bluuebunny/crossref_metadata_2025 huggingface dataset:
On Hospice Operations Under Medicare Reimbursement Policies
Authors: Ata Barış , Killaly Bradley L. , Olsen Tava Lennon , Parker Rodney P.
Published: December 2012

This paper analyzes the United States Medicare hospice reimbursement policy. The existing policy consists of a daily payment for each patient under care with a global cap of revenues accrued during the Medicare year, which increases with each newly admitted patient. We investigate the hospice's expected profit and provide reasons for a spate of recent provider bankruptcies related to the reimbursement policy; recommendations to alleviate these problems are given. We also analyze a hospice's incentives for patient management, finding several unintended consequences of the Medicare reimbursement policy. Specifically, a hospice may seek short-lived patients (such as cancer patients) over patients with longer expected lengths of stay. The effort with which hospices seek out, or recruit, such patients will vary during the year. Furthermore, the effort they apply to actively discharge a patient whose condition has stabilized may also depend on the time of year. These phenomena are unintended and undesirable but are a direct consequence of the Medicare reimbursement policy. We propose an alternative reimbursement policy to ameliorate these shortcomings.

This paper was accepted by Christian Terwiesch, operations management.
Laser-Induced Breakdown Spectroscopy (LIBS) of Heavy Metal Ions at the Sub-Parts per Million Level in Water
Authors: Lee Yonghoon , Oh Se-Woung , Han Song-Hee
Published: December 2012

We report a simple sub parts per million (sub-ppm) detection method for heavy metals in water by laser-induced breakdown spectroscopy (LIBS). Filter papers were used as the substrates for both transforming aqueous solutions to solid samples and for pre-concentrating dissolved heavy metal ions. The amount of sample uptake was 1.2 g by soaking a filter paper. This provides limit-of-detection (LOD) values of 2.7 and 0.36 ppm for Pb and Cr, respectively. The LODs could be improved remarkably by pre-concentrating the heavy metal ions. When a 40 g sample solution was evaporated on a filter paper, the LODs of 75 and 18 parts per billion (ppb) were obtained for Pb and Cr, respectively. Moreover, by either increasing the evaporated amount of sample solution or applying an argon gas flow, further improvement of the LODs was found to be very promising. The LIBS spectra of tap water were recorded using the pre-concentration method and are discussed in comparison with the results from inductively coupled plasma atomic emission spectroscopy (ICP-AES). We could observe strong emission lines of Ca, Mg, K, Cu, and Sr in the tap water, of which concentrations were determined to be 6.3, 1.3, 1.1, 0.64, and 0.046 ppm, respectively, by ICP-AES. Our method shows promise as a fast, reliable, water-quality monitoring tool for heavy-metal concentrations as well as for hardness.
Resonance Micro-Raman Investigations of the Rat Medial Preoptic Nucleus: Effects of a Low-Iron Diet on the Neuroglobin Content
Authors: Ramser Kerstin , Malinina Evgenya , Candefjord Stefan
Published: December 2012

The aim of this study was to investigate the medial preoptic nucleus (MPN) of the anterior hypothalamus by resonance Raman spectroscopy (514.5 nm) to determine if it is possible to enhance the Raman scattering of hemoproteins in fresh brain tissue slices. The resonance effect was compared with near-infrared Raman spectra. Two groups of male Sprague Dawley rats were studied, one control group on a normal diet and one group on a low-iron diet to evoke iron deficiency. Each group consisted of four rats, 38–41 days old. The diets lasted for 11, 12, and 15 days. The MPN regions of brain tissue slices were analyzed by monitoring raw and pre-processed mean data, by cluster analysis, and by deriving difference spectra from pre-processed mean spectra. Cluster analysis of the resonance Raman spectra could identify different hemoprotein groups, namely, hemoglobin (Hb) and neuroglobin (Ngb). Spectra from randomly distributed spots revealed high Hb content, whereas Ngb was evenly distributed in the MPN. The different spectra showed a decrease of the Ngb and lipid content for the animals on the low-iron diet. The Ngb decrease was approximately 20%. The data show that resonance Raman spectroscopy is well suited to study hemoproteins in fresh brain tissue.
Effect of Experimental Design on the Prediction Performance of Calibration Models Based on Near-Infrared Spectroscopy for Pharmaceutical Applications
Authors: Bondi Robert W. , Igne Benoît , Drennen James K. , Anderson Carl A.
Published: December 2012

Near-infrared spectroscopy (NIRS) is a valuable tool in the pharmaceutical industry, presenting opportunities for online analyses to achieve real-time assessment of intermediates and finished dosage forms. The purpose of this work was to investigate the effect of experimental designs on prediction performance of quantitative models based on NIRS using a five-component formulation as a model system. The following experimental designs were evaluated: five-level, full factorial (5-L FF); three-level, full factorial (3-L FF); central composite; I-optimal; and D-optimal. The factors for all designs were acetaminophen content and the ratio of microcrystalline cellulose to lactose monohydrate. Other constituents included croscarmellose sodium and magnesium stearate (content remained constant). Partial least squares-based models were generated using data from individual experimental designs that related acetaminophen content to spectral data. The effect of each experimental design was evaluated by determining the statistical significance of the difference in bias and standard error of the prediction for that model's prediction performance. The calibration model derived from the I-optimal design had similar prediction performance as did the model derived from the 5-L FF design, despite containing 16 fewer design points. It also outperformed all other models estimated from designs with similar or fewer numbers of samples. This suggested that experimental-design selection for calibration-model development is critical, and optimum performance can be achieved with efficient experimental designs (i.e., optimal designs).
A Theoretical and Experimental Study of Time-Resolved Thermal Mirror with Non-Absorbing Heat-Coupling Fluids
Authors: Lukasievicz Gustavo V. B. , Malacarne Luis C. , Astrath Nelson G. C. , Zanuto Vitor S. , Herculano Leandro S. , Bialkowski Stephen E.
Published: December 2012

A theoretical and experimental study taking sample-fluid heat coupling into account in time-resolved photothermal mirror experiments is presented. Thermoelastic equations were solved to obtain a semi-analytical solution to the phase shift induced by the sample and the surrounding fluid. The solution was used to model the thermal mirror effects and found to be in excellent agreement with the finite element method analysis and experiment. Heat transferred to the air-coupling fluid did not introduce important effects in the phase shift when compared with the solution obtained, without considering heat flux. However, when using water as the fluid, heat coupling led to a significant effect in fluid phase shift. Experimental results using stainless steel in air and water were used to demonstrate the potentiality of the thermal mirror technique to determine the thermal properties of both the sample and the fluid.
AFM–IR: Combining Atomic Force Microscopy and Infrared Spectroscopy for Nanoscale Chemical Characterization
Authors: Dazzi Alexandre , Prater Craig B. , Hu Qichi , Chase D. Bruce , Rabolt John F. , Marcott Curtis
Published: December 2012

Polymer and life science applications of a technique that combines atomic force microscopy (AFM) and infrared (IR) spectroscopy to obtain nanoscale IR spectra and images are reviewed. The AFM–IR spectra generated from this technique contain the same information with respect to molecular structure as conventional IR spectroscopy measurements, allowing significant leverage of existing expertise in IR spectroscopy. The AFM–IR technique can be used to acquire IR absorption spectra and absorption images with spatial resolution on the 50 to 100 nm scale, versus the scale of many micrometers or more for conventional IR spectroscopy. In the life sciences, experiments have demonstrated the capacity to perform chemical spectroscopy at the sub-cellular level. Specifically, the AFM–IR technique provides a label-free method for mapping IR-absorbing species in biological materials. On the polymer side, AFM–IR was used to map the IR absorption properties of polymer blends, multilayer films, thin films for active devices such as organic photovoltaics, microdomains in a semicrystalline polyhydroxyalkanoate copolymer, as well as model pharmaceutical blend systems. The ability to obtain spatially resolved IR spectra as well as high-resolution chemical images collected at specific IR wavenumbers was demonstrated. Complementary measurements mapping variations in sample stiffness were also obtained by tracking changes in the cantilever contact resonance frequency. Finally, it was shown that by taking advantage of the ability to arbitrarily control the polarization direction of the IR excitation laser, it is possible to obtain important information regarding molecular orientation in electrospun nanofibers.
Hong Kong Animation: The Uncanny Brush in Wuxia Film
Authors: Ka-Min Kenny Chow
Published: December 2012

This paper is to look into this specialty of Hong Kong animation in two folds, namely the Chinese myth of wuxia fantasy and the eastern visual effect culture behind the uncanny story. Hong Kong animation is in peripheral existence to the Hong Kong film industry. Compared with the variety
of praised and commercially successful genres in Hong Kong cinema, it is ironically not easy to identify the trails of local animated movies. Do we have an animation industry? Where is it rooted? How has it evolved?
Formation of Stereotype: The Disabled as the "Other" in Hindi Films
Authors: Mukherjee Tutun
Published: December 2012

This paper explores the way the disabled are presented in Hindi films that leads to the formation of stereotypes which thereby contribute to the formulation of cultural and representational meanings of disability. We will discuss the contention of the stereotypical representation of
the disabled in the films derive from the deep rooted social prejudices which demarcate the boundary between the "normal" and the "disabled" as its "other," privileging the former and denigrating the latter.
After the Wave: Sex, Violence, and Comedy in the Films of Takashi Miike
Authors: Karatsu Rie
Published: December 2012

The aims of this paper are to come to an understanding of the distinctive aspects in the films of Takashi Miike and to explore the continuities and discontinuities between the filmmakers of Japan's cinematic generations. Miike's films revolve around the use of social marginals, sex
and violence, having some elements in common with the films of Shohei Imamura and Nagisa Oshima, representative directors in the Japanese New Wave of the 1960s. This article first examines how an emphasis on popular criticism over elitist criticism in Miike's cinema offers an example of going
beyond conventional anti-establishment cinema. The next section discusses how Miike's emphasis on artificiality over primitivism challenges the failings of his New Wave predecessors. In the concluding section, I argue that an emphasis on comic presentation over realistic documentation in Miike's
films contributes to the unique appeal of his work.
Feng Xiaogang and Chinese New Year Films
Authors: Zhu Ying
Published: December 2012

This article seeks to understand what makes Feng's New Year films tick among the Chinese audiences. To begin with, how can one approach Feng's films? What frame of reference do we have in making sense of Feng's New Year films? Feng's is clearly a commercial practice, which can not be
accounted for by the social and economic logics of China's indigenous blockbuster films. Hollywood's reputation of producing blockbuster films in terms of budget and boxoffice and its affinity with such a practice make it an obvious point of entrance for our understanding of Feng Xiaogang's
New Year films.
A Socio-Cultural Study of the Growing Popularity of Pan-Chinese Movies in the U.S.: Trends, Contributing Factors, and Implications
Authors: Su Tuo-yu , Kim Jang Hyun , Hong Junhao
Published: December 2012

This study defines a "Pan-Chinese" movie as one produced by Asian film companies from China, Taiwan, and Hong Kong. This paper questions the reasons for Chinese movies' growing popularity in the West since the 1990s. Further, it leads to another question: what elements of
these movies the Western audience like and dislike. The authors conducted a case study by analyzing the success of two Chinese movies in America. The authors also surveyed more than 300 American moviegoers to find out their motivations to see Pan-Chinese movies and what they like and dislike
about them.
Ecologies of choreography: Three portraits of practice
Authors: Ashley Tamara
Published: December 2012

How are dance artists dealing with ideas about environmental change in their everyday practice? How are discourses of environmental change contributing to the development of new ways of thinking about choreographic practice and the role of the dance artist in contemporary society? By
sharing portraits of practice of three ecologically concerned dance artists, Eeva-Maria Mutka, Tim Rubidge and Nala Walla, this article offers some insight into what might constitute ecological choreographic practices.
Citizenship education in England in the shadow of the Great War
Authors: Brett Peter
Published: December 2012

This article explores a comparatively undocumented gap in the history of citizenship education in England. Drawing upon archival material from the Civic Education League, the study analyses calls for citizenship education around the time of the First World War and its aftermath. On
the face of it social and political circumstances after 1918 were propitious for citizenship education. The article goes on to explain why arguments in favour of enhancing citizenship education in schools failed to gain significant purchase.
When Curating Meets Piracy: Rehashing the History of Unauthorized Exhibition-Making
Authors: Kushnir Alana
Published: December 2012

This article outlines key historical instances of the practice of unauthorized exhibition-making and examines related curatorial approaches. Taking the practice of appropriation by artists and various national court cases, statutes and international agreements as points of reference,
it examines how the legal and ethical rights held by artists may impinge on curators' freedom of expression. It proposes that where curators re-use an artwork in a curated project without the artist's authorization, but with a measure of criticality, those actions may be justified. A deviation
in the history of exhibition-making is revealed where the freedom of expression of the curator is not subordinate to that of the artist.
Été 70: The Plein-Air Exhibitions of Supports-Surfaces
Authors: O'Neill Rosemary
Published: December 2012

In the summer of 1970, artists of the collective Supports-Surfaces installed ephemeral works across the French Mediterranean coastline, a prelude to their first Paris exhi-bition as a named group. Curated by Claude Viallat and Jacques Lepage, and entitled Intérieur/Extérieur,
artworks were situated on beaches, hill towns, riverbeds and landscapes in the lower Alps. This article examines how this peripatetic exhibi-tion, and its subsequent re-installation in Travaux de l’Été 70 (1971) at the Jean Fournier Gallery, interrogated the conventional
practice of painting by dismantling its material components, challenging its social and political ideology, and sanction-ing artistic autonomy.
EXHIBITION REVIEWS
Authors: Tedford Catherine , Conley Christine , Bieler Andrew
Published: December 2012

7th BERLIN BIENNALE: FORGET FEAR Curated by Artur Żmijewski in collaboration with associate curator Joanna Warsza and the art collective Voina, presented at the KW Institute for Contemporary Art and other venues (27 April-1 July 2012), Berlin

PRETERNATURAL Curated by Celina
Jeffery, Canadian Museum of Nature (9 December 2011-4 March 2012), St. Brigid's Centre for the Arts (10 December 2011-17 February 2012), and Patrick Mikhail Gallery (4 January-7 February 2012), Ottawa

U-N-F-O-L-D: A CULTURAL RESPONSE TO CLIMATE CHANGE Curated by David Buckland and Chris
Wainwright, Anna-Maria and Stephen Kellen Gallery, Parsons The New School for Design, New York (30 September-15 December 2011). An exhibition first shown at the University of Applied Arts, Vienna (18 May-8 June 2010) and traveling to seven locations, most recently at Liverpool John Moores
University, Liverpool (8 March-26 April 2012).
BOOK REVIEWS
Authors: Videkanic Bojana , Reeve Charles , Morgan-Feir Caoimhe , Roberts Cynthia , Weil Harry J.
Published: December 2012

GENDER, SEXUALITY AND MUSEUMS: A ROUTLEDGE READER, AMY K. LEVIN (ED.) London and New York: Routledge (2010), 336 pp., ISBN: 0415554926, Paperback, $49.95

RE-PRESENTING DISABILITY: ACTIVISM AND AGENCY IN THE MUSEUM, RICHARD SANDELL, JOCELYN DODD AND ROSEMARIE GARLAND-THOMPSON
(EDS) London and New York: Routledge (2010), 284 pp., Paperback, ISBN: 978-0-415-49473-1, $42.95

THE STORY OF IRISH MUSEUMS 1790-2000: CULTURE, IDENTITY AND EDUCATION, MARIE BOURKE Cork: Cork University Press (2011), ISBN: 978-1-8591-8475-2, 594 pp., Hardcover, US$59.00

'CURATING
ARCHITECTURE', LOG, 20, CYNTHIA DAVIDSON (ED.) Fall (2010), 168 pp., ISSN: 1547-4690, $15.00

FRANKLIN FURNACE AND THE SPIRIT OF THE AVANT-GARDE: A HISTORY OF THE FUTURE, TONI SANT London: Intellect Books (2011), 184 pp., Paperback, ISBN: 978-1841503714, £24.95
O vitae experientia dux. Die Rolle der Erfahrung im theoretischen und praktischen Weltbezug des frühen Humanismus und ihre Konsequenzen
Authors: Keßler Eckhard
Published: December 2012

The essay is divided into five sections: the first section gives a short overview of the history of “experience” – Greek empeiria, Latin experientia – which takes Aristotle’s theory of knowledge as its starting point. Within its theoretical framework, experience served as a crucial mediator between sensory perception and intellectual knowledge. In the philosophy of Late Antiquity and the High Middle Ages the category of experience then was reduced to marginal importance under neo-Platonic and Arabic influences. At the dusk of the Middle Ages, however, it was rehabilitated and turned into a rallying cry by those who attempted to overcome late medieval philosophy. The following section describes the revaluation of experience as the fountain of real knowledge under the auspices of Petrarchism, which ran contrary to the formalistic teachings of the Scholastics. The remaining sections first deal with the role of the humanist concept of experience in the field of moral philosophy (specifically regarding the teaching of history). Secondly, it shows how experience worked as an incentive for field research in natural history and medicine and how it precipitated a revival of ancient Aristotelian empiricism within natural philosophy, thereby paving the way for the modern empirical science of nature.
Intrikate Expertise. Die magische Pharmakognostik des Leonhard Thurneysser zum Thurn
Authors: Bulang Tobias
Published: December 2012

Leonhard Thurneysser zum Thurn (1531–1596) was not only the personal physician of the elector of Brandenburg, but also a notorious alchemist, astrologist, pharmacist, and entrepreneur. As printer of his own works, he published a remarkable number of volumes on various subjects. Praised as a “miracle man” by some of his contemporaries, he was repeatedly accused of being a sorcerer, conjurer, and charlatan. This article focuses on his herbal book, printed in 1578. Taking into account the state of contemporary knowledge, this paper examines Thurneysser’s explanations of plant names, his interpretation of plant signatures and his magical approach to pharmacology. Scientifically, Thurneysser’s innovations in these fields have not stood the test of time. However, examined within the context of intellectual history, they can be interpreted as strategies for laying claim to a field of expertise, by a man whose reputation was at risk.
Inline-Partikelmessung an hochkonzentrierten Suspensionen
Authors: Wöckel Sebastian , Hempel Ulrike , Weser Robert , Wessely Benno , Auge Jörg
Published: December 2012

Ein methodisch neuer Ansatz zur Charakterisierung der Feststoffphase in Suspensionen mit Ultraschall wird vorgestellt. Gegenüber bekannten Transmissionsverfahren ermöglicht die Messung in Reflexion auch die Analyse höher konzentrierter Stoffsysteme. Mit der inline aus dem Schallsignal abgeleiteten Information zur Partikelkonzentration bietet sich eine verfahrenstechnische Alternative zu Partikelmesstechniken, die auf aufwändiger Offlineanalytik basieren.
Journey by Bottle: Uncovering the Allure of Guyanese Cassareep
Authors: duford darrin
Published: December 2012

Since before the arrival of Europeans in South America, the Amerindians of Guyana have been boiling down the poisonous juice of cassava to make cassareep, a safe, flavorful sauce for meats and stews. Cassareep is used to flavor pepperpot, Guyana's national dish of slow-cooked meat, whose popularity has spread from the country's Amerindian communities to the Afro-Guyanese and Indo-Guyanese communities. To uncover the origins of cassareep, the author visits an inland village of Makushi Amerindians, where the sauce is still made by hand in the traditional way. First, the cook packs shredded cassava solids into a matapee, a cylindrical basket that is squeezed to extract the juice. The juice is then boiled to destroy the cyanide, and spices such as cinnamon and habanero peppers are added. Because small artisan operations do not produce enough cassareep to satisfy the current demand of the Guyanese at home and abroad, the author tours a bottling plant near the capital to observe how cassareep is produced on a commercial scale and discovers appliances and machinery custom-made for Guyana's temperamental power grid.
A Rat on the Plate: The Last Supper Window in Saint Mary's Church, Warwick
Authors: bauer olivier
Published: December 2012

What is a rat doing on a Last Supper plate? Did Jesus and his disciples really eat such a disgusting animal? At the end of the sixteenth century, an anonymous artist positioned a rat in front of Jesus in a Last Supper window of the church of Warwick (UK). The Gospels do not state that Jesus' last meal included rat, and rat was not a common food at that time; so why did the artist include a rat, if it is indeed a rat? The rat could convey a mysterious message. At the Lord's Table, the real “rat” might not be who he seems to be!
On the Zampone Trail
Authors: carafoli john f.
Published: December 2012

This article explores a renowned Italian salume (cured meat product) made of many different pork oddments that give it a complex but melting texture. It is usually found in one of two forms, cotechino or—the chief focus of the article—the more demanding zampone. Both are associated with the Christmas-New Year's holiday season throughout the Emilia-Romagna region. For cotechino, a mixture of pork meat, tendons, rind, and bits of snout and jowl is filled into hog casings just as for other sausages; for the more demanding zampone, a similar mixture is stuffed into an almost completely deboned pig's foot. The article traces the history of zampone from Renaissance Modena to modern commercial versions; it then recounts the author's attempt to make it from scratch, as was done in his childhood in the Cape Cod village of Sagamore, a community of immigrants from Emilia-Romagna who long preserved traditions of home butchering and sausage-making.
Perception of Dyads of Impulsive and Sustained Instrument Sounds
Authors: Tardieu Damien , McAdams Stephen
Published: December 2012

perception of instrumental blend is important for understanding aspects of orchestration, but no work has studied blends of impulsive and sustained instruments. The first experiment identified the factors that influence the rating of blendedness of dyads formed of one sustained sound and one impulsive sound. Longer attack times and lower spectral centroids increased blend. The contribution of the impulsive sound’s properties to the degree of blend was greater than that of the sustained sound. The second experiment determined the factors that influence similarity ratings among dyads. The mean spectral envelope and the attack time of the dyad best explained the dissimilarity ratings. However, contrary to the first experiment, the spectral envelope of the sustained sound was more important than that of the impulsive sound. Multidimensional scaling of dissimilarity ratings on blended dyads yielded one dimension correlated with the attack time of the dyad and another dimension whose spectral correlate was different for two different clusters within the space, spectral spread for one and spectral flatness for the other, suggesting a combined categorical-analogical organization of the second dimension.
The Vocal Generosity Effect: How Bad Can Your Singing Be?
Authors: Hutchins Sean , Roquet Catherine , Peretz Isabelle
Published: December 2012

prior work indicates that listeners may be more likely to call a note in-tune when it is sung than when it is in another timbre. The current study seeks to confirm whether this vocal generosity effect generalizes to melodies. Musicians and nonmusicians listened to pairs of single tones and scale-based melodies performed with the voice or the violin. The final note was varied in how well it was tuned to the prior context, and for each example, listeners judged whether the final note was intune or not. A strong vocal generosity effect was found for musicians and nonmusicians in both melodic and single tone conditions – a higher degree of mistuning was necessary for listeners to decide that sung tones were out-of-tune compared with violin notes. These results confirm the role of timbre in tuning judgments, and help explain why singers are typically less well-tuned than instrumentalists in performance.
The Song Remains the Same: A Replication and Extension of the MUSIC Model
Authors: Rentfrow Peter J. , Goldberg Lewis R. , Stillwell David J. , Kosinski Michal , Gosling Samuel D. , Levitin Daniel J.
Published: December 2012

there is overwhelming anecdotal and empirical evidence for individual differences in musical preferences. However, little is known about what drives those preferences. Are people drawn to particular musical genres (e.g., rap, jazz) or to certain musical properties (e.g., lively, loud)? Recent findings suggest that musical preferences can be conceptualized in terms of five orthogonal dimensions: Mellow, Unpretentious, Sophisticated, Intense, and Contemporary (conveniently, MUSIC). The aim of the present research is to replicate and extend that work by empirically examining the hypothesis that musical preferences are based on preferences for particular musical properties and psychological attributes as opposed to musical genres. Findings from Study 1 replicated the five-factor MUSIC structure using musical excerpts from a variety of genres and subgenres and revealed musical attributes that differentiate each factor. Results from Studies 2 and 3 show that the MUSIC structure is recoverable using musical pieces from only the jazz and rock genres, respectively. Taken together, the current work provides strong evidence that preferences for music are determined by specific musical attributes and that the MUSIC model is a robust framework for conceptualizing and measuring such preferences.
Distortions in Reproduction of Two-Interval Rhythms: When the “Attractor Ratio” Is Not Exactly 1:2
Authors: Repp Bruno H. , London Justin , Keller Peter E.
Published: December 2012

when rhythms consisting of two unequal intervals are reproduced cyclically, their interval ratio tends to be distorted in the direction of 1:2 (= 0.5), which thus seems to function as an “attractor ratio” (AR). However, recent results for musicians in a synchronization task (Repp, London, & Keller, 2011) have suggested an upward-shifted AR (USAR) somewhat greater than 0.5. Three new experiments suggest that this shift is not due to synchronization versus continuation tapping, the range of interval ratios employed, unimanual versus bimanual tapping, intensity differences between taps, or mental subdivision of the long interval, although some of these factors may affect its size. The new results also show that the USAR is found more consistently in musicians than in nonmusicians and seems to arise in rhythm production, not in perception. While the exact causes of the USAR remain unclear, the results suggest that the AR is not necessarily the mathematically simplest interval ratio.
Maternal Prepregnancy BMI and Child Cognition: A Longitudinal Cohort Study
Authors: Basatemur Emre , Gardiner Julian , Williams Carrie , Melhuish Edward , Barnes Jacqueline , Sutcliffe Alastair
Published: December 2012

OBJECTIVE:

To examine the association between maternal prepregnancy BMI and cognitive performance in children at 5 and 7 years of age.

METHODS:

This is a secondary analysis of data from the Millennium Cohort Study, a prospective population based cohort of 19 517 children in the United Kingdom. Standardized cognitive assessments of children, involving components of the British Ability Scales, second edition and a number skills test, were performed at 5 and 7 years of age. Principal components analysis was used to identify a general cognitive ability factor (g) from individual test scores. Maternal prepregnancy BMI was retrospectively self-reported when children were 9 months old. Mixed-effects linear regression models were fitted, controlling for multiple socio-demographic factors, child’s birth weight, child’s BMI, maternal smoking, and maternal diabetes. Complete data were available for 11 025 children at 5 years, and 9882 children at 7 years.

RESULTS:

Maternal prepregnancy BMI was negatively associated with children’s cognitive performance (g) at age 5 (P = .0069) and age 7 (P < .0001). The overall effect size was modest: a 10-point increase in maternal BMI was associated with a decrease in cognitive performance of ∼1/10th of an SD at age 7.

CONCLUSIONS:

Maternal prepregnancy BMI is negatively associated with children’s cognitive performance, even after adjusting for multiple socio-demographic confounders and children’s BMI. The relationship appears to become stronger as children get older, although the overall effect size is modest. In utero fetal programming or residual confounding may explain these findings.
Preventability of Early Readmissions at a Children’s Hospital
Authors: Hain Paul D. , Gay James C. , Berutti Tyler W. , Whitney Gina M. , Wang Wenli , Saville Benjamin R.
Published: December 2012

OBJECTIVE:

To determine whether pediatric readmissions within 15 days of discharge were considered preventable.

METHODS:

Retrospective chart review of 200 randomly selected readmissions (8% of all readmissions) occurring within 15 days of discharge from a freestanding children’s hospital between January 1, 2007, and December 31, 2008. The degree of preventability was assessed independently for each case by 4 pediatricians using a 5-point Likert scale and was correlated with chronic conditions and reason for index admission with 3M’s Clinical Risk Groups and All Patient-Refined Diagnostic-Related Groups, respectively.

RESULTS:

The rate of 15-day readmissions considered more likely preventable by the discharging hospital was 20.0% (1.7% of total admissions, 95% confidence interval 14.8%–26.4%). Reviewers failed to reach initial consensus in 62.5% of cases, although final consensus was achieved after the panel reviewed cases together. Consensus ratings served as the standard for the remainder of the study. Readmissions in children with malignancies were considered less preventable than those in children with other chronic illnesses (5.8% vs 25.8%, P = .003). Readmissions following surgical admissions were considered more likely preventable than those following medical admissions (38.9% vs 15.9%, P = .002). Central venous catheter infections and ventricular shunt malfunctions accounted for 8.5% of all readmissions reviewed.

CONCLUSIONS:

Although initial consensus about which readmissions were more likely preventable was difficult to achieve, the overall rate of preventable pediatric 15-day readmissions was low. Pediatric readmissions are unlikely to serve as a highly productive focus for cost savings or quality measurement.
Peripheral Gangrene in Children With Atypical Hemolytic Uremic Syndrome
Authors: Malina Michal , Gulati Ashima , Bagga Arvind , Majid Mohammad A. , Simkova Eva , Schaefer Franz
Published: December 2012

Atypical hemolytic uremic syndrome (aHUS) is a thrombotic microangiopathy with severe clinical manifestation, frequent recurrence, and poor long-term prognosis. It is usually caused by abnormalities in complement regulation. We report 2 cases of children affected by a catastrophic extrarenal complication. A 4-year-old Indian girl developed gangrene of the finger tips 2 days after initial presentation of aHUS. Factor H autoantibodies were identified. Renal function continued to decline despite daily plasma exchanges, and she was started on peritoneal dialysis 5 days after admission. The distal tips of the left hand remained gangrenous with a line of demarcation. Three weeks later, she did not return for follow-up and died at home because of dialysis-related complications. An Arabic girl developed end-stage renal disease due to aHUS in the fourth month after birth. A de novo activating C3 mutation was found. At age 9 months, she suddenly developed ischemic changes in fingers of both hands and several toes. The lesions progressed, and several finger tips became gangrenous despite intense plasma exchange therapy. The decision was made to administer complement blocking therapy with the C5 antibody eculizumab. All nonnecrotic digits rapidly regained perfusion. The 3 already gangrenous fingers healed with loss of the end phalanges. During maintenance, eculizumab aHUS activity subsided completely and some late recovery of renal function was observed. aHUS may present by thrombotic macroangiopathy of small peripheral arteries. Eculizumab appears effective in preserving tissue viability if administered before gangrene occurs and should be considered as first-line rescue therapy in such cases.
Effects of Iron Supplementation of LBW Infants on Cognition and Behavior at 3 Years
Authors: Berglund Staffan K. , Westrup Björn , Hägglöf Bruno , Hernell Olle , Domellöf Magnus
Published: December 2012

OBJECTIVE:

Low birth weight (LBW) infants are at increased risk of cognitive and behavioral problems and at risk for iron deficiency, which is associated with impaired neurodevelopment. We hypothesized that iron supplementation of LBW infants would improve cognitive scores and reduce behavioral problems.

METHODS:

In a randomized controlled trial, 285 marginally LBW (2000–2500 g) infants received 0, 1, or 2 mg/kg/day of iron supplements from 6 weeks to 6 months of age. At 3.5 years of age, these infants and 95 normal birth weight controls were assessed with a psychometric test (Wechsler Preschool and Primary Scale of Intelligence) and a questionnaire of behavioral problems (Child Behavior Checklist; CBCL).

RESULTS:

There were no significant differences in IQ between the LBW groups or LBW infants versus controls. Mean (SD) full-scale IQ was 105.2 (14.5), 104.2 (14.7), and 104.5 (12.7) in the placebo, 1 mg, and 2 mg groups, respectively (P = .924). However, for behavioral problems, there was a significant effect of intervention. The prevalence of children with CBCL scores above the US subclinical cutoff was 12.7%, 2.9%, and 2.7% in the placebo, 1-mg, and 2-mg groups, respectively (P = .027), compared with 3.2% in controls. Relative risk (95% confidence interval) for CBCL score above cutoff in placebo-treated children versus supplemented was 4.5 (1.4–14.2).

CONCLUSIONS:

Early iron supplementation of marginally LBW infants does not affect cognitive functions at 3.5 years of age but significantly reduces the prevalence of behavioral problems. The study suggests a causal relation between infant iron deficiency and later behavioral problems.
Growth in Children With Congenital Heart Disease
Authors: Daymont Carrie , Neal Ashley , Prosnitz Aaron , Cohen Meryl S.
Published: December 2012

OBJECTIVE:

We sought to describe growth in young children with congenital heart disease (CHD) over time.

METHODS:

We performed a retrospective matched cohort study, identifying children with CHD in a large primary care network in Pennsylvania, New Jersey, and Delaware and matching them 10:1 with control subjects. The primary endpoint was the difference in mean World Health Organization z score for cases and controls for weight-for-age (WFAZ), length-for-age (LFAZ), weight-for-length (WFLZ), and head circumference-for-age (HCFAZ) at traditional ages for preventive visits, stratified by CHD category.

RESULTS:

We evaluated 856 cases: 37 with single ventricle (SV) physiology, 52 requiring complex repair (CR), 159 requiring simple repair (SR), and 608 requiring no repair. For children in the SV, CR, and SR categories, large, simultaneous, and statistically significant (Student’s t test P < .05) decreases in WFAZ and LFAZ appeared within the first month of life, peaked near 4 months, and persisted through 24 or 36 months. There were fewer and smaller decreases in the no-repair group between 2 and 18 months. HC data were available between 1 week and 24 months; at those ages, decreases in mean HCFAZ generally paralleled decreases in WFAZ and LFAZ in the SV, CR, and SR groups.

CONCLUSIONS:

Children with CHD experience early, simultaneous decreases in growth trajectory across weight, length, and head circumference. The simultaneous decrease suggests a role for altered growth regulation in children with CHD.
Improving Situation Awareness to Reduce Unrecognized Clinical Deterioration and Serious Safety Events
Authors: Brady Patrick W. , Muething Stephen , Kotagal Uma , Ashby Marshall , Gallagher Regan , Hall Dawn , Goodfriend Marty , White Christine , Bracke Tracey M. , DeCastro Victoria , Geiser Maria , Simon Jodi , Tucker Karen M. , Olivea Jason , Conway Patrick H. , Wheeler Derek S.
Published: December 2012

BACKGROUND AND OBJECTIVE:

Failure to recognize and treat clinical deterioration remains a source of serious preventable harm for hospitalized patients. We designed a system to identify, mitigate, and escalate patient risk by using principles of high-reliability organizations. We hypothesized that our novel care system would decrease transfers determined to be unrecognized situation awareness failures events (UNSAFE). These were defined as any transfer from an acute care floor to an ICU where the patient received intubation, inotropes, or ≥3 fluid boluses in first hour after arrival or before transfer.

METHODS:

The setting for our observational time series study was a quaternary care children’s hospital. Before initiating tests of change, 2 investigators reviewed recent serious safety events (SSEs) and floor-to-ICU transfers. Collectively, 5 risk factors were associated with each event: family concerns, high-risk therapies, presence of an elevated early warning score, watcher/clinician gut feeling, and communication concerns. Using the model for improvement, an intervention was developed and tested to reliably and proactively identify patient risk and mitigate that risk through unit-based huddles. A 3-times daily inpatient huddle was added to ensure risks were escalated and addressed. Later, a “robust” and explicit plan for at-risk patients was developed and spread.

RESULTS:

The rate of UNSAFE transfers per 10 000 non-ICU inpatient days was significantly reduced from 4.4 to 2.4 over the study period. The days between inpatient SSEs also increased significantly.

CONCLUSIONS:

A reliable system to identify, mitigate, and escalate risk was associated with a near 50% reduction in UNSAFE transfers and SSEs.
Dietary Salt Intake, Sugar-Sweetened Beverage Consumption, and Obesity Risk
Authors: Grimes Carley A. , Riddell Lynn J. , Campbell Karen J. , Nowson Caryl A.
Published: December 2012

OBJECTIVE:

To determine the association among dietary salt, fluid, and sugar-sweetened beverage (SSB) consumption and weight status in a nationally representative sample of Australian children aged 2 to 16 years.

METHODS:

Cross-sectional data from the 2007 Australian National Children’s Nutrition and Physical Activity Survey. Consumption of dietary salt, fluid, and SSB was determined via two 24-hour dietary recalls. BMI was calculated from recorded height and weight. Regression analysis was used to assess the association between salt, fluid, SSB consumption, and weight status.

RESULTS:

Of the 4283 participants, 62% reported consuming SSBs. Older children and those of lower socioeconomic status (SES) were more likely to consume SSBs (both Ps < .001). Dietary salt intake was positively associated with fluid consumption (r = 0.42, P < .001); each additional 1 g/d of salt was associated with a 46 g/d greater intake of fluid, adjusted for age, gender, BMI, and SES (P < .001). In those consuming SSBs (n = 2571), salt intake was positively associated with SSB consumption (r = 0.35, P < .001); each additional 1 g/d of salt was associated with a 17 g/d greater intake of SSB, adjusted for age, gender, SES, and energy (P < .001). Participants who consumed more than 1 serving (≥250 g) of SSB were 26% more likely to be overweight/obese (odds ratio: 1.26, 95% confidence interval: 1.03–1.53).

CONCLUSIONS:

Dietary salt intake predicted total fluid consumption and SSB consumption within consumers of SSBs. Furthermore, SSB consumption was associated with obesity risk. In addition to the known benefits of lowering blood pressure, salt reduction strategies may be useful in childhood obesity prevention efforts.
Adolescent ADHD and Adult Physical and Mental Health, Work Performance, and Financial Stress
Authors: Brook Judith S. , Brook David W. , Zhang Chenshu , Seltzer Nathan , Finch Stephen J.
Published: December 2012

OBJECTIVE:

There is a scarcity of longitudinal studies of adolescents with attention-deficit/hyperactivity disorder (ADHD) followed until adulthood. We studied the relationship between ADHD in adolescence and impaired general physical health, impaired general mental health, antisocial personality disorder, impaired work performance, and high financial stress in adulthood.

METHODS:

A prospective design incorporated 6 assessments of participants spanning mean ages from 14 to 37 years. Two baseline assessments were taken between ages 14 and 16 years, and 5 outcome assessments were taken at mean age 37 years. Participants were assessed with structured interviews and questionnaires. The participants were from a community sample of individuals initially drawn in 1975 and followed to a mean age of 37 years in 2009.

RESULTS:

The adjusted odds ratios and 95% confidence intervals (CIs) for ADHD in adolescence as related to internal stress in adulthood were 1.82 (95% CI = 1.01–3.25; P < .05) for impaired general physical health, 2.36 (95% CI = 1.23–4.51; P < .01) for impaired general mental health, and 3.28 (95% CI = 1.51–7.13; P < .01) for antisocial personality disorder. The adjusted odds ratios and 95% CIs for ADHD in adolescence as related to external stress were 2.46 (95% CI = 1.37–4.43; P < .01) for impaired work performance and 3.33 (95% CI = 1.70–6.55; P < .001) for high financial stress.

CONCLUSIONS:

Clinicians should focus on early diagnosis and treatment of adolescent ADHD because it is a major predictor of an array of physical, mental, work, and financial problems in adulthood.
Laparoscopos technikával végzett subtotalis gyomorresectióinkról
Authors: Benedek Zsófia , Benedek György , Hamvas József
Published: December 2012

Absztrakt

A laparoscopos sebészet fejlődése világszerte rohamléptekkel halad előre. Egyre több intraabdominalis vagy retroperitonealis szerv megbetegedésénél lehet műtéti megoldásként alkalmazni. Osztályunkon a laparoscopos profil, azaz epe-, különböző sérv- és vastagbélműtétek mellett a korán diagnosztizált gyomordaganatok laparoscopos sebészi megoldásait kezdtük alkalmazni. Az eljárás bevezetésekor laparoscopos gyomorexcisiók, majd laparoscoppal asszisztált distalis gyomorresectiók után, 2010-ben elkezdtünk subtotalis laparoscopos gyomorresectiókat végezni. Összességében a gyomor laparoscopos műtétei közül ékresectiót, intragastricus mucosaresectiót és laparoscopos subtotalis resectiót tudunk osztályunkon jelenleg elvégezni. Jelen cikkünkben a 2010-ben végzett első négy subtotalis resectióval kapcsolatos kezdeti tapasztalatainkat tesszük közzé. Beteganyagunkból kiválasztottuk azokat, akiknél az elváltozások kis kiterjedésű, 3 cm körüli, malignus sejtburjánzást mutató, több esetben ismert fekély területén kialakult, distalis vagy antralis elhelyezkedésűek voltak. Minden esetben laparoscopos technikával végeztünk subtotalis resectiót retrocolicus gastroentero-anastomosisszal. A betegek kora a műtét típusának választását nem befolyásolta, mivel nemzetközi tapasztalatok szerint a beavatkozás posztoperatív morbiditását, mortalitását nem befolyásolja. A műtétek elvégzéséhez minimum 2, maximum 4 óra időtartam volt szükséges. Kezdeti pozitív tapasztalatainkat megosztva, a műtéti típus végzését javasoljuk.
A spontán primer légmell aetiopathogenesiséhez. Marihuána: ok vagy bűnbak?
Authors: Jakab László , Szántó Zalán , Benkő István , Szalai Zsuzsanna , Pótó László , Molnár F. Tamás
Published: December 2012

Absztrakt

Háttér: Az alapadatok hiánya az egyik fő oka annak, hogy ellentmondásosak a marihuána és a krónikus tüdősérülés közötti kapcsolat megítélése. Anekdotikus esetbeszámolók szerint a fiatal marihuánaszívók körében a spontán primer pneumothorax (SPP) gyakorisága nagyobb, s ez oki kapcsolatot vet fel. Betegek és módszer: Retrospektíve dolgoztuk fel az SPP miatt az elmúlt két évben klinikánkon kezelt 20 beteg adatait. Vizsgáltuk a demográfia és a kezelési mód szerinti információkat, figyeltük a kimenetelt. Khi-négyzet-próbát, Mann–Whitney-tesztet és Fisher-tesztet használtunk statisztikai analízisre. Nem szerinti megoszlás: 16 férfi, 4 nő, átlagéletkor 23,95 ± 4,57 év: min. 18 év, max. 32 év. Önbevallás szerint 13/20 rendszeres cannabishasználó (CH), fogyasztó volt, közülük 11 férfi, 2 nő, átlagéletkor 24,54 ± 4,77 év. Összesen 7/20 betegnek volt már korábban pneumothoraxa. Eredmények: A nem cannabishasználó (NCH) csoportban 3/7 beteg csupán mellűri drainage-ra is gyógyult. 4/7 NCH betegnél „nagy” műtétre volt szükség, mind a négy betegnél VATS-ot végeztünk. A CH csoportban 4/13 beteg csak mellkasi drainage-ra szorult. 9/13 páciens mellkasnyitást igényelt (8 VATS, 1 nyitott műtét). Rövidebb drainage-hosszot észleltünk a NCH csoportban (4,00 ± 1,00 nap NCH vs. 4,5 ± 1,73 nap CH, p = 0,651). Nagyobb volt a nem megfelelő tüdőtágulás vagy tartós áteresztés miatti operatív esetek aránya a cannabishasználó csoportban (69,23% vs. NCH 57,14%, p = 0,651). Mellkasi drainage után 2 betegnél észleltünk recidívát, egy CH, egy NCH betegnél, mindkettő VATS műtétet követően szövődménymentesen gyógyult. A CH csoportban magasabb a recidív légmell aránya (odds ratio 1,56). A szövettani vizsgálat során nem találtunk lényeges eltérést a két csoportban, az operatív esetekből 11/13 betegnél igazolódott emphysaema pulmonum. A megyei demográfiai és klinikai adatokkal egybevetve a klinikai előfordulást, a marihuánahasználók közt magasabb a légmell kockázata (odds ratio 3,86). Következtetések: A kis mintaméret ellenére úgy látszik, van kapcsolat a marihuánahasználat és a SPP közt. Azt nem tudjuk, hogy a cannabis közvetlen oka-e a légmell kialakulásának, vagy csak súlyosbít egy alapvetően meglévő gyenge tüdőparenchyma-állapotot. A fiatalok e kockázatos csoportjában agresszívebb sebészi kezelést ajánlunk, figyelembe véve a mögöttes tüdőparenchyma-károsodást és a magasabb recidívaarányt.