bluuebunny/crossref_metadata_2025 huggingface dataset:
Application and evaluation of forecasting methods for municipal solid waste generation in an eastern-European city
Authors: Rimaitytė Ingrida , Ruzgas Tomas , Denafas Gintaras , Račys Viktoras , Martuzevicius Dainius
Published: March 2011

Forecasting of generation of municipal solid waste (MSW) in developing countries is often a challenging task due to the lack of data and selection of suitable forecasting method. This article aimed to select and evaluate several methods for MSW forecasting in a medium-scaled Eastern European city (Kaunas, Lithuania) with rapidly developing economics, with respect to affluence-related and seasonal impacts. The MSW generation was forecast with respect to the economic activity of the city (regression modelling) and using time series analysis. The modelling based on social-economic indicators (regression implemented in LCA-IWM model) showed particular sensitivity (deviation from actual data in the range from 2.2 to 20.6%) to external factors, such as the synergetic effects of affluence parameters or changes in MSW collection system. For the time series analysis, the combination of autoregressive integrated moving average (ARIMA) and seasonal exponential smoothing (SES) techniques were found to be the most accurate (mean absolute percentage error equalled to 6.5). Time series analysis method was very valuable for forecasting the weekly variation of waste generation data ( r2 > 0.87), but the forecast yearly increase should be verified against the data obtained by regression modelling. The methods and findings of this study may assist the experts, decision-makers and scientists performing forecasts of MSW generation, especially in developing countries.
Statistical analysis of waste generation in healthcare services: a case study
Authors: Eker Hasan Hüseyin , Bilgili Mehmet Sinan
Published: March 2011

In the present study, the amounts of medical waste materials, sharps, liquid waste, hazardous waste, household waste and recyclables generated from 375 healthcare services including private hospitals, state hospitals, university hospitals, private medical centres, dialysis centres, cottage hospitals and private dentist surgeries were determined, and the relation between the amount of the waste and the bed capacities, inpatient and outpatient numbers were evaluated. The amount of regulated medical waste corresponded to 28.8% of the total waste streams collected from the healthcare services, and the major producers were private hospitals. The major producers of hazardous waste were state hospitals with a generation rate of 57.9%. The main results of the study indicate that the quantities of the waste streams generated from healthcare services in accordance with the outpatient number gave more appropriate results than the other evaluation methods. Furthermore, evaluation based on the bed capacities gave reasonable results except for recyclables and hazardous waste. As a result of the evaluation of the medical waste generation rate with bed capacities, the generation rate was determined as 2.11 ± 3.83 kg bed-1 day-1 and this rate was 1.45 ± 9.84 kg outpatient-1 day-1 for the evaluation by outpatient numbers. The observed significant P values (P > 0.05) indicate that the evaluation of the waste streams in healthcare services based upon outpatient numbers did not show any reasonable change according to service category.
Sources of microbial pathogens in municipal solid waste landfills in the United States of America
Authors: Gerba Charles P , Tamimi Akrum H , Pettigrew Charles , Weisbrod Anne V , Rajagopalan Vijay
Published: March 2011

Municipal solid waste (MSW) categories, as specified by United States Environmental Protection Agency (US EPA), were evaluated for their relative contribution of pathogenic viruses, bacteria, and protozoan parasites into MSW landfills from 1960 to 2007. The purpose of this study was to identify trends and quantify the potential contribution of pathogens in MSW as an aid to the assessment of potential public health risks. A review of the literature was conducted to estimate values for the concentrations of faecal indicator bacteria and pathogens in the major categories of MSW. The major sources of MSW contributing enteric pathogens were food waste, pet faeces, absorbent products, and biosolids. During the last 47 years, recycling of glass, metals, plastic, paper and some organic wastes in MSW has increased, resulting in a decreased proportion of these materials in the total landfilled MSW. The relative proportion of remaining waste materials has increased; several of these waste categories contain pathogens. For all potential sources, food waste contributes the greatest number of faecal coliforms (80.62%). The largest contribution of salmonellae (97.27%), human enteroviruses (94.88%) and protozoan parasites (97%) are expected to come from pet faeces. Biosolids from wastewater treatment sludge contribute the greatest number of human noroviruses (99.94%). By comparison, absorbent hygiene products do not appear to contribute significantly to overall pathogen loading for any group of pathogens. This is largely due to the relatively low volume of these pathogen sources in MSW, compared, for example, with food waste at almost 40% of total MSW.
A Comprehensive Review of the Literature on Summary of Performance
Authors: McCormack Richter Sharon , Mazzotti Valerie L.
Published: March 2011

The Individuals with Disabilities Education Act (2004) requires local education agencies to provide students with disabilities exiting high school with a Summary of Performance document, which includes academic and functional performance information and recommendations for helping the student reach postsecondary goals. However, the federal mandate does not provide guidance for completing Summary of Performance documents for transitioning students with disabilities, resulting in inconsistency across the field. To address these challenges, the purpose of this comprehensive literature review was to (a) review the literature related to Summary of Performance, (b) identify recommendations for practice, and (c) make suggestions for future research related to Summary of Performance.
Benzodiazepines and antipsychotic medications for treatment of acute cocaine toxicity in animal models – A systematic review and meta-analysis
Authors: Heard Kennon , Cleveland Nathan R , Krier Shay
Published: March 2011

There are no controlled human studies to determine the efficacy of benzodiazepines or antipsychotic medications for prevention or treatment of acute cocaine toxicity. The only available controlled data are from animal models and these studies have reported inconsistent benefits. The objective of this study was to quantify the reported efficacy of benzodiazepines and antipsychotic medication for the prevention of mortality due to cocaine poisoning. We conducted a systematic review to identify English language articles describing experiments that compared a benzodiazepine or antipsychotic medication to placebo for the prevention of acute cocaine toxicity in an animal model. We then used these articles in a meta-analysis with a random-effects model to quantify the absolute risk reduction observed in these experiments. We found 10 articles evaluating antipsychotic medications and 15 articles evaluating benzodiazepines. Antipsychotic medications reduced the risk of death by 27% (95% CI, 15.2%–38.7%) compared to placebo and benzodiazepines reduced the risk of death by 52% (42.8%–60.7%) compared to placebo. Both treatments showed evidence of a dose-response effect, and no experiment found a statistically significant increase in risk of death. We conclude that both benzodiazepines and antipsychotic medications are effective for the prevention of lethality from cocaine toxicity in animal models.
Hypomethylation of the HTR1A promoter region and high expression of HTR1A in the peripheral blood lymphocytes of patients with systemic lupus erythematosus
Authors: Xu J , Zhang GL , Cheng YQ , Chen B , Dong Y , Li LQ , Xu L , Xu XF , Lu ZP , Wen JF
Published: March 2011

Abstract: The occurrence of systemic lupus erythematosus (SLE) involves a gene–environment interaction and epigenetic regulations, such as DNA methylation, may play important role in the etiology of SLE. Some neurotransmitters, such as serotonin, can regulate T- and B-cell proliferation via the 5-HT1A receptor and are involved in the pathology of SLE. The abnormal methylation of DNA has been reported in SLE, but there has been no study concerning the serotonin system. This study was conducted to explore the DNA methylation status of the promoter region of HTR1A (PR-HTR1A) and the level of HTR1A mRNA in the peripheral blood lymphocytes (PBLC) of SLE patients and healthy controls (HC). In this study, the DNA methylation status of PR-HTR1A and the level of HTR1A mRNA were detected in the PBLC of SLE patients and HC. The results showed significant hypomethylation of PR-HTR1A in SLE patients compared with HC. The patients also showed a significantly higher HTR1A mRNA level than did the controls. Relatively higher percentage of anti-histone antibodies in methylated SLE patients was found compared with unmethylated patients. Our results support the hypothesis that the hypomethylation of PR-HTR1A and overexpression of HTR1A might contribute to SLE. These results also reveal that epigenetic regulation via the serotonin system may contribute to SLE, and reveal the link between the brain and the immune system.
Concentric and Diametric Structures in Yin/Yang and the Mandala Symbol
Authors: Downes Paul
Published: March 2011

A silent discourse pervades psychology regarding how its theories are framed. This framing process needs to be brought more to the fore to challenge the traditional frames in Western psychology and to explore frames drawn more from Eastern traditions. Two primordial archetypal symbols, yin/yang and the mandala were partially developed by Jung in his attempt to employ Eastern frames for psychological understanding. Both symbols are highlighted as offering a prelinguistic discourse of implication requiring further examination. A relational discourse of assumed connection and assumed separation, expressed through concentric and diametric structures of relation underlying yin/yang and the mandala, are argued to be meaningful for psychology. Jung’s attempts to embed psychological theory with Eastern symbolic frames can be construed as the first wave of this process for psychology, and a new wave of interpretation of these primordial symbols offers fresh insights for a culture-inclusive and context-sensitive psychology.
Agents’ beliefs and the evolution of institutions for common-pool resource management
Authors: Bravo Giangiacomo
Published: March 2011

The joint exploitation of open-access natural resources is often modeled as a social dilemma with no escape for rational actors. Nevertheless, real individuals are not helplessly trapped in this dilemma and are often able to sustainably manage their commons by building endogenous institutions. This paper proposes both a simple analytical model and a more complex agent-based one designed to study common-pool resource management problems with a specific focus on the relation between agents’ beliefs and institutions. The conditions where agents are allowed to build management institutions lead to much better outcomes than the ones where agents can only rely on individual beliefs in order to limit the resource consumption. This happens despite the fact that agents act in a competitive environment favoring high resource consumers.
Numerical Evaluation Method for Semi-Active Damping Characteristics of a Passive-Type MR Damper with Functional Damping Force
Authors: Murakami Takahiro , Nakano Masami
Published: March 2011

An evaluation method for the damping force characteristics of a passive-type MR damper with functional damping characteristics equivalent to a semi-active damper is developed. Although the MR damper is a fully passive device without any electrical components such as sensors, power supplies, or power controllers, it exhibits a functional variable damping characteristic analogous to that of a semi-active damper. The developed evaluation method consists of static magnetic field analysis and algebraic equations representing the simplified fluid flow, and is executable with a low computational cost. The developed method was applied to the characteristic evaluation of a prototype passive-type MR damper. The obtained analytical results agree well with the measured damping force and the response characteristics of a single-degree-of-freedom system with the damper obtained in a shaking table test. These results indicate that the evaluation method can be effectively used when designing passive-type MR dampers.
Cherry-Picking Customers by Party Size in Restaurants
Authors: Thompson Gary M.
Published: March 2011

This paper examines the phenomenon of cherry-picking customers—serving the high value customers and denying service to low value customers. These actions are fundamental to revenue management, but have received essentially no attention in the context of restaurants. Two common characteristics of restaurants make them a logical environment in which to implement cherry-picking—compared to smaller parties, larger parties typically take longer to dine and spend less per person. A short example provides motivation and the author reports on an international survey of restaurant managers, which indicates that cherry-picking actions are not uncommon. The author also reports on a simulation study to explore the factors affecting the level of excess demand necessary to justify cherry-picking. Important factors are customers’ willingness to wait for tables, the length of the peak-demand window, and the proportionality of space required by different size tables. The author also evaluates two heuristics for predicting the viability of cherry-picking. The author believes that the most important finding for managers is that the viability of cherry-picking is very dependent on restaurant size, being generally impractical for larger restaurants. From an academic perspective, since this is underinvestigated topic, the author identifies nine research extensions of this work, ranging from empirical to analytical investigations.
Impact of electoral volatility and party replacement on voter turnout levels
Authors: Robbins Joseph W. , Hunter Lance Y.
Published: March 2011

While elections are viewed as the lynchpin of modern democracies, few works have adequately assessed the role played by political parties in mobilizing voters. Much of the extant work has relied on the number of parties in a party system to estimate the impact on voter turnout; not surprisingly, the voluminous literature on voter turnout has arrived at a theoretical impasse regarding the relationship between party systems and voter turnout. We argue that in order to better understand the relationship between party systems and voter turnout, researchers should consider other relevant party system measures. In particular, several scholars have surmised that party system stability holds numerous implications for democracies, but there has yet to be an empirical analysis of this claim. In this study, we anticipate that lower volatility and replacement rates – both indicating more stable party systems – should have a positive impact on aggregate turnout. Even when including several control variables, the results of our cross-sectional time-series analyses confirm our hypotheses.
Exploiting blank spots for model-based background correction in discovering genes with DNA array data
Authors: Arima Serena , Liseo Brunero , Mariani Francesca , Tardella Luca
Published: March 2011

Motivated by a real data set deriving from a study on the genetic determinants of the behavior of Mycobacterium tuberculosis (MTB) hosted in macrophage, we take advantage of the presence of control spots and illustrate modelling issues for background correction and the ensuing empirical findings resulting from a Bayesian hierarchical approach to the problem of detecting differentially expressed genes. We prove the usefulness of a fully integrated approach where background correction and normalization are embedded in a single model-based framework, creating a new tailored model to account for the peculiar features of DNA array data where null expressions are planned by design. We also advocate the use of an alternative normalization device resulting from a suitable reparameterization. The new model is validated by using both simulated and our MTB data. This work suggests that the presence of a substantial fraction of exact null expressions might be the effect of an imperfect background calibration and shows how this can be suitably re-calibrated with the information coming from control spots. The proposed idea can be extended to all experiments in which a subset of genes whose expression levels can be ascribed mainly to background noise is planned by design.
An assessment of empirical Bayes and composite estimators for small areas
Authors: Longford Nicholas T
Published: March 2011

We compare the classes of empirical Bayes and composite estimators of the population means of the districts (small areas) of a country and show that the commonly adopted modelling strategy of searching for a well-fitting random coefficient (two-level) model and using it for estimation of the district-level means can be ineffective. In particular, we show that variables with small district-level variation are not useful as covariates even when they are strong predictors of the target variable.
Missing covariates in logistic regression, estimation and distribution selection
Authors: Consentino Fabrizio , Claeskens Gerda
Published: March 2011

We derive explicit formulae for estimation in logistic regression models where some of the covariates are missing. Our approach allows for modelling the distribution of the missing covariates either as a multivariate normal or as a multivariate t-distribution. A main advantage of this method is that it is fast and does not require the use of iterative procedures. A model selection method is derived which allows to choose among these distributions. In addition, we consider versions of Akaike’s information criterion that are based on the expectation–maximization algorithm and multiple imputation methods that have a wide applicability to model selection in likelihood models in general.
‘Time for a Fresh Start’, but is this it? A Critical Assessment of The Report of the Independent Commission on Youth Crime and Antisocial Behaviour
Authors: Goldson Barry
Published: March 2011

In 2010, the Independent Commission on Youth Crime and Antisocial Behaviour published a major report entitled Time for a Fresh Start (Independent Commission on Youth Crime and Antisocial Behaviour, 2010). The Commission’s report exposes the youth justice system in England and Wales to critical scrutiny. During the course of its inquiries the Commission consulted with, and/or received ‘evidence’ from, over 170 individuals and organizations. At the conclusion of the same inquiries, the report was published alongside a companion volume entitled A New Response to Youth Crime (Smith, 2010). The titles of the report and its accompanying book leave little to the imagination; the Commission clearly believes that a ‘fresh start’ and/or a ‘new response’ to youth crime and youth justice are needed in England and Wales. Informed by a long-term research project centred on national and international youth justice theory, law, policy and practice, this article focuses exclusively upon the Commission’s report and subjects it to critical assessment. Whilst endorsing the Commission’s perceived need for change, the article presents a detailed critique of its ‘alternative’ vision. It concludes by raising core questions pertaining to youth justice policy formation and the politics of policy influence.
Classification of CAM Use and Its Correlates in Patients With Early-Stage Breast Cancer
Authors: Saquib Juliann , Madlensky Lisa , Kealey Sheila , Saquib Nazmus , Natarajan Loki , Newman Vicky A. , Patterson Ruth E. , Pierce John P.
Published: March 2011

Hypothesis: Self-reported use of complementary and alternative medicine (CAM) has been shown to increase following a cancer diagnosis, and breast cancer survivors are the heaviest users among cancer survivors. The aim of this study was to determine whether the prevalence estimate of CAM use varied according to classification of CAM. The authors used a comprehensive system to classify CAM users and test differences in demographic, lifestyle, quality of life, and cancer characteristics among them. Study design and methods: Participants were 2562 breast cancer survivors participating in the Women’s Healthy Eating and Living (WHEL) Study, aged 28 to 74 years. A structured telephone interview assessed CAM use, questioning about specific CAM practices, and whether use was related to cancer. This study examined CAM use in relation to demographics, health behaviors, and quality of life. Results: Approximately 80% of the women used CAM for general purposes but only 50% reported CAM use for cancer purposes. Visual imagery, spiritual healing, and meditation were the most frequently used practices for cancer purposes. CAM use, defined as consulting a CAM practitioner and regular use, was significantly related to younger age, higher education, increased fruit and vegetable intake, and lower body mass index ( P < .05). CAM users who had seen a practitioner were also more likely to report poor physical and mental health than non-CAM users ( P < .05). CAM use was not associated with changes in physical and mental health between study baseline and 1-year follow-up. Conclusion: This study addressed important differences in the classification of CAM use among breast cancer survivors. Future studies need to further test the potential benefits and risks associated with CAM use.
Chan-Yu-Bao-Yuan-Tang, the Water Extract of a Chinese Medicine Prescription, Induces S-Phase Arrest and Mitochondria-Mediated Apoptosis in Human Lung Adenocarcinoma Cells
Authors: Liu XiaoGuang , Li YunCheng , Zeng Fang , Huang YanYan , Zhou JiHang , Wang YeKai , Zhou ShiQuan , Zhu WangYu , Chen Gang , Zhang YongKui
Published: March 2011

Previous clinical studies have shown good efficacy of the traditional Chinese medicinal herbal water extract Chan-Yu-Bao-Yuan-Tang (CYBYT) in lung cancer patients. In this study, CYBYT’s effects on proliferation and apoptosis of human lung adenocarcinoma cell line SPC-A-1 cultured in vitro were explored. An XTT assay, cell cycle analysis, Annexin V-FITC staining and Western blot were applied to identify the viability of cells, cell cycle arrest, stages of apoptosis, and signaling proteins, respectively. The results showed that CYBYT inhibited the growth of SPC-A-1 cells by reducing the cells in G0/G1 phase but increasing them in S phase in a concentration-dependent manner, and inducing apoptosis, whereas it had no significant inhibitory effects on the normal human IMR-90 fibroblasts. Furthermore, early and total induction of apoptosis was positively correlated with the concentration of CYBYT in SPC-A-1 cells, and the rate of total apoptosis was greater in the CYBYT 100 µg/mL and 50 µg/mL groups than that of the positive control 5-fluorouracil (5-Fu) group. Moreover, CYBYT upregulated bax, cleaved caspase-3 protein expression, downregulated bcl-2 protein expression, and released mitochondrial cytochrome c into the cytosol in a time- and concentration-dependent manner. Our findings indicated that CYBYT could significantly inhibit growth and induce apoptosis via the mitochondrial pathway in human lung adenocarcinoma cell line SPC-A-1.
Altered Circadian Rhythms and Cancer-Related Fatigue Outcomes
Authors: Payne Judith K.
Published: March 2011

Fatigue is one of the most frequent and distressing complaints reported by patients with cancer. Describing relationships among disrupted circadian rhythms and cancer-related fatigue is important to the design and testing of interventions that target specific underlying etiology of fatigue. The purpose of this article is to review the literature on whether evidence exists to support the notion that disrupted circadian rhythms provide a mechanism of cancer-related fatigue. Searches were conducted from January 1950 to January 2010, to locate pertinent articles using 4 electronic databases: PubMed, MEDLINE, CINAHL, and Scopus. Results identified 42 quantitative research studies, which were then retrieved. After reviewing the articles, 15 were selected as meeting the established criteria of the study and were critiqued. Statistical approaches varied across studies, which may influence generalizability of results. Although commonalities across studies did emerge, there was a lack of consistency in variables studied, and most studies did not identify a theoretical framework. More research needs to be conducted using consistent types and characteristics of disrupted circadian rhythms in relation to fatigue, including temporal relationships between circadian rhythms, fatigue, and cancer.
Qingyihuaji Formula Inhibits Progress of Liver Metastases From Advanced Pancreatic Cancer Xenograft by Targeting to Decrease Expression of Cyr61 and VEGF
Authors: Yin Jian-Hua , Shi Wei-Dong , Zhu Xiao-Yan , Chen Zhen , Liu Lu-Ming
Published: March 2011

Objective. To observe the effects of Qingyihuaji formula (QYHJ) on the progression of liver metastases from human pancreatic cancer and to detect the expression changes of some biological factors associated with angiogenesis and metastasis during the development of advanced pancreatic cancer. Methods. Nude mice were inoculated intrasplenically with human pancreatic cancer cell line SW1990 and then randomly assigned into 4 groups: a control group and groups QYHJ-A, QYHJ-B, and QYHJ-C. Following this, the mice were treated with or without QYHJ formula for 4 weeks and were sacrificed at the end of the sixth week. The changes in body weight were observed, followed by the livers being excised and weighed. Then, both the numbers and the volume of metastatic nodules per liver were evaluated. Subsequently, the expressions of MMPs, VEGF, and Cyr61 in the tissue of liver metastases were detected by reverse transcription polymerase chain reaction, immunohistochemistry, or Western blot. Finally, the correlation was evaluated between the expressions of the factors associated with metastasis and the growth of liver metastasis. Results. Liver metastases were identified in 11 of 15 mice (73%) in the control group, 9 of 15 mice (60%) in group QYHJ-A, 6 of 14 mice (43%) in group QYHJ-B, and 8 of 14 mice (57%) in group QYHJ-C both the number and the volume of metastatic nodules per liver same as the ratio of liver-body weight in QYHJ groups were significantly less than the controlled group ( P < 0.05). The expressions of Cyr61, MMP-2, and VEGF at the levels of mRNA and protein were decreased in the QYHJ groups when compared with the control, as confirmed by immunohistochemistry detection ( P < .05). However, no significant difference was observed in the mRNA expression of MMP-1 and MMP-9 between the QYHJ groups and the control group ( P > .05). Regression analysis indicated that QYHJ possessed an evident inhibition against the progression of liver metastasis by downregulating the expression of VEGF and Cyr61 rather than MMP-2. Conclusions. The QYHJ formula exerted an inhibitory effect on the growth of liver metastasis from pancreatic cancer, perhaps by targeting VEGF and Cyr61 to some extent.
Relationship Between Touch Impairment and Brain Activation After Lesions of Subcortical and Cortical Somatosensory Regions
Authors: Carey Leeanne M. , Abbott David F. , Harvey Matthew R. , Puce Aina , Seitz Rüdiger J. , Donnan Geoffrey A.
Published: March 2011

Background. The neural basis underlying somatosensory impairment and recovery poststroke is virtually unexplored. Objective. To investigate the relationship between touch discrimination impairment and task-related brain activation in stroke survivors with somatosensory impairment following subcortical or cortical lesions. Methods. A total of 19 stroke survivors with touch impairment were investigated using fMRI and a touch discrimination paradigm 1-month poststroke; 11 had subcortical and 8 cortical sensory lesions; 12 age-matched healthy controls were also studied. Mean task-related contrast images were regressed with sensory impairment using random effects analysis for each subgroup and the total group. Results. There was no significant difference in touch impairment between stroke subgroups. Touch discrimination of the affected hand correlated negatively with task-related activation in the ipsilesional primary somatosensory cortex (SI; adjacent to the SI hand area activated in healthy controls); ipsilesional secondary somatosensory cortex (SII); contralesional thalamus; and attention-related frontal and occipital regions in the subcortical group. In contrast, the cortical group did not show significant correlated activity. Yet there was no significant between-group difference in a priori somatosensory regions: only in the superior medial frontal gyrus. A negative correlation was observed in the contralesional thalamus for the total group, irrespective of lesion type. Conclusion. The findings provide novel evidence of neural correlates of poststroke touch impairment involving a distributed network of ipsilesional SI and SII, the contralesional thalamus, and frontal attention regions, particularly following subcortical lesions. Further systematic investigation of a modulatory role for ipsilesional SI, the thalamus, and frontal attention regions in sensory processing and recovery is warranted, particularly given implications for rehabilitation.
Professors’ Experiences With Student Disclosures of Sexual Assault and Intimate Partner Violence: How “Helping” Students Can Inform Teaching Practices
Authors: Branch Kathryn A. , Hayes-Smith Rebecca , Richards Tara N.
Published: March 2011

As female faculty teaching classes on sensitive topics (e.g., Family Violence, Women and Crime, Victimology), we have received numerous disclosures of sexual assault and intimate partner violence (IPV) victimization from our students both in and outside the classroom. These experiences have caused each of us to reflect on our teaching practices within the classroom. When college professors receive disclosures from their students they have to develop strategies on how to effectively handle the disclosure, how to manage the classroom environment and assignments knowing that a survivor is in the course, and how to effectively handle their own emotional impact that may result from the disclosure. This paper explores the strategies that faculty report using when responding to disclosures by students and how receiving student disclosures can be used to inform teaching practices.
The increasing pediatric stone disease problem
Authors: Clayton Douglass B. , Pope John C.
Published: March 2011

While once thought to be relatively rare in developed nations, the prevalence of pediatric urolithiasis appears to be increasing, and a number of factors may be contributing to this increase. Many theories are plausible and such theories include the increasing childhood obesity epidemic, a changing sex predilection, climate change, alterations in dietary habits and improving diagnostic modalities. Yet, unlike adult patients, rigorous epidemiologic studies do not exist in pediatric populations. Thus, in the setting of an increasing prevalence of childhood stone disease, improved research is critical to the development of uniform strategies for pediatric urolithiasis management.
A laboratory investigation and validation of methods for sampling contaminated uniforms and work-wear
Authors: Lusardi Gail , Lipp Allyson , Phillips Peter , Hay Paul , Ashman Pamela
Published: March 2011

This study was designed to investigate and validate methods for sampling and retrieval of micro-organisms from contaminated uniform/work-wear. Recent guidance in the United Kingdom states there is no conclusive evidence that work-wear poses an infection transmission risk in the healthcare environment. Although some studies have identified the presence of pathogenic organisms on uniforms, the link between healthcare associated infection (HCAI) and work-wear has not been established in the current literature. A key aspect of such investigations is the ability to reproducibly recover and detect the number of micro-organisms on the garments under investigation. Therefore, in order to undertake further research into contamination levels of uniforms, the methods used to retrieve organisms need to be validated for this particular purpose.

In this study swatches of standard, sterile work-wear polyester mix material were inoculated with Staphylococcus aureus, Bacillus subtilis and Bacillus atrophaeus to represent potentially pathogenic organisms likely to be implicated in HCAI. Following incubation, four sampling methods were tested in a laboratory setting (swabbing, carpet sampler, Sartorius air sampler, Casella slit sampler) against the reference method (stomaching) and the numbers of colony forming units (cfu) recovered from the swatches were then recorded.

The carpet sampler was the most efficient method in recovering microbiological contamination that had been applied dry to the sterile swatches. At the higher inoculum levels, the carpet sampler retrieved 51% of the challenge organisms compared to the Sartorius air sampler (6%), Casella slit sampler (10%) and swabbing (6%). The reference method of stomaching recovered 104%.

The results demonstrated that wet contamination of certain materials can lead to significant binding of micro-organisms to the test fabric.

Advantages of the carpet sampler compared to other methods include the requirement for less equipment, ease of use in a clinical environment and the capacity to test large numbers rapidly.
Prognostic factors in stage III non-small cell lung cancer: a review of conventional, metabolic and new biological variables
Authors: Berghmans Thierry , Paesmans Marianne , Sculier Jean-Paul
Published: March 2011

Lung cancer is one of the most frequently occurring neoplasms and usually has a poor prognosis because most of the patients present with advanced or metastatic disease at the time of diagnosis. Numerous prognostic factors (PFs) have been studied, but the two most prominent, having both prognostic and operational values, are disease stage and performance status. Even if the literature on PFs in lung cancer is impressive, the number of publications specifically dealing with PFs in stage III non-small cell lung cancer (NSCLC) is limited. We reviewed the literature on this topic and separated the available information into three groups: conventional PFs, metabolic criteria (standardized uptake value [SUV] measured on18F-FDG-PET) and new biomarkers. Performance status and the distinction between stage IIIA and IIIB confirmed their prognostic value in stage III NSCLC. Other conventional PFs have been suggested such as age, weight loss, response to treatment and some characteristics describing the locoregional extension of the tumour. There is a place for the SUV as a PF for survival in early NSCLC, but its role in stage III NSCLC has to be further assessed. Some new biomarkers involved in cell cycle regulation or in apoptosis have been shown to have potential value. Their role needs to be confirmed in large prospective studies including conventional PFs to determine their independent value as a PF in stage III NSCLC. In conclusion, few PFs have been well evaluated in stage III NSCLC. New studies, taking into account the modifications derived from the 7th international staging system of the UICC, have to be performed.
Sternocostoclavicular Hyperostosis: A Review
Authors: Carroll Matthew B.
Published: March 2011

Sternocostoclavicular hyperostosis (SCCH) is a chronic inflammatory disorder which presents with erythema, swelling, and pain of the sternoclavicular joint. Approximately one half of patients have acne or pustular lesions with the best described association being with palmoplantar pustulosis (PPP). Extrasternal articular disease occurs in about a quarter of patients. The inflammatory process spans several years and has periods of exacerbation followed by remission. The histologic picture demonstrates a sterile osteomyelitis of the sternum and medial end of the clavicle. The diagnosis of SCCH is confirmed radiographically by hyperostosis and sclerosis of the sternum with involvement of the first rib on computed tomography (CT). The focal uptake of radiopharmaceutical on bone scintigraphy called the ‘bullhead’ sign is highly sensitive of SCCH. Treatment is aimed at easing pain and modifying the inflammatory process. Evidence over the last two decades suggests a role for intravenous bisphosphonates and tumor necrosis factor alpha inhibitors. A low level of awareness of SCCH often leads to a delay in diagnosis. This translates into significant morbidity and brings a psychological burden. Untreated chronic inflammation of the sternoclavicular joint leads to restricted mobility and secondary degenerative joint changes. In the search for a diagnosis, patients often undergo multiple serologic and imaging studies and in the experience of the author are referred to multiple specialists before a correct diagnosis is made. Greater awareness of SCCH is needed to prevent the irreversible physical and psychological impairments associated with the disease.
Managing cardiovascular risk in people with chronic kidney disease: a review of the evidence from randomized controlled trials
Authors: Jun Min , Lv Jicheng , Perkovic Vlado , Jardine Meg J.
Published: March 2011

Cardiovascular disease is the leading cause of death and morbidity in people with chronic kidney disease (CKD) making measures to modify cardiovascular risk a clinical priority. The relationship between risk factors and cardiovascular outcomes is often substantially different in people with CKD compared with the general population, leading to uncertainty around pathophysiological mechanisms and the validity of generalizations from the general population. Furthermore, published reports of subgroup analyses from clinical trials have suggested that a range of interventions may have different effects in people with kidney disease compared with those with normal kidney function. There is a relative scarcity of randomized controlled trials (RCTs) conducted in CKD populations, and most such trials are small and underpowered. As a result, evidence to support cardiovascular risk modification measures for people with CKD is largely derived from small trials and post hoc analyses of RCTs conducted in the general population. In this review, we examine the available RCT evidence on interventions aimed at preventing cardiovascular events in people with kidney disease to identify beneficial treatments as well as current gaps in knowledge that should be a priority for future research.
Assessment of hypermucoviscosity as a virulence factor for experimental Klebsiella pneumoniaeinfections: comparative virulence analysis with hypermucoviscosity-negative strain
Authors: Lin Yi-Chun , Lu Min-Chi , Tang Hui-Ling , Liu Hsu-Chung , Chen Ching-Hsien , Liu Keh-Sen , Lin Chingju , Chiou Chien-Shun , Chiang Ming-Ko , Chen Chuan-Mu , Lai Yi-Chyi
Published: March 2011

Background

Klebsiella pneumoniaedisplaying the hypermucoviscosity (HV) phenotype are considered more virulent than HV-negative strains. Nevertheless, the emergence of tissue-abscesses-associated HV-negative isolates motivated us to re-evaluate the role of HV-phenotype.

Results

Instead of genetically manipulating the HV-phenotype ofK. pneumoniae, we selected two clinically isolated K1 strains, 1112 (HV-positive) and 1084 (HV-negative), to avoid possible interference from defects in the capsule. These well-encapsulated strains with similar genetic backgrounds were used for comparative analysis of bacterial virulence in a pneumoniae or a liver abscess model generated in either naïve or diabetic mice. In the pneumonia model, the HV-positive strain 1112 proliferated to higher loads in the lungs and blood of naïve mice, but was less prone to disseminate into the blood of diabetic mice compared to the HV-negative strain 1084. In the liver abscess model, 1084 was as potent as 1112 in inducing liver abscesses in both the naïve and diabetic mice. The 1084-infected diabetic mice were more inclined to develop bacteremia and had a higher mortality rate than those infected by 1112. A mini-Tn5mutant of 1112, isolated due to its loss of HV-phenotype, was avirulent to mice.

Conclusion

These results indicate that the HV-phenotype is required for the virulence of the clinically isolated HV-positive strain 1112. The superior ability of the HV-negative stain 1084 over 1112 to cause bacteremia in diabetic mice suggests that factors other than the HV phenotype were required for the systemic dissemination ofK. pneumoniaein an immunocompromised setting.
Focused ultrasound-mediated suppression of chemically-induced acute epileptic EEG activity
Authors: Min Byoung-Kyong , Bystritsky Alexander , Jung Kwang-Ik , Fischer Krisztina , Zhang Yongzhi , Maeng Lee-So , In Park Sang , Chung Yong-An , Jolesz Ferenc A , Yoo Seung-Schik
Published: March 2011

Background

Epilepsy is a common neurological disorder, which is attributed to uncontrollable abnormal hyper-excitability of neurons. We investigated the feasibility of using low-intensity, pulsed radiation of focused ultrasound (FUS) to non-invasively suppress epileptic activity in an animal model (rat), which was induced by the intraperitonial injection of pentylenetetrazol (PTZ).

Results

After the onset of induced seizures, FUS was transcranially administered to the brain twice for three minutes each while undergoing electroencephalographic (EEG) monitoring. An air-backed, spherical segment ultrasound transducer (diameter: 6 cm; radius-of-curvature: 7 cm) operating at a fundamental frequency of 690 KHz was used to deliver a train of 0.5 msec-long pulses of sonication at a repetitive rate of 100 Hz to the thalamic areas of the brain. The acoustic intensity (130 mW/cm2) used in the experiment was sufficiently within the range of safety guidelines for the clinical ultrasound imaging. The occurrence of epileptic EEG bursts from epilepsy-induced rats significantly decreased after sonication when it was compared to the pre-sonication epileptic state. The PTZ-induced control group that did not receive any sonication showed a sustained number of epileptic EEG signal bursts. The animals that underwent sonication also showed less severe epileptic behavior, as assessed by the Racine score. Histological analysis confirmed that the sonication did not cause any damage to the brain tissue.

Conclusions

These results revealed that low-intensity, pulsed FUS sonication suppressed the number of epileptic signal bursts using acute epilepsy model in animal. Due to its non-invasiveness and spatial selectivity, FUS may offer new perspectives for a possible non-invasive treatment of epilepsy.
En bloc excision and autogenous fibular reconstruction for aggressive giant cell tumor of distal radius: a report of 12 cases and review of literature
Authors: Saini Raghav , Bali Kamal , Bachhal Vikas , Mootha Aditya K , Dhillon Mandeep S , Gill Shivinder S
Published: March 2011

Introduction

Giant cell tumor (GCT) of distal radius follows a comparatively aggressive behaviour. Wide excision is the management of choice, but this creates a defect at the distal end of radius. The preffered modalities for reconstruction of such a defect include vascularized/non-vascularized bone graft, osteoarticular allografts and custom-made prosthesis. We here present our experience with wide resection and non-vascularised autogenous fibula grafting for GCT of distal radius.

Materials and methods

Twelve patients with a mean age of 34.7 years (21-43 years) with Campanacci Grade II/III GCT of distal radius were managed with wide excision of tumor and reconstruction with ipsilateral nonvascularised fibula, fixed with small fragment plate to the remnant of the radius. Primary autogenous iliac crest grafting was done at the fibuloradial junction in all the patients.

Results

Mean follow up period was 5.8 years (8.2-3.7 years). Average time for union at fibuloradial junction was 33 weeks (14-69 weeks). Mean grip strength of involved side was 71% (42-86%). The average range of movements were 52° forearm supination, 37° forearm pronation, 42° of wrist palmerflexion and 31° of wrist dorsiflexion with combined movements of 162°. Overall revised musculoskeletal tumor society (MSTS) score averaged 91.38% (76.67-93.33%) with five excellent, four good and three satisfactory results. There were no cases with graft related complications or deep infections, 3 cases with wrist subluxation, 2 cases with non union (which subsequently united with bone grafting) and 1 case of tumor recurrence.

Conclusion

Although complication rate is high, autogenous non-vascularised fibular autograft reconstruction of distal radius can be considered as a reasonable option after en bloc excision of Grade II/III GCT.
Inspiratory muscle strength training improves weaning outcome in failure to wean patients: a randomized trial
Authors: Martin A Daniel , Smith Barbara K , Davenport Paul D , Harman Eloise , Gonzalez-Rothi Ricardo J , Baz Maher , Layon A Joseph , Banner Michael J , Caruso Lawrence J , Deoghare Harsha , Huang Tseng-Tien , Gabrielli Andrea
Published: March 2011

Introduction

Most patients are readily liberated from mechanical ventilation (MV) support, however, 10% - 15% of patients experience failure to wean (FTW). FTW patients account for approximately 40% of all MV days and have significantly worse clinical outcomes. MV induced inspiratory muscle weakness has been implicated as a contributor to FTW and recent work has documented inspiratory muscle weakness in humans supported with MV.

Methods

We conducted a single center, single-blind, randomized controlled trial to test whether inspiratory muscle strength training (IMST) would improve weaning outcome in FTW patients. Of 129 patients evaluated for participation, 69 were enrolled and studied. 35 subjects were randomly assigned to the IMST condition and 34 to the SHAM treatment. IMST was performed with a threshold inspiratory device, set at the highest pressure tolerated and progressed daily. SHAM training provided a constant, low inspiratory pressure load. Subjects completed 4 sets of 6-10 training breaths, 5 days per week. Subjects also performed progressively longer breathing trials daily per protocol. The weaning criterion was 72 consecutive hours without MV support. Subjects were blinded to group assignment, and were treated until weaned or 28 days.

Results

Groups were comparable on demographic and clinical variables at baseline. The IMST and SHAM groups respectively received 41.9 ± 25.5 vs. 47.3 ± 33.0 days of MV support prior to starting intervention, P = 0.36. The IMST and SHAM groups participated in 9.7 ± 4.0 and 11.0 ± 4.8 training sessions, respectively, P = 0.09. The SHAM group's pre to post-training maximal inspiratory pressure (MIP) change was not significant (-43.5 ± 17.8 vs. -45.1 ± 19.5 cm H2O, P = 0.39), while the IMST group's MIP increased (-44.4 ± 18.4 vs. -54.1 ± 17.8 cm H2O, P < 0.0001). There were no adverse events observed during IMST or SHAM treatments. Twenty-five of 35 IMST subjects weaned (71%, 95% confidence interval (CI) = 55% to 84%), while 16 of 34 (47%, 95% CI = 31% to 63%) SHAM subjects weaned, P = .039. The number of patients needed to be treated for effect was 4 (95% CI = 2 to 80).

Conclusions

An IMST program can lead to increased MIP and improved weaning outcome in FTW patients compared to SHAM treatment.

Trial Registration

ClinicalTrials.gov: NCT00419458