bluuebunny/crossref_metadata_2025 huggingface dataset:
On the relevance of premium payment schemes for the performance of mutual funds with investment guarantees
Authors: Gatzert Nadine
Published: October 2013

Purpose

– In financial planning, customers are typically confronted with choosing a premium payment scheme when investing in a mutual fund, which is often equipped with an investment guarantee to provide downside protection. Guarantee costs may thereby also be charged differently depending on the provider. The paper aims to investigate the impact of the premium payment method on different performance measures for a mutual fund with an investment guarantee.

Design/methodology/approach

– The paper compares a fund with annual and upfront premiums as well as constant guarantee costs versus the guarantee price as an annual percentage fee of the fund value, always ensuring that the present value of premium payments is the same for all product variants. The paper further studies the relevance of the guarantee level and the contract term.

Findings

– The results emphasize that even though the present value of premiums paid into the contract is the same, the type of premium (upfront versus annual) as well as the type of guarantee cost (upfront versus annual fee) has a considerable impact on the performance.

Practical implications

– Providers can thus make a product more attractive for consumers by individually adjusting the premium scheme depending on their preferences and by making the resulting risk-return-profile transparent, while keeping the other contract characteristics unchanged (e.g. extent of the guarantee).

Originality/value

– To date, there has been no comprehensive analysis with specific focus on the impact of different premium payment schemes (in particular with respect to savings premiums and guarantee costs) on risk and return of a mutual fund with otherwise given contract characteristics such as the underlying fund strategy and the investment guarantee, even though the premium scheme itself can already have a considerable impact on the terminal payoff distribution and thus risk-return profiles. In addition, such an analysis can provide important information for consumers and providers in designing and choosing attractive products by simply adjusting the premium scheme (if possible) instead of or in addition to changing other product features.
The missing leaders: rediscovering the ward sister/charge nurse role
Authors: Hewison Alistair
Published: October 2013

Purpose

– The aim of this paper is to examine the leadership role of the ward sister/charge nurse in the English National Health Service and demonstrate that its influence in maintaining standards of care has been undermined.

Design/methodology/approach

– This is achieved through a critical review of the relevant research and policy literature. Evidence relating to recent failures in the provision of nursing care is summarised to establish the nature of the problem. This is followed by an analysis of existing research concerned with the ward sister/manager role in the context of recent policy.

Findings

– The evidence demonstrating that the ward sister/charge nurse is one of the key determinants of quality care has been overlooked in recent years and this in part accounts for the quality failures that have occurred in NHS hospitals of late.

Practical implications

– Action is needed to place the ward sister/charge nurse at the heart of the hospital system. Systems of organisational and mutual support are needed to ensure that these ward-based leaders can reach their full potential as the guardians of care.

Originality/value

– The perspective offered in this paper illustrates how a solution to pressing organisational problem can be found through accessing the appropriate literature. Although the recommended action may not be “new” it is novel in the sense that it is based on rediscovering a role that already exists and can be supported to bring about change, rather than seeking wholesale complex change.
Effect of hydrostatic initial stress on a fiber-reinforced thermoelastic medium with fractional derivative heat transfer
Authors: Ibrahim Othman Mohamed , M. Said Samia , Sarker N.
Published: October 2013

Purpose

– The purpose of this paper is to investigate the influences of fractional order, hydrostatic initial stress and gravity field on the plane waves in a linearly fiber-reinforced isotropic thermoelastic medium.

Design/methodology/approach

– The problem has been solved analytically and numerically by using the normal mode analysis.

Findings

– Numerical results for the temperature, the displacement components and the stress components are presented graphically and analyzed the results. The graphical results indicate that the effect of fractional order, hydrostatic initial stress and gravity field on the plane waves in the fiber-reinforced thermoelastic medium are very pronounced. Comparisons are made with the results in the absence and presence of hydrostatic initial stress and gravity field.

Originality/value

– In the present work, the authors shall formulate a fiber-reinforced two-dimensional problem under the effect of fractional order, hydrostatic initial stress, and gravity field. The normal mode analysis is used to obtain the exact expression for the temperature, displacement components, and stress components. A comparison is also made between the three theories in the absence and presence of gravity field. Such problems are very important in many dynamical systems.
A comparative picture of corporate social responsibility approaches by leading companies in the United Kingdom and Brazil
Authors: Cavalcanti Sá Abreu Mônica , Barlow Claire
Published: October 2013

Purpose

– This paper aims to compare the CSR strategy, stakeholder engagement and overseas approaches of six leading companies that have large potential environmental and social impacts, influential stakeholders and notable CSR actions.

Design/methodology/approach

– This is an exploratory survey based on interviews with senior executives from British and Brazilian companies operating in the steel, petroleum and retail sectors, that makes comparisons between and within them.

Findings

– The British companies interviewed are more rule-based, adopt an implicit CSR approach, react to stakeholders' demands based on moral motives, and focus on environmental issues. The Brazilian companies reviewed in this study adopt an explicit CSR approach, have relational motives to engage with stakeholders, and are more concerned with building a responsible image and narrowing social gaps.

Research limitations/implications

– The survey is based on the perceptions of the senior executives interviewed, which may or may not correspond to actual practices. The sample size restricts generalisation of the results, and the specific firms interviewed may not represent the prevailing CSR business strategy in their respective countries.

Practical implications

– British companies can learn from the Brazilian experience how to become more innovative in a broader approach to CSR. Brazil should reinforce its legal framework to provide a more systematic and rule-based approach to CSR, close to the UK experience.

Originality/value

– The way CSR is conceived and implemented depends on the ethical, socioeconomic, legal and institutional environment of the country in which the firm operates.
Quantifying variation among garden plants in attractiveness to bees and other flower‐visiting insects
Authors: Garbuzov Mihail , Ratnieks Francis L. W.
Published: October 2013

Pollinating insects are globally declining, with one of the main causes being the loss of flowers. With the value of countryside reducing, urban areas, particularly gardens, are increasingly recognized as of benefit to wildlife, including flower‐visiting insects.

Many gardeners specifically select plant varieties attractive to wildlife. Given the wide public interest, many lists of recommended varieties have been produced by both amateurs and professional organizations, but appear not to be well grounded in empirical data. These lists, however, are not without merit and are an obvious starting point. There is clearly a need to put the process onto a firmer footing based more on data and less on opinion and general experience.

We collected data over two summers by counting flower‐visiting insects as they foraged on 32 popular summer‐flowering garden plant varieties in a specially planted experimental garden, with two smaller additional gardens set up in year two to check the generality of the results. With many thousands of plant varieties available to gardeners in the United Kingdom, and other countries or regions, it would have been an impossible task to make a comprehensive survey resulting in a complete and authoritative list.

Our results are valuable and encouraging. Garden flowers attractive to the human eye vary enormously, approximately 100‐fold, in their attractiveness to insects. Insects, especially bees and hover flies, can be attracted in large numbers with clear differences in the distribution of types attracted by different varieties.

Our results clearly show that there is a great scope for making gardens and parks more bee‐ and insect‐friendly by plant selection. Horticulturally modified plant varieties created by plant breeding, including hybrids, are not necessarily less attractive to insects and in some cases are more attractive than their wild‐type counterparts. Importantly, all the plants we compared were considered highly attractive to humans, given that they are widely sold as ornamental garden plants.

Helping insect pollinators in gardens does not involve extra cost or gardening effort, or loss of aesthetic attractiveness. Furthermore, the methods of quantifying insect‐friendliness of plant varieties trialled in this study are relatively simple and can form the basis of further research, including ‘citizen science’.
Are there evolutionary consequences of plant–soil feedbacks along soil gradients?
Authors: Schweitzer Jennifer A. , Juric Ivan , van de Voorde Tess F. J. , Clay Keith , van der Putten Wim H. , Bailey Joseph K.
Published: October 2013

Both abiotic and biotic gradients exist in soils, and several of these gradients have been shown to select for plant traits. Moreover, plants possess a multitude of traits that can lead to strong niche construction (i.e. plant‐induced changes to soils). Our objectives in this paper are to outline both empirical and theoretical evidence for the evolutionary consequences of plant–soil linkages and feedbacks on plants along soil heterogeneity gradients.

We describe a simple mathematical model of plant evolution to explore the relationship between the sign and magnitude of feedback and the divergence of plant traits. We also constructed an individual‐based simulation model to study the conditions under which plant–soil feedbacks occur, niche construction evolves, and plant traits diverge.

This approach allows us to address specific hypotheses regarding relationships between positive and negative plant–soil feedback with variation in niche construction, the strength of selective gradients and the relative importance of local adaptation vs. feedbacks.

The models suggest that feedbacks between soils and plants may commonly result in evolutionary interactions. The simulation model indicates that plant traits can diverge with niche construction and traits can be selected for in response to niche construction. However, the magnitude of feedbacks and how strongly they evolve depends on the amount of gene flow and the strength of selective gradients over time.

These results suggest that plant–soil feedback can lead to evolution in plants and reveals new research directions for further inquiry. Questions addressing trade‐offs and relationships between positive and negative feedbacks as well as adaptation and maladaptation of plant traits represent important frontiers in plant–soil feedback studies.
Umlaut in the Bantu B80 Languages of the Kwilu (DRC)
Authors: Bostoen Koen , Muluwa Joseph Koni
Published: October 2013

Umlaut is a rather uncommon sound change in Bantu. However, it is prolific in a number of closely related Bantu languages spoken in the Kwilu District of DR Congo, also known as the ‘Bantu B80’ languages. This shared phonological innovation is not only diagnostic of the genealogical unity of this language cluster, but variation in the way it is realized is also significant for their internal classification. In some languages, umlaut leads to an increase in phonemes through the creation of a new set of rounded front vowels. In others, umlaut triggers vowel change without impact on the number of vowel qualities. This paper presents a detailed descriptive and comparative study of this specific kind of vowel harmony and the phonological contexts in which it is triggered.
Credit Constraint and the Asymmetric Monetary Policy Effect on House Prices
Authors: Chen Nan‐Kuang , Chou Yu‐Hsi , Wu Jyh‐Lin
Published: October 2013

We study the possible asymmetric effect of monetary policy on house prices under different credit regimes. We first derive the implications of a theoretical model in which agents may be collateral‐constrained. We then empirically examine the implications of the model using the threshold vector autoregression model. Two different measures reflecting the tightness of the credit market are computed to serve as the threshold variable. We find that house prices react to a monetary shock initially more strongly but the effect is less persistent in a credit boom regime than in a normal credit regime. This result is consistent with the findings of our theoretical model.
Risk of colorectal cancer in women with pelvic inflammatory disease: a matched cohort study
Authors: Hsu M‐I , Lin H‐W
Published: October 2013

Objective

Inflammation is an important risk factor for the development of colorectal cancer (CRC). Pelvic inflammatory disease (PID) comprises a spectrum of upper genital tract infections and inflammatory diseases. We aimed to evaluate the association between CRC and PID.

Design

Matched cohort study using the National Health Insurance Research Database.

Setting

Women with PID in Taiwan.

Population and sample

From the Longitudinal Health Insurance Database 2005 (LHID2005) in Taiwan, we obtained data on women from 13 to 45 years of age who were diagnosed with PID. The women with PID were matched 1:4 to selected members of the population without PID based on age and year of first entry into the LHID2005.

Methods

A Cox proportional hazards model was used to evaluate the hazard ratio for CRC during the 5‐year follow‐up period, after adjusting for sociodemographic characteristics and selected comorbid medical disorders.

Main outcome measures

Colorectal cancer.

Results

Of the 19 029 women with PID, 30 were diagnosed with CRC during the 78 965 person‐year follow‐up period. Of the 76 116 control women, 66 were diagnosed with CRC. The CRC hazard ratio during the 5‐year follow‐up period was 2.00 (95% CI 1.30–3.08) for women with PID relative to control women. Similarly, after adjusting for age, Charlson comorbidity index score, urbanisation level and monthly income, the adjusted CRC hazard ratio was 1.71 (95% CI 1.10–2.65) for the women with PID relative to the women in the comparison cohort.

Conclusions

Here we show a weak association between PID and CRC. Additional studies are needed to further evaluate this association and examine plausible mechanisms, including the influence of specific microorganisms.
Effect of Hospital–SNF Referral Linkages on Rehospitalization
Authors: Rahman Momotazur , Foster Andrew D. , Grabowski David C. , Zinn Jacqueline S. , Mor Vincent
Published: October 2013

Objective

To determine whether the rate of rehospitalization is lower among patients discharged to skilled nursing facilities (SNFs) with which a hospital has a strong linkage.

Data Sources/Collection

We used national Medicare enrollment, claims, and the Minimum Data Set to examine 2.8 million newly discharged patients to 15,063 SNFs from 2,477 general hospitals between 2004 and 2006.

Study Design

We examined the relationship between the proportion of discharges from a hospital and alternative SNFs on the rehospitalization of patients treated by that hospital–SNF pair using an instrumental variable approach. We used distances to alternative SNFs from residence of the patients of the originating hospital as the instrument.

Principal Findings

Our estimates suggest that if the proportion of a hospital's discharges to an SNF was to increase by 10 percentage points, the likelihood of patients treated by that hospital–SNF pair to be rehospitalized within 30 days would decline by 1.2 percentage points, largely driven by fewer rehospitalizations within a week of hospital discharge.

Conclusions

Stronger hospital–SNF linkages, independent of hospital ownership, were found to reduce rehospitalization rates. As hospitals are held accountable for patients' outcomes postdischarge under the Affordable Care Act, hospitals may steer their patients preferentially to fewer SNFs.
Assessing Farmers' Willingness to Accept “Greening”: Insights from a Discrete Choice Experiment in Germany
Authors: Schulz Norbert , Breustedt Gunnar , Latacz‐Lohmann Uwe
Published: October 2013

This paper explores farmers' prospective responses to the “greening” of the Common Agricultural Policy. The analysis is based on discrete choice experiments with 128 German farmers. Participants were asked to choose between a “greening” option with a given set of management prescriptions and an “opt‐out” alternative with a stipulated cut of the single direct payment. A binary logit model is used to identify the variables affecting the likelihood of “greening” being chosen. In addition, latent class estimations are carried out to group respondents into latent classes of “compliers” and “non‐compliers”. We find that farmers' choices are driven by “greening” policy attributes, personal and farm characteristics, and interactions between these two groups of variables. Farmers perceive “greening” as a costly constraint, but not all farmers are equally affected and not all “greening” provisions are regarded as equally demanding. Specialised arable farms on highly productive land and intensive dairy farms are most likely to opt out of “greening” and voluntarily forgo part of their single payment entitlements. The paper concludes with a set of recommendations for improving the design of a second‐best policy.
When should FDG‐PET be used in the modern management of lymphoma?
Authors: Barrington Sally Fiona , Mikhaeel Nabegh George
Published: October 2013

Positron Emission Tomography (PET) is a functional imaging technique that, combined with computerized tomography (PET‐CT), is increasingly used in lymphoma. Most subtypes accumulate fluorodeoxyglucose (FDG) and the increased sensitivity of PET‐CT, especially for extranodal disease, compared to CT, makes PET‐CT an attractive staging tool. The availability of a staging PET‐CT scan also improves the accuracy of subsequent response assessment. ‘Interim’ PET‐CT can be used to assess early response and end‐of‐treatment PET‐CT assesses remission. Clinical trials are currently seeking to establish whether the predictive value of PET‐CT can be successfully used to guide individual treatment to reduce toxicity and/or to improve outcomes. Standardized methods for performing and reporting PET have been developed in the context of trials. The role of PET in transplantation selection is currently evolving, as it appears to be more accurate and prognostic than CT. The role of FDG PET‐CT throughout the management course in patients with lymphoma is explored in this review, with areas discussed that may limit the use of PET‐CT imaging which clinicians should be familiar with to inform practice.
The protein kinase C inhibitor sotrastaurin allows regulatory T cell function
Authors: de Weerd A , Kho M , Kraaijeveld R , Zuiderwijk J , Weimar W , Baan C
Published: October 2013

The novel immunosuppressant sotrastaurin is a selective inhibitor of protein kinase C isoforms that are critical in signalling pathways downstream of the T cell receptor. Sotrastaurin inhibits nuclear factor (NF)-κB, which directly promotes the transcription of forkhead box protein 3 (FoxP3), the key regulator for the development and function of regulatory T cells (Tregs). Our center participated in a randomized trial comparing sotrastaurin (n = 14) and the calcineurin inhibitor Neoral (n = 7) in renal transplant recipients. We conducted ex vivo mixed lymphocyte reaction (MLR) and flow cytometry studies on these patient samples, as well as in vitro studies on samples of blood bank volunteers (n = 38). Treg numbers remained stable after transplantation and correlated with higher trough levels of sotrastaurin (r = 0·68, P = 0·03). A dose-dependent effect of sotrastaurin on alloresponsiveness was observed: the half maximal inhibitory concentration (IC50) to inhibit alloactivated T cell proliferation was 45 ng/ml (90 nM). In contrast, Treg function was not affected by sotrastaurin: in the presence of in vitro-added sotrastaurin (50 ng/ml) Tregs suppressed the proliferation of alloactivated T effector cells at a 1:5 ratio by 35 versus 47% in the absence of the drug (P = 0·33). Signal transducer and activator of transcription 5 (STAT)-5 phosphorylation in Tregs remained intact after incubation with sotrastaurin. This potent Treg function was also found in cells of patients treated with sotrastaurin: Tregs inhibited the anti-donor response in MLR by 67% at month 6, which was comparable to pretransplantation (82%). Sotrastaurin is a potent inhibitor of alloreactivity in vitro, while it did not affect Treg function in patients after kidney transplantation.
Visualization of the Centre of Projection Geometrical Locus in a Single Image
Authors: Stojaković V. , Popov S. , Tepavčević B.
Published: October 2013

Single view reconstruction (SVR) is an important approach for 3D shape recovery since many non‐existing buildings and scenes are captured in a single image. Historical photographs are often the most precise source for virtual reconstruction of a damaged cultural heritage. In semi‐automated techniques, that are mainly used under practical situations, the user is the one who recognizes and selects constraints to be used. Hence, the veridicality and the accuracy of the final model partially rely on man‐based decisions. We noticed that users, especially non‐expert users such as cultural heritage professionals, usually do not fully understand the SVR process, which is why they have trouble in decision making while modelling. That often fundamentally affects the quality of the final 3D models. Considering the importance of human performance in SVR approaches, in this paper we offer a solution that can be used to reduce the amount of user errors. Specifically, we address the problem of locating the centre of projection (CP). We introduce a tool set for 3D visualization of the CP's geometrical loci that provides the user with a clear idea of how the CP's location is determined. Thanks to this type of visualization, the user becomes aware of the following: (1) the constraint relevant for CP location, (2) the image suitable for SVR, (3) more constraints for CP location required, (4) which constraints should be used for the best match, (5) will additional constraints create a useful redundancy. In order to test our approach and the assumptions it relies on, we compared the amount of user made errors in the standard approaches with the one in which additional visualization is provided.
Scintigraphic assessment of gastrointestinal motility: a brief review of techniques and data interpretation
Authors: Madsen Jan L.
Published: October 2013

Gastrointestinal transit reflects overall gastrointestinal motor activity and is regulated by a complex interplay between neural and hormonal stimuli. Thus, transit measurements provide a measure of the combined effects of gastrointestinal muscular activity and feedback from the gut and brain. Dysmotility in the different major segments of the gastrointestinal tract may give rise to similar symptoms; hence, localizing transit abnormalities to a specific segment is a valuable element of diagnostic evaluation. Scintigraphy is an effective noninvasive tool to assess gastric emptying as well as small intestinal and colonic transit. This article reviews current imaging techniques, methods for data processing and principles for evaluating results when scintigraphy is used to assess gastrointestinal motility. Furthermore, clinical indications for performing scintigraphy are reviewed.
High prevalence of human metapneumovirus subtype B in cases presenting as severe acute respiratory illness: an experience at tertiary care hospital
Authors: Jain Bhawana , Singh Ajay Kr , Dangi Tanushree , Agarwal Anjali , Verma Anil Kumar , Dwivedi Mukesh , Singh Kaleshwar P. , Jain Amita
Published: October 2013

Purpose

A comparatively newly discovered human metapneumovirus (HMPV) has emerged as an important cause of severe acute respiratory illness (SARI), second only to respiratory syncytial virus (RSV). RSV and HMPV taxonomically belong to same family and subfamily, and their clinical presentation and seasonal distribution are also seemed to be indistinguishable. Present study was planned to know the epidemiology and prevalence of HMPV and RSV in patients presented as SARI in a tertiary care hospital.

Methods

Nasopharyngeal aspirate of 440 patients fulfilling World Health Organization criteria of SARI, enrolled during a 2‐year study period, were collected and tested for the presence of RSV, HMPV and their subtypes A and B by real time polymerase chain reaction along with other respiratory viruses, viz influenza A, B, parainfluenza 1, 2, 3, 4, adenovirus, measles virus and bocavirus. The demographic details, clinical profile, underlying diseases, clinical diagnosis at the time of admission and seasonal distribution were studied and analyzed statistically.

Results

Overall positivity of RSV was 14.3% (24.68% in <5 years) and of HMPV was 3.63% (5.1% in <5 years and 5.08% in 6–12 years). Among RSV, subtype A (89%), and among HMPV, genotype B (68.8%) were predominating. Adults having underlying chronic obstructive pulmonary disease were more prone to acquire RSV and HMPV infections. RSV and HMPV positivity was restricted to winter season. We are reporting replacement of RSV with HMPV in this population.

Conclusions

HMPV has emerged as an important cause of SARI in children <12 years of age. Alternative predominance of RSV and HMPV is an important observation.
Spirometry may underestimate airway obstruction in professional Greek athletes
Authors: Myrianthefs Pavlos , Grammatopoulou Irini , Katsoulas Theodoros , Baltopoulos George
Published: October 2013

Purpose

Lung development and consequently, lung volumes, are affected by the duration, type and intensity of sporting. Athletes may have higher spirometric values compared to predicted which may lead to misclassification of this population and misdiagnosis during clinical evaluation. The aim of the study was to compare measured spirometric values with those predicted from the European Community for Steel and Coal statement in Greek professional athletes.

Methods

Measured and predicted spirometric values were recorded from 276 normal professional athletes (168 males, 108 females), aged 15–60 years originated from the metropolitan area of Athens, Greece. Predicted and measured spirometric values were compared using a paired sample t‐test and analysed using Bland–Altman method.

Results

Measured FEV1 was 109.6 (1.02%) and 109.4 (1.29%) and FVC was 110.8 (1.07%) and 109.6 (1.02%) compared to predicted in males and females respectively. The FEV1/FVC ratio was 102.2 (0.55%) and 103.2 (0.58%) compared to predicted for males and females, respectively. Bland–Altman analysis revealed a significant bias and magnitude of difference between predicted and measured spirometric values.

Conclusions

European Community for Steel and Coal predicted spirometric values significantly underestimated measured lung volumes and FEV1/FVC ratio in Greek athletes of both sexes. Predicted spirometric indices should be used with caution in the evaluation of athletes presenting with respiratory symptoms for the risk of underestimation of restrictive disease or airway obstruction.
De novo psychogenic nonepileptic attacks after adult epilepsy surgery: An underestimated entity
Authors: Markoula Sofia , de Tisi Jane , Foong Jacqueline , Duncan John S.
Published: October 2013

We retrospectively assessed all patients in a large cohort of patients with epilepsy surgery at the National Hospital for Neurology and Neurosurgery (NHNN) over 12 years, to identify patients with postoperative psychogenic nonepileptic attacks (PNEA). Twenty‐nine patients (23 women) were identified of a total of 790 patients, a frequency of 3.7%. Female gender and presurgical psychiatric diagnosis, other than psychosis, were significant risk factors for PNEA development. In female patients with a preoperative psychiatric diagnosis the chance of developing PNEA after epilepsy surgery was 8.5%. PNEA developed between 2 weeks and 10 years after epilepsy surgery, independently of outcome of epileptic seizures. In most cases, PNEA differed from the present or past epileptic seizures, and motor symptoms were the most common manifestations. Seizures after epilepsy surgery should be carefully evaluated. Physicians should consider the possibility of PNEA, especially in female patients with preoperative psychiatric comorbidity developing “atypical” seizures with motor manifestations postoperatively, even many years after epilepsy surgery.
Comparison of cystatin C and Beta‐2‐microglobulin kinetics in children on maintenance hemodialysis
Authors: Marsenic Olivera , Wierenga Andrea , Wilson Donna R. , Anderson Michael , Shrivastava Tripti , Simon Garfield A. , Beck Anne M. , Swanson Tiffany J. , Studnicka Kathleen , Elberg Dorit , Singh Nisha S. , Couloures Kevin , Henry Dwayne , Turman Martin A.
Published: October 2013

Middle‐molecules (MM) are not monitored in children on hemodialysis (HD), but are accumulated and increase the risk of cardiovascular disease and mortality. Molecular properties of Cystatin C (CyC), 13 kDa, potentially make it a preferred MM marker over Beta‐2‐Microglobulin (B2M), 12 kDa. We compared CyC and B2M kinetics to investigate if CyC can be used as preferred MM marker. CyC (mg/L) and B2M (μg/mL) were measured in 21 low‐flux HD sessions in seven children. Blood samples were taken at HD start (pre), 1 and 2 hours into HD and at end of HD (post) for all sessions and 60 minutes after the first HD (Eq). PreCyC (9.85 ± 2.15) did not differ (P > 0.05) from postCyC (10.04 ± 2.83). PostB2M (38.87 ± 7.12) was higher (P < 0.05) than preHD B2M (33.27 ± 7.41). There was no change in CyC at 1 and 2 hours into HD, while B2M progressively increased. CyC or B2M changes did not significantly correlate with spKt/V (2.09 ± 0.86), ultrafiltration (4.61 ± 1.98%) or HD duration (218 ± 20 minutes). EqCyC was not different from postCyC (11.07 ± 3.14 vs. 10.71 ± 2.85, P > 0.05), while EqB2M was lower than postB2M (36.48 ± 7.68 vs. 41.09 ± 8.99, P < 0.05). MMs as represented by B2M and CyC are elevated in children on standard HD. Intensified HD modalities would be needed for their removal. B2M is affected by the dialytic process with a rise during HD independent of ultrafiltration and decrease 1 hour after, while CyC remains unchanged. We suggest that CyC be used as preferred marker of MM removal and as a marker of adequacy of intensified HD regimens.
Calciphylaxis and subtotal parathyroidectomy: A double‐edged sword
Authors: Katikaneni Madhavi , Lwin Lin , Villanueva Hugo , Yoo Jinil
Published: October 2013

Calciphylaxis, also called calcific uremic arteriolopathy is a dreadful, life‐threatening ischemic vasculopathy, primarily involving skin and subcutaneous tissue, mostly on patients with end‐stage kidney disease. Calciphylaxis is a well‐described, but still a poorly understood disorder of mineral metabolism. Its occurrence is rare, but increasingly reported. We describe a 62‐year‐old obese lady on hemodialysis for end‐stage kidney disease due to type 2 diabetes, who developed two episodes of calciphylactic skin lesions during the 3 years observation. The healing of lesions in the first episode was prompted by a subtotal parathyroidectomy for severe secondary hyperparathyroidism. However, the resumption of oral calcium and vitamin D analog for the parathyroidectomy‐related hypocalcemia induced another occurrence of widespread calciphylactic skin lesions in areas of great adiposity. The typical regimen of IV sodium thiosulfate brought a successful outcome to the second episode. Now, growing numbers of successful treatment for calciphylaxis are reported with more specific therapies and a clear understanding of the pathogenetic mechanism is in sight.
An investigation of the international literature on nurse practitioner private practice models
Authors: Currie J. , Chiarella M. , Buckley T.
Published: October 2013

Aim

To investigate and synthesize the international literature surrounding nurse practitioner (NP) private practice models in order to provide an exposition of commonalities and differences.

Background

NP models of service delivery have been established internationally and most are based in the public healthcare system. In recent years, opportunities for the establishment of NP private practice models have evolved, facilitated by changes in legislation and driven by identification of potential patient need. To date, NP private practice models have received less attention in the literature and, to the authors' knowledge, this is the first international investigation of NP private practice models.

Design

Integrative literature review.

Method

A literature search was undertaken in October 2012. Database sources utilized included Medical Literature Analyses and Retrieval (MEDLINE), the Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest, Scopus and the Cochrane Database of Systematic Reviews (CDSR). The grey literature was also searched. The following Medical Subject Headings (MeSH) and search terms used both individually and in combination included nurse practitioners; private practice; joint practice; collaboration; and insurance, health and reimbursement. Once literature had been identified, a thematic analysis was undertaken to extract themes.

Results

Thirty manuscripts and five publications from the grey literature were included in the final review. Private practice NP roles were identified in five countries, with the majority of the literature emanating from the USA. The thematic analysis resulted in the identification of five themes: reimbursement, collaborative arrangements, legislation, models of care and acceptability.

Conclusion

Proportionally, there are very few NPs engaged in private practice internationally. The most common NP private practice models were community based, with NPs working in clinic settings, either alone or with other health professionals. Challenges in the context of legislation and financial reimbursement were identified in each country where private practice is being undertaken.
The in‐vitro antibacterial effects of organic salts, chemical disinfectants and antibiotics against pathogens of black disease in fairy shrimp of Thailand
Authors: Saejung C , Hatai K , Sanoamuang L
Published: October 2013

The antibacterial effects of organic salts, chemical disinfectants and antibiotics were evaluated on cultures of Aeromonas hydrophila C03, Aeromonas sobria C26, A. sobria C29, Aeromonas caviae C24 and Acinetobacter sp. SH‐94B, the pathogens that cause black disease found in fairy shrimps (Streptocephalus sirindhornae Sanoamuang et al. (2000) and Branchinella thailandensis Sanoamuang, Saengphan & Murugan) of Thailand. The minimal inhibitory concentrations (MICs) of organic salts (sodium chloride and potassium chloride) and antibiotics (oxytetracycline dihydrate, streptomycin sulphate, kanamycin monosulphate, chloramphenicol and ampicillin) were determined using the agar‐dilution method. The effect of chemical disinfectants (sodium hypochlorite and chlorine dioxide) was evaluated by exposing bacteria to different concentrations of these chemicals for different periods of time. Interestingly, all strains were intrinsically resistant to 0.25–3% sodium chloride and potassium chloride. The effect of sodium hypochlorite was greater than that of chlorine dioxide, and 5–20 μg mL−1 of sodium hypochlorite was sufficient to inhibit the growth of these bacteria, but the exposure time varied, depending on the bacterial species. Of the antibiotics tested, chloramphenicol and oxytetracycline dihydrate completely inhibited the selected strains. Chloramphenicol showed the highest antibacterial effect against all pathogenic species – the MIC and minimal bactericidal concentration (MBC) ranged from 0.8 to 3.1 μg mL−1 from 3.1 to 6.25 μg mL−1, respectively. To achieve control of black disease during cultivation of fairy shrimp, data derived from this study can be used as a basis for further toxicity tests in vivo.
Performance of a New Steroid‐Eluting Coronary Sinus Lead Designed for Left Ventricular Pacing
Authors: ACHTELIK MICHAEL , BOCCHIARDO MARIO , TRAPPE HANS‐JOACHIM , GAITA FIORENZO , LOZANO IGNACIO , NIAZI IMRAN , GOLD MICHAEL , YONG PATRICK , DUBY CHRISTIAN ,   On behalf of the ventak chf/contak CD CLINICAL INVESTIGATION STUDY GROUP
Published: October 2013

The Ventak CHF/CONTAK CD Biventricular Pacing Study is a prospective randomized trial to examine the safety and efficacy of biventricular (BV) pacing in patients with standard indications for an ICD, symptomatic heart failure, a LVEF ≤ 0.35, and a QRS ≥ 120 ms. Patients underwent implantation of a BV pacing and sensing system with backup defibrillation capability, which includes a steroideluting coronary venous lead that is advanced into the coronary venous vasculature by over‐the‐wire techniques. LV pacing threshold, BV impedance, and BV R wave amplitude were measured in 58 consecutive patients. Using a percutaneous over‐the‐wire insertion technique, steroid‐eluting coronary venous leads were associated with satisfactory mean LV pacing threshold, BV impedance, and BV R wave amplitude acutely up to 4 months after implantation. Pacing threshold stabilized 2 weeks after lead implantation and sensing threshold remained stable from the time of implant.
Influence of Posture, Breathing Pattern, and Type of Exercise on Minute Ventilation Estimation by a Pacemaker Transthoracic Impedance Sensor
Authors: DURU FIRAT , RADICKE DIRK , WILKOFF BRUCE L. , COLE CHRISTOPHER R. , ADLER STUART , NELSON LINDA , JENSEN DONALD N. , STROBEL ULLA , PORTZLINE GERALD , CANDINAS RETO
Published: October 2013

Previous studies have shown a high correlation between transthoracic impedance minute ventilation (IMV) determined by a pacemaker sensor and actual minute ventilation (VĖ) measured by standard methods. We hypothesized that several factors (e.g., posture, breathing pattern, and exercise type) could potentially affect the calibration between IMV and VĖ. In patients with Medtronic Kappa 400 pacemakers, VĖ (L/min) was monitored using a standard cardiopulmonary metabolic gas analysis system with simultaneous recording of IMV (ohms/min) using DR‐180 extended telemetry monitors. Effects of posture and of breathing pattern at rest (19 patients; age 60 ± 13 years) were evaluated by monitoring each patient under three conditions: (a) slow breathing, supine, (b) slow breathing, sitting, and (c) shallow breathing, supine. Calibration at rest was defined as the ratio of IMV to VĖ. Effect of type of exercise on calibration compared treadmill versus graded bicycle ergometer exercise (18 patients; age 62 ± 14 years). Calibration during exercise was defined as: (a) “Begin” (the IMV to VĖ ratio at VĖ =10 L/min, the typical VĖ value at beginning of exercise), and (b) slope of the IMV/VĖ regression line. Calibration of IMV/VĖ was significantly smaller for sitting versus supine position (0.7130.177, P ≤ 0.001) and for shallow versus slow breathing (0.7210.373, P < 0.001), and larger for treadmill versus bicycle exercise (Begin: 1.240.43, P = 0.018; Slope: 1.260.42, P = 0.013). In conclusion, posture, breathing pattern, and type of exercise affect the IMV estimation of the actual VĖ, possibly by altering the static or dynamic geometry (thus, the impedance) of the intrathoracic viscera.
Low Chronic Pacing Thresholds of Steroid‐Eluting Active‐Fixation Ventricular Pacemaker Leads: A Useful Alternative to Passive‐Fixation Leads
Authors: HIDDEN‐LUCET FRANÇOISE , HALIMI FRANCK , GALLAIS YVES , PETITOT JEAN‐CLAUDE , FONTAINE GUY , FRANK ROBERT
Published: October 2013

Active‐fixation pacemaker leads enable pacing at various sites, have a low dislodgment rate, and are easier to extract than passive‐fixation leads, though are usually not routinely implanted in the ventricle because of their higher pacing threshold. The long‐term pacing threshold associated with an active‐fixation steroid‐eluting lead was prospectively measured in 18 women and 20 men. At a mean follow‐up of 14 months (range 3–25 months), pacing threshold increased from 0.71 ± 0.29 V to 0.96 ± 0.28 V (P = 0.01) between implant and the first month of follow‐up, then remained stable over time, consistently allowing the long‐term programming of the ventricular output at 2.5 V, while lead impedance remained stable (from 647 ± 161 Ω at implant to 666 ± 122 Ω at last follow‐up). If the long‐term performance of this type of lead is confirmed, the routine implantation of ventricular steroid‐eluting active‐fixation leads should be considered since lead extraction has become a major concern.
Suppression of Sodium Current by Arachidonic Acid in Atrial Myocytes from Patients with Coronary Heart Disease
Authors: DING GUO‐LIANG , HU DAYI , LIU XIULAN , LI JIE , ZHANG GYU , LI CUILAN
Published: October 2013

This study was designed to examine the effects of arachidonic acid (AA) on atrial myocytes from patients with coronary heart disease. The patch clamp technique was used to record sodium current in human atrial myocytes, before and after administration of intracellular AA. The suppression of sodium current induced by AA was voltage‐ and dose‐dependent, with an IC50 of 10.3 μM. The activation curves of relative conductance in absence versus presence of AA, 10 μM, nearly overlapped. The 50% channel activation was at 40.8 ± 2.7 mV in the control state versus 42.5 ± 3.1 mV in presence of AA (n = 10, P > 0.05). AA at 10 μM shifted the steady‐state inactivation relationship significantly, from 94.5 ± 3.4 mV to 116.6 ± 4.1 mV (n = 11, P < 0.01) at the 50% channel inactivation point. The 50% recovery time from the inactivation state was significantly longer in the presence of 10 μM AA (27.3 ± 1.7 ms), than in the control state (5.9 ± 0.4 ms n = 8, P < 0.01). In conclusion, AA suppressed the sodium current and prolonged the duration of recovery from inactivation in atrial myocytes from patients with coronary heart disease.
Circadian Variations in Atrial Fibrillatory Frequency in Persistent Human Atrial Fibrillation
Authors: BOLLMANN ANDREAS , SONNE KAI , ESPERER HANS‐DIETER , TOEPFFER INES , KLEIN HELMUT U.
Published: October 2013

Atrial fibrillatory frequency reflects the atrial refractory period during AF. This study was conducted to investigate noninvasively the diurnal fluctuations of fibrillatory frequency in persistent human atrial fibrillation and to determine the relationship between changes in ventricular rate and fibrillatory frequency. Ambulatory ECGs were recorded in 30 patients (18 men, 12 women, mean age 60 ± 11 years) with persistent AF (< 24 hours). AF frequency was measured in 1‐minute ECG segments by subtracting averaged QRST complexes and applying Fourier analysis to the resulting signals at 4 pm, 10 pm, 4 am, and 10 am. Peak frequency was determined in the 3–12 Hz frequency band. Mean fibrillatory frequency measured 6.6 ± 0.6 Hz (range 5.0–7.8 Hz). Two different frequency patterns were distinguished comparing maximal diurnal versus nocturnal fibrillatory frequency. In six (20%) patients an increase (P = 0.045) in nocturnal fibrillatory frequency (type I) was found. In the remaining 24 (80%) patients a decrease (P < 0.001) in fibrillatory frequency occurred (type II). Type I AF showed a strong inverse correlation between relative changes (percent) in ventricular rate and fibrillatory frequency obtained from two consecutive measurement points (r = −0.88 to −.97, P < 0.01), whereas in type II AF a moderate positive correlation (r = 0.36 to 0.41, P < 0.05) was detected. These data indicate a circadian pattern in AF frequency that concurs with ventricular rate changes suggesting a modulating influence of the autonomic nervous system on atrial electrophysiology in persistent human AF.
Electrocardiographic Characteristics of Left Ventricular Outflow Tract Tachycardia
Authors: HACHIYA HITOSHI , AONUMA KAZUTAKA , YAMAUCHI YASUTERU , HARADA TOMOO , IGAWA MASAYUKI , NOGAMI AKIHIKO , IESAKA YOSHITO , HIROE MICHIAKI , MARUMO FUMIAKI
Published: October 2013

Catheter ablation of idiopathic left ventricular outflow tract tachycardia (LVOT‐VT) is rare because a safe ablation technique at this site has not been described, and serious complications may occur. This study compared the QRS morphology of LVOT‐VT with that of idiopathic right ventricular outflow tract tachycardia. A comparison was made between the electrocardiographic characteristics of LVOT‐VT originating from the supravalvular region of a coronary cusp (Supra‐Ao group) with those of LVOT‐VT originating from the infravalvular endocardial region of a coronary cusp of the aortic valve within the LV (Infra‐Ao group). After precise mapping of the right ventricle, left ventricle, pulmonary artery, coronary cusps, and proximal portion of the anterior interventricular vein, there were 17 patients in whom VT was thought to be located at the LVOT by both activation and pace mapping. They were divided between a Supra‐Ao group (n = 8), and an Infra‐Ao group (n = 9). Analysis of the 12‐lead electrocardiogram (ECG) revealed an S wave in lead I in all 17 patients. A precordial R wave transition was also observed at V1 or V2 in 16 patients (94%). In 7 of 8 patients (88%) with Supra‐Ao LVOT‐VT, no S wave was observed in either V5 or V6. In contrast, an Rs pattern was observed in both V5 and V6, or in V6 only, in 100% of the patients with Infra‐Ao LVOT‐VT. A LVOT‐VT should be suspected when the ECG shows an S wave in lead I and an R/S ratio greater than 1 in lead V1 or V2, versus a coronary cusp location if there is no S wave in either lead V5 or V6.
Repolarization Changes in a Double‐Blind Crossover Study of Dofetilide Versus Sotalol in the Treatment of Ventricular Tachycardia
Authors: BORIANI GIUSEPPE , BIFFI MAURO , DE SIMONE NICOLA , BACCHI LETIZIA , MARTIGNANI CRISTIAN , BITONTI FEDERICA , ZANNOLI ROMANO , BUTROUS GHAZWAN , BRANZI ANGELO
Published: October 2013

The aim of this study was to determine whether a therapeutic response to Class III antiarrhythmic drugs is related to predictable changes in repolarization on the electrocardiogram (ECG). A group of 57 patients with ischemic heart disease and inducible ventricular tachycardia (VT) at electrophysiological study (EPS) were selected from a population enrolled in a randomized double‐blind crossover study of dofetilide (500 μg bid) versus sotalol (160 mg bid). ECGs were analyzed blindly, and RR, QT (maximum value/12 leads), QTc (Bazett's formula), QT dispersion (QTmax ‐ QTmin over 12 leads) and QTc dispersion, were calculated at baseline and on the third day of treatment (4 hours after dosing), when patients underwent EPS to test the effects of study drugs on VT inducibility. Results: At EPS 21 patients were responders to dofetilide and 22 to sotalol. On day 3, a significant increase in QT and QTc and decrease in QT and QTc dispersion, compared to baseline, was measured in responders and nonresponders, with both dofetilide and sotalol. No significant difference in QTc or QT dispersion between responders and nonresponders was observed in either treatment group. In conclusion, treatment with dofetilide and sotalol was associated with an increase in QT and QTc, and a decrease in QT and QTc dispersion. In contrast with previous reports, a differential effect on QT or QTc dispersion was not observed in drug responders versus nonresponders.