bluuebunny/crossref_metadata_2025 huggingface dataset:
The frequency and nature of drug administration error during anaesthesia in a Chinese hospital
Authors: ZHANG Y. , DONG Y. J. , WEBSTER C. S. , DING X. D. , LIU X. Y. , CHEN W. M. , MENG L. X. , WU X. Y. , WANG D. N.
Published: September 2012

Background

Throughout the world, drug administration error remains a known and significant threat to patients undergoing anaesthesia. Estimates of the extent of the problem vary, but few are based on large prospectively collected datasets. Furthermore, little is known about whether differences in work culture are important in error rates.

Methods

A prospective incident monitoring study was conducted at a large tertiary hospital in China to estimate the frequency of drug administration error during anaesthesia. Anaesthetists were asked to return a study form anonymously for every anaesthetic, indicating whether or not a drug administration error had occurred, including incident details if affirmative.

Results

From 24,380 anaesthetics, 16,496 study forms were returned (67.7% response rate), reporting 179 errors. The frequency (95% confidence interval) of drug administration error was 0.73% (0.63% to 0.85%) based on total study anaesthetics and 1.09% (0.93% to 1.26%) based on total forms returned. The largest categories of error were omissions (27%), incorrect doses (23%) and substitutions (20%). Errors resulted in prolonged stay in recovery for 21 patients, transfer to the ICU for five and one case each of haemorrhagic shock and asthmatic attack. More respondents who were not fully rested reported inattention as a contributing factor to error (21%) than those who were fully rested (7%, P = 0.04).

Conclusion

Our results are comparable with other international prospective estimates indicating that drug administration error is of concern in China as elsewhere. These results will form a baseline from which to detect the effects of countermeasures.
LMA ProSealTM vs. i‐GelTM in ventilated children: A randomised, crossover study using the size 2 mask
Authors: GASTEIGER L. , BRIMACOMBE J. , OSWALD E. , PERKHOFER D. , TONIN A. , KELLER C. , TIEFENTHALER W.
Published: September 2012

Background

The Laryngeal Mask Airway (LMA) ProSealTM and the i‐GelTM are two extraglottic devices with either an inflatable cuff or a non‐inflatable cuff.

Aim

We test the hypothesis that oropharyngeal leak pressure and fiberoptic position of the airway tube differ between the size 2 LMA ProSealTM and the i‐GelTM in non‐paralysed ventilated children.

Methods

Fifty‐one children aged 1.5–6 years weighing 10–25 kg were studied using a crossover design. Anaesthesia was with remifentanil/propofol mixture. The LMA ProSealTM and the i‐GelTM were inserted into each patient in random order.

Results

Oropharyngeal leak pressure for the LMA ProSealTM and the i‐GelTM was similar at 22 (5) and 21 (5) cm H2O, respectively. Fiberoptic position of the airway tube for the LMA ProSealTM and the i‐GelTM was similar, with the vocal cords visible from the distal airway tube in 94% and 96%, respectively.

Conclusion

We conclude that oropharyngeal leak pressure and fiberoptic position of the airway tube are similar for the size 2 LMA ProSealTM and i‐GelTM in non‐paralysed ventilated children.
Concomitant medication among persistent opioid users with chronic non‐malignant pain
Authors: MELLBYE A. , SVENDSEN K. , BORCHGREVINK P. C. , SKURTVEIT S. , FREDHEIM O. M. S.
Published: September 2012

Background

Recent guidelines for opioid treatment of chronic non‐malignant pain discourage co‐medication with benzodiazepines and benzodiazepine‐related hypnotics, whereas co‐medication with non‐opioid analgesics and co‐analgesics may offer a beneficial opioid sparing effect, and is recommended. The aim of this study was to describe 1‐year periodic prevalence of co‐medication with benzodiazepines, benzodiazepine‐related hypnotics, non‐opioid analgesics, co‐analgesics and antidepressants in persistent opioid users with chronic non‐malignant pain.

Methods

The study is based on data from the Norwegian Prescription Database, covering all drugs dispensed to outpatients in 2008. Concomitant medication levels were compared between users in two definitions of persistent opioid use, all Norwegian adults dispensed opioids in 2008 and the Norwegian background population.

Results

Of the Norwegian adult population studied, 1.2% met the criteria of persistent opioid use based on prescription pattern and prescription level. Sixty per cent of persistent opioid users were dispensed a benzodiazepine or benzodiazepine‐related hypnotic in amounts indicating regular use, with 15% dispensed a high amount of both classes. Sixty‐two percent of persistent opioid users were dispensed one or more non‐opioid analgesics, 47% an antidepressant and 33% were dispensed an antiepileptic drug.

Conclusion

Approximately 60% of persistent opioid users also receive benzodiazepines or benzodiazepine‐related hypnotics in amounts indicating regular use. This is in conflict with recent guidelines for the treatment of chronic non‐malignant pain and may indicate that these users are at an increased risk of developing problematic opioid use.
Epidemiology in evolutionary time: the case of Wolbachia horizontal transmission between arthropod host species
Authors: Zug R. , Koehncke A. , Hammerstein P.
Published: September 2012

Wolbachia are bacterial endosymbionts that manipulate the reproduction of their arthropod hosts. Although theory suggests that infections are frequently lost within host species due to the evolution of resistance, Wolbachia infect a huge number of species worldwide. This apparent paradox suggests that horizontal transmission between host species has been a key factor in shaping the global Wolbachia pandemic. Because Wolbachia infections are thus acquired and lost like any other infection, we use a standard epidemiological model to analyse Wolbachia horizontal transmission dynamics over evolutionary time. Conceptually modifying the model, we apply it not to transmission between individuals but between species. Because, on evolutionary timescales, infections spread frequently between closely related species and occasionally over large phylogenetic distances, we represent the set of host species as a small‐world network that satisfies both requirements. Our model reproduces the effect of basic epidemiological parameters, which demonstrates the validity of our approach. We find that the ratio between transmission rate and recovery rate is crucial for determining the proportion of infected species (incidence) and that, in a given host network, the incidence may still be increasing over evolutionary time. Our results also point to the importance of occasional transmission over long phylogenetic distances for the observed high incidence levels of Wolbachia. In conclusion, we are able to explain why Wolbachia are so abundant among arthropods, although selection for resistance within hosts often leads to infection loss. Furthermore, our unorthodox approach of using epidemiology in evolutionary time can be applied to all symbionts that use horizontal transmission to infect new hosts.
Surgical outcomes of 230 resected hilar cholangiocarcinoma in a single centre
Authors: Song Sun Choon , Choi Dong Wook , Kow Alfred Wei‐Chieh , Choi Seong Ho , Heo Jin Seok , Kim Woo Seok , Kim Min Jung
Published: September 2012

Abstracts

Background

Low resectability rate and poor survival outcomes after surgical resection for hilar cholangiocarcinoma are common in most institutions. We retrospectively reviewed the surgical outcomes of hilar cholangiocarcinoma in a tertiary institution focusing on the surgical procedures, radicalities, survival rates and independent prognostic factors.

Methods

Two hundred thirty patients who underwent surgical resection for hilar cholangiocarcinoma between 1995 and 2010 were retrospectively analysed based on the clinical variables, Bismuth‐Corlette types, radicality of operation and survival rates.

Results

The median overall and disease‐free survival time in the whole cohort were 39.1 and 19.2 months, respectively. Patients with type I or II tumour were more likely to undergo segmental bile duct resection than combined liver resection with lower R0 rates (68.2% and 76.1%, respectively). Liver resection (P < 0.001) and combined caudate lobectomy (P = 0.003) were associated with significantly higher R0 rates. Multivariate analysis showed that lymph node metastasis (P = 0.001), preoperative level of bilirubin above 3.0 mg/dL (P = 0.003) and positive resection margin (P = 0.033) were independent prognostic factors on overall survival.

Conclusion

Liver resection and combined caudate lobectomy increased curative resection rates in hilar cholangiocarcinoma regardless of Bismuth‐Corlette types. Preoperative biliary drainage should be performed in jaundiced patients to improve perioperative outcome and survival.
Dedicated hip fracture service: implementing a novel model of care
Authors: Sivakumar Brahman Shankar , McDermott Luke Michael , Bell Jack Joseph , Pulle Chrys Ranjeev , Jayamaha Sophie , Ottley Michael Carl
Published: September 2012

Background

Hip fracture is a common clinical problem with historically high morbidity and mortality, and various model of acute and subacute care have been employed. We describe 12‐month results from the first dedicated hip fracture unit in Australia, and compare it with other models of care both locally and internationally.

Methods

This was performed as a prospective uncontrolled study over a 12‐month period. After application of exclusion criteria, a total of 346 patients were yielded. Outcomes measured included performance indicators as well as morbidity and mortality data.

Results

Improvements in performance indicators (adequate preoperative medical assessment, time to surgery, return to premorbid residence, etc.) and morbidity and mortality data (such as pressure sores, infections and in‐hospital death) are noted.

Conclusions

Early results suggest more comprehensive preoperative assessment, shorter times to theatre, reduced post‐operative complications and diminished mortality rates when the principles undermining this unit are instituted.
Outcomes of patients with histologically proven acute acalculous cholecystitis
Authors: Nikfarjam Mehrdad , Manya Kiran , Fink Michael A. , Hadj Andrew K. , Muralidharan Vijayaragavan , Starkey Graham , Jones Robert M. , Christophi Christopher
Published: September 2012

Background

Acute acalculous cholecystitis (AAC) is traditionally described in the setting of critical illness, where the diagnosis is based on clinical assessment and imaging criteria. Very few studies have assessed the features and outcomes of AAC in patients treated by cholecystectomy.

Methods

Patients with histologically confirmed acute cholecystitis treated in a specialized unit in a tertiary hospital between 2005 and 2011 were identified from prospectively maintained database. Retrospective review of data was undertaken and patients with AAC were compared with those patients with acute cholecystitis and confirmed gallstones.

Results

AAC was identified in 35 of 412 (8.5%) patients with acute cholecystitis. These patients were older (69 years versus 61 years; P = 0.004) and were more likely to be febrile (46% versus 21%; P = 0.001) and hypotensive (23% versus 5%; P < 0.001) at initial presentation. There was a higher incidence of chronic obstructive airways disease (COAD) in the AAC group (26% versus 6%; P < 0.001). Other co‐morbidities were similar among the groups. Operative outcomes were similar between the groups. There were no overall differences in postoperative complications between AAC and calculous acute cholecystitis patients (17% versus 16%; P = 0.063). However, the postoperative length of stay was higher in the AAC group (5 days versus 3 days; P = 0.026).

Conclusion

AAC more commonly occurs in older patients and those with COAD. The operative outcomes and complications of AAC treated by cholecystectomy are similar to cases of acute calculous cholecystitis.
Objective structured assessment of technical skills and checklist scales reliability compared for high stakes assessments
Authors: Gallagher Anthony G. , O'Sullivan Gerald C. , Leonard Gerald , Bunting Brendan P. , McGlade Kieran J.
Published: September 2012

Background

The establishment of assessment reliability at the level of the individual trainee is an important attribute of assessment methodologies, particularly for doctors who have been failed. This issue is of particular importance for the process of competence assessment in the USA, UK, Australia and New Zealand.

Methods

We use data from 19 applicants for higher surgical training in 2008 at the Royal College of Surgeons in Ireland to compare: (i) the objective structured assessment of technical skills (OSATS) method; and (ii) a procedure‐specific checklist to assess surgical technical skills in the excision of a sebaceous cyst task by two experienced senior surgeons.

Results

The overall interrater reliability (IRR) of the OSATS assessment as determined by a correlation coefficient was 0.507 (P < 0.03) and 0.67 with coefficient alpha, considerably below the accepted 0.8 level of IRR. The checklist's overall IRR was 0.89. Individually, only five (26%) of the OSATS assessments reached the 0.8 level of IRR in contrast to 18 (95%) of the checklist assessments.

Discussion

We propose binary procedure‐based assessment checklists as more reliable assessment instruments with more robust reproducibility.
Disruption of raphé serotonergic neural projections to the cortex: a potential pathway contributing to remote loss of brainstem neurons following neonatal hypoxic–ischemic brain injury
Authors: Reinebrant Hanna E. , Wixey Julie A. , Buller Kathryn M.
Published: September 2012

Neuronal injury is a key feature of neonatal hypoxic–ischemic (HI) brain injury. However, the mechanisms underpinning neuronal losses, such as in the brainstem, are poorly understood. One possibility is that disrupted neural connections between the cortex and brainstem may compromise the survival of neuronal cell bodies in the brainstem. We investigated whether brainstem raphé serotonergic neurons that project to the cortex are lost after HI. We also tested if neuroinflammation has a role in disrupting brainstem raphé projections. Postnatal day 3 (P3) rats underwent unilateral carotid artery ligation followed by hypoxia (6% oxygen for 30 min). A retrograde tracer, choleratoxin b, was deposited in the motor cortex on P38. On P45 we found that retrogradely labelled neurons in the dorsal raphé dorsal, ventrolateral, interfascicular, caudal and ventral nuclei were lost after P3 HI. All retrogradely labelled neurons in the raphé nuclei were serotonergic. Numbers of retrogradely labelled neurons were also reduced in the ventromedial thalamus and basolateral amygdala. Minocycline treatment (45 mg/kg 2 h post‐HI, 22.5 mg/kg daily P4–P9) attenuated losses of retrogradely labelled neurons in the dorsal raphé ventrolateral, interfascicular and ventral raphé nuclei, and the ventromedial thalamus. These results indicate that raphé neurons projecting to the cortex constitute a population of serotonergic neurons that are lost after P3 HI. Furthermore, neuroinflammation has a role in the disruption of raphé and thalamic neural projections. Future studies investigating the cellular mechanisms of axonal degeneration may reveal new targets for interventions to prevent neuronal losses after neonatal HI.
Predominance of thaumarchaeal ammonia oxidizer abundance and transcriptional activity in an acidic fen
Authors: Herrmann Martina , Hädrich Anke , Küsel Kirsten
Published: September 2012

We investigated the abundance, community composition and transcriptional activity of ammonia‐oxidizing archaea (AOA) and bacteria (AOB) in the acidic fen Schlöppnerbrunnen (Germany) that was subjected to water table manipulations. Quantitative PCR targeting amoA gene copies and transcripts showed that AOA dominated the ammonia‐oxidizing community in the upper 20 cm of the peat soil. Numbers of archaeal amoA gene copies and transcripts as well as the relative fraction of AOA of the total archaea decreased with depth. AOA‐AmoA sequences were 96.2–98.9% identical to that of Candidatus Nitrosotalea devanaterra while bacterial AmoA sequences affiliated with Nitrosospira clusters 2 and 4. Archaeal but not bacterial amoA transcripts were detected in short‐term laboratory incubations of peat that showed nitrifying activity. Nitrate accumulated in the peat pore water after 6 weeks of induced drought during a field experiment. Subsequent rewetting resulted in a significant decrease of AOA transcriptional activity, indicating that AOA responded to water table fluctuations on the transcriptional level. Our results suggest that nitrification in this fen is primarily linked to archaeal ammonia oxidation. pH and anoxia appear to be key factors regulating AOA community composition, vertical distribution and activity in acidic fens.
Hip circumference, height and risk of type 2 diabetes: systematic review and meta‐analysis
Authors: Janghorbani M. , Momeni F. , Dehghani M.
Published: September 2012

Although several epidemiological studies have investigated the relationship between type 2 diabetes mellitus (T2DM) and hip circumference or height, the results are inconsistent. The present systematic review and meta‐analysis of published observational studies was conducted to assess the effects of hip circumference and height on diabetes risk. Online databases were searched through January 2012, and the reference lists of pertinent articles reporting observational studies in humans were examined. Pooled relative risks (RR) and 95% confidence intervals (CI) were calculated with a random‐effects model. Eighteen studies (nine cross‐sectional and nine cohort) were included, with 250,497 participants and 7,765 cases of T2DM. Hip circumference was inversely associated with an increased risk of T2DM in men (summary RR [95% CI] 0.60 [0.45, 0.80]) and women (0.54 [0.42, 0.70]). These results were consistent between cross‐sectional and cohort studies. An inverse association between height and T2DM was observed in women only (summary RR [95% CI] 0.83 [0.73, 0.95]). Our meta‐analysis strongly supports an inverse relationship between hip circumference and risk of T2DM in men and women. The inverse association between height and risk was significant only in women.
DETECTING EMOTION CAUSES WITH A LINGUISTIC RULE‐BASED APPROACH1
Authors: Lee Sophia Yat Mei , Chen Ying , Huang Chu‐Ren , Li Shoushan
Published: September 2012

Most theories of emotion treat recognition of a triggering cause event as an integral part of emotion processing. This paper proposes emotion cause detection as a new research area in emotion processing. As a first step toward fully automatic inference of emotion‐cause correlation, we propose a text‐driven, rule‐based approach to emotion cause detection in Chinese. First, we constructed a Chinese emotion cause annotated corpus based on our proposed annotation scheme. Next, we analyzed the corpus data, which yielded the identification of seven groups of linguistic cues and two sets of generalized linguistic rules for the detection of emotion causes. We then developed a rule‐based system for emotion cause detection based on the linguistic rules. In addition, we proposed an evaluation scheme with two phases for performance assessment. The results of our experiments show that our system achieved a promising performance for cause occurrence detection, as well as for cause event detection. The current study should lay the groundwork for future research on the inferences of implicit information and the discovery of new information based on cause‐event relation.
ADDRESSING UTILITY SPACE COMPLEXITY IN NEGOTIATIONS INVOLVING HIGHLY UNCORRELATED, CONSTRAINT‐BASED UTILITY SPACES
Authors: Marsa‐Maestre Ivan , Lopez‐Carmona Miguel A. , Klein Mark , Ito Takayuki , Fujita Katsuhide
Published: September 2012

There is an increasing interest in complex automated negotiations, where agents negotiate about multiple, interdependent issues and agent utility functions exhibit low autocorrelation. In these scenarios, the negotiation mechanisms used to find agreement solutions among agents tend to fail due to the complexity of agents’ preference spaces, and this tendency increases as the degree of autocorrelation decreases. In this paper, we propose an automated negotiation model specially tailored for highly uncorrelated utility spaces based on weighted constraints. The model relies on a mediated, auction‐based interaction protocol and a set of heuristic mechanisms for bidding and deal identification. To address the challenges raised by highly uncorrelated utility spaces, we propose to use a quality factor, which allows agents to balance utility and deal probability when placing their bids or when searching for agreement regions among these bids. Experiments show that the proposed negotiation model achieves high optimality results and low failure rates even in negotiation scenarios involving highly uncorrelated utility spaces, thus outperforming previous approaches.
AN INTEGRATED CLUSTERING‐BASED APPROACH TO FILTERING UNFAIR MULTI‐NOMINAL TESTIMONIES
Authors: Liu Siyuan , Zhang Jie , Miao Chunyan , Theng Yin‐Leng , Kot Alex C.
Published: September 2012

Reputation systems have contributed much to the success of electronic marketplaces. However, the problem of unfair testimonies has to be addressed effectively to improve the robustness of reputation systems. Until now, most of the existing approaches focus only on reputation systems using binary testimonies, and thus have limited applicability and effectiveness. In this paper, We propose an integrated CLUstering‐Based approach called iCLUB to filter unfair testimonies for reputation systems using multinominal testimonies, in an example application of multiagent‐based e‐commerce. It adopts clustering techniques and considers buyer agents’ local as well as global knowledge about seller agents. Experimental evaluation demonstrates the promising results of our approach in filtering various types of unfair testimonies, its robustness against collusion attacks, and better performance compared to competing models.
Religious Beliefs, Diet, and Physical Activity Among Jewish Adolescents
Authors: Benjamins Maureen R.
Published: September 2012

Despite a well‐documented connection between religion and mortality, the link between religion and obesity‐related outcomes and behaviors has not been adequately studied, particularly among adolescents. This study examines whether self‐reported religious beliefs influence decisions about physical activity and diet in a sample of Jewish adolescents (n = 351). The results show that reporting a stronger influence of religious beliefs on health behaviors is associated with behaviors related to physical activity, but not diet. In adjusted regression models, individuals who report that their religious beliefs influence decisions about being physically active “a lot” have significantly more active days per week than those who say their religious beliefs do not influence such decisions. Similar effects are seen with regard to the students’ overall amount of sedentary time. The results shed light on previously documented relationships between religion and health, provide practical implications for religious organizations and leaders, and suggest areas for future research.
Extreme Asceticism: Confucian Practice and Riesebrodt's Religious Virtuoso
Authors: Choi Mihwa
Published: September 2012

The ascetic ideals initially established by Confucius are moderate and rational. Yet, virtuoso asceticism became a social phenomenon when the state desired to institute a more powerful channel to disseminate Confucian values in the broader populace beyond the literati. The reason that the cult of the virtuoso particularly served this purpose was that the enshrinement of virtuoso generated social power within community. That social power, somewhat equivalent to charisma, derived from the enshrined spirit's connection with transcendence having official and public offerings from community. The social process in the formation of the ascetic virtuoso and its social function in the Confucian tradition follow a pattern similar to that laid out by Martin Riesebrodt: denial of the physical self, restructuring of social relations, and spiritual transformation. Ascetic virtuosos stemming from the tradition of “inner‐worldly” asceticism closed a gap between a rationalized system of behavior‐regulating practices and interventionist practice with reference to transcendence.
Use of mixture models to characterize site quality in philopatric animals: a case study withBonelli's eagle
Authors: Chevallier C. , Crochet P‐A. , Vincent‐Martin N. , Ravayrol A. , Besnard A.
Published: September 2012

TheFrench population of theBonelli's eagleAquila fasciatahas suffered a sharp decline over the last decades, resulting in the implementation of several conservation actions since 1990. In parallel, a capture–recapture (CR) program has been conducted to monitor the population. Field practitioners suspected that certain breeding sites were responsible for most of the adult deaths and were interested in confirming this hypothesis in order to focus their actions on these particular sites. Our study sought to determine whether there was indeed a quantifiable difference in the quality of the eagle's breeding sites. SinceBonelli's eagles are highly faithful to their breeding site, we tested whether the turnover of breeding individuals observed at different sites resulted from a mixture of two different turnover rates. We also used the recent multi‐eventCRmodeling approach to test whether or not we could detect adult survival heterogeneity in the population. Our study revealed that there was a difference in breeding‐site quality a decade ago, before large efforts were made to insulate high‐voltage power lines, but failed to detect a difference in breeding‐site quality more recently. No survival heterogeneity was detected. These counterintuitive results could be due to a lack of statistical power or because the conservation actions performed over the last 20 years cloud the issue. When noa prioriinformation is available on habitat quality differences, we advocate for the use of a mixture modeling approach since it is consistent and fairly general.
Identification and Confirmation of an Exonic Splicing Enhancer Variation in Exon 5 of the Alzheimer Disease Associated PICALM Gene
Authors: Schnetz‐Boutaud Nathalie C. , Hoffman Joshua , Coe Jared E. , Murdock Deborah G. , Pericak‐Vance Margaret A. , Haines Jonathan L.
Published: September 2012

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by memory and cognitive impairment and is the leading cause of dementia in the elderly. A number of genome wide association studies and subsequent replication studies have been published recently on late onset AD (LOAD). These studies identified several new susceptibility genes including phosphatidylinositol‐binding clathrin assembly protein (PICALM) on chromosome 11. The aim of our study was to examine the entire coding sequence of PICALM to determine if the association could be explained by any previously undetected sequence variation. Therefore, we sequenced 48 cases and 48 controls homozygous for the risk allele in the signal SNP rs3851179. We did not find any new variants; however, rs592297, a known coding synonymous SNP that is part of an exonic splice enhancer region in exon 5, is in strong linkage disequilibrium with rs3851179 and should be examined for functional significance in Alzheimer pathophysiology.
Assessing behavioural and morphological responses of frog tadpoles to temporal variability in predation risk
Authors: Hossie T. J. , Murray D. L.
Published: September 2012

Finely tuned adjustment of an individual's phenotype can offer substantial fitness benefits when it is closely matched with environmental change. For instance, prey may be safeguarded against unnecessary costs to growth or development when their responses to temporally variable predation risk include plastic anti‐predator defences. Yet, the correspondence between perceived predation risk and related responses should differ between behavioural and morphological phenotypes when risk fluctuates because behaviour can be modified quickly, whereas morphological phenotypes require time to build. Theoretical models predict intermediate expression when risk fluctuates rapidly relative to the time required to mount a response, whereas traits that can be modified relatively quickly should more closely track current conditions. Using a tadpole‐dragonfly larva system, we sought to compare the expression of behavioural and morphological defences following exposure to constant versus variable predation risk. By varying the pattern and total duration of predator cue exposure, but not cue concentration, we quantified phenotypic plasticity and trait reversibility. Our results show that strong behavioural responses were limited to early ontogeny but closely matched current level of risk. The morphology of prey experiencing a weekly changing predator environment was intermediate to that of prey in the no‐predator and constantly exposed treatments. Yet, prey exposed to a predator environment for the same total duration as the weekly changing environment, but in a different exposure pattern, was morphologically unresponsive to the onset of predation risk. Finally, unexposed tadpoles gained deeper tails and smaller relative body size in late development, coincident with limb bud development. Such changes are consistent with anti‐predator response and represent either an innate response when prey are more vulnerable or shape optimization when faced with increased drag. We conclude that phenotypic expression depends critically on patterns of temporal variability in the environment, although the actual extent of expression depends on the specific trait in question.
Patient–patient interaction – caring and sharing
Authors: Birkelund Regner , Larsen Lene Søndergaard
Published: September 2012

Aim:  The aim of this study is to provide an understanding of the significance of hospitalized patients’ interpersonal interaction with fellow patients in an infectious disease ward in a large Danish hospital.

Method:  A qualitative approach was selected using participant observation and semi‐structured qualitative interviews. Six female participants at the age of 32–81 years with different types of infectious diseases accepted to participate in interviews. The analysis was carried out using Kvales’ three levels of qualitative data analysis. Data were catalogued into two main categories with several subcategories representing significance of patients’ interaction with fellow patients.

Results:  The qualitative analysis resulted in two main categories: (i) Caring for fellow patients and (ii) Sharing illness information with fellow patients. Each of the main categories was elucidated through several subcategories.

Our findings clearly showed that interpersonal interaction with fellow patients was of utmost importance when it came to care and support and when they needed information about their illness. Typically, the interpersonal interaction was experienced as giving and referred to in positive terms, but occasionally, the opposite was experienced too. Less typically, the patients experienced interaction with fellow patients as a burden and referred to it in negative terms.

Conclusions:  Patients’ interaction resembled care as well as self‐care. Patient–patient interaction was an important part of the social support system during hospitalization.
The Relationship between Mental Health Diagnosis and Treatment with Second‐Generation Antipsychotics over Time: A National Study of U.S. Medicaid‐Enrolled Children
Authors: Matone Meredith , Localio Russell , Huang Yuan‐Shung , dosReis Susan , Feudtner Chris , Rubin David
Published: September 2012

Objective

To describe the relationship between mental health diagnosis and treatment with antipsychotics among U.S. Medicaid‐enrolled children over time.

Data Sources/Study Setting

Medicaid Analytic Extract (MAX) files for 50 states and the District of Columbia from 2002 to 2007.

Study Design

Repeated cross‐sectional design. Using logistic regression, outcomes of mental health diagnosis and filled prescriptions for antipsychotics were standardized across demographic and service use characteristics and reported as probabilities across age groups over time.

Data Collection

Center for Medicaid Services data extracted by means of age, ICD‐9 codes, service use intensity, and National Drug Classification codes.

Principal Findings

Antipsychotic use increased by 62 percent, reaching 354,000 youth by 2007 (2.4 percent). Although youth with bipolar disorder, schizophrenia, and autism proportionally were more likely to receive antipsychotics, youth with attention deficit hyperactivity disorder (ADHD) and those with three or more mental health diagnoses were the largest consumers of antipsychotics over time; by 2007, youth with ADHD accounted for 50 percent of total antipsychotic use; 1 in 7 antipsychotic users were youth with ADHD as their only diagnosis.

Conclusions

In the context of safety concerns, disproportionate antipsychotic use among youth with nonapproved indications illustrates the need for more generalized efficacy data in pediatric populations.
Control of TMEM16A by INO‐4995 and other inositolphosphates
Authors: Tian Yuemin , Schreiber Rainer , Wanitchakool Podchanart , Kongsuphol Patthara , Sousa Marisa , Uliyakina Inna , Palma Marta , Faria Diana , Traynor‐Kaplan Alexis E , Fragata José I , Amaral Margarida D , Kunzelmann Karl
Published: September 2012

Background And Purpose

Ca2+‐dependent Cl− secretion (CaCC) in airways and other tissues is due to activation of the Cl− channel TMEM16A (anoctamin 1). Earlier studies suggested that Ca2+‐activated Cl− channels are regulated by membrane lipid inositol phosphates, and that 1‐O‐octyl‐2‐O‐butyryl‐myo‐inositol 3,4,5,6‐tetrakisphosphate octakis(propionoxymethyl) ester (INO‐4995) augments CaCC. Here we examined whether TMEM16A is the target for INO‐4995 and if the channel is regulated by inositol phosphates.

Experimental Approach

The effects of INO‐4995 on CaCC were examined in overexpressing HEK293, colonic and primary airway epithelial cells as well as Xenopus oocytes. We used patch clamping, double electrode voltage clamp and Ussing chamber techniques.

Key Results

We found that INO‐4995 directly activates a TMEM16A whole cell conductance of 6.1 ± 0.9 nS pF–1 in overexpressing cells. The tetrakisphosphates Ins(3,4,5,6)P4 or Ins(1,3,4,5)P4 and enzymes controlling levels of InsP4 or PIP2 and PIP3 had no effects on the magnitude or kinetics of TMEM16A currents. In contrast in Xenopus oocytes, human airways and colonic cells, which all express TMEM16A endogenously, Cl− currents were not acutely activated by INO‐4995. However incubation with INO‐4995 augmented 1.6‐ to 4‐fold TMEM16A‐dependent Cl− currents activated by ionomycin or ATP, while intracellular Ca2+ signals were not affected. The potentiating effect of INO‐4995 on transient ATP‐activated TMEM16A‐currents in cystic fibrosis (CF) airways was twice of that observed in non‐CF airways.

Conclusions And Implications

These data indicate that TMEM16A is the target for INO‐4995, although the mode of action appears different for overexpressed and endogenous channels. INO‐4995 may be useful for the treatment of CF lung disease.
The role of the paracrine/autocrine mediator endothelin‐1 in regulation of cardiac contractility and growth
Authors: Drawnel Faye M , Archer Caroline R , Roderick H Llewelyn
Published: September 2012

Endothelin‐1 (ET‐1) is a critical autocrine and paracrine regulator of cardiac physiology and pathology. Produced locally within the myocardium in response to diverse mechanical and neurohormonal stimuli, ET‐1 acutely modulates cardiac contractility. During pathological cardiovascular conditions such as ischaemia, left ventricular hypertrophy and heart failure, myocyte expression and activity of the entire ET‐1 system is enhanced, allowing the peptide to both initiate and maintain maladaptive cellular responses. Both the acute and chronic effects of ET‐1 are dependent on the activation of intracellular signalling pathways, regulated by the inositol‐trisphosphate and diacylglycerol produced upon activation of the ETA receptor. Subsequent stimulation of protein kinases C and D, calmodulin‐dependent kinase II, calcineurin and MAPKs modifies the systolic calcium transient, myofibril function and the activity of transcription factors that coordinate cellular remodelling. The precise nature of the cellular response to ET‐1 is governed by the timing, localization and context of such signals, allowing the peptide to regulate both cardiomyocyte physiology and instigate disease.

Linked Articles

This article is part of a themed section on Endothelin. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2013.168.issue‐2
Traumatic brain injury: Risks of epilepsy and implications for medicolegal assessment
Authors: Christensen Jakob
Published: September 2012

Traumatic brain injury (TBI) is a potentially preventable cause of epilepsy. Increasing incidence among army personnel and the high incidence among children and young people raise concern. This article presents a review of selected studies dealing with the risks of TBI and the risk of posttraumatic epilepsy in humans. The incidence of persons admitted to hospital with TBI has decreased in developed countries in recent years. However, there is little change in TBI‐associated deaths, and the decrease in hospitalization may merely reflect that more people with head injury are cared for on an outpatient basis. It is clear that epilepsy is a frequent consequence of brain injury, even many years after the injury. However, several well‐controlled studies have been unable to identify therapies that prevent the development of epilepsy after TBI. Posttraumatic epilepsy has significant implications for the affected individuals, family, and society. Despite several interventions used to prevent posttraumatic epilepsy, the only proven “intervention” to date is to prevent TBI from occurring.
Seizures and encephalitis: Clinical features, management, and potential pathophysiologic mechanisms
Authors: Michael Benedict D. , Solomon Tom
Published: September 2012

Encephalitis is an inflammation and swelling of the brain, which is often caused by a viral infection; it is an important cause of acute symptomatic seizures as well as subsequent epilepsy. Herein we describe the definition, epidemiology, and etiology of encephalitis as a cause of seizures. We then focus on encephalitis due to herpes simplex virus (the most common sporadic viral cause of encephalitis) and Japanese encephalitis virus (the most common epidemic viral cause). We also discuss the evidence for seizures occurring in the context of antibody‐associated encephalitis, an increasingly important condition. Finally, we describe the acute and longer‐term management of encephalitis‐related seizures and their potential pathophysiologic mechanisms, concluding with the emerging etiologic role of human herpesvirus 6.
Surgical treatment of epilepsy associated with cortical dysplasia: 2012 update
Authors: Hauptman Jason S. , Mathern Gary W.
Published: September 2012

Cortical dysplasia is the most common etiology in children and the third most frequent finding in adults undergoing epilepsy neurosurgery. The new International League Against Epilepsy (ILAE) classification grades isolated cortical dysplasia into mild type I (cortical dyslamination), severe type II (dyslamination plus dysmorphic neurons and balloon cells), and dysplasia associated with other epileptogenic lesions (type III). Multilobar type II lesions present at an earlier age and with more severe epilepsy compared with focal type I abnormalities, often in the temporal lobe, and these findings are reflected in types and age of operations for cortical dysplasia. Presurgical evaluation of patients with epilepsy from cortical dysplasia can be challenging. Interictal and ictal scalp electroencephalography (EEG) accurately localizes cortical dysplasia with 50–66% accuracy. Structural magnetic resonance imaging (MRI) is negative in roughly 30% of cases, most often linked with mild type I cases. FDG‐PET can be 80–90% accurate, but is not 100% sensitive. Chronic intracranial electrodes are used in about 50% of cases with cortical dysplasia, but often do not capture restricted ictal‐onset zones. About 60% of patients with cortical dysplasia are seizure free after epilepsy neurosurgery, with much higher rates of becoming seizure free with complete (80%) compared with incomplete (20%) resections. The most common reason for incomplete resection is the risk of an unacceptable neurologic deficit. Future challenges include better tools in identifying subtle forms of type I cortical dysplasia, and development of adjunctive treatments from basic research for those undergoing incomplete resections.
Provoked and reflex seizures: Surprising or common?
Authors: Kasteleijn‐Nolst Trenité Dorothée G. A.
Published: September 2012

Most patients with epilepsy report that seizures are sometimes, or exclusively, provoked by general internal precipitants (such as stress, fatigue, fever, sleep, and menstrual cycle) and by external precipitants (such as excess alcohol, heat, bathing, eating, reading, and flashing lights). Some patients describe very exotic and precise triggers, like tooth brushing or listening to a particular melody. Nevertheless, the most commonly noticed seizure increasers by far are stress, lack of sleep, and fatigue. Recognized reflex seizure triggers are usually sensory and visual, such as television, discotheques, and video games. Visually evoked seizures comprise 5% of the total of 6% reflex seizures. The distinction between provocative and reflex factors and seizures seems artificial, and in many patients, maybe all, there is a combination of these. It seems plausible that all of the above‐mentioned factors can misbalance the actual brain network; at times, accumulation of factors leads then to primary generalized, partial, or secondarily generalized seizures. If the provoking factors are too exotic, patients may be sent to the psychiatrist. Conversely, if the seizure‐provoking fluctuating mechanisms include common habits and environmental factors, these may hardly be considered as provocative factors. Awareness of precipitating factors and its possible interactions might help us to unravel the pathophysiology of epilepsy and to change the notion that seizure occurrence is unpredictable. This article provides an overview of the epidemiology, classification, diagnosis, treatment, and especially similarities in the variety of provocative and reflex factors with resulting general hypotheses.
Epileptic encephalopathies (including severe epilepsy syndromes)
Authors: Covanis Athanasios
Published: September 2012

Epileptic encephalopathies represent a group of devastating epileptic disorders that appear early in life and are characterized by pharmacoresistant generalized or focal seizures, persistent severe electroencephalography (EEG) abnormalities, and cognitive dysfunction or decline. The ictal and interictal epileptic discharges are age‐specific and are the main etiologic factors causing cognitive deterioration. This is most obvious in the idiopathic group. In the symptomatic group, the most common causes are structural, congenital, or acquired and rarely some metabolic disorders. In certain cases, clinical and EEG abnormalities persist and may evolve from one type to another as the child grows older. Various factors trigger and sustain the underlying pathophysiologic process and the ongoing epileptic and epileptiform activity during the most critical periods of brain maturation, perpetuating their deleterious effect on the brain. Immune‐mediated mechanisms may have a role, suggested by certain encephalopathies responding to immune‐modulating treatments and by the finding of various autoimmune antibodies. The chance of a better cognitive outcome improves with early diagnosis and treatment that is appropriate and effective. Current antiepileptic drugs are, in general, not effective: we urgently need new trials in this very special epileptic category. This article briefly reviews the most common epileptic encephalopathies and analyzes the most important clinical issues.
An In Vivo Evaluation of Fit of Zirconium‐Oxide Based Ceramic Single Crowns, Generated with Two CAD/CAM Systems, in Comparison to Metal Ceramic Single Crowns
Authors: Biscaro Leonello , Bonfiglioli Roberto , Soattin Massimo , Vigolo Paolo
Published: September 2012

Purpose: The purpose of this study was to assess in vivo the marginal fit of single crowns produced using two CAD/CAM all‐ceramic systems, in comparison to more traditional metal ceramic crowns.

Materials and Methods: Thirty vital, caries‐free, and previously untreated teeth were chosen in five patients who needed extraction for implant placement and therefore were included in this study. In the control group (C), 10 regular metal ceramic crowns with porcelain occlusal surfaces were fabricated. In the other two groups (Z and E), CAD/CAM technology was used for the fabrication of 20 zirconium‐oxide‐based ceramic single crowns with two systems. All zirconia crowns were cemented with glass‐ionomer cement, always following the manufacturer's instructions. The same dentist carried out all clinical phases. The teeth were extracted 1 month later. Marginal gaps along vertical planes were measured for each crown, using a total of four landmarks for each tooth by means of a microscope at a magnification of 50×. On completion of microscopic evaluation, representative specimens from each group were prepared for ESEM evaluation. Mean and standard deviations of the four landmarks (mesial, distal, buccal, palatal) at each single crown were calculated for each group. Multivariate analysis of variance (MANOVA) was performed to determine whether the four landmarks, taken into consideration together, differed between groups. Two‐way ANOVA was performed to study in detail, for each landmark, how the three systems used to produce the FPDs affected the gap measurements. Differences were considered to be significant at p < 0.05.

Results: MANOVA revealed no quantitative differences of the four landmarks, when taken into consideration together, between the three groups (p < 0.0001). Two‐way ANOVA, performed at each landmark, revealed no quantitative differences between the three groups (p < 0.0001 for each landmark).

Conclusions: Within the limitations of this study, it was concluded that the two zirconium‐oxide‐based ceramic CAD/CAM systems demonstrated a similar and acceptable marginal fit when compared to more traditional metal ceramic crowns.