bluuebunny/crossref_metadata_2025 huggingface dataset:
Intentional overdose of azathioprine in a patient with systemic lupus erythematosus
Authors: Mahmood K , Khan AM , Ramanan AV , Martin K
Published: November 2013

A 14-year-old girl with systemic lupus erythematosus presented with a mixed overdose of paracetamol, ibuprofen and azathioprine (1500 mg) following a deliberate self-harm attempt. The patient was admitted and monitored. No adverse effects were observed. A review of the literature showed very few reported azathioprine overdoses. Lupus patients are at risk of developing low mood and depression (and related self-harm including overdose of medication). This can be as a consequence of the disease process itself or in reaction to the stresses of living with a chronic disease, which are perhaps particularly acute in some adolescents with the disease. An intentional overdose in a patient with lupus is clearly a cry for help and should be appropriately managed. Counselling of young people and their parents about possible mood disorders is an important part of the management of this chronic disease. Despite the theoretical risk of significant myelosuppression as well as other potential adverse effects, azathioprine in acute overdose seems to be generally well tolerated.
Massive mesenteric and portal venous thrombosis secondary to hormone replacement therapy
Authors: Watt DG , Shapter O , Mittapalli D , Murray WG
Published: November 2013

Hormone replacement therapy increases risk of deep venous thrombosis (DVT) mainly in the extremities and lungs. There are reports of mesenteric ischemia secondary to oral contraceptive pills but no reports on hormone replacement therapy and mesenteric thrombosis. The authors present a case of a 44-year-old obese (BMI 32) woman, on long-term hormone replacement therapy, presented with thrombosis of portal, splenic and superior mesenteric veins. She underwent surgical resection of ischemic bowel and planned re-look laparotomies with further resections and jejuno-ileal anastomosis at final laparotomy. Thorough haematological investigations were normal. The authors conclude that hormone replacement therapy in obese patients with no other risk factors can cause a catastrophic mesenteric thrombosis. Aggressive surgical resection with re-look laparotomies and further resections can be lifesaving.
Learning safe practice by improving care: student-led intervention on oxygen prescribing in a respiratory ward
Authors: Dolan R , Linden D , Johnston T , Paterson G , Rossi J , Lynch N , Arbuckle S , MacLean A , Davey P
Published: November 2013

Background and objective

The primary aim of this intervention was to improve oxygen prescribing in accordance with the 2008 British Thoracic Society guidelines for the prescription of emergency oxygen in adults.

Methods

Eight final year medical students reviewed the drug charts of all patients admitted to the respiratory ward on a daily basis in order to collect data on five audit questions: (1) Has oxygen (O2) been prescribed? (2) Has an O2 target saturation level been indicated? (3) Has O2 been prescribed as an ‘as required’ (PRN) or ‘continuous therapy’? (4) Has the prescription been signed? (5) Has O2 been signed for in every drug round since the original prescription? Following an initial audit cycle an educational poster was distributed to all clinical staff via email and hard copies of the poster were placed strategically throughout the ward before its effectiveness was measured.

Results

During the pre-intervention phase, compliance with all five measures varied from 0 to 25%. There was an increase in the variation in compliance after the poster intervention to 14–44%; however, this masked better overall compliance with all five investigative questions with figures of 44%, 39% and 42% being recorded in three of the four post-intervention days. Overall there was increased compliance with four of the five audit questions. Indeed compliance with question 3 rose from 14% to 83%.

Conclusions

The poster intervention was marginally effective while also showing that students can improve prescribing in a clinical setting.
Online Budget Transparency in OECD Member Countries and Administrative Culture
Authors: Rodríguez Bolívar Manuel Pedro , del Carmen Caba Pérez María , López-Hernández Antonio M.
Published: November 2013

The Organisation for Economic Co-Operation and Development emphasizes the e-government process as a tool for promoting budget transparency making all fiscal reports publicly available on the Internet. Nonetheless, the particular approach adopted to New Public Management models may influence different policies concerning the concepts of information quality and transparency. Based on an administrative culture approach, the aim of this article is to analyze whether the new technologies are being used by central governments for improving their accountability and democracy making their budgetary figures transparent for all stakeholders. The results of this study confirm that differences do exist across countries under different administrative cultures.
Factors enhancing aerofoil wings for wind energy harnessing in buildings
Authors: Elbakheit Abdel Rahman
Published: November 2013

This paper presents an approach towards enhanced building-integrated wind harnessing. It uses building forms and profiles to trigger continuous air entrainment to power turbines. Computational fluid dynamics is used for evaluating, testing, and optimizing proposed designs. Wind separation around buildings is modeled alongside an investigation into the parameters of a wing-profile to accelerate wind. Computational fluid dynamics provides a good tool for modeling, designing, and optimizing aerofoil shapes. The main parameters affecting the wing’s wind harnessing capabilities are the distance between the wing and the building and the angle of attack of the wing. The aerofoil can magnify wind velocity by a factor ranging from 0.53 to 3.5; that is, from just below Betz limit to over six times the limit, depending on incident velocities.

Practical applications: The approach presented in this paper can be implemented directly into optimization of new designs of buildings to integrate wind energy harnessing. Furthermore, new proposed wing shapes or profiles can be investigated by the same procedure presented in this study. Computational fluid dynamics investigations to building-mounted wind technologies, such as the ones presented here, are becoming increasingly adopted in the design process in practice, in university courses and future research.
Naming Patterns Reveal Cultural Values
Authors: Brown Ryan P. , Carvallo Mauricio , Imura Mikiko
Published: November 2013

Four studies examined the hypothesis that honor norms would be associated with a pronounced use of patronyms, but not matronyms, for naming children. Study 1 shows that men who endorse honor values expressed a stronger desire to use patronyms (but not matronyms) for future children, an association that was mediated by patriarchal attitudes. Study 2 presents an indirect method for assessing state patronym and matronym levels. As expected, patronym scores were significantly higher in honor states and were associated with a wide range of variables linked previously to honor-related dynamics. Study 3a shows that following the terrorist attacks of 9/11, patronyms increased in honor states, but not in non-honor states. Likewise, priming men with a fictitious terrorist attack (Study 3b) increased the association between honor ideology and patronym preferences. Together, these studies reveal a subtle social signal that reflects the masculine values of an honor culture.
Evaluation and the NIH Clinical and Translational Science Awards
Authors: Pincus Harold Alan , Abedin Zainab , Blank Arthur E. , Mazmanian Paul E.
Published: November 2013

Since 2006, a total of 61 Clinical and Translational Science Institutes (CTSAs) have been funded by the National Institutes of Health (NIH), with the aim of reducing translation time from a bench discovery to when it impacts patients. This special issue of Evaluation & the Health Professions focuses on evaluation within and across the large, complex system of the CTSA Program of NIH. Through insights gained by reading the articles in this special edition and the experience of the authors, a “top ten” list of lessons learned and insights gained is presented. The list outlines issues that face those who evaluate the influence of the CTSA Program, as they work to anticipate what will be needed for continuing success. Themes include (1) considering the needs of stakeholders, (2) the perspective of the evaluators, (3) the importance of service improvement, (4) the importance of teams and people, (5) costs and return on investments, (6) methodology considerations to evaluate the CTSA enterprise, (7) innovation in evaluation, (8) defining the transformation of research, (9) evaluating the long-term impact of the CTSAs on public health, and (10) contributing to science policy formulation and implementation. The establishment of the CTSA Program, with its mandated evaluation component, has not only influenced the infrastructure and nature of translational research but will continue to impact policy and management in science.
Heterogeneity at Work
Authors: Kane Cathleen , Alexander Angela , Hogle Janice A. , Parsons Helen M. , Phelps Lauren
Published: November 2013

The Clinical and Translational Science Award (CTSA) program is an ambitious multibillion dollar initiative sponsored by the National Institutes of Health (NIH) organized around the mission of facilitating the improved quality, efficiency, and effectiveness of translational health sciences research across the country. Although the NIH explicitly requires internal evaluation, funded CTSA institutions are given wide latitude to choose the structure and methods for evaluating their local CTSA program. The National Evaluators Survey was developed by a peer-led group of local CTSA evaluators as a voluntary effort to understand emerging differences and commonalities in evaluation teams and techniques across the 61 CTSA institutions funded nationwide. This article presents the results of the 2012 National Evaluators Survey, finding significant heterogeneity in evaluation staffing, organization, and methods across the 58 CTSAs institutions responding. The variety reflected in these findings represents both a liability and strength. A lack of standardization may impair the ability to make use of common metrics, but variation is also a successful evolutionary response to complexity. Additionally, the peer-led approach and simple design demonstrated by the questionnaire itself has value as an example of an evaluation technique with potential for replication in other areas across the CTSA institutions or any large-scale investment where multiple related teams across a wide geographic area are given the latitude to develop specialized approaches to fulfilling a common mission.
Treatment Considerations for Early Glottic Carcinoma: Lessons Learned and a Primer for the General Otolaryngologist
Authors: Jamal Nausheen , Sofer Elazar , Chhetri Dinesh K.
Published: November 2013

In this commentary, we review our experience with early glottic carcinomas in an attempt to identify points to consider when developing a treatment protocol and technical considerations in oncologic resection to maintain laryngeal function. We highlight several consistent themes: (1) difficult exposure is not always a contraindication to endoscopic resection; (2) depth of invasion may be apparent only intraoperatively; (3) radiation therapy should be offered for deeply invasive cancers requiring extensive cordectomy or for patients who cannot afford lengthy vocal downtime; however, (4) radiation therapy leads to acute dysphagia and collateral damage to the contralateral vocal fold that is avoided with surgery; (5) good voice can be obtained after healing if resection is limited to intramuscular cordectomy; (6) the key to optimal vocal results is adequate glottal closure; and (7) second look operations are occasionally necessary, and therefore preoperative counseling should include this possibility. Since both surgery and radiation therapy achieve excellent oncologic control, a patient‐centered approach is preferred in management.
Hardware Removal after Osseous Free Flap Reconstruction
Authors: Day Kristine E. , Desmond Renee , Magnuson J. Scott , Carroll William R. , Rosenthal Eben L.
Published: November 2013

Objective

Identifying risk factors for hardware removal in patients undergoing mandibular reconstruction with vascularized osseous free flaps remains a challenge. The purpose of this study is to identify potential risk factors, including osteocutaneous radial forearm versus fibular flap, for need for removal and to describe the fate of implanted hardware.

Study Design

Case series with chart review

Setting

Academic tertiary care medical center.

Subjects and Methods

Two hundred thirteen patients undergoing 227 vascularized osseous mandibular reconstructions between the years 2004 and 2012. Data were compiled through a manual chart review, and patients incurring hardware removals were identified.

Results

Thirty‐four of 213 evaluable vascularized osseous free flaps (16%) underwent surgical removal of hardware. The average length of time to removal was 16.2 months (median 10 months), with the majority of removals occurring within the first year. Osteocutaneous radial forearm free flaps (OCRFFF) incurred a slightly higher percentage of hardware removals (9.9%) compared to fibula flaps (6.1%). Partial removal was performed in 8 of 34 cases, and approximately 38% of these required additional surgery for removal.

Conclusion

Hardware removal was associated with continued tobacco use after mandibular reconstruction (P =. 03). Removal of the supporting hardware most commonly occurs from infection or exposure in the first year. In the majority of cases the bone is well healed and the problem resolves with removal.
The Government 2.0 utilization model and implementation scenarios
Authors: Khan Gohar Feroz
Published: November 2013

Although it seems that Government 2.0 will finally deliver the promise of a truly transparent government, many practitioners around the globe (particularly those in the developing world) are reluctant or unable to develop strategies and allocate resources to Government 2.0. As a result, governments around the world ignore or mishandle the opportunities and threats presented by Government 2.0. The primary reason underlying this behavior is the lack of understanding regarding Government 2.0. The purpose of the study is to address this gap in knowledge and understanding by presenting and illustrating fundamental concepts of Government 2.0. A web survey of 200 government websites from 40 countries (20 each from advanced and developing countries) and 45 Web 2.0 initiatives across the globe was used to present and illustrate fundamental concepts of Government 2.0. We suggested a three stage Government 2.0 Utilization Model (GUM) starting from information socialization (stage 1), and then moving on to mass collaboration (stage 2), and social transaction (stage 3). Based on the web survey, we also suggested three Government 2.0 implementation scenarios (i.e., standalone, nested, and hybrid implementation). The study will help researchers and practitioners in understanding the Government 2.0 phenomenon and the opportunities presented by it.
Employee Empowerment and Job Satisfaction in the U.S. Federal Bureaucracy
Authors: Fernandez Sergio , Moldogaziev Tima
Published: November 2013

Employee empowerment practices have been widely adopted in public organizations in Europe, the Pacific Rim, and North America. In this study, employee empowerment is conceptualized as a multifaceted approach composed of various practices aimed at sharing information, resources, rewards, and authority with lower level employees. Self-Determination Theory is used to theorize about the effects of these different empowerment practices on job satisfaction. The results of the empirical analysis, based on 2010 Federal Employee Viewpoint Survey (FEVS) data, indicate that empowerment practices aimed at promoting self-determination (i.e., sharing information about goals and performance, providing access to job-related knowledge and skills, and granting discretion to change work processes) have positive and sizable effects on job satisfaction. Conversely, empowerment practices that undermine autonomy (i.e., offering contingent-based rewards) have no meaningful effect on job satisfaction.
Space for curiosity
Authors: Phillips Richard
Published: November 2013

In education and creative industries, ordinary workplaces and everyday life, curiosity is widely regarded as a good thing, worthy of encouragement and support. This raises practical questions about how to be more curious and encourage curiosity in others. To bring these questions into focus, it helps to think geographically, asking: how can we find and make ‘space’ for curiosity? But curiosity is not simply a practical problem. Through spaces for curiosity, it is possible to raise more fundamental questions about what curiosity is and what it can be: about who can be curious, and what curiosity is for.
Scholastic Success
Authors: Downey Luke A. , Lomas Justine , Billings Clare , Hansen Karen , Stough Con
Published: November 2013

The aim of the current study was to examine the role of fluid intelligence, personality traits, and emotional intelligence (EI) in predicting female Year 9 students’ grade point average (GPA) and to determine whether any differences in scholastic performance were related to differences in EI or Personality. Two-hundred and forty-three female secondary students who were enrolled in Year 9 (age: M = 14.63 years, SD = 0.49) completed the Adolescent Swinburne University EI Test, Raven’s Standard Progressive Matrices, and the Mini International Personality Item Pool (Mini-IPIP) and a GPA was calculated from the core subjects. The results revealed that higher GPAs were related to higher levels of Emotional Management and Control (EMC), Conscientiousness, and lower levels of Extraversion. The stepwise regression analysis revealed that variation in GPA was accounted for by IQ (21.8%), Conscientiousness, Extraversion, and EMC. It was concluded that the consistent predictive efficacy of EI skills in relation to scholastic outcomes, although modest in comparison to IQ, should be considered important, especially in the context of students achieving grades appropriate to their intellect across their schooling experience.
Power Differentials in Bullying
Authors: Schumann Lyndall , Craig Wendy , Rosu Andrei
Published: November 2013

Central to the definition of bullying is the abuse of power. Power relationships are inherent in social groups, by virtue of differing size, strength, age, socioeconomic status (SES), or social connectedness of individuals. Beyond the influence of these individual characteristics, environmental factors have the potential to affect the power dynamic in bullying and victimization, but are a relatively unexplored research area. In particular, we know little about how the community-level factors relate to bullying in the adolescent population. The present study is guided by a social ecological perspective to gain a deeper understanding of the individual and built community characteristics (e.g., parks, recreational spaces, buildings that facilitate social interaction and community connectedness) that contribute to the power dynamics related to victimization or bullying in traditional and electronic contexts. Data were collected from 17,777 students in Grades 6 to 10 as part of the 2009/2010 Health Behavior in School-aged Children (HBSC) Survey, from Geographical Information Systems (GIS) data, and from 2006 Canadian Census data. Two nested models were run using HLM with age, gender, ethnicity, SES, social inclusion factors (e.g., collective efficacy), and community resource factors (e.g., access to recreation) as predictors. Characteristics of individuals that placed them at a power disadvantage (being younger, female, and having low SES) were linked to higher rates of victimization. Lower individual collective efficacy was also associated with higher rates of traditional and electronic victimization. Community recreational opportunities were associated with decreased victimization in both contexts. The relative importance of individual and built environmental factors and conceptualization of bullying interactions within a social ecology model are discussed.
Age-Related Changes in Dating Aggression in Spanish High School Students
Authors: Fernández-González Liria , O’Leary K. Daniel , Muñoz-Rivas Marina Julia
Published: November 2013

Prevention programs for dating partner aggression should be based on knowledge about when such aggression starts and how it changes. Given the very few studies regarding such trends, changes in physical, psychological, and sexual aggression against dating partners were examined in 14- to 20-year-old Spanish high school students ( N = 2,016). Overall, psychological aggression increased linearly, whereas physical aggression had a negative quadratic association, peaking at 16 to 17 years for males and females. Sexual aggression was infrequent, but it spiked at age 16 for males. Although physical aggression diminished in late adolescence, injuries as a consequence of such aggression increased linearly for females, and they were also significantly higher for females (14.9%) than for males (3%) at ages 18 to 20 years. The findings support the hypothesis that dating physical aggression for males and females peaks during middle-to-late adolescence and shows a similar developmental pattern to other antisocial and criminal behaviors. Prevention of dating aggression, escalation of such aggression, and prevention of injury should consider developmental trends in dating aggression.
Delusions and Hallucinations in Persons With Dementia
Authors: Cohen-Mansfield Jiska , Golander Hava , Heinik Jeremia
Published: November 2013

This study compares formal and informal caregivers’ perceptions of delusions and hallucinations in older persons with dementia (PWDs). The study population consisted of 151 community-dwelling PWDs aged 65 and older, 90 formal caregivers, and 151 informal caregivers residing in Israel. Assessments included the Behavioral Pathology in Alzheimer’s Disease Rating Scale, Neuropsychiatric Inventory, Etiological Assessment of Psychotic Symptoms in Dementia, Activities of Daily Living, and Mini-Mental State Examination. Informal caregivers reported higher rates and a higher level of severity of delusions and hallucinations than formal caregivers. Different caregivers showed varying degrees of emotional involvement, empathy, and efforts to find the meaning of the delusion for the person experiencing it. Family members and staff members may see different parts of the total picture. The combination of both points of view is essential in order to establish an accurate, comprehensive assessment of dementia symptoms and to enhance the understanding of the reality of the different parties.
A gamma Bayesian exponential model for computing and updating residual life distribution of bearings
Authors: Li Bing , Gao Zhen , Shen ZhongJie , Chen XueFeng , He ZhengJia
Published: November 2013

Residual life estimation occupies an important place in modern mechanical design and condition-based maintenance programs. Condition monitoring information can reflect the health status of the individual device, and the effective use of this information can help continuously predict the individual residual life. In this study, an exponential degradation model is developed to describe the degradation characteristics of devices for residual life estimation. This model is based on a gamma-prior Bayesian updating approach and an acceptance–rejection algorithm. With the gamma distribution representing the degradation rate differences among individuals, the real-world data can be described flexibly. By aid of Bayesian updating approach, the model can be updated with both the historical data and real-time monitoring signals. Furthermore, on the basis of the updated model and by means of acceptance–rejection algorithm, the residual life distribution can be computed without redundant computation. Consequently, the residual life can be estimated using the results of the residual life distribution. Finally, the proposed method is applied to real-world vibration-based degradation signals resulting from the accelerated fatigue testing of conical roller bearings. The results show that this method can avoid redundant computation and effectively estimate and update the bearing’s residual life. Therefore, the engineering value and general application of this novel method has been validated.
A new generatrix of the cavity profile of a diaphragm compressor
Authors: Li Jiyang , Liang Lin , Jia Xiaohan , Peng Xueyuan
Published: November 2013

The small flowrate and the diaphragm’s short life are two shortcomings of the diaphragm compressor. This paper presents a new generatrix of the cavity profile of a diaphragm compressor to increase cavity volume and decrease diaphragm's radial stress. To verify the design theory, the radial stresses on the oil side of the diaphragm in the cavities with the new and traditional generatrices were tested, and the experimental radial stresses agreed with the theoretical values. As the most important evaluation criteria of the cavity profile, the volumes of the cavities with different generatrices and the radial stress distribution of the diaphragm within were investigated under various design conditions. The results showed that the volume of the cavity with the new generatrix was about 6.5% larger than that with the traditional generatrix under the same design condition. Otherwise, with the same cavity volume and radius, the maximal radial stress of the diaphragm in the cavity with the new generatrix decreased by 10.3% stably, compared to that in the cavity with a traditional generatrix. Likewise, in the diaphragm’s centric region where the additional stress caused by the discharge holes occurred, the maximal radial stress of the diaphragm in the cavity with the new generatrix decreased about 11.5%.
An efficient real-time vehicle simulation method using a chassis-based kinematic formulation
Authors: Lee Jung Keun , Kang Jong Su , Bae Dae Sung
Published: November 2013

The purpose of this research is to develop an efficient kinematic formulation for an implicit integration method so that relatively low-cost computers can be used for the real-time simulation of multi-body vehicle dynamics models without sacrificing modelling details. The most time-consuming processes associated with the implicit method are the generation and LU decomposition of the system Jacobian matrix of the augmented equations of motion and the constraints at every time step. In order to save the computation time in these processes, a new kinematic formulation is developed to make the system Jacobian remain nearly constant. This allows us to employ a Newton chord method for implicit integration without the need to update the Jacobian. The formulation is motivated by the idea that relative motions between the chassis and other bodies (e.g. suspension components) are limited. Thus, the equations of motion, as well as the joint constraint equations and the generalized force equations, are formulated with respect to the chassis-body reference frame instead of the inertial reference frame. Consequently, the initial Jacobian can be used for long-term vehicle simulation. A comparison of the proposed approach with the conventional approach shows that the proposed approach drastically improved the computational efficiency; i.e. the computational cost of the proposed method was only 35% of the cost of the conventional method. The proposed algorithm yielded almost exact solutions for a prototype multi-body vehicle model run in real time on a 3.5 GHz personal computer.
The impact of work and family responsibilities on healthy sleep habits
Authors: Tienoven TP van , Glorieux I , Minnen J
Published: November 2013

Healthy sleep habits include sufficient sleep, regular bedtimes and established sleep routines. The responsibilities of paid and unpaid work that arise during the daytime are assumed to haunt us at night as well, eventually affecting these sleep habits. A long-term comparison of sleep duration from 1966 and 1999 time-diary data shows that sleep duration has not declined to the large extent that is generally assumed. Moreover, analyses of timing of sleep and sleep routines using time-diary data from 1999 and 2004 also do not show much evidence of this assumed decline. On the contrary, increasing work and family responsibilities positively affect regular bedtimes and sleep routines.
A corrected formulation for marginal inference derived from two-part mixed models for longitudinal semi-continuous data
Authors: Tom Brian DM , Su Li , Farewell Vernon T
Published: November 2013

For semi-continuous data which are a mixture of true zeros and continuously distributed positive values, the use of two-part mixed models provides a convenient modelling framework. However, deriving population-averaged (marginal) effects from such models is not always straightforward. Su et al. presented a model that provided convenient estimation of marginal effects for the logistic component of the two-part model but the specification of marginal effects for the continuous part of the model presented in that paper was based on an incorrect formulation. We present a corrected formulation and additionally explore the use of the two-part model for inferences on the overall marginal mean, which may be of more practical relevance in our application and more generally.
Fryderyc-François Chopin (1810–1849): Music and malady
Authors: Leigh FW
Published: November 2013

Chopin was born in Żelazowa Wola in Western Poland. He had no formal piano tuition and one could say that his skill as a pianist was self-taught, close to a miracle. All his compositions included the piano; this was not a restriction for him. The illnesses that plagued him and the cause of his death are the subject of articles by retrospective diagnosticians.
Online Status
Authors: Reese Jill A.
Published: November 2013

The purpose of this qualitative study was to describe preservice music teachers’ perceptions of their experiences participating in virtual field experiences and mentoring episodes with experienced teachers during their elementary general music methods course. Participants were 21 preservice music teachers and 8 elementary general music teachers. Each cohort of two or three preservice teachers was assigned a mentor teacher. Using virtual conferencing technology, cohorts completed two observations of their mentor teacher, two 30-minute post-observation conferences with their mentor teacher, and three post–field teaching conferences with their mentor teacher. Data were preservice teachers’ written reflections about post-observation conferences and post–field teaching conferences. Analysis revealed challenges to and benefits of the virtual observations and conferences. Challenges included limitations of the technology and virtual experiences, and difficulty scheduling experiences. Benefits included improved logistics, view of reality, expanded perspective, and learning from dialogic inquiry. Overall, benefits were perceived to outweigh challenges.
Updates in Antiplatelet Agents Used in Cardiovascular Diseases
Authors: Cheng Judy W. M.
Published: November 2013

Background:

Antiplatelet therapy is a cornerstone in coronary artery disease management. However, patients with acute coronary syndrome still remain at risk of recurrent cardiovascular events despite the advance of medical therapy.

Objective:

This article provides a review of antiplatelet agents used in cardiovascular diseases and focus on updates in the past 5 years.

Method:

Peer-reviewed clinical trials and relevant treatment guidelines were identified from MEDLINE and Current Content database (from 1966 to April 15, 2013) using search terms aspirin, clopidogrel, prasugrel, ticagrelor, glycoprotein IIb/IIIa inhibitors, antiplatelet agents, coronary artery disease, acute coronary syndrome, pharmacology, pharmacokinetics, and pharmacodynamics. Citations from the available articles were also reviewed for additional references.

Results:

In unstable angina and non-ST-segment elevation myocardial infarction (MI), dual antiplatelet therapy (aspirin and clopidogrel) demonstrated a reduction in death from cardiovascular causes, nonfatal MI, or stroke (relative risk 0.80; 95% confidence interval [CI], 0.72-0.90). In ST-segment elevation MI, dual antiplatelet therapy reduced the rate of occluded infarct-related artery/death or recurrent MI (95% CI, 24%-47%). Newer agents such as prasugrel, when compared to clopidogrel, reduced death from vascular causes, MI, or stroke in patients undergoing percutaneous coronary intervention (PCI; hazard ratio [HR], 0.81; 95% CI 0.73-0.90) but not in those receiving medical management only. When compared to clopidogrel, ticagrelor reduces death from vascular causes, MI, or stroke (HR: 0.84; 95% CI, 0.77-0.92) in patients undergoing PCI or receiving medical management only. Both the agents, however, increase the risk of bleeding in certain patient population.

Conclusions:

In the last 5 years, newer antiplatelet agents, including prasugrel and ticagrelor, have been demonstrated to reduce recurrent cardiovascular events compared to standard therapy and, however, also caused increase bleeding in selected patient populations. Newer agents including shorter acting P2Y12 inhibitor or antiplatelets that target other receptors are being evaluated to improve/maintain therapeutic efficacy yet minimize the risk of bleeding.
Production of Anti-platelet Factor 4/Heparin Complex Antibodies After Cardiovascular Surgery
Authors: Matsuo Takefumi , Motohashi Shinya , Wanaka Keiko , Walenga Jeanine M.
Published: November 2013

To study the production of anti-platelet factor 4 (anti-PF4)/heparin complex antibodies of Ig (immunoglobulin) G/IgA/IgM using enzyme-linked immunosorbent assay (ELISA; heparin-induced thrombocytopenia [HIT] antibodies) in 79 patients undergoing cardiovascular surgery, we employed Δoptical density (OD) as a marker of HIT-antibody production. The ΔODs were calculated from the differences in the ODs using ELISA. Patient were classified into 3 ΔOD ranges: ΔOD ≥ 1.0, ΔOD ≥ 0.4 to <1.0, and ΔOD < 0.4. The underlying disease, time course of the postoperative platelet count, d-dimer level, postoperative brain magnetic resonance imaging (MRI), use of cardiopulmonary bypass and postoperative thrombocytosis were not considered for the 3 ΔOD classifications. None of the 6 patients with ΔOD ≥1.0 and a positive functional assay was diagnosed with HIT due to the absence of HIT-derived thrombocytopenia. In conclusion, HIT-antibody production increased until day 7 after heparin cessation and reached a trace level on day 14. It was demonstrated that HIT-antibody production is in remission unless there is any evidence of a further increase during the second week postsurgery.
Impact of -455G/A Polymorphism of the β-Fibrinogen Gene on Platelet Aggregation in Patients With Acute Coronary Syndrome
Authors: Sevimli Serdar , Karakoyun Suleyman , Bakirci Eftal Murat , Topcu Selim , Kalkan Kamuran , Borekci Abdurrezzak , Vançelik Serhat
Published: November 2013

We aimed to investigate the association of aspirin and/or clopidogrel low response with −455G/A polymorphism of β-fibrinogen in patients with acute coronary syndrome (ACS). We enrolled 114 consecutive patients (mean age 61 ± 7, 31 female [27.2%], 83 male [72.8%]) with a first ACS. The diagnostic criteria for ACS were based on current guidelines. The -455 G/A β-fibrinogen polymorphism genotype distribution in the patient group was determined as the following: 54.4% GG homozygote, 39.5% GA, and 6.1% AA homozygote. Clopidogrel low response was present in 25 (21.9%) patients, aspirin low response in 21 (18.4%) patients, and dual antiplatelet low response in 9 (7.9%) patients. In our study, no difference was observed in terms of the distribution of -455 G/A β-fibrinogen polymorphism between the groups with and without aspirin and/or clopidogrel or dual antiplatelet low response in the patient group who underwent aspirin and clopidogrel treatment for ACS ( P > .05).
Drawing Drawn (A Taxonomy)
Authors: Farthing Stephen
Published: November 2013

This reflections on practice essay is organized into three parts; Development, Structure and Application, as a way to describe through drawing and writing the building of a ‘Taxonomy of Drawing’. The first part on Development focuses on the period from 2005–2010 and the roll that different genera of drawing played as enabling tools in the development of the taxonomy. Structure was developed during the period from 2010–2012, and tracked drawn images from the point of origination within the domain of two-dimensional representation through to their emergence as drawings that are products of one or other of the six genera. Finally, the last part Application, tracks the journey of six sample drawings through the taxonomy. This essay is illustrated by the 12 line drawings used in the development and testing of the taxonomy.
Extending the notion of ‘text’: the visual and performing arts doctoral thesis
Authors: Ravelli Louise , Paltridge Brian , Starfield Sue , Tuckwell Kathryn
Published: November 2013

Doctoral writing in the visual and performing arts poses many challenges for the academy, not the least of which is accounting for the possible relations which can hold between the written and creative/performed components of a doctoral thesis in these fields. This article proposes that the interrelations between the two components in doctoral submissions of this kind can be theorized as being on a continuum of interrelations, with a number of key text types (or archetypes) being manifested. Through textual analysis of the written component only, the different possible relations can be distinguished through the ways in which the creative component is resemiotized in the written text, through both the verbal and visual semiosis of the written component. This enables us to identify a number of ways in which the ‘one’ project can be construed through its two different component parts, casting an important light on debates within the field in terms of the relations between creative practice and research.
Cross-media communication in advertising: exploring multimodal connections between television commercials and websites
Authors: Jessen Iben Bredahl , Graakjær Nicolai Jørgensgaard
Published: November 2013

The aim of this article is to advance current understandings of cross-media communication in advertising. The study is based on a sample of 80 television commercials and their announced websites, and the article is inspired by recent studies of cross-media advertising effectiveness as well as semiotic perspectives on multimodal analysis. The authors present three dimensions to be considered when examining multimodal connections between television commercials and websites: announcements, participants and address strategy. These dimensions are brought together in an analytical framework that can serve as inspiration for further research on cross-media communication in advertising and possibly in other types of communication.
Abstraction and realism in the design of avatars for the simulated environment for theatre
Authors: Ruecker Stan , Grotkowski Ali , Gabriele Sandra , Roberts-Smith Jennifer , Sinclair Stéfan , Dobson Teresa , Akong Annemarie , Fung Sally , Hong Marcelo , DeSouza-Coelho Shawn , Rodriguez Omar
Published: November 2013

The Simulated Environment for Theatre (SET) is an experimental three-dimensional interface for use in blocking plays. Created using the Unity3D game engine, SET allows directors or student directors to associate character movement and speech with a timeline that represents the line of action, as well as to annotate choices, change the script, place viewpoints in the audience, and specify the scale-model stage and set. In this article, the authors discuss the iterative design choices involved in creating an appropriate range of characters and character attributes, where they were conscious of the need to keep complexity to a minimum while simultaneously providing as wide a range as possible of the features necessary for a director planning blocking. These include considerations of character attributes such as direction of movement, posture, age, and species, while at the same time the authors decided to de-emphasize control of features such as height, weight, gender, costume, and limbs. The purpose of this discussion is twofold: to cast light on the intricacies of the design decisions around what appear to be relatively simple objects; and to help inform related discussions for other researchers making decisions about avatar design, whether in virtual theatre projects or other broader contexts.
Tidal energy machines: A comparative life cycle assessment study
Authors: Walker Stuart , Howell Robert , Hodgson Peter , Griffin Allan
Published: November 2013

Marine energy in the United Kingdom is undergoing a period of growth in terms of development and implementation. The current installed tidal energy capacity is expected to rise to provide 20% of the United Kingdom’s electricity demand by 2050. This article used life cycle assessment to study four tidal energy devices, comparing their embodied energy and carbon dioxide emissions. The device designs studied included a multi-blade turbine, two three-blade horizontal axis turbine machines and an Archimedes’ screw device. These machines were chosen to represent a cross section of design for the device, foundation, installation and operation. Embodied energy was considered over the lifetime of each device. Energy use from fabrication, transport, installation, maintenance, decommissioning and recycling was all calculated and compared to the energy generated by each device. Finally, the embodied energy, CO2 intensity and energy payback periods were compared to those of conventional power generating systems and other renewable energy sources. Devices were studied based on a functional unit, defined as a 10 MW array installed for 100 years. Of the devices studied, the OpenHydro Open Centre turbine was found to have the best ratio of generated to embodied energy. All devices achieved CO2 and energy payback within 12 years and exhibited CO2 intensity between 18 and 35 gCO2/kW h. This compares favourably against current energy sources such as wind (8–12 gCO2/kW h), solar photovoltaic (~30 gCO2/kW h), nuclear (~70 gCO2/kW h) and coal (~1000 gCO2/kW h).
Stokes drift estimation based on long-term variation of wave conditions
Authors: Myrhaug Dag
Published: November 2013

This article provides a simple analytical method which can be used to give estimates of the Stokes drift based on long-term variation of wave conditions. This is achieved by providing bivariate distributions of significant wave height with surface Stokes drift as well as with volume Stokes transport. These Stokes drift parameters are defined in terms of significant wave height and characteristic wave periods. This article presents the mean value and the standard deviation of these Stokes drift parameters, that is, more precisely the conditional expected values and the conditional variances for given significant wave height, as well as examples of results corresponding to typical field conditions. Based on, for example, global wave statistics, the present analytical results can be used to make estimates of the Stokes drift.
The business model: A theoretically anchored robust construct for strategic analysis
Authors: Zott Christoph , Amit Raphael
Published: November 2013

Anchored in our research on business models, we delineate in this article a future research agenda. We establish that the theoretical and empirical advancements in business model research provide solid conceptual and empirical foundations on which scholars can build in order to explore a range of important, yet unanswered research questions. We draw inspiration on the direction of the business model research agenda by briefly reviewing several distinct bodies of literature adjacent to the business model literature including new organizational forms, ecosystems, activity systems, and value chain. In doing so, we also distinguish the business model concept from seemingly similar concepts that have been proposed by researchers.
A smart LED luminaire for energy savings in pedestrian road lighting
Authors: Juntunen E , Tetri E , Tapaninen O , Yrjänä S , Kondratyev V , Sitomaniemi A , Siirtola H , Sarjanoja EM , Aikio J , Heikkinen V
Published: November 2013

In this paper, an energy efficient streetlight for pedestrian roads is introduced. Energy efficiency is achieved via up-to-date light-emitting diode (LED) technology and added intelligence utilising integrated sensors and wireless control. Thermal and electrical design of the luminaire contributed to good technical functionality. The performance of the luminaire was validated with testing. The luminaire was compared with commercial lamp and LED-based street lighting technology by technical values and user acceptance. Energy savings of 19–44% through improved luminous efficacy was demonstrated without added intelligence. With smart control further power saving potential of 40–60% was shown depending on the lighting environment and pedestrian presence. User feedback of a pilot installation comparing commercial luminaires with the newly developed streetlight revealed that on average the users preferred the developed streetlight over the commercial luminaires.
Initial Results of Transradial Iliac Artery Stenting
Authors: Shinozaki Norihiko , Ogata Nobuhiko , Ikari Yuji
Published: November 2013

Aims:

Iliac artery stenting is commonly performed via the ipsilateral or contralateral femoral artery. However, transradial intervention is less invasive than the transfemoral approach. We evaluated initial results of transradial iliac artery stenting.

Methods and Results:

We implanted stents in 32 iliac arteries of 30 patients via the radial artery. Transradial intervention was attempted at the discretion of the operator. Clinical data were analyzed retrospectively. Patients were excluded using a scheduled bidirectional approach. Twenty-one patients were male. In all, 8, 20, 16, and 9 patients had diabetes mellitus, hypertension, dyslipidemia, and smoking habit, respectively. In all, 30 lesions were stenosed and only 2 were occluded. A total of 39 stents were inserted, of which 36 were E-Luminexx stents and the other 3 were SMART control stents. All lesions were successfully treated with a good final angiographic result via a 6F radial access system. Ankle brachial index significantly improved from 0.68 ± 0.13 to 0.92 ± 0.15 ( P < .01). Hospital stay was 2.09 ± 1.12 days. None of the patients had any procedural or access site-related complications (hematoma, major bleeding, blood transfusion, stroke, cholesterol embolism, aortic dissection, or arterial perforation).

Conclusions:

Transradial iliac artery stenting is a feasible and safe alternative in carefully selected patients.