bluuebunny/crossref_metadata_2025 huggingface dataset:
Utility and diagnostic accuracy of endobronchial ultrasound-guided transbronchial fine-needle aspiration cytology of mediastinal lesions: Saudi Arabian experience
Authors: Raddaoui Emad , Alhamad Esam H , Zaidi Shaesta Naseem , Al-Habeeb Fatmah F , Arafah Maha
Published: July 2014

Objective:

The objective of this study is to evaluate the cytological accuracy of endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS-TFNA) of the mediastinal mass/nodular lesions.

Study Design:

Over 3½ years from inception at King Khalid University Hospital, a retrospective analysis of the cytological diagnoses of all the EBUS-TFNA procedures performed in 80 patients who had mediastinal mass/nodular enlargement. Cytology results were reviewed and correlated with the histologic follow-up.

Results:

Of the 80 patients who underwent EBUS-TFNA, 15 cases (18.75%) were positive for malignancy, 48 cases (60%) negative for malignancy and 17 cases (21.25%) unsatisfactory. Of the 48 cases, which were negative for malignancy, 24 (50%) cases were of granulomatous inflammation. The overall diagnostic yield of our EBUS-TFNA specimen was 78.75%. Forty-seven cases (58.75%) of 80 cases had histological follow-up biopsies. Among them, 32 cases (68%) had the same cytological and histological diagnosis and 15 cases (31.09%) had discordance between the cytology and the follow-up histological diagnosis. The sensitivity, specificity, and positive and negative predictive values for diagnosing granulomas by EBUS-TFNA are 77%, 82%, 83%, and 75% and for diagnosing malignancy are 71%, 100%, 100%, and 82%, respectively.

Conclusion:

Preliminary results show that cytological samples obtained through EBUS-TFNA are accurate and specific in making a diagnosis of the mediastinal mass/nodular lesions. Its optimum use depends on the effective collaboration between the cytotechnologist, pathologist, and the bronchoscopist.
The Impact of SCHIP on Insurance Coverage of Children
Authors: Hudson Julie L. , Selden Thomas M. , Banthin Jessica S.
Published: July 2014

In this paper we use the Medical Expenditure Panel Survey between 1996 and 2002 to investigate the impact of the State Children's Health Insurance Program (SCHIP) on insurance coverage for children. We explore a range of alternative estimation strategies, including instrumental variables and difference-in-trends models. We find that SCHIP had a significant impact in decreasing uninsurance and increasing public insurance for both children targeted by SCHIP and those eligible for Medicaid. With respect to changes in private coverage our results are less conclusive: some specifications resulted in no significant effect of SCHIP on private insurance coverage, while others showed significant decreases in private insurance. Associated estimates of SCHIP crowd-out had wide confidence intervals and were sensitive to estimation strategy.
Unstable Inferences? An Examination of Complex Survey Sample Design Adjustments Using the Current Population Survey for Health Services Research
Authors: Davern Michael , Jones Arthur , Lepkowski James , Davidson Gestur , Blewett Lynn A.
Published: July 2014

Statistical analysis of the Current Population Survey's Annual Social and Economic Supplement is used widely in health services research. However, the statistical evidence cited from the Current Population Survey (CPS) is not always consistent because researchers use a variety of methods to produce standard errors that are fundamental to significance tests. This analysis examines the 2002 Annual Social and Economic Supplement's (ASEC) estimates of national and state average income, national and state poverty rates, and national and state health insurance coverage rates. Findings show that the standard error estimates derived from the public use CPS data perform poorly compared with the survey design-based estimates derived from restricted internal data, and that the generalized variance parameters currently used by the U.S. Census Bureau in its ASEC reports and funding formula inputs perform erratically. Because the majority of published research (both by academics and Census Bureau analysts) does not make use of the survey design-based information available only on the internal ASEC data file, we argue that the Census Bureau ought to use alternative methods for its official ASEC reports. We also argue that for public use data the Census Bureau should produce a set of replicate weights for the ASEC or release a set of sample design variables that incorporate statistical “noise” to maintain respondent confidentiality (e.g., pseudo-primary sampling units) as other federal government surveys do. This is essential to make appropriate inferences using the ASEC data regarding statistical significance and estimate variance for health policy analysis.
Comparison of surface and column measurements of aerosol scattering properties over the western North Atlantic Ocean at Bermuda
Authors: Aryal R. P. , Voss K. J. , Terman P. A. , Keene W. C. , Moody J. L. , Welton E. J. , Holben B. N.
Published: July 2014

Abstract. Light scattering by size-resolved aerosols in near-surface air at Tudor Hill, Bermuda, was measured between January and June 2009. Vertical distributions of aerosol backscattering and column-averaged aerosol optical properties were characterized in parallel with a micro-pulse lidar (MPL) and an automated sun–sky radiometer. Comparisons were made between extensive aerosol parameters in the column, such as the lidar-retrieved extinction at 400 m and the aerosol optical depth (AOD), and scattering was measured with a surface nephelometer. Comparisons were also made for intensive parameters such as the Ångström exponent and calculations using AERONET(Aerosol Robotic Network)-derived aerosol physical parameters (size distribution, index of refraction) and Mie theory, and the ratio of submicron scattering to total scattering for size-segregated nephelometer measurements. In these comparisons the r2 was generally around 0.50. Data were also evaluated based on back trajectories. The correlation between surface scattering and lidar extinction was highest for flows when the surface scattering was dominated by smaller particles and the flow had a longer footprint over land then over the ocean. The correlation of AOD with surface scatter was similar for all flow regimes. There was also no clear dependence of the atmospheric lapse rate, as determined from a nearby radiosonde station, on flow regime. The Ångström exponent for most flow regimes was 0.9–1.0, but for the case of air originating from North America, but with significant time over the ocean, the Ångström exponent was 0.57 ± 0.18. The submicron fraction of aerosol near the surface (Rsub-surf) was significantly greater for the flows from land (0.66 ± 0.11) than for the flows which spent more time over the ocean (0.40 ± 0.05). When comparing Rsub-surf and the column-integrated submicron scattering fraction, Rsub-col, the correlation was similar, r2 = 0.50, but Rsub-surf was generally less than Rsub-col, indicating more large particles contributing to light scattering at the surface, contrary to conditions over continents and for polluted continental transport over the ocean. In general, though, the marginal correlations indicate that the column optical properties are weakly correlated with the surface optical measurements. Thus, if it is desired to associate aerosol chemical/physical properties with their optical properties, it is best to use optical and chemical/physical measurements with both collected at the surface or both collected in the column.
Reactive oxygen species associated with water-soluble PM2.5 in the southeastern United States: spatiotemporal trends and source apportionment
Authors: Verma V. , Fang T. , Guo H. , King L. , Bates J. T. , Peltier R. E. , Edgerton E. , Russell A. J. , Weber R. J.
Published: July 2014

Abstract. We assess the potential of the water-soluble fraction of atmospheric fine aerosols in the southeastern US to generate reactive oxygen species (ROS) and identify major ROS-associated emission sources. ROS-generation potential of particles was quantified by the dithiothreitol (DTT) assay and involved analysis of fine particulate matter (PM) extracted from high-volume quartz filters (23 h integrated samples) collected at various sites in different environmental settings in the southeast, including three urban Atlanta sites, in addition to a rural site. Paired sampling was conducted with one fixed site in Atlanta (Jefferson Street), representative of the urban environment, with the others rotating among different sites, for ~250 days between June 2012 and September 2013 (N = 483). A simple linear regression between the DTT activity and aerosol chemical components revealed strong associations between PM ROS generation potential and secondary organic aerosol (WSOC) in summer, and biomass burning markers in winter. Redox-active metals were also correlated with the DTT activity, but mostly at urban and roadside sites. Positive matrix factorization (PMF) was applied to apportion the relative contribution of various sources to the ROS generation potential of water-soluble PM2.5 in urban Atlanta. PMF showed that vehicular emissions contribute uniformly throughout the year (12 to 25%), while secondary oxidation processes dominated the DTT activity in summer (46%) and biomass burning in winter (47%). Mineral dust was significant only during drier periods (~12% in summer and fall). Source apportionment by chemical mass balance (CMB) was reasonably consistent with PMF, but with higher contribution from vehicular emissions (32%). Given the spatially large data set of PM sampled over an extended period, the study reconciles the results from previous work that showed only region- or season-specific aerosol components or sources contributing to PM ROS activity, possibly due to smaller sample sizes. Our results indicate that the ability to generate ROS is a generic property of fine PM to which almost all major emission sources contribute to variable extents. The ubiquitous nature of the ROS generation property of ambient particulate matter suggests widespread population exposures to aerosol components that have the ability to catalyze the production of oxidants in vivo.
HCOOH measurements from space: TES retrieval algorithm and observed global distribution
Authors: Cady-Pereira K. E. , Chaliyakunnel S. , Shephard M. W. , Millet D. B. , Luo M. , Wells K. C.
Published: July 2014

Abstract. Presented is a detailed description of the TES (Tropospheric Emission Spectrometer)-Aura satellite formic acid (HCOOH) retrieval algorithm and initial results quantifying the global distribution of tropospheric HCOOH. The retrieval strategy, including the optimal estimation methodology, spectral microwindows, a priori constraints, and initial guess information, are provided. A comprehensive error and sensitivity analysis is performed in order to characterize the retrieval performance, degrees of freedom for signal, vertical resolution, and limits of detection. These results show that the TES HCOOH retrievals (i) typically provide at best 1.0 pieces of information; (ii) have the most vertical sensitivity in the range from 900 to 600 hPa with ~ 2 km vertical resolution; (iii) require at least 0.5 ppbv (parts per billion by volume) of HCOOH for detection if thermal contrast is greater than 5 K, and higher concentrations as thermal contrast decreases; and (iv) based on an ensemble of simulated retrievals, are unbiased with a standard deviation of ±0.4 ppbv. The relative spatial distribution of tropospheric HCOOH derived from TES and its associated seasonality are broadly correlated with predictions from a state-of-the-science chemical transport model (GEOS-Chem CTM). However, TES HCOOH is generally higher than is predicted by GEOS-Chem, and this is in agreement with recent work pointing to a large missing source of atmospheric HCOOH. The model bias is especially pronounced in summertime and over biomass burning regions, implicating biogenic emissions and fires as key sources of the missing atmospheric HCOOH in the model.
Quantifying the impact of ocean acidification on our future climate
Authors: Matear R. J. , Lenton A.
Published: July 2014

Abstract. Ocean acidification (OA) is the consequence of rising atmospheric CO2 levels, and it is occurring in conjunction with global warming. Observational studies show that OA will impact ocean biogeochemical cycles. Here, we use an Earth system model under the RCP8.5 emission scenario to evaluate and quantify the first-order impacts of OA on marine biogeochemical cycles, and its potential feedback on our future climate. We find that OA impacts have only a small impact on the future atmospheric CO2 (less than 45 ppm) and global warming (less than a 0.25 K) by 2100. While the climate change feedbacks are small, OA impacts may significantly alter the distribution of biological production and remineralisation, which would alter the dissolved oxygen distribution in the ocean interior. Our results demonstrate that the consequences of OA will not be through its impact on climate change, but on how it impacts the flow of energy in marine ecosystems, which may significantly impact their productivity, composition and diversity.
Correction of systematic model forcing bias of CLM using assimilation of cosmic-ray neutrons and land surface temperature: a study in the Heihe catchment, China
Authors: Han X. , Hendricks Franssen H.-J. , Rosolem R. , Jin R. , Li X. , Vereecken H.
Published: July 2014

Abstract. The recent development of the non-invasive cosmic-ray soil moisture sensing technique fills the gap between point scale soil moisture measurements and regional scale soil moisture measurements by remote sensing. A cosmic-ray probe measures soil moisture for a footprint with a diameter of ~600 m (at sea level) and with an effective measurement depth between 12 and 76 cm, depending on the soil humidity. In this study, it was tested whether neutron counts also allow to correct for a systematic error in the model forcings. Lack of water management data often cause systematic input errors to land surface models. Here, the assimilation procedure was tested for an irrigated corn field (Heihe Watershed Allied Telemetry Experimental Research – HiWATER, 2012) where no irrigation data were available as model input although the area a significant amount of water was irrigated. Measured cosmic-ray neutron counts and Moderate Resolution Imaging Spectroradiometer (MODIS) land surface temperature (LST) products were jointly assimilated into the Community Land Model (CLM) with the Local Ensemble Transform Kalman Filter. Different data assimilation scenarios were evaluated, with assimilation of LST and/or cosmic-ray neutron counts, and possibly parameter estimation of leaf area index (LAI). The results show that the direct assimilation of cosmic-ray neutron counts can improve the soil moisture and evapotranspiration (ET) estimation significantly, correcting for lack of information on irrigation amounts. The joint assimilation of neutron counts and LST could improve further the ET estimation, but the information content of neutron counts exceeded the one of LST. Additional improvement was achieved by calibrating LAI, which after calibration was also closer to independent field measurements. It was concluded that assimilation of neutron counts was useful for ET and soil moisture estimation even if the model has a systematic bias like neglecting irrigation. However, also the assimilation of LST helped to correct the systematic model bias introduced by neglecting irrigation and LST could be used to update soil moisture with state augmentation.
Bundesrepublik Deutschland v. Kaveh Puid (E.C.J.)
Authors: Goodwin-Gill Guy S.
Published: July 2014

The judgment in Bundesrepublik Deutschland v. Kaveh Puid concerns the Common European Asylum System (CEAS) and, in particular, the “Dublin Rules,” the intra-European arrangement that governs which State shall be responsible for determining a claim to asylum. This process began under the 1990 Dublin Convention, which was replaced by European Union (EU) Regulation 343/2003, commonly referred to as “Dublin II” (Dublin Regulation).
O Telejornalismo Estendido nas Redes Sociais: Participação ou Interação?
Authors: CAJAZEIRA Paulo Eduardo Silva Lins
Published: July 2014

Os processos de convergência de mídias TV/Internet geram novas formas de participação da audiência no telejornalismo e simulam um sistema de interação dinâmico e aparentemente constante. Este estudo procura compreender as novas relações comunicacionais do telejornal, com o uso das Redes Sociais, na Internet. A presença quase onipresente da televisão na sociedade contemporânea tem apresentado uma alteração na produção e na recepção dos mass media. Na parte empírica da investigação, realizou-se um monitoramento das interações dos sujeitos (telejornal/público), nos perfis dos telejornais (fanpages) Edição da Manhã (SIC TV/Portugal) e Bom Dia Brasil (TV Globo/Brasil), na Rede Social Facebook, de 02 de setembro a 31 de dezembro de 2013, com o objetivo de verificar as novas formas de comunicação do telejornalismo estendido em multiplataformas digitais. As Teorias da Comunicação, a Semiótica e a Análise da Linguagem e do Conteúdo no ambiente virtual são tomadas como base para analisar as participações e as interações, por meio da interface das fanpages, na Internet.
Jornalismo Científico, Ambiental e de Saúde: Análise dos Trabalhos Apresentados nos Primeiros Dez Encontros da SBPJor
Authors: JOHN Valquíria Michela , COSTA Felipe Da , TONINI Jamile
Published: July 2014

Neste trabalho nos propomos analisar os artigos apresentados nos dez Encontros Nacionais da Sociedade Brasileira de Pesquisadores em Jornalismo (SBPJor), no período de 2003 a 2012. Trata-se de uma pesquisa bibliográfica e documental, tendo como instrumento de coleta e tratamento de dados a técnica categorial da análise de conteúdo. Foram analisados todos os trabalhos apresentados nas sessões de comunicação livre dos 10 eventos. O corpus final de análise é composto por 51 artigos, subdivididos nas temáticas: Jornalismo Científico, Jornalismo Ambiental e Jornalismo de Saúde, com 16, 23 e oito trabalhos, respectivamente. Os resultados apontam uma grande quantidade de estudos sobre a área ambiental. Os jornais e os veículos regionais se destacam como objeto de pesquisa e os procedimentos metodológicos mais utilizados são as análises de conteúdo e do discurso.
A Patente como Instrumento de Divulgação Científica - a Relação entre os Requisitos de Patenteabilidade e os Critérios de Noticiabilidade
Authors: MAZOCCO Fabricio José , ANDRADE Thales Haddad Novaes de
Published: July 2014

Várias ações, seja no âmbito político, seja no econômico, vêm sendo realizadas no Brasil visando promover a inovação tecnológica. Um dos caminhos necessários para se atingir esse objetivo é a divulgação dos resultados de pesquisas passíveis de serem protegidas: as patentes. Além de fonte de informação tecnológica, a patente também pode ser entendida como importante instrumento de divulgação científica. O presente artigo objetiva o estudo da patente como ferramenta de divulgação científica visando explorar seu potencial na disseminação da ciência, contribuindo, assim, para a divulgação de pesquisa científica e sua transformação em tecnologia a serviço da sociedade. Para isso serão abordados os requisitos necessários para a proteção da patente, suas dimensões e a relação com os critérios de noticiabilidade.
O Estado da Arte da Pesquisa em Divulgação Científica no Brasil: Apontamentos Iniciais
Authors: CALDAS Graça , ZANVETTOR Kátia
Published: July 2014

Este artigo traz resultados iniciais do Projeto “Divulgação Científica e Sociedade: Memória e Estado da Arte”, do Grupo de Pesquisa “Comunicação, Educação, Ciência e Sociedade”, do Labjor/Unicamp. Elabora um diagnóstico nacional sobre a pesquisa em Divulgação Científica, nos programas de Pós-Graduação do país. Inicialmente foi realizado um mapeamento no banco de teses da Capes, a partir de palavras-chave relacionadas à área, com destaque para a produção do Estado de São Paulo. O método de abordagem é descritivo e experimental, de natureza quantitativa e qualitativa. Os primeiros resultados da análise de seis palavras-chave computam o registro de 761 trabalhos, em todo o Brasil. Restringindo a análise para três palavras-chave aparecem 338 trabalhos, sendo que 78 ocorrem nas universidades do Estado de São Paulo. Os destaques são para “Divulgação Científica”, com maior incidência na Unicamp (27), seguida da USP (26), UMESP (11) e UFSCAR (8). Os resultados indicam, ainda, que os trabalhos são de natureza múltipla e integram grupos de pesquisa de diferentes áreas do conhecimento.
Comunicação Científica Além da Ciência
Authors: TARGINO Maria das Graças , TORRES Názia Holanda
Published: July 2014

Objetiva-se discutir a comunicação científica além da ciência, ou seja, a importância do fluxo informacional que extrapola os limites da comunidade científica e chega às coletividades. A comunicação científica fundamenta-se na informação científica, responsável pelo conhecimento científico, o qual representa acréscimo ao status quo das áreas de conhecimento. A pesquisa científica está no alicerce da comunicação científica. Esta extrapola o ciclo restrito de fluxo informacional intramuros (comunidade científica) e, graças à divulgação científica, alcança a população, transformando-a em alfabetizada cientificamente. Ciência e tecnologia determinam a evolução da humanidade, o que requer dos cidadãos habilidades para desvendarem o universo da ciência, pois a inacessibilidade aos novos conhecimentos cerceia a prática cidadã.
Adult Identification of Music Behaviors Demonstrated by Young Children
Authors: Reese Jill A.
Published: July 2014

The purpose of this research was to investigate how adults identify music behaviors of young children in play-based early childhood settings. Seventy-two adults (24 child development teachers, 24 early childhood music teachers, and 24 professional musicians) participated. In each professional expertise group, half were parents. Adults watched video of young children (ages 5 months to 15 months) and adults interacting musically, and pressed the spacebar to identify music behaviors demonstrated by the children. Adults heard one of two directions: half identified behaviors that made musical sense, and half identified behaviors that seemed intentionally musical. Total number of identified behaviors varied significantly based on professional expertise (child development, early childhood music, and professional musician), but not significantly based on parental status or directions. Total number of consensus acts (music behaviors identified by 75% or more of participants in a group) varied significantly based on professional expertise. Consensus acts contained common features: beat-related movements and vocalizations. Results suggest professional expertise in early childhood music may enhance adults’ abilities to identify behaviors as music. Early childhood music teachers identified significantly more music behaviors than the other two groups. Results suggest professional expertise may influence the types of behaviors adults identify as music. All adults agreed beat-related movement was music; early childhood music teachers were significantly more likely than any other group to identify vocalizations as music behaviors.
The Underlying Structure of Parental Involvement–Home Environment in Music
Authors: Zdzinski Stephen
Published: July 2014

The purpose of this study was to examine the underlying multifaceted structure of home environment in music using a factor analysis methodology, and to create a scale that reflects this structure. Students from a major metropolitan area in the southeastern United States (N = 523) enrolled in general music classes, orchestra classes, band classes, and chorus classes in grades 4–12 completed a 99-item pool measure. Items were created based on previous research in music education and education. A factor analysis of the item measure identified seven parental involvement–home environment in music factors: Home Musical Structure, Attitudes Toward Music, Home Musical Environment, Music Program Support, Parental Expectations, Family Musical Participation, and Family Musical Background. Six items for each factor were selected for the final scale based on factor loadings and to measure unique aspects of each factor. The MANOVA revealed that five of the seven factors (Home Musical Structure, Attitudes Toward Music, Home Musical Environment, Music Program Support, and Family Musical Participation) differed by sample characteristics.
Influence of Drying Conditions on the Effective Moisture Diffusivity and Energy Requirements of Ginger Slices
Authors: Afolabi Tinuade J. , Tunde-Akintunde Toyosi Y. , Oyelade Olusegun J.
Published: July 2014

The thin layer drying behaviour of ginger slices in a laboratory dryer was examined. The slices of 5 mm, 10 mm and 15 mm thicknesses were dried using heated ambient air at temperatures from 40 to 70 ºC and air velocity of 1.5 m/s. The effects of drying air temperature and slice thickness on the drying characteristics, drying time and energy requirement of drying process was determined. The results have shown that an increase in the drying air temperature causes shorter drying times. Thinner slices also causes a shorter drying time. The effective moisture diffusivity values increased from 3.36814 × 10-10 m2/s to 5.82524 × 10-9 m2/s while the activation energy values for different slice thickness of ginger varied from 196.15 to 198.79 kJ/mol. The total needed energy varied from 735.3 to 868.5 kWh while the value of specific energy requirement varied from 3676.6 to 4342.4 kWh/kg respectively.
Riboflavin in Nutrition, Food Processing, and Analysis - A Review
Authors: Golbach Jennifer L. , Ricke Steven C. , O'Bryan Corliss A. , Crandall Philip G.
Published: July 2014

Riboflavin is an essential micronutrient in the human diet. Because riboflavin is water soluble and not stored in appreciable amounts in the body, sources of riboflavin must be constantly consumed. In the United States many cereal grains are being fortified with riboflavin. In this review we briefly discuss the chemistry of riboflavin, the role of riboflavin in nutrition and health, effects of food processing and storage and means of measuring riboflavin in food and animal feeds.
Investigations of the capacity and strength of seed germination in Allium victorialis L.
Authors: Winiarczyk Krystyna , Skrzypczak Katarzyna , Jaroszuk-Sciseł Jolanta , Bocianowski Jan
Published: July 2014

The aim of the study was to examine the strength and energy of seed germination in Allium victorialis. Despite the normal structure of seeds containing a viable embryo and compliance with all International Seed Testing Association recommendations, no germination in A. victorialis was observed. Additionally, the scarification and stratification treatments applied did not improve the dynamics of germination of A. victorialis seeds. Microbiological analyses of soil sampled from natural localities of the plant revealed a typical composition of bacteria and fungi. The high number of fungi [4.5 log10CFU (colony forming units) of fungi × g−1 dry mass of soil] and various groups of bacteria (about 7.0 log10CFU of bacteria × g−1 dry mass of soil) were detected in the root-free-soil around garlic roots. In the interior of A. victorialis roots, the number of microorganisms decreased 1000 to 10 000 times but all the tested microbial groups, especially copiotrophic bacteria and fungi (1.6 and 2.2, respectively, log10CFU × g−1 dry mass of roots) were detected.

Changes in such parameters as dehydrogenase activity, pH values, and the total organic C (TOC) content in the particular parts of the rhizosphere and in comparison to the rhizosphere with root-free-soil were observed. The dehydrogenase activity and TOC content were highly positively correlated with the total number of CFU of the microorganisms.
AGRANULOCITOSE RELACIONADA À OXACILINA. RELATO DE CASO
Authors: Souza Kleber Jordão , Oliveira Juliana Mussolini Celestino de , Gomes Rodolfo Dias , Bressa Rebeca Carvalho , Bressa José Antonio Nascimento
Published: July 2014

Agranulocytosis is characterized by a reduction of neutrophils in peripheral blood, and about two thirds of cases occur due to adverse reactions to drugs. We report a case of a Caucasian man that in prolonged use of oxacillin due a septic spondylodiscytis developed agranulocytosis. Male patient, 70 years-old, was admitted to the emergency room complaining of pain in the lumbar region for 30 days. Diagnosed with septic spondylodiscytis on plateaus vertebral level L5-S1. He was treated empirically with oxacillin. Antibiotic therapy continued until the twenty-ninth day. Blood count presented: leukocyte counts of 0.870/mm³ (without differential count). After suspension of oxacillin, white blood cell count was not reestablished, was administered granulocyte colony-stimulating factor Filgastrima at a dose of 0.5MU/Kg day (5g/Kg/day) for three days. This report aims to highlight that the use of intravenous oxacillin for prolonged periods may induce agranulocytosis, and to emphasize that even asymptomatic patient monitoring should be performed.
Localized Cutaneous Infections in Immunocompetent Individuals Due to Rapidly Growing Mycobacteria
Authors: Fowler John , Mahlen Steven D.
Published: July 2014

Rapidly growing mycobacteria (RGM) cause skin infections that are refractory to standard antibiotic regimens. Although typically associated with disseminated cutaneous or other systemic infections in immunocompromised patients, RGM sometimes cause localized cutaneous infections in immunocompetent hosts. These infections are almost always associated with precedent skin trauma and inoculation, and therefore have been implicated in outbreaks involving contaminated tattoo ink and inadequately sterilized acupuncture needles. Histologic features often include suppurative granulomatous inflammation, and microorganisms are rarely visualized with stains for acid-fast bacilli. The differential diagnosis includes granulomatous fungal and non-RGM bacterial infections as well as noninfectious suppurative or sarcoidlike conditions. Because no pathognomonic histologic features exist for cutaneous RGM infections, clinical suspicion and appropriate workup are essential to reach an accurate and timely diagnosis. Most localized cutaneous RGM infections in immunocompetent individuals respond well to either clarithromycin or amikacin, in combination with surgical debridement.
Transformation of Small B-Cell Lymphoma Into Large Cell CD30+, CD4+, Epstein-Barr Virus–Negative Lymphoma
Authors: Shaver Aaron C. , Ma Ly , Vnencak-Jones Cindy , Schwarting Roland S. , Fasig Kristina J. , Kim Annette S.
Published: July 2014

We report here 2 separate cases in which patients with known low-grade B-cell lymphomas presented with transformed lesions that were CD30+, CD4+, Epstein-Barr virus negative, and negative or focally weak for a wide range of B-cell, T-cell, and histiocytic/dendritic cell markers. In each case the transformed lymphoma possessed an identical pattern of immunoglobulin heavy chain and/or BCL2 rearrangement to the corresponding original low-grade B-cell lymphoma, confirming their identity as transformed B-cell lymphoma. A review of the relevant literature reveals that, to our knowledge, no transformed B-cell lymphomas with this immunophenotype have been previously reported, which creates the opportunity for potential errors of diagnosis. These cases highlight the importance of correlation with the patient's history and with molecular genetic results in rendering an accurate diagnosis.
Is Pneumatosis Cystoides Intestinalis Gas-Distended and Ruptured Lymphatics?: Reappraisal by Immunohistochemistry
Authors: Gui Xianyong , Zhou Yi , Eidus Leslie , Falck Vincent , Gao Zu-hua , Qin Lihui
Published: July 2014

Context.—Pneumatosis cystoides intestinalis (PCI) is a condition with multiple gas-filled cysts within the bowel wall, associated with diverse background diseases. Its pathogenesis is still a mystery. Some previous observations scattered in the literature have suggested an association of the cystic spaces in PCI with the lymphatics.

Objective.—To further investigate whether PCI results from the ballooning of gas-filled lymphatic channels.

Design.—We did immunostaining of podoplanin, a mucoprotein preferentially expressed in lymphatic endothelial cells, in 13 cases (8 men, 5 women; age range, 18–80 years) of PCI. Ten cases were diagnosed in resected segments of bowel and 3 in biopsies. Pneumatosis was seen in the right side of the colon (9 cases), transverse colon (1 case), sigmoid colon (1 case), and small bowel (2 cases). In addition, immunostaining for CD31, calretinin, WT1, CD68, smooth muscle actin, desmin, vimentin, and cytokeratins was also performed for comparison and correlation.

Results.—A strong immunopositivity of podoplanin was seen in a condensed linear structure in the pericystic interstitium in 100% of the cases, but was not seen in the overlying giant and flat cells that were all CD68-positive histiocytes. Meanwhile, the podoplanin-expressing structure was negative for calretinin and WT1, which ruled out the possible mesothelial origin. There were coexistent variable immunopositivity of smooth muscle actin, which suggests an admixture of myofibroblasts. These findings indicated that the PCI cases were gas-distended lymphatics with the lymphatic epithelium ruptured and embedded in the reactive histiocytes and giant cells.

Conclusion.—Our findings support the lymphatic theory about the pathogenesis of PCI.
Pathologic T1 Subclassification of Ampullary Carcinoma With Perisphincteric or Duodenal Submucosal Invasion: Is It T1b?
Authors: You DongDo , Heo JinSeok , Choi SeongHo , Choi DongWook , Jang Kee-Taek
Published: July 2014

Context.—In ampullary carcinoma staging, T1 is defined as a tumor limited to the ampulla of Vater or the sphincter of Oddi, and T2 is defined as invasion into the duodenal wall. However, the definition of duodenal wall invasion is vague. Ampullary carcinoma that invades beyond the sphincteric of Oddi (perisphincteric invasion) or into the duodenal submucosa could be considered pT1b because submucosal invasion is classified as pT1b in gastrointestinal tract tumors. However, there are no data regarding T subclassifications for ampullary carcinoma with perisphincteric or duodenal submucosa invasion.

Objectives.—To determine the T subclassification of ampullary carcinoma that invades into perisphincteric or duodenal submucosa.

Design.—Pathologically proven ampullary carcinomas with T1 or T2 were reviewed (n = 105). We reclassified tumors as pT1a that were limited to within the sphincter of Oddi (n = 40; 38%), as pT1b for tumors that invaded beyond the sphincter of Oddi or into the duodenal submucosa (n = 25; 24%), and as pT2 for tumors that invaded into duodenal proper muscle (n = 40; 38%).

Results.—Lymph node metastasis and recurrence were absent in ampullary carcinoma with pT1a, whereas nodal metastasis were noted in 24% (6 of 25) and 40% (16 of 40) of the ampullary carcinomas with pT1b and pT2, respectively. Tumor recurrence/metastasis rate of ampullary carcinoma with pT1b and pT2 was 44% (11 of 25) and 40% (16 of 40), respectively. The 5-year disease-free-survival rates from ampullary carcinoma with pT1a, pT1b, and pT2 were 95% (38 of 40), 56% (14 of 25), and 58% (23 of 40), respectively (P = .003). The 5-year overall survival from ampullary carcinoma with pT1a, pT1b, and pT2 was 98% (39 of 40), 72% (18 of 25), and 60% (24 of 40), respectively.

Conclusions.—The clinicopathologic outcome of ampullary carcinoma with a pT1b subclassification was worse than it was for T1a and approached the outcome for pT2.
Welcome to Volume 20: A Birthday with a Mission
Authors: Klein Bob
Published: July 2014

Introductory remarks by the MTMS Editorial Panel launch the 2014–2015 volume year.
Solve It: Student Thinking: Lemon Tea?
Authors: Bair Sherry L. , Cady JoAnn
Published: July 2014

Solutions to a November 2013 Solve It problem are discussed, and the procedures used with problem solving are explored.
Cartoon Corner: Presidential Puzzlers
Authors: Peirce Lincoln
Published: July 2014

A cartoon involving presidential birth dates is coupled with a full-page activity sheet.
Interpreting Standards as Sense-Making Opportunities
Authors: Choppin Jeffrey M. , Callard Cynthia H. , Kruger Jennifer S.
Published: July 2014

Student-generated algorithms, despite being inelegant and cumbersome, can nevertheless highlight a Common Core standard on rational number subtraction to show flexibility and understanding.
Supporting English Learners: Lessons from Research
Authors: Nikula Johannah , Nelson Courtney L.
Published: July 2014

Careful attention to lesson design and implementation can make the opportunities to learn, which are described in the Common Core, viable for all students—including English language learners.
Dessert Dilemma
Authors: Moss Erin
Published: July 2014

This department showcases students' in-depth thinking and work on problems previously published in Teaching Children Mathematics. This article discusses solutions to the Dessert Dilemma problem that ran in the August 2013 issue.
13 Rules That Expire
Authors: Karp Karen S. , Bush Sarah B. , Dougherty Barbara J.
Published: July 2014

Overgeneralizing commonly accepted practices, using imprecise vocabulary, and relying on tips and tricks that do not promote conceptual mathematical understanding can lead to misunderstanding later in students' math careers.
Early Mathematics Fluency with CCSSM
Authors: Matney Gabriel T.
Published: July 2014

To develop second-grade students' confidence and ease, use these three specific types of tasks that align with Common Core State Standards for Mathematics expectations.
Statistics at Play
Authors: English Lyn D.
Published: July 2014

Three core components in developing children's understanding and appreciation of data—establish a context, pose and answer statistical questions, represent and interpret data—lay the foundation for the fourth component: use data to enhance existing context.
Clocks: For more than telling time
Authors: Guarino Jody
Published: July 2014

Postscript items are designed as rich “grab-and-go” resources that any teacher can quickly incorporate into their classroom repertoire with little effort and maximum impact. In this article, classroom clocks are used as an effective tool to support student understanding of basic number, fraction, and geometry concepts.
Prevalence of depression and validation of the Beck Depression Inventory‐II and the Children's Depression Inventory‐Short amongst HIV‐positive adolescents in Malawi
Authors: Kim Maria H , Mazenga Alick C , Devandra Akash , Ahmed Saeed , Kazembe Peter N , Yu Xiaoying , Nguyen Chi , Sharp Carla
Published: July 2014

Introduction

There is a remarkable dearth of evidence on mental illness in adolescents living with HIV/AIDS, particularly in the African setting. Furthermore, there are few studies in sub‐Saharan Africa validating the psychometric properties of diagnostic and screening tools for depression amongst adolescents. The primary aim of this cross‐sectional study was to estimate the prevalence of depression amongst a sample of HIV‐positive adolescents in Malawi. The secondary aim was to develop culturally adapted Chichewa versions of the Beck Depression Inventory‐II (BDI‐II) and Children's Depression Inventory‐II‐Short (CDI‐II‐S) and conduct a psychometric evaluation of these measures by evaluating their performance against a structured depression assessment using the Children's Rating Scale, Revised (CDRS‐R).

Study design

Cross‐sectional study.

Methods

We enrolled 562 adolescents, 12–18 years of age from two large public HIV clinics in central and southern Malawi. Participants completed two self‐reports, the BDI‐II and CDI‐II‐S, followed by administration of the CDRS‐R by trained clinicians. Sensitivity, specificity and positive and negative predictive values for various BDI‐II and CDI‐II‐S cut‐off scores were calculated with receiver operating characteristics analysis. The area under the curve (AUC) was also calculated. Internal consistency was measured by standardized Cronbach's alpha coefficient, and correlation between self‐reports and CDRS‐R by Spearman's correlation.

Results

Prevalence of depression as measured by the CDRS‐R was 18.9%. Suicidal ideation was expressed by 7.1% (40) using the BDI‐II. The AUC for the BDI‐II was 0.82 (95% CI 0.78–0.89) and for the CDI‐II‐S was 0.75 (95% CI 0.70–0.80). A score of ≥13 in BDI‐II achieved sensitivity of >80%, and a score of ≥17 had a specificity of >80%. The Cronbach's alpha was 0.80 (BDI‐II) and 0.66 (CDI‐II‐S). The correlation between the BDI‐II and CDRS‐R was 0.42 (p<0.001) and between the CDI‐II‐S and CDRS‐R was 0.37 (p<0.001).

Conclusions

This study demonstrates that the BDI‐II has sound psychometric properties in an outpatient setting among HIV‐positive adolescents in Malawi. The high prevalence of depression amongst HIV‐positive Malawian adolescents noted in this study underscores the need for the development of comprehensive services for HIV‐positive adolescents.
The Subtalar Joint Axis Palpation Technique
Authors: Van Alsenoy Ken K. , D'Août Kristiaan , Vereecke Evie E. , De Schepper Joris , Santos Derek
Published: July 2014

Background

Clinically locating the point of no rotation to determine the subtalar joint axis location by applying pressure on the plantar surface of the foot was described by Kirby in 1987 but was never validated. We sought to extend a previously validated mechanical model to cadaver feet and to examine the intratester and intertester reliability.

Methods

Four testers with different levels of experience determined the subtalar joint axis location and moved the subtalar joint through its range of motion, capturing the movement using kinematic analysis. The comparison of the spatial subtalar joint axis location as determined by palpation between and within testers determined the intertester and intratester reliability. The helical axis method was performed to validate the model.

Results

The intrarater reliability varied from a high of α = 0.96 to a low of α = 0.26 for the slope and was, in general, high (α = 0.78–0.95) for the intersection. The interrater reliability scored moderate to high, depending on the specific cadaver specimen. Concerning the exact location of the subtalar joint axis, no significant difference was found between the results determined by different testers and the helical axis method.

Conclusions

The palpation technique as part of the subtalar joint axis location and rotational equilibrium theory proposed by Kirby is a reliable and valid clinical tool. Experience in performing the palpation technique has a positive influence on the accuracy of the results. In the context of evidence-based practice, this technique could be a standard tool in the examination of patients with lower-limb–related pathologic disorders.
Personalized Orthoses as a Good Treatment Option for Charcot Neuro-osteoarthropathy of the Foot
Authors: Fernández Maria Luz González , Lozano Rosario Morales , Rincón Carmen Martínez , Hernández David Martínez
Published: July 2014

Background

We sought to assess the biomechanical characteristics of the feet of patients with Charcot neuro-osteoarthropathy and to determine reulceration rates before and after personalized conservative orthotic treatment.

Methods

A longitudinal prospective study was performed in 35 patients with Charcot's foot. Although some patients had a history of ulcers, at the study outset no patient had ulcers. All of the patients underwent biomechanical testing and a radiographic study. A radiophotopodogram was prepared by superimposing an imprint of the sole on a plantar radiograph. Based on the results of these tests, an orthopedic insole was prepared and therapeutic footwear prescribed for each foot. The following variables were compared between the Charcot and unaffected feet: previous ulcers and ulcer sites, reulcerations produced after treatment, type of foot (neuropathic/neuroischemic), ankle mobility, first-ray mobility, and relaxed calcaneal stance position. Treatment efficacy was determined by comparing ulcers presenting in patients in the year leading up to the study period and the year in which treatment was received.

Results

In a 1-year period, 70 feet received orthotic treatment, of which 41 were Charcot's feet. Ulceration rates before the study were 73.2% in feet with Charcot's and 31.0% in those without. After 1 year of wearing the customized orthoses, rates fell significantly to 9.8% in the Charcot feet and 0% in the feet without this condition.

Conclusions

Conservative customized orthotic treatment was effective at preventing ulcers and the complications that often lead these patients to surgery.
Radiographic Anatomy of the Foot and Ankle—Part 1
Authors: Christman Robert A.
Published: July 2014

The normal radiographic anatomy of the foot and ankle, aside from my previous work, has been addressed only superficially or sparingly in the medical literature. This project correlates the detailed radiographic anatomy of the entire adult foot and ankle (two-dimensional) to osteology (three-dimensional). Each bone's position was determined after meticulous examination and correlation to an articulated skeleton relative to the image receptor and direction of the x-ray beam, with correlation to the radiograph for confirmation. Images of each foot and distal leg bone (“front” and “back” perspectives) are presented alongside a corresponding radiographic image for comparison. The normal gross and radiographic anatomy is correlated and described for each radiographic positioning technique. Foundational knowledge is provided that future researchers can use as a baseline (“normal”) and that students and practitioners can use for comparison when interpreting radiographs and distinguishing abnormal findings. The findings from the original project, owing to its broad scope, have been divided into five parts: the lower leg (the focus of this paper), the greater tarsus, the lesser tarsus, the metatarsals, and the phalanges.
Exertional Compartment Syndrome of the Medial Foot Compartment—Diagnosis and Treatment
Authors: Izadi Faye E. , Richie Douglas H.
Published: July 2014

Exertional compartment syndrome in the foot is rarely reported and often confused with plantar fasciitis as a cause of arch pain in the running athlete. We describe a case involving a 19-year-old competitive collegiate runner who developed a chronic case of bilateral medial arch pain during training, which was initially diagnosed as plantar fasciitis but failed to respond to conventional treatment. After symptoms began to suggest exertional compartment syndrome, the diagnosis was confirmed by measuring an elevated resting pressure in the medial compartment of both feet. The patient underwent a bilateral medial compartment fasciotomy, which allowed a full return to activity, and has remained pain free after a 1-year follow-up.
Merkel Cell Carcinoma of the Lower Extremity
Authors: Roda Dominic J. , Albano Brian , Rathore Bharti , Zhou Linda
Published: July 2014

Merkel cell carcinoma is a rare, often fatal, neuroendocrine cutaneous malignancy with a highly variable clinical presentation. Due to the rapid progression of the disease, early detection and treatment is vital to survival. Here, we report the case of a 45-year-old woman whose podiatrist noticed an unusual lesion on her lower left leg and referred her to a dermatologist for work-up. A diagnostic excisional biopsy confirmed the diagnosis and was followed by treatment that included wide local excision of the primary lesion with subsequent chemotherapy and radiation. At the time of diagnosis, sentinel lymph node biopsy was positive. Due to the increasing prevalence of Merkel cell carcinoma in the past decade and its propensity to present on the lower extremity, podiatric physicians need to be aware of the clinical presentation and treatment guidelines for this elusive disease.
Row with the flow
Authors: Friedrich Benjamin M , Riedel-Kruse Ingmar H
Published: July 2014

Fluid forces are sufficient to keep flagella beating in synchrony.