Published: May 2014

Aboriginal children are overrepresented in care. Aboriginal foster parents are underrepresented. There is a need to recruit and retain Aboriginal foster parents. In the study, Aboriginal foster parents were asked: “What do you need emotionally to be a good foster parent?” The results were analyzed using multidimensional scaling and cluster analysis, leading to eight concepts, including: awareness, contentment, self‐assurance, appreciation, resolve, space, caring, and commitment to one's values. These results were compared with the existing foster parent literature. Similarities and differences were described.
Are suspected stroke patients identified by paramedics transported to appropriate stroke centres in Victoria, Australia?
Authors: Bray J. E. , Coughlan K. , Mosley I. , Barger B. , Bladin C.
Published: May 2014

Emergency medical services (EMS) are vital to ensuring acute stroke patients are transported to thrombolysis and/or stroke unit centres. This 6‐month audit of Victorian EMS cases found the majority of suspected acute strokes are transported to appropriate stroke centres. However, there is still room for improvement, in particular, strategies to improve access to stroke services in some rural regions and to ensure patients/relatives are fully informed when requesting transport to a non‐stroke service hospital.
Prostate cancer: measuring PSA
Authors: Pezaro C. , Woo H. H. , Davis I. D.
Published: May 2014

Population screening with prostate‐specific antigen (PSA) for detection of prostate cancer is a topic associated with ongoing dissent and confusion within the oncology and wider medical community. The PSA blood test has been used in various stages of prostate cancer management, including screening and the assessment of future risk of prostate cancer development, detection of recurrent disease after local therapy and in the management of advanced disease. However, PSA‐based decision‐making in prostate cancer has significant shortcomings. This review will summarise the evidence and current recommendations for the use of PSA in detection and management of prostate cancer.
Physical activity levels and patients' expectations of physical activity during acute general medical admission
Authors: Cattanach N. , Sheedy R. , Gill S. , Hughes A.
Published: May 2014

Bedrest during hospital admission is common and might be harmful. There is scarce published evidence that quantifies physical activity levels and expectations regarding physical activity of general medical patients during an acute inpatient stay. The current study aimed to investigate physical activity levels and expectations regarding physical activity in general medical patients at a large Australian teaching hospital. A convenience sample of 24 general medical patients was observed at 10‐min intervals in one day between 8:00 and 17:00 and their physical activity status recorded. Participants completed a questionnaire regarding their expectations of physical activity during illness and hospital admission. Patients were observed to be in bed 51% of the time, were sitting out of bed 43% of the time, were standing 1% of the time and were walking 5% of the time. One third of participants (n = 8) were not observed to walk during the observation period. Questionnaire data indicated that nine (38%) participants expected to remain in bed while in hospital. General medical patients had low levels of physical activity during their hospital stay, which was consistent with many participants' expectations of appropriate activity when in hospital. If physical activity is an important part of acute general medical patient management, then patient expectations of the appropriateness of physical activity need to be addressed and methods to increase physical activity implemented.
Does Hepatic Steatosis Have an Impact on the Short Term Hepatic Response After Complete Attenuation of Congenital Extrahepatic Portosystemic Shunts? A Prospective Study of 20 Dogs
Authors: Hunt Geraldine B. , Luff Jennifer , Daniel Leticia , Zwingenberger Allison
Published: May 2014

Objective

To evaluate the relationship between hepatic steatosis and increase in liver size and resolution of shunting after surgical attenuation of congenital extrahepatic portosystemic shunts in dogs.

Study Design

Prospective study.

Animals

Dogs (n = 20) with congenital extrahepatic portosystemic shunts.

Methods

Shunts were attenuated using ameroid ring constrictors. Portal blood flow and liver volume were evaluated using computed tomography before and ≥8 weeks after surgery. Hepatic steatosis was quantified by stereological point counting of lipid droplets and lipogranulomas (LG) in liver biopsies stained with Oil‐red‐O. Associations between steatosis and preoperative liver volume, liver growth after surgery, and development of acquired shunts were evaluated.

Results

Acquired shunts developed in 2 dogs (10%). Dogs with larger preoperative liver volumes relative to bodyweight had fewer lipid droplets per tissue point (P = .019). LG per tissue point were significantly associated with age: 0.019 ± 0.06 for dogs <12 months versus 0.25 ± 0.49 for dogs >12 months (P = .007). There was a significant positive association between liver growth after surgery and the number of LG/month of age in dogs >12 months (P = .003). There was no association between steatosis, presence of macrosteatosis, the number of LG or development of acquired shunts.

Conclusions

This preliminary study suggests that the presence of hepatic lipidosis and LG has no demonstrable effect on development of acquired shunts or the magnitude of increase in liver volume after attenuation of congenital extrahepatic portosystemic shunts in dogs.
Tibial Plateau Leveling Osteotomy in Small Breed Dogs With High Tibial Plateau Angles Using a 4‐Hole 1.9/2.5 mm Locking T‐Plate
Authors: Witte Philip G. , Scott Harry W.
Published: May 2014

Objectives

To report clinical experiences with tibial plateau leveling osteotomy (TPLO) to address cranial cruciate ligament (CCL) disease in small breed dogs with high tibial plateau angles (TPA) using a specific 4‐hole locking T‐plate.

Study design

Retrospective case series.

Animals

Small breed dogs (<15 kg) with high TPA (>30°): n = 19 (29 CCL ruptures).

Methods

TPLO was performed by standard technique using a 1.9/2.5 mm 4‐hole locking T‐plate. Preoperative, immediate postoperative, and 6–8 weeks postoperative TPA were measured from radiographs. Lameness was scored subjectively preoperatively and 6–8 weeks postoperatively. Mid to long term follow‐up was by client telephone questionnaire (mean, 12.1 months after surgery).

Results

Mean ± SD preoperative TPA was 37.0 ± 4.9°, immediate postoperative TPA, 6.4 ± 2.8° and 6–8 weeks postoperative TPA, 8.0 ± 4.9°. Postoperative complications occurred in 4 dogs (13.8%) all of which had been operated as single‐session bilateral procedures. Three stifles had failure of a single screw and postoperative increase in TPA. Periprosthetic infection necessitated plate removal in 1 dog. Lameness scores by veterinary assessment reduced from mean 3.4/5 preoperatively to 0.4/5 at 6–8 weeks postoperatively. Mid to long‐term follow‐up revealed no lameness by owner assessment.

Conclusion

A 4‐hole 1.9/2.5 mm locking T‐plate may be used in the stabilization of unilateral TPLO in small breed dogs with high TPA.
What makes a successful export? Evidence from firm‐product‐ level data
Authors: Görg Holger , Kneller Richard , Muraközy Balázs
Published: May 2014

Abstract We analyse a very rich and unique panel database that provides information on exports at the firm‐product level. Motivated by the recent theory of multi‐product firms, we investigate what determines the survival of products in the export mix to find that, in export dynamics, characteristics of the product as well as that of the firm matter. In particular, firm productivity as well as product scale and tenure are associated with a higher export survival rate. This suggests, in line with theory, that there are firm‐ as well as firm‐product‐specific competencies that are important for shaping firms’ export mix.
The taxation of passive foreign investment: lessons from German experience
Authors: Ruf Martin , Weichenrieder Alfons J.
Published: May 2014

Abstract The paper evaluates the working of German CFC rules that restrict the use of foreign subsidiaries located in low‐tax countries to shelter passive investment income from home taxation. While passive investments make up a significant fraction of German outbound FDI, we find that German CFC rules are quite effective in restricting investments in low‐tax jurisdictions. We find evidence that the German 2001 tax reform, which unilaterally introduced exemption of passive income in medium‐ and high‐tax countries, has led to some shifting of passive assets into countries for which the exemption was previously limited.