bluuebunny/crossref_metadata_2025 huggingface dataset:
Myxomas Causing Coronary Emboli Resulting in Acute Myocardial Infarction
Authors: Taşdemir Kutay , Andaç M Halit , Ceyran Hakan , Yasim Alptekin
Published: May 2013

A 26-year-old female presented with chest pain, numbness in the legs, and electrocardiographic signs of left ventricular aneurysm and recent myocardial infarction. Transesophageal echocardiography detected a mass in each atria. Angiography demonstrated normal coronary arteries, a left ventricular aneurysm, and an apical thrombus. At surgery, myxomas were excised from both atria and the aneurysm was plicated, followed by peripheral embolectomy. The patient made a good recovery.
Tricuspid Valve Endocarditis with Pulmonary Embolism Due to Postpartum Septicemia
Authors: Srivastava Ashok K , Aggarwal Anil , Kapoor Aditya
Published: May 2013

Tricuspid valve endocarditis usually affects drug addicts without any preexisting heart disease. We report the successful surgical management of a case of tricuspid valve endocarditis with pulmonary artery embolism arising from postpartum septicemia.
Two Years Survival of Dissecting Ascending Aortic Aneurysm with Medical Treatment
Authors: Göl M Kamil , Saritaş Ahmet , Küçüker Şeref A , Taşdemir Oğuz , Bayazit Kemal
Published: May 2013

Aortic dissections in the acute phase have a dramatic outcome, especially those in the ascending and arcus segments. The fate of these dissections in the chronic phase is not well established. We describe a case treated medically for over two years and then successfully repaired surgically.
Ruptured Hydatid Cyst of the Right Ventricular Outflow Tract
Authors: Rajasekhar Durgaprasad , Manoj Padmanabhan , Dilip Dronamraju
Published: May 2013

A 12-year-old boy who presented with recurrent syncope was diagnosed to have a hydatid cyst of the right ventricular outflow tract. He underwent emergency surgery for cyst rupture but died due to pulmonary embolism and right heart failure.
Early and Midterm Results of Aortic Annular Enlargement
Authors: Aydoğan Hakki , Akay Hakan , Orhan Gökçen , Filizcan Uğur , Kaynarca Nurşin , Yücel Okan , Cömertoğlu Yildirim , Aykut-Aka Serap , Eren Ergin E
Published: May 2013

From November 1987 to May 1998, 16 patients with a small aortic annulus underwent patch enlargement of the aortic valve by Nicks' technique (in 9) or Manouguian's method (in 7). The mean age of the patients was 40 years (range, 22 to 58 years), mean body surface area was 1.54 m2 (range, 0.95 to 2.05 m2), and 11 were female. Concomitant procedures were mitral valve replacement in 4 cases, tricuspid commissurotomy and De Vega annuloplasty in 2, and one case each of patent ductus arteriosus ligation and coronary bypass. Aortic annular sizes were 15 to 19 mm (mean, 17.4 mm) preoperatively and 20 to 24 mm (mean, 22.1 mm) after the procedure. Two patients (12.5%) died in the early postoperative period. Peak pressure gradients across the prostheses were 15 to 22 mm Hg (mean, 19.4 mm Hg) on echocardiography. The mean duration of follow-up was 32.85 months (3 months to 8 years) and it was 92.8% complete. There were no late deaths. Mitral valve function was good except in one patient who had minimal mitral regurgitation after Manouguian's procedure. Both methods were found to be effective and reliable and should be performed when there is a risk of patient-prosthesis mismatch.
Aortic Root Replacement with Composite Graft: Experience in 95 Patients
Authors: Sun Li Zhong , Ren Jie , Wu Qing Yu , Chang Qian , Yang Tian Yu , Zhao Xiao Qin , Zhu Jun Ming , Liu Yong Ming
Published: May 2013

Between January 1994 and June 1998, 95 patients with a mean age of 40.6 years (range, 23 to 69 years) underwent aortic root replacement with composite grafts. The operations were performed under hypothermia and cardiopulmonary bypass. In dissecting aortic aneurysm or aneurysms involving the aortic arch, selective cerebral perfusion via the right subclavian artery was employed, with additional femoral arterial cannulation if necessary. Combined procedures included partial arch replacement (6), elephant trunk technique (2), and mitral valve replacement (2). The mean duration of aortic crossclamping was 74.3 ± 17.9 min (42 to 133 min) and the mean duration of cardiopulmonary bypass was 117.8 ± 28.6 min (60 to 232 min). The hospital mortality was 1.1% (1 patient) and there was one late death. Complications comprised reexploration for bleeding (2), pericardial effusion (2), cerebral infarction (1), pleural effusion (1), and pneumothorax (1). Blood transfusion was not needed in 8 patients. Hemorrhage was the most dangerous complication. Suitable operative methods and improved techniques are the keys to successful aortic root replacement.
Percutaneous Occlusion of Patent Ductus Arteriosus with Controlled-Release Coil
Authors: Kumar Arramraj Sreenivas , Kapoor Aditya , Sinha Nakul , Shahi Madhukar , Goel Pravin Kumar , Radhakrishnan Sitaraman , Srivastava Savitri
Published: May 2013

We evaluated the efficacy of the controlled-release Cook coil for percutaneous patent ductus arteriosus occlusion. Between October 1994 and December 1997, 45 consecutive patients with patent ductus arteriosus underwent cardiac catheterization and coil occlusion was attempted in 41, of whom 37 had Cook coils. A single coil was deployed in 34 of these patients and 2 or more coils were deployed in 3, with successful occlusion in 36 (97%). Immediate complete angiographic closure was achieved in 15 (41%), 18 (49%) had a trivial residual shunt, and 3 had a mild residual shunt on post-occlusion aortograms. Color Doppler echocardiography 24 hours after the procedure, revealed no detectable shunt in 33/36 (92%) and only a trivial residual shunt in 3 (8%) patients. Thus, 86% of patients with residual shunts immediately after occlusion had no evidence of residual shunts by 24 hours. No evidence of residual shunt or obstruction of the left pulmonary artery or the descending aorta was present at a mean follow-up of 26 months We concluded that Cook coils are a safe and cost-effective modality for percutaneous occlusion of patent ductus arteriosus with a high success rate and favorable intermediate-term follow-up.
Restenosis after Angioplasty in Patients with Left Ventricular Dysfunction
Authors: Magdy Ahmed , Al-Abbady Magid , Ghoga Abdullatif , Heib Klaus , Ozbek Cem
Published: May 2013

Clinical and angiographic rates of restenosis after angioplasty were compared in 80 patients (group A) with ejection fractions below 40% (mean, 28.3% ± 5.2%) and 50 (group B) with ejection fractions above 50% (mean, 58% ± 5.4%). Mean angina class improved to the same degree in both groups after angioplasty. Recurrence of significant angina within 6 to 12 months affected 30 patients (38%) in group A compared to 12 (24%) in group B (p > 0.05). Angiographic restenosis occurred in 42 patients (53%) in group A compared to 14 (28%) in group B (p = 0.006). Restenosis after single-vessel angioplasty was 46% in group A and 25% in group B (p > 0.05), after multivessel angioplasty it was 62% in group A and 33% in group B (p = 0.05). In group A, restenosis was more frequent in the left anterior descending coronary artery (46%) compared to the right coronary (41%) or circumflex (30%). Higher rates of restenosis occurred in patients with prior coronary artery bypass grafting (64%) or recanalization of chronic total occlusion (61%). Angina was a less reliable indication of restenosis in group A. We attribute the higher rate of restenosis in patients with low ejection fractions partly to low coronary perfusion pressure.
Aorto-Left Atrial Fistula Complicating Native Aortic Valve Endocarditis
Authors: Rajasekhar Durgaprasad , Manoj Padmanabhan , Dilip Dronamraju
Published: May 2013

A 21-year-old male with native aortic valve Streptococcus viridans endocarditis was found to have an aorto-left atrial fistula by transthoracic echocardiography. He underwent successful fistula plication and aortic valve replacement.
Anomalous Origin and Course of Left Anterior Descending Coronary Artery
Authors: Rajasekhar Durgaprasad , Ghosh Probal , Chandra Abha , Raju Narendranath
Published: May 2013

A 56-year-old female with exertional angina had signs of ischemia on an exercise electrocardiogram. Coronary arteriography revealed anomalous origin of the left anterior descending coronary artery from the right coronary artery. The initial portion was septal and it then coursed between the aorta and the pulmonary artery. The patient declined surgical revascularization.
Simple and Cost-Effective Gas Jet for Non-Pump Coronary Bypass Surgery
Authors: Posacioğlu Hakan , Atay Yüksel , Yağdi Tahir , Çalkavur Tanzer , Çikirikçioğlu Mustafa , Büket Suat , Hamulu Ahmet , Yüksel Münevver , Bilkay Önol
Published: May 2013

A gas jet is one method of achieving a bloodless surgical field. We describe a simple and cost-effective oxygen blower system for coronary artery bypass surgery performed without cardiopulmonary bypass.
Extrafascial Harvesting of Radial Artery for Coronary Artery Grafting
Authors: Ramasubrahmanyam Gutti , Raju Kati Venkata Ramana , Rao Goli Nagasaina , Varma N V Neeladri , Rao Kummara Chinna Venkateswara , Rani Guntaboina Usha , Rao Dasari Prasada
Published: May 2013

A modified method of harvesting radial artery conduit for use in coronary bypass surgery is described. Extrafascial harvesting reduces the incidence of conduit spasm during harvest and after grafting. The muscular branches are of adequate size to be ligated with silk without using clips. Whether there is any difference in long-term graft patency rates between extrafascial and intrafascial harvesting needs to be evaluated.
Influence of Lactation on Internal Mammary Artery Size and Flow
Authors: Kuralay Erkan , Demirkiliç Ufuk , Özal Ertuğrul , Öz Bilgehan , Cingöz Faruk , Tatar Harun
Published: May 2013

This prospective study compared internal mammary artery blood flow and diameter and hospital mortality after coronary artery bypass grafting in 3 groups of patients: group 1, 32 women who had breast fed; group 2, 21 women who had not breast fed; and group 3, 30 average-sized males. Mean internal mammary artery flow was significantly lower in group 2 (94 mL·min−1 in group 1, 65 mL·min−1 in group 2, 105 mL·min−1 in group 3). Mean distal internal mammary artery diameter was also less in group 2 (1.35 mm in group 1, 1 mm in group 2, 1.5 mm in group 3). Postoperative myocardial infarction occurred in 1 patient in group 1, 4 in group 2, and 1 in group 3. Anterior myocardial infarction in the 4 patients in group 2 was caused by internal mammary artery spasm. Hospital mortality was 3.13% in group 1, 9.52% in group 2, and 3.33% in group 3. The angina-free period in group 1 was significantly longer than in group 2 (4.5 versus 1.7 years). It was concluded that in women who had not breast fed, the internal mammary artery diameter was inadequate to supply myocardial demand and the graft was prone to lifethreatening spasm.
Enlargement of Small Aortic Annulus by Modified Manouguian's Technique
Authors: Sankar Nainar Madhu , Rajan Sethurathinam , Singh Rajarathinam Karnan Kalyan , Cherian Kotturathu Mammen
Published: May 2013

From January 1981 to June 1994, 17 patients underwent aortic annulus enlargement by a modified Manouguian's technique. A small aortic root associated with stenotic lesions was the main indication. The ages of the patients ranged from 5 to 55 years (mean, 21 ± 14 years). There were 10 males and 7 females. Four had concomitant mitral valve replacement, 2 had open mitral valvotomy, 1 underwent ventricular septal defect closure, excision of a subaortic membrane, and ascending aortic replacement. The aortic roots were enlarged to between 20 to 30 mm. A Dacron patch was used in 16 patients and glutaraldehyde-treated autologous pericardium was used in 1. Two patients (12%) died in the postoperative period, 1 due to hemorrhage and the other due to septicemia. Mitral regurgitation (grade 1) was seen in 1 patient postoperatively but there was no further deterioration on serial evaluation. Four patients were lost to follow-up. Of the 11 followed up over a period of 10 years, 7 were in New York Heart Association functional class I and 4 were in class II.
Intracardiac Right-to-Left Shunt Complicating Right Ventricular Failure
Authors: Sharif Hasanat , Pezzella A Thomas , Farah Husam H , Baljepally Raj , Maki Dennis
Published: May 2013

Three cases of intracardiac right-to-left shunt at the atrial level complicating right ventricular failure (RV) are described. Severe hypoxemia resulted in 2 patients and stroke in the third. This was a consequence of right ventricular infarction causing right-sided heart failure resulting in high right-sided pressures. Echocardiography demonstrated the shunts. A review of the literature on this uncommon problem suggested management strategies based on the limited experience with this condition.
Subxiphoid Approach for Treatment of Pericardial Effusion
Authors: Sarigül Ali , Farsak Bora , Ateş M Şanser , Demircin Metin , Paşaoğlu İlhan
Published: May 2013

Subxiphoid pericardiotomy was the primary treatment in 305 patients with pericardial effusion from January 1984 to June 1996. There were 198 males and 107 females, ages ranged from 15 days to 75 years. The procedure was carried out with local anesthesia and sedation in 263 (86.2%) patients and under general anesthesia in 42 (13.8%). Median drainage was 975.25 ± 48.46 mL in 264 patients with benign effusion and 1131.25 ± 97.48 mL in 41 (13.4%) with malignant disease; cytology was positive in 14 of 38 (36.8%) and pericardial biopsy showed cancer in 12 of 36 (33.3%). Intraoperative complications in 22 patients (7.2%) included cardiac arrest in 12 (3.9%) of whom, 7 (2.3%) died. Overall 30-day mortality was 16.3%; it was 46.3% (19/41) in malignant cases versus 11.7% (31/264) in cases of benign effusion. Follow-up of 234 (91.8%) hospital survivors for 18 ± 3.62 months (range, 2 to 54 months) showed recurrent pericardial effusion needing further intervention in 31 (13.2%) of whom, 8 had cancer and 23 had benign disease. Median survival in benign cases was more than 107 days versus 56 days in malignant cases. Because of its acceptable mortality and morbidity, subxiphoid pericardiotomy is recommend as an initial procedure.
Patent Ductus Arteriosus in a Population-Based Study
Authors: Grech Victor
Published: May 2013

This study was carried out to establish diagnostic and interventional trends in patent ductus arteriosus in a population-based study of births between 1935 and 1994 and to calculate the birth prevalence of this condition. This was done in the setting of a regional hospital catering for diagnosis and follow-up of all cases of congenital heart disease in Malta, under the supervision of visiting consultant pediatric cardiologists from the United Kingdom. Patent ductus arteriosus was diagnosed in 51 cases. Both age at diagnosis and age at surgery declined significantly in the period under study (p < 0.0001). Prior to the mid-1980s, preoperative diagnosis was made clinically with or without catheter confirmation. Subsequently, preoperative diagnosis was made almost exclusively by echocardiography. No mortality was associated with any of the interventions. Birth prevalence for the period 1980 to 1994 was 0.2 per 1000 live births. Rates for this lesion in historical studies vary widely from 0.09 to 2.11 per 1000 live births and this variation was attributed to methodological differences between studies. It was concluded that patent ductus arteriosus in Malta has been diagnosed and treated safely at progressively younger ages and this was attributed to improving medical services over the period studied.
Intrapulmonary Hematoma and Hemothorax following Penetrating Chest Injury
Authors: Çikirikçioğlu Mustafa , Çağirici Ufuk , Posacioğlu Hakan , Atay Yüksel , Savaş Recep , Yüksel Münevver , Bilkay Önol
Published: May 2013

Hemothorax and intrapulmonary hematoma were successfully treated in a 25-year-old male who suffered a penetrating chest injury. This very rare combination of clinical entities in the same patient is discussed in the light of pertinent literature.
Intrathoracic Migration of a Kirschner Wire
Authors: Emiroğullari Ö Naci , Kahraman Cemal , Taşdemir Kutay , Oğuzkaya Fahri
Published: May 2013

Intrathoracic migration of a Kirschner wire is a serious complication and immediate removal of the wire is mandatory. We describe a case of Kirschner wire migration from the left shoulder to the thorax. The wire was successfully retrieved from the intrapleural cavity.
Pulmonary Hydatid Cyst and Endogenous Lipoid Pneumonia
Authors: Elbeyli Levent , Filiz Ayten , Tunçözgür Bülent , Kepekci Yalçin , Kervancioğlu Reşat
Published: May 2013

Lipoid pneumonia associated with pulmonary hydatid cyst in a 20-year-old male is described. On the basis of clinical and radiological findings suggestive of pulmonary hydatid cyst, a thoracotomy was performed. Histopathology of the resected right upper lobe indicated hydatid cyst and lipoid pneumonia.
Endobronchial Inflammatory Pseudotumor: A Cause of Chronic Cough
Authors: Yildirim Zeki , Soysal Ömer , Gökirmak Münire , Cihan Hasan Berat , Mizrak Bülent , Hasanoğlu H Canan
Published: May 2013

Endobronchial location of an inflammatory pseudotumor is extremely rare. A 48-year-old female presented with chronic cough. An endobronchial polypoid inflammatory pseudotumor was diagnosed by bronchoscopic biopsy and treated by a middle lobectomy.
Modified “Elephant Trunk” Procedure for Type-A Aortic Dissection
Authors: Ogino Hitoshi , Ueda Yuichi , Matsubayashi Keiji , Nomoto Takuya
Published: May 2013

A modified “elephant trunk” procedure was successfully carried out in a 60-year-old female requiring double-barrel distal aortic anastomosis for chronic type-A aortic dissection. Initial rough fixation of the inserted graft to the descending aortic wall was followed by anastomosis of the graft to the descending aorta-to-arch graft with side-branches. Then aortic arch replacement was carried out with individual reconstruction of the three arch vessels.
Ultrasonic Devices in Cardiac Surgery
Authors: Ghosh Probal
Published: May 2013

Recent innovations in ultrasonic devices include high-frequency coagulating shears with piezoelectric ceramic electrostrictive transducers for both open and endoscopic procedures. Various ultrasonic devices have been used for the dissection of internal mammary, radial, and gastroepiploic arteries, aortic root, proximal right coronary artery, and left main coronary artery, as well as prior to surgical coronary ostial reconstruction and for elimination of stenotic induration in coronary arteries, release of muscle bridges, exposure of deep-seated coronary arteries, pericardiectomy, and removal of a cardiac tumor. Unlike valve decalcification, the required energy output of ultrasonic aspirators in coronary artery surgery is much lower and harvesting time of arterial conduits is significantly shortened. Ultrastructural studies of harvested internal mammary artery segments with scanning and transmission electron microscopy revealed no structural alteration of the wall or luminal surface when low energy output was used for dissection. On direct application of higher energy, subendothelial blistering may be detected occasionally. Ultrasonic devices help to remove thick fatty tissue and muscle bridges with almost no bleeding. Use of these devices may facilitate precise coronary artery surgery.
Takayasu's Arteritis: Current Status of Angioplasty and Stenting
Authors: Bali Harinder K , Jain Anshul K
Published: May 2013

Takayasu's arteritis is a chronic inflammatory disease characterized by stenotic occlusive lesions of the aorta and its major branches. The medical management of such lesions is far from satisfactory and surgical treatment is associated with high morbidity and mortality. Angioplasty with or without stenting has emerged as the treatment of choice for such lesions. Angioplasty and stenting of various vessels in Takayasu's arteritis are reviewed, highlighting the advantage of stents in reducing the rate of restenosis in chronically occluded or diffusely diseased vessels.
Biosense Left Ventricular Electromechanical Mapping
Authors: Bhargava Balram , Kornowski Ran
Published: May 2013

Biosense is a new technology for left ventricular endocardial mapping and catheter-based intramyocardial therapeutics. The system reconstructs electromechanical maps of the left ventricle without using x-ray fluoroscopy. The 3-dimensional electromechanical maps generated by the system are utilized to precisely identify viable target zones based on integration of endocardial electrical and mechanical signals for online diagnosis of myocardial viability in the catheterization laboratory. It may be used for guidance of radiofrequency ablation and may potentially be used to apply intramyocardial therapy by its integration with a laser fiber for transmyocardial laser revascularization procedures.
Comparison of Nikkiso and Bio-Medicus Pumps in Thoracoabdominal Aortic Surgery
Authors: Coselli Joseph S , Ledesma Dwayne F , LeMaire Scott A , Tayama Eiki , Raskin Steve A , Ohtsubo Satoshi , Harlin Stuart , Browning Neil G , Nosé Yukihiko
Published: May 2013

Left heart bypass reduces the risk of ischemic complications during the repair of extensive thoracoabdominal aortic aneurysms. This prospective study compared the performance of the recently developed Nikkiso centrifugal pump with the well-established Bio-Medicus pump during left heart bypass for thoracoabdominal aortic aneurysm surgery. Thirty-five consecutive patients undergoing graft repair of extensive thoracoabdominal aortic aneurysms were prospectively assigned to have left heart bypass using either the Bio-Medicus (in the first 19 patients) or Nikkiso pump (in the next 16 patients). There were no significant differences in pump flow rates or patient hemodynamics between the two groups and there was no evidence of pump malfunction. All patients survived and none developed postoperative coagulopathy, myocardial infarction, or left heart failure. Paraparesis developed in 2 patients in the Nikkiso group (12.5%); there were no neurologic complications in the Bio-Medicus group (p = 0.202). One patient in the Bio-Medicus group developed renal failure (5.3%; p = 1.000 vs. Nikkiso group). Overall, no significant differences were found in the incidence of postoperative complications. Although a small series, this comparison demonstrates that the Nikkiso centrifugal pump is as effective and safe in providing left heart bypass during thoracoabdominal aortic aneurysm repair as the widely-used Bio-Medicus model.
‘Jammin’ with Karlik’: The German-Polish ‘Radio War’ and the Gleiwitz ‘Provocation’, 1925–1939
Authors: Polak-Springer Peter
Published: May 2013

This essay aims to shed light on the role of radio in state territorial conflicts during the interwar era, a topic that has hardly received serious attention from scholars. Its focus is on the use of radio in the German-Polish contest over the Upper Silesian borderland. State actors of both countries built radio stations at the border with the explicit aim of integrating the largely culturally-mixed and ‘nationally indifferent’ population of locals on both sides of the borderland into – and thereby to secure the whole region for – their nation. A ‘radio war’ thus erupted by 1927, as the two sides competed against one another in this effort, and it lasted to the very end of the interwar era. This essay focuses its analysis on the programmes of the Polish Radio Katowice as they were broadcast over and received in German Upper Silesia. It demonstrates that contrary to the views of Polish nationalists, the popularity of this radio station stemmed not so much from widespread Polish consciousness as the quality of the programmes and popularity of the performers.
Resentment and the Right: A Twentieth-Century Cycle of Reaction, Revaluation, and Retreat by the French Extreme Right
Authors: Shurts Sarah E
Published: May 2013

Throughout the twentieth century, French intellectuals of the Right have been locked in a cycle of resentment and reaction against the intellectual Left whom they blame for repeatedly ostracizing them from the role of ‘intellectuel’. This resentment of a perceived exclusion has resulted in a recurring trope of left-wing cultural hegemony and right-wing marginalization that has come to define the individual and collective identities of the intellectual Right today. This process of perceived hegemony, resentment, and identity reconstruction is readily apparent in the work of right-wing intellectuals Ferdinand Brunetière, Ramon Fernandez, Drieu la Rochelle, Maurice Bardèche, and Alain de Benoist. When faced with perceived left-wing hegemony, these intellectuals reacted with resentment, revaluation of their designation as the excluded ‘other’, and retreat to self-segregated cultural communities. Over time, this process has both distinctly defined the intellectual Right and effectively radicalized and alienated it from mainstream intellectual life and the French public.
Understanding and Measuring Evaluation Capacity
Authors: Taylor-Ritzler Tina , Suarez-Balcazar Yolanda , Garcia-Iriarte Edurne , Henry David B. , Balcazar Fabricio E.
Published: May 2013

This study describes the development and validation of the Evaluation Capacity Assessment Instrument (ECAI), a measure designed to assess evaluation capacity among staff of nonprofit organizations that is based on a synthesis model of evaluation capacity. One hundred and sixty-nine staff of nonprofit organizations completed the ECAI. The 68-item measure assessed participants’ perceptions of individual and organizational predictors of two evaluation capacity outcomes: mainstreaming and use of evaluation findings. Confirmatory Factor Analysis and internal consistency results support the inclusion of the items and factors measured by the ECAI. Moreover, structural equation modeling results support the synthesis model and its depiction of relationships among evaluation capacity predictors and outcomes. We discuss the implications of using a validated model and instrument in evaluation capacity building research and practice.
Lessons From a Concurrent Evaluation of Eight Antibullying Programs Used in Sweden
Authors: Flygare Erik , Gill Peter Edward , Johansson Björn
Published: May 2013

Sweden has a low prevalence of bullying and Swedish schools are legally obliged to have anti-bullying policies. Many commercial programs are available. A mixed methods, quasi-experimental, concurrent evaluation of 8 programs, chosen from a pool of 21 widely used anti-bullying programs, was planned. Preliminary data, based on 835 stakeholder interviews, both individual and group, revealed extensive program-contamination in "treatment" schools ( n = 31), and extensive program use in nominally designated control/comparison schools ( n = 8). An evolved evaluation strategy focused on arrays of program components, use of which was assessed through detailed qualitative data gathered from principals, teaching and non-teaching staff, anti-bullying teams, and pupils. Bullying victimization, Grades 4-9, in 39 schools, was assessed by questionnaire, administered in three waves. Response rates were 76.1% (with N = 10,919) at the first wave, 74.3% (of 10,660) at the second wave, and 70.6% (of 10,523) at the final wave. Longitudinal aggregate and individual outcomes (3,487 pupils answered all three questionnaires) were assessed. Prevalence of victimization was 8.1% at first wave and (7.4% at last). Based on individual data, persistent victimization (bullied at both waves) was estimated at 1.5% with 4.7% experiencing a worsening situation (not bullied at the first wave but bullied at last) and 4.8% with an improved situation. Hierarchical cluster analysis was used to designate intervention types (shared arrays of strong, weak, or absent component use) and schools with similar approaches. A quasi-experimental, longitudinal design with individual data and an aggregate cross-sectional follow-up indicated differences in effective, ineffective, and iatrogenic components, component clusters (intervention types), and successful schools.
Evaluation in an Era of Accountability
Authors: Carman Joanne G.
Published: May 2013

In “The Case for Participatory Evaluation in an Era of Accountability” (this issue), Jill Chouinard highlights seven tensions between the participatory and technocratic approaches to evaluation. She suggests that there is a need to create opportunities for more participatory approaches to evaluation. In this essay, I suggest that the era of accountability has actually created unexpected opportunities for participatory and meaningful evaluation. These include: encouraging organizations to use evidence-based practices and be more deliberate about program strategy; identifying common outcomes and indicators for program managers to adopt and use; and using accountability mandates to create opportunities for capacity building and organizational learning. I also describe how evaluators can use the current focus on outcomes and impact to create opportunities to have broader discussions about the benefits of other types of evaluation.
The Practice of Evaluation in Public Sector Contexts
Authors: Chouinard Jill Anne
Published: May 2013

In the original paper, it was argued that while there is an array of methods and methodologies available, their use is delimited by the culture of accountability that prevails in public sector institutions, a fact that is particularly problematic given the complexity and diversity of evaluation contexts today. This short rejoinder, to responses made by J.G. Carmen and L.-E. Datta to The Case for Participatory Evaluation in an Era of Accountability (both, this issue), argues further that given the prevalence and widespread use of evaluation “technologies” as formal mechanisms for decision making, monitoring, reporting, and controlling the activities and expenditures within public sector institutions, we have a responsibility to consciously and conscientiously explore some of the taken-for-granted assumptions that guide evaluation practice. Three main points are advanced: 1) evaluation as institutionalized practice, 2) evaluation as influencing and shaping public perception, and 3) evaluation as a reflection of certain values.
On Analysis of Symmetrically Predicted Endogenous Subgroups
Authors: Peck Laura R.
Published: May 2013

Researchers and policy makers are increasingly dissatisfied with the “average treatment effect.” Not only are they interested in learning about the overall causal effects of policy interventions, but they want to know what specifically it is about the intervention that is responsible for any observed effects. In the U.S., using experimentally-designed evaluation to capture the average treatment effect is both commonplace and preferred practice; but, as this paper argues, there are many important questions yet to be asked and answered via our body of experimental research. As a reconsideration of Peck (2003), on the tenth anniversary of its publication, this article recasts earlier work on analyzing “what works” as a call to action for evaluators and policy analysts: we can and should do better.
Legal defenses and outcomes in Paragraph IV patent litigation
Authors: Glass Gregory
Published: May 2013

Since 2006, there has been a dramatic increase in patent litigation filed between brand and generic pharmaceutical companies in the United States. The Federal Food, Drug, and Cosmetic Act (commonly referred to the Hatch Waxman Act) enables generic companies to apply to the FDA to enter the market before the brand product’s patents expire. In turn, the filing of an application permits the brand company to file patent infringement actions against the generic applicants. Known as “Paragraph IV” cases, these actions beg the question of which legal defenses generic companies use to defend the actions and to what degree these defenses are successful. Analyzing all Paragraph IV cases decided from 1 January 2009 to 31 December 2012, this paper identifies the case outcomes and analyzes the success of generic companies and their defenses.
Technical gaps faced by Chinese generic medicine manufacturers to achieve the standards of WHO medicines Prequalification
Authors: Huang Baobin , Barber Sarah L , Smid Milan , Hoet Patrick , Kupferman Alain , Sun Jim , Wu Chunfu
Published: May 2013

The study aims to determine the type and extent of technical gaps faced by Chinese generic medicine manufacturers to achieve the standards of WHO Medicines Prequalification. The study was undertaken with four manufacturers producing anti-tuberculosis Fixed Dose Combinations (FDCs) in China from March 2010 to June 2011 and with 47 manufacturers producing anti-HIV/AIDS, anti-tuberculosis, and anti-malaria medicines in China in August 2011. The study assessed key elements required to comply with WHO Good Manufacturing Practices and completion of regulatory dossiers. For Good Manufacturing Practices, the study found technical gaps in quality management, validation and qualification, and calibration and maintenance. More technical gaps were identified in risk management and correction action and prevention action. For dossiers, the study found three technical gaps: bioequivalence testing, incomplete information from active pharmaceutical ingredients suppliers, and stability testing. The study indicates the need for technical assistance to Chinese generic medicine manufacturers, particularly for dossier preparation but also that technical gaps are attributed to differences between the standards of Chinese drug regulations and of WHO Medicines Prequalification Program.
Factors determining the post-patent entry of generic medicines in Malaysia: A survey of the Malaysian generic pharmaceutical industry
Authors: Fatokun Omotayo , Ibrahim Mohamed IM , Hassali Mohamed A
Published: May 2013

Malaysia is reliant on the availability of generic medicines to contain the rising national pharmaceutical expenditure. This paper assesses the factors determining the market entry of a new generic medicine following patent expiration on the innovator product in Malaysia. Data were gathered by using mail survey approach. The pre-validated Likert-scale questionnaire was mailed to all licensed members of the Malaysian Organization of Pharmaceutical Industries. A usable response rate of 53.8% (14/26) was achieved following four successive mailings. The overall internal reliability coefficients for the 5-item entry decision variables scale and 11-item entry barrier variables scale were 0.62 and 0.82 respectively. The results revealed that the major factors driving decisions to develop and introduce a new generic medicine into the Malaysian pharmaceutical market are consistent with the business model of the generic pharmaceutical industry. The pre-patent expiration market value of the innovator product was found to be a significant factor influencing entry decisions for domestic market-oriented generic firms as compared with export-oriented firms (Z = −2.36, p = 0.01). Foremost among the barriers to new generic medicines development and market introduction in Malaysia were patent clustering by innovator firms and the earlier market entry of imported generic medicines. There is a need for strict adherence to the patentability criteria in the examination and grant of pharmaceutical patents in Malaysia, and coherence in policies related to local generic drug development and production is recommended in order to meet the policy objectives of drug affordability and containment of pharmaceutical cost.
A systematic review on the use of new anticoagulants in pregnancy
Authors: Tang Ai-Wei , Greer Ian
Published: May 2013

New anticoagulants such as direct factor Xa inhibitors and direct thrombin inhibitors have been recently developed, but their experience in pregnancy is limited. This review therefore aims to systematically search for studies on the use of these newer anticoagulants in pregnancy and the puerperal period. Searches were performed on electronic databases MEDLINE (from 1966), EMBASE (from 1974) and the Cochrane Library, until October 2011 using terms of ‘pregnancy’, ‘puerperium’, ‘breastfeeding’ and names of specific anticoagulants. The search yielded 561 citations and 11 studies (10 on fondaparinux, 1 on ximelagatran) were included. Newer anticoagulants (fondaparinux, hirudin and argatroban) on the limited evidence appear not to have adverse pregnancy outcomes, but there is currently no experience of new oral anticoagulants (rivaroxaban, apixaban, betrixaban or dabigatran) use in pregnancy. There is a need for reporting on new oral anticoagulation use in pregnancy to provide more information about the safety and risks to the fetus in utero.
A case report of obstetrical management of a pregnancy with hypermobile Ehlers–Danlos syndrome and literature review
Authors: Khalil H , Rafi J , Hla T T
Published: May 2013

We present a case report of a successful pregnancy outcome in a woman diagnosed with Ehlers–Danlos syndrome (EDS) hypermobility type or type III. EDS is a group of connective tissue disorders that has a common genotypic defect, but heterogeneous phenotypic presentations. The variation in EDS manifestations can result in moderate to severe effects on life-expectancy for some types. A number of studies and a review of the literature indicate that generally in pregnant women with EDS, maternal and neonatal outcomes are favourable. However, in EDS type IV, pregnancy can be associated with serious maternal complications. Therefore, obstetrical management should be individualized. This paper discusses the obstetric management of a patient with EDS hypermobility type and compares it to other studies in the literature.
Management of menopausal symptoms after cancer and risk-reduction bilateral oophorectomy: a move towards consensus
Authors: Cochrane Rosemary , Gebbie Ailsa E , Walker Graeme
Published: May 2013

As more women survive reproductive cancers, menopausal symptoms following treatment can be a significant problem affecting quality of life and wellbeing. Hormone replacement therapy may or may not be contraindicated. Women often receive conflicting information about their management from different specialists. The aim of this study, based in a regional menopause clinic, was to examine referral patterns and symptom profiles of women with cancer or at high risk of cancer; to identify areas of need where a more integrated approach to management might be required; and to reach a local consensus across disciplines involved in the care of these women regarding prescribing of hormonal therapies. A retrospective case record review of all women attending Edinburgh Menopause Clinic for one 12-month period in 2011/2012 for management of cancer-related menopausal symptoms was undertaken. The results of the review were discussed at a multidisciplinary meeting and regional guidance on the management of these women was agreed. There has been an immediate improvement in communication between departments and the quality of information received in referral letters.
Evolutionary relationships of ATP-Binding Cassette (ABC) uptake porters
Authors: Zheng Wei Hao , Västermark Åke , Shlykov Maksim A , Reddy Vamsee , Sun Eric I , Saier Milton H
Published: May 2013

Background

The ATP-Binding Cassette (ABC) functional superfamily includes integral transmembrane exporters that have evolved three times independently, forming three families termed ABC1, ABC2 and ABC3, upon which monophyletic ATPases have been superimposed for energy-coupling purposes [e.g., J Membr Biol 231(1):1-10, 2009]. The goal of the work reported in this communication was to understand how the integral membrane constituents of ABC uptake transporters with different numbers of predicted or established transmembrane segments (TMSs) evolved. In a few cases, high resolution 3-dimensional structures were available, and in these cases, their structures plus primary sequence analyses allowed us to predict evolutionary pathways of origin.

Results

All of the 35 currently recognized families of ABC uptake proteins except for one (family 21) were shown to be homologous using quantitative statistical methods. These methods involved using established programs that compare native protein sequences with each other, after having compared each sequence with thousands of its own shuffled sequences, to gain evidence for homology. Topological analyses suggested that these porters contain numbers of TMSs ranging from four or five to twenty. Intragenic duplication events occurred multiple times during the evolution of these porters. They originated from a simple primordial protein containing 3 TMSs which duplicated to 6 TMSs, and then produced porters of the various topologies via insertions, deletions and further duplications. Except for family 21 which proved to be related to ABC1 exporters, they are all related to members of the previously identified ABC2 exporter family. Duplications that occurred in addition to the primordial 3 → 6 duplication included 5 → 10, 6 → 12 and 10 → 20 TMSs. In one case, protein topologies were uncertain as different programs gave discrepant predictions. It could not be concluded with certainty whether a 4 TMS ancestral protein or a 5 TMS ancestral protein duplicated to give an 8 or a 10 TMS protein. Evidence is presented suggesting but not proving that the 2TMS repeat unit in ABC1 porters derived from the two central TMSs of ABC2 porters. These results provide structural information and plausible evolutionary pathways for the appearance of most integral membrane constituents of ABC uptake transport systems.

Conclusions

Almost all integral membrane uptake porters of the ABC superfamily belong to the ABC2 family, previously established for exporters. Most of these proteins can have 5, 6, 10, 12 or 20 TMSs per polypeptide chain. Evolutionary pathways for their appearance are proposed.
Surgery and risk for multiple sclerosis: a systematic review and meta-analysis of case–control studies
Authors: Lunny Carole , Knopp-Sihota Jennifer A , Fraser Shawn N
Published: May 2013

Background

Although the precise etiology of multiple sclerosis is largely unknown, there is some speculation that a prior history of surgery may be associated with the subsequent risk for developing the disease. Therefore, we aimed to examine surgery as a risk factor for the diagnosis of multiple sclerosis.

Methods

We searched for observational studies that evaluated the risk for developing multiple sclerosis after surgery that occurred in childhood (≤ 20 years of age) or “premorbid” (> 20 years of age). We specifically included surgeries classified as: tonsillectomy, appendectomy, adenoidectomy, or “surgery”. We performed a systematic review and meta-analyses and calculated odds ratios (OR) and their 95% confidence intervals (CIs) using a random effects model.

Results

We identified 33 case–control studies, involving 27,373 multiple sclerosis cases and 211,756 controls. There was a statistically significant association between tonsillectomy (OR = 1.32, 95% CI 1.08-1.61; 12 studies, I2 = 44%) and appendectomy (OR = 1.16, 95% CI 1.01-1.34; 7 studies, I2 = 0%) in individual’s ≤ 20 years of age and the subsequent risk for developing multiple sclerosis. There was no statistically significant association between risk for multiple sclerosis and tonsillectomy occurring after age 20 (OR = 1.20, 95% CI 0.94-1.53; 9 studies, I2 = 32%), in those with appendectomy at > 20 years (OR = 1.26, 95% CI 0.92-1.72; 5 studies, I2 = 46%), and in those with adenoidectomy at ≤ 20 years of age (OR = 1.06, 95% CI 0.68-1.68; 3 studies, I2 = 35%). The combined OR of 15 studies (N = 2,380) looking at “surgery” before multiple sclerosis diagnosis was not statistically significant (OR = 1.19, 95% CI 0.83-1.70; I2 = 71%).

Conclusions

We found a small but statistically significant and clinically important increased risk for developing multiple sclerosis, in those with tonsillectomy and appendectomy at ≤ 20 years of age. There was no convincing evidence to support the association of other surgeries and the risk for multiple sclerosis. Well-designed prospective etiological studies, pertaining to the risk for developing multiple sclerosis, ought to be conducted and should include the examination of various surgeries as risk factors.
The screen for cognitive impairment in psychiatry: diagnostic-specific standardization in psychiatric ill patients
Authors: Gómez-Benito Juana , Guilera Georgina , Pino Óscar , Rojo Emilio , Tabarés-Seisdedos Rafael , Safont Gemma , Martínez-Arán Anabel , Franco Manuel , Cuesta Manuel J , Crespo-Facorro Benedicto , Bernardo Miguel , Vieta Eduard , Purdon Scot E , Mesa Francisco , Rejas Javier ,   the Spanish Working Group in Cognitive Function
Published: May 2013

Background

The Screen for Cognitive Impairment in Psychiatry (SCIP) is a simple and easy to administer scale developed for screening cognitive deficits. This study presents the diagnostic-specific standardization data for this scale in a sample of schizophrenia and bipolar I disorder patients.

Methods

Patients between 18 and 55 years who are in a stable phase of the disease, diagnosed with schizophrenia, schizoaffective disorder, schizophreniform disorder, or bipolar I disorder were enrolled in this study.

Results

The SCIP-S was administered to 514 patients (57.9% male), divided into two age groups (18–39 and 40–55 years) and two educational level groups (less than and secondary or higher education). The performance of the patients on the SCIP-S is described and the transformed scores for each SCIP-S subtest, as well as the total score on the instrument, are presented as a percentile, z-score, T-scores, and IQ quotient.

Conclusions

We present the first jointly developed benchmarks for a cognitive screening test exploring functional psychosis (schizophrenia and bipolar disorder), which provide increased information about patient’s cognitive abilities. Having guidelines for interpreting SCIP-S scores represents a step forward in the clinical utility of this instrument and adds valuable information for its use.