bluuebunny/crossref_metadata_2025 huggingface dataset:
Prophylaxis in severe forms of von Willebrand's disease: results from the von Willebrand Disease Prophylaxis Network (VWD PN)
Authors: Abshire T. C. , Federici A. B. , Alvárez M. T. , Bowen J. , Carcao M. D. , Cox Gill J. , Key N. S. , Kouides P. A. , Kurnik K. , Lail A. E. , Leebeek F. W. G. , Makris M. , Mannucci P. M. , Winikoff R. , Berntorp E. ,   VWD PN
Published: July 2012

The bleeding patterns of severe von Willebrand's disease (VWD) adversely affect quality of life, and may be life threatening. There is a presumed role for prophylaxis with VWF‐containing concentrates, but data are scarce. The von Willebrand Disease Prophylaxis Network (VWD PN) was formed to investigate the role of prophylaxis in clinically severe VWD that is not responsive to other treatment(s).Using a retrospective design, the effect of prophylaxis was studied. Availability of records to document, or reliably assess, the type and frequency of bleeding episodes prior to, and after, the initiation of prophylaxis was required. Annualized bleeding rates were calculated for the period prior to prophylaxis, during prophylaxis and by primary bleeding indication defined as the site accounting for more than half of all bleeding symptoms. The Wilcoxon signed‐rank test of differences in the medians was used. Sixty‐one subjects from 20 centres in 10 countries were enrolled. Data for 59 were used in the analysis. The median age at onset of prophylaxis was 22.4 years. Type 3 VWD accounted for the largest number (N = 34, 57.6%). Differences in bleeding rates within individuals during compared with before prophylaxis were significant for the total group (P < 0.0001), and for those with primary bleeding indications of epistaxis (P = 0.0005), joint bleeding (P = 0.002) and GI bleeding (P = 0.001). The effect of prophylaxis was similar among those age < 18 years and those ≥18. One person developed an inhibitor during treatment. We conclude that prophylactic treatment of VWD is efficacious.
FromDTCA‐PDto patient information to health information: the complex politics and semantics ofEUhealth policy
Authors: Brooks Eleanor , Geyer Robert
Published: July 2012

Rationale, aims and objectives

Between 2001 and 2011 the pharmaceutical industry, supported byDG Enterprise, was engaged in an ongoing campaign to repeal/amend theEuropeanUnion (EU) ban on direct‐to‐consumer advertising of prescription drugs (DTCA‐PD). As it became increasingly clear that the ban would not be repealed,DTCA‐PDsupporters tried to shift the debate away from advertising and towards the provision of ‘patient information’ and the rights of patients to access such information. Meanwhile, a variety of national and European health organizations, supported byDG SANCO, sought to maintain the ban and oppose the industry‐supported ‘patient information’ campaign. Instead, they promoted a concept of ‘health information’ that included all aspects of citizens' health, not just pharmaceuticals. This article aims to analyse the transition fromDTCA‐PDto patient information to health information and examine its implications forEUhealth policy as a complex policy space.

Methods

The article examines the emergence and development ofEUhealth policy and the evolution of theDTCA‐PDdebate through the lens of complexity theory. It analyses the nature of the semantic, political and policy transition and asks why it occurred, what it tells us aboutEUhealth policy and futureEUhealth legislation and how it may be understood from a complexity perspective.

Results and conclusions

The article concludes that the complexity framework is ideally suited for the field of public health and, in particular, theDTCA‐PDdebate. Having successfully shifted the policy‐focus of the debate to patients’ rights and health information, opponents of the legislation are likely to face their next battle in the realm of cyberspace, where regulatory issues change the nature of advertising.
The effects of cranio‐cervical flexion on activation of swallowing‐related muscles
Authors: Woo H.‐S. , Park S.‐H. , Jung M.‐Y. , Yoo E.‐Y. , Park J.‐H.
Published: July 2012

We tested the effects of cranio‐cervical flexion (CCF) on activation of swallowing‐related muscles while swallowing liquid in a sample of 45 healthy volunteers. Activation following CCF movement was examined across two positions (supine and sitting) and, three pressure levels and two different postures were examined in each condition, respectively. When CCF was applied, activation of swallowing‐related muscles was significantly increased compared to the neutral neck position, and such findings were found across both the supine and sitting positions. Also in the supine position, when the pressure level of the stabilizer was escalated, there was a significant difference in the activity of the swallowing‐related muscles compared to the baseline level. In conclusion, our results suggest that CCF may be a viable method to enhance the effectiveness of swallowing‐related muscles by changing neck position. When CCF is applied, the stability of the deep flexor muscles must be secured first after which superficially located muscles may better assist swallowing with less effort.
Low Digit Ratio Predicts Early Age at Menarche in Colombian Schoolgirls
Authors: Oberg Anna S. , Villamor Eduardo
Published: July 2012

Background:  The ratio between the lengths of the second and fourth fingers (digit ratio: 2D : 4D), a purported negative correlate of prenatal androgen exposure, has been inversely related to age at menarche. However, a recent study found high digit ratios in carriers of a single variant in the LIN28B gene, which has been linked to delayed menarche.

Methods:  We investigated the association of digit ratio and age at menarche in 299 pre‐menarcheal girls aged 5–12 years who participated in a longitudinal cohort study in Bogotá, Colombia. Finger lengths were measured at baseline and the occurrence of menarche was periodically ascertained over a median 32 months of follow‐up. We used time‐to‐event analysis to estimate median ages at menarche as well as hazard ratios for menarche according to tertiles of the digit ratio for each hand.

Results:  Estimated median age at menarche was lower for girls in the lowest digit ratio tertile of the right hand compared with those in the highest (12.0 vs. 12.3 years; P‐value = 0.04). After adjustment for baseline age, height‐ and body mass index‐for‐age z‐scores, the hazard of menarche was 86% higher in girls of the lowest digit ratio tertile (hazard ratio 1.9 [95% confidence interval 1.2, 2.9]) compared with those in the highest digit ratio tertile of the right hand. No significant associations were found with the left hand.

Conclusions:  Digit ratio was positively associated with age at menarche in this longitudinal investigation, consistent with results from a recent gene‐linkage study.
The SELMA Study: A Birth Cohort Study in Sweden Following More Than 2000 Mother–Child Pairs
Authors: Bornehag Carl‐Gustaf , Moniruzzaman Syed , Larsson Malin , Lindström Cecilia Boman , Hasselgren Mikael , Bodin Anna , von Kobyletzkic Laura B. , Carlstedt Fredrik , Lundin Fredrik , Nånberg Eewa , Jönsson Bo A. G. , Sigsgaard Torben , Janson Staffan
Published: July 2012

Background:  This paper describes the background, aim and study design for the Swedish SELMA study that aimed to investigate the importance of early life exposure during pregnancy and infancy to environmental factors with a major focus on endocrine disrupting chemicals for multiple chronic diseases/disorders in offspring.

Methods:  The cohort was established by recruiting women in the 10th week of pregnancy. Blood and urine from the pregnant women and the child and air and dust from home environment from pregnancy and infancy period have been collected. Questionnaires were used to collect information on life styles, socio‐economic status, living conditions, diet and medical history.

Results:  Of the 8394 reported pregnant women, 6658 were invited to participate in the study. Among the invited women, 2582 (39%) agreed to participate. Of the 4076 (61%) non‐participants, 2091 women were invited to a non‐respondent questionnaire in order to examine possible selection bias. We found a self‐selection bias in the established cohort when compared with the non‐participant group, e.g. participating families did smoke less (14% vs. 19%), had more frequent asthma and allergy symptoms in the family (58% vs. 38%), as well as higher education among the mothers (51% vs. 36%) and more often lived in single‐family houses (67% vs. 60%).

Conclusions:  These findings indicate that the participating families do not fully represent the study population and thus, the exposure in this population. However, there is no obvious reason that this selection bias will have an impact on identification of environmental risk factors.
Twin studies of pain
Authors: Nielsen CS , Knudsen GP , Steingrímsdóttir ÓA
Published: July 2012

Twin studies provide a method for estimating the heritability of phenotypes and for examining genetic and environmental relationships between phenotypes. We conducted a systematic review of twin studies of pain, including both clinical and experimental pain phenotypes. Fifty‐six papers were included, whereof 52 addressed clinical phenotypes. Of the most comprehensively studied phenotypes, available data indicates heritability around 50% for migraine, tension‐type headache and chronic widespread pain, around 35% for back and neck pain, and around 25% for irritable bowel syndrome. However, differences in phenotype definitions make these results somewhat uncertain. All clinical studies relied on dichotomous outcomes and none used pain intensity as continuous phenotype. This is a major weakness of the reviewed studies and gives reason to question their validity with respect to pain mechanisms. Experimental pain studies indicate large differences in heritability across pain modalities. Whereas there is evidence for substantial common genetic risk across many clinical pain conditions, different experimental pain phenotypes appear to be associated with different genetic factors. Recommendations for future research include inclusion of pain intensity scaling and number of pain sites in phenotyping. Furthermore, studies examining the genetic relationships between pain phenotypes, in particular between clinical and experimental phenotypes, should be prioritized.
A new african fossil caprin and a combined molecular and morphological bayesian phylogenetic analysis of caprini (Mammalia: Bovidae)
Authors: Bibi F. , Vrba E. , Fack F.
Published: July 2012

Given that most species that have ever existed on Earth are extinct, no evolutionary history can ever be complete without the inclusion of fossil taxa. Bovids (antelopes and relatives) are one of the most diverse clades of large mammals alive today, with over a hundred living species and hundreds of documented fossil species. With the advent of molecular phylogenetics, major advances have been made in the phylogeny of this clade; however, there has been little attempt to integrate the fossil record into the developing phylogenetic picture. We here describe a new large fossil caprin species from ca. 1.9‐Ma deposits from the Middle Awash, Ethiopia. To place the new species phylogenetically, we perform a Bayesian analysis of a combined molecular (cytochrome b) and morphological (osteological) character supermatrix. We include all living species of Caprini, the new fossil species, a fossil takin from the Pliocene of Ethiopia (Budorcas churcheri), and the insular subfossil Myotragus balearicus. The combined analysis demonstrates successful incorporation of both living and fossil species within a single phylogeny based on both molecular and morphological evidence. Analysis of the combined supermatrix produces superior resolution than with either the molecular or morphological data sets considered alone. Parsimony and Bayesian analyses of the data set are also compared and shown to produce similar results. The combined phylogenetic analysis indicates that the new fossil species is nested within Capra, making it one of the earliest representatives of this clade, with implications for molecular clock calibration. Geographical optimization indicates no less than four independent dispersals into Africa by caprins since the Pliocene.
The evolution of experience‐mediated plasticity in mate preferences
Authors: Fowler‐Finn K. D. , Rodríguez R. L.
Published: July 2012

Experience of sexual signals can alter mate preferences and influence the course of sexual selection. Here, we examine the patterns of experience‐mediated plasticity in mate preferences that can arise in response to variation in the composition of mates in the environment. We use these patterns to test hypotheses about potential sources of selection favouring experience‐mediated plasticity. We manipulated signal experience of female Enchenopa treehoppers (Hemiptera: Membracidae) in a vibrational playback experiment with the following treatments: silence; two types of non‐preferred signals; preferred signals; and a mixture of preferred and non‐preferred signals. This experiment revealed plasticity in mate preference selectivity, with greatest selectivity in the mixed signal treatment, followed by the preferred signal treatment. We found no plasticity in peak preference. These results suggest that females have been selected to adjust preference selectivity according to the variability of potential mates in their social environment, as well as to the presence/absence of preferred mates. We discuss how experience‐mediated plasticity in mate preferences can influence the strength of selection on male signals and can result in evolutionary dynamics between variation in preferences and signals that either promote the maintenance of variation or facilitate rapid trait fixation.
Do immunological, endocrine and metabolic traits fall on a single Pace‐of‐Life axis? Covariation and constraints among physiological systems
Authors: Versteegh M. A. , Schwabl I. , Jaquier S. , Tieleman B. I.
Published: July 2012

Variation in demographic and physiological attributes of life history is thought to fall on one single axis, a phenomenon termed the Pace‐of‐Life. A slow Pace‐of‐Life is characterized by low annual reproduction, long life span and low metabolic rate, a fast Pace‐of‐Life by the opposite characteristics. The existence of a single axis has been attributed to constraints among physiological mechanisms that are thought to restrict evolutionary potential. In that case, physiological traits should covary in the same fashion at the levels of individual organisms and species. We examined covariation at the levels of individual and subspecies in three physiological systems (metabolic, endocrine and immune) using four stonechat subspecies with distinct life‐history strategies in a common‐garden set‐up. We measured basal metabolic rate, corticosterone as endocrine measure and six measures of constitutive immunity. Metabolic rate covaried with two indices of immunity at the individual level, and with corticosterone concentrations and one index of immunity at the subspecies level, but not with other measures. The different patterns of covariation among individuals and among subspecies demonstrate that links among physiological traits are loose and suggest that these traits can evolve independent of each other.
Beyond the pollination syndrome: nectar ecology and the role of diurnal and nocturnal pollinators in the reproductive success of Inga sessilis (Fabaceae)
Authors: Amorim F. W. , Galetto L. , Sazima M.
Published: July 2012

Inga species present brush‐type flower morphology allowing them to be visited by distinct groups of pollinators. Nectar features in relation to the main pollinators have seldom been studied in this genus. To test the hypothesis of floral adaptation to both diurnal and nocturnal pollinators, we studied the pollination ecology of Inga sessilis, with emphasis on the nectar secretion patterns, effects of sequential removals on nectar production, sugar composition and the role of diurnal and nocturnal pollinators in its reproductive success. Inga sessilis is self‐incompatible and pollinated by hummingbirds, hawkmoths and bats. Fruit set under natural conditions is very low despite the fact that most stigmas receive polyads with sufficient pollen to fertilise all ovules in a flower. Nectar secretion starts in the bud stage and flowers continually secreting nectar for a period of 8 h. Flowers actively reabsorbed the nectar a few hours before senescence. Sugar production increased after nectar removal, especially when flowers were drained during the night. Nectar sugar composition changed over flower life span, from sucrose‐dominant (just after flower opening, when hummingbirds were the main visitors) to hexose‐rich (throughout the night, when bats and hawkmoths were the main visitors). Diurnal pollinators contributed less than nocturnal ones to fruit production, but the former were more constant and reliable visitors through time. Our results indicate I. sessilis has floral adaptations, beyond the morphology, that encompass both diurnal and nocturnal pollinator requirements, suggesting a complementary and mixed pollination system.
Behaviour of pollinator insects within inflorescences of Scrophularia species from Iberian Peninsula
Authors: Valtueña F. J. , Ortega‐Olivencia A. , Rodríguez‐Riaño T. , Pérez‐Bote J. L. , Mayo C.
Published: July 2012

Several hypotheses have been proposed to explain the pattern of pollinator visits to vertical inflorescences. These range from a response to a pattern of resources to merely instinctive behaviour. In dichogamous plants, such behaviour has been associated with promoting outcrossing and avoiding geitonogamy. We here analyse behaviour of the principal pollinator groups in five protogynous species of Scrophularia with different flower sizes (S. sambucifolia, S. grandiflora, S. lyrata, S. scorodonia and S. canina), and the distribution of sexual phases along the inflorescences. The results in all cases show that pollinators follow a pattern of ascending visits accompanied by movements between flowers of the same whorl (horizontal movements). The relative frequency of these horizontal movements depends on the flower size, with a higher frequency in species with large flowers. In vertical movements of the three more common pollinator groups to several plant species (bumblebees, wasps and small bees), the behaviour was essentially independent of flower size, with bumblebees having the highest ratio of ascents to descents. Behaviour of the pollinators, together with the absence of a definite pattern of distribution of the sexual phases along the inflorescence, implies that geitonogamy is not avoided in any of the Scrophularia species studied.
Effects of intrauterine infection or inflammation on fetal lung development
Authors: Westover Alana J , Moss Timothy JM
Published: July 2012

Intrauterine infection or inflammation is common in cases of preterm birth. Preterm infants are at risk of acute respiratory distress as a result of lung immaturity; evidence of exposure to infection and/or inflammation before birth is associated with a reduced risk of neonatal respiratory distress syndrome (RDS). Experimentally induced intrauterine inflammation or infection in sheep causes a precocious increase in pulmonary surfactant in the preterm lungs that improves preterm lung function, consistent with the reduced risk of RDS in human infants exposed to infection and/or inflammation before birth.

The effects of intrauterine inflammation on fetal lung development appear to result from direct action of proinflammatory stimuli within the lungs rather than by systemic signals, such as the classical glucocorticoid‐mediated lung maturation pathway. However, paracrine and/or autocrine production and/or metabolism of glucocorticoids in fetal lung tissue may occur as a result of inflammation‐induced changes in the expression of 11β‐hydroxysteroid dehydrogenase (types 1 and 2).

Likely candidates that mediate inflammation‐induced surfactant production by the preterm lung include prostaglandin E2 and/or other arachidonic acid metabolites. Intrauterine inflammation induces the expression of enzymes responsible for prostaglandin production in fetal lung tissue. Inhibition of prostaglandin production prevents, at least in part, the effects of inflammation on fetal lungs.

Our experiments are identifying mechanisms of surfactant production by the preterm lungs that may be exploited as novel therapies for preventing respiratory distress in preterm infants. Elucidation of the effects of inflammation on the fetal lungs and other organs will allow more refined approaches to the care of preterm infants exposed to inflammation in utero.
Acute tubulointerstitial nephritis, treatment with steroid and impact on renal outcomes
Authors: RAZA MUHAMMAD N , HADID MUHAMMAD , KEEN CHARLES E , BINGHAM CORALIE , SALMON ANDREW HJ
Published: July 2012

Background:  The use and timing of steroids in the management of acute tubulointerstitial nephritis (ATIN) remains debatable.

Aims:  To determine the incidence and aetiology of ATIN in our unit, and to examine trends in the use of steroids and their impact on renal outcomes.

Methods:  Patients with a histological diagnosis of ATIN over a 9‐year period were identified and divided into steroid‐treated (StG) and steroid‐naïve groups (SnG). Mean change in estimated glomerular filtration rate (eGFR) was determined.

Results:  Forty‐nine patients had ATIN as their main diagnosis, 67% of cases were drug‐induced, and proton pump inhibitors (PPI) were the second commonest implicated drug category. Majority (75%) of patients received steroids, and eGFR improved to a significantly greater degree in these steroid‐treated patients (3.4‐fold improvement vs 2.0‐fold in SnG; P < 0.05, unpaired t‐test). Despite comparable eGFR at presentation (StG: 11.7; SnG: 15.4), steroid‐treated patients were less likely to receive dialysis, although not significantly so (OR 0.27; 95% CI 0.06–1.15, P = 0.066, chi‐squared test). However, there was no significant relation between the degree of eGFR improvement and delay in starting steroids (Pearson r = −0.25, P > 0.45), and no difference in eGFR at the time of last follow‐up (StG: 33 ± 3; SnG: 32 ± 7; P > 0.9, unpaired t‐test).

Conclusion:  StG patients had a greater degree of improvement in renal function, but with no correlation between degree of improvement in eGFR and delay in starting steroids, and similar eGFR values at final follow‐up. PPI were the second commonest drug category among drug‐induced cases.
Serum carcinoembryonic antigen correlates with severity of idiopathic pulmonary fibrosis
Authors: FAHIM AHMED , CROOKS MICHAEL G. , WILMOT RACHEL , CAMPBELL ANNE P. , MORICE ALYN H. , HART SIMON P.
Published: July 2012

Background and objective:  Idiopathic pulmonary fibrosis (IPF) is the commonest idiopathic interstitial pneumonia and carries a poor prognosis. Epidemiological evidence suggests that patients with IPF have an increased risk of developing lung cancer. Carcinoembryonic antigen (CEA) has a close association with epithelial malignancy. The aim of this study was to evaluate serum CEA concentrations in patients with IPF and to perform correlation with pulmonary function.

Methods:  Serum CEA concentrations were measured by two‐site sequential chemiluminescent immunometric assay in 41 non‐smoking patients with IPF. Patients with a history of gastrointestinal tract malignancy or other disorder known to be associated with raised serum CEA were excluded.

Results:  A total of 41 patients were evaluated. The mean (±standard deviation) age of patients was 73 ± 7 years. The mean (±standard deviation) forced vital capacity was 88 ± 20% of predicted, and the mean (±standard deviation) diffusing factor for carbon monoxide (DLco) was 52 ± 19% of predicted. Twenty‐one (51%) patients had a serum CEA concentration higher than upper limit of the normal range (0–5 ng/mL). CEA concentration was significantly negatively correlated with lung function (P = 0.005; R2 = 0.20 for forced vital capacity and P = 0.006; R2 = 0.20 for DLco). Raised CEA level also correlated significantly with the extent of fibrosis. A lung biopsy specimen from a patient with IPF demonstrated strong staining for CEA in metaplastic epithelium lining the honeycombed cysts and respiratory bronchioles.

Conclusions:  Serum CEA concentration is elevated in approximately half of patients with IPF and is correlated with disease severity. Immunohistochemical staining reveals that CEA localizes to metaplastic epithelium lining honeycombed bronchioles.
Genome‐wide microarray comparison reveals downstream genes of Pax6 in the developing mouse cerebellum
Authors: Ha Thomas J. , Swanson Douglas J. , Kirova Roumyana , Yeung Joanna , Choi Kunho , Tong Yiai , Chesler Elissa J. , Goldowitz Daniel
Published: July 2012

The Pax6 transcription factor is expressed in cerebellar granule cells and when mutated, as in the Sey/Sey mouse, produces granule cells with disturbed survival and migration and with defects in neurite extension. The impact of Pax6 on other genes in the context of cerebellar development has not been identified. In this study, we performed transcriptome comparisons between wildtype and Pax6‐null whole cerebellar tissue at embryonic day (E) 13.5, 15.5 and 18.5 using Affymetrix arrays (U74Av2). Statistical analyses identified 136 differentially regulated transcripts (FDR 0.05, 1.2‐fold change cutoff) over time in Pax6‐null cerebellar tissue. In parallel we examined the Math1‐null granuloprival cerebellum and identified 228 down‐regulated transcripts (FDR 0.05, 1.2‐fold change cutoff). The intersection of these two microarray datasets produced a total of 21 differentially regulated transcripts. For a subset of the identified transcripts, we used qRT‐PCR to validate the microarray data and demonstrated the expression in the rhombic lip lineage and differential expression in Pax6‐null cerebellum within situhybridisation analysis. The candidate genes identified in this way represent direct or indirect Pax6‐downstream genes involved in cerebellar development.
Resveratrol prevents CA1 neurons against ischemic injury by parallel modulation of both GSK‐3β and CREB through PI3‐K/Akt pathways
Authors: Simão Fabrício , Matté Aline , Pagnussat Aline S. , Netto Carlos A. , Salbego Christianne G.
Published: July 2012

Accumulating evidence indicates that resveratrol potently protects against cerebral ischemia damage due to its oxygen free radicals scavenging and antioxidant properties. However, cellular mechanisms that may underlie the neuroprotective effects of resveratrol in brain ischemia are not fully understood yet. This study aimed to investigate the potential association between the neuroprotective effect of resveratrol and the apoptosis/survival signaling pathways, in particular the glycogen synthase kinase 3 (GSK‐3β) and cAMP response element‐binding protein (CREB) through phosphatidylinositol 3‐kinase (PI3‐K)‐dependent pathway. An experimental model of global cerebral ischemia was induced in rats by the four‐vessel occlusion method for 10 min and followed by different periods of reperfusion. Nissl staining indicated extensive neuronal death at 7 days after ischemia/reperfusion. Administration of resveratrol by i.p. injections (30 mg/kg) for 7 days before ischemia significantly attenuated neuronal death. Both GSK‐3β and CREB appear to play a critical role in resveratrol neuroprotection through the PI3‐K/Akt pathway, as resveratrol pretreatment increased the phosphorylation of Akt, GSK‐3β and CREB in 1 h in the CA1 hippocampus after ischemia/reperfusion. Furthermore, administration of LY294002, an inhibitor of PI3‐K, compromised the neuroprotective effect of resveratrol and decreased the level of p‐Akt, p‐GSK‐3β and p‐CREB after ischemic injury. Taken together, the results suggest that resveratrol protects against delayed neuronal death in the hippocampal CA1 by maintaining the pro‐survival states of Akt, GSK‐3β and CREB pathways. These data suggest that the neuroprotective effect of resveratrol may be mediated through activation of the PI3‐K/Akt signaling pathway, subsequently downregulating expression of GSK‐3β and CREB, thereby leading to prevention of neuronal death after brain ischemia in rats.
Incidence and causes of perioperative endotracheal reintubation in children: a review of 28 208 anesthetics
Authors: Ing Caleb , Chui Inca , Ohkawa Susumu , Kakavouli Athina , Sun Lena
Published: July 2012

Objectives/Aim:  To determine the incidence, risk factors, and causes of endotracheal reintubation in children and identify methods to reduce the occurrence.

Background:  Reintubation during the perioperative period is a serious and potentially preventable adverse event that can result in significant morbidity.

Methods:  A total of 28 208 anesthetics were delivered to pediatric patients at our institution between May 2006 and May 2009. Reintubations were identified with our quality assurance (QA) surveillance database coupled with chart review by our QA nurse. Cases were classified as planned versus inadvertent extubations, and adverse events were assessed.

Results:  We discovered 27 cases of reintubation with an incidence of 9.6 : 10 000 anesthetics. Reintubated patients were found to be younger than the general population (P = 0.001) with a high rate of comorbid disease. While most reintubations could be attributed to respiratory causes, 30% were attributed to inadvertent displacement of the endotracheal tube. No mortalities were seen, but 22% of patients needed resuscitative medications and 7% received chest compressions. Of the patients who failed planned extubations, 53% were left intubated with an average duration of postoperative intubation of 2.4 ± 1.9 days.

Conclusions:  The incidence of endotracheal reintubation in children is low, but can result in significant morbidity. Because of the high frequency of inadvertent extubation, a significant number of reintubations could be prevented with greater care during transfer of patients with endotracheal tubes, and in procedures near the airway. Increased vigilance in younger children is also recommended as children under 3 years old required the majority of the reintubations.
A prospective observational quality improvement study of the sustained effects of a program to reduce unplanned extubations in a pediatric intensive care unit
Authors: Rachman Bonnie R. , Mink Richard B.
Published: July 2012

Background:  The use of endotracheal intubation is routine in the care of critically ill children. Unplanned extubation exposes the patient to morbidity and mortality over and above that associated with the patient’s underlying disease. All unplanned extubations are unacceptable because of their potential for causing unnecessary harm to the patient.

Objective:  To prospectively determine whether a quality improvement program adopted 9 years ago has continued to be successful in maintaining a low rate of unplanned extubation in our pediatric intensive care unit (PICU).

Design:  Prospective, observational study.

Setting:  10‐bed PICU in an urban, county, teaching hospital.

Patients:  All intubated pediatric patients in the PICU from February 15, 2009 to February 14, 2010.

Intervention:  None.

Measurements and Results:  Prior to the implementation of the program in 2000, our PICU had an unplanned extubation rate of 6.4 unplanned extubations per 100 ventilated days. After implementation of the quality improvement program, the rate of unplanned extubation decreased to 1.0 unplanned extubation per 100 ventilated days. In this study, we reevaluated the unplanned extubation rate 9 years after the implementation of the quality improvement program. We found that the rate had remained unchanged (P > 0.05): 1.5 unplanned extubations per 100 ventilated days as compared to 1.0 unplanned extubation per 100 ventilated days. There were no significant differences (P > 0.05) in age, weight, endotracheal tube size, duration of intubation or rate of unplanned extubation.

Limitations:  In this study, no randomization took place, in which one group was not subject to the quality improvement program. We did not account for potential changes in severity of illness or staffing issues.

Conclusions:  In the 9 years since implementation, our program has remained successful in decreasing unplanned extubations. It is important to periodically reevaluate quality improvement programs to determine whether they have continued to achieve their intended goals.

The initiative is reported here using the Standards for Quality Improvement Reporting Excellence (SQUIRE).
What are the symptoms of internal rectal prolapse?
Authors: Wijffels N. A. T. , Jones O. M. , Cunningham C. , Bemelman W. A. , Lindsey I.
Published: July 2012

Aim  Although high‐grade internal rectal prolapse is believed to cause functional symptoms such as obstructed defaecation, little has been published on the exact distribution and frequency of symptoms. The aim of this study was to identify the most common symptoms of patients with high‐grade internal rectal prolapse.

Method  Patients were diagnosed with high‐grade prolapse (grade 3 and 4) on proctography using the Oxford Rectal Prolapse Grade. Information from a prospectively collected database was supplemented by a retrospective case note review.

Results  Eighty eight patients (94% of them women) were included for analysis. Faecal incontinence (56%) was the most common symptom at presentation. Symptoms related to obstructed defaecation syndrome were the next most common, including incomplete evacuation (45%), straining (34%), digital assistance (34%) and repetitive toilet visits (33%).

Conclusion  A variety of symptoms may be caused by high‐grade internal rectal prolapse Although symptoms of obstructed defaecation were frequent, urge faecal incontinence was the most common.
“Participation”, White Privilege and Environmental Justice: Understanding Environmentalism Among Hispanics in Toronto
Authors: Gibson‐Wood Hilary , Wakefield Sarah
Published: July 2012

Abstract:  The environmental justice movement has highlighted not only the unequal distribution of environmental hazards across lines of race and class, but also the white, middle‐class nature of some environmentalisms, and broader patterns of marginalization underlying people's opportunities to participate or not. There is a significant body of work discussing Hispanic environmental justice activism in the US, but not in Canada. This paper draws on interviews with representatives of organizations working on environmental initiatives within the Hispanic population of Toronto, Canada to explore definitions of and approaches to environmentalism(s) and community engagement. Four interrelated “mechanisms of exclusion” are identified in this case study—economic marginalization; (in)accessibility of typical avenues of participation; narrow definitions of “environmentalism” among environmental organizations; and the perceived whiteness of the environmental movement. Taken together, these mechanisms were perceived as limiting factors to environmental activism in Toronto's Hispanic population. We conclude that the unique context of Toronto's Hispanic community, including contested definitions of “community” itself, presents both challenges and opportunities for a more inclusive environmentalism, and argue for the value of “recognition” and “environmental racialization” frameworks in understanding environmental injustice in Canada.
MAKING THE COLONIAL STATE: DEVELOPMENT, DEBT, AND WARFARE IN NEW ZEALAND, 1853–76
Authors: ATTARD BERNARD
Published: July 2012

Warfare in New Zealand during the 1860s has recently been linked to the rise of the central state and growth of the national debt in that colony. This article argues that any parallel to the growth of the European fiscal‐military state is misguided. The fundamental cause of state centralisation and rising indebtedness was the same long‐run dynamic of colonial development active in all settler societies during the nineteenth century. The colonial state functioned, in part, to raise capital for development, and if necessary the colonial state would be remodelled in order to achieve this. New Zealand was no exception.
DID GOOD INSTITUTIONS PRODUCE GOOD TARIFFS? EVIDENCE FROM TARIFF PROTECTION IN COLONIAL VICTORIA
Authors: WILSON JOHN K. , SHANAHAN MARTIN P.
Published: July 2012

Were tariff rates in the Australian colony of Victoria directed towards growth‐enhancing industries or rent seekers? Recent research suggests tariffs may be welfare enhancing if they are directed at industries with positive externalities; something more likely when institutions are strong. Using disaggregated tariff data for the years 1872, 1880, and 1890, we analyse the relationship between industry characteristics and tariffs, finding little evidence that Victorian industries with positive externalities received tariff protection. Our results throw doubt on good institutions necessarily producing good tariff outcomes and suggest the relationship between tariffs and growth is more complex than current studies assume.
THE ART OF WAR CORPUS AND CHINESE JUST WAR ETHICS PAST AND PRESENT
Authors: Lo Ping‐cheung
Published: July 2012

The idea of “just war” is not alien to Chinese thought. The term “yi zhan” (usually translated as “just war” or “righteous war” in English) is used in Mencius, was renewed by Mao Zedong, and is still being used in China today (zhengyi zhanzheng). The best place to start exploring this Chinese idea is in the enormous Art of War corpus in premodern China, of which the Seven Military Classics is the best representative. This set of treatises served as the military bible in imperial China from 1078 CE. Ideas analogous to ius ad bellum and ius in bello can be found in these texts. These norms are present in these military texts, elaborated in subsequent commentaries, understood as a matter of fact in Chinese political history, and recently and briefly acknowledged by a few Chinese military scholars in the mainland and in Taiwan. This Chinese just war ethics has its distinctiveness vis‐à‐vis James Turner Johnson's articulation of the Western classic view. It differs from Johnson's claims that military lethal violence is intrinsically morally neutral and that last resort is not a primary consideration in deciding for war. Contemporary Chinese People's Liberation Army (PLA) military publications show that the PLA understands the general idea of just war, but they acknowledge only the ad bellum part, not the in bello components.
Extra‐Network Organizational Reputation and Blame Avoidance in Networks: The Hurricane Katrina Example
Authors: MOYNIHAN DONALD P.
Published: July 2012

Research on public service networks has identified a variety of mechanisms to foster coordination, including trust and reciprocity norms. This article argues that network actors are also driven by a desire to avoid blame. Network membership is often a political responsibility rather than a voluntary act, and members may be at least as attuned to their extra‐network organizational reputation as to their intra‐network reputation, creating an incentive to utilize blame avoidance strategies when failure occurs. Blame avoidance strategies undermine intra‐network trust and coordination, representing a significant threat to the implementation of public policy. To illustrate the potential of the concept for network theory, blame avoidance strategies are identified under the conditions of high political risk and task salience, as represented by the crisis response network in the U.S. disaster of Hurricane Katrina.
Heritage in the Dynamic City: The Politics and Practice of Urban Conservation on the Swahili Coast
Authors: HEATHCOTT JOSEPH
Published: July 2012

This study presents a series of everyday spaces in Swahili cities in order to problematize current urban heritage practices and to call for a more critical approach to conservation. Efforts to save elements of the Swahili built environment are hampered by colonial legacies that frame conservation in terms of pure archetypes, static taxonomies, and racially distinct building cultures. Conservationists draw on these legacies in defining particular architectural and landscape forms as ‘traditional’, and therefore worthy of protection. Ironically, these ‘traditional’ forms emerged within the crucible of an ever‐changing urban condition where the ‘tradition’ was innovation. The question thus arises as to the ultimate object of conservation practice: select buildings or the cultural processes that produced them? Through a careful reading of the Swahili built environment, this article examines key locations where urban spaces are formed, contested, and remade. The study concludes that to reflect the dynamic, multifaceted and cosmopolitan character of Swahili cities, conservationists must pay close attention to the ill‐fitting spaces where landscape innovations arise. Not only will this approach augur a more socially just organization of urban cultural resources, it will more accurately reflect the lived realities of Swahili cities in a global age.

À travers plusieurs espaces du quotidien dans des villes swahilies, cette étude met en question les pratiques actuelles liées au patrimoine urbain et appelle à une approche plus critique de la préservation. Les démarches de sauvegarde d'éléments de l'environnement bâti swahili sont entravées par des héritages coloniaux qui enferment la conservation dans des archétypes purs, des taxonomies statiques et des cultures de construction racialisées. Les défenseurs de l'environnement utilisent ces héritages pour qualifier certaines formes d'architecture et de paysage de ‘traditionnelles’, donc dignes d'être protégées. Paradoxalement, ces formes sont apparues dans un cadre urbain en constante évolution où la ‘tradition’était une innovation. Ce qui pose la question du but ultime de la sauvegarde pratiquée: des bâtiments privilégiés ou les processus culturels qui les produisent? Tout en déchiffrant l'environnement bâti swahili, l'article examine les lieux prépondérants où les espaces urbains sont façonnés, contestés et remaniés. D'après les conclusions, s'ils veulent traduire le caractère dynamique et cosmopolite des villes swahilies aux multiples facettes, les défenseurs de cet environnement doivent prêter une attention particulière aux espaces mal adaptés où naissent des paysages innovants. Non seulement cette approche annoncera une meilleure justice sociale dans l'organisation des ressources culturelles urbaines, mais elle offrira aussi une image plus exacte des réalités vécues dans les villes swahilies à l'ère de la mondialisation.
The Capitalization of Public Services and Amenities into Land Prices — Empirical Evidence from German Communities
Authors: Ebertz Alexander
Published: July 2012

Applying the hedonic approach to land prices, this article investigates the capitalization of public services and pure amenities in a cross section of German communities. Possible spillover effects from neighboring municipalities are explicitly included in the analysis and prove to be of considerable importance. Estimates of the impacts of local attributes on land prices are obtained taking into account the spatial structure among unobserved variables. The results confirm that differences in land prices are largely attributable to local conditions and policies. This implies a significant degree of mobility as well as high estimation of local attributes on the part of German households.
International Migration, Remittances and Subsistence Farming: Evidence from Nepal
Authors: Maharjan Amina , Bauer Siegfried , Knerr Beatrice
Published: July 2012

Although international migration is playing an increasingly important role in Nepal, at both the macro and household levels, and in particular for the poverty reduction of rural families, empirical work focusing on this phenomenon has been largely absent. With a special view on the rural poor, in this paper we investigate the impact of international labour migration on subsistence agricultural production in the Western Mid Hills of Nepal, based on a survey conducted among smallholders with migrating family members. The results demonstrate that international migration leads to negligence of cereals – paddy, wheat, maize and millet, in particular, being the major subsistence crops. While bearing a negative impact on family labour input, its impact on hired farm labour is positive. Yet it does not affect material inputs such as fertilizer, and although it helps to ease households’ liquidity and capital constraints, it does not contribute to moving subsistence farming towards more profitable commercial farming. Therefore, although migration reduces poverty in the short run and also allows for higher daily consumption, its negative impact on cereal production requires attention by policymakers.
Trends in International and Internal Teacher Mobility in Three Pacific Island Countries
Authors: Iredale Robyn R. , Voigt‐Graf Carmen , Khoo Siew‐Ean
Published: July 2012

High‐skilled migration has increasingly been the subject of migration research over the past decade, but the focus has tended to be on health and IT professionals. In this paper, we address the mobility of schoolteachers in a region that has so far received little attention, the Pacific Islands. It is timely to examine trends in teacher mobility in the Pacific, given the shortages that are occurring elsewhere. In particular, the tailoring of immigration policies to attract highly skilled workers in areas of shortage could impact on the Pacific. The focus of the paper is on emigration and we argue that of three countries studied, only Fiji is negatively affected by teacher mobility. The Cook Islands and Vanuatu are currently experiencing low levels of international teacher emigration. Levels of internal mobility are also investigated in an attempt to see if remote areas and outer islands are experiencing teacher shortages. The preference for working near one’s land or on one’s home island is a strong drawcard in bringing people back home to teach. A problem arises, however, when not enough people are trained from a region/island and the incentives to encourage others to go and work there are less than effective.
The role of oxygen‐associated therapies for the healing of chronic wounds, particularly in patients with diabetes
Authors: Brimson C.H. , Nigam Y.
Published: July 2012

This paper discusses the role of molecular oxygen as an aid to wound healing, and the potential value of the three major therapies which allow the delivery of oxygen to the wound site: Hyperbaric Oxygen Therapy (HBOT), Topical Oxygen Therapy (TOT) and a new sterile wound dressing, OxyzymeTM. We summarize studies which have been undertaken using these interventions, and discuss their reported effect on chronic, non‐healing wounds, in particular, on ulcers associated with Diabetes. The main conclusions drawn from the studies reviewed indicate that therapeutic oxygen can be used as an aid to the healing of chronic wounds; and benefits are clearly evident with the use of both HBOT and TOT. There is also potential for the use of a new, portable, topical oxygen delivery system, oxyzyme. However its use is still embryonic and studies on its effectiveness are limited. More robust measures of its efficacy are urgently needed.