bluuebunny/crossref_metadata_2025 huggingface dataset:
EXPLORANDO EL POTENCIAL DE ICP-MS EN EL ESTUDIO DE NANOPARTÍCULAS METÁLICAS EN CONTEXTOS CLÍNICOS Y TOXICOLÓGICOS
Authors: Rodríguez Martín-Doimeadios Rosa Carmen , Rodríguez Fariñas Nuria , Jiménez-Moreno María , Guzmán Bernardo Francisco Javier , López Sanz Sara , Fernández-Trujillo Sergio , Sánchez-Cachero Armando
Published: July 2024

El creciente uso de las nanopartículas metálicas (NPs) está generando una importante preocupación y se necesitan estudios toxicológicos para determinar los riesgos asociados. En estos estudios, se deben considerar las transformaciones que pueden sufrir las NPs, tales como la liberación de iones, adsorción de biomoléculas o procesos de agregación/aglomeración, que modifican sus propiedades y determinan su perfil toxicológico. En este contexto, es un reto para la Química Analítica conocer con detalle su composición química, cuantificarlas y poder seguir estas transformaciones. Aunque una sola técnica no proporciona toda la información requerida, la espectrometría de masas con plasma de acoplamiento inductivo (ICP-MS, Inductively Coupled Plasma Mass Spectrometry) está llamada a desempeñar un papel clave por sus características inherentes y el fácil acoplamiento a diferentes técnicas de separación. En este artículo se evalúan críticamente diversas modalidades de ICP-MS en la investigación de NPs en muestras de interés clínico y/o toxicológico.
Observational study on diet compliance in hospitalized patients diagnosed with liver disease
Authors: Yadav Ritu
Published: July 2024

Background: Malnutrition is very common in patients suffering with liver disorders and it is also proven to deteriorate the patient’s prognosis. Various types of liver disorders are linked with many nutrient deficiencies. Chronic liver disease patients generally exhibit fat malabsorption and decreased albumin levels. These physiological derangements lead to malnutrition in liver patients. These patients can undergo liver transplant, therefore improved nutritional status prior to transplant can improve their prognosis after transplant. Therefore, it is crucial to identify malnutrition in these patients in order to treat it and to achieve and maintain ideal body weight, improve their response to treatment and reduce complications. This study aimed to determine the nutritional status and dietary intake of CLD patients. Methods: A prospective observational study was conducted on the patients who were suffering from chronic liver disease, among which 50 subjects were studied, between 19 to 59 years of age. Duration of the study was 3 months. Nutritional status of the patients was assessed using Subjective global assessment (SGA) that was based on anthropometry, biochemical reports, clinical examination and dietary intake of patients. Results: On the basis of results obtained from the present study it can be concluded that majority of patients were males, the mean height of males was 163 cm and for females, it was 155 cm. The mean weight of males and females was 72 kg and 61 kg respectively. The majority of the patients showed Body Mass Index in the normal range. The majority (34%) of patients were suffering from Chronic liver disease, Alcoholic liver disease, with symptoms of jaundice, ascites, portal hypertension and diabetes. Diet intake data depicted that 54% patients had moderately lower energy and protein intake (60-79%) of their requirements Conclusion: It can be concluded from the present study that Chronic liver disease and treatment of Chronic liver disease both put the patients at nutritional risk by causing malnutrition, increased nutritional needs and decreased food intake. It can be prevented by timely or early detection of nutritional status or requirements, so that timely decision can be taken for right nutritional intervention for them
SPIRITUALITY AND ECOLOGY: EXPLORING THOMAS BERRY'S THOUGHTS ON THE RELATIONSHIP BETWEEN HUMANS AND NATURE "Spiritualitas dan Ekologi: Mendalami Pemikiran Thomas Berry tentang Hubungan Manusia dengan Alam"
Authors: Hadia Martanti Baiq
Published: July 2024

Penelitian ini bertujuan untuk menyelidiki pemikiran Thomas Berry tentang hubungan manusia dengan alam, dengan fokus pada dimensi spiritualitas dan ekologi. Metode yang digunakan adalah pendekatan kualitatif dengan analisis filosofis. Teknik pengumpulan data melibatkan studi literatur yang mendalam tentang karya-karya Berry dan kajian filsafat ekologi. Data dianalisis menggunakan pendekatan hermeneutika untuk memahami teks-teks yang relevan dengan konteks spiritualitas dan ekologi. Hasil penelitian mengungkapkan bahwa Berry menekankan pentingnya memandang alam sebagai subjek spiritual yang memiliki nilai intrinsik, bukan hanya sebagai objek pemanfaatan manusia. Implikasi dari pemikiran Berry adalah perlunya mengubah paradigma manusia terhadap alam, dari dominasi menjadi kerjasama dan penghormatan terhadap keberagaman hayati. Hal ini mendorong adopsi praktik-praktik ekologis yang berkelanjutan dan pengembangan spiritualitas yang menyatu dengan alam. Temuan ini memberikan implikasi yang signifikan bagi keberlanjutan lingkungan dan kesejahteraan manusia di masa depan
EKSPLORASI DESAIN USER INTERFACE ONLINE PUBLIC ACCESS CATALOG (OPAC) PERPUSTAKAAN BERBASIS WEBSITE DENGAN FIGMA
Authors: Andini Safitri  , Avini Tertia , Sugeng
Published: July 2024

Untuk memastikan pengalaman pengguna yang optimal, desain antarmuka pengguna (UI) sangat penting, terutama untuk sistem seperti OPAC (Online Public Access Catalog) di perpustakaan. Desain UI yang baik dapat meningkatkan aksesibilitas OPAC dan efisiensi penggunaan, sehingga pengguna dapat dengan mudah mencari dan mengakses sumber daya perpustakaan. Tujuan dari penelitian ini adalah untuk meningkatkan pengalaman pengguna OPAC melalui desain antarmuka berbasis web yang menggunakan Figma. Metode penelitian yang digunakan adalah DSRM (Design Science Research Methodology). Hasil penelitian menunjukkan bahwa desain antarmuka berbasis web dengan Figma dapat menyediakan fitur-fitur penting seperti pencarian, filter dan sortir, koleksi detail , serta halaman registrasi, yang semuanya mendukung peningkatan kualitas dan efisiensi website OPAC.
Manajemen dan Pengembangan Wakaf Produktif di Rumah Sakit “Pusat Kesehatan Umum ‘Aisiyyah” Boyolali
Authors: Merdekasari Nisa Fatikhah
Published: July 2024

Pengelolaan dan pengembangan wakaf yang produktif memiliki potensi besar di Indonesia.Wakaf merupakan salah satu strategi dalam meningkatkan pertumbuhan ekonomi. Wakaf produktif harus dikelola dan dikembangkan dengan baik guna meningkatkan kesejahteraan masyarakat. Penelitian ini bertujuan untuk mengetahui bagaimana rumah sakit PKU 'Aisiyyah Boyolali mengelola dan mengembangkan wakaf produktifnya. Penelitian ini merupakan penelitian kualitatif yang menggunakan analisis deskriptif dengan metode pengumpulan data melalui wawancara, observasi, dan dokumentasi. Analisis data menggunakan teknik analisis, penyimpulan, dan deskriptif. Pengelolaan wakaf di rumah sakit PKU 'Aisiyyah Boyolali menggunakan empat pilar manajemen; perencanaan, pengorganisasian, kepemimpinan, dan pengawasan. Dalam pengelolaannya, nazhir juga mengukur menggunakan analisis SWOT untuk meninjau kendala, peluang, hambatan, dan juga tantangan. Dengan pengelolaan yang baik, menciptakan produktifitas dan hasil yang dapat dikembangkan. Pengembangan rumah sakit dapat berwujud pembebasan lahan, dan memodernisasi fasilitas rumah sakit. Dalam mengembangkan hasil dari produktifitasnya rumah sakit memiliki program-program, antara lain; meningkatkan kualitas layanan, kerjasama, peningkatan fasilitas, dan publikasi keunggulan dan citra rumah sakit.
أولويات الإنفاق في حفظ الضروريات الخمس
Authors: Muttaqin Muhammad Azhar
Published: July 2024

قد وضع الشريعة الإسلامية الأمور الكثيرة حسب مكانها و ذلك بطريقة ترتيب الأولويات بين تلك الأمور. فمن بين تلك الأمور التي لها دور كبير في حفظ الضروريات الخمس هي إنفاق المال الذي يعد عصب الحياة و وسيلة المعيشة، فإن الأموال العامة هي عصب حياة الدولة ومواطينها والوسيلة العملية في إدارة دفة الحكم، وتتمثل الأموال العامة في الإيرادات والنفقات. و النفقة هي التي ينفقها شخص عام كالدولة و الهيئات و المؤسسات العامة التابعة للدولة لتحقيق مصلحة عامة. و من فوائد مراعاة الأولويات سيؤدي إلى رفع مستوى التفكير لدى المسلم بأسلوب مرن يتكيف مع الواقع، و بعقل نيّر وفق منهجية واضحة، وبالتالي سيساعد في تمكين الأمة الإسلامية من القدرة على مواجهة المتغيرات بحكمة، دون المعاناة من التعميمات والمتناقضات، وغير ذلك من انعكاسات سلبية على تربية الجيل. و أولويات الإنفاق في حفظ ضرورية الخمس تكون بمراعاة ثلاثة أقسام مرتبة ترتيبًا حسب الأهم فالمهم. فيجب أن يكون الإنفاق أولاً لتوفية الضروريات ثم الحاجيات ثم التحسينيات ويجب الإلتزام بهذا الترتيب وإلا خرج الإنفاق العام على مساره الصحيح وعدّ مخالفاً للشريعة.
Evaluering af sprogforståelsen i danske sprogmodeller - med udgangspunkt i semantiske ordbøger
Authors: Olsen Sussi
Published: July 2024

Artiklen beskriver hvordan vi har udviklet en række datasæt – et såkaldt benchmark – til at evaluere forskellige aspekter af sprogforståelse i danske sprogmodeller. Vores antagelse er at den viden der allerede er beskrevet i en række eksisterende danske ordbøger, kan opfattes som ’ground truth’ for semantikken i det danske ordforråd. Vores metode går derfor ud på at ’vende’ de semantiske ordbøger om og bruge dem til at generere et benchmark der afprøver modellernes evne til at forstå dansk. Mere specifikt undersøger vi hvor godt modellerne i) forstår synonymi, nærsynonymi, og hvornår noget er semantisk associeret, ii) skaber inferens i relation til begrebsmæssig viden og nedarvning af egenskaber fra overbegreb til underbegreb, iii) laver korrekte følgeslutninger i forbindelse med specifikke handlinger og hændelser, iv) skelner mellem centrale betydninger af et ord i kontekst og v) håndterer positiv og negativ konnotation eller ’sentiment’ i løbende tekst. Vi afprøver vores datasæt på ChatGPT 3.5 turbo og på ChatGPT 4.0 og kan se at datasættene har en passende sværhedsgrad i forhold til hvad modellerne er i stand til at håndtere, om end ChatGPT 4.0 opnår særdeles gode resultater for flere af datasættene.
Crossing the Textual Boundaries of James Clavell’s Novel Shōgun in FX’s TV Adaptation (2024)
Authors: Benslama Oussama , Souhali Hichem
Published: July 2024

This paper is an analytical, comparative study between James Clavell’s 1975 novel, Shōgun, and the 2024 mini-series adaptation created by Rachel Kondo and Justin Marks under the same name. It investigates the adaptation’s artful methods of storytelling and the crucial decisions made by the showrunners throughout its production. Their attempt to polish the rich original story written by Clavell represents an important showcase for all modern adaptations that aspire to bring new ideas into classical narratives. As the novel had been known for its tendency to divulge into, long explanatory segments about the cultural and inner workings of Japan through abundant descriptions told by an omniscient narrator and through the use of inner monologues, the TV series is left to face the challenge of fitting all of the cultural guidelines and abstract thoughts onto a different frame. To compensate for its bound lacklustre textual expression, the producers are forced to cross the novelistic boundaries of the book by focusing their efforts on the great visual potential that the story could offer. In this research, I will explore the decisions that carried the show throughout its episodes by relying on the structural theories of adaptation and the various socio-cultural opinions of scholars and critics, which revolve around the representation of Japanese culture by Western artists. My research mainly aims to assess the level of collaboration the two art mediums are able to achieve, both thematically and culturally, in their overall contribution to the story.
Gender patterns of transgender people: a historical, cultural and sociological reconstruction through the experience of social and health professionals
Authors: Coppola Marianna , Oliva Gabriele
Published: July 2024

This paper aims to illustrate the research path and methodological aspects of the study of sexual normativity with reference to a specific population of the LGBTQ+ universe, namely binary and non-binary transgender people in the Italian context through the analysis and historical reconstructions of the path of gender affirmation, in daily life and in the narrative proposed by the main old media. The decision to orient the focus of the analysis on transnormativity is related to the observation of an important research gap present in the scholarly literature, which has so far analyzed the processes of the construction of sexual normativity in mainstream society - and, as a result, has produced several studies and theorizing on heteronormativity and the male homosexual population (or homonormativity) - while conspicuously leaving out noncisgenderist sexual identities (transgender, genderfluid, agender, etc.). Following up on these premises, specifically, the following research questions were set: what are the reference gender models that guide and direct the identity construction of transgender people? And what are those of binary and non-binary people? how do these models reflect aspects attributable to mainstream sexual normativity (mainly heteronormativity and cisgenderism) furthermore, what differences are evident among these reference models in relation to various socio-demographic and identity aspects (how do they vary according to age, educational qualification, gender identity status, and sexual orientation). In order to try to answer the questions of the research design, a survey was conducted, using a biographical approach, through the administration of semi-structured interviews with privileged witnesses working in the field of gender reaffirmation pathways in the medical, clinical and legal fields, in order to reconstruct the chronological and cultural stages of the construction of transnormativity from the enactment of State Law 164/1982 to the present day. In contrast to this perspective, new, increasingly fluid, complex, and differentiated demands are emerging, which have generated debate on the one hand and tension both with mainstream society and within the LGBTQ+ community on the other. This further fragmentation of cis-heteronormative criteria could, for some, pose a threat to the achievements and social positions acquired through years of struggle, demands and construction of their own sexual normativity.
The global reach of the new Italian associationism: Challenges in the exploratory analysis of the phenomenon
Authors: Moffa Grazia
Published: July 2024

This study examines the evolution and impact of Italian associations abroad in the context of recent emigration trends. Italian migration has diversified in profiles, motivations, and paths since 2008, challenging traditional analysis models. Italian associations, which historically supported emigrant integration and cultural identity preservation, now adapt to new emigrant generations and skilled professionals. Using data from various Italian and international sources, the research highlights the associations’ roles in legal, professional, and emotional support, particularly through digital technologies. Case studies from Argentina and China illustrate their critical functions during crises like the COVID-19 pandemic. The findings emphasize the associations’ importance in maintaining cultural ties and providing practical assistance, underscoring their relevance in a globalized world.
Path-Dependent Criminality: Criminal Governance after the Paramilitary Demobilization in Cali and Medellín
Authors: Durán-Martínez Angélica
Published: July 2024

Objective/context: After the paramilitary demobilization in Colombia, Cali and Medellín—major cities with a long history of political and criminal violence—saw a decline in violence despite the continuing operation of criminal groups. Yet, while Cali remained more violent than the national average, with criminal groups displaying less ability to regulate local affairs and security, Medellín became less violent than the national average and criminal groups engaged in more intensive governance. Methodology: I compare these cities using case studies constructed through fieldwork and interviews with security officials, NGO and social leaders, and former members of groups, drawing on my long-term, ongoing research engagement in both locations. Conclusions: The contrast between these cities exemplifies varied manifestations of post-conflict criminality. I argue that this variation in criminal governance is connected to the wartime balance of power, specifically, the level of territorial control and political connections armed groups had before the demobilization. Where control and political connections of paramilitary before demobilization were high, post-conflict crime groups were more likely to engage in governance behaviors. By contrast, disputed territories during wartime were likely to experience less criminal governance. Drawing on path dependence ideas, I introduce an overlooked mechanism through which wartime orders affect criminal behavior: learning processes inside and outside criminal groups. Originality: I show that to fully understand post-conflict criminality, it is crucial to consider armed actors peripherally involved in the war but essential for territorial control, whereas to understand criminal governance, the mid-ranks of armed groups and learning processes are crucial.
La contribución de las mujeres de la diáspora colombiana organizada en Cataluña a la generación de prácticas trasnacionales de defensa de derechos humanos
Authors: Solarte Fuentes Lina , Camps Calvet Clara , Bonet-Marti Jordi , Almeda Samaranch Elisabet
Published: July 2024

Objective/context: To learn about the contributions of women of the organized Colombian diaspora in Catalonia to creating transnational practices in favor of peace and denunciation of human rights violations in Colombia. Specifically, we seek to identify the main actors, organizational spaces, and collective action repertoires developed by Colombian women in Catalonia. Therefore, we approach the literature on the political participation of migrant and exiled women from the perspective of political transnationalism. Methodology: This qualitative and participatory research study examines bibliographic and documentary sources, semi-structured interviews with Colombian women participating in the organized diaspora, and participant observation of mobilizations. Conclusions: The analysis and discussion of the results show that for some women, their participation is based on their exile and previous political involvement. For others, it is driven by the recognition of their condition as migrant subjects, as well as the different axes of inequality that cross them, which allows them to connect their individual discomfort with the collective discomfort of their country of origin and develop new interpretative frameworks and new repertoires of action aimed at sensitizing and influencing the Colombian socio-political reality. Originality: This research contribution allows for further debate on the transnational political role of migrations in a globalized world and what role women can play in it.
Effect of intensity training block on anxiety state and performance in competitive swimmers
Authors: Aouani Hajer , Amara Sofiene , Sahli Faten , Barbosa Tiago M. , Souissi Nizar , Tillaar Roland van den
Published: July 2024

Background

An increase in training intensity could create changes in psychological and physiological variables in competitive athletes. For this reason, it is very relevant to know how an intensive training block could influence psychological variables in competitive swimmers. This study examined the effect of an intensive training block (HIT) for 2 weeks on the anxiety state and swimming performance compared to standard aerobic training.

Methods

Twenty-two male competition swimmers were randomly assigned to two groups: HIT group (n = 11; age = 16.5 ± 0.29 years) and control group following the standard training program (n = 11; age = 16.1 ± 0.33 years). Psychological status variables (cognitive anxiety, somatic anxiety and self-confidence) and swimming performance (100-m front crawl) were measured pre-and post-test.

Results

A significant effect of time was found for all psychological variables and swimming performance (F ≥ 17.6; p < 0.001; d ≥ 0.97). Furthermore, a significant group × time interaction effect was found in cognitive (F = 14.9; p < 0.001; d = 0.62) and somatic anxiety (F = 5.37; p = 0.031; d = 0.55) were found. Only a significant group effect was found in somatic anxiety (F = 27.1; p < 0.001; d = 1.2). Post hoc comparison revealed that both groups increased their cognitive anxiety and swimming performance, and decreased their self-confidence from pre to post test. However, cognitive anxiety increase significantly more in the HIT group compared to the control group. Furthermore, only the HIT training group significantly increased somatic anxiety over time, while somatic anxiety did not change significantly over time in the control group.

Conclusion

Our findings indicated that a sudden increase in training intensity increased state anxiety more than standard training, but both conditions similarly enhanced swimming performance. Although the current level of psychological state is not affecting swimming performance negatively over this period, it should be regularly monitored by psychologists as it over a longer training period perhaps could have a negative influence on swimming performance.
Tunable Trion-Polaritons in Hybrid WS2-Plasmonic System
Authors: Wu Tingting , Luo Yu
Published: July 2024

The profound interplay between Two-Dimensional (2D) Transition Metal Dichalcogenides (TMDs) and cavity photons has facilitated a deeper understanding of the fundamental physical properties of many-body complexes and their response to light interaction. The intrinsic properties of trions in TMD semiconductors, together with their interaction with light, remain a scientific puzzle warranting experimental investigation. Here, by integrating WS2 flakes on a plasmonic metasurface, we demonstrate dynamically tunable weak, strong and ultra-strong couplings of trions to plasmons under ambient conditions. We demonstrate dynamically tunable couplings of trions to plasmons, demonstrating the potential to manipulate these interactions even at room temperature. In addition, the investigation extends to the effects of ultrastrong coupling on the ground state energy, providing insights into the tunable nature of trion-plasmon coupling. The results pave the way for advances in optoelectronic devices and quantum technologies that exploit the tunability of trion polaritons in hybrid WS2-plasmonic systems.
Encuadres construidos: Oportunidades de mediación arquitectónica para la experimentación ecológica en Alto Patache
Authors:   , Johnson Pérez Catalina
Published: July 2024

La presente tesis propone explorar el uso estratégico de las riquezas naturales para la experimentación y estudio del efecto de los objetos construidos en la flora y fauna de Alto Patache, bajo una propuesta de arquitectura como mediadora que tenga interés en el contexto ecológico como un sistema. Se trata de una consideración crítica y proyectual de las posibilidades de establecer arquitecturas e infraestructuras orientadas a la mediación, abordando la condición antrópica de habitabilidad humana y sus efectos ecológicos en el Oasis de Niebla de Alto Patache, región de Tarapacá, frente al problema de la disminución de especies endémicas de la zona. A partir de una mirada arquitectónica, se emplazan operaciones proyectuales en sectores específicos, que logren vincular lo vivo y no vivo que son relevantes a la tesis. El proyecto busca la implementación de una arquitectura consciente del entorno, que al mismo tiempo pueda albergar al ser humano como el responsable del estudio ecológico, la experimentación y del correcto funcionamiento de estos objetos eco-técnicos introducidos. La tesis explorará diversos escenarios de fricción existentes entre los organismos y el hábitat de Alto Patache con el fin de mediarlas a través de la arquitectura. Estas fricciones serán analizadas a la luz de los sujetos que habitan el desierto y los objetos con los cuales se relacionan actualmente. Esta lectura de escenario, objetos y sujetos en torno al concepto de fricción es una oportunidad de diseño. Al comprender y valorar las fricciones como puntos de contacto significativos, se abrirá la puerta a la exploración y el diseño de soluciones traducibles a un proyecto de arquitectura mediante estrategias que promuevan la interacción enriquecedora entre lo humano y lo no humano. La realización de un estudio para impulsar la ecología de un desierto reviste una importancia crítica dado el avance global de la desertificación. Esta problemática planetaria demanda una respuesta inmediata y multidisciplinaria. La presente investigación busca enfrentar esta problemática a través de soluciones innovadoras, que aborden tanto la conservación del ecosistema desertificado, como la adaptación de las sociedades a estos entornos cambiantes mediante una serie de encuadres de interés investigativo que se convertirán en marcos construidos de proyecto. Considerando que las formas modernas de ocupación del suelo por parte del ser humano implican la destrucción del ecosistema local, se propone investigar posibilidades donde -al contrario de provocar daño al resto de las especies- las estructuras humanas introducidas potencien lo preexistente, sin destruir el equilibrio ecosistémico. Esta perspectiva busca inspirar una nueva forma de habitar los ecosistemas, promoviendo soluciones innovadoras para la coexistencia entre el ser humano y el entorno natural a través del diseño.
Incidence of Major Insect Pest of Cluster Bean against Different Dates of Sowing
Authors: Arun Yadav Nishikant , Singh Pradyumn , Sasode Rajni S. , Singh Jagendra , Yadav A. S.
Published: July 2024

Aims: The present study was undertaken to determine the major sucking pests viz., jassid, Empoasca kerri, whitefly, Bemisia tabaci and aphid, Aphis craccivora and Thrips, Megalurothrips distalis attacking cluster bean crop sown at different dates to determine the optimum sowing of dates.
Place and Duration of Study: An experiment was conducted at the experimental farm, College of Agriculture, Gwalior (Madhya Pradesh) during two consecutive years of Kharif 2022 and 2023 to evaluate the effect of different sowing dates on incidence and severity of insect pest against cluster bean.
Methodology: An experiment was laid out in a simple randomized block design with five different dates of sowing. The observations on the population of sucking pest were recorded on Ten randomly selected tagged plants at weekly intervals. The data were subjected to statistical analysis by adopting the appropriate method of analysis of variance.
Results: The results show that the early sown crop had the minimum infestation of major sucking pests and the highest seed yield was obtained as compared to the late sowing crop. Our research found that sowing date has a substantial impact on pest populations, with early sowing dates often having fewer pest pressures than later dates. This can be attributed to the synchronization of crop development stages and insect life cycles.
Conclusion: The result was concluded that crops sown on early date are less susceptible to significant insect pests such aphid, jassid, thrips and whitefly. However, Crops sown later were more vulnerable to insect pest attack, resulting in more damage and lower production.
Validation of the revised International Prognostic Scoring System in treated patients with myelodysplastic syndromes
Authors: Mishra Asmita , Corrales‐Yepez Maria , Ali Najla Al , Kharfan‐Dabaja Mohamed , Padron Eric , Zhang Ling , Epling‐Burnette Pearlie K. , Pinilla‐Ibarz Javier , Lancet Jeffrey E. , List Alan F. , Komrokji Rami S.
Published: April 2013

The International Prognostic Scoring System (IPSS) was recently revised (IPSS‐R) under the auspices of the MDS Foundation as a collaborative international effort to refine its prognostic power. Our purpose was to externally validate this new risk model using a large single‐institution cohort, determine its prognostic power in patients receiving active treatment, and explore its utility in guiding therapeutic decisions. Data were collected retrospectively from our myelodysplastic syndrome (MDS) database and verified by chart review. Of the data available for 1,088 patients, 152 (14%), 353 (32%), 237 (22%), 190 (18%), and 156 (14%) patients were classified as very low, low, intermediate, high, and very high risk, respectively, with median overall survival (OS) of 90 (95%CI 71–109), 54 (95%CI 50–59), 34 (95%CI 26–43), 21 (95%CI 17–25), and 13 months (95%CI 11–15), respectively (P < 0.005). We found that the IPSS‐R further refined prognostic discrimination in all IPSS risk categories, particularly in the intermediate 1 and 2 groups. Among high and very high IPSS‐R patients receiving azacitidine, OS was significantly improved versus patients not receiving azacitidine, with corresponding median OS of 25 versus 18 months (P = 0.028) and 15 versus 9 months (P = 0.005), respectively. Similarly, patients with IPSS‐R high‐ and very high‐risk disease who underwent allogeneic hematopoietic stem cell transplantation had significantly improved OS versus nontransplant approaches (P < 0.005). High and very high IPSS‐R patients derived a survival advantage from disease‐modifying therapies. Our data validate the prognostic value of the proposed IPSS‐R and show that its refined IPSS prognostic discrimination can be applied to actively treated patients. Am. J. Hematol. 88:566–570, 2013. © 2013 Wiley Periodicals, Inc.
Management and outcomes for patients with TTP: analysis of 100 cases at a single institution
Authors: Chaturvedi Shruti , Carcioppolo Desiree , Zhang Li , McCrae Keith R.
Published: April 2013

The advent of plasma exchange has led to a dramatic improvement in the survival of patients with thrombotic thrombocytopenic purpura (TTP), though approximately 10% of patients still die and a third suffer relapses. Clinical features that identify poor risk patients have not been clearly identified. We reviewed 100 patients who were treated for a first episode of TTP at the Cleveland Clinic between 2000 and 2012 to identify factors predictive of poor outcomes. On multivariate analysis, increasing age, especially age > 60 (RR: 7.08, 95% CI: 2.15–23.39, P = 0.002), severe neurological symptoms at presentation (RR: 18.37, 95% CI: I4.19–80.13, P < 0.001) and a persistently elevated LDH level after two plasma exchanges were predictive of mortality. Patients with ADAMTS13 activity above or below 5% did not differ in terms of clinical presentation or mortality and relapse rates, although ADAMTS13 activity > 5% was an independent predictor of adverse renal outcomes (need for dialysis and progression to chronic kidney disease). These variables may be useful for risk stratification and identification of patients who could potentially benefit from early institution of adjunctive therapy. Am. J. Hematol. 88:560–565, 2013. © 2013 Wiley Periodicals, Inc.
Genetic modifiers of sickle cell anemia in the BABY HUG cohort: influence on laboratory and clinical phenotypes
Authors: Sheehan Vivien A. , Luo Zhaoyu , Flanagan Jonathan M. , Howard Thad A. , Thompson Bruce W. , Wang Winfred C. , Kutlar Abdullah , Ware Russell E. ,   BABY HUG Investigators
Published: April 2013

The recently completed BABY HUG trial investigated the safety and efficacy of hydroxyurea in infants with sickle cell anemia (SCA). To investigate the effects of known genetic modifiers, genomic DNA on 190 randomized subjects were analyzed for alpha thalassemia, beta‐globin haplotype, polymorphisms affecting endogenous fetal hemoglobin (HbF) levels (XmnI, BCL11A, and HBS1L‐MYB), UGT1A1 promoter polymorphisms, and the common G6PD A− mutation. At study entry, infants with alpha thalassemia trait had significantly lower mean corpuscular volume, total bilirubin, and absolute reticulocyte count. Beta‐globin haplotypes associated with milder disease had significantly higher hemoglobin and %HbF. BCL11A and XmnI polymorphisms had significant effects on baseline HbF, while UGT1A1 promoter polymorphisms significantly influenced baseline serum bilirubin. At study exit, subjects randomized to placebo still exhibited laboratory effects of alpha thalassemia and other modifiers, while those assigned hydroxyurea had treatment effects that exceeded most genetic influences. The pain phenotype was influenced by HbF modifiers in both treatment groups. These data document that genetic polymorphisms do modify laboratory and clinical phenotypes even in very young patients with SCA. The hydroxyurea effects are more potent, however, indicating that treatment criteria should not be limited to certain genetic subsets, and supporting the use of hydroxyurea for all young patients with SCA. Am. J. Hematol. 88:571–576, 2013. © 2013 Wiley Periodicals, Inc.
Optimal timing of allogeneic hematopoietic stem cell transplantation in patients with myelodysplastic syndrome
Authors: Alessandrino Emilio Paolo , Della Porta Matteo G. , Malcovati Luca , Jackson Christopher H , Pascutto Cristiana , Bacigalupo Andrea , van Lint Maria Teresa , Falda Michele , Bernardi Massimo , Onida Francesco , Guidi Stefano , Iori Anna Paola , Cerretti Raffaella , Marenco Paola , Pioltelli Pietro , Angelucci Emanuele , Oneto Rosi , Ripamonti Francesco , Rambaldi Alessandro , Bosi Alberto , Cazzola Mario ,   Gruppo Italiano Trapianto di Midollo Osseo (GITMO)
Published: April 2013

Allogeneic hematopoietic stem cell transplantation (HSCT) represents the only curative treatment for patients with myelodysplastic syndrome (MDS), but involves non‐negligible morbidity and mortality. Registry studies have shown that advanced disease stage at transplantation is associated with inferior overall survival. To define the optimal timing of allogeneic HSCT, we carried out a decision analysis by studying 660 patients who received best supportive care and 449 subjects who underwent transplantation. Risk assessment was based on both the International Prognostic Scoring System (IPSS) and the World Health Organization classification‐based Prognostic Scoring System (WPSS). We used a continuous‐time multistate Markov model to describe the natural history of disease and evaluate the effect of allogeneic HSCT on survival. This model estimated life expectancy from diagnosis according to treatment policy at different risk stages. Relative to supportive care, estimated life expectancy increased when transplantation was delayed from the initial stages until progression to intermediate‐1 IPSS‐risk or to intermediate WPSS‐risk stage, and then decreased for higher risks. Modeling decision analysis on WPSS versus IPSS allowed better estimation of the optimal timing of transplantation. These observations indicate that allogeneic HSCT offers optimal survival benefits when the procedure is performed before MDS patients progress to advanced disease stages. Am. J. Hematol. 88:581–588, 2013. © 2013 The Authors Americanl Journal of Hematology Published by Wiley Periodicals, Inc.
Relationships between diurnal changes in blood pressure and catecholamines among Filipino‐American and European‐American women
Authors: Van Berge‐Landry Helene , James Gary D. , Brown Daniel E.
Published: April 2013

Objectives

Studies show that diurnal blood pressure (BP) sensitivity to epinephrine (EPI) in African‐American women is significantly greater than that of European‐American (EA) women. Few if any studies have examined diurnal catecholamine‐BP relationships in women of other ethnic groups. The purpose of this study was to compare the effects of diurnal changes in EPI and norepinephrine (NE) on the diurnal changes in BP between Filipino‐American (FA) and EA women.

Methods

The subjects included 31 FA and 27 EA nurses and nurses aides and eight FA and 19 EA hotel workers from Hawaii who wore an ambulatory BP monitor and collected timed urine specimens (4 h at work, approx.4 h at home and approx. 8 h overnight) for assay of EPI and NE. Proportional changes in systolic and diastolic BP from sleep to work and sleep to home were examined using ANCOVA models including fixed effect‐covariate interactions, with ethnicity as a fixed factor, and BMI and the appropriate proportional change in EPI or NE as covariates.

Results

The results show that there was no association between changes in EPI and BP, either overall or by ethnic group; however, overall changes in diastolic BP from sleep to work tended to be smaller among the FAs (P < 0.06). There was also an interactive effect of NE and ethnic group on diastolic BP such that among FAs, as diastolic BP increased, the corresponding NE change decreased (P < 0.039).

Conclusion

The relationships between diurnal BP and catecholamine variations differ by ethnicity. Further research is needed to better understand the mechanisms behind the differences and to evaluate whether this vascular tonic relationship has been the focus of natural selective processes. Am. J. Hum. Biol. 25:431–433, 2013. © 2013 Wiley Periodicals, Inc.
Characterization of the infant BMI peak: Sex differences, birth year cohort effects, association with concurrent adiposity, and heritability
Authors: Johnson William , Choh Audrey C. , Lee Miryoung , Towne Bradford , Czerwinski Stefan A. , Demerath Ellen W.
Published: April 2013

Objectives

To characterize an early trait in the BMI‐for‐age curve, the infant BMI peak.

Methods

BMI‐for‐age curves were produced for 747 non‐Hispanic, white Fels Longitudinal Study participants, from which individual age (AgePeak) and BMI (BMIPeak) at maximum infant BMI were estimated. Multivariable general linear regression was used to examine the effects of sex and birth year cohort (1929–1950, 1951–1970, and 1971–2010) on AgePeak and BMIPeak, with associations between BMIPeak and concurrent sum of four skinfold thicknesses assessed in a subsample (N = 155). Heritability (h2) of AgePeak and BMIPeak was estimated using maximum‐likelihood variance components analysis.

Results

AgePeak occurred at 9 months of age in both sexes, but BMIPeak was 0.4 kg/m2 higher for boys than for girls (P‐value < 0.001). Infants born between 1971 and 2010 experienced a 1.5 month earlier AgePeak and a 0.35 kg/m2 lower BMIPeak than infants born between 1929 and 1950 (P‐values < 0.001). Skinfold thickness explained 37% of the variance in BMIPeak in boys and 20% of the variance in girls (p‐values < 0.001). AgePeak and BMIPeak were significantly heritable (h2 = 0.54 and 0.75, respectively).

Conclusions

Both AgePeak and BMIPeak decreased over successive birth year cohorts in the Fels Longitudinal Study. Despite a positive association of BMIPeak with concurrent adiposity, AgePeak appears to occur later than does the well‐documented peak in infant fat mass and BMIPeak does not capture known sex differences in infant adiposity. Strong heritability of these infant BMI traits suggests investigation of genetic control, and validation of their relationship to body composition is greatly needed. Am. J. Hum. Biol. 25:378–388, 2013. © 2013 Wiley Periodicals, Inc.
Relationships between biomarkers of inflammation, ovarian steroids, and age at menarche in a rural polish sample
Authors: Clancy Kathryn B.H. , Klein Laura D. , Ziomkiewicz Anna , Nenko Ilona , Jasienska Grazyna , Bribiescas Richard G.
Published: April 2013

Objectives

To test the hypothesis that life history trade‐offs between maintenance and reproductive effort would be evident through inverse associations between levels of a biomarker of inflammation [C‐reactive protein (CRP)], and ovarian hormones. Associations between CRP and age at menarche were also explored.

Methods

Urinary CRP, salivary progesterone, and estradiol were measured over one menstrual cycle from rural Polish women (n = 25), representing a natural fertility sample. Age of menarche was assessed through interview recall methods. We used minimum second‐order Akaike Information Criteria as a means of multiple regression model selection, and repeated measures ANOVA to test cycle‐dependent hypotheses.

Results

Comparisons of individuals in high and low CRP tertiles revealed that those with high CRP had significantly lower progesterone (luteal P = 0.03, mid luteal P = 0.007) but not estradiol (follicular P = 0.21, luteal P = 0.15) concentrations through the menstrual cycle. However, when the age at menarche was included in the analysis, both age at menarche and urinary CRP were negatively associated with estradiol (R2 = 0.44, P = 0.0007). Age at menarche and estradiol were the strongest negative predictors of CRP (R2 = 0.52, P = 0.0001).

Conclusions

Inflammation itself may suppress ovarian function, or indicate immune challenges that lead to ovarian suppression. The timing of menarche may also influence adult inflammatory sensitivity and ovarian hormone concentrations. This lends support to existing models of trade‐offs between maintenance and reproduction in women. Am. J. Hum. Biol. 25:389–398, 2013. © 2013 Wiley Periodicals, Inc.
Ambulatory blood pressure and blood lipids in a multiethnic sample of healthy adults
Authors: James Gary D. , Van Berge‐Landry Helene M. , Morrison Lynn A. , Reza Angela M. , Nicolaisen Nicola M. , Bindon James R. , Brown Daniel E.
Published: April 2013

Objectives

Elevated blood pressure (BP), elevated serum cholesterol, and aberrant lipoprotein fractions (low levels of high‐density lipoprotein (HDL) and high levels of low‐density lipoprotein fractions and triglycerides) have all been used as measures that assess the “metabolic syndrome” and more recently in indexes of allostatic load, which are designed to assess the degree of integrated metabolic pathology. While there are ample data regarding the interrelationships of these measures in various pathophysiological settings, there are limited data regarding the interrelationship of ambulatory BP (ABP) and blood lipids in healthy subjects. The present study evaluates ABP‐blood lipid relationships in a multiethnic sample of healthy adults.

Methods

The subjects were 37 men (age = 40.9 ± 10.7 years) and 42 women (age = 35.8 ± 10.4 years) who were employed as hotel workers in Hawaii. Each wore an ABP monitor for one midweek workday and had pressures averaged in three daily microenvironments (work, home, and during sleep). They also had fasting blood samples taken for lipid profiling.

Results

Multivariate analysis of covariance shows that there was a strong inverse relationship between HDL and both systolic (P < 0.006) and diastolic (P < 0.006) BP, overall and in each microenvironment, but no statistically significant relationships with other lipid measures.

Conclusion

These results suggest lipids and BP do not act as a group in healthy adults but that higher HDL is associated with lower BP. This latter finding is consistent with research that shows that HDL promotes vasodilation via its effect on endothelial nitric oxide synthase. Am. J. Hum. Biol. 25:563–565, 2013. © 2013 Wiley Periodicals, Inc.
Interrater reliability of a phenotypic assessment tool for the ear morphology in microtia
Authors: Luquetti Daniela V. , Saltzman Babette S. , Sie Kathleen C. , Birgfeld Craig B. , Leroux Brian G. , Evans Kelly N. , Smartt James M. , Tieu David D. , Dudley Daniel J. , Heike Carrie L.
Published: April 2013

The Elements of Morphology Standard Terminology working group published standardized definitions for external ear morphology. The primary objective of our study was to use these descriptions to evaluate the interrater reliability for specific features associated with microtia. We invited six raters from three different subspecialities to rate 100 ear photographs on 32 features. We calculated overall and within specialty and professional experience intraclass correlation coefficients (ICC) and 95% confidence intervals. A total of 600 possible observations were recorded for each feature. The overall interrater reliability ranged from 0.04 (95% CI: 0.00–0.14) for the width of the antihelix inferior crus to 0.93 (95% CI: 0.91–0.95) for the presence of the inferior crux of the antihelix. The reliability for quantitative characteristics such as length or width of an ear structure was generally lower than the reliability for qualitative characteristics (e.g., presence or absence of an ear structure). Categories with very poor interrater reliability included anti‐helix inferior crux width (0.04, 95% CI: 0.00–0.14), crux helix extension (0.17, 95% CI 0.00–0.37), and shape of the incisura (0.14, 95% CI: 0.01–0.27). There were no significant differences in reliability estimates by specialty or professional experience for most variables. Our study showed that it is feasible to systematically characterize many of structures of the ear that are affected in microtia. We incorporated these descriptions into a standardized phenotypic assessment tool (PAT‐Microtia) that might be used in multicenter research studies to identify sub‐phenotypes for future studies of microtia. © 2013 Wiley Periodicals, Inc.
Low‐frequency electrical stimulation of a fiber tract in temporal lobe epilepsy
Authors: Koubeissi Mohamad Z. , Kahriman Emine , Syed Tanvir U. , Miller Jonathan , Durand Dominique M.
Published: April 2013

Objective

Surgical resection of the temporal lobe is an effective treatment for medically intractable temporal lobe epilepsy, but can cause memory impairment. Deep brain stimulation in epilepsy has targeted gray matter structures using high frequencies, but achieved limited success. We tested the hypothesis that low‐frequency stimulation of the fornix reduces interictal epileptiform discharges and seizures in patients with intractable mesial temporal lobe epilepsy, without affecting memory.

Methods

We implanted depth electrodes in 11 patients for surgical evaluation of intractable epilepsy. Low‐frequency stimulation of the fornix occurred in 4‐hour sessions in the video‐electroencephalography unit. Mental status assessment was performed at baseline and during stimulation. We studied the effect of stimulation on hippocampal spikes and seizures.

Results

There were no complications, and the patients were unaware of the stimulation. Fornix stimulation elicited evoked responses in the hippocampus and the posterior cingulate gyrus. Hourly Mini‐Mental Status Examination (MMSE) scores showed an increase during stimulation when compared to prestimulation MMSE, largely due to improvement in recall, possibly representing a practice effect. Hippocampal spikes were significantly reduced during and outlasting each stimulation session. Seizure odds (n = 7) were reduced by 92% in the 2 days that followed stimulation.

Interpretation

Low‐frequency stimulation of the fornix activates the hippocampus and other areas of the declarative memory circuit. The results of this preliminary study suggest that low‐frequency stimulation is tolerable and reduces epileptiform discharges and seizures in patients with intractable mesial temporal lobe epilepsy. A controlled clinical trial may be warranted. Ann Neurol 2013;74:223–231
A novel treatment‐responsive encephalitis with frequent opsoclonus and teratoma
Authors: Armangue Thaís , Titulaer Maarten J. , Sabater Lidia , Pardo‐Moreno Javier , Gresa‐Arribas Nuria , Barbero‐Bordallo Natalia , Kelley Gordon R. , Kyung‐Ha Noh , Takeda Akitoshi , Nagao Takahiro , Takahashi Yukitoshi , Lizcano Angélica , Carr Aisling S. , Graus Francesc , Dalmau Josep
Published: April 2013

Among 249 patients with teratoma‐associated encephalitis, 211 had N‐methyl‐D‐aspartate receptor antibodies and 38 were negative for these antibodies. Whereas antibody‐positive patients rarely developed prominent brainstem–cerebellar symptoms, 22 (58%) antibody‐negative patients developed a brainstem–cerebellar syndrome, which in 45% occurred with opsoclonus. The median age of these patients was 28.5 years (range = 12–41), 91% were women, and 74% had full recovery after therapy and tumor resection. These findings uncover a novel phenotype of paraneoplastic opsoclonus that until recently was likely considered idiopathic or postinfectious. The triad of young age (teenager to young adult), systemic teratoma, and high response to treatment characterize this novel brainstem–cerebellar syndrome. ANN NEUROL 2014;75:435–441