bluuebunny/crossref_metadata_2025 huggingface dataset:
On the competition among aerosol number, size and composition in predicting CCN variability: a multi-annual field study in an urbanized desert
Authors: Crosbie E. , Youn J.-S. , Balch B. , Wonaschütz A. , Shingler T. , Wang Z. , Conant W. C. , Betterton E. A. , Sorooshian A.
Published: June 2015

Abstract. A 2-year data set of measured CCN (cloud condensation nuclei) concentrations at 0.2 % supersaturation is combined with aerosol size distribution and aerosol composition data to probe the effects of aerosol number concentrations, size distribution and composition on CCN patterns. Data were collected over a period of 2 years (2012–2014) in central Tucson, Arizona: a significant urban area surrounded by a sparsely populated desert. Average CCN concentrations are typically lowest in spring (233 cm−3), highest in winter (430 cm−3) and have a secondary peak during the North American monsoon season (July to September; 372 cm−3). There is significant variability outside of seasonal patterns, with extreme concentrations (1 and 99 % levels) ranging from 56 to 1945 cm−3 as measured during the winter, the season with highest variability. Modeled CCN concentrations based on fixed chemical composition achieve better closure in winter, with size and number alone able to predict 82 % of the variance in CCN concentration. Changes in aerosol chemical composition are typically aligned with changes in size and aerosol number, such that hygroscopicity can be parameterized even though it is still variable. In summer, models based on fixed chemical composition explain at best only 41 % (pre-monsoon) and 36 % (monsoon) of the variance. This is attributed to the effects of secondary organic aerosol (SOA) production, the competition between new particle formation and condensational growth, the complex interaction of meteorology, regional and local emissions and multi-phase chemistry during the North American monsoon. Chemical composition is found to be an important factor for improving predictability in spring and on longer timescales in winter. Parameterized models typically exhibit improved predictive skill when there are strong relationships between CCN concentrations and the prevailing meteorology and dominant aerosol physicochemical processes, suggesting that similar findings could be possible in other locations with comparable climates and geography.
A process-based 222Rn flux map for Europe and its comparison to long-term observations
Authors: Karstens U. , Schwingshackl C. , Schmithüsen D. , Levin I.
Published: June 2015

Abstract. Detailed 222Rn flux maps are an essential prerequisite for the use of radon in atmospheric transport studies. Here we present a high-resolution222Rn flux map for Europe, based on a parameterization of 222Rn production and transport in the soil. The 222Rn exhalation rate was parameterized based on soil properties, uranium content, and modelled soil moisture from two different land-surface reanalysis data sets. Spatial variations in exhalation rates are primarily determined by the uranium content of the soil, but also influenced by local water table depth and soil texture. Temporal variations are related to soil moisture variations as the molecular diffusion in the unsaturated soil zone depends on available air-filled pore space. The implemented diffusion parameterization was tested against campaign-based 222Rn profile measurements. Monthly 222Rn exhalation rates from European soils were calculated with a nominal spatial resolution of 0.083° × 0.083° and compared to long-term direct measurements of 222Rn exhalation rates in different areas of Europe. The two realizations of the 222Rn flux map, based on the different soil moisture data sets, both realistically reproduce the observed seasonality in the fluxes but yield considerable differences for absolute flux values. The average 222Rn flux from soils in Europe is estimated to be 10 or 15 mBq m-2 s-1, depending on the soil moisture data set, and the seasonal variations in the two realisations range from 7.1 mBq m-2 s-1 in February to 13.9 mBq m-2 s-1 in August and from 10.8 mBq m-2 s-1 in March to 19.7 mBq m-2 s-1 in July, respectively. This systematic difference highlights the importance of realistic soil moisture data for a reliable estimation of 222Rn exhalation rates.
Technical Note: Towards resolving in situ, centimeter-scale location and timing of biomineralization in calcareous meiobenthos – the Calcein-Osmotic pump method
Authors: Bernhard J. M. , Phalen W. G. , McIntyre-Wressnig A. , Mezzo F. , Wit J. C. , Jeglinski M. , Filipsson H. L.
Published: June 2015

Abstract. Insights into oceanographic environmental conditions such as paleoproductivity, sea-surface temperatures, deep-water temperatures, salinity, ice volumes, circulation patterns, and nutrient cycling have all been obtained from geochemical analyses of biomineralized carbonate of marine organisms. However, we cannot fully understand geochemical proxy incorporation and the fidelity of such in species until we better understand fundamental aspects of their ecology such as where and when these (micro)organisms calcify. Here, we present an innovative method using osmotic pumps and the fluorescent marker calcein to help identify where and when calcareous meiofauna calcify in situ. Method development initially involved juvenile quahogs (Mercenaria mercenaria); subsequent method refinement involved a neritic benthic foraminiferal community. Future applications of this method will allow determinations of in situ growth rate in calcareous organisms and provide insights about microhabitats where paleoceanographically relevant benthic foraminifera actually calcify.
Implementation of counted layers for coherent ice core chronology
Authors: Lemieux-Dudon B. , Bazin L. , Landais A. , Toyé Mahamadou Kele H. , Guillevic M. , Kindler P. , Parrenin F. , Martinerie P.
Published: June 2015

Abstract. A recent coherent chronology has been built for four Antarctic ice cores and the NorthGRIP (NGRIP) Greenland ice core (Antarctic Ice Core Chronology 2012, AICC2012) using a Bayesian approach for ice core dating (Datice). When building the AICC2012 chronology, and in order to prevent any confusion with official ice core chronology, the AICC2012 chronology for NGRIP was forced to fit exactly the GICC05 chronology based on layer counting. However, such a strong tuning did not satisfy the hypothesis of independence of background parameters and observations for the NGRIP core, as required by Datice. We present here the implementation in Datice of a new type of markers that is better suited for constraints deduced from layer counting: the duration constraints. Estimating the global error on chronology due to such markers is not straightforward and implies some assumption on the correlation between individual counting errors for each interval of duration. We validate this new methodological implementation by conducting twin experiments and a posteriori diagnostics on the NGRIP ice core. Several sensitivity tests on marker sampling and correlation between counting errors were performed to provide some guidelines when using such a method for future dating experiments. Finally, using these markers for NGRIP in a five-core dating exercise with Datice leads to new chronologies that do not differ by more than 410 years from AICC2012 for Antarctic ice cores and 150 years from GICC05 for NGRIP over the last 60 000 years.
CranSLIK v2.0: improvements on the stochastic prediction of oil spill transport and fate using approximation methods
Authors: Rutherford R. , Moulitsas I. , Snow B. J. , Kolios A. J. , De Dominicis M.
Published: June 2015

Abstract. Oil spill models are used to forecast the transport and fate of oil after it has been released. CranSLIK is a model that predicts the movement and spread of a surface oil spill at sea via a stochastic approach. The aim of this work is to identify parameters that can further improve the forecasting algorithms and expand the functionality of CranSLIK, while maintaining the run time efficiency of the method. The results from multiple simulations performed using the operational, validated oil spill model, MEDSLIK-II, were analysed using multiple regression in order to identify improvements which could be incorporated into CranSLIK. This has led to a revised model, namely CranSLIK v2.0, which was validated against MEDSLIK-II forecasts for real oil spill cases. The new version of CranSLIK demonstrated significant forecasting improvements by capturing the oil spill accurately in real validation cases and also proved capable of simulating a broader range of oil spill scenarios.
Hermann Karsten, pioneer of geologic mapping in northwestern South America
Authors: Aalto K. R.
Published: June 2015

Abstract. In the late 19th century, a regional map of Nueva Granada (present-day Colombia, Panama and parts of Venezuela and Ecuador) was published by German botanist and geologist Hermann Karsten (1817–1908). Karsten's work was incorporated by Agustín Codazzi (1793–1859), an Italian who emigrated to Venezuela and Colombia to serve as a government cartographer and geographer, in his popular Atlas geográfico e histórico de la Republica de Colombia (1889). Geologic mapping and most observations provided in this 1889 atlas were taken from Karsten's Géologie de l'ancienne Colombie bolivarienne: Vénézuela, Nouvelle-Grenade et Ecuador (1886), as cited by Manual Paz and/or Felipe Pérez, who edited this edition of the atlas. Karsten defined four epochs in Earth history: Primera – without life – primary crystalline rocks, Segunda – with only marine life – chiefly sedimentary rocks, Tercera – with terrestrial quadrupeds and fresh water life forms life – chiefly sedimentary rocks, and Cuarta – mankind appears, includes diluvial (glacigenic) and post-diluvial terranes. He noted that Colombia is composed of chiefly of Quaternary, Tertiary and Cretaceous plutonic, volcanic and sedimentary rocks, and that Earth's internal heat (calor central) accounted, by escape of inner gases, for volcanism, seismicity and uplift of mountains. Karsten's regional mapping and interpretation thus constitutes the primary source and ultimate pioneering geologic research.
Factors favouring large organic production in the northern Adriatic: towards the northern Adriatic empirical ecological model
Authors: Kraus R. , Supić N. , Precali R.
Published: June 2015

Abstract. Influenced by one of the largest Mediterranean rivers, Po, the northern Adriatic production is highly variable seasonally and interannually. The changes are especially pronounced between winters and seemingly reflect on total Adriatic bioproduction of certain species (anchovy). We analysed the long-term changes in the phytoplankton production at the transect in the region, as derived from monthly oceanographic cruises, in relation to concomitant geostrophic currents distribution in the area and in the Po River discharge rates in days preceding the cruises. In winter and early spring the phyto-abundances depended on existing circulation fields, in summer and autumn they were related to 1–15 days earlier Po River discharge rates and on concomitant circulation fields, while in late spring phyto-abundances increased 1–3 days after high Po River discharge rates regardless of circulation fields. During the entire year the phyto-abundances were dependant on forcing of the previous 1–12 months of surface fluxes and/or Po River rates. Large February blooms are, as well as February circulation patterns, precondited by low evaporation rates in previous November. From 1990 to 2004 a shift towards large winter bioproduction induced by circulation changes appeared. Performed investigations represent the preliminary actions in building of an empirical ecological model of the northern Adriatic which can be used in the sustainable economy of the region, however also in validation of the numerical ecological model of the region, which is currently being developed.
Lessons for Successful Aging: A Centenarian's Lifestyle in a Mexican Community of Aging
Authors: Barry José Azoh
Published: June 2015

It is clearly established in the scientific literature that an appropriate lifestyle is key to achieving and maintaining optimum health and functional status in old age. In this frame, the practice of physical activity on a regular basis fits into the active aging paradigm, a notorious shift away from aging as a dependent stage of life. Through a longitudinal case study conducted in the outskirts of Monterrey, Nuevo Leon, Mexico, an aspect of the lifestyle –physical activity – of a centenarian who lives permanently in senior-only housing, has been documented in contrast to his coresidents’ lifestyles. Extensive open-ended interviews and direct observations of a convenience sample of residents of a community of aging, from 1999 to the present, allowed for a triangulation and saturation of data.In contrast to his peers, who predominantly displayed sedentary lifestyles, the centenarian consistently had a related physically and socially active lifestyle. I suggest that the attitudes of fellow residents can be understood in light of the Theory of Planned Behavior (Fishbein and Ajzen 1975). Fieldwork also provided the opportunity to document how fitness and independenceaffected the quality of life of the centenarian. This individual is atypical in his environment and the external validity of this study is analytical rather than statistical. However, it suggests that non-institutional barriers may challenge the promotion of an active aging paradigm.
Giving meaning to health:Daily occupations among elderly South Africans
Authors: Schatz Enid
Published: June 2015

None
The Theory of Multinational Enterprises: Revisiting Eclectic Paradigm and Uppsala Model
Authors: Chowdhury Ataul Kaium
Published: June 2015

Globalization has been evolving through the growing trend of multinational enterprises (MNE) for a prolonged period. In this fierce competitive market, corporations are trying to spread out their operations in different geographic locations in order to gain different advantages. Based on past literatures, the goal of this paper is to explain the relevant theories of multinational enterprise through proven theories and scholars viewpoint. With the theoretical ground of ‘Uppsala model’—that explains the internationalization process and, ‘Eclectic Paradigm’—that explore the factual reasons behind internationalization, this paper would focus on the rationale and process of becoming MNE. Additionally, with many critics’ viewpoint, real life examples of successful MNEs, this paper found the foundations that embolden the new generation firms to spread its production and head office in different part of the world successfully as a process of turning into MNE.
Effect of Increased Exposure Times on Amount of Residual Monomer Released from Single-Step Self-Etch Adhesives
Authors: Altunsoy Mustafa , Botsali Murat Selim , Tosun Gonca , Yasar Ahmet
Published: June 2015

Background

The aim of this study was to evaluate the effect of increased exposure times on the amount of residual Bis-GMA, TEGDMA, HEMA and UDMA released from single-step self-etch adhesive systems.

Methods

Two adhesive systems were used. The adhesives were applied to bovine dentin surface according to the manufacturer's instructions and were polymerized using an LED curing unit for 10, 20 and 40 seconds (n = 5). After polymerization, the specimens were stored in 75% ethanol-water solution (6 mL). Residual monomers (Bis-GMA, TEGDMA, UDMA and HEMA) that were eluted from the adhesives (after 10 minutes, 1 hour, 1 day, 7 days and 30 days) were analyzed by high-performance liquid chromatography (HPLC). The data were analyzed using 1-way analysis of variance and Tukey HSD tests.

Results

Among the time periods, the highest amount of released residual monomers from adhesives was observed in the 10th minute. There were statistically significant differences regarding released Bis-GMA, UDMA, HEMA and TEGDMA between the adhesive systems (p<0.05). There were no significant differences among the 10, 20 and 40 second polymerization times according to their effect on residual monomer release from adhesives (p>0.05).

Conclusions

Increasing the polymerization time did not have an effect on residual monomer release from single-step self-etch adhesives.
Treatment of Endometriosis-Associated Pain with Elagolix, an Oral GnRH Antagonist: Results from a Phase 2, Randomized Controlled Study
Authors: Ács Nándor , O'Brien Chris , Jiang Ping , Burke Joshua , Jimenez Roland , Garner Elizabeth , Chwalisz Kristof
Published: June 2015

Purpose

Elagolix is a novel, oral GnRH antagonist that dose-dependently suppresses estradiol levels. This study evaluated safety and efficacy of elagolix vs. leuprorelin acetate (LA) and placebo in women with endometriosis-associated pain.

Methods

In this multicenter, double-blind study, women with laparoscopically confirmed endometriosis were randomized to oral elagolix 150 or 250 mg once daily, placebo or 3.75 mg LA intramuscularly (i.m.) monthly for 12 weeks. Placebo and LA patients were re-randomized to elagolix, and elagolix patients continued treatment for another 12 weeks.

Results

Baseline demographics were similar among groups (mean age 31.7 years). Significantly greater reductions in monthly mean pelvic pain compared with placebo (p<0.05) were observed in both elagolix doses at week 4, elagolix 250 mg at week 8 and LA at weeks 4, 8 and 12. The mean (95% CI) percentage change in spinal bone mineral density (BMD) from baseline at week 12 was -1.05 (-1.68, -0.43), -0.80 (-1.53, -0.07) and -1.63 (-2.28, -0.99) for elagolix 150-mg, 250-mg and LA groups, respectively, compared with a mean percentage increase in placebo group (0.11 [-0.50, 0.71]). Headache was the most common adverse event for all treatment groups.

Conclusions

Both elagolix and LA reduced endometriosis-associated pain for up to 24 weeks of treatment and were associated with generally acceptable safety profiles in this study. Based on relatively small changes from baseline to week 12 in BMD, elagolix may offer a potential long-term treatment option for endometriosis-associated pain in affected women. Larger clinical studies with elagolix are warranted.

Trial Registration

Clinicaltrials.gov Identifier: NCT00797225.
The influence of socioeconomic deprivation on early outcomes in vascular access surgery
Authors: Khalid Usman , Powell-Chandler Anna , Sabah Tarique , Horvath Szabolcs , Morris Rhys , Ilham Mohamed A. , Stephens Michael R.
Published: June 2015

Introduction

Socioeconomic deprivation is an important factor in determining poor health and is associated with a higher prevalence of many chronic diseases including diabetes and renal failure, and often poorer outcomes for patients with such conditions. The influence of deprivation on outcomes following vascular access surgery has not previously been reported.

Methods

The Welsh Index of Multiple Deprivation was used to assess the influence of socioeconomic deprivation on outcomes following 507 consecutive first upper limb arteriovenous (AV) fistulas from a single institution in the United Kingdom, performed between 2011 and 2014. The primary outcome measures were early failure and maturation into a working fistula.

Results

Four hundred and five (80%) patients had a patent AV fistula at the 2-week follow-up clinic. Three hundred and fifty-nine (71%) patients developed a functionally mature AV fistula as determined by clinical assessment and a Doppler scan. There were no differences in either early failure rates ( p = 0.95) or maturation rates ( p = 0.77) between the least and most deprived groups of patients.

Conclusions

In conclusion, this study has shown that socioeconomic deprivation does not influence outcomes following vascular access surgery.
Vascular access for incident hemodialysis patients in Catalonia: analysis of data from the Catalan Renal Registry (2000-2011)
Authors: Roca-Tey Ramon , Arcos Emma , Comas Jordi , Cao Higini , Tort Jaume ,   Catalan Society of Nephrology (SCN), Feixas J. , Fontseré N. , Graterol F. , Ibeas J. , Martínez J. , de Arellano M. Ramírez , Sans R.
Published: June 2015

Purpose

Arteriovenous fístula is the best vascular access (VA) for hemodialysis. We analyzed the VA used at first session and the factors associated with the likelihood to start hemodialysis by fistula in 2000-2011.

Methods

Data of VA type were obtained in 9,956 incident hemodialysis patients from the Catalan Registry.

Results

Overall, 47.9% of patients initiated hemodialysis with a fistula, 1.2% with a graft, 15.9% with a tunneled catheter and 35% with an untunneled catheter. The percentage of incident patients with fistula and catheter has remained stable at around 50% over the years. The likelihood to start hemodialysis with fistula was significantly lower in females [adjusted odds ratio: 0.69, 95% confidence interval (CI): 0.61-0.75], patients aged 18-44 years (0.78, 95% CI: 0.64-0.94), patients with comorbidity (0.67, 95% CI: 0.60-0.75) and tended to be lower in patients aged over 74 years (0.89, 95% CI: 0.78-1.01). The probability to use fistula was significantly higher in patients with polycystic kidney disease (2.08, 95% CI: 1.63-2.67), predialysis nephrology care longer than 2 years (4.14, 95% CI: 3.63-4.73) and steady chronic kidney disease (CKD) progression (10.97, 95% CI: 8.41-14.32). During 1 year of follow-up, 67.2% and 59.6% of patients using untunneled and tunneled catheter changed to fistula, respectively.

Conclusions

Starting hemodialysis by fistula was related with nonmodifiable patient characteristics and modifiable CKD practice processes, such as predialysis care duration. Half of the incident patients were exposed annually in Catalonia to potential catheter complications. This scenario can be improved by optimizing the processes of CKD care.
Predictors of difficult pediatric intravenous access in a community Emergency Department
Authors: Petroski Adam , Frisch Adam , Joseph Nicole , Carlson Jestin N.
Published: June 2015

Background

Successful intravenous (IV) placement is important in the care of the acutely ill and injured pediatric patient. There are little data that exist regarding predicators of difficult IV access in pediatric Emergency Department (ED) patients who present to community EDs.

Methods

We retrospectively analyzed all pediatric charts for the calendar year 2012 from a single community teaching hospital. We identified all cases with patients less than 18 years of age in whom an IV or IV medications were ordered. We defined difficult IV access as those requiring more than one attempt, or those where the IV team was required to place the IV. We identified patient, provider, and procedural characteristics. Data were analyzed using descriptive statistics and univariate logistic regression to determine the odds ratio (OR) for predictors of difficult IV access.

Results

We identified 652 patients, 607 (93%) without difficult access and 45 with difficult access. Increasing age [OR 0.94 (0.89-0.99) p = 0.017] was associated with decreased odds of difficult IV access. IVs attempted in the hand [OR 3.02 (1.06-8.58) p = 0.039] and lower extremity [OR 7.82 (2.27-26.91) p = 0.001)]) were associated with greater odds of difficult access than the antecubital fossa. Non-black/non-white race [2.37 (1.1-5.12) p = 0.028] was also associated with difficult IV access. Other factors (sex, IV catheter size, and so on) were not associated.

Conclusions

In this retrospective study of pediatric patients in a community ED, decreasing age, non-black/non-white race, and IV attempt location (hand and lower extremity vs. antecubital fossa) were associated with greater odds of difficult IV access.
Cytology Smears as Diagnostic Material for EGFR Gene Testing in Non-small Cell Lung Cancer
Authors: Powrózek Tomasz , Krawczyk Paweł , Pankowski Juliusz , Reszka Katarzyna , Jakubiak Magdalena , Obrochta Anna , Wojas-Krawczyk Kamila , Buczkowski Jarosław , Milanowski Janusz
Published: June 2015

Aims and Background

Cytology smears can be effectively used for EGFR mutation testing in the qualification of NSCLC patients for EGFR tyrosine kinase inhibitor therapy. However, tissue specimens are preferred for EGFR mutation analysis. The aim of this study was to estimate the effectiveness of the real-time PCR method for EGFR testing in histology and cytology materials obtained simultaneously from NSCLC patients.

Methods

Fourteen adenocarcinoma patients with EGFR–mutation-positive primary tumor tissues were included in the study. Corresponding cytological smears of metastatic lymph nodes obtained by EBUS-TBNA were examined. EGFR Mutation Analysis Kit (EntroGen, USA) and real-time PCR (m2000rt system, Abbott, USA) were used for EGFR mutation analysis in both types of material.

Results

In primary tumor tissues, 12 deletions in exon 19 and 2 substitutions in exon 21 (L858R mutation) of the EGFR gene were found. Except for 1 deletion in exon 19, the same EGFR gene mutations were detected in all corresponding cytology samples. The percentage of tumor cells, DNA concentration, percentage of mutated DNA as well as ΔCt values were similar in cytology slides and histology material. In both types of materials, no significant correlations were found between the percentage of tumor cells and the percentage of mutated DNA nor between the DNA concentration and the percentage of mutated DNA.

Conclusions

We demonstrated the high effectiveness of a sensitive real-time PCR method in EGFR gene mutation detection in cytology smears.
Hepatosplenic T-cell Lymphoma with Aberrant Expression of Serum β-HCG: A Case Report
Authors: Bellodi Andrea , Rivoli Giulia , Arboscello Eleonora , Fornarini Giuseppe , Orcioni Giulio Fraternali , Avenoso Daniele , Miglino Maurizio , Ghio Riccardo
Published: June 2015

Background

Peripheral T-cell lymphomas (PTCL) represent a heterogeneous group of hematologic malignancies frequently presenting at advanced stage of diagnosis.

Methods

We report a case of PTCL with an uncommon and aggressive onset with disseminated intravascular coagulation (DIC).

Results

Laboratory findings revealed an aberrant expression of β subunit of human chorionic gonadotropin (β-HCG). Other than for determination of pregnancy, β-HCG is regularly found as a tumor marker in germ cell tumors with trophoblastic differentiation and its aberrant expression has been reported in the literature in other neoplastic conditions only in the context of case reports.

Conclusions

In hematologic malignancies, β-HCG expression has been described only in sporadic cases. Awareness of this feature could avoid diagnostic delay in such an aggressive disease.
Foreign body in the liver: Case report and review of literature
Authors: Aftab Zia , Ali Syed Muhammad , Koliyadan Sreedharan , Al-Kindi Nayil
Published: June 2015

Foreign bodies in the liver, although rare, have been described previously in the literature. While more common in children, adults may also swallow foreign bodies that can reach the liver by penetrating the stomach, duodenum or colon. We describe the case of a young lady who accidentally swallowed a needle, which was later found in the liver by abdominal X-ray and computed tomography (CT). It was removed intact by laparoscopy. A foreign body in the liver is a rare occurrence. Radiology is important in diagnosis through modalities including plain X-ray, ultrasonography and abdominal CT. Removal can be achieved by laparotomy or laparoscopy.
Marriage Patterns and Childbearing: Results From a Quantitative Study in North of Iran
Authors: Taghizadeh Ziba , Behmanesh Fereshteh , Ebadi Abbas
Published: June 2015

Social changes have rapidly removed arranged marriages and it seems the change in marriage pattern has played a role in childbearing. On the other hand, there is a great reduction in population in many countries which requires a comprehensive policy to manage the considerable drop in population. To achieve this goal, initially, the factors affecting fertility must be precisely identified. This study aims to examine the role of marriage patterns in childbearing. In this cross-sectional quantitative study, 880 married women 15-49 years old, living in the north of Iran were studied using a cluster sampling strategy. The results showed that there are no significant differences in reproductive behaviors of three patterns of marriage in Bobol city of Iran. It seems there is a convergence in childbearing due to the different patterns of marriage and Policymakers should pay attention to other determinants of reproductive behaviors in demographic planning.

 
 
Incidentalomas: concept, relevance and challenges for medical practice
Authors: Mariño María Ana
Published: June 2015

Incidentaloma (which has not been included as a MeSH term neither in other medical databases or Bioportal) is a neologism used to describe an incidentally discovered mass (or abnormality) in asymptomatic persons. Incidentaloma, or incidental finding, is extremely common now and in most cases harmless, but sometimes it is not possible to exclude the possibility of real damage and in very few cases, some people can get benefit from its discovery. Therefore, most of incidentalomas represent overdiagnosis originated by the massive use of high-resolution diagnostic procedures. In many cases, incidentaloma causes anxiety, consume time and resources, and can even cause further damage to patients’ health as a result of procedures performed in the post-finding follow-up. Thus, it is important to recognize the problem to try to avoid it if possible, and learn strategies to deal with it once we stumbled upon an incidentaloma.
Excesos y alternativas de la salud mental en atención primaria
Authors: Ortiz Lobo Alberto , Bernstein Jorge
Published: June 2015

La extraordinaria expansión de la psiquiatría y la psicología está propiciando el tratamiento de personas sanas que acaban siendo etiquetadas como trastornos mentales. El reduccionismo biológico del modelo médico centrado en los síntomas favorece la transformación de problemas sociales en conflictos individuales y la exposición de los ciudadanos a los efectos adversos de tratamientos excesivos e improcedentes. La prevención cuaternaria en salud mental contempla el empleo de narrativas y formulación de casos (más allá de la etiqueta diagnóstica), la indicación de no-tratamiento y un empleo de los psicofármacos prudente, que considere su deprescripción.
Surgical pathology in cancer diagnosis: implications for quaternary prevention
Authors: Yver Matthieu
Published: June 2015

Surgical pathology is the medical specialty in charge of cancer diagnosis. Although very important since oncology development, its link with overdiagnosis and overtreatment remains understudied. Despite big mediatisation, molecular biology has not brought much progress to tumour classifications. On the contrary, the silent apparition of immunohistochemistry at the end of the 1980's improved much of tumour classifications so significantly that it could cast doubts in some trials’ results of that period. This article discusses how the booming and abuse of immunohistochemistry might have led to overdiagnosis. It also highlights that the ISO 15189 standardization, as well as the tumour classification complexity, might function to induce overtreatment. In summary, critical reading and understanding of pathology reports by general practitioners are essential. Therefore, family doctors should not hesitate to discuss the cancer diagnosis with the pathologist, and in some cases also question the oncologist decision. This approach can be considered a quaternary prevention action which can prevent overtreatment.
The words of prevention, part I: changing the model
Authors: Jamoulle Marc , Gavilán Enrique , Cardoso Raquel Vaz , Mariño María Ana , Pizzanelli Miguel
Published: June 2015

Objective: this part I article explores the different meanings of relevant keywords for General Practice/Family Medicine (GP/FM) in the prevention domain. The aim is to contribute to information process in GP/FM by keeping in line with the main terms used in health care organization. Methods: important keywords for GP/FM in the prevention domain were selected. Then, a search was carried out on the main sources in GP/FM databases, as well as in Medical Subject Heading and major terminological databases available online. Results and Discussion: there is discrepancy between the conceptual contents of major prevention models amongst the usual bibliographic sources of knowledge in GP/FM in particular and medicine in general. Conclusion: For GP/FM, distribution of preventive activities is now firmly established on a new constructivist model, privileging the doctor-patient relationships and introducing a cybernetic thinking on the health care activities with a special commitment to ethics and the positive duty of beneficence.
Prevenção quaternária como diretriz para a equipe editorial de uma revista de medicina baseada em evidência
Authors: De Jonghe Michel
Published: June 2015

O presente artigo tem como objetivo analisar as atividades de redação da revista Minerva, periódico belga de medicina baseada em evidência (MBE), de acordo com as diretrizes da prevenção quaternária. A partir da produção editorial da revista Minerva foi realizada uma análise narrativa de suas atividades de redação em relação ao questionamento clínico, à pesquisa, à crítica e à interpretação de informações clínicas relevantes à prática profissional. São detalhados os limites da MBE e as ferramentas e linhas de reflexão emitidas pela equipe de redação da revista a fim de favorecer a implementação da MBE na prática clínica. Dessa forma, se pretende prevenir o intervencionismo médico desnecessário, ao se fortalecer a prevenção quaternária como uma competência fundamental dos trabalhadores da saúde ao longo de sua vida profissional a serviço dos pacientes, o que pode ser reforçado pelo trabalho da equipe editorial de uma revista de MBE.
Multimorbidity and Quaternary Prevention (P4)
Authors: Mangin Dee , Heath Iona
Published: June 2015

Multimorbidity has become the norm for the majority of patients attending primary care, and while the proportion of those with multimorbidity is higher in older age, the absolute number of people with multimorbidity is greater in those under 65. The specialist-based single-disease model of treatment assumes that each index disease is the dominant illness within the complex system and that the other comorbid illnesses are held constant while management is focussed on the single condition. Thus, applying single disease guidelines to a person with five chronic comorbidities, no matter what they are, results in potentially harmful polypharmacy. This approach has led to the current ‘epidemic’ in morbidity and mortality from adverse drug reactions that now outstrip the target diseases as a cause of death. In this article, we highlight four characteristics of quaternary prevention framework that policymakers should take into account when considering the quality of health care.
Prevenção quaternária: um olhar sobre a medicalização na prática dos médicos de família
Authors: Cardoso Raquel Vaz
Published: June 2015

A medicalização é um fenômeno social complexo e disseminado no qual estão envolvidos diferentes agentes e instituições, tais como a indústria médica/farmacêutica, governos, profissionais/sistemas de saúde e cidadãos. Por sua vez, médicos e profissionais de saúde desempenham importante papel na reprodução e no enfrentamento da medicalização haja visto que a medicina e os cuidados em saúde podem gerar tanto danos como benefícios. Médicos de família lidam diariamente com a sobremedicalização e seus fenômenos associados (i.e. sobrediagnóstico, sobretratamento, comercialização de doenças) por desempenharem função-filtro nos sistemas de saúde. Por serem o primeiro ponto de contato, esses profissionais e suas equipes acolhem as demandas e necessidades sociais trazidas pelas pessoas e comunidades sob seus cuidados, que comumente estão influenciadas por uma perspectiva médica intervencionista e pelo marketing da saúde. Este artigo discute alguns conceitos principais da medicalização e seus determinantes, em especial as contribuições da ciência biomédica e suas bases epistemológicas para o fenômeno. Ele também desenvolve, sucintamente, algumas reflexões sobre a medicalização na prática do médico de famíliae comunidade, no contexto brasileiro. Por fim, analisa o enfoque da prevenção quaternária acerca da medicalização, que propõe mudanças de objeto e de atitude na prática médica, evitando, assim, intervenções desnecessárias e protegendo os pacientes dos excessos da medicina.
La evaluación de la producción científica: breve análisis crítico
Authors: Giménez-Toledo Elea
Published: June 2015

Se realiza una revisión histórica (centrada fundamentalmente en España, pero con múltiples referencias a otros ámbitos internacionales) del proceso de evaluación de las producción científica, especialmente de las publicaciones periódicas. Se analizan también las alternativas disponibles en la actualidad, tras una etapa convulsa que ha visto desaparecer diversos instrumentos para la evaluación de revistas. Por último se identifican algunas tendencias y necesidades en el ámbito de la evaluación de publicaciones científicas que presumiblemente marcaran el desarrollo futuro de futuros instrumentos y procedimientos
Retesamentos discursivos: um olhar foucaultiano do estilo antidogmático de Nietzsche
Authors: Ribeiro Carlos Eduardo , Carvalho Alexandre Filordi de
Published: June 2015

O presente artigo investiga, segundo a noção foucaultiana de nível discursivo, como o pensamento de Nietzsche explora determinados limites linguísticos em favor de uma renovação da escrita filosófica. Esses limites podem ser averiguados no constante tensionar discursivo e experimental presentes no estilo aforismático. Explicita-se esses retesamentos discursivos na clara associação do antidogmatismo nietzschiano ao estilo de sua escrita filosófica, opção realizada essencialmente em Além do bem e do mal.
Por uma injustiça, dois Platões: tempo e genealogia em F. Nietzsche e M. Foucault
Authors: Ribeiro Felipe Figueiredo de Campos
Published: June 2015

Este artigo pretende explorar as leituras que Friedrich Nietzsche e Michel Foucault, respectivamente, fizeram da filosofia de Platão, na medida em que esta interessa e se articula às temáticas da vida/existência e das relações entre presente e passado (história) no pensamento de cada um dos dois primeiros autores mencionados. Tem-se, em Nietzsche e em Foucault, dois diagnósticos, em certa medida, opostos sobre os efeitos que a filosofia de Platão teria surtido na cultura ocidental. Como compreender esta diferença de interpretações entre autores que entre si estabelecem reconhecida herança e conexão filosófica? Hipótese do trabalho: o gesto de Foucault enquanto genealogista, no momento tardio de seus trabalhos, parece preservar uma relação profunda - a mais profunda ao longo de sua obra - com o modo nietzschiano de fazer filosofia. Isto, na medida em que tal gesto contraria a interpretação de Nietzsche sobre o nascimento – com Platão - da Filosofia. Seguindo a premissa de que a presença de Nietzsche nos trabalhos de Foucault não é apenas nominalmente explícita, mas também (e, sobretudo) oculta, recorreu-se analiticamente - justificando-se o porquê disto - a um texto de juventude do primeiro autor; texto este que o segundo, no mais das vezes, não tomou diretamente como foco proeminente de seus interesses e análises: a Segunda Consideração Extemporânea (1874). À luz deste texto, localizei de forma cotejada importantes modificações ocorridas ao longo do desenvolvimento dos trabalhos de Foucault; modificações estas que seguem uma lógica de aproximação cada vez mais estreita ao pensamento histórico do Nietzsche. Ao culminar nos dois últimos cursos proferidos por Foucault no Collège de France (1983/1984), identifiquei presentes – em partes, propiciado pela função que os Diálogos platônicos exercem nestes cursos - alguns elementos novos que tornam seu pensamento histórico tanto mais afiliado ao de Nietzsche. A questão do presente, tal como elaborada no mencionado texto deste autor - e declarada por Foucault como sendo a tradição por ele seguida - é a pedra de toque à compreensão de como e porque dois diagnósticos distintos e inconciliáveis a respeito de um mesmo objeto não dão prova de inconsistência; mas, ao contrário. A diferença de diagnósticos faz jus aos registros da criação-ação-atividade presentes no texto nietzschiano; assim como também faz jus, arrisco, às elaborações foucaultianas a propósito do dizer-a-verdade arriscadamente em sua relação com o dar prova da própria vida (bios).
Prazer, sexualidade e normalização do real
Authors: Temple Giovana Carmo , Rodrigues Malcom Guimarães
Published: June 2015

O presente artigo percorre o modo pelo qual Foucault, nos rastros do pensamento nietzschiano, problematiza o dispositivo de sexualidade a partir de uma perspectiva genealógica. O principal objetivo de nosso percurso é analisar a constituição deste dispositivo a partir da racionalização da norma médica. Em meio aos jogos de verdade, frente às relações de saber-poder ao redor da sexualidade, nossa meta é interrogar a emergência das práticas, discursos, instituições e saberes que legitimam a normalização do real. Pretendemos concluir que, no centro desta emergência, encontramos um acontecimento singular: o prazer em naturalizar a norma.
Improving Resident Performance Through a Simulated Rapid Response Team: A Pilot Study
Authors: Burke Peter A. , Vest Michael T. , Kher Hemant , Deutsch Joseph , Daya Sneha
Published: June 2015

Background: The Joint Commission requires hospitals to develop systems in which a team of clinicians can rapidly recognize and respond to changes in a patient’s condition. The rapid response team (RRT) concept has been widely adopted as the solution to this mandate. The role of house staff in RRTs and the impact on resident education has been controversial. At Christiana Care Health System, eligible residents in their second through final years lead the RRTs.

Objective: To evaluate the use of a team-based, interdisciplinary RRT training program for educating and training first-year residents in an effort to improve global RRT performance before residents start their second year.

Methods: This pilot study was administered in 3 phases. Phase 1 provided residents with classroom-based didactic sessions using case-based RRT scenarios. Multiple choice examinations were administered, as well as a confidence survey based on a Likert scale before and after phase 1 of the program. Phase 2 involved experiential training in which residents engaged as mentored participants in actual RRT calls. A qualitative survey was used to measure perceived program effectiveness after phase 2. In phase 3, led by senior residents, simulated RRTs using medical mannequins were conducted. Participants were divided into 5 teams, in which each resident would rotate in the roles of leader, nurse, and respiratory therapist. This phase measured resident performance with regard to medical decision making, data gathering, and team behaviors during the simulated RRT scenarios. Performance was scored by an attending and a senior resident.

Results: A total of 18 residents were eligible (N=18) for participation. The average multiple choice test score improved by 20% after didactic training. The average confidence survey score before training was 3.44 out of 5 (69%) and after training was 4.13 (83%), indicating a 14% improvement. High-quality team behaviors correlated with medical decision making (0.92) more closely than did high-quality data gathering (0.11). This difference narrowed during high-pressure scenarios (0.84 and 0.72, respectively).

Conclusion: Our data suggest that resident training using a team-based, interdisciplinary RRT training program may improve resident education, interdisciplinary team-based dynamics, and global RRT performance. In turn, data gathering and medical decision making may be enhanced, which may result in better patient outcomes during RRT scenarios.
Effects of Osteopathic Manipulative Treatment on Diabetic Gastroparesis
Authors: Van Ravenswaay Valerie J. , Hain Simeon J. , Grasso Sierra , Shubrook Jay H.
Published: June 2015

As the number of diagnoses of diabetes mellitis continues to increase, so does the incidence of diabetic complications, such as gastroparesis. The current case report examines the effect of osteopathic manipulative treatment (OMT) on the symptoms of diabetic gastroparesis in a patient with type 1 diabetes mellitus. After a prescribed regimen of OMT, the patient’s Gastroparesis Cardinal Symptom Index score improved from 13 to 8, and his hospitalization stays decreased from once every 6 to 8 weeks to once in 6 months. After 6 sessions of OMT, the patient experienced a reduction in and subsequent relief of diabetic gastroparesis symptoms and improved quality of life. The role of OMT needs to be further investigated as a cost-effective adjunctive treatment for patients with diabetic gastroparesis.
Assessment of the Postoperative Appearance of the Rotator Cuff Tendon Using Serial Sonography After Arthroscopic Repair of a Rotator Cuff Tear
Authors: Yoo Hye Jin , Choi Ja-Young , Hong Sung Hwan , Kang Yusuhn , Park Jina , Kim Sae Hoon , Kang Heung Sik
Published: June 2015

Objectives

The purpose of this study was to evaluate serial changes in sonographic findings of a rotator cuff tendon after rotator cuff repair.

Methods

Sixty‐five arthroscopically repaired rotator cuff tears (43 full‐thickness tears and 22 partial‐thickness tears) were retrospectively included in this study. Serial sonographic examinations were performed at 5 weeks, 3 months, and 6 months after surgery. The sonographic findings of the repaired tendon were assessed for a recurrent tear, tendon thickness, morphologic tendon characteristics, vascularity, and bursitis at each time point.

Results

Four recurrent tears occurred within 3 months of surgery. The postoperative tendon thickness decreased from 5 weeks to 6 months after surgery (P = .001). There were significant changes in the morphologic tendon characteristics, including the echo texture, fibrillar pattern, and surface irregularity of the repaired tendon, from 5 weeks to 6 months after surgery (P < .001). Additionally, subacromial‐subdeltoid bursitis and the vascularity of the repaired tendon decreased postoperatively over time.

Conclusions

Serial sonography after arthroscopic rotator cuff repair was useful for monitoring the postoperative changes in a repaired tendon. The morphologic appearance of the repaired tendon and peritendinous soft tissue changes improved over time and nearly normalized within 6 months of surgery.