bluuebunny/crossref_metadata_2025 huggingface dataset:
Non-Parametric Tests for Right-Censored Data with Biased Sampling
Authors: Ning Jing , Qin Jing , Shen Yu
Published: July 2010

Testing the equality of two survival distributions can be difficult in a prevalent cohort study when non-random sampling of subjects is involved. Owing to the biased sampling scheme, the independent censoring assumption is often violated. Although the issues about biased inference caused by length-biased sampling have been widely recognized in the statistical, epidemiological and economical literature, there is no satisfactory solution for efficient two-sample testing. We propose an asymptotic most efficient non-parametric test by properly adjusting for length-biased sampling. The test statistic is derived from a full likelihood function and can be generalized from the two-sample test to a k-sample test. The asymptotic properties of the test statistic under the null hypothesis are derived by using its asymptotic independent and identically distributed representation. We conduct extensive Monte Carlo simulations to evaluate the performance of the test statistics proposed and compare them with the conditional test and the standard log-rank test for various biased sampling schemes and right-censoring mechanisms. For length-biased data, empirical studies demonstrated that the test proposed is substantially more powerful than the existing methods. For general left-truncated data, the test proposed is robust, still maintains accurate control of the type I error rate and is also more powerful than the existing methods, if the truncation patterns and right censoring patterns are the same between the groups. We illustrate the methods by using two real data examples.
High Dimensional Structured Additive Regression Models: Bayesian Regularization, Smoothing and Predictive Performance
Authors: Kneib Thomas , Konrath Susanne , Fahrmeir Ludwig
Published: July 2010

Data structures in modern applications frequently combine the necessity of flexible regression techniques handling, for example, non-linear and spatial effects with high dimensional covariate vectors. Whereas estimation of the former is typically achieved by supplementing the likelihood with a suitable smoothness penalty, the latter are usually assigned shrinkage penalties that enforce sparse models. We consider a Bayesian unifying perspective, where conditionally Gaussian priors can be assigned to all types of regression effects. Suitable hyperprior assumptions on the variances of the Gaussian distributions then induce the desired smoothness or sparseness properties. As a major advantage, general Markov chain Monte Carlo simulation algorithms can be developed that allow for the joint estimation of smooth and spatial effects and regularized coefficient vectors. Two applications demonstrate the usefulness of the procedure proposed: a geoadditive regression model for data from a rental guide in Munich and an additive probit model for the prediction of consumer credit defaults. In both cases, high dimensional vectors of categorical covariates will be included in the regression models. The predictive ability of the resulting high dimensional structured additive regression models compared with expert models is of particular relevance and will be evaluated on cross-validation test data.
On Seeing That Someone is Angry
Authors: McNeill W. E. S.
Published: July 2010

Abstract: Some propose that the question of how you know that James is angry can be adequately answered with the claim that you see that James is angry. Call this the Perceptual Hypothesis. Here, I examine that hypothesis.

I argue that there are two different ways in which the Perceptual Hypothesis could be made true. You might see that James is angry by seeing his bodily features. Alternatively, you might see that James is angry by seeing his anger. If you see that James is angry in the first way, your knowledge is inferential. If you see that James is angry in the second way, your knowledge is not inferential. These are different ways of knowing that James is angry. So the Perceptual Hypothesis alone does not adequately answer the question of how you know that fact. To ascertain how you know it, we need to decide whether or not you saw his anger.

This is an epistemological argument. But it has consequences for a theory of perception. It implies that there is a determinate fact about which features of an object you see. This fact is made true independently of what you come to know by seeing.

In the final section of the paper, I seek to undermine various ways in which the claim that you see James' anger may be thought implausible.
A fast expert system for electrocardiogram arrhythmia detection
Authors: Mahmoodabadi Sina Zarei , Ahmadian Alireza , Abolhasani Mohammadjavad , Babyn Paul , Alirezaie Javad
Published: July 2010

Abstract: A fast expert system for electrocardiogram (ECG) arrhythmia detection has been designed in this study. Selecting proper wavelet details, the ECG signals are denoised and beat locations are detected. Beat locations are later used to locate the peaks of the individual waves present in each cardiac cycle. Onsets and offsets of the P and T waves are also detected. These are considered as ECG features which are later used for arrhythmia detection utilizing a novel fuzzy classifier. Fourteen types of arrhythmias and abnormalities can be detected implementing the proposed procedure. We have evaluated the algorithm on the MIT–BIH arrhythmia database. Application of the wavelet filter with the scaling function which closely resembles the shape of the ECG signal has been shown to provide precise results in this study.
Association of ITGAM polymorphism with systemic lupus erythematosus: a meta‐analysis
Authors: Fan Y , Li L‐H , Pan H‐F , Tao J‐H , Sun Z‐Q , Ye D‐Q
Published: July 2010

Background  ITGAM is one of the major non‐human leucocyte antigen that has been implicated in the pathogenesis of systemic lupus erythematosus (SLE). The association of ITGAM polymorphism with SLE has been reported in several studies, but with inconclusive results.

Objectives  The aim of this study was to assess whether combined evidence shows the association between ITGAM polymorphism and SLE.

Methods  A meta‐analysis was performed to survey studies on the ITGAM polymorphism and SLE using comprehensive Medline search and review of the references. A total of five published studies including 12 123 patients with SLE and 17 016 controls were involved. Meta‐odds ratios (ORs) and 95% confidence intervals (CIs) based on fixed effects models or random effects models were depended on Cochran’s Q‐statistic and I2 values.

Results  The overall ORs for the minor A‐allele (OR 1.795; 95%CI 1.676–1.921), AA vs. GG (OR 3.540; 95%CI 2.771–4.522), AG vs. GG (OR 1.750; 95%CI 1.617–1.895), dominant model (OR 1.857;95%CI 1.719–2.005), recessive model (OR 3.041; 95%CI 2.384–3.878) of ITGAM rs1143679 were significantly increased in SLE and fixed effects models were conducted. All controls were in Hardy–Weinberg (HW) proportion. Although this meta‐analysis showed significant association of rs1143683 (A vs. G, OR 1.534;95%CI 1.312–1.792), rs9888739 (T vs. C,OR 1.627;95%CI 1.380–1.918), rs1143678 (T vs. C, OR 1.543; 95%CI 1.330–1.790), rs9937837 (A vs. G, OR 0.466; 95%CI 0.227–0.957) with SLE; all of these were conducted in random effects model as heterogeneity was detected. No significant association was detected in the analysis between rs11574637 and SLE. No publication bias was presented.

Conclusions  This meta‐analysis demonstrates a significant association between ITGAM gene polymorphism and SLE in multiple ethnic populations.
Complexities of conflict: the importance of considering social factors for effectively resolving human–wildlife conflict
Authors: Dickman A. J.
Published: July 2010

Human–wildlife conflict is one of the most critical threats facing many wildlife species today, and the topic is receiving increasing attention from conservation biologists. Direct wildlife damage is commonly cited as the main driver of conflict, and many tools exist for reducing such damage. However, significant conflict often remains even after damage has been reduced, suggesting that conflict requires novel, comprehensive approaches for long‐term resolution. Although most mitigation studies investigate only the technical aspects of conflict reduction, peoples' attitudes towards wildlife are complex, with social factors as diverse as religious affiliation, ethnicity and cultural beliefs all shaping conflict intensity. Moreover, human–wildlife conflicts are often manifestations of underlying human–human conflicts, such as between authorities and local people, or between people of different cultural backgrounds. Despite evidence that social factors can be more important in driving conflict than wildlife damage incurred, they are often ignored in conflict studies. Developing a broader awareness of conflict drivers will advance understanding of the patterns and underlying processes behind this critical conservation issue. In this paper, I review a wide variety of case studies to show how social factors strongly influence perceptions of human–wildlife conflict, and highlight how mitigation approaches should become increasingly innovative and interdisciplinary in order to enable people to move from conflict towards coexistence.
The presence of accessory cusps in chimpanzee lower molars is consistent with a patterning cascade model of development
Authors: Skinner Matthew M. , Gunz Philipp
Published: July 2010

Tooth crown morphology is of primary importance in fossil primate systematics and understanding the developmental basis of its variation facilitates phenotypic analyses of fossil teeth. Lower molars of species in the chimp/human clade (including fossil hominins) possess between four and seven cusps and this variability has been implicated in alpha taxonomy and phylogenetic systematics. What is known about the developmental basis of variation in cusp number – based primarily on experimental studies of rodent molars – suggests that cusps form under a morphodynamic, patterning cascade model involving the iterative formation of enamel knots. In this study we test whether variation in cusp 6 (C6) presence in common chimpanzee and bonobo lower molars (n = 55) is consistent with predictions derived from the patterning cascade model. Using microcomputed tomography we imaged the enamel‐dentine junction of lower molars and used geometric morphometrics to examine shape variation in the molar crown correlated with variation in C6 presence (in particular the size and spacing of the dentine horns). Results indicate that C6 presence is consistent with predictions of a patterning cascade model, with larger molars exhibiting a higher frequency of C6 and with the location and size of later‐forming cusps correlated with C6 variation. These results demonstrate that a patterning cascade model is appropriate for interpreting cusp variation in Pan and have implications for cusp nomenclature and the use of accessory cusp morphology in primate systematics.
Annual Research Review: Parenting and children’s brain development: the end of the beginning
Authors: Belsky Jay , de Haan Michelle
Published: July 2010

After questioning the practical significance of evidence that parenting influences brain development – while highlighting the scientific importance of such work for understanding how family experience shapes human development – this paper reviews evidence suggesting that brain structure and function are ‘chiselled’ by parenting. Although the generalisability of most findings is limited due to a disproportionate, but understandable focus on clinical samples (e.g., maltreated children with post‐traumatic stress disorder (PTSD)) and causal inferences are difficult to draw because of the observational nature of most of the evidence, it is noteworthy that some work with community samples and very new experimental work (e.g., parent training) suggests that tentative conclusions regarding effects of parenting on the developing brain may well be substantiated in future research. Such efforts should focus on parenting in the normal range, experimental manipulations of parenting, differential susceptibility to parenting effects and pathway models linking parenting to brain development and, thereby, to behavioural development. Research on parenting and children’s brain development may be regarded as at ‘the end of the beginning’.
Disentangling true shape differences and experimenter bias: are dextral and sinistral snail shells exact mirror images?
Authors: Schilthuizen M. , Haase M.
Published: July 2010

In theory, snails can come in two enantiomorphs: either dextral (coiling clockwise) or sinistral (coiling counter‐clockwise). In snail species where both forms are actually present, coiling direction is determined by a single gene with delayed maternal inheritance; there is no predictable relationship between a snail's own coiling genotype and its actual coiling direction. Because of this genetic decoupling, it might be expected that dextral and sinistral individuals would be exact mirror images of one another. However, indications exist that there is a subtle but detectable shape difference between dextral and sinistral individuals that derive from the same gene pool. In this paper, we attempt to detect such differences in 50 dextral and 50 sinistral individuals of Amphidromus inversus, a species of land snail that is consistently chirally dimorphic. Four out of 18 volunteers who measured the shells with Vernier calipers found that sinistrals are stouter to a significant degree. A similar result was found by one out of five volunteers who measured the shells from photographs. These results do not allow distinguishing between real shape differences and a handling bias of sinistral as compared with dextral shells. However, when the same set of shells was subjected to a geometric morphometric analysis, we were able to show that sinistrals indeed exhibit a slight but significant widening and twisting of the shell near the palatal and parietal apertural areas. This result is surprising because species of the subgenus Amphidromus s. str. share a long history of chiral dimorphism, and the species would be expected to have been purged from disadvantageous interactions between direction of coil and general shell shape. We conclude that selection on the shape differences is either very weak or constrained by the fact that the pleiotropic effects of the chirality gene are of importance very early in development only.
The N400 as a snapshot of interactive processing: Evidence from regression analyses of orthographic neighbor and lexical associate effects
Authors: Laszlo Sarah , Federmeier Kara D.
Published: July 2010

Linking print with meaning tends to be divided into subprocesses, such as recognition of an input's lexical entry and subsequent access of semantics. However, recent results suggest that the set of semantic features activated by an input is broader than implied by a view wherein access serially follows recognition. EEG was collected from participants who viewed items varying in number and frequency of both orthographic neighbors and lexical associates. Regression analysis of single item ERPs replicated past findings, showing that N400 amplitudes are greater for items with more neighbors, and further revealed that N400 amplitudes increase for items with more lexical associates and with higher frequency neighbors or associates. Together, the data suggest that in the N400 time window semantic features of items broadly related to inputs are active, consistent with models in which semantic access takes place in parallel with stimulus recognition.
Sleep state instabilities in major depressive disorder: Detection and quantification with electrocardiogram‐based cardiopulmonary coupling analysis
Authors: Yang Albert C. , Yang Cheng‐Hung , Hong Chen‐Jee , Tsai Shih‐Jen , Kuo Chung‐Hsun , Peng Chung‐Kang , Mietus Joseph E. , Goldberger Ary L. , Thomas Robert J.
Published: July 2010

Sleep disruption is an important aspect of major depressive disorder but lacks an objective and inexpensive means of assessment. We evaluated the utility of electrocardiogram (ECG)‐based cardiopulmonary coupling analysis to quantify physiologic sleep stability in patients with major depression. Relative to controls, unmedicated depressed patients had a reduction in high‐frequency coupling, an index of stable sleep, an increase in low‐frequency coupling, an index of unstable sleep, and an increase in very‐low‐frequency coupling, an index of wakefulness/REM sleep. The medicated depressed group showed a restoration of stable sleep to a level comparable with that of the control group. ECG‐based cardiopulmonary coupling analysis may provide a simple, cost‐efficient point‐of‐care method to quantify sleep quality/stability and to objectively evaluate the severity of insomnia in patients with major depression.
EEG power changes reflect distinct mechanisms during long‐term memory retrieval
Authors: Khader Patrick H. , Rösler Frank
Published: July 2010

The roles of theta and alpha oscillations for long‐term memory (LTM) retrieval are still under debate. Both are modulated by LTM retrieval demands, but it is unclear what specific LTM functions they are related to. Here, different oscillatory correlates of LTM retrieval could be obtained for theta and alpha with a paradigm that is suited to monitor the activation of a varying number of material‐specific LTM representations. Both frequency bands responded parametrically to the number of retrieved items. However, only the alpha effect dissociated topographically for material type, indicating that the activation of material‐specific representations became systematically modulated. For theta, this effect was material‐unspecific with mid‐frontal topography. These results suggest that alpha is functionally related to the activation of stored information, whereas theta is a sign of retrieval‐related control processes.
Cervical cytology and glandular neoplasia
Authors: Cullimore JE , Waddell C
Published: July 2010

Please cite this paper as: Cullimore J, Waddell C. Cervical cytology and grandular neoplasia. BJOG 2010;117:1047–1050.
Copper T380A intrauterine device for emergency contraception: a prospective, multicentre, cohort clinical trial
Authors: Wu S , Godfrey EM , Wojdyla D , Dong J , Cong J , Wang C , von Hertzen H
Published: July 2010

Please cite this paper as: Wu S, Godfrey E, Wojdyla D, Dong J, Cong J, Wang C, von Hertzen H. Copper T380A intrauterine device for emergency contraception: a prospective, multicentre, cohort clinical trial. BJOG 2010;117:1205–1210.

Objective  To determine the effectiveness of the Copper T380A (CuT380A) intrauterine device (IUD) as an emergency contraceptive in women.

Design  Prospective, multicentre, cohort clinical trial.

Setting  Eighteen family planning clinics in China.

Sample  A cohort of 1963 women, aged 18–44 years, requesting emergency contraception within 120 hours of unprotected sexual intercourse.

Methods  Women requesting emergency contraception were followed at 1, 3 and 12 months after the insertion of CuT380A.

Main outcome measures  Efficacy of CuT380A as emergency contraception and for up to 12 months of postinsertion use. Insertion complication rates, reported side‐effects and continuation rates at 12 months were also recorded.

Results  No pregnancies occurred prior to or at the first follow‐up visit, making CuT380A 100% effective as emergency contraception in this study. The pregnancy rate over the 12‐month period was 0.23 per 100 women. In all, 29 (1.5%) women experienced a difficult IUD insertion process, requiring local anaesthesia or prophylactic antibiotics. No uterine perforations occurred. The main side‐effects were increased menstrual bleeding and menstrual disturbances. The 12‐month postinsertion continuation rate was 94.0 per 100 woman‐years.

Conclusions  CuT380A is a safe and effective method for emergency contraception. The advantages of CuT380A include its ability to provide effective, long‐term contraception.
Amniotic fluid embolism in an Australian population‐based cohort
Authors: Roberts CL , Algert CS , Knight M , Morris JM
Published: July 2010

Please cite this paper as: Roberts C, Algert C, Knight M, Morris J. Amniotic fluid embolism in an Australian population‐based cohort. BJOG 2010;117:1417–1421.

We utilised linked birth, hospital and death data for the entire population to determine the incidence of amniotic fluid embolism (AFE) and its mortality and morbidity. AFE diagnoses were identified from International Classification of Diseases, 10th Revision (ICD10)‐coded hospital and/or death records with additional case definition criteria imposed. The AFE incidence was 3.3 per 100 000 (95% CI, 1.9–4.7), maternal fatality rate 35% (95% CI, 15–59) and perinatal mortality rate 32% (95% CI, 12–56). Newly identified risk factors included induction with vaginal prostaglandin and manual removal of the placenta, and survivors were at increased risk of cerebral infarction. Although two‐thirds of women and infants survived, AFE also caused severe morbidity.
First‐time pregnant women’s experience of the decision‐making process related to completing or terminating pregnancy – a phenomenological study
Authors: Kjelsvik Marianne , Gjengedal Eva
Published: July 2010

Scand J Caring Sci; 2011; 25; 169–175
 
Pregnant and ambivalent. First‐time pregnant women’s experience of the decision‐making process related to completing or terminating pregnancy – a phenomenological study

Every year about 30 000 women in Norway become unexpectedly pregnant and have to decide whether to complete or terminate the pregnancy. Few studies have been performed of these women’s experiences. The aim of this qualitative study was to get new and more extensive information regarding women’s experiences relating to their considerations of whether to terminate a pregnancy in the first trimester. In‐depth interviews with four participants between 25 and 32 years were conducted. None of them had previously given birth or had had an abortion. Each woman was interviewed twice during a period of 2 weeks. The first interview took place between 7 and 11 weeks into the pregnancy. None of the women had reached a decision on whether to complete or terminate the pregnancy. All the women described an increased awareness of their body and a struggle to make ‘the right decision’. They described a desire for autonomy as well as a need for understanding and acknowledgement from significant others and health care providers. They experienced a tension between their pregnant body and the surrounding world, between their own body and the foetus and between their own choice and the opinions of others. One consequence of a woman’s right to choose can be an unwanted loneliness or giving in to other people’s choices. There is consequently a need for professionals who are able to exercise skilled judgement and who are aware of their own power in the relationship so as to assure that the pregnant woman does in fact makes her own decision.
Extraendothelial and constitutive COX‐2 expression is involved in the contractile effect of angiotensin II in the rat aorta
Authors: Castillo‐Hernández M. C. , Martinez‐Godinez M. A. , Guevara‐Balcazar G. , Miliar‐Garcia A. , Mancilla J. , Lopez‐Mayorga R. M. , Castillo‐Henkel E. F. , Castillo‐Henkel C.
Published: July 2010

1 The role of the extraendothelial and constitutive isoforms of cyclo‐oxygenase‐2 (COX‐2) in the contractile effect of angiotensin II (Ang II) was investigated using thoracic and abdominal aortic rings without endothelium from young Wistar rats.

2 Ang II elicited similar contractions in both aortic segments, and the effect was inhibited by pretreatment with NS398 (a selective COX‐2 inhibitor) but not SC‐560 [selective cyclo‐oxygenase‐1 (COX‐1) inhibitor].

3 COX‐2 mRNA was expressed under basal conditions in both aortic segments. Additionally, Ang II increased COX‐2 mRNA expression in the abdominal but not the thoracic segment, while cycloheximide (a protein synthesis inhibitor) did not affect the contractile response to Ang II in either of the two segments; this suggests that the effect is not associated with de novo COX‐2 synthesis.

4 In conclusion, the basal amount of COX‐2 found in aortic smooth muscle cells is sufficient to explain the production of the prostanoids related to the contractile effect of Ang II. The production of these prostanoids, which are derived from constitutive COX‐2, occurs independently of the endothelium vascular system.
Cyclophilin D links programmed cell death and organismal aging in Podospora anserina
Authors: Brust Diana , Daum Bertram , Breunig Christine , Hamann Andrea , Kühlbrandt Werner , Osiewacz Heinz D.
Published: July 2010

Cyclophilin D (CYPD) is a mitochondrial peptidyl prolyl‐cis,trans‐isomerase involved in opening of the mitochondrial permeability transition pore (mPTP). CYPD abundance increases during aging in mammalian tissues and in the aging model organism Podospora anserina. Here, we show that treatment of the P. anserina wild‐type with low concentrations of the cyclophilin inhibitor cyclosporin A (CSA) extends lifespan. Transgenic strains overexpressing PaCypD are characterized by reduced stress tolerance, suffer from pronounced mitochondrial dysfunction and are characterized by accelerated aging and induction of cell death. Treatment with CSA leads to correction of mitochondrial function and lifespan to that of the wild‐type. In contrast, PaCypD deletion strains are not affected by CSA within the investigated concentration range and show increased resistance against inducers of oxidative stress and cell death. Our data provide a mechanistic link between programmed cell death (PCD) and organismal aging and bear implications for the potential use of CSA to intervene into biologic aging.
Application of Moiré Interferometry to Study Residual Deformation in Lap‐Welded Steel Plates
Authors: Xie H. M. , Wang Y. F. , Tang M. J. , Liu Z. W. , Hu Z. X. , Lu J. , Chen P. W.
Published: July 2010

Abstract:  Moiré interferometry combined with hole‐drilling is an effective method for measuring welding residual deformation. In this study, two lap‐welded rectangular steel plates with different overlap widths were manufactured, and cross‐gratings with a frequency of 1200 lines per mm were replicated on test areas of the welds. Sixteen through holes were drilled in the plates to release residual stress, while Moiré interferometry, integrated with a phase‐shifting technique, was used to determine the corresponding surface residual deformation. The distribution characteristics of the residual displacements around the drilled holes were investigated using the experimental data as basis. The relationship between the residual displacement located in the plates and the distance to the weld lines is also presented in this paper. Furthermore, the magnitude and direction of the residual strain both near the holes and within the plates were analysed. The experimental data and detailed analysis in this paper can serve as some reference for research on the residual strain of welds.
Inhibition of vascular ectonucleotidase activities by the pro‐drugs ticlopidine and clopidogrel favours platelet aggregation
Authors: Lecka Joanna , Rana Manjit Singh , Sévigny Jean
Published: July 2010

BACKGROUND AND PURPOSE After conversion to their active forms by the liver, ticlopidine and clopidogrel exert antiplatelet effects through irreversible inhibition of the P2Y12 receptor. Concentrations of nucleotides such as ADP, the physiological agonist at platelet P2Y1 and P2Y12 receptors, are regulated by vascular ectonucleotidases, mainly nucleoside triphosphate diphosphohydrolase (NTPDase)1 and ecto‐5′‐nucleotidase. Here we evaluate the effect of these pro‐drugs on vascular ectonucleotidase activity and on the natural function of these enzymes in regulating platelet aggregation.

EXPERIMENTAL APPROACH Nucleotidase assays were performed by HPLC and by Pi determination, using human umbilical vein endothelial cells (HUVEC) and protein extracts from transfected COS‐7 cells as sources of enzymes. Platelet aggregation was assayed using human platelet‐rich plasma.

KEY RESULTS Each pro‐drug inhibited endothelial ectonucleotidase activities and decreased their ability to block platelet aggregation in vitro. At their therapeutic concentrations, ticlopidine (60 µM) and clopidogrel (20 µM) inhibited ADP hydrolysis by HUVEC by about 80%, and AMP hydrolysis by one‐third. Accordingly, these compounds showed a mixed‐type inhibition of recombinant human NTPDase1 with an apparent Ki (Ki,app) of 10 µM (clopidogrel) and 14 µM (ticlopidine). Recombinant rat ecto‐5′‐nucleotidase, but not its human orthologue, was inhibited by ticlopidine with a Ki,app of 4.5 mM.

CONCLUSIONS AND IMPLICATIONS These pro‐drugs facilitated platelet aggregation via the inhibition of vascular NTPDase1 in vitro. Further studies should be performed to assess whether this effect also occurs in vivo, especially at the beginning of treatment, before sufficient levels of active metabolites are produced by the liver.
Apnoeic–hypopnoeic episodes during obstructive sleep apnoea are associated with histological nonalcoholic steatohepatitis
Authors: Mishra Poonam , Nugent Clarke , Afendy Arian , Bai Chunhong , Bhatia Priya , Afendy Mariam , Fang Yun , Elariny Hazem , Goodman Zachary , Younossi Zobair M.
Published: July 2010

Background: Nonalcoholic fatty liver disease (NAFLD) and obstructive sleep apnoea are associated with metabolic syndrome and atherosclerotic heart disease. This study evaluates the potential association between the NAFLD subtypes and a number of polysomnographical (PSG) parameters.

Methods: This study included patients undergoing bariatric surgery with extensive clinical and histological data for whom complete PSG data before surgery were also available. Excess alcohol intake and other causes of liver disease were excluded. Apnoea, hypopnoea and apnoea–hypopnoea index (AHI) were calculated as described previously.

Results: In this study, a total of 101 patients [77 nonalcoholic steatohepatitis (NASH) and 22 non‐NASH controls] with PSG data were included (age 42.9 ± 11.4 years, body mass index 51.6 ± 9.5 kg/m2, fasting serum glucose 117.4 ± 53.4 mg/dl, fasting serum triglycerides 171.3 ± 82.9 mg/dl, 58% hypertension and 33% diabetes mellitus). Subjects with histological NASH had significantly lower lowest desaturation (77 vs. 85%, P=0.006), lower mean nocturnal oxygen saturation (91 vs. 93%, P=0.05), higher AHI (35 vs. 22, P=0.03), higher respiratory disturbance index (46 vs. 21, P=0.02) and higher alanine aminotransferase/aspartate aminotransferase ratio (1.4 vs. 1.3, P=0.05) compared with non‐NASH controls. In multivariate analysis, the lowest desaturation (P=0.04) was independently associated with histological NASH. Lowest desaturation and mean nocturnal oxygen saturation were significantly lower in subjects with fibrosis (76 vs. 85%, P=0.004 and 90.4 vs. 93.0%, P=0.02).

Conclusions: Our results suggest that the frequent nocturnal hypoxic episodes in NAFLD patients may be a risk factor for developing NASH. Additional studies are needed to study the effect of optimizing sleep apnoea management on the outcomes of patients with NAFLD.
Refractions and recombinations of the ‘economic’ and the ‘social’: a personalized reflection on challenges by—and to—feminist urban geographies
Authors: ROSE DAMARIS
Published: July 2010

This invited essay responds to requests by the Suzanne Mackenzie Memorial Lecture Nominating Committee and by the former Editor of this journal to take stock of and provide intellectual‐historical context for the major preoccupations that characterized feminist urban geography in its early years, by means of a personalized reflection in light of the author's own positioning in those debates and interventions. The thread running through the article is that of the relationship between the ‘economic’ and the ‘social’ in urban geography. The last section briefly considers new challenges that neoliberalism poses for critical feminist urban geographies.
At the Intersection of Social and Cognitive Development: Internal Working Models of Attachment in Infancy
Authors: Johnson Susan C. , Dweck Carol S. , Chen Frances S. , Stern Hilarie L. , Ok Su‐Jeong , Barth Maria
Published: July 2010

Three visual habituation studies using abstract animations tested the claim that infants’ attachment behavior in the Strange Situation procedure corresponds to their expectations about caregiver–infant interactions. Three unique patterns of expectations were revealed. Securely attached infants expected infants to seek comfort from caregivers and expected caregivers to provide comfort. Insecure‐resistant infants not only expected infants to seek comfort from caregivers but also expected caregivers to withhold comfort. Insecure‐avoidant infants expected infants to avoid seeking comfort from caregivers and expected caregivers to withhold comfort. These data support Bowlby’s (1958) original claims—that infants form internal working models of attachment that are expressed in infants’ own behavior.
Are All Trauma Centers Created Equally? A Statewide Analysis
Authors: Cudnik Michael T. , Sayre Michael R. , Hiestand Brian , Steinberg Steven M.
Published: July 2010

ACADEMIC EMERGENCY MEDICINE 2010; 17:701–708 © 2010 by the Society for Academic Emergency Medicine

Objectives:  Prior work has shown differences in mortality at different levels of trauma centers (TCs). There are limited data comparing mortality of equivalently verified TCs. This study sought to assess the potential differences in mortality as well as discharge destination (discharge to home vs. to a rehabilitation center or skilled nursing facility) across Level I TCs in the state of Ohio.

Methods:  This was a retrospective, multicenter, statewide analysis of a state trauma registry of American College of Surgeons (ACS)‐verified Level I TCs from 2003 to 2006. All adult (>15 years) patients transferred from the scene to one of the 10 Level I TCs throughout the state were included (n = 16,849). Multivariable logistic regression models were developed to assess for differences in mortality, keeping each TC as a fixed‐effect term and adjusting for patient demographics, injury severity, mechanism of injury, and emergency medical services and emergency department procedures. Outcomes included in‐hospital mortality and discharge destination (home vs. rehabilitation center or skilled nursing facility). Adjusted odds ratios (ORs) for each TC were also calculated.

Results:  Considerable variability existed in unadjusted mortality between the centers, from 3.8% (95% confidence interval [CI] = 3.7% to 3.9%) to 24.2% (95% CI = 24.1% to 24.3%), despite similar patient characteristics and injury severity. Adjusted mortality had similar variability as well, ranging from an OR of 0.93 (95% CI = 0.47 to 1.84) to an OR of 6.02 (95% CI= 3.70 to 9.79). Similar results were seen with the secondary outcomes (discharge destination).

Conclusions:  There is considerable variability in the mortality of injured patients at Level I TCs in the state of Ohio. The patient differences or care processes responsible for this variation should be explored.
Pediatric Emergency Physician Opinions on Ankle Radiograph Clinical Decision Rules
Authors: Boutis Kathy , Constantine Erika , Schuh Suzanne , Pecaric Martin , Stephens Derek , Narayanan Unni G.
Published: July 2010

ACADEMIC EMERGENCY MEDICINE 2010; 17:709–717 © 2010 by the Society for Academic Emergency Medicine

Objectives:  The Low Risk Ankle Rule (LRAR) is a validated clinical decision rule (CDR) about the indications for ankle radiographs in children with acute blunt ankle trauma. Although application of the LRAR has the potential to safely reduce the rate of ankle radiography by 60%, current x‐ray rates in most emergency departments (EDs) in the United States and Canada remain unnecessarily high (85%–100%). To evaluate this gap between knowledge and practice, physicians who treat pediatric ankle injuries in EDs were surveyed to determine physician awareness and use of the LRAR, acceptability of the LRAR as measured by the Ottawa Acceptability for Decision Rules Scale (OADRS), and perceived barriers to the use of a validated pediatric ankle x‐ray rule.

Methods:  An on‐line survey of members of two national pediatric emergency medicine (PEM) physician associations in the United States and Canada was conducted using a modified Dillman technique.

Results:  Response rates were 75.6% (149/197) in Canada and 45.7% (352/770) in the United States, yielding an aggregate rate of 51.8%. Only 119 of 478 respondents (24.9%) had heard of the LRAR, and 53 of 432 (12.3%) were sufficiently familiar with the LRAR to apply it. The LRAR scored a mean (± standard deviation [SD]) OADRS score of 4.28 out of 6 (±0.67), comparable to published OADRS scores for two well‐known CDRs used in adults. Of the respondents, 434 of 471 (92.1%) at least “slightly agreed” that ankle x‐ray CDRs would be useful in their practice, with no significant differences between the two sides of the border (p = 0.28). Ankle x‐ray rules were felt to save time by 342 (72.6%) of the participants, and the pediatric ankle exam was considered easy enough to apply a CDR by 306 (65.0%). The most common barriers reported for use of any ankle x‐ray rule included perceived reduction in family satisfaction without imaging in 380 (80.7%), nurse‐initiated x‐ray protocols not based on ankle x‐ray rules in 285 (60.5%), concerns about missing a significant fracture in 248 (52.7%), and a preference for own clinical judgment in 246 (52.2%).

Conclusions:  Although the LRAR had a high acceptability score among respondents in this survey, this validated CDR is not widely known and is even less frequently applied by PEM physicians in the United States and Canada. Barriers were identified that will guide efforts to improve the knowledge translation of the LRAR into pediatric EDs.
Use of Quantitative Broad‐based Polymerase Chain Reaction for Detection and Identification of Common Bacterial Pathogens in Cerebrospinal Fluid
Authors: Rothman Richard , Ramachandran Padmini , Yang Samuel , Hardick Andrew , Won Helen , Kecojevic Aleksandar , Quianzon Celeste , Hsieh Yu‐Hsiang , Gaydos Charlotte
Published: July 2010

ACADEMIC EMERGENCY MEDICINE 2010; 17:741–747 © 2010 by the Society for Academic Emergency Medicine

Background:  Conventional laboratory diagnosis of bacterial meningitis based on microscopy followed by culture is time‐consuming and has only moderate sensitivity.

Objectives:  The objective was to define the limit of detection (LOD), analytic specificity, and performance characteristics of a broad‐based quantitative multiprobe polymerase chain reaction (PCR) assay for rapid bacterial detection and simultaneous pathogen‐specific identification in patients with suspected meningitis.

Methods:  A PCR algorithm consisting of initial broad‐based detection of Eubacteriales by a universal probe, followed by pathogen identification using either pathogen‐specific probes or Gram‐typing probes, was employed to detect pathogens. The 16S rRNA gene, which contains both conserved and variable regions, was chosen as the target. Pathogen‐specific probes were designed for Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Staphylococcus epidermidis, Staphylococcus aureus, Escherichia coli, and Listeria monocytogenes. Gram‐positive and ‐negative typing probes were designed based on conserved regions across all eubacteria. The LOD and time to detection were assessed by dilutional mocked‐up samples. A total of 108 convenience cerebrospinal fluid (CSF) clinical samples obtained from the Johns Hopkins Hospital (JHH) microbiology laboratory were tested, and results were compared with hospital microbiologic culture reports.

Results:  The LOD of the assay ranged from 101 to 102 colony‐forming units (CFU)/mL. Pathogen‐specific probes showed no cross‐reactivity with other organisms. Time to detection was 3 hours. In clinical specimens, the universal probe correctly detected 16 of 22 culture‐positive clinical specimens (sensitivity = 72.7%; 95% confidence interval [CI] = 49.8% to 89.3%), which were all correctly characterized by either pathogen‐specific or Gram‐typing probes. Adjusted sensitivity after removing probable microbiologic laboratory contaminants was 88.9% (95% CI = 65.3% to 98.6%). The universal probe was negative for 86 of 86 culture‐negative specimens.

Conclusions:  A broad‐based multiprobe PCR assay demonstrated strong analytic performance characteristics. Findings from a pilot clinical study showed promise in translation to human subjects, supporting potential utility of the assay as an adjunct to traditional diagnostics for early identification of bacterial meningitis.
Emergency Medicine in the Developing World: A Delphi Study
Authors: Hodkinson Peter W. , Wallis Lee A.
Published: July 2010

ACADEMIC EMERGENCY MEDICINE 2010; 17:765–774 © 2010 by the Society for Academic Emergency Medicine

Objectives:  Emergency medicine (EM) as a specialty has developed rapidly in the western world, but remains largely immature in developing nations. There is an urgent need for emergency services, but no clear guidelines are available on the priorities for establishing EM in the developing world. This study seeks to establish consensus on key areas of EM development in developing world settings, with respect to scope of EM, staffing needs, training requirements, and research priorities.

Methods:  A three‐round Delphi study was conducted via e‐mail. A panel was convened of 50 EM specialists or equivalent, with experience in or interest in EM in the developing world. In the first round, panelists provided free‐text statements on scope, staffing, training, and research priorities for EM in the developing world. A five‐point Likert scale was used to rate agreement with the statements in Rounds 2 and 3. Consensus statements are presented as a series of synopsis statements for each of the four major themes.

Results:  A total of 168 of 208 statements (81%) had reached consensus at the end of the study. Key areas in which consensus was reached included EM being a specialist‐driven service, with substantial role for nonphysicians. International training courses should be adapted to local needs. EM research in developing countries should be clinically driven and focus on local issues of importance.

Conclusions:  The scope and function of EM and relationships with other specialties are defined. Unambiguous principles are laid out for the development of the specialty in developing world environments. The next step required in this process is translation into practical guidelines for the development of EM in developing world settings where they may be used to drive policy, protocols, and research.
Intestinal‐FABP and Liver‐FABP: Novel Markers for Severe Abdominal Injury
Authors: Relja Borna , Szermutzky Maika , Henrich Dirk , Maier Marcus , De Haan Jacco‐Juri , Lubbers Tim , Buurman Wim A. , Marzi Ingo
Published: July 2010

ACADEMIC EMERGENCY MEDICINE 2010; 17:729–735 © 2010 by the Society for Academic Emergency Medicine

Objectives:  Fatty acid–binding proteins (FABPs) have relatively high tissue concentrations and low plasma concentrations and are released into the circulation following organ injury. We explored the utility of intestinal‐(I)‐FABP and liver‐(L)‐FABP for the diagnosis of abdominal injury in patients with multiple trauma.

Methods:  This prospective study included 102 trauma patients and 30 healthy volunteers. Plasma I‐FABP and L‐FABP levels were measured in the emergency department (ED) by enzyme‐linked immunosorbent assay (ELISA). Forty‐one patients suffered from serious or severe abdominal trauma (Abbreviated Injury Score [AIS] code “ai” for abdominal injury, AISai ≥ 3) and nine were moderately abdominally injured (AISai < 3). Fifty‐two had no abdominal injury.

Results:  Median I‐FABP and L‐FABP levels in the AISai ≥ 3 group (516 pg/mL and 135 ng/mL, respectively) were significantly higher compared to the AISai < 3 group (154 pg/mL and 13 ng/mL, respectively) or those without abdominal injury (207 pg/mL and 21 ng/mL, respectively) or normal controls (108 pg/mL and 13 ng/mL, respectively). The cutoff to distinguish the ai ≥ 3 is 359 pg/mL for I‐FABP and 54 ng/mL for L‐FABP, with 93% specificity and 75% sensitivity for I‐FABP and 93% and 82% for L‐FABP, respectively.

Conclusions:  High I‐FABP and L‐FABP levels correlate with relevant severity of abdominal tissue damage in patients with multiple trauma. I‐FABP and L‐FABP could be useful as markers for the early detection of significant abdominal injury in acute multiple trauma and identify patients who require rapid intervention.
Core Curricular Elements for Fellowship Training in International Emergency Medicine
Authors: Bayram Jamil , Rosborough Stephanie , Bartels Susan , Lis Julian , VanRooyen Michael J. , Bobby Kapur G. , Anderson Philip D.
Published: July 2010

ACADEMIC EMERGENCY MEDICINE 2010; 17:748–757 © 2010 by the Society for Academic Emergency Medicine

Objectives:  The objective was to describe the common educational goals, curricular elements, and methods of evaluation used in international emergency medicine (IEM) fellowship training programs currently. IEM fellowship programs have been developed to provide formal training for emergency physicians (EPs) interested in pursuing careers in IEM. Those fellowships are variable in scope, objectives, and duration. Previously published articles have suggested a general curriculum structure for IEM fellowships.

Methods:  A search of MEDLINE, EMBASE, and CINAHL databases from 1950 to June 2008 was performed, combining the terms international, emergency medicine, and fellowship. Online curricula and descriptive materials from IEM fellowships listed by the Society for Academic Emergency Medicine (SAEM) were reviewed. Knowledge and skill areas common to multiple programs were organized in discrete categories. IEM fellowship directors were contacted for input and feedback.

Results:  Eight articles on IEM fellowships were identified. Two articles described a general structure for fellowship curriculum. Sixteen of 20 IEM fellowship programs had descriptive materials posted online. These information sources, plus input from seven fellowship program directors, yielded the following seven discrete knowledge and skill areas: 1) emergency medicine systems development, 2) humanitarian relief, 3) disaster management, 4) public health, 5) travel and field medicine, 6) program administration, and 7) academic skills.

Conclusions:  While IEM fellowships vary with regard to objectives and structure, this article presents an overview of the current focus of IEM fellowship training curricula that could serve as a resource for IEM curriculum development at individual institutions.
Myocardial telocytes: a specific new cellular entity
Authors: Kostin Sawa
Published: July 2010

Introduction

Cellular compartments of telocytes

Distribution of telocytes in the heart

Possible functions of telocytes in the myocardium

Telocytes and myocardial remodelling

Unresolved issues regarding myocardial telocytes

The existence of a new type of interstitial cells in the heart namely, interstitial Cajal‐like cells (ICLC), has been described for the first time by Hinescu and Popescu in 2005. This study was then followed by an ascending trend of publications regarding the morphology, phenotype and distribution of myocardial ICLC in diverse species including human patients. Recently the new term ‘telocytes’ has been proposed for cells formerly known as ICLC, and the term ‘telopodes’ has been proposed for the prolongations of these cells. The identification of these cells is based on ultrastructural criteria. In addition, telocyters/telyopodes can be identified by several complementary approaches including methylene blue vital staining, silver impregnation and immunoreactivity against CD117/c‐kit, vimentin, etc. This point of view presents critical data existing in literature, as well as own results, which unequivocally provide compelling evidence that telocytes are a new distinct cellular entity of myocardial interstitium. Several presumable functions of the myocardial telocytes are discussed: (i) intercellular signalling, (ii) cardiac repair/remodelling and (iii) stem cell nursing in cardiac renewal.