bluuebunny/crossref_metadata_2025 huggingface dataset:
Controlled follow-up survey of qualified advance directives two years after implementation of an ACP program
Authors: In Der Schmitten J , Mellert C , Wegscheider K , Marckmann G
Published: May 2012

Background: Implemented in 02/2009, the German regional ACP programbeizeiten begleiten® (‘be caring betimes’), based on Respecting Choices®, has demonstrated a moderate effect on the distribution of advance directives in the intervention region's nursing homes. In a follow-up study, we examined whether the effect was sustained and increasing over time.

Methods: Two years after the intervention (04/2011), in a cross-sectional controlled follow-up survey we compared written AD's of all live residents and a random sample of recently (since 1.7.10) deceased residents of the three co-operating nursing homes (n/hs) of our intervention region with corresponding random samples of similar size among the residents of 8 n/hs in our control regions. Primary endpoint is the prevalence of qualified ADs; an AD was regarded qualified if it included a decision on CPR, and carried a physician's signature. AD status of 235 live and 35 recently deceased residents in the intervention region was compared with that of 279 live and 36 deceased residents in the control region.

Results: In the comparison between intervention and control region, 56.7% vs. 26.0% had any written AD, 42.6% vs. 1.3% had an AD regarded helpful in case of sudden cardiac arrest, 38.3 vs. 5.7% were signed by a physician, and 37.8% vs. 0.6% fulfilled both criteria (p<0.001 for all comparisons).

Conclusion: The data confirm a sustained and relevant effect of the regional ACP program's implementation whereas qualified AD's seem rare exceptions elsewhere in German nursing homes.
CREATING SACRED SPACE FOR DYING: THE CHRYSALIS ROOM
Authors: Downs Loretta
Published: May 2012

The environment in which an experience occurs impacts the quality of that experience.

Hospitals and nursing homes are the locations for 75% of deaths in America, contrary to the surveyed preference that 80% of us want to die at home.

Institutions need to provide sacred space in the form of a private room(s) designated for the purpose of keeping vigil with the dying during the final, most sacred transformation of life:

a Chrysalis Room.

Death at home means a familiar environment filled with personal possessions and loved ones caring for the person dying. It means autonomy, privacy, comfort, quiet, control, and dignity. These qualities of home create the opportunity to care for each other, share stories, to make meaning of a life, to do the spiritual, emotional and psychological work of preparing for death. A chrysalis room in a nursing home or hospital is a quiet, comfortable, spacious, esthetic space designated for a dying person, in the care of hospice, to be supported through the final days of life. Family can be present and comfortable 24 hours. In a nursing home, the staff and other residents become family to each other. They are invited to be part of the vigil. Rituals are performed. Those who have been able to keep vigil in such sacred space report a peaceful experience, feelings of sorrow rather than painful emotions, and satisfaction for having been able to be there with one they love.
Disease specific advance care planning in a large health system
Authors: Schellinger S
Published: May 2012

Current advance care planning practices focus on completion of a health care directive which usually lack clarity in treatment preferences, provide little assistance for patients, health care agents, care team to reliably honour goals and wishes and generally focus on end of life decisions. Individuals and their health care agents living with chronic illness are unprepared to respond to the medical decision making expected when an individual has an expected complication which results in an unexpected “bad outcome.” Individuals and health care agents who participate in Disease Specific Advance Care Planning (DS-ACP) discussions have excellent satisfaction ratings; are more confident in knowing individual treatment preferences; have increase prevalence of advance care plan documents in the medical record (94.3% vs. 24.9%, p<0.001); are more likely to receive care according to documented wishes; and receive end of life care prior to death (56% vs. 37%, p=0.002). As a result of the positive outcomes from DS-ACP, it is cultural accepted as standard in for all patients living with chronic progressive illness. DS-ACP facilitator certification is now a required competency for staff caring for the complex chronically ill.

Key learning from the DS-ACP pilot identified the importance of the following strategies for successful adoption:

Leadership/stakeholders engagement.

Electronic referral and documentation process.

Patient, family, care team engagement.

DS-ACP included in system care improvement strategies.

Standard ACP education/training

Leadership to support process improvement and change management.
An innovative approach to improve advance care planning: catalysing active patient decision making at end-of-life
Authors: D. Blank H
Published: May 2012

Vital Decisions' Living Well Program is a nationally recognised patient-centred, telephonically delivered counselling program for end-of-life patients. A growing consensus in the literature notes that advance care planning may best be understood as a “health behaviour” and that the most effective intervention to increase patient participation is to provide custom-tailored information and counselling matching the individual's readiness for engagement. Our unique behaviour change Prochaska model, motivational interviewing, and counsellor neutrality, catalyses patients to become pro-active in their advance care planning and improves the communication and decision making processes. Using proprietary algorithms, patients are identified six to nine months prior to anticipated death to foster informed decision making. Engaging the patient “upstream” allows counsellors to work with the person while they are undergoing life prolonging therapies and have a relationship in place when care plan shifts become appropriate. The intervention, delivered over three to six sessions, focuses on helping patients reach the stage where they are ready, willing and able to discuss future quality of life priorities. This typically results in a Living Well Progress Plan that aligns with patient goals of care. Our rigorous outcomes measures indicate an enhanced quality of life, increased satisfaction and lower costs in advanced illness patients. The primary driver of savings is increased self-selection of palliative and hospice care earlier in the disease trajectory for longer periods. In conducting over 15,000 cases, our results demonstrate that patient activation during this time results in informed advance care planning with decreasing demand for non-beneficial treatments.
Advance care planning evaluation in hospitalised elderly patients: a multicenter, prospective study (The ACCEPT Study)
Authors: Heyland D , Dodek P , Lamontagne F
Published: May 2012

We conducted a multicenter, prospective audit to evaluate the quantity and quality of advance care planning (ACP) in 12 cities in Canada. Using validated questionnaires, we conducted face to face interviews with hospitalised patients who had advanced illness and/or their family members about their pre-hospital ACP. 123 patients (average age 80±9 years) and 77 family members (average age 62±13) participated. Preliminary data documented that, in the event of future incapacitation due to illness, 84 (68.3%) of patients had formally designated someone to represent them concerning medical treatment decisions; 67 (54.5%) had written documentation describing the medical treatments they would want or not; 100 (81.3%) had ever thought about what kinds of life-sustaining treatments they would want or not and 84 (84.0%) had discussed their wishes with family members, or with their doctor (27 (27.0%). In 77 family members (average age 62±13), we found that in the event of future incapacitation due to illness, 51 (66.2%) reported that their relative (the patient) had formally designated someone to represent them concerning medical treatment decisions; 40 (52.0%) reported that their relative had written documentation describing the medical treatments they would want or not; 67 (87.0%) had ever thought about what kinds of life-sustaining treatments they would want for their relative and 55 (82.1%) had discussed these wishes with the patient, or with their family doctor (14 (20.9%). Large numbers of patients have not completed key components of ACP by the time that they are hospitalised and are at high-risk for dying.
What do people want at the end of life, with or without an advance directive?
Authors: Van Wijmen MPS , Pasman HRW , Widdershoven GAM , Onwuteaka-Philipsen BD
Published: May 2012

In order to treat patients in accordance with their preferences as much as possible, you have to know what these preferences are. In our study we tried to resolve a part of the question what people want at the end of life in close connection to Advance Directives (ADs), because these documents are a mean to make one's preferences known. As research population a representative sample of the Dutch population (n=1402) and a cohort of people who own an AD (n=5836) were used. In written questionnaires, the participants were asked about their treatment preferences in two hypothetical scenarios, one concerning an advanced stage of cancer and the other concerning an advanced stage of dementia. The treatments included artificial feeding and hydration, resuscitation, antibiotics and artificial respiration. The results show that the preferences of the majority of people who own ADs are consistent with the document. However for some standard ADs, given out by patient organisations, this is not the case. Owners of the most common standard ADs and the general population are both more inclined to forgo treatment, but the former are more explicit. Also people distinguish between the different scenarios and treatments. Besides the results regarding people owning an AD, the authors will present how certain background characteristics, ideas and experiences with regard to the end of life are related with preferences to forgo or continue treatment.
Utilisation of the advance health directive among older Australian rural adults: a qualitative study
Authors: Sinclair C , Auret K , Forrester L , Knight A , Burgess A , Bulsara C
Published: May 2012

Advance care planning (ACP) facilitates communication of an individual's treatment wishes to their family and medical staff. Research suggests this process is beneficial, however community uptake of ACP, and its associated legal documentation, has been slow. Prochaska's transtheoretical model explains the process of engaging with health behaviours, proposing discrete stages of readiness (precontemplation, contemplation, preparation, action and maintenance). Applying this model in the ACP context suggests that an individual's perceived susceptibility and empowerment will influence transition towards the behaviour. We used qualitative methods to investigate factors influencing uptake of the newly legislated Advance Health Directive (AHD) among older adults in rural Western Australia. Interviews were conducted with 61 older adults, recruited from different sectors of the community for variation in individual levels of perceived susceptibility and empowerment. Participant responses indicated moderate levels of awareness of the AHD, and general community support for the document, however this did not predict the individual's personal stage of readiness to engage in ACP. Factors associated with the individual's level of perceived susceptibility (e.g. personal/family health scares, past experience with close others in end of life care, physician prompting) were associated with transition through the earlier stages of the model. Factors associated with the individual's level of empowerment (e.g. cognitive capacity, support from physician and family) were associated with transition through later stages of the model. A number of factors which boosted susceptibility also lowered empowerment (e.g. health scares and absence of physician or family support) suggesting the importance of timely prompting of ACP.
Physicians faced to treatments refusals
Authors: Biclet P
Published: May 2012

French Law allows patients to refuse medical treatments even if they are indispensable for their survival. Faced with this situation, physicians are generally reluctant to stop treatments but finally comply with the patient's will. However they must be certain that the decision is conscious and free. We present different cases: Adult and minor Jehovah witnesses, hunger strikers free or in prisons, patients refusing artificial alimentation, people committing suicide, adolescents refusing cancer chemotherapy and discuss the role of physicians and care team. According the specificities of the different situations, the following points must be checked:

- accurate information about the legal status of the situation faced with,

- confirmation of the patient's decision after a reasonable period,

- information about the nature futile or non futile of the treatment proposed,

- aptitude of the patient to understand physician's proposal and to make up his mind.

- certainty of the patient's age (minor), of the persons titulars of parental authority or identity of the guardians.

Precautions that must be taken by the physician include precise writings of his, diligences, consultation of the care team, recourse to the attorney or to the judge according the country laws.
The results of the invasive neurodestructive procedures in cancer pain pilot study (INPIC) What is the role of cordotomy in pain associated with malignant mesothelioma?
Authors: Makin M. , Ellershaw J. , Leach A. , Poolman M. , Sharma M. , Jeffers G. , Bridson J.
Published: May 2012

Introduction

There are around 1800 new cases of mesothelioma annually in the UK.The incidence of mesothelioma is still rising and is expected to peak between 2010 and 2015.Symptom control is central to the management of patients with mesothelioma. The National Mesothelioma Framework (2007) has suggested that patients should have access to services that offer cordotomy to provide relief from pain. There is however, great inequity in the provision of services offering cordotomy; the level of evidence to support the provision of invasive neuro-destructive procedures such as cordotomy is poor. For this small group of patients the procedures may yield significant analgesic benefit, however there is an as yet unquantified associated morbidity. This is a pilot study that focuses on cordotomy.

Aims and Methods

To establish consensus on the role of cordotomy in mesothelioma related pain and to set up a National Registry. We undertook a systematic review of the literature, and used a novel web based consensus methodology approach to clarify the role of cordotomy in the management of mesothelioma-related pain. We examined whether there was sufficient evidence to support continued provision and commissioning of cordotomy, and provide a benchmark for the availability and use of this procedure in the treatment of pain associated with mesothelioma in the U.K. The study culminated in a Consensus Conference at the Royal Society of Medicine on the 10th October 2011. Following this, we will establish a national registry study for cordotomy in mesothelioma-related pain management with Dendrite Clinical Systems.

Results

The results of the systematic review and web based consensus work will be presented. 101 participants completed the web based questionnaire; there were two rounds of Delphi before consensus was reached. Availability of cordotomy in the U.K. will be discussed.

Conclusion

The approach of systematic review, Web Based Delphi, Nominal Group and Consensus Conference was successful. In view of this we plan to apply the methodology to other interventional approaches in palliative and supportive care. A surprise finding was the quantity of qualitative data that came through the web based consensus tool.
Bored to death? An exploratory study of boredom amongst hospice inpatients
Authors: E. Leahy H. , E. Sheils R. , M. Sorley R. , M. Taylor P. , Lennard R.
Published: May 2012

Introduction

Boredom impacts upon psychological well-being and quality of life. There is little research into boredom in the physically ill, and none of patients in hospices in the UK.

Aims and Methods

To assess whether boredom is a problem in hospice inpatients; to identify factors that suggest which patients are most at risk of boredom; and to determine whether a single question (“Are you bored?”) identifies boredom as effectively as a detailed questionnaire. A validated scale, thePurposelessness, Understimulation and Boredom (PUB) Scale,was used to identify bored patients in 71 patients at three hospice inpatient units. Further questions were asked to look for an association of boredom with performance status, deafness and poor eyesight, ability to pursue long standing interests, and with depression.

Results

There was a high prevalence (79%) of boredom in this sample population. There was no clearly identified predictor of susceptibility to boredom, nor correlation with a single question. If boredom is suspected then depression should be excluded as the two are closely linked.

Conclusion

Given the psychological impact of boredom, we should investigate whether we can help hospice in-patients to find interesting or fulfilling activities in order to improve their quality of life.
It's getting harder to breath: non-invasive ventilation (NIV) in advanced chronic obstructive pulmonary disease (COPD)
Authors: Khan N. , Munday D.
Published: May 2012

Introduction

Domiciliary non-invasive positive-pressure ventilation (NIPPV) is increasingly employed to provide respiratory support in chronic respiratory failure (CRF) due to COPD. Whilst there are associated positive financial implications in a particular sub-section of patients due to reduction in hospital admission stays, significant debate remains around its long-term usefulness in COPD patients.

Aims and Methods

1. Has health-related quality of life (HRQL) been assessed in severe COPD patients undergoing domiciliary NIPPV? 2. If so, what is the impact of domiciliary NIPPV on the HRQL of severe COPD patients? 3. What are the attitudes of COPD patients towards receiving NIV to palliate breathlessness during end-stage disease? Literature review and narrative analysis.

Results

A small number of studies have been identified that have assessed HRQL impacts of domiciliary NIPPV as a secondary outcome. However, there was wide methodological heterogeneity in NIPPV use and the HRQL tools used. There is a suggestion that severe COPD patients requiring NIPPV have a worse psychological status than non-COPD patients requiring NIPPV. NIPPV may help to reduce sleep disturbance and improve components of HRQL scores, however evidence is not conclusive. No studies were found that attempted to explore the attitudes of COPD patients towards receiving NIV to palliative breathlessness in terminal disease. Conclusion: HRQL has been assessed in severe COPD patients as part of studies that aim to assess health-related outcomes of undergoing domiciliary NIPPV. However, evidence regarding the role of domiciliary NIV in improving HRQL in end-stage COPD is conflicting due to a lack of adequate studies designed to answer this question primarily and methodological heterogeneity in existing studies. No qualitative research has been carried out to address this question. There is a need for qualitative studies that examine COPD patients attitudes towards NIV as a palliative measure, as it may be of relevance for patients in the decision-making process as part of advance care planning in COPD.
Volunteer activity in end–of-life care: a national survey of current practice
Authors: France R. , Sampson L. , Bravery R. , Low J. , Candy B.
Published: May 2012

Introduction

Specialised end-of-life care supports patients and families during the last months of life and, in the UK, is commonly provided either in a hospice or in a patient's home. Demand for such care in the UK will increase with mortality rates predicted to rise from 2012 to 2030 by 17%. The precise number and contribution of volunteers is unknown. However, it is estimated that there are over 100,000 volunteers working in UK hospices and that their contribution reduces costs by around 25%. The current economic situation is likely to limit funding. This means it is essential that we understand where volunteers are currently deployed to enable planning to be based on real practice.

Aims and Methods

Focusing on volunteers in direct contact with patients and families this survey seeks to establish the extent of volunteer activity in UK end-of-life specialised care. A web-based nationwide survey of end-of-life care organisations, targeted at over 200 managers of volunteer services, including managers of hospices and home care teams.

Results

The results, which will be available, will be analysed using descriptive statistics. They will give an overview of volunteer involvement in supporting patients and families in end-of-life care, detailing aspects volunteers are involved in and establishing which services are often volunteer-led.

Conclusion

This will be the first UK-wide survey of its kind. It will highlight where further evaluation and development should be focused.
Supportive, interactive staff training may improve outcomes for residents dying in a care home.
Authors: Lewis-Holmes E. , Taylor E. , Pitfield C. , Morris J. , Wills G. , Carson N. , Jacobs H. , Livingston G.
Published: May 2012

Introduction

Dementia is associated with shortened life expectancy. Death may occur unexpectedly without end of life care planned. Most people would prefer to die at home, if possible, rather than in hospital. However, many with advanced dementia lack explicit end of life plans.

Aims and Methods

The project aimed to increase the number of residents with dementia (RWD) receiving their end of life care in the way that they and their relatives planned. We trained staff interactively, using case scenarios and encouraging reflection on their work, to enable end of life discussions with relatives. Our evaluation included residents' quality of life (QoL), and measures of staff's job demands. We implemented a training package addressing staff concerns, knowledge and communication skills. In depth interviews were carried out with staff and relatives, and collected QoL measures from 53 relatives of RWD, and retrospectively if their relative died. Staff job demand was measured.

Results

Interview analysis showed improvements in end-of-life planning and communication, and QoL improved at RWD's end-of-life. Staff's experience of job demand improved.

Conclusion

The intervention improved end-of-life communication, planning and care, as shown by themes in qualitative analysis and QoL measures.
‘Unpacking the home’ – a social science approach to researching dying at home
Authors: Turner M. , Seamark D. , Milligan C. , Brearley S. , Wang X. , Blake S. , Payne S.
Published: May 2012

Introduction

Current UK end of life care policy places high priority on patients having choice about their place of care, and promotes dying at home, based on an assumption that there are family carers able and willing to provide care for the dying person.

Aims and Methods

This paper will discuss how perspectives from a range of social sciences were brought together to investigate the experiences of people caring for a dying family member at home. Researchers with expertise in social gerontology, health geography, health psychology, primary care, medical sociology, nursing and palliative care collaborated to develop a two-year study. Their combined perspectives are being used to investigate how family carers experience ‘dying at home’. As user involvement is also important in social science research, individuals with experience of caring for a dying family member at home have helped to develop the research, and will continue to be involved throughout the study.

Results

A proposal was successfully funded through peer-reviewed competition. The qualitative design uses in-depth interviews with up to 50 bereaved carers in the north and south of England recruited via GP practices. Pilot interviews in both areas have been conducted. Using the principles of grounded theory, a cross-sectional thematic analysis of all data will be undertaken, followed by a narrative analysis of a subset of 30 transcripts.

Conclusion

A social science approach can offer perspectives on cultural beliefs and practices that would not be captured using a single disciplinary approach.
Diagnostic performance of procalcitonin for hospitalised children with acute pyelonephritis presenting to the paediatric emergency department
Authors: Chen Shan-Ming , Chang Hung-Ming , Hung Tung-Wei , Chao Yu-Hua , Tsai Jeng-Dau , Lue Ko-Huang , Sheu Ji-Nan
Published: May 2012

Objectives

Urinary tract infection (UTI) is a common bacterial infection in children that can result in permanent renal damage. This study prospectively assessed the diagnostic performance of procalcitonin (PCT) for predicting acute pyelonephritis (APN) among children with febrile UTI presenting to the paediatric emergency department (ED).

Methods

Children aged ≤10 years with febrile UTI admitted to hospital from the paediatric ED were prospectively studied. Blood PCT, C reactive protein (CRP) and white blood cell (WBC) count were measured in the ED. Sensitivity, specificity, predictive values, multilevel likelihood ratios, receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were used to assess quantitative variables for diagnosing APN.

Results

The 136 enrolled patients (56 boys and 80 girls; age range 1 month to 10 years) were divided into APN (n=87) and lower UTI (n=49) groups according to99mTc-dimercaptosuccinic acid scan results. The cut-off value for maximum diagnostic performance of PCT was 1.3 ng/ml (sensitivity 86.2%, specificity 89.8%). By multivariate regression analysis, only PCT and CRP were retained as significant predictors of APN. Comparing ROC curves, PCT had a significantly greater area under the curve than CRP, WBC count and fever for differentiating between APN and lower UTI.

Conclusions

PCT has better sensitivity and specificity than CRP and WBC count for distinguishing between APN and lower UTI. PCT is a valuable marker for predicting APN in children with febrile UTI. It may be considered in the initial investigation and therapeutic strategies for children presenting to the ED.
The future of gastroenterology training: instruction in technical skills
Authors: Anderson John
Published: May 2012

Endoscopy training has developed extensively over the past decade but despite significant improvements many challenges remain and further development of endoscopy training programmes and content is required. Endoscopy training is struggling with increasing pressure from service provision and competition for limited National Health Service (NHS) resources. There is a rapidly increasing proportion of work shifting from diagnostic to therapeutic practice in the face of limited dedicated therapeutic training provision. In addition, there is a need to align quality assurance outcomes related to endoscopic practice with the key NHS quality indicators of patient experience, clinical effectiveness and safety. A vision for the future of endoscopy training is presented focusing on the need to target training resources most effectively and developing technical skills training in parallel to non-technical skills training (eg, effective decision making, communication and teamwork). Proposals for specialist technical skills training, future information technology systems and quality assurance framework integration are developed. The need to challenge some existing culture and behaviours is explained along with a challenge to embed a life-long learning approach in endoscopy training. Endoscopy training developments aim to ensure a high quality assured endoscopy service for all patients, where a skilled workforce can be provided to meet rising demand and changing technical skills requirements.
The future developments in inflammatory bowel disease care: Table 1
Authors: Irving Peter
Published: May 2012

Inflammatory bowel disease (IBD) care has evolved markedly in the last decade and recent innovations in both therapeutics and service development should drive further improvements in the coming years. However, the challenges of the global economic downturn combined with more local issues, such as the reform of the National Health Service, will impact upon IBD service provision in the United Kingdom. Marrying the seemingly conflicting goals of ensuring that IBD care is provided by IBD specialists with the drive towards community-based care will require imaginative solutions. Fortunately, improvements in communication and other technologies should help in this regard.
The future developments in gastrointestinal radiology
Authors: Helbren Emma L , Plumb Andrew A , Taylor Stuart A
Published: May 2012

The last decade has witnessed great advances in abdominal imaging with technological developments and diagnostic improvements in CT, MRI and positron emission tomography-CT. Over the next decade, gastrointestinal imaging is set to rapidly evolve. Fluoroscopic techniques will be left behind and we will develop beyond simply anatomical imaging, embracing increasingly functional and quantitative techniques. Dose reduction and radiation-free modalities will take centre stage as imaging goes mobile, allowing clinicians at the bedside and remote subspecialty radiologists to review radiology from electronic devices. The authors discuss some of the key trends set to define the next decade in gastrointestinal radiology.
Alternative foraging strategies among bears fishing for salmon: a test of the dominance hypothesis
Authors: Gill I.D. , Helfield J.M.
Published: May 2012

Previous studies of bears (genus Ursus L., 1758) fishing for Pacific salmon (genus Oncorhynchus Suckley, 1861) suggest that dominant individuals are the most efficient foragers owing to their ability to secure access to the most productive locations. We tested this hypothesis by observing brown bears ( Ursus arctos L., 1758) fishing for chum salmon ( Oncorhynchus keta (Walbaum in Artedi, 1792)) at McNeil River, Alaska. We did not observe strong relationships between the foraging efficiency of individual bears and the frequency with which they engaged in dominance-related behaviors (e.g., displacing competitors, stealing fish, using more popular or productive locations). Although some dominant individuals achieved high catch rates, other nondominant bears foraged with comparable or greater efficiency by developing alternative strategies adapted to specific locations. Our observations demonstrate that bears may employ a variety of fishing strategies, the success of which may be location-specific and frequency-dependent. These findings suggest that physical and cognitive skills may be as important as social dominance in determining foraging success among bears.
TSIRELSON'S PROBLEM AND KIRCHBERG'S CONJECTURE
Authors: FRITZ TOBIAS
Published: May 2012

Tsirelson's problem asks whether the set of nonlocal quantum correlations with a tensor product structure for the Hilbert space coincides with the one where only commutativity between observables located at different sites is assumed. Here it is shown that Kirchberg's QWEP conjecture on tensor products of C*-algebras would imply a positive answer to this question for all bipartite scenarios. This remains true also if one considers not only spatial correlations, but also spatiotemporal correlations, where each party is allowed to apply their measurements in temporal succession. We provide an example of a state together with observables such that ordinary spatial correlations are local, while the spatiotemporal correlations reveal nonlocality. Moreover, we find an extended version of Tsirelson's problem which, for each nontrivial Bell scenario, is equivalent to the QWEP conjecture. This extended version can be conveniently formulated in terms of steering the system of a third party. Finally, a comprehensive mathematical appendix offers background material on complete positivity, tensor products of C*-algebras, group C*-algebras, and some simple reformulations of the QWEP conjecture.
AN EMPIRICAL STUDY OF FEATURE RANKING TECHNIQUES FOR SOFTWARE QUALITY PREDICTION
Authors: KHOSHGOFTAAR TAGHI M. , GAO KEHAN , NAPOLITANO AMRI
Published: May 2012

The primary goal of software quality engineering is to produce a high quality software product through the use of some specific techniques and processes. One strategy is applying data mining techniques to software metric and defect data collected during the software development process to identify potential low-quality program modules. In this paper, we investigate the use of feature selection in the context of software quality estimation (also referred to as software defect prediction), where a classification model is used to predict whether program modules (instances) are fault-prone or not-fault-prone. Seven filter-based feature ranking techniques are examined. Among them, six are commonly used, and the other one, named signal to noise ratio (SNR), is rarely employed. The objective of the paper is to compare these seven techniques for various software data sets and assess their effectiveness for software quality modeling. A case study is performed on 16 software data sets, and classification models are built with five different learners and evaluated with two performance metrics. Our experimental results are summarized based on statistical tests for significance. The main conclusion is that the SNR technique performs as well as the best performer of the six commonly used techniques.
PROGRAM MATCHING THROUGH CODE ANALYSIS AND ARTIFICIAL NEURAL NETWORKS
Authors: NASCIMENTO TIAGO M. , BOCCARDO DAVIDSON R. , PRADO CHARLES B. , MACHADO RAPHAEL C. S. , CARMO LUIZ F. R. C.
Published: May 2012

Program matching refers to the mapping between equivalent codes written in different languages — including high-level and low-level languages. This equivalence is useful for some software engineering scenarios such as determining whether rewritten code is correct, which version of a program is being used, and whether a malware is present in the program. In the present work, we propose a novel approach to solve the executable code traceability by using program code analysis and artificial neural networks. From the program code analysis we obtained execution behavior properties of the codes, and from the artificial neural networks we judge about their correspondence. Our evaluation using real code examples shows an acceptable correspondence rate between 62% and 100% with the very low rate of 4% false positives.
FRACTAL BASES OF Lp SPACES
Authors: NAVASCUÉS M. A.
Published: May 2012

The methodology of fractal sets generates new procedures for the analysis of functions whose graphs have a complex geometric structure. In the present paper, a method for the definition of fractal functions is described. The new mappings are perturbed versions of classical bases as Legendre polynomials, etc. The new elements are non-differentiable and may serve as models for pseudo-random behaviour. The proposed fractal functions have good algebraic properties and good approximation properties as well. In the present paper it is proved that they constitute bases for the most important functional spaces as, for instance, the Lebesgue spaces [Formula: see text](1 ≤ p < ∞), where I is a compact interval in the reals.
OSTEOID OSTEOMA OF THE RADIAL STYLOID MIMICKING WRIST ARTHRITIS: A CASE STUDY
Authors: Yiannakopoulos Christos K. , Foufa Konstantina , Theocharakis Stylianos , Stamoulis Efthimios , Maniatis Vassilios
Published: May 2012

Osteoid osteoma in the wrist and hand region is an uncommon but severely symptomatic primary bone tumour. We report the case of a professional athlete with a radial styloid osteoid osteoma who presented with significant wrist pain and stiffness resembling arthritis for which she was treated initially. The symptoms started after a fall on the outstretched hand and significant delay in the diagnosis occurred. Following detailed imaging evaluation of the tumour site excision biopsy was curative.
AN UNUSUAL CASE OF PRIMARY CUTANEOUS LYMPHOMA PRESENTING IN THE UPPER EXTREMITY: A CASE REPORT
Authors: Sia Wei-Tee , Tan Puay-Ling , Chuah Khoon-Leong , Teoh Lam-Chuan
Published: May 2012

Primary cutaneous lymphomas rarely present to the hand surgeon. Diagnosis of primary cutaneous lymphoma in the upper extremity can be difficult to make, as they are rare, and may be mistaken for other lesions. We report an unusual case of primary cutaneous lymphoma presenting in the upper extremity. This rare differential should be considered when encountered with a lump of similar appearance in the upper extremity.
SUBUNGUAL GLOMANGIOMYOMA — A CASE REPORT
Authors: Wollstein Adi , Wollstein Ronit
Published: May 2012

Glomus tumors are benign neoplasms that develop from normal glomus bodies. These tumors are most commonly found in the nail bed of the hands and are characterized by point tenderness, and temperature sensitivity. Histologically, they are classified into three groups, the least common is glomangiomyoma, which is a variant distinguished by its predominant smooth muscle cellular content. This report describes a patient with a subungual glomangiomyoma that was surgically excised with a favorable outcome. The tumor is unusual for this location; a location common for typical glomus tumors. It presented without the typical associated symptoms of point and temperature sensitivity. This may suggest that the histological type may be more important in predicting the clinical presentation than the anatomical location of the glomus tumor.
A SIMPLE REDUCTION TECHNIQUE IN INTRAMEDULLARY NAILING (MICRONAIL) OF DISTAL RADIUS FRACTURE — INTRAFOCAL ELASTIC-SPRING PINNING METHOD
Authors: Tajima Kosuke , Koba Takeshi , Takao Eiryu
Published: May 2012

On treating distal radius fracture with intramedullary nailing (MICRONAIL, Wright Medical), completed anatomical reduction is indispensable before inserting the nail. However, complete reduction in percutaneous pinning or in Kapandji intrafocal pinning is troublesome. Thus, majority of the operation time is usually spent on reducing the fracture appropriately. We have commenced the "intrafocal elastic-spring pinning" as a reduction technique and have simplified the reduction prior to nailing. First, curve the 1.5 mm Kirschner wire properly. Next, pins are introduced percutaneously and intrafocally into the marrow cavity. The nail is then inserted in a standard manner. With this technique, an average of 16 consecutive intraoperative surgical times was 32.1 minutes (range, 16–55); apparently shorter than other previous reports. The bending-induced tension in the pins counteracts the postero-lateral displacing forces, and is especially efficient in comminuted or osteoporotic fractures. The nail will just brush aside the elastic pins when the pins interfere with the nail insertion.
LANGUAGE DYNAMICS
Authors: BARONCHELLI ANDREA , LORETO VITTORIO , TRIA FRANCESCA
Published: May 2012

Thirty authors of different disciplines, ranging from cognitive science and linguistics to mathematics and physics, address the topic of language origin and evolution. Language dynamics is investigated through an interdisciplinary effort, involving field and synthetic experiments, modelling and comparison of the theoretical predictions with empirical data. The result consists in new insights that significantly contribute to the ongoing debate on the origin and the evolution of language. In this Topical Issue the state of the art of this novel and fertile approach is reported by major experts of the field.
COMPLEX STRUCTURES AND SEMANTICS IN FREE WORD ASSOCIATION
Authors: GRAVINO PIETRO , SERVEDIO VITO D. P. , BARRAT ALAIN , LORETO VITTORIO
Published: May 2012

We investigate the directed and weighted complex network of free word associations in which players write a word in response to another word given as input. We analyze in details two large datasets resulting from two very different experiments: On the one hand the massive multiplayer web-based Word Association Game known as Human Brain Cloud, and on the other hand the South Florida Free Association Norms experiment. In both cases, the networks of associations exhibit quite robust properties like the small world property, a slight assortativity and a strong asymmetry between in-degree and out-degree distributions. A particularly interesting result concerns the existence of a characteristic scale for the word association process, arguably related to specific conceptual contexts for each word. After mapping, the Human Brain Cloud network onto the WordNet semantics network, we point out the basic cognitive mechanisms underlying word associations when they are represented as paths in an underlying semantic network. We derive in particular an expression describing the growth of the HBC graph and we highlight the existence of a characteristic scale for the word association process.
Cyclic AMP-induced K+ secretion occurs independently of Cl− secretion in rat distal colon
Authors: Sandle Geoffrey I. , Rajendran Vazhaikkurichi M.
Published: May 2012

cAMP induces both active Cl− and active K+ secretion in mammalian colon. It is generally assumed that a mechanism for K+ exit is essential to maintain cells in the hyperpolarized state, thus favoring a sustained Cl− secretion. Both Kcnn4c and Kcnma1 channels are located in colon, and this study addressed the questions of whether Kcnn4c and/or Kcnma1 channels mediate cAMP-induced K+ secretion and whether cAMP-induced K+ secretion provides the driving force for Cl− secretion. Forskolin (FSK)-enhanced short-circuit current (indicator of net electrogenic ion transport) and K+ fluxes were measured simultaneously in colonic mucosa under voltage-clamp conditions. Mucosal Na+ orthovanadate (P-type ATPase inhibitor) inhibited active K+ absorption normally present in rat distal colon. In the presence of mucosal Na+ orthovanadate, serosal FSK induced both K+ and Cl− secretion. FSK-induced K+ secretion was 1) not inhibited by either mucosal or serosal 1-[(2-chlorophenyl) diphenylmethyl]-1H-pyrazole (TRAM-34; a Kcnn4 channel blocker), 2) inhibited (92%) by mucosal iberiotoxin (Kcnma1 channel blocker), and 3) not affected by mucosal cystic fibrosis transmembrane conductance regulator inhibitor (CFTRinh-172). By contrast, FSK-induced Cl− secretion was 1) completely inhibited by serosal TRAM-34, 2) not inhibited by either mucosal or serosal iberiotoxin, and 3) completely inhibited by mucosal CFTRinh-172. These results indicate that cAMP-induced colonic K+ secretion is mediated via Kcnma1 channels located in the apical membrane and most likely contributes to stool K+ losses in secretory diarrhea. On the other hand, cAMP-induced colonic Cl− secretion requires the activity of Kcnn4b channels located in the basolateral membrane and is not dependent on the concurrent activation of apical Kcnma1 channels.
p120-Catenin prevents neutrophil transmigration independently of RhoA inhibition by impairing Src dependent VE-cadherin phosphorylation
Authors: Alcaide Pilar , Martinelli Roberta , Newton Gail , Williams Marcie R. , Adam Alejandro , Vincent Peter A. , Luscinskas Francis W.
Published: May 2012

Leukocyte transendothelial migration (TEM) is regulated by several signaling pathways including Src family kinases (SFK) and the small RhoGTPases. Previous studies have shown that vascular endothelial-cadherin (VE-cad) forms a complex with β-,γ-, and p120-catenins and this complex disassociates to form a transient gap during leukocyte TEM. Additionally, p120-catenin (p120-1A) overexpression in human umbilical vein endothelial cells (HUVEC) stabilizes VE-cad surface expression, prevents tyrosine phosphorylation of VE-cad, and inhibits leukocyte TEM. Based on reports showing that p120 overexpression in fibroblasts or epithelial cells inhibits RhoA and activates Rac and Cdc42 GTPases, and on other reports showing that RhoA activation in endothelial cells is necessary for leukocyte TEM, we reasoned that p120 overexpression inhibited TEM through inhibition of RhoA. To test this idea, we overexpressed a mutant p120 isoform, p120-4A, which does not interact with RhoA. p120-4A colocalized with VE-cad in HUVEC junctions and enhanced VE-cad surface expression, similar to overexpression of p120-1A. Interestingly, overexpression of either p120-4A or p120-1A dramatically blocked TEM, and overexpression of p120-1A in HUVEC did not affect RhoA basal activity or activation of RhoA and Rac induced by thrombin or ICAM-1 crosslinking. In contrast, biochemical studies revealed that overexpression of p120-1A reduced activated pY416-Src association with VE-cad. In summary, p120 overexpression inhibits neutrophil TEM independently of an effect on RhoA or Rac and instead blocks TEM by preventing VE-cad tyrosine phosphorylation and association of active Src with the VE-cad complex.
Treatment with constitutive androstane receptor ligand during pregnancy prevents insulin resistance in offspring from high-fat diet-induced obese pregnant mice
Authors: Masuyama Hisashi , Hiramatsu Yuji
Published: May 2012

The constitutive androstane receptor (CAR) has been reported to decrease insulin resistance even during pregnancy, while exposure to a high-fat diet (HFD) in utero in mice can induce a type 2 diabetes phenotype that can be transmitted to the progeny. Therefore, we examined whether treatment with a CAR ligand during pregnancy could prevent hypertension, insulin resistance, and hyperlipidemia in the offspring from HFD-induced obese pregnant mice (OH mice). We employed four groups of offspring from HFD-fed and control diet-fed pregnant mice with or without treatment with a CAR ligand. Treatment with a CAR ligand during pregnancy improved glucose tolerance and the levels of triglyceride and adipocytokine and restored the changes induced by HFD with amelioration of hypertension in the adult OH mice. This treatment also increased adiponectin mRNA expression, suppressed leptin expression in adipose tissues of OH mice, and abolished the effect of HFD on the epigenetic modifications of the genes encoding adiponectin and leptin in the offspring during immaturity and adulthood. Our data suggest that CAR might be a potential therapeutic target to prevent metabolic syndrome in adulthood of offspring exposed to an HFD in utero.