bluuebunny/crossref_metadata_2025 huggingface dataset:
Conceptualizing and implementing the distributed leadership practices in Indian organizations
Authors: K. Jain Ajay , Jeppe Jeppesen Hans
Published: April 2014

Purpose

– The purpose of this paper is to measure employees’ attitude toward distributed leadership (DL) practices and investigate the challenges involved in implementing DL practices in Indian organizations.

Design/methodology/approach

– This study is conducted within an exploratory research framework. The data were collected from 180 young middle-level executives from a diverse group of industry sectors belonging to private and multinational organization located in northern part of India. Unstructured (personal interviews and focus group interviews) and structured interview schedule (questionnaire) were administered to measure employees’ attitude and challenges of implementation.

Findings

– The qualitative and quantitative analytic strategies were adopted to analyze the data. Results of exploratory factors analysis showed the existence of five underlying dimensions about the significance of DL practices, namely, self-initiatives, improved functioning, achieving organizational goals, accountability and mutual respect. Furthermore, results showed the importance of contextual factors in implementing DL practices namely horizontal structure, professionalism, work commitment and power sharing. Also, the attitudinal dimensions were found to be positively correlated with the dimensions of implementing DL practices in Indian work context.

Research limitations/implications

– This study strengthens the importance of measuring employees’ attitudes that can be a good predictor of implementing best practices in organizations. The major limitation of this study is of the small sample size and has been limited to young managers.

Originality/value

– This is an original paper based on the empirical data from Indian managers. No study is conducted on the concept of distributing leadership in Indian work context on a similar or related theme.
Dynamics and traits of entrepreneurship: an Islamic approach
Authors: Hoque Nazamul , Mamun Abdullahil , Mohammad Ahshanul Mamun Abdullah
Published: April 2014

Purpose

– The purpose of this paper is to develop traits and model of entrepreneurship development from Islamic point of view.

Design/methodology/approach

– The study is descriptive, in so far as its goal is to describe a method, and the nature of the paper is conceptual. The study draws on secondary materials through library research.

Findings

– In this paper both the traits as well as model of entrepreneurship are developed from Islamic perspective. The salient traits are knowledge, initiative, risk taking, customer orientation, employee involvement, strategic thinking, fear of Allah, hard working, innovativeness, excellence, honesty and truthfulness, morality, vision, optimism, patience, social welfare, Halal earnings and economical. The model would be used for developing entrepreneurship from Islamic perspective by performing various types of activities relating to the phases of preparatory and awareness development, support and motivation and feedback.

Research limitations/implications

– The paper has implications for government, potential entrepreneurs and existing entrepreneurs of Muslim countries representing one fourth of the world population. It is also expected that the study will help and encourage Islamic scholars to think over the matter and make them more aware in developing entrepreneurship based on Quran and Sunna in the modern business world.

Practical implications

– The findings of this research can be used as a guide to develop entrepreneurship in Muslim countries from Islamic point of view. The study could have practical implications falling within the purview of social sciences such as economics, business studies, public administration, political science, development studies, sociology, law, Quranic science, industrial management, education and human resource management.

Originality/value

– While many studies, partially, have focussed on traditional entrepreneurship sparing the demand of Muslim world, in this paper, the authors open a new avenue contributing to the literature on entrepreneurship development from Islamic perspective. The proposed model will be of genuine interest and benefits to government as prime policymaker, existing entrepreneurs, potential entrepreneurs, Islamic scholars and academicians.
Tongues of Fire: Women's Suicide and Self-Injury by Burns in the Kurdistan Region of Iraq
Authors: Rasool Izaddin A. , Payton Joanne L.
Published: April 2014

Self-burning and self-immolation are forms of self-harm found across the Eastern Mediterranean region and South and Central Asia. The majority of those choosing these methods of self-harm are young women. Using data from 100 young female survivors of suicidal attempts in the Kurdistan Region of Iraq, this article analyses the phenomenon in the context of a life-course progression arguing that the period around first marriage is a time of particular trauma to women. We suggest that self-burning should be understood as a communicative act with an indigenous semiology which functions as an expression of subordinated agency within a male-dominated society, in which marriage is a major source of conflict between generations and genders.
Uncertainty: the Curate's egg in financial economics
Authors: Pixley Jocelyn
Published: April 2014

Economic theories of uncertainty are unpopular with financial experts. As sociologists, we rightly refuse predictions, but the uncertainties of money are constantly sifted and turned into semi‐denial by a financial economics set on somehow beating the future. Picking out ‘bits’ of the future as ‘risk’ and ‘parts’ as ‘information’ is attractive but socially dangerous, I argue, because money's promises are always uncertain. New studies of uncertainty are reversing sociology's neglect of the unavoidable inability to know the forces that will shape the financial future.
Examining the Association between Utilization Management and Downstream Cardiovascular Imaging
Authors: Agiro Abiy , Sylwestrzak Gosia , Shah Christiane , Power Thomas , DeVries Andrea
Published: April 2014

Objectives

To examine the association of echocardiography utilization management (EUM) program with downstream cardiac imaging utilization.

Data Sources/Study Setting

Administrative claims data from commercial health plans in Indiana, Ohio, Kentucky, Wisconsin, and Georgia.

Study Design

Patients undergoing index cardiovascular imaging with no imaging in the preceding year were identified (N = 112,308). Claims‐derived cardiac risk scores were used for one‐to‐one propensity score matching of patients subject to EUM to patients without EUM (n = 96,906). Downstream cardiac imaging utilization for 12–24 months postindex imaging was analyzed using generalized linear models and Cox proportional hazards model.

Principal Findings

Downstream cardiac imaging tests were performed for 10,630 (21.9 percent) and 12,012 (24.8 percent) patients in the EUM and non‐EUM groups, respectively. At 12‐month follow‐up, adjusted utilization was 15.2 (95 percent CI, 7.6–22.5) tests per 1,000 initially tested patients lower in the EUM group (p < .001). The likelihood of obtaining downstream cardiac imaging in the EUM group was 7.0 percent lower than the non‐EUM group (hazard ratio: 0.930; 95 percent CI, 0.897–0.964, p < .001).

Conclusions

Downstream cardiac imaging is relatively common among commercially insured patients. Every 10 initial diagnostic tests yielded two downstream imaging tests in first 24 months. EUM program was associated with lower volumes of downstream imaging.
Community Factors and Hospital Readmission Rates
Authors: Herrin Jeph , St. Andre Justin , Kenward Kevin , Joshi Maulik S. , Audet Anne‐Marie J. , Hines Stephen C.
Published: April 2014

Objective

To examine the relationship between community factors and hospital readmission rates.

Data Sources/Study Setting

We examined all hospitals with publicly reported 30‐day readmission rates for patients discharged during July 1, 2007, to June 30, 2010, with acute myocardial infarction (AMI), heart failure (HF), or pneumonia (PN). We linked these to publicly available county data from the Area Resource File, the Census, Nursing Home Compare, and the Neilsen PopFacts datasets.

Study Design

We used hierarchical linear models to assess the effect of county demographic, access to care, and nursing home quality characteristics on the pooled 30‐day risk‐standardized readmission rate.

Data Collection/Extraction Methods

Not applicable.

Principal Findings

The study sample included 4,073 hospitals. Fifty‐eight percent of national variation in hospital readmission rates was explained by the county in which the hospital was located. In multivariable analysis, a number of county characteristics were found to be independently associated with higher readmission rates, the strongest associations being for measures of access to care. These county characteristics explained almost half of the total variation across counties.

Conclusions

Community factors, as measured by county characteristics, explain a substantial amount of variation in hospital readmission rates.
Sub‐dissociative‐dose intranasal ketamine for moderate to severe pain in adult emergency department patients
Authors: Yeaman Fiona , Meek Robert , Egerton‐Warburton Diana , Rosengarten Pamela , Graudins Andis
Published: April 2014

Background

There are currently no studies assessing effectiveness of sub‐dissociative intranasal (IN) ketamine as the initial analgesic for adult patients in the ED.

Objective

The study aims to examine the effectiveness of sub‐dissociative IN ketamine as a primary analgesic agent for adult patients in the ED.

Method

This is a prospective, observational study of adult ED patients presenting with severe pain (≥6 on 11‐point scale at triage). IN ketamine dose was 0.7 mg/kg, with secondary dose of 0.5 mg/kg at 15 min if pain did not improve. After 6 months, initial dose was increased to 1.0 mg/kg with the same optional secondary dose.

Primary outcomes

The primary outcomes are change in VAS rating at 30 min; percentage of patients reporting clinically significant reduction in VAS (≥20 mm) at 30 min; dose resulting in clinically significant pain reduction.

Results

Of the 72 patients available for analysis, median age was 34.5 years and 64% were men. Median initial VAS rating was 76 mm (interquartile range [IQR]: 65–82). Median total dose of IN ketamine for all patients was 0.98 mg/kg (IQR: 0.75–1.15, range: 0.59–1.57). Median reduction in VAS rating at 30 min was 24 mm (IQR: 2–45). Forty (56%, 95% CI: 44.0–66.7) reported VAS reduction ≥20 mm, these patients having had a total median ketamine dose of 0.94 mg/kg (IQR: 0.72–1.04).

Conclusion

IN ketamine, at a dose of about 1 mg/kg, was an effective analgesic agent in 56% of study patients. The place of IN ketamine in analgesic guidelines for adults requires further investigation.
Implications for public access defibrillation placement by non‐traumatic out‐of‐hospital cardiac arrest occurrence in Singapore
Authors: Zakaria Nur Diana , Ong Marcus Eng Hock , Gan Han Nee , Foo David , Doctor Nausheen , Leong Benjamin Sieu‐Hon , Goh E Shaun , Ng Yih Yng , Tham Lai Peng , Charles Rabind , Shahidah Nur , Sultana Papia , Anantharaman Venkataraman ,   PAROS study group
Published: April 2014

Introduction

The American Heart Association recommends automated external defibrillator placement in public areas with a high probability (>1) of out‐of‐hospital cardiac arrest (OHCA) occurring in 5 years. We aimed to determine the incidence rate of OHCA for different location categories in Singapore.

Methods

Cardiac arrest incidence was obtained from a national registry. Denominators for the actual number of sites per location category were obtained from public accessible sources, government officers and purchased statistics. Analysis was performed and expressed in terms of the corresponding 95% confidence interval (CI).

Results

From 1 October 2001 to 14 October 2004, 2254 non‐trauma OHCA cases were included. Mean age for arrests was 62.2 years, with 67.5% men. The location category with the highest incidence of cardiac arrests per site per 5 years was Port/Airport/Immigration Checkpoints (5.24 CI [3.66–7.20]). Top individual site with high average incidence of cardiac arrests per 5 years was Changi Airport (25.0 CI [16.18–36.90]). Seventy‐one per cent of arrests occurred in residential areas. The postal sector with the highest average incidence per 100 000 population was Bedok Reservoir (54.89), whereas that with the highest population density was Bukit Merah/Alexandra with 348.14 population per 100 km2.

Conclusion

In this study, we found the categories and individual sites that clearly fulfilled the American Heart Association criteria of at least 1 OHCA per site per 5 years. This study provides a model of how cardiac arrest registry data can be used to guide local health policy on automated external defibrillator deployment.
Ultrasound use in Australasian emergency departments: A survey of Australasian College for Emergency Medicine Fellows and Trainees
Authors: Craig Simon , Egerton‐Warburton Diana , Mellett Tanya
Published: April 2014

Objective

To describe current practice of EDUS by ACEM Trainees and Fellows; to describe potential barriers to US use in the Australasian setting; to determine compliance with current college guidelines regarding US credentialing.

Methods

Data were collected by a cross‐sectional online survey. Respondents were Trainees and Fellows of the ACEM. Outcome measures included the percentage of respondents currently undergoing or that had completed US credentialing for Focused Assessment with Sonography for Trauma (FAST) and assessment of abdominal aortic aneurysm (AAA) scans. The perceived barriers to use of emergency US were explored.

Results

There were 512 survey respondents, giving an overall response rate of 15%. Fellows were more likely to be credentialed compared with Trainees. There were 61% of respondents not credentialed for FAST and assessment of AAA scans. However, a significant proportion performed these scans regularly, and did not routinely seek independent confirmation of their findings. Barriers to credentialing included limited time and no credentialing programme at the individual's hospital.

Conclusions

The present study showed that only a minority of ACEM Trainees and Fellows are credentialed to perform routine ED scans. Many non‐credentialed ACEM Trainees and Fellows are performing scans, many without independent confirmation of their findings.
CHANGES IN CRIMINAL OFFENDING AROUND THE TIME OF JOB ENTRY: A STUDY OF EMPLOYMENT AND DESISTANCE
Authors: SKARDHAMAR TORBJØRN , SAVOLAINEN JUKKA
Published: April 2014

Does employment promote desistance from crime? Most perspectives assume that individuals who become employed are less likely to offend than those who do not. The critical issue has to do with the timing of employment transitions in the criminal trajectory. The turning point hypothesis expects reductions in offending after job entries, whereas the maturation perspective assumes desistance to have occurred ahead of successful transitions to legitimate work. Focusing on a sample of recidivist males who became employed during 2001–2006 (N = 783), smoothing spline regression techniques were used to model changes in criminal offending around the point of entry to stable employment. Consistent with the maturation perspective, the results showed that most offenders had desisted prior to the employment transition and that becoming employed was not associated with further reductions in criminal behavior. Consistent with the turning point hypothesis, we identified a subset of offenders who became employed during an active phase of the criminal career and experienced substantial reductions in criminal offending thereafter. However, this trajectory describes less than 2 percent of the sample. The patterns observed in this research suggest that transition to employment is best viewed as a consequence rather than as a cause of criminal desistance.
HEART RATE AND ANTISOCIAL BEHAVIOR: THE MEDIATING ROLE OF IMPULSIVE SENSATION SEEKING
Authors: PORTNOY JILL , RAINE ADRIAN , CHEN FRANCES R. , PARDINI DUSTIN , LOEBER ROLF , JENNINGS J. RICHARD
Published: April 2014

Although a low resting heart rate is considered the best‐replicated biological correlate of antisocial behavior, the mechanism underlying this relationship remains largely unknown. Sensation‐seeking and fearlessness theories have been proposed to explain this relationship, although little empirical research has been conducted to test these theories. This study addressed this limitation by examining the relationship between heart rate and antisocial behavior in a community sample of 335 adolescent boys. Heart rate was measured during a series of cognitive, stress, and rest tasks. Participants also completed self‐report measures of state fear, impulsive sensation seeking, and both aggressive and nonaggressive forms of antisocial behavior. As expected, increased levels of aggression and nonviolent delinquency were associated with a low heart rate. Impulsive sensation seeking, but not fearlessness, significantly mediated the association between heart rate and aggression. This study is the first to show that impulsive sensation seeking partly underlies the relationship between aggression and heart rate, and it is one of the few to examine the mechanism of action linking heart rate to antisocial behavior. Findings at a theoretical level highlight the role of impulsive sensation seeking in understanding antisocial behavior and at an intervention level suggest it as a potential target for behavioral change.
Small and Semi‐subsistence Farms in the EU: Significance and Development Paths
Authors: Davidova Sophia
Published: April 2014

In Europe, family farming is an umbrella concept which incorporates farms of many different types and sizes. Some are specialised commercial operations, while others produce mainly to satisfy household food needs, the so‐called semi‐subsistence farms (SSFs). In 2010, there were 8.1 million farms in the EU‐27 farming less than 5 ha, including 5.6 million holdings of under 2 ha. Small‐scale farming is socially of key importance in providing income and in keeping millions of farmers and their households in rural areas, thus avoiding depopulation. SSFs account for almost half of all agricultural holdings in the EU‐27, and about three‐quarters of small holdings under 2 ha of agricultural area. Their distribution varies greatly between MSs but they are located predominantly in the New Member States and the Southern EU‐15. Three main paths of development for SSFs and small farms in the EU can be envisaged, with different implications for policy: Disappearance due to absorption into larger commercialised farm holdings, or to land abandonment (e.g. in remoter areas); Transformation of SSFs into small commercial farms via greater market integration – the main development path sought by EU Rural Development policy and Continuation through diversification, non‐agricultural wage employment, or ‘forced’ re‐entry as successive family generations do not have other income sources.
Current EU Policy Treatment of Small and Semi‐subsistence Farms
Authors: Thomson Kenneth J.
Published: April 2014

The CAP comprises a well‐developed system of common farm income support but a much weaker set of structural instruments which tackle the obvious problems of many small and semi‐subsistence farmers (SSFs) in most parts of the European Union, especially in the New Member States which joined in the 2000s. This policy imbalance derived from both Member State reluctance to agree on a common set of instruments directed at such issues, and a general focus on full‐time or main‐occupation farmers, to the neglect of part‐time farming and other income sources. In the CAP to date, Pillar I payments are based largely on farm size. Along with minimum eligibility criteria, this has resulted in a policy bias against small and SSFs, while residual market support measures tend to favour larger farms. Pillar II measures, with their more flexible programming and eligibility structures, are potentially more valuable to small and SSFs. However, such farms are often excluded in practice, either directly due to eligibility criteria built into the design of Rural Development Programmes, or indirectly due to complex application procedures or the associated risk‐taking.
Farm Size: Why Should We Care?
Authors: Rabinowicz Ewa
Published: April 2014

Farm size matters for two reasons: the poverty of (some but not all) small farmers, and their environmentally friendly practices. Encouraging structural change to increase incomes and discouraging it to preserve biodiversity seems impossible, but clever design of agri‐environmental schemes (AESs) can help. The Common Agricultural Policy (CAP) objective of a fair standard of living for farmers still applies, but paying peanuts to many semi‐subsistence farms (SSFs) and large amounts to a few big farms, as in Romania and Bulgaria, is not acceptable. In post‐war Finland, many small farms/SSFs were created for refugees, and support was differentiated according to size, in order to address poverty, labour surplus and food security, but certainly slowed structural change, and reduced agricultural efficiency. Direct CAP payments cannot substitute for social policy. The only long‐term solution given the present size of the agricultural labour force is for farm labour to leave the sector. The CAP could encourage non‐farm employment and suitable skills through its Rural Development Programmes (RDPs). There are several suitable measures in the proposed new RDP regulation. In contrast to most farm business investment, preservation of biodiversity contributes to a public good. Hence, there is a case for public support for small farms through targeted and monitored AES payments.
Structural Change and Agricultural Policy for SSFs: a View from the 2004 NMSs
Authors: Erjavec Emil , Fałkowski Jan , Juvančič Luka
Published: April 2014

The many semi‐subsistence farms (SSFs) in the ten New Member States joining the EU in 2004 (the 2004 NMSs) may be seen as a legacy of communism, or the result of neglect. A highly fragmented farm structure either existed before transition to a market economy, or resulted from the land reforms of the 1990s. Remote areas have seen agriculture permanently abandoned, and consequent depopulation. In more accessible areas, small farms and SSFs have often become less labour‐intensive, or have added value by innovative marketing. However, rural–urban disparities have increased. Most SSFs exist to survive rural poverty, and off‐farm employment is becoming the predominant strategy. Farm diversification often remains beyond these farms’ resources, and their economic role, particularly in local food chains, has declined; quality‐label designation has yet to add significant value. Pillar I payments may have slowed structural change, especially where SSFs are important. Such farms have not been among Pillar II priorities, and the 2004 NMSs have differed on their funding and eligibility criteria. Moreover, SSFs have few direct economic linkages with large infrastructural or corporate projects supported by other (structural) EU funds. The policy problem is not so much one of substance, but more a matter of priorities and focus in policy design and implementation.
Are alcohol policies associated with alcohol consumption in low‐ and middle‐income countries?
Authors: Cook Won Kim , Bond Jason , Greenfield Thomas K.
Published: April 2014

Aims

To examine the associations between alcohol control policies in four regulatory domains with alcohol consumption in low‐ and middle‐income countries (LAMICs), controlling for country‐level living standards and drinking patterns.

Design

Cross‐sectional analyses of individual‐level alcohol consumption survey data and country‐level alcohol policies using multi‐level modeling.

Setting

Data from 15 LAMICs collected in the Gender, Alcohol, and Culture: an International Study (GENACIS) data set.

Participants

Individuals aged 18–65 years.

Measurements

Alcohol policy data compiled by the World Health Organization; individual‐level current drinking status, usual quantity and frequency of drinking, binge drinking frequency and total drinking volume; gross domestic product based on purchasing power parity (GDP‐PPP) per capita; detrimental drinking pattern scale; and age and gender as individual‐level covariates.

Findings

Alcohol policies regulating the physical availability of alcohol, particularly those concerning business hours or involving a licensing system for off‐premises alcohol retail sales, as well as minimum legal drinking age, were the most consistent predictors of alcohol consumption. Aggregate relative alcohol price levels were associated inversely with all drinking variables (P < 0.05) except drinking volume. Greater restrictions on alcohol advertising, particularly beer advertising, were associated inversely with alcohol consumption (P < 0.05). Policies that set legal blood alcohol concentration (BAC) limits for drivers and random breath testing to enforce BAC limits were not associated significantly with alcohol consumption.

Conclusions

Alcohol policies that regulate the physical availability of alcohol are associated with lower alcohol consumption in low‐ and middle‐income countries.
Signaling Alliance Commitments: Hand‐Tying and Sunk Costs in Extended Nuclear Deterrence
Authors: Fuhrmann Matthew , Sechser Todd S.
Published: April 2014

How can states signal their alliance commitments? Although scholars have developed sophisticated theoretical models of costly signaling in international relations, we know little about which specific policies leaders can implement to signal their commitments. This article addresses this question with respect to the extended deterrent effects of nuclear weapons. Can nuclear states deter attacks against their friends by simply announcing their defense commitments? Or must they deploy nuclear weapons on a protégé's territory before an alliance is seen as credible? Using a new dataset on foreign nuclear deployments from 1950 to 2000, our analysis reveals two main findings. First, formal alliances with nuclear states appear to carry significant deterrence benefits. Second, however, stationing nuclear weapons on a protégé's territory does not bolster these effects. The analysis yields new insights about the dynamics of “hand‐tying” and “sunk cost” signals in international politics.
Results of pancreatic resection associated with portal vein resection in an Australian tertiary care centre
Authors: Iorgulescu Dragos G. , Ling Sophia , Nikfarjam Mehrdad , Fink Michael A. , Jones Robert , Muralidharan Vijayaragavan , Starkey Graham , Christophi Christopher
Published: April 2014

Background

Portal vein resection (PVR) with pancreatectomy is now accepted practice in cases with involvement by tumour. We present our experience of this procedure with particular emphasis on morbidity and survival.

Methods

A retrospective case‐control analysis of a prospectively maintained database between 2004 and 2012 was undertaken. A total of 17 patients had pancreatic resections with PVR for cancer and were compared with 17 patients with identical tumour type and stage who underwent pancreatic resection without PVR next in chronological order. Information obtained included patient demographics, radiological and histological evidence of major vein involvement and post‐operative morbidity. Disease‐ and recurrence‐free survival were calculated using Kaplan–Meier curves.

Results

Procedures associated with PVR included pancreatico‐duodenectomy in 11 and total pancreatectomy in six. Three patients underwent pancreatic resection as a re‐operation. Pathological staging showed 2× T2N0, 5× T3N0, 1× T1N1, 2× T2N1 and 7× T3N1 tumours. Seven PVR patients (41%) had post‐operative morbidity Clavien 3 and 4, compared with none in no‐PVR group, but rates of Clavien 1 and 2 complications were similar. Six PVR patients developed PV thrombosis (35%), all with significant clinical consequences. Comparing the PVR group with the no‐PVR group, there was significantly reduced median overall survival in (13.8 versus 43.1 months; P = 0.028) and recurrence‐free survival (7.5 months versus 39.7; P = 0.004).

Conclusions

Survival of patients after pancreatectomy with PVR was reduced and morbidity was high compared with no‐PVR. Delayed portal vein thrombosis due to recurrence was common. Routine post‐operative anticoagulation may be indicated in this group.
Hand‐assisted versus conventional laparoscopic splenectomy: a systematic review and meta‐analysis
Authors: Qian Daohai , He Zhigang , Hua Jie , Gong Jian , Lin Shengping , Song Zhenshun
Published: April 2014

Background

Hand‐assisted laparoscopic splenectomy (HALS) has been widely applied for the resection of larger spleens. We conducted a systematic review and meta‐analysis to evaluate the safety and feasibility of HALS compared with conventional laparoscopic splenectomy (CLS).

Methods

A comprehensive literature search in MEDLINE, EMBASE and Cochrane Library databases was performed to compare clinical outcomes of CLS and HALS. Data were extracted by two independent reviewers. Pooled odds ratios and weighted mean differences with 95% confidence intervals were calculated by meta‐analytic software.

Results

Nine non‐randomized controlled studies for a total of 463 patients were selected to satisfy the inclusion criteria (HALS versus CLS: 170 versus 293, respectively). The groups were similar in operative time, estimated operative blood loss, length of hospital stay, mortality and intraoperative and post‐operative complications. There was a significantly reduced conversion rate in the HALS versus CLS group (odds ratio: 2.98; 95% confidence interval 1.28 to 6.93; P = 0.01). Splenic weights in the HALS group were higher than in the CLS group (weighted mean differences: −0.93; 95% confidence interval −1.74 to −0.11; P = 0.03).

Conclusion

HALS may be preferable to CLS for the treatment of patients with enlarged spleens. The result needs to be certified by further random controlled trials.
Platelet Adhesion to Polyurethane Urea Under Pulsatile Flow Conditions
Authors: Navitsky Michael A. , Taylor Joshua O. , Smith Alexander B. , Slattery Margaret J. , Deutsch Steven , Siedlecki Christopher A. , Manning Keefe B.
Published: April 2014

Platelet adhesion to a polyurethane urea surface is a precursor to thrombus formation within blood‐contacting cardiovascular devices, and platelets have been found to adhere strongly to polyurethane surfaces below a shear rate of approximately 500 s−1. The aim of the current work is to determine the properties of platelet adhesion to the polyurethane urea surface as a function of time‐varying shear exposure. A rotating disk system was used to study the influence of steady and pulsatile flow conditions (e.g., cardiac inflow and sawtooth waveforms) for platelet adhesion to the biomaterial surface. All experiments were conducted with the same root mean square angular rotation velocity (29.63 rad/s) and waveform period. The disk was rotated in platelet‐rich bovine plasma for 2 h, with adhesion quantified by confocal microscopy measurements of immunofluorescently labeled bovine platelets. Platelet adhesion under pulsating flow was found to decay exponentially with increasing shear rate. Adhesion levels were found to depend upon peak platelet flux and shear rate, regardless of rotational waveform. In combination with flow measurements, these results may be useful for predicting regions susceptible to thrombus formation within ventricular assist devices.
A Reproductive Justice Approach to Women's Health
Authors: Chrisler Joan C.
Published: April 2014

This commentary provides a brief history of the term reproductive justice and describes ways that it differs from the more commonly used term reproductive rights. Reproductive justice is a broader concept, situated firmly in the movement for social justice and based on a principle of positive rights. The author then shows how the articles by Mollen () and DeLucca and Lobel () both reflect and contribute to our understanding of reproductive justice.
Comparison of the prognostic utility of the revised International Prognostic Scoring System and the French Prognostic Scoring System in azacitidine‐treated patients with myelodysplastic syndromes
Authors: Zeidan Amer M. , Lee Ju‐Whei , Prebet Thomas , Greenberg Peter , Sun Zhuoxin , Juckett Mark , Smith Mitchell R. , Paietta Elisabeth , Gabrilove Janice , Erba Harry P. , Tallman Martin S. , Gore Steven D. ,   the Eastern Cooperative Oncology Group (ECOG) and North American Leukemia intergroup
Published: April 2014

The revised International Prognostic Scoring System (IPSS‐R) was developed in a cohort of untreated myelodysplastic syndromes (MDS) patients. A French Prognostic Scoring System (FPSS) was recently reported to identify differential survival among azacitidine‐treated patients with high‐risk MDS. We applied the FPSS and IPSS‐R to 150 patients previously randomized to azacitidine monotherapy or a combination of azacitidine with entinostat (a histone deacetylase inhibitor). Neither score predicted response but both discriminated patients with different overall survival (OS; median OS, FPSS: 9·7, 14·7, and 25·3 months, P = 0·018; IPSS‐R: 12·5, 11·3, 20·8, and 36 months, P = 0·005). Statistical analysis suggested no improvement in OS prediction for the FPSS over the IPSS‐R in azacitidine‐treated patients.
Chemical modification of peanut conglutin reduces IgE reactivity but not T cell reactivity in peanut‐allergic patients
Authors: van Hoffen E. , van der Kleij H. P. M. , den Hartog Jager C. F. , van Doorn W. A. , Knol E. F. , Opstelten D.‐J. , Koppelman S. J. , Knulst A. C.
Published: April 2014

Background

Specific immunotherapy for peanut allergy is associated with significant side‐effects. Chemically modified allergens may provide a safer alternative.

Objective

This study aimed to analyse the immunogenicity and allergenicity of modified peanut conglutin.

Methods

Native peanut conglutin and two modifications thereof were generated (RA and RAGA). Conglutin‐specific T cell lines from 11 peanut‐allergic patients were analysed for proliferation and cytokine production. Sera from 14 patients were analysed for IgE/IgG1/IgG4 binding by immunoblot and ELISA. IgE reactivity was analysed by direct and indirect basophil activation test (BAT), in presence and absence of patient plasma or CD32‐blocking antibodies.

Results

T cell proliferation to RA was unchanged, and proliferation to RAGA was reduced compared to native conglutin. Cytokine profiles remained unchanged. IgE, IgG1 and IgG4 binding to RA and RAGA was significantly reduced. In the direct BAT, the relative potency of modified conglutin was decreased in 67% and increased/similar in 33% of the patients. In the indirect BAT, RA and RAGA were 10–100 times less potent than native conglutin. Addition of plasma to the indirect BAT increased the relative potency of modified conglutin in patients with high peanut‐specific IgG levels. This was mediated via blocking of the response to native conglutin, most likely by soluble IgG, and not via CD32.

Conclusion and Clinical Relevance

Chemical modification of peanut conglutin by RA retains immunogenicity and reduces allergenicity and may be a promising approach for development of a curative treatment for peanut allergy. In a subgroup of patients, where the reactivity of native conglutin is already partially blocked by IgG, the effect of the modification of conglutin is less pronounced.
A validation study on the use of intra‐operative video recording as an objective assessment tool for core ENT surgery
Authors: Bowles P.F.D. , Harries M. , Young P. , Das P. , Saunders N. , Fleming J.C.
Published: April 2014

Objectives

To investigate the reliability and validity of remote scoring a video assessment of a core ENT surgical procedure (myringotomy and grommet insertion) and its suitability as an objective tool for assessing the technical skills of ENT surgeons.

Design

Single‐blinded (raters) video assessment.

Setting

Tertiary Care University Hospital.

Participants

Consultant and trainee [Specialty Registrar (StR) and Core Trainee (CT)] ENT surgeons performing a total of 30 consecutive index procedures.

Main outcome measures

To determine the construct validity and the reliability of video assessment scoring of myringotomy and grommet insertion by two raters at ENT Consultant level with a subspecialty interest in Otology. To measure the performance (by rating) of participants compared to operative time.

Results

A strong correlation between scores by the two blinded raters was demonstrated (ρ = 0.748; P < 0.001). Median scores (/45) for each group were as follows: CT 25.5 (IQR 21.13–31.25), StR 33 (IQR 24.88–35) and Consultant 40 (IQR 35.38–42.63). Kruskal–Wallis test analysis showed statistically significant mean rank scores between the three different levels of experience (H = 12.77, P = 0.002). Multiple group comparisons indicated a significant difference between CT and Consultant groups (P < 0.001) and StR and Consultant groups (P = 0.007). Analysis of the time taken between the experience groups demonstrated a difference (H = 8.689, P = 0.013) although individual intergroup comparisons indicated this was only significant between CT and Consultant groups (P = 0.004). There was a significant negative correlation (ρ = −0.842; P < 0.001) between time taken for procedure and score achieved.

Conclusions

Video assessment of myringotomy and ventilation tube insertion may represent a valid, feasible tool for use in summative and formative assessments of trainee ENT surgeons. Remote scoring of assessment procedures minimises bias and enables blinding of raters. ENT is well positioned to benefit from video assessment due to the high number of surgical procedures within the specialty that are performed utilising digital technology.
Patch testing with methylchloroisothiazolinone/methylisothiazolinone 200 ppm aq. detects significantly more contact allergy than 100 ppm. A multicentre study within the European Environmental and Contact Dermatitis Research Group
Authors: Bruze Magnus , Isaksson Marléne , Gruvberger Birgitta , Andersen Klaus E. , Gonçalo Margarida , Goossens An , Johansen Jeanne D. , Maibach Howard I. , Rustemeyer Thomas , Le Coz Christophe‐J. , White Ian R.
Published: April 2014

Background

Methylchloroisothiazolinone (MCI) and methylisothiazolinone (MI) are the active ingredients in commonly used preservative systems (e.g. Kathon CG®). MCI/MI is present in the European baseline patch test series at 100 ppm aq. Since 1986, 200 ppm (dose 0.006 mg/cm2) has been used in Sweden without causing skin irritation. Centres in Spain, the United Kingdom and Ireland have also used 200 ppm in their baseline series.

Objectives

To find the optimal patch test concentration for MCI/MI.

Materials and methods

MCI/MI 100 ppm aq. and MCI/MI 200 ppm aq. were simultaneously patch tested in 3300 consecutively tested dermatitis patients at eight European patch test clinics and one US patch test clinic. With the Finn Chambers® technique (diameter 8 mm), 15 µl was micropipetted on to the filter paper in the chamber. The corresponding volume for Van der Bend® chambers was 20 µl, and that for IQ Chambers® was 25 µl.

Results

Contact allergy to MCI/MI at 100 and 200 ppm was found in 1.2% and 2.1% of patients, respectively (p < 0.001).

Conclusions

MCI/MI 200 ppm aq. (dose 0.006 mg/cm2) diagnoses significantly more contact allergy than the presently used concentration of 100 ppm (dose 0.003 mg/cm2), without resulting in more adverse reactions. MCI/MI at 200 ppm should therefore be considered for inclusion in the European baseline test series.
Degree of blood loss during surgery for rectal cancer: a population‐based epidemiologic study of surgical complications and survival
Authors: Egenvall M. , Mörner M. , Påhlman L. , Gunnarsson U.
Published: April 2014

Aim

The hypothesis tested in this study was that major blood loss during surgery for rectal cancer increases the risk for surgical complications and for small bowel obstruction (SBO) as a result of adhesions or tumour recurrence, and reduces overall survival.

Method

Data were retrieved from the Uppsala/Örebro Regional Rectal Cancer Registry for all patients undergoing radical resection for rectal cancer during 1997–2003 (n = 1843) and were matched against the Swedish National Patient Registry regarding surgery and admission for SBO. These patient records were scrutinized to determine the etiology of surgery for SBO. The registry was scrutinized for blood loss and other surgical complications associated with surgery. Uni‐ and multivariate Cox analysis and logistic regression were used.

Results

Ninety‐four (5.1%) patients underwent surgery for SBO > 30 days after the index operation: 82 for adhesions and 12 for tumour recurrence. The volume of blood lost did not influence the risk of surgery for SBO as a result of adhesions, but blood loss above the median (≥ 800 ml) increased the risk for surgery for SBO caused by tumour recurrence (hazard ratio = 10.52; 95% CI: 1.36–81.51). Increased blood loss increased the risk of surgical complications (OR = 1.78; 95% CI: 1.35–2.35 with blood loss of ≥ 450 ml) but did not reduce overall survival. Irradiation before surgery increased blood loss, complications and admission for SBO.

Conclusion

Major blood loss during surgery for rectal cancer increases the risk of later surgery for SBO caused by tumour recurrence and surgical complications, but overall survival is not affected.
Vessel Strikes to Large Whales Before and After the 2008 Ship Strike Rule
Authors: van der Hoop Julie M. , Vanderlaan Angelia S. M. , Cole Timothy V. N. , Henry Allison G. , Hall Lanni , Mase‐Guthrie Blair , Wimmer Tonya , Moore Michael J.
Published: April 2014

To determine effectiveness of Seasonal Management Areas (SMAs), introduced in 2008 on the U.S. East Coast to reduce lethal vessel strikes to North Atlantic right whales, we analyzed observed large whale mortality events from 1990–2012 in the geographic region of the “Ship Strike Rule” to identify changes in frequency, spatial distribution, and spatiotemporal interaction since implementation. Though not directly coincident with SMA implementation, right whale vessel‐strike mortalities significantly declined from 2.0 (2000–2006) to 0.33 per year (2007–2012). Large whale vessel‐strike mortalities have decreased inside active SMAs, and increased outside inactive SMAs. We detected no significant spatiotemporal interaction in the 4‐year pre‐ or post‐Rule periods, although a longer time series is needed to detect these changes. As designed, SMAs encompass only 36% of historical right whale vessel‐strike mortalities, and 32% are outside managed space but within managed timeframes. We suggest increasing spatial coverage to improve the Rule's effectiveness.
Science Cafés: Engaging Scientists and Community through Health and Science Dialogue
Authors: Ahmed Syed , DeFino Mia C. , Connors Emily R. , Kissack Anne , Franco Zeno
Published: April 2014

Engagement of the community through informal dialogue with researchers and physicians around health and science topics is an important avenue to build understanding and affect health and science literacy. Science Cafés are one model for this casual interchange; however the impact of this approach remains under researched. The Community Engagement Key Function of the Clinical and Translational Science Institute of Southeast Wisconsin hosted a series of Science Cafés in which topics were collaboratively decided upon by input from the community. Topics ranged from Personalized Medicine to Alzheimer's and Dementia to BioMedical Innovation. A systematic evaluation of the impact of Science Cafés on attendees' self‐confidence related to five health and scientific literacy concepts showed statistically significant increases across all items (Mean differences between mean retrospective pre‐scores and post‐scores, one tailed, paired samples t‐test, n = 141, p < .0001 for all items). The internal consistency of the five health and scientific literacy items was excellent (n = 126, α = 0.87). Thematic analysis of attendees' comments provides more nuance about positive experience and suggestions for possible improvements. The evaluation provides important evidence supporting the effectiveness of brief, casual dialogue as a way to increase the public's self‐rated confidence in health and science topics.
Pallidotomy in the 21st century
Authors: Lumsden Daniel E
Published: April 2014

This commentary is on the original article by Marras et al. on pages
649–656 of this issue.
Development of the swimming acorn worm Glandiceps hacksi: similarity to holothuroids
Authors: Urata Makoto , Iwasaki Sadaharu , Ohtsuka Susumu , Yamaguchi Masaaki
Published: April 2014

Spawnings of Glandiceps hacksi (Hemichordata: Enteropneusta) were stimulated in the laboratory by a brief increase in temperature, and the development from fertilization through metamorphosis is described for the first time for a member of the family Spengelidae. When fertilized, the spawned female gametes, which are primary oocytes, rapidly raise a fertilization membrane and undergo two maturation divisions. Holoblastic, radial cleavage produces a blastula; a gastrula then forms by invagination from the vegetal pole, and the blastopore closes soon thereafter. In previously described enteropneust embryos, the archenteron buds off the protocoel before the latter connects to the exterior via the proboscis pore. By contrast, in G. hacksi the archenteron precociously connects with the exterior before the protocoel forms. Soon thereafter, the embryo becomes uniformly ciliated and then hatches from the fertilization envelope at approximately 32 h (15°C culture temperature). At day 3 of development, the protocoel separates from the gut, which establishes a mouth opening to the exterior; by this time, the gut has differentiated into an esophagus, a stomach, and an intestine that opens posteriorly as an anus. The larva grows to form a tornaria with distinctive pigment patches along its ciliary bands.
Learning to See with Different Eyes: A Nietzschean Challenge to Multicultural Dialogue
Authors: Yacek Douglas W.
Published: April 2014

Empathy is a necessity in our multicultural world. Modern democratic societies are home to communities with the most diverse religious, political, and moral convictions, and these convictions often directly, even perilously, contradict one another. Educational theorists differ on how empathy can be taught in the face of these contradictions. Does proper pedagogical action entail an attempt to teach students to understand the other, to see their world through the eyes of the other? Or is such an attempt doomed to fail, a vain and presumptuous striving to surpass the epistemologically preordained limits of subjectivity? While theorists who promote mutual understanding traditionally look to some form of dialogue to establish their empathic pedagogies, those who doubt the possibility of mutual understanding formulate critical, often monological pedagogies in which students are encouraged to “talk back” to their others about their idiosyncratic perspectives. Theorists have thus had choose: dialogue or relativism? Using the robust educational philosophy of Friedrich Nietzsche, Douglas Yacek demonstrates that this is a most unsatisfactory choice, one that ignores the pedagogical complexity needed to teach students genuine empathy. He argues that Nietzsche's educational writings yield a tripartite empathic pedagogy founded on self‐knowledge, foreign language learning, and experimentalism. Upon these three pedagogical pillars, Yacek problematizes Megan Laverty's recent attempt to formulate an empathic pedagogy as dialogical philosophical inquiry. Although Nietzsche would endorse much of Laverty's pedagogy, Yacek concludes that Nietzsche's pedagogy requires engagement with perspectives across the democratic curriculum and, indeed, beyond.