bluuebunny/crossref_metadata_2025 huggingface dataset:
Site‐specific deformable imaging registration algorithm selection using patient‐based simulated deformations
Authors: Nie Ke , Chuang Cynthia , Kirby Neil , Braunstein Steve , Pouliot Jean
Published: March 2013

Purpose:

The accuracy of deformable image registration could have a significant dosimetric impact in radiation treatment planning. Various image registration algorithms have been developed for clinical application. However, validation of these algorithms in the current clinical setting remains subjective, relying on visual assessment and lacking a comparison to the ground‐truth deformation. In this study, the authors propose a framework to quantitatively validate various image registration solutions by using patient‐based synthetic quality assurance (QA) phantoms, which can be applied on a site‐by‐site basis.

Methods:

The computer‐simulated deformation was first generated with virtual deformation QA software and further benchmarked using a physical pelvic phantom that was modeled after real patient CT images. After the validity of the virtual deformation was confirmed, a set of synthetic deformable images was produced to simulate various anatomical movements during radiotherapy based on real patient CT images. Three patients with head‐and‐neck, prostate, and spine cancer were included. The transformations included bladder filling, soft tissue deformation, mandible, and vertebral body movement, etc., which provided various ground‐truth images to validate deformable registration. Several clinically available deformable registration algorithms were tested on these images with multiple registration setups, such as global or regional and single‐pass or multipass optimization. The generated deformation fields and the ground‐truth deformation are compared using voxel‐by‐voxel based analysis as well as regional based analysis.

Results:

Performance of registration algorithms varies with clinical sites. The voxel‐by‐voxel analysis showed the intensity‐based free‐form deformation by MIM generated the greatest accuracy for low‐contrast small regions that underwent significant deformation, such as bladder expansion for prostate. However, for large field deformations with strong contrast, this approach may increase errors, which is especially evident in the cranial spinal irradiation (CSI) case. Both single‐pass and multipass B‐spline registrations performed well for the head‐and‐neck patient and CSI patients.

Conclusions:

QA for deformable image registration is essential to verify the cumulated dose for accurate adaptive radiotherapy. In this study, the authors develop a workflow that can validate image registration techniques for several different clinical sites and for various types of deformations using patient‐based simulated deformations. This work could provide a reference for clinicians and radiation physicists on how to choose appropriate image registration algorithms for different situations.
Automated knowledge‐based detection of nonobstructive and obstructive arterial lesions from coronary CT angiography
Authors: Kang Dongwoo , Slomka Piotr J. , Nakazato Ryo , Arsanjani Reza , Cheng Victor Y. , Min James K. , Li Debiao , Berman Daniel S. , Jay Kuo C.‐C. , Dey Damini
Published: March 2013

Purpose:

Visual analysis of three‐dimensional (3D) coronary computed tomography angiography (CCTA) remains challenging due to large number of image slices and tortuous character of the vessels. The authors aimed to develop a robust, automated algorithm for unsupervised computer detection of coronary artery lesions.

Methods:

The authors’ knowledge‐based algorithm consists of centerline extraction, vessel classification, vessel linearization, lumen segmentation with scan‐specific lumen attenuation ranges, and lesion location detection. Presence and location of lesions are identified using a multi‐pass algorithm which considers expected or “normal” vessel tapering and luminal stenosis from the segmented vessel. Expected luminal diameter is derived from the scan by automated piecewise least squares line fitting over proximal and mid segments (67%) of the coronary artery considering the locations of the small branches attached to the main coronary arteries.

Results:

The authors applied this algorithm to 42 CCTA patient datasets, acquired with dual‐source CT, where 21 datasets had 45 lesions with stenosis ≥25%. The reference standard was provided by visual and quantitative identification of lesions with any stenosis ≥25% by three expert readers using consensus reading. The authors algorithm identified 42 lesions (93%) confirmed by the expert readers. There were 46 additional lesions detected; 23 out of 39 (59%) of these were less‐stenosed lesions. When the artery was divided into 15 coronary segments according to standard cardiology reporting guidelines, per‐segment basis, sensitivity was 93% and per‐segment specificity was 81% using 10‐fold cross‐validation.

Conclusions:

The authors’ algorithm shows promising results in the detection of both obstructive and nonobstructive CCTA lesions.
Needle segmentation using 3D Hough transform in 3D TRUS guided prostate transperineal therapy
Authors: Qiu Wu , Yuchi Ming , Ding Mingyue , Tessier David , Fenster Aaron
Published: March 2013

Purpose:

Prostate adenocarcinoma is the most common noncutaneous malignancy in American men with over 200 000 new cases diagnosed each year. Prostate interventional therapy, such as cryotherapy and brachytherapy, is an effective treatment for prostate cancer. Its success relies on the correct needle implant position. This paper proposes a robust and efficient needle segmentation method, which acts as an aid to localize the needle in three‐dimensional (3D) transrectal ultrasound (TRUS) guided prostate therapy.

Methods:

The procedure of locating the needle in a 3D TRUS image is a three‐step process. First, the original 3D ultrasound image containing a needle is cropped; the cropped image is then converted to a binary format based on its histogram. Second, a 3D Hough transform based needle segmentation method is applied to the 3D binary image in order to locate the needle axis. The position of the needle endpoint is finally determined by an optimal threshold based analysis of the intensity probability distribution. The overall efficiency is improved through implementing a coarse‐fine searching strategy. The proposed method was validated in tissue‐mimicking agar phantoms, chicken breast phantoms, and 3D TRUS patient images from prostate brachytherapy and cryotherapy procedures by comparison to the manual segmentation. The robustness of the proposed approach was tested by means of varying parameters such as needle insertion angle, needle insertion length, binarization threshold level, and cropping size.

Results:

The validation results indicate that the proposed Hough transform based method is accurate and robust, with an achieved endpoint localization accuracy of 0.5 mm for agar phantom images, 0.7 mm for chicken breast phantom images, and 1 mm forin vivo patient cryotherapy and brachytherapy images. The mean execution time of needle segmentation algorithm was 2 s for a 3D TRUS image with size of 264 × 376 × 630 voxels.

Conclusions:

The proposed needle segmentation algorithm is accurate, robust, and suitable for 3D TRUS guided prostate transperineal therapy.
Structural Features for Functional Selectivity at Serotonin Receptors
Authors: Wacker Daniel , Wang Chong , Katritch Vsevolod , Han Gye Won , Huang Xi-Ping , Vardy Eyal , McCorvy John D. , Jiang Yi , Chu Meihua , Siu Fai Yiu , Liu Wei , Xu H. Eric , Cherezov Vadim , Roth Bryan L. , Stevens Raymond C.
Published: March 2013

Dissecting Serotonin Receptors

Serotonin receptors are the targets for many widely used drugs prescribed to treat ailments from depression to obesity and migraine headaches (see the Perspective by

Palczewski and Kiser

).

C. Wang
et al.

(p.
610
, published online 21 March) and

Wacker
et al.

(p.
615
, published online 21 March) describe crystal structures of two members of the serotonin family of receptors bound to antimigraine medications or to a precursor of the hallucinogenic drug LSD. Subtle differences in the way particular ligands bind to the receptors cause substantial differences in the signals generated by the receptor and the consequent biological responses. The structures reveal how the same ligand can activate one or both of the two main serotonin receptor signaling mechanisms, depending on which particular receptor it binds.
Complete Genome Sequence of the Avian Pathogenic Escherichia coli Strain APEC O78
Authors: Mangiamele Paul , Nicholson Bryon , Wannemuehler Yvonne , Seemann Torsten , Logue Catherine M. , Li Ganwu , Tivendale Kelly A. , Nolan Lisa K.
Published: March 2013

Colibacillosis, caused by avian pathogenic
Escherichia coli
(APEC), is a significant disease, causing extensive animal and financial losses globally. Because of the significance of this disease, more knowledge is needed regarding APEC's mechanisms of virulence. Here, we present the fully closed genome sequence of a typical avian pathogenic
E. coli
strain belonging to the serogroup O78.
Draft Genome of Pseudomonas stutzeri Strain NF13, a Nitrogen Fixer Isolated from the Galapagos Rift Hydrothermal Vent
Authors: Peña Arantxa , Busquets Antonio , Gomila Margarita , Mayol Joan , Bosch Rafael , Nogales Balbina , García-Valdés Elena , Bennasar Antonio , Lalucat Jorge
Published: March 2013

Pseudomonas stutzeri
strain NF13 was isolated from a water sample taken at a hydrothermal vent in the Galapagos rift. It was selected for its ability to metabolize sulfur compounds and to grow diazotrophically. Here, we report the first draft genome of a member of genomovar 19 of the species.
Medical lessons learnt from the US and Canadian experience of treating combat casualties from Afghanistan and Iraq
Authors: Dharm-Datta Shreshth , McLenaghan J
Published: March 2013

The Winston Churchill Memorial Trust, established in 1965, funds Travelling Fellowships and both authors visited hospitals in Germany, Canada and the USA regarded as centres of excellence with expertise in the early care, reconstruction and rehabilitation of the combat casualties of our NATO Allies, as recipients of these Fellowships. This article presents some of the lessons learnt in the field of musculoskeletal trauma and rehabilitation from the Canadian and US military medical systems. In trauma, there were significant differences in wound debridement policy, use of external fixators for fractures, primary use of circular frames for open tibial fractures and a far more liberal use of bone morphogenetic protein in fracture treatment. Differences in soft tissue reconstruction policy regarding flaps for soft tissue cover over exposed bone, near-universal usage of topical negative pressure dressings and use of Allgöwer-Donati suture pattern to close all wounds were noted. Ertl amputation osteoplasty, a modified form of transtibial amputation, had also been reintroduced. In rehabilitation, the management of heterotopic ossification, in particular with imaging techniques and excision surgery, was identified. For the upper limb, we observed the patient training required to use a myoelectric hand and the future possibility of targeted muscle re-innervation to make controlling these myoelectric prostheses more natural using innate motor patterns. For the lower limb, we found we used identical above knee prostheses. For patients who have had limb reconstruction and have poor function, an energy-storing orthosis was demonstrated to compensate for the loss of range of motion and muscle power.
Acute hepatitis A virus infections in British Gurkha soldiers
Authors: Green Chris A , Ross D A , Bailey M S
Published: March 2013

Hepatitis A virus (HAV) and hepatitis E virus (HEV) infections are endemic in most developing countries, including Nepal and Afghanistan, and may cause outbreaks in military personnel. Previously, more than 99% of new British Gurkha recruits were already immune to HAV because of prior infection, but this may be declining due to improved living conditions in their countries of origin. Acute HAV infections have occurred in Gurkha soldiers serving in Afghanistan, which made them unfit for duty for 2–3 months. In one case, early serological diagnosis was impeded by IgM results against both HAV and HEV that were caused by cross-reactivity or persistence from a previous infection. These cases have led to a policy change whereby all Gurkha recruits are now tested for previous HAV infection and if negative they are offered vaccination. Meanwhile, HEV infection remains a significant threat in Nepal and Afghanistan with low levels of background immunity and no commercially available vaccine.
DERIVATION OF A HOMOGENIZED VON-KÁRMÁN PLATE THEORY FROM 3D NONLINEAR ELASTICITY
Authors: NEUKAMM STEFAN , VELČIĆ IGOR
Published: March 2013

We rigorously derive a homogenized von-Kármán plate theory as a Γ-limit from nonlinear three-dimensional elasticity by combining homogenization and dimension reduction. Our starting point is an energy functional that describes a nonlinear elastic, three-dimensional plate with spatially periodic material properties. The functional features two small length scales: the period ε of the elastic composite material, and the thickness h of the slender plate. We study the behavior as ε and h simultaneously converge to zero in the von-Kármán scaling regime. The obtained limit is a homogenized von-Kármán plate model. Its effective material properties are determined by a relaxation formula that exposes a non-trivial coupling of the behavior of the out-of-plane displacement with the oscillatory behavior in the in-plane directions. In particular, the homogenized coefficients depend on the relative scaling between h and ε, and different values arise for h ≪ ε, ε ~ h and ε ≪ h.
A SURFACE-BASED ELECTROPHYSIOLOGY MODEL RELYING ON ASYMPTOTIC ANALYSIS AND MOTIVATED BY CARDIAC ATRIA MODELING
Authors: CHAPELLE DOMINIQUE , COLLIN ANNABELLE , GERBEAU JEAN-FRÉDÉRIC
Published: March 2013

Computational electrophysiology is a very active field with tremendous potential in medical applications, albeit it leads to highly intensive simulations. We here propose a surface-based electrophysiology formulation, motivated by the modeling of thin structures such as cardiac atria, which greatly reduces the size of the computational models. Moreover, our model is specifically devised to retain the key features associated with the anisotropy in the diffusion effects induced by the fiber architecture, with rapid variations across the thickness that cannot be adequately represented by naive averaging strategies. Our proposed model relies on a detailed asymptotic analysis in which we identify a limit model and establish strong convergence results. We also provide detailed numerical assessments that confirm an excellent accuracy of the surface-based model – compared with the reference 3D model – including in the representation of a complex phenomenon, namely, spiral waves.
EMERGENCE OF POWER-LAW AND TWO-PHASE BEHAVIOR IN FINANCIAL MARKET FLUCTUATIONS
Authors: KOSTANJČAR ZVONKO , JEREN BRANKO
Published: March 2013

In this paper, we provide an insight into the emergence of power-law and two-phase behavior in the financial market fluctuations by defining an analytical model for time evolution of stock share prices. The defined model can exhibit bimodal behavior in the supply-demand structure of the market. Moreover, it differs from existing Ising-type models. It turns out that the constructed model is a solution of a thermodynamic limit of a Gibbs probability measure when the number of investors and the number of stock shares approaches the infinity. The energy functional of the Gibbs probability measure is derived from the Nash equilibrium of the underlying game.
Controlling Natural Killer Cell Responses: Integration of Signals for Activation and Inhibition
Authors: Long Eric O. , Sik Kim Hun , Liu Dongfang , Peterson Mary E. , Rajagopalan Sumati
Published: March 2013

Understanding how signals are integrated to control natural killer (NK) cell responsiveness in the absence of antigen-specific receptors has been a challenge, but recent work has revealed some underlying principles that govern NK cell responses. NK cells use an array of innate receptors to sense their environment and respond to alterations caused by infections, cellular stress, and transformation. No single activation receptor dominates; instead, synergistic signals from combinations of receptors are integrated to activate natural cytotoxicity and cytokine production. Inhibitory receptors for major histocompatibility complex class I (MHC-I) have a critical role in controlling NK cell responses and, paradoxically, in maintaining NK cells in a state of responsiveness to subsequent activation events, a process referred to as licensing. MHC-I-specific inhibitory receptors both block activation signals and trigger signals to phosphorylate and inactivate the small adaptor Crk. These different facets of inhibitory signaling are incorporated into a revocable license model for the reversible tuning of NK cell responsiveness.
Brain-Reactive Antibodies and Disease
Authors: Diamond B. , Honig G. , Mader S. , Brimberg L. , Volpe B.T.
Published: March 2013

Autoimmune diseases currently affect 5–7% of the world's population; in most diseases there are circulating autoantibodies. Brain-reactive antibodies are present in approximately 2–3% of the general population but do not usually contribute to brain pathology. These antibodies penetrate brain tissue only early in development or under pathologic conditions. This restriction on their pathogenicity and the lack of correlation between serum titers and brain pathology have, no doubt, contributed to a delayed appreciation of the contribution of autoantibodies in diseases of the central nervous system. Nonetheless, it is increasingly clear that antibodies can cause damage in the brain and likely initiate or aggravate multiple neurologic conditions; brain-reactive antibodies contribute to symptomatology in autoimmune disease, infectious disease, and malignancy.
Milk osteopontin, a nutritional approach to prevent alcohol-induced liver injury
Authors: Ge Xiaodong , Lu Yongke , Leung Tung-Ming , Sørensen Esben S. , Nieto Natalia
Published: March 2013

Alcohol consumption is a leading cause of liver disease worldwide; thus, there is an urgent need to develop novel therapeutic interventions. Key events for the onset and progression of alcoholic liver disease result in part from the gut-to-liver interaction. Osteopontin is a cytokine present at high concentration in human milk, umbilical cord, and infants' plasma with beneficial potential. We hypothesized that dietary administration of milk osteopontin could prevent alcohol-induced liver injury perhaps by maintaining gut integrity and averting hepatic inflammation and steatosis. Wild-type mice were fed either the control or the ethanol Lieber-DeCarli diets alone or in combination with milk osteopontin for 3 wk, and parameters of gut and liver damage were measured. Milk osteopontin protected the stomach and the gut by increasing gland height, crypt cell plus enterocyte proliferation, and mucin content in addition to lowering macrophages, plasmacytes, lymphocytes, and neutrophils in the mucosa and submucosa in alcohol-fed mice. Milk osteopontin targeted the gut-liver axis, preserving the expression of tight-junction proteins in alcohol-fed mice thus maintaining intestinal integrity and permeability. There was protection from liver injury since transaminases, the activity scores, triglyceride levels, neutrophil infiltration, 3-nitrotyrosine residues, lipid peroxidation end products, translocation of gram-negative bacteria, lipopolysaccharide levels, and tumor necrosis factor-α were lower in cotreated than in ethanol-fed mice. Furthermore, milk osteopontin diminished ethanol-mediated liver injury in OPN knockout mice. Milk osteopontin could be a simple effective nutritional therapeutic strategy to prevent alcohol hepatotoxicity due, among others, to gut protective, anti-inflammatory, and anti-steatotic actions.
Hepatocellular Carcinoma with Sarcomatoid Change without Anticancer Therapies
Authors: Yoshida Naoki , Midorikawa Yutaka , Kajiwara Takahiro , Yoshida Nao , Nakayama Hisashi , Sugitani Masahiko , Takayama Tadatoshi
Published: March 2013

Hepatocellular carcinoma (HCC) with sarcomatoid change is a rare neoplasm of the liver, and recurrent therapies for HCC such as transcatheter arterial chemoembolization and percutaneous ablation therapy are presumed to promote sarcomatoid change. A 73-year-old man was admitted to our hospital diagnosed as having liver cancer originating from hepatitis C-related cirrhosis without any previous treatment for HCC. Ultrasonography showed that the tumor was hypoechoic, 3 cm in diameter, with unclear margins. Computed tomography demonstrated a low-density lesion with ring enhancement on delayed phase. Under a diagnosis of poorly differentiated HCC the patient underwent liver resection. Histologically, the tumor consisted of proliferation of spindle-shaped sarcomatoid carcinoma cells with unclear trabecular and pseudoglandular structures including a nodule of typical moderately differentiated HCC, which was observed to shift mutually in one region. Here, we report a case of sarcomatoid HCC with a review of the literature.
Lack of Invariant Natural Killer T Cells Affects Lipid Metabolism in Adipose Tissue of Diet-Induced Obese Mice
Authors: Strodthoff Daniela , Lundberg Anna M. , Agardh Hanna E. , Ketelhuth Daniel F.J. , Paulsson-Berne Gabrielle , Arner Peter , Hansson Göran K. , Gerdes Norbert
Published: March 2013

Objective—

Obesity promotes a chronic inflammatory condition in adipose tissue (AT). Impairment of insulin sensitivity coincides with infiltration of T cells into AT in early stages of obesity, when macrophages are not yet present. Here, we examine the role of invariant natural killer T (iNKT) cells, a subtype of T cells activated by lipid antigens, on glucose and lipid metabolism in obesity.

Approach and Results—

Jα18
−/−
mice, specifically lacking iNKT cells, and wild-type mice consumed a chow or high-fat diet for 10 weeks. One third of all T lymphocytes in the liver of wild-type mice were iNKT cells, whereas few were detected in AT. Diet-induced obesity increased blood glucose in both genotypes of mice, whereas glucose tolerance test revealed similar kinetics of glucose clearance in
Jα18
−/−
and wild-type mice. Under obese conditions, expression of inflammatory cytokines in AT did not differ between the groups, although the number of T cells and macrophages was lower in
Jα18
−/−
mice. Nonetheless, AT homeostasis in
Jα18
−/−
mice was altered evidenced by lower AT weight, smaller adipocytes, accelerated lipogenesis, increased expression of hormone-sensitive lipase, and accelerated basal lipolysis.

Conclusions—

iNKT cells do not affect glucose clearance but rather modulate lipid metabolism in both liver and AT. Only few iNKT cells are found in AT under lean and obese conditions, suggesting that their effects on lipid metabolism are mainly mediated in the liver, their primary host organ.
Paradoxical Association of Enhanced Cholesterol Efflux With Increased Incident Cardiovascular Risks
Authors: Li Xin-Min , Tang Wai Hong Wilson , Mosior Marian K. , Huang Ying , Wu Yuping , Matter William , Gao Vivian , Schmitt David , DiDonato Joseph A. , Fisher Edward A. , Smith Jonathan D. , Hazen Stanley L.
Published: March 2013

Objective—

Diminished cholesterol efflux activity of apolipoprotein B (apoB)–depleted serum is associated with prevalent coronary artery disease, but its prognostic value for incident cardiovascular events is unclear. We investigated the relationship of cholesterol efflux activity with both prevalent coronary artery disease and incident development of major adverse cardiovascular events (death, myocardial infarction, or stroke).

Approach and Results—

Cholesterol efflux activity from free cholesterol–enriched macrophages was measured in 2 case–control cohorts: (1) an angiographic cohort (n=1150) comprising stable subjects undergoing elective diagnostic coronary angiography and (2) an outpatient cohort (n=577). Analysis of media from cholesterol efflux assays revealed that the high-density lipoprotein fraction (1.063<
d
<1.21) contained only a minority (≈40%) of [
14
C]cholesterol released, with the majority found within the lipoprotein particle–depleted fraction, where ≈60% was recovered after apolipoprotein A1 immunoprecipitation. Albumin immunoprecipitation recovered another ≈30% of radiolabeled cholesterol within this fraction. Enhanced cholesterol efflux activity from ATP-binding cassette transporter A1–stimulated macrophages was associated with reduced risk of prevalent coronary artery disease in unadjusted models within both cohorts; however, the inverse risk relationship remained significant after adjustment for traditional coronary artery disease risk factors only within the outpatient cohort. Surprisingly, higher cholesterol efflux activity was associated with increase in prospective (3 years) risk of myocardial infarction/stroke (adjusted hazard ratio, 2.19; 95% confidence interval, 1.02–4.74) and major adverse cardiovascular events (adjusted hazard ratio, 1.85; 95% confidence interval, 1.11–3.06).

Conclusions—

Heightened cholesterol efflux to apoB-depleted serum was paradoxically associated with increased prospective risk for myocardial infarction, stroke, and death. The majority of released radiolabeled cholesterol from macrophages in cholesterol efflux activity assays does not reside within a high-density lipoprotein particle.
Risk of Rupture of an Intracranial Aneurysm Based on Patient Characteristics
Authors: Vlak Monique H.M. , Rinkel Gabriel J.E. , Greebe Paut , Algra Ale
Published: March 2013

Background and Purpose—

Knowledge about risk factors contributes to understanding the pathophysiological mechanisms that cause intracranial aneurysm rupture and helps to develop possible treatment strategies. We aimed to study lifestyle and personal characteristics as risk factors for the rupture of intracranial aneurysms.

Methods—

We performed a case–control study with 250 patients with an aneurysmal subarachnoid hemorrhage and 206 patients with an unruptured intracranial aneurysm. All patients with an aneurysmal subarachnoid hemorrhage and patients with a unruptured intracranial aneurysm were asked to fill in a structured questionnaire about their lifestyle and medical history. For patients with an unruptured intracranial aneurysm, we also collected data on the indication for imaging. With logistic regression analysis, we identified independent risk factors for aneurysmal rupture.

Results—

Reasons for imaging in patients with an unruptured intracranial aneurysm were atherosclerotic disease (23%), positive family history (18%), headache (8%), preventive screening (3%), and other (46%). Factors that increased risk for aneurysmal rupture were smoking (odds ratio, 1.9; 95% confidence interval, 1.2–3.0) and migraine (2.4; 1.1–5.1); hypercholesterolemia decreased this risk (0.4; 0.2–1.0), whereas a history of hypertension did not independently influence the risk.

Conclusions—

Smoking, migraine and, inversely, hypercholesterolemia are independent risk factors for aneurysmal rupture. Data from the questionnaire are insufficient to conclude whether hypercholesterolemia or its treatment with statins exerts a risk-reducing effect. The pathophysiological mechanisms through which smoking and migraine increase the risk of aneurysmal rupture should be investigated in further studies. Although a history of hypertension does not increase risk of rupture, a sudden rise in blood pressure might still trigger aneurysmal rupture.
Legal Aspects of Personalized Health Monitoring
Authors: Callens Stefaan
Published: March 2013

Abstract

Personal health monitoring (PHM) can be defined as comprising all technical systems, processing, collecting, and storing of data linked to a person. PHM involves several legal issues that are described in this article. This article analyses firstly the short term actions that are needed at the European level to allow personal health monitoring in respect of the interests and rights of patients such as the need to have more harmonized medical liability rules at the EU level. Introducing PHM implies also legal action at the EU level on the long run. These long-term actions are related to e.g., the way in which hospitals are organized in their relation with healthcare professionals and with other hospitals or healthcare actors. The paper will finally analyse also how health monitoring projects may change the traditional (non-) relationship between patients and pharmaceutical/medical device industry. Today, the producers and distributors of medicinal products have no specific contact with patients. This situation may change when applying telemonitoring projects and may require to new legal rules.
Incremental Correction for the Dynamical Downscaling of Ensemble Mean Atmospheric Fields
Authors: Yoshimura Kei , Kanamitsu Masao
Published: March 2013

This research was motivated by the need for an improved method compared to the conventional brute-force approach to ensemble downscaling. That method simply applies dynamical downscaling to each ensemble member. It obtains a reliable forecast by taking the ensemble average of all the downscaled ensemble members. This approach, although straightforward, has a problem in that the computational cost is too large for an operational environment. Herein a method for downscaling ensemble mean forecasts is proposed. Although this method does not provide probabilistic forecasts, it will provide the regional-scale detail at minimum cost. In this product, all of the predicted parameters are dynamically and physically consistent (i.e., most likely to occur on a seasonal time scale). It is believed that such a product has great utility for regional climate forecast and application products. The method applies a correction to one of the global forecast members in such a way that the seasonal mean is equal to that of the ensemble mean, and it then downscales the corrected global forecast. This method was tested for a 140-yr period by using the Twentieth-Century Reanalysis dataset, which is a product of ensemble Kalman filtering data assimilation. Use of the method clearly improves the downscaling skill compared to the case of using only a single member; the skill becomes equivalent to that achieved when between two and six members are used directly.
Examination of Situation-Dependent Background Error Covariances at the Convective Scale in the Context of the Ensemble Kalman Filter
Authors: Chung Kao-Shen , Chang Weiguang , Fillion Luc , Tanguay Monique
Published: March 2013

A high-resolution ensemble Kalman filter (HREnKF) system at the convective scale has been developed based on the Canadian Meteorological Center's operational global ensemble Kalman filter (EnKF) system. This study focuses on the very early stage of transition from purely homogeneous isotropic background error correlations to situation-dependent correlations. It has been found that forecast error structures can develop situation-dependent features in as little as 15 min. Furthermore, the dynamic and thermodynamic variables require different periods of time to build up their own forecast error structures. Differences in these structures between regions with and without precipitation are also investigated. An examination of temperature tendencies revealed that physical processes are as important as dynamical forcing in determining the structure of convective-scale errors structures, and that once physical processes become active, these structures change rapidly before the onset of precipitation. This study is intended to be the basis for a systematic exploration in the near future of the usefulness of the HREnKF system in assimilating high-density observations such as radar data.
Patients’ and carers’ perception of needs in a Polish sample
Authors: Cialkowska-Kuzminska Magdalena , Misiak Blazej , Kiejna Andrzej
Published: March 2013

Background:

The assessment of patients’ needs is an essential element of psychiatric health care planning and evaluation. Not much interest has been paid to the study of psychiatric patients’ needs in Poland so far.

Aims:

To assess the relation between inpatients’ and their key carers’ perception of needs in a Polish sample.

Methods:

Out of 324 inpatients invited to take part in the study, 60 sets were finally included. Patients and their carers were examined by means of CANSAS to rate patients’ and carers’ perception of needs.

Results:

The mean number of general needs indicated by patients themselves was 7.11 (± 2.98), and those indicated by carers equalled 9.53 (± 3.92). The more unmet needs identified by the patient, the more met and general needs of the patient identified by their carer ( r = .27, p = .03; r = .38, p = .02, respectively). The more general needs perceived by the patient themself, the higher the indicator of unmet and general needs scored by their carer ( r = .32, p = .01; r = .39, p = .001, respectively).

Conclusions:

There is a significant association between the inpatients’ and their carers’ perception of needs. Patients’ perspective should serve as a high priority in developing treatment plans.
Contextual and Contested: Reassessing Europeanization in the Case of Turkey
Authors: Kaliber Alper
Published: March 2013

This article introduces a novel conceptual/analytical framework to Europeanization studies. Its main aims are twofold: first, it problematizes the mainstream usage of the term Europeanization, and the notion of change that it has embraced, and second, it develops a fuller account of the impact of European integration on societies. An analytical distinction is drawn between EU-ization as a formal process of alignment with the EU’s body of law and institutions, and Europeanization as a wider sociopolitical and normative context. The impact of Europeanization in a given society is heavily conditioned by the extent and the ways in which Europe is used as a context by domestic actors. To substantiate its arguments, the article focuses on the Turkish case, where Europeanization as a normative–political context has extensively been implicated in its modernization and nation-building processes as well as in recent domestic debates concerning the country’s identity and future orientation.
The development of interrogative forms and functions in early childhood Cantonese
Authors: Li Hui , Tse Shek Kam , Sin Wong Jessie Ming , Mei Wong Eileen Chin , Leung Shing On
Published: March 2013

This study investigated question acquisition in Cantonese-speaking young children with a focus on the development of interrogative forms and functions. Data from a child Cantonese corpus (492 children aged 36, 48 and 60 months) were analysed. The main results were that: (1) all the interrogative forms and functions were produced by the three age groups and no age difference was found; (2) significant gender differences in favour of females were found; and (3) a significant form-function preference was obtained, with wh- and multiple questions being primarily used to seek information, and yes/no and rising tone/echo questions being largely used to request action.
Operative Time and Cost of Resident Surgical Experience: Effect of Instituting an Otolaryngology Residency Program
Authors: Pollei Taylor R. , Barrs David M. , Hinni Michael L. , Bansberg Stephen F. , Walter Logan C.
Published: March 2013

Objective

Describe the procedure length difference between surgeries performed by an attending surgeon alone compared with the resident surgeon supervised by the same attending surgeon.

Study Design

Case series with chart review.

Setting

Tertiary care center and residency program.

Subjects and Methods

Six common otolaryngologic procedures performed between August 1994 and May 2012 were divided into 2 cohorts: attending surgeon alone or resident surgeon. This division coincided with our July 2006 initiation of an otolaryngology–head and neck surgery residency program. Operative duration was compared between cohorts with confounding factors controlled. In addition, the direct result of increased surgical length on operating room cost was calculated and applied to departmental and published resident case log report data.

Results

Five of the 6 procedures evaluated showed a statistically significant increase in surgery length with resident involvement. Operative time increased 6.8 minutes for a cricopharyngeal myotomy (P =. 0097), 11.3 minutes for a tonsillectomy (P <. 0001), 27.4 minutes for a parotidectomy (P =. 028), 38.3 minutes for a septoplasty (P <. 0001), and 51 minutes for tympanomastoidectomy (P <. 0021). Thyroidectomy showed no operative time difference. Cost of increased surgical time was calculated per surgery and ranged from $286 (cricopharyngeal myotomy) to $2142 (mastoidectomy). When applied to reported national case log averages for graduating residents, this resulted in a significant increase of direct training‐related costs.

Conclusion

Resident participation in the operating room results in increased surgical length and additional system cost. Although residency is a necessary part of surgical training, associated costs need to be acknowledged.
Somatosensory Evoked Potentials Help Prevent Positioning‐Related Brachial Plexus Injury during Skull Base Surgery
Authors: Jellish W. Scott , Sherazee Gazenfer , Patel Jagruti , Cunanan Renato , Steele Janet , Garibashvilli Konstantin , Baldwin Maria , Anderson Douglas , Leonetti John P.
Published: March 2013

Objective

Evaluate the use of somatosensory evoked potentials (SSEP) monitoring to detect positioning‐related brachial plexus injury during skull base surgery.

Study Design

Prospective cohort observational study.

Setting

University Hospital.

Subjects and Methods

Patients undergoing skull base surgery had a focused neurologic exam of the brachial plexus performed before and after surgery. Under stable anesthesia, brachial plexus SSEP values were obtained before and after surgical positioning. Significant SSEP changes required a readjustment of arm or neck positions. SSEPs were assessed every 30 minutes. If changes were noted, position was readjusted and SSEPs were reassessed until surgical completion. Demographic data, neurologic exams, SSEP latency, and amplitude values were recorded. Persistent changes were correlated with postoperative neurologic findings.

Results

Sixty‐five patients, 15 to 77 years old, were studied. Six patients (9.2%) developed SSEP amplitude changes after positioning (average amplitude decrease 72.8%). One patient had a significant latency increase. The sensitivity of SSEP for detection of injury was 57%, while specificity was 94.7%. The average body mass index (BMI) of patients with normal and abnormal SSEPs was 28.7 ± 5.6 versus 29.2 ± 8.0, respectively. Average BMI of patients with postoperative symptoms regardless of SSEP findings was 33.8 ± 4.3. Two patients who had persistent SSEP changes after positioning had BMIs of 40.1 and 31.2 kg/m2, respectively. Improvement in neurologic findings occurred in all patients after surgery.

Conclusions

This study demonstrates that upper extremity nerve stress can be detected in real time using SSEP and may be of value in protecting patients from nerve injury undergoing lateral skull base surgery.
J. Andrew Kirk, Civilizations in Conflict? Islam, the West and Christian Faith
Authors: Miller Paul M
Published: March 2013

J. Andrew Kirk’s book examines – and eventually agrees with – Samuel Huntington’s controversial claim that a dangerous ‘Clash of Civilisations’ today poisons the Western-and-Islamic relationship. Kirk then suggests ways for improving these relations, highlighting Islam’s need to reform itself through a re-embrace of its more eirenic, prophetic Meccan phase. While there is much that is admirable here, the review below suggests Kirk’s interpretation of the ‘prophetic’ relationship to government is too one-sidedly Anabaptist.
Transnational Islamic Movements
Authors: Münster Anna
Published: March 2013

The focus of this paper is on the network aspect of Islamic movements, i.e. what networks are, what their structure is and what some of their properties are. The discussion focuses on scale-free networks, their properties and networks value expressed in social capital and formulated in the Strength of Weak Ties theory by Granovetter. Al-Qaeda has been the most frequent reference in the research on the transnational Islamic networks, so somewhat unintentionally al-Qaeda’s example often appears in this paper as well.
‘Coming Out’ as a Faith Changer: Experiences of Faith Declaration for Arabs of a Muslim Background who Choose to Follow a Christian Faith
Authors: Kraft Kathryn
Published: March 2013

In the process of conversion, one of the greatest challenges faced by Arab Muslims who choose to follow a Christian faith is determining how to relate to their birth communities, especially their immediate families. They continue to identify with their family and desire to function within its communal system and expectations, but also desire to be true to their new faith. For most converts in the Middle East, ceasing to adhere to the Islamic creed per se is not an act of apostasy, but declaring that one has left Islam and chosen another faith is, and is seen as an act of rebellion by the community. The process of self-disclosure, or ‘coming out’, is complex, and many converts consider their decision about how to do this to be very important. There are various approaches converts may take, and various ways their families may respond, but one implicitly shared understanding between many converts and their families may be labelled ‘don’t ask, don’t tell’, whereby converts speak openly about their changed beliefs without explicitly declaring they have converted, and their families respond in kind, deliberately not asking if they have converted, in order to maintain a strong relationship with their loved ones.
An application of Multifaceted Rasch measurement in the Yes/No Angoff standard setting procedure
Authors: Hsieh Mingchuan
Published: March 2013

When implementing standard setting procedures, there are two major concerns: variance between panelists and efficiency in conducting multiple rounds of judgments. With regard to the former, there is concern over the consistency of the cutoff scores made by different panelists. If the cut scores show an inordinately wide range then further rounds of group discussion are required to reach consensus, which in turn leads to the latter concern. The Yes/No Angoff procedure is typically implemented across several rounds. Panelists revise their original decisions for each item based on discussion with co-panelists between each round. The purpose of this paper is to demonstrate a framework for evaluating the judgments in the standard setting process. The Multifaceted Rasch model was applied as a tool to evaluate the quality of standard setting in a context of language assessment. The results indicate that the Multifaceted Rasch model offers a promising approach to examination of the variability in the standard setting procedures. In addition, this model can identify aberrant decision making for each panelist, which can be used as feedback for both standard setting designers and panelists.
Minimal extracorporeal circulation reduces the incidence of postoperative major adverse events after elective coronary artery bypass grafting in high-risk patients. A single-institutional prospective randomized study
Authors: Asteriou C , Antonitsis P , Argiriadou H , Deliopoulos A , Konstantinou D , Foroulis C , Papakonstantinou C , Anastasiadis K
Published: March 2013

Coronary artery bypass grafting (CABG) using minimal extracorporeal circulation (MECC) has been associated with an improved short-term clinical outcome compared to conventional extracorporeal circulation (CECC). The aim of this study was to evaluate the impact of MECC compared to CECC on postoperative major adverse events in high-risk patients undergoing elective coronary revascularization procedures. Two hundred patients undergoing elective CABG were randomized into two groups. In Group A (n=100), MECC was used while Group B (n=100) included patients who were operated on CECC. The incidence of postoperative major adverse events (myocardial infarction, renal failure, stroke, death) was the primary end-point of the study. MECC was associated with a 77% relative risk reduction in the incidence of major adverse events compared to CECC (p=0.004). The rate of major adverse events occurring in the high-risk patient subgroup (preoperative left ventricular ejection fraction ≤40%, age >65 years, EuroSCORE II >5) operated on with MECC was significantly lower in comparison to their CECC counterparts. Based on our results, cardiac centres should be encouraged to use MECC as the standard circuit when performing elective coronary procedures, even in a high-risk population.
Noradrenergic modulation of cognition: Therapeutic implications
Authors: Chamberlain Samuel R , Robbins Trevor W
Published: March 2013

The noradrenaline (norepinephrine) system exerts profound influences on cognition via ascending projections to the forebrain, mostly originating from the locus coeruleus. This paper provides an overview of available infrahuman and healthy human studies, exploring the effects of specific noradrenergic manipulations on dissociable cognitive functions, including attention, working memory, cognitive flexibility, response inhibition and emotional memory. Remarkable parallels across species have been reported which may account for the mechanisms by which noradrenergic medications exert their beneficial effects in disorders such as depression and attention-deficit hyperactivity disorder (ADHD). The literature is discussed in relation to prevailing models of noradrenergic influences over cognition and novel therapeutic directions, including in relation to investigating the effects of noradrenergic manipulations on other disorders characterized by impulsivity, and dementias. Unanswered questions are also highlighted, along with key avenues for future research, both proof-of-concept and clinical.
Animal geographies I
Authors: Buller Henry
Published: March 2013

Animal geographies has emerged over the last 15 years as a lively and provocative area of current human/non-human geographical research and scholarship. Yet, while the ‘animal turn’ has arguably impacted widely across a range of social sciences and the humanities, for ‘human’ geography it offers what is potentially a far more fundamental and profound reconfiguration of the discipline’s traditional ontological and epistemological reach, not least given the challenge that the ‘animal’ brings to the exclusivity of geography’s adjectival humanism. This article is the first of three reports on animal geographies. It sets out the development of the subdiscipline, from the mid-1990s onwards, and charts the emergence of what has become a distinctive and innovative field with increasing interdisciplinary connections.
The Journey of One Pregnant Incarcerated Woman Through Systemic Bias
Authors: Mason Laina G. B.
Published: March 2013

This case study examines the journey of a pregnant, incarcerated woman and the advocacy efforts of helping professionals from a perinatal home visiting agency. The agency worked with the mother to help her understand her baby’s development, both prenatally and postpartum, and addressed many other parenting concerns, including guardianship rights. The agency found that it is rare for pregnant inmates to maintain custody of their infants in jail postpartum, despite certain legal rights that are afforded them. The agency worked with the inmate and her family to advocate for her right to mother her child.