bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical simulation fidelity and nurses’ identification of critical event risk: a signal detection analysis
Authors: Thompson Carl , Yang Huiqin , Crouch Simon
Published: February 2012

thompson c., yang h. & crouch s. (2012) Clinical simulation fidelity and nurses’ identification of critical event risk: a signal detection analysis.Journal of Advanced Nursing68(11), 2477–2485.

Aims. This article is a report of a study exploring the effect of increasing fidelity on nurses’ risk detection in clinical simulation and the effect of clinical experience on nurses’ risk detection ability.

Background. Clinical environments can be recreated successfully using simulation. However, how judgement changes as simulation fidelity increases is unknown. Knowledge of the effects of increased fidelity on judgement may help in the design of educational interventions seeking to improve clinical judgement in nurses.

Design. Quasi experimental signal detection study.

Method. During 2008–2009, using a quasi experimental signal detection design, 63 nursing students and 34 experienced nurses were presented with 25 paper and 25 human simulator ‘cases’ based on real patient records from a single UK National Health Service hospital. Nurses judged whether a simulated case was ‘at risk’ or ‘not at risk’ of a critical event. Clinical judgement performance was measured using standard signal detection measures.

Findings. Judgement performance, as measured by hit rates and signal detection ability were significantly lower in higher fidelity clinical simulations. False alarm rates and bias (β) did not differ according to the fidelity of simulation. Clinical experience did not predict the ability to detect risk.

Conclusion. As fidelity of simulation increased, both novice and experienced nurses’ were less likely to be able to separate important clinical risk from clinical noise in a simulated clinical environment.
Chronic Cocaine Exposure During Pregnancy Increases Postpartum Neuroendocrine Stress Responses
Authors: Williams S. K. , Barber J. S. , Jamieson‐Drake A. W. , Enns J. A. , Townsend L. B. , Walker C. H. , Johns J. M.
Published: February 2012

The cycle of chronic cocaine (CC) use and withdrawal results in increased anxiety, depression and disrupted stress‐responsiveness. Oxytocin and corticosterone (CORT) interact to mediate hormonal stress responses and can be altered by cocaine use. These neuroendocrine signals play important regulatory roles in a variety of social behaviours, specifically during the postpartum period, and are sensitive to disruption by CC exposure in both clinical settings and preclinical models. To determine whether CC exposure during pregnancy affected behavioural and hormonal stress response in the early postpartum period in a rodent model, Sprague–Dawley rats were administered cocaine daily (30 mg/kg) throughout gestation (days 1–20). Open field test (OFT) and forced swim test (FST) behaviours were measured on postpartum day 5. Plasma CORT concentrations were measured before and after testing throughout the test day, whereas plasma and brain oxytocin concentrations were measured post‐testing only. The results obtained indicated increased CORT response after the OFT in CC‐treated dams (P ≤ 0.05). CC‐treated dams also exhibited altered FST behaviour (P ≤ 0.05), suggesting abnormal stress responsiveness. Peripheral, but not central, oxytocin levels were increased by cocaine treatment (P ≤ 0.05). Peripheral oxytocin and CORT increased after the FST, regardless of treatment condition (P ≤ 0.05). Changes in stress‐responsiveness, both behaviourally and hormonally, may underlie some deficits in maternal behaviour; thus, a clearer understanding of the effect of CC on the stress response system may potentially lead to treatment interventions that could be relevant to clinical populations. Additionally, these results indicate that CC treatment can have long‐lasting effects on peripheral oxytocin regulation in rats, similar to changes observed in persistent social behaviour and stress‐response deficits in clinical populations.
Outcome and complications of endoscopic ultrasound guided pancreatic pseudocyst drainage using combined endoprosthesis and naso‐cystic drain
Authors: Puri Rajesh , Mishra Smruti R , Thandassery Ragesh Babu , Sud Randhir , Eloubeidi Mohamad A
Published: February 2012

Background and Aim:  Endoscopic ultrasound guided pancreatic pseudocyst drainage (EUS‐PPD) is increasingly being used for management of pancreatic pseudocysts. We evaluated the outcome and complications of EUS‐PPD with modified combined technique by inserting both endoprosthesis and naso‐cystic drain.

Methods:  Forty patients referred between August 2007 and January 2010 for EUS‐PPD were prospectively studied. EUS‐PPD was attempted for symptomatic pancreatic pseudocysts which were; (i) resistant to conservative treatment, (ii) in contact with the gastric or duodenal wall on EUS and (iii) having no bulge seen on endoscopy. Controlled radial expansion wire guided balloon dilation of the puncture tract was performed followed by insertion of a 10 French double pigtail stent and 7‐Fr naso‐biliary drain. The early and late outcome and complications of EUS‐PPD were analyzed.

Results:  Thirty‐two patients had non‐infected and eight had infected pseudocysts. EUS‐PPD was technically successful in all. Pseudocysts resolved completely in 39 patients, while one with infected pseudocyst underwent surgical resection for bleeding in the cyst. Naso‐cystic drain was removed in 39 patients after median duration of 13 days. Thereafter, the double pigtail stent was removed in all cases after median duration of 10 weeks. Pseudocyst recurred in one patient requiring a second session of EUS‐PPD. All 32 patients without cystic infection were successfully treated by EUS‐PPD. Seven out of eight patients (87%) with cystic infection were successfully treated by EUS‐PPD.

Conclusion:  Endoscopic ultrasound guided pancreatic pseudocyst drainage with modified combined technique is safe and is associated with high success rate.
Enhanced recovery after laparoscopic colorectal resection with primary anastomosis: accelerated discharge is safe and does not give rise to increased readmission rates
Authors: Gash K. J. , Greenslade G. L. , Dixon A. R.
Published: February 2012

Aims  Enhanced recovery programmes after colorectal surgery are promoted to minimize complications and expedite recovery, thus reducing length of hospital stay where appropriate and improving the overall standard of patient care. There are few published trials of enhanced recovery programmes in the context of laparoscopic colorectal surgery.

Methods  Data were prospectively collected on all laparoscopic colorectal resections carried out in our institution from May 2004 to November 2009. An informal move to 48‐h discharge was introduced in May 2004 and the official enhanced recovery programme was launched in November 2008. We identified all patients with a primary anastomosis discharged within 3 days of surgery. Early outcomes – leaks, complications, readmission rates and returns to theatre – were analysed.

Results  In all, 606 resections were performed in this period. Median length of stay was 4 (0–52) days. Of these patients, 279 (46%) met the criteria of accelerated discharge by day 3: 2 (0.7%) were discharged on the day of surgery, 70 (25.1%) within 24 h, 116 (41.6%) within 48 h and 91 (32.6%) by 72 h. Age was not a significant factor in determining length of stay. Patients undergoing right hemicolectomy were more likely to be discharged by 24 h than those with left‐sided anastomoses, and patients having total mesorectal excision resections were more likely to stay 3 days. The readmission rate was 4%, regardless of day of discharge.

Conclusion  Accelerated discharge is feasible and safe. High readmission rates reported in enhanced recovery programmes after open colorectal surgery have not occurred in our laparoscopic experience.
The use of triclosan eluting stents effectively reduces ureteral stent symptoms: a prospective randomized trial
Authors: Mendez‐Probst Carlos E. , Goneau Lee W. , MacDonald Kyle W. , Nott Linda , Seney Shannon , Elwood Chelsea N. , Lange Dirk , Chew Ben H. , Denstedt John D. , Cadieux Peter A.
Published: February 2012

Study Type – Therapy (RCT)

Level of Evidence 1b

What's known on the subject? and What does the study add?

Infection, encrustation and ureteral‐stent‐related symptoms (USRS) including pain, urgency and frequency are all major problems associated with stent use. No current ureteral stent or exogenously applied therapy adequately deals with these problems and antibiotic use is ineffective once a bacterial biofilm forms on the device. Triclosan is a broad spectrum antibacterial agent widely used in numerous healthcare products and has been previously shown to reduce inflammation on the skin and in the oral cavity. This study tested a triclosan‐impregnated ureteral stent for its ability to reduce infection, encrustation and USRS.

This study shows that while a triclosan‐impregnated ureteral stent cannot reduce infection rates alone compared with antibiotic use, the stent can reduce several USRS including pain during indwelling. This study suggests that the triclosan eluting stent may have a role in treating patients, perhaps in combination with standard antibiotic therapy.

OBJECTIVE

To evaluate the capacity of triclosan‐loaded ureteral stents to reduce stent‐associated bacterial attachment, biofilm formation and encrustation, thereby potentially reducing infection development and other device‐related sequelae.

PATIENTS AND METHODS

Twenty subjects requiring short‐term stenting (7–15 days) were randomized to receive either a Percuflex Plus® non‐eluting stent (control) or a Triumph® triclosan eluting stent.

Control‐stented subjects received 3 days of levofloxacin prophylaxis (500 mg once daily) while Triumph®‐stented subjects did not.

All subjects were assessed for positive urine and stent cultures, stent biofilm development and encrustation.

Following device removal, each subject completed an analogue‐scale symptom assessment questionnaire.

RESULTS

Ureteral stenting was performed after nine ureteroscopic and one extracorporeal shock wave lithotripsy procedure in the control group and eight ureteroscopic and two shock wave lithotripsy procedures in the triclosan group.

No significant differences were observed for culture, biofilm and encrustation between the two groups.

Subjects in the triclosan group reported significant reductions in lower flank pain scores during activity (58.1% reduction, P= 0.017) and urination (42.6%, P= 0.041), abdominal pain during activity (42.1%, P= 0.042) and urethral pain during urination (31.7%, P= 0.049).

CONCLUSIONS

In this study, the use of the Triumph® triclosan eluting stent had no marked impact on biofilm formation, encrustation or infection development in short‐term stented patients.

The Triumph® device led to significant reductions in several common ureteral‐stent‐related symptoms, supporting its use in this patient population.
An examination of the dynamic changes in prostate‐specific antigen occurring in a population‐based cohort of men over time
Authors: Inman Brant A. , Zhang Jingyu , Shah Nilay D. , Denton Brian T.
Published: February 2012

Study Type – Diagnosis (exploratory cohort)

Level of Evidence 2b

What's known on the subject? and What does the study add?

A single serum PSA measurement is commonly used as a screening test to identify men with prostate cancer. A rise in PSA over time may identify men at increased risk of prostate cancer. Dynamic measures of PSA change (ex: PSA velocity, PSA doubling time) are frequently used to justify prostate biopsy in men.

We demonstrate that the current serum PSA is the best predictor of future prostate cancer risk among commonly available clinical variables. We show that dynamic measures of PSA change do not improve upon PSA's ability to predict future prostate cancer. Our study suggests that dynamic measures of PSA change may not be useful in screening for prostate cancer.

OBJECTIVE

To determine whether prostate‐specific antigen velocity (PSA‐V), PSA doubling time (PSA‐DT), or PSA percentage change (PSA‐PC) add incremental information to PSA alone for community‐based men undergoing prostate cancer (PCa) screening.

PARTICIPANTS AND METHODS

A population‐based cohort of 11 872 men from Olmsted County, MN undergoing PSA screening for PCa from 1993 to 2005 was analysed for PSA, PSA‐DT, PSA‐PC and PSA‐V and subsequent PCa.

Receiver‐operating characteristics curves and logistic regression were used to calculate the area under the curve (AUC) and Aikaike's information criterion.

Reclassification analysis was performed and the net reclassification improvement and integrated discrimination improvement were measured.

The method of Begg and Greenes was used to adjust for verification bias.

RESULTS

The single best predictor of future PCa was PSA (AUC = 0.773) with PSA‐V (AUC = 0.729) and PSA‐DT/PSA‐PC (AUC = 0.689) performing worse.

After age adjustment, combining PSA with PSA‐V (AUC = 0.773) or PSA‐DT/PSA‐PC (AUC = 0.773) resulted in no better predictions than PSA alone.

Reclassification analysis showed that adding PSA‐V or PSA‐DT/PSA‐PC to PSA did not result in a meaningful amount of reclassification.

CONCLUSIONS

PSA is a better predictor of future PCa than PSA‐V, PSA‐DT, or PSA‐PC.

Adding PSA‐V, PSA‐DT, or PSA‐PC to PSA does not result in clinically relevant improvements in the ability to predict future PCa.
Patients aged more than 70 had higher risk of locally advanced prostate cancers and biochemical recurrence in Korea
Authors: Kim Jung Kwon , Cho Sung Yong , Jeong Chang Wook , Lee Seung Bae , Ku Ja Hyeon , Hong Sung Kyu , Byun Seok‐Soo , Kwak Cheol , Him Hyeon Hoe , Lee Sang Eun , Jeong Hyeon
Published: February 2012

Study Type – Prognosis (cohort series)

Level of Evidence 2b

What's known on the subject? and What does the study add?

This study reports that patients aged 70 years or older have a higher possibility of locally advanced cancer than younger patients. Instead of conservative management, radical eradication of clinically localized prostate cancer should be actively considered in well‐selected healthy patients older than 70 years.

OBJECTIVE

To analyse the differences in the clinicopathological results between two groups of Korean patients aged younger or older than 70 years with clinically localized prostate cancer.

METHODS

A cohort of consecutive male patients who underwent radical prostatectomy was retrospectively analysed. In total, 995 patients (74.6%) were younger than 70 years, and 338 patients (25.4%) were 70 years or older.

Biochemical recurrence (BCR) ‐free survival was evaluated in the patients, who were followed up for more than 24 months.

The Kaplan–Meier method was used to calculate survival estimates for BCR‐free survival. Multivariate Cox proportional hazard regression analysis was performed to predict non‐organ‐confined status and BCR.

RESULTS

Mean preoperative prostate‐specific antigen (PSA) levels and biopsy or pathological Gleason scores showed no differences between the two age groups.

Older patients, aged more than 70 years, displayed significantly higher risk of locally advanced prostate cancer and BCR than younger patients.

Subgroup analysis showed that the risk of the presence of locally advanced disease was significantly increased in patients of 70 years or older when we compared the proportion of locally advanced disease only in patients with PSA <4 ng/mL.

Multivariate analysis showed that old age, high PSA and high Gleason score were significantly associated with non‐organ confined status and BCR.

CONCLUSIONS

Patients aged 70 years or older had a higher possibility of locally advanced cancer than younger patients.

Radical eradication of clinically localized prostate cancer should be actively considered in well‐selected healthy patients older than 70 years.
Debulking surgery in the setting of very high‐risk prostate cancer scenarios
Authors: Oderda Marco , Joniau Steven , Spahn Martin , Gontero Paolo
Published: February 2012

Study Type – Therapy (case series)

Level of Evidence 4

What's known on the subject? and What does the study add?

Nowadays radical prostatectomy (RP) is considered an effective treatment in high‐risk prostate cancer (PCa) and the indications for a surgical approach are expanding, even in cases of very high PSA or node‐positive disease. We explored the outcomes of debulking surgery in the setting of these very high‐risk PCa patients, in order to assess its feasibility.

This review confirms the important role achieved by surgery in the complex setting of patients with very high‐risk PCA. Excellent survival rates have been reported, even when PSA exceeds 100 ng/mL. The completion of RP with lymphadenectomy might give a survival benefit in patients who were found intraoperatively to be node‐positive. Furthermore, salvage RP confirmed to be the most effective treatment option after RT failure. On the contrary, up‐to‐date surgery of isolated nodal recurrences has shown only little benefit. Finally, there is no evidence supporting the efficacy of debulking surgery in metastatic or in hormone‐refractory tumours. An accurate selection of the patient is essential.

OBJECTIVE

To conduct a critical analysis of the available literature on the feasibility of debulking surgery in the setting of very high‐risk prostate cancer (PCa) scenarios.

PATIENTS AND METHODS

We performed a systematic literature search of PubMed and Embase using combinations of the following keywords: radical prostatectomy, surgery, high‐risk, high PSA (prostate‐specific antigen), radiorecurrent, hormone‐refractory, metastatic prostate cancer, salvage.

With the term ‘very high‐risk PCa’ we indicated a clinical disease beyond the common definition of high‐risk PCa, i.e. any clinical stage > T3, N0 or N+, any PSA level > 50 ng/mL and any recurrent disease after primary treatment.

RESULTS

Radical prostatectomy (RP) achieved excellent survival rates in high‐risk PCa, even in patients with very high PSA level. The completion of RP with lymphadenectomy might give a survival benefit in patients who were found intraoperatively to be node‐positive.

Salvage RP was confirmed to be the most effective treatment option after radiotherapy failure, with increased functional outcomes and decreased side‐effects in the most recent series.

Surgery of isolated nodal recurrences after previous radical therapy has shown little benefit according to the few available series.

There is no evidence supporting the efficacy of debulking surgery in metastatic or hormone‐refractory PCa.

CONCLUSION

Debulking surgery achieved an important role in several aggressive PCa scenarios. An accurate selection of the patient is essential.
Validation of a novel robotic‐assisted partial nephrectomy surgical training model
Authors: Hung Andrew J. , Ng Casey K. , Patil Mukul B. , Zehnder Pascal , Huang Eric , Aron Monish , Gill Inderbir S. , Desai Mihir M.
Published: February 2012

Study Type – Therapy (case series)

Level of Evidence 4

What's known on the subject? and What does the study add?

One area of particular growth for robotic surgery has been partial nephrectomy. Despite a perceived notion that robotic‐assisted partial nephrectomy is more easily adaptable compared to laparoscopic partial nephrectomy, there is nonetheless an associated learning curve.

Validated training models with a corresponding assessment method for robotic‐assisted partial nephrectomy were previously unavailable. We have designed and validated a RAPN surgical model appropriate for resident and fellow training.

OBJECTIVE

To evaluate the face, content and construct validities of a novel ex vivo surgical training model for robotic‐assisted partial nephrectomy (RAPN).

METHODS

We prospectively identified participants as novice (not completed any robotic console cases), intermediate (at least one robotic console case but <100 cases), and expert (≥100 robotic console cases). Each participant performed a partial nephrectomy using the da Vinci Si Surgical System on an ex vivo porcine kidney with an embedded Styrofoam ball that mimics a renal tumour. Subjects completed a post‐study questionnaire assessing training model realism and utility. Participants were anonymously judged by three expert reviewers using a validated laparoscopic assessment tool. Performance between groups was compared using the tukey–kramer test.

RESULTS

The 46 participants recruited for this study included 24 novices, nine intermediates, and 13 experts. Overall, expert surgeons rated the training model as ‘very realistic’ (median visual analogue score 7/10) (face validity). Experts also rated the model as an ‘extremely useful’ training tool for residents (median 9/10) and fellows (9/10) (content validity), although less so for experienced robotic surgeons (5/10). Experts outscored novices on overall performance (P= 0.0002) as well as individual metrics, including ‘depth perception,’‘bimanual dexterity,’‘efficiency,’‘tissue handling,’‘autonomy,’‘precision,’ and ‘instrument and camera awareness’ (P < 0.05) (construct validity). Experts similarly outperformed intermediates in most metrics (P < 0.05).

CONCLUSION

Our novel ex vivo RAPN surgical model has demonstrated face, content and construct validity. Future development of this model should include simulation of haemostasis management and renal reconstruction.
How does lifestyle intervention affect depressive symptoms? Results from the Finnish Diabetes Prevention Study
Authors: Ruusunen A. , Voutilainen S. , Karhunen L. , Lehto S. M. , Tolmunen T. , Keinänen‐Kiukaanniemi S. , Eriksson J. , Tuomilehto J. , Uusitupa M. , Lindström J.
Published: February 2012

Diabet. Med. 29, e126–e132 (2012)

Aims  To assess the effect of lifestyle intervention on depressive symptoms during a 36‐month randomized clinical trial designed to prevent Type 2 diabetes.

Methods  A total of 522 middle‐aged participants, who were overweight or obese and had impaired glucose tolerance, were randomized to the lifestyle intervention or control group in the Finnish Diabetes Prevention Study. The intervention group received individualized counselling aimed at reducing weight and increasing physical activity. Depressive symptoms were measured using the Beck Depression Inventory among a subgroup of 140 participants.

Results  On study entry, the mean Beck Depression Inventory scores ± sd were 6.8 ± 5.6 in the intervention group and 6.7 ± 5.5 in the control group. Beck Depression Inventory scores reduced during the intervention study: the mean ± sd (95% CI) reduction was 0.90 ± 4.54 (−1.99 to −0.19) scores in the intervention group and 0.75 ± 4.47 (−1.80 to 0.31) in the control group, with no difference between the groups. In a stepwise linear multivariate regression analysis, the variables with the strongest associations with the change in Beck Depression Inventory scores were baseline Beck Depression Inventory scores, marital status, weight change and change of total energy intake (R2 = 0.209, P < 0.001).

Conclusions  Participation in the study lowered depression scores, with no specific group effect. Among the lifestyle changes, particularly successful reduction of body weight was associated with the greater reduction of depressive symptoms. Thus, regardless of the intensity of the treatment, the success in executing alterations in one’s lifestyle and behaviour is associated with beneficial changes in mood.
Policing Civil Disobedience
Authors: Smith William
Published: February 2012

Civil disobedience is a public, non-violent and conscientious infringement of law carried out to express opposition to law and policy. The normative literature provides thorough treatments of several key issues related to the post-arrest treatment of civilly disobedient citizens, such as the propriety of imposing various types of legal sanction. An important issue that has received rather less consideration, though, is the matter of how police forces should react to civil disobedience prior to and during its commission. This article aims to encourage reflection on this issue by sketching a normative framework to orientate moral evaluation of the ways in which liberal democratic societies police civilly disobedient protest. The central argument is that the police should, wherever possible, adopt a strategy of ‘negotiated accommodation’ towards civil disobedience. The core requirement of this strategy is that police officers should attempt to engage in dialogue with protest groups before or during their civil disobedience actions. This dialogue must be underpinned by a conscientious and sincere commitment on the part of officers to balance the traditional goals of public order policing with the good of accommodating civil disobedience. The article contrasts the idea of negotiated accommodation with alternative strategies for policing civil disobedience, illustrates its practical implications through considering various examples, and defends it against important objections.
Combining welfare mix and New Public Management: The case of long‐term care insurance in Germany
Authors: Theobald Hildegard
Published: February 2012

Theobald H. Combining welfare mix and New Public Management: The case of long‐term care insurance in Germany

With the introduction of Long‐term Care Insurance, Germany restructured formal care provision by implementing reforms inspired by New Public Management (NPM), emphasising the market, competition and efficiency. The article analyses the process of implementation of NPM measures within the preconditions of Germany's welfare mix of care responsibility and the political‐administrative system of the social insurance‐based welfare state. Conceptually, it combines welfare mix approaches with NPM concepts. Empirically, it is based on a literature review and representative statistics. The article reveals how the German assumptions on welfare mix paved the way for NPM reforms and how the social insurance‐based welfare state strengthened the position of the state. It shows the increase of for‐profit providers, tensions emerging due to new organisational forms of care provision and underlying values within welfare associations, and the situation of care workers. The analysis undermines the idea of NPM as a mere management technique.
In Search of Symbolic Markers: Transforming the Urbanized Landscape of the Rotterdam Rijnmond
Authors: Dembski Sebastian
Published: February 2012

The change in the form of cities over the last few decades into amorphous patterns classified as Zwischenstadt (in‐between city) has encouraged many urban regions to launch planning strategies that address the urbanized landscape in city‐regions. Symbolic markers are used to signify spatial transformation and mobilize various public and private stakeholders (including citizens). As the mindset of people is institutionalized in old perceptions of urban life, strategies employing symbolic markers may be thought of as attempts at institutional innovation. I will argue that the imagination of new regional spaces in the urban fringe is often voluntaristic. Instituting imaginative reconstructions of the Zwischenstadt through symbolic markers relies on a very precise notion of institutional meaning in practice. Using the Rotterdam Rijnmond area in the Netherlands and its attempt to develop new images of the regional urban landscape as an example, I will show that the transformative potential of symbolic markers depends on the way existing cultural and institutional practices are recombined.

Au cours des dernières décennies, les villes ont vu leur forme évoluer selon des schémas amorphes appelés Zwischenstadt (entre‐ville), poussant de nombreuses régions métropolitaines à entreprendre des stratégies d’aménagement pour résoudre la question de leur paysage urbanisé. Les «marqueurs symboliques» permettent de mettre en évidence la transformation spatiale et de mobiliser divers acteurs publics et privés (dont les habitants). Étant donné la vision normalisée de la population selon des perceptions anciennes de la vie urbaine, on peut considérer les stratégies qui recourent à ces marqueurs comme des tentatives d’innovation institutionnelle. Imaginer de nouveaux espaces régionaux à la périphérie urbaine est souvent une initiative volontariste. Par ailleurs, instituer les reconstructions imaginatives de la Zwischenstadt au moyen de marqueurs symboliques repose sur une notion très précise de la signification institutionnelle dans des situations pratiques. À partir du cas hollandais de la région de Rotterdam‐Rijnmond et de ses efforts d’élaboration de nouvelles images de son paysage métropolitain, cette étude montre que le potentiel de transformation des marqueurs symboliques dépend de la façon dont les pratiques culturelles et institutionnelles existantes sont recombinées.
Severe postpartum haemorrhage and mode of delivery: a retrospective cohort study
Authors: Holm C , Langhoff‐Roos J , Petersen KB , Norgaard A , Diness BR
Published: February 2012

Please cite this paper as: Holm C, Langhoff‐Roos J, Petersen KB, Norgaard A, Diness BR. Severe postpartum haemorrhage and mode of delivery: a retrospective cohort study. BJOG 2012;119:596–604.

Objective  To examine the association between intended mode of delivery and severe postpartum haemorrhage.

Design  A retrospective cohort study.

Setting  Material from a nationwide study in Denmark.

Population  Danish women giving birth in 2001–08.

Methods  We compared use of red blood cell transfusion by intended mode of delivery in the total population (n = 382 266), in low‐risk nulliparous women (n = 147 132) and in women with a previous caesarean delivery (n = 25 156).

Main outcome measure  Red blood cell transfusion within 7 days of delivery.

Results  In the total population the crude transfusion rates for women with planned caesarean delivery and intended vaginal delivery were 2.24 and 1.75%. After adjustment for maternal age, body mass index, birthweight, smoking, parity, number of infants and previous caesarean delivery, the risk of red blood cell transfusion was significantly lower in women with planned caesarean delivery compared with intended vaginal delivery (odds ratio 0.82; 95% CI 0.73–0.92; P < 0.01). In low‐risk nulliparous women and in women with a previous caesarean delivery the transfusion rates were lower for planned caesarean delivery compared with intended vaginal delivery before and after adjustment.

Conclusion  Compared with intended vaginal delivery, planned caesarean delivery was associated with a reduced risk of severe postpartum haemorrhage indicated by use of red blood cell transfusion.
Clinical utility of array comparative genomic hybridisation for prenatal diagnosis: a cohort study of 3171 pregnancies
Authors: Lee C‐N , Lin S‐Y , Lin C‐H , Shih J‐C , Lin T‐H , Su Y‐N
Published: February 2012

Please cite this paper as: Lee C, Lin S, Lin C, Shih J, Lin T, Su Y. Clinical utility of array comparative genomic hybridisation for prenatal diagnosis: a cohort study of 3171 pregnancies. BJOG 2012;119:614–625.

Objective  To evaluate the clinical value of prenatal array comparative genomic hybridisation (CGH) in screening for submicroscopic genomic imbalances.

Design  Cross‐sectional study.

Setting  Tertiary referral centre.

Population  From June 2008 to February 2011, 3171 fetuses underwent prenatal array CGH testing and karyotyping at the National Taiwan University Hospital. Indications for invasive prenatal diagnosis included abnormal karyotype, abnormal ultrasound, advanced maternal age and parental anxiety.

Methods  In all, 2497 fetuses were screened with 1‐Mb resolution bacterial artificial chromosome array‐based CGH, and 674 fetuses with 60‐K oligonucleotide array‐based CGH. Multiplex ligation‐dependent probe amplification, fluorescence in situ hybridization, or 105‐K oligonucleotide array CGH provided further confirmation.

Main outcome measure  Copy number variations identified by array CGH.

Results  Array CGH detected numerical chromosome anomalies in 37 (1.2%) fetuses, microdeletion/duplication in 34 (1.1%) fetuses, large deletion/duplication in 13 (0.4%) fetuses, benign copy number changes in 13 (0.4%) fetuses and variation of unknown clinical significance in five (0.2%) fetuses. Array CGH was effective in identifying submicroscopic genomic imbalance in fetuses with de novo balance translocations (2/17, 1.8%), supernumerary marker chromosomes (3/6, 50%), and abnormal prenatal ultrasound findings (33/194, 17.0%). Array CGH detected microdeletions/duplications in 12 fetuses with normal karyotype.

Conclusion  Prenatal array CGH is effective in screening for submicroscopic genomic imbalance. Array CGH may add 8.2% to the diagnostic field, compared with conventional karyotyping, for fetuses with abnormal ultrasound results, and is particularly useful in fetuses with karyotypic balanced translocation or marker chromosomes. There is a 0.52% baseline risk of submicroscopic genomic imbalance, even in women with an uneventful prenatal examination.
Invasive alien predator causes rapid declines of native European ladybirds
Authors: Roy Helen E. , Adriaens Tim , Isaac Nick J. B. , Kenis Marc , Onkelinx Thierry , Martin Gilles San , Brown Peter M. J. , Hautier Louis , Poland Remy , Roy David B. , Comont Richard , Eschen René , Frost Robert , Zindel Renate , Van Vlaenderen Johan , Nedvěd Oldřich , Ravn Hans Peter , Grégoire Jean‐Claude , de Biseau Jean‐Christophe , Maes Dirk
Published: February 2012

Aim  Invasive alien species (IAS) are recognized as major drivers of biodiversity loss, but few causal relationships between IAS and species declines have been documented. In this study, we compare the distribution (Belgium and Britain) and abundance (Belgium, Britain and Switzerland) of formerly common and widespread native ladybirds before and after the arrival of Harmonia axyridis, a globally rapidly expanding IAS.

Location  Europe

Methods  We used generalized linear mixed‐effects models (GLMMs) to assess the distribution trends of eight conspicuous and historically widespread and common species of ladybird within Belgium and Britain before and after the arrival of H. axyridis. The distribution data were collated largely through public participatory surveys but verified by a recognized expert. We also used GLMMs to model trends in the abundance of ladybirds using data collated through systematic surveys of deciduous trees in Belgium, Britain and Switzerland.

Results  Five (Belgium) and seven (Britain) of eight species studied show substantial declines attributable to the arrival of H. axyridis. Indeed, the two‐spot ladybird, Adalia bipunctata, declined by 30% (Belgium) and 44% (Britain) over 5 years after the arrival of H. axyridis. Trends in ladybird abundance revealed similar patterns of declines across three countries.

Main conclusion  Together, these analyses show H. axyridis to be displacing native ladybirds with high niche overlap, probably through predation and competition. This finding provides strong evidence of a causal link between the arrival of an IAS and decline in native biodiversity. Rapid biotic homogenization at the continental scale could impact on the resilience of ecosystems and severely diminish the services they deliver.
Thrombotic Microangiopathy: Current Knowledge and Outcomes With Plasma Exchange
Authors: Clark William F.
Published: February 2012

The classification of thrombotic microangiopathy has evolved and expanded due to treatment and mechanistic advances. The two basic clinical forms of thrombotic microangiopathy (excluding disseminated intravascular coagulation [DIC]), thrombotic thrombocytopenic purpura (TTP), and hemolytic uremic syndrome (HUS) encompass a wide range of primary and secondary forms. The advent of plasma therapy and the identification of an inhibitor to ADAMTS13 in the idiopathic or acute forms of TTP and its absence in diarrheal HUS have had a major impact on our current classification of thrombotic microangiopathy. In adults, the difficulty of differentiating TTP, which is much more common than HUS and the need for a speedy diagnosis to provide life‐saving plasma therapy has resulted in the term TTP/HUS for adult forms of thrombotic microangiopathy that present with unexplained thrombocytopenia and microangiopathic hemolytic anemia without a DIC. In this adult population a primary idiopathic and hereditary form as well as eight known secondary categories or clinical forms of TTP/HUS have been identified. HUS also embraces a primary (atypical HUS) and secondary forms (majority, diarrheal HUS secondary to Escherichia coli 0157:H7). In children, who present with HUS with no preceding history of diarrhea, plasma therapy is also offered on an urgent basis and studies are carried out to determine if they are suffering an abnormality in complement activation that may require eculizumab therapy. The advent of plasma therapy in the treatment of thrombotic microangiopathy has led to a clearer understanding of the role of ADAMTS13, both short‐ and long‐term outcomes and the need for future surveillance and intervention.
SYSTEMATICS OF THE GENUS ZYGNEMA (ZYGNEMATOPHYCEAE, CHAROPHYTA) FROM CALIFORNIAN WATERSHEDS1
Authors: Stancheva Rosalina , Sheath Robert G. , Hall John D.
Published: February 2012

Natural populations of Zygnema were collected from 80 stream sites across California, and eight species were identified and characterized morphologically. Generic and infrageneric concepts of Zygnema and Zygogonium were tested with cox3 and rbcL gene sequence analysis. Strains of Zygnema were positioned in a single monophyletic clade sister to Zygogonium tunetanum Gauth.‐Lièvre. In both the rbcL and cox3 phylogenies, strains of Zygnema formed two major clades. The first clade contained species that have zygospores with a blue‐colored mesospore or akinetes with a colorless mesospore. The second clade contained species that have a yellow or brown mesospore. The existing taxonomic concepts for Zygnema classification are not consistent with our molecular phylogeny and do not correspond to natural groups. We propose that mesospore color may be useful in the infrageneric classification of Zygnema. Newly described Zygnema aplanosporum sp. nov. and Zygnema californicum sp. nov. have zygospores with a blue mesospore formed in the conjugation tube and separated by a cellulosic sporangial wall. Z. aplanosporum also possessed a combination of vegetative and reproductive features characteristic of Zygogonium, such as presence of short branches, rhizoidal outgrowths, thickened vegetative cell walls, purple‐colored cell content, small compressed‐globular chloroplasts as well as predominant asexual reproduction. Z. aplanosporum and Z. californicum were deeply embedded in a larger clade of Zygnema both in rbcL and cox3 analyses. Based on our observations, there are no features or combination of features that separate Zygnema and Zygogonium. Therefore, we conclude that Zygogonium is probably a synonym of Zygnema.
CHARACTERIZATION OF THE ALTERNATIVE OXIDASE GENE IN PORPHYRA YEZOENSIS (RHODOPHYTA) AND CYANIDE‐RESISTANT RESPIRATION ANALYSIS1
Authors: Zhang Bao Y. , He Lin W. , Jia Zhao J. , Wang Guang C. , Peng Guang
Published: February 2012

The full‐length cDNA of the alternative oxidase (AOX) gene from Porphyra yezoensis Ueda (PyAOX) [currently assigned as Pyropia yezoensis (Ueda) M. S. Hwang et H. G. Choi (http://www.algaebase.org)] an ancient member of the Rhodphyta, was cloned by electronic cloning, rapid amplification of cDNA ends (RACE), and reverse transcription PCR. The nucleotide sequence of PyAOX consists of 1,650 bp, including a 5′ untranslated region (UTR) of 170 bp, a 3′ UTR of 148 bp, and an open reading frame (ORF) of 1,332 bp that can be translated into a 443‐amino‐acid residue with a molecular mass of 47.33 kDa and a putative isoelectric point (pI) of 9.71. The putative amino acids had 50%–61% identity with AOX genes in Eukaryota and higher plants and had AOX‐like characteristics. The expression of PyAOX mRNA in different stages of the life cycle, conchospores, filamentous thalli (conchocelis stage), and leafy thalli, was detected by real‐time quantitative PCR (qPCR). The highest level of expression, which was observed in filamentous thalli, was three times higher than that observed in leafy thalli. The next highest level, which was observed in the conchospores, was twice as high as that observed in leafy thalli. We showed that an alternative respiration pathway existed in P. yezoensis with a noninvasive microsensing system. The contribution of the alternative pathway to total respiration in filamentous thalli was greater than that in leafy thalli. This result was consistent with the level of AOX gene expression observed in different stages of the life cycle.
Adenosine and Glutamate Signaling in Neuron–Glial Interactions: Implications in Alcoholism and Sleep Disorders
Authors: Nam Hyung W. , McIver Sally R. , Hinton David J. , Thakkar Mahesh M. , Sari Youssef , Parkinson Fiona E. , Haydon Phillip G. , Choi Doo‐Sup
Published: February 2012

Recent studies have demonstrated that the function of glia is not restricted to the support of neuronal function. Especially, astrocytes are essential for neuronal activity in the brain. Astrocytes actively participate in synapse formation and brain information processing by releasing or uptaking gliotransmitters such as glutamate, d‐serine, adenosine 5′‐triphosphate (ATP), and adenosine. In the central nervous system, adenosine plays an important role in regulating neuronal activity as well as in controlling other neurotransmitter systems such as GABA, glutamate, and dopamine. Ethanol (EtOH) increases extracellular adenosine levels, which regulates the ataxic and hypnotic/sedative (somnogenic) effects of EtOH. Adenosine signaling is also involved in the homeostasis of major inhibitory/excitatory neurotransmission (i.e., GABA or glutamate) through neuron–glial interactions, which regulates the effect of EtOH and sleep. Adenosine transporters or astrocytic SNARE‐mediated transmitter release regulates extracellular or synaptic adenosine levels. Adenosine then exerts its function through several adenosine receptors and regulates glutamate levels in the brain. This review presents novel findings on how neuron–glial interactions, particularly adenosinergic signaling and glutamate uptake activity involving glutamate transporter 1 (GLT1), are implicated in alcoholism and sleep disorders.
Borderline Personality Symptoms in Short‐Term and Long‐Term Abstinent Alcohol Dependence
Authors: Fein George , Nip Vincent
Published: February 2012

Background

Comorbidity of borderline personality disorder (BPD) and substance and alcohol use disorders (SUDs and AUDs) is very high. The literature suggests a negative synergy between BPD and SUDs, which may impact an individual's ability to achieve and maintain remission of either disorder in the face of the other.

Methods

We examined lifetime and current (past year) BPD symptom counts in 3 gender‐ and age‐comparable groups: short‐term abstinent alcoholics (STA, 6 to 15 weeks abstinent), long‐term abstinent alcoholics (LTA, more than 18 months abstinent), and nonsubstance‐abusing controls (NSAC). Abstinent individuals were recruited primarily from mutual‐help recovery networks and about half had comorbid drug dependence. BPD symptoms were obtained using the Structured Clinical Interview for DSM‐IV‐TR Axis II Personality Disorders, followed up with questions regarding currency, but did not require that BPD symptoms represent persistent or pervasive behavior such as would meet criteria for BPD diagnosis. Thus, our study dealt only with BPD symptoms, not BPD diagnoses.

Results

Alcoholics had more lifetime and current symptoms for most all BPD criteria than NSAC. In general, STA and LTA did not differ in BPD symptoms, except for a group‐by‐gender effect for both lifetime and current anger‐associated symptoms and for lifetime abandonment avoidance symptoms. For these cases, there were much higher symptom counts for STA women versus men, with comparable symptom counts for LTA women versus men.

Conclusions

Our results suggest for the most part that BPD symptoms do not prevent the maintenance of recovery in AUD and SUD individuals who have established at least 6 weeks abstinence within the mutual‐help recovery network—in fact the presence of BPD symptoms is the norm. However, we did find difficulty in establishing longer‐term abstinence in women with anger‐associated symptoms and abandonment avoidance symptoms.
Cardiac Pacemakers in Electric and Magnetic Fields of 400‐kV Power Lines
Authors: KORPINEN LEENA , KUISTI HARRI , ELOVAARA JARMO , VIRTANEN VESA
Published: February 2012

Background:
 The cardiac pacemaker (PM) implantation rate per million is high. Earlier studies have found interference to PMs by electromagnetic fields. The aim of the study is to investigate disturbances in cardiac PM using a human‐shaped phantom in electric and magnetic fields of 400‐kV power lines.

Methods:
 The phantom was used in the following manner: isolated from the ground, grounded from left or right foot, or grounded from left or right hand.

Results:
 Out of the tested PMs one had such a disturbance that it set the pace 60 times per minute, when the electric field was 6.7–7.5 kV/m and the magnetic field was 2.4–2.9 μT. The electrode configuration of the PM was unipolar. In bipolar configuration, the same PM had no disturbance. During the test period, other PMs only had minor disturbances or none at all. Some PMs do not record time information for minor disturbances. In such cases, it was impossible to link the disturbances to the exposure under the power line.

Conclusions:
 The electric field under a 400‐kV power line may disturb a PM. However, only one type out of several tested PMs showed a major disturbance and that was only with a unipolar electrode configuration. The risk of disturbances is therefore not deemed to be high. PACE 2012; 35:422–430)
Feasibility of Transradial Coronary Angiography and Intervention Using a Single Ikari Left Guiding Catheter for ST Elevation Myocardial Infarction
Authors: CHOW JEREMY , TAN CHONG HIOK , TIN AUNG SOE , ONG SEA HING , TAN VERN HSEN , GOH YEW SEONG , GAN HWA WOOI , TAN KOK SOON , LINGAMANAICKER JAYARAM
Published: February 2012

Background:

Transradial coronary intervention (TRI) has been widely adopted in ST elevation myocardial infarction (STEMI) patients but there is limited literature on the use of a single catheter for both diagnostic angiography and intervention. We aim to evaluate the feasibility and outcomes of TRI with a single Ikari left (IL) guiding catheter in STEMI patients.

Methods:

This is a retrospective study of 362 consecutive STEMI patients from August 2007 to December 2008. We assessed the feasibility of TRI with a single IL and compared this strategy with conventional transfemoral intervention (TFI) on the following outcomes: (1) door to perfusion time, (2) total procedural duration, (3) total fluoroscopy duration, and (4) major adverse cardiac events (MACE) by intention to treat analysis.

Results:

TRI was attempted in 185 patients. There were no failed radial cannulations. Overall success rate of primary TRI with a single IL was 96.9% and there were only 2 failures that required conversion to TFI. Compared to TFI, TRI with IL tended to a shorter median door to perfusion time, 90 (IQR 76.0 − 119.5) versus 98 (IQR 80.8 − 120.5) minutes (P = 0.07) and a shorter median procedure duration of 34 (IQR 27.0 − 45.0) versus 37 (IQR 28.0 − 49.3) minutes (P = 0.06). The median fluoroscopy duration was longer in the TRI group. MACE were comparable between the 2 groups.

Conclusion:

In experienced centers, TRI with a single IL catheter for STEMI is a feasible and effective approach and outcomes are comparable to conventional TFI. (J Interven Cardiol 2012;25:235–244)