bluuebunny/crossref_metadata_2025 huggingface dataset:
Mass concentrations and indoor-outdoor relationships of PM in selected educational buildings in Nis, Serbia
Authors: Kovacevic Renata , Tasic Visa , Zivkovic Marija , Zivkovic Nenad , Djordjevic Amelija , Manojlovic Dragan , Jovasevic-Stojanovic Milena
Published: May 2014

Mass concentrations of particulate matter (PM) fractions were measured in
educational buildings in the city of Nis, Republic of Serbia. Two sampling
campaigns were conducted in winter periods. The first campaign was in the
period from 21 February to 15 April 2010 at the Faculty of Occupational
Safety (FOS) and the second campaign was from 20 March to 4 April 2013 at the
primary school Vozd Karadjordje (VK). PM measurements were carried out with low
volume samplers Sven/Leckel LVS3. The average daily PM10 concentration inside
the FOS (47.0 ?21.8 ?g/m3) was lower than PM10 concentration in outdoor air
(50.7 ?28.1 ?g/m3). The average daily PM10 concentration inside the VK (54.6
? 17.6 ?g/m3) was higher than in outdoor air (47.9 ? 22.8 ?g/m3). The 24
hours average PM10 concentrations at FOS exceeded the EU limit value (50
mg/m3) during 34 % of days outdoors, and 39 % of days indoors. The 24 hours
average PM10 concentrations at VK exceeded the limit value during 35 % of
days outdoors, and 53 % of days indoors. The 24 hours average PM2.5
concentrations at VK exceeded the WHO daily mean guideline value (25 mg/m3)
during 71 % of days outdoors, and 88 % of days indoors. The average PM10 I/O
ratio at VK was 1.57 during teaching hours, and 1.00 during no teaching
hours. Similarly, average PM2.5 I/O ratio at VK was 1.11 during teaching
hours and 0.90 during no teaching hours. Average daily PM2.5/PM10 ratio in
the ambient air at VK was 0.87, and 0.82 at FOS. Very strong correlations
between the indoor and outdoor PM concentrations were observed at VK during
no teaching hours (r>0.8). Moderate to strong negative correlations were
found between the wind speed and PM at both schools. High outdoor PM
concentrations and resuspension of particles are probably the most possible
reasons for the elevated indoor PM concentrations found in the study.
America's Descent into Madness
Authors: Giroux Henry A.
Published: May 2014

This article describes America's descent into madness under the regime of neoliberalism that has emerged in the United States since the late 1970s. In part, this is due to the emergence of a public pedagogy produced by the corporate-owned media that now saturates Americans with a market-driven value system that undermines those formative cultures and public spheres necessary to educate a critical and engaged citizenry. A culture of illiteracy, cruelty, and punishment is circulated through the various stories that America now tells about its self—stories that are narrated by the one percent and legitimated by the anti-public intellectuals who work for them. Neoliberal stories occupy a dead zone inimical to the promises of a substantive democracy and must be challenged by making education central to any viable notion of politics. Stories that invoke collective struggle, public memories of resistance, and modes of individual and collective agency are needed to inspire a populist politics and an organized social movement.

America has entered one of its periods of historical madness, but this is the worst I can remember: worse than McCarthyism, worse than the Bay of Pigs and in the long term potentially more disastrous than the Vietnam War. (le Carré)
‘Keeping up the Good Fight’: The Said and Unsaid in Flores v. Arizona
Authors: Thomas Melinda Hollis , Aletheiani Dinny Risri , Carlson David Lee , Ewbank Ann Dutton
Published: May 2014

The authors' purpose in this article is to interrogate the mediated and political discourses that emerged alongside the Flores v. Arizona case. The authors endeavor to offer another voice, framework and approach that may help sustain a continuous, paramount conversation concerning the educational rights of English language learners and the ways in which the public rationalizes appropriate state provisions for such students. Therein, the manuscript operationalizes the rationalities that appear across pro- Flores data (which consists of public opinion rhetoric positioned in support of the plaintiff and therefore in favor of appropriate state support for English language learners). The analysis of this data lays bare the echoes of the discursive regime surrounding the Flores case, a regime which unmasks neo-liberal rationalities for supporting English language learners. For example, the findings indicate that neo-liberal rationalities such as commodification, competition, risk, security, insurance and entrepreneurialism dominate the discursive landscape and eclipse alternative ways of arguing in support of students' rights to equitable and appropriate education, including social justice, pluralism and democracy.
Problem-Based Learning: A Promising Pathway for Empowering Pre-Service Teachers for ICT-Mediated Language Teaching
Authors: Kharade Kalpana , Peese Hema
Published: May 2014

Information and communication technology (ICT) has become a prominent part of education and offers numerous means of improving teaching and learning in the classroom. However, the tendency to take the teacher education curriculum for granted and the assumption that it adequately prepares teachers for the integration of ICT into their teaching practice need to be questioned. Recent studies on technology have shifted from the emphasis on technology skills alone to integrating pedagogy and content with technology, which is termed technological pedagogical content knowledge (TPACK). Deeper understanding of how TPACK can be cultivated is needed. This design-based research explored how a problem-based learning approach can help pre-service language teachers to develop TPACK and impact their teaching practices. Data was collected via self-progress surveys, ICT-mediated language lesson plans, reflections by the pre-service teachers, student-produced artefacts, records of instructional design and log entries by the facilitators. Based on the survey data, the pre-service teachers believed that they had developed TPACK. By comparing the qualitative data, it was discovered that the pre-service teachers became better positioned to use ICT in their teaching practices. The shift from teacher-centredness to student-centredness was also observed in their instructional planning. The problem-based learning approach created critical but safe opportunities for pre-service teachers to better understand that while using technology, teachers may have to re-evaluate their teaching practices and to rethink the nature and scope of the subject for which it will be used.
Economic Objects: How Policy Discourse in the United Kingdom Represents International Students
Authors: Lomer Sylvie
Published: May 2014

Despite the significant and increasing presence of international students in the United Kingdom, on a national level there has been a lack of formal policy towards international students. Instead, in policy discourse, international students are represented in economic terms to the exclusion of other dimensions of experience and action. This article seeks to describe and challenge these discursive representations of international students in the United Kingdom's national policy environments. It takes a critical linguistic approach to analysing two texts representative of Coalition policy discourses. The choices of vocabulary, grammar and the content reveal three key assumptions: that education is a marketplace; that the primary value of students is financial; and that students are independent consumers, not influenced by education agents. These assumptions are argued to derive from neo-liberal ideological influences, which oversimplify interactions between international students, host countries and education agents by relying on a market-based discourse. Alternative discourses are needed to challenge these assumptions of policy discourse in the United Kingdom.
Neo-Liberal Policy Agendas and the Problem of Inequality in Higher Education: The Ethiopian Case
Authors: Molla Tebeje
Published: May 2014

Under the influence of the external policy pressure of donors such as the World Bank, higher education in Ethiopia has witnessed a series of institutional and system-wide reforms. This article reviews selected policy documents to show key neo-liberal policy agendas endorsed in the reforms and explicate how they have affected social equity in the subsystem. The analysis shows that higher education reforms in Ethiopia, primarily framed by concerns of economic efficiency, have constrained social equity in two important ways. First, at a discursive level, the problem of inequality is represented as a lack of access and a disadvantage in the human capital formation of the nation. Second, the drive for greater efficiency and reduced costs in the educational provision embedded in the reforms is inconsistent with the need for the financial and political commitments required to benefit marginalised members of the society through relevant equity instruments. If the equity policy provisions should be instrumental in ensuring participation, retention and successful completion, and thereby supporting the social mobility of disadvantaged groups, they need to draw on a broad social justice perspective.
On the Critique of Everyday Life to Metaphilosophy: Henri Lefebvre's Philosophical-Political Legacy of the Cultural Revolution
Authors: Sünker Heinz
Published: May 2014

Henri Lefebvre (1901–91), philosopher and sociologist, is, together with Theodor W. Adorno, Max Horkheimer, Walter Benjamin and Ernst Bloch, one of the most relevant representatives of the first generation in Western Marxism. His engagement with Marxism led him to analyse everyday life in post-war France in order to decipher the possibilities of, and chances for, real social change and not only the exchange of functional elites and dominant powers. His intention was to deal with Marx's critique of political economy and undergird it with the concrete elements of the life of the people. He extended the theoretical elements of Capital to the real experiences of the people. He took everyday life — rehabilitating it in the process — as the starting point for all other activities of human beings. Complementary to this, he reconstructed the philosophical tradition within his concept of metaphilosophy. Therefore we can speak of a mediation between a sociological and a philosophical task or challenge, which develops content and perspective for a revolutionary change of our society, i.e. a cultural revolutionary approach which means changing not only some social structures but all the conditions of human experience from an emancipatory perspective. This article reconstructs the analytical approach of Lefebvre, and discusses his foundations and aims in relation to how he developed the idea of cultural revolution.

No knowledge of (global) society without critical knowledge of everyday life in the way it implants itself — with its organisation and its privatisation, with the organisation of its privatisation –in the middle of this society and its history. No knowledge of everyday life without critical knowledge of the (entire) society. (Lefebvre)
Behavioral-Economic Nudges and Performance Measurement Models
Authors: Malina Mary A. , Selto Frank H.
Published: May 2014

We describe the context wherein a Fortune 500 company's performance measurement model (PMM) has endured and evolved over a 15-year period. The PMM's tenure and continued importance refute the alleged faddish nature of PMMs such as the Balanced Scorecard, at least in this case, and allow identification of factors that add to theory about PMM longevity. We use a behavioral-economic framework and qualitative and quantitative data to examine the mechanisms behind this successful PMM. Aspects of the way the PMM is designed and implemented appear to enable the company using the PMM to exploit or mitigate common behavioral heuristics and biases in decision-making. The PMM helps manage cognitive load in a way that is consistent with the company's priorities, and it manages biases by allowing the company to frame performance information in ways that nudge managers toward strategically important results and risks. The behavioral-economic connection might be a reason why this PMM, and perhaps others, endures. Thus, this study adds to and presents preliminary empirical support for testable behavioral-economic PMM theory.

Data Availability: Use of all data collected for this study is regulated by a strict nondisclosure agreement, which requires the researchers to protect the company's identity and its proprietary information.
Novel Agents for the Treatment of Type 2 Diabetes
Authors: DeFronzo Ralph A. , Triplitt Curtis L. , Abdul-Ghani Muhammad , Cersosimo Eugenio
Published: May 2014

In Brief

Impaired insulin secretion, increased hepatic glucose production, and decreased peripheral glucose utilization are the core defects responsible for the development and progression of type 2 diabetes. However, the pathophysiology of this disease also includes adipocyte insulin resistance (increased lipolysis), reduced incretin secretion/sensitivity, increased glucagon secretion, enhanced renal glucose reabsorption, and brain insulin resistance/neurotransmitter dysfunction. Although current diabetes management focuses on lowering blood glucose, the goal of therapy should be to delay disease progression and eventual treatment failure. Recent innovative treatment approaches target the multiple pathophysiological defects present in type 2 diabetes. Optimal management should include early initiation of combination therapy using multiple drugs with different mechanisms of action. This review examines novel therapeutic options that hold particular promise.
A Brief History of the Development of Diabetes Medications
Authors: White John R.
Published: May 2014

In Brief

This article provides an overview of the development of insulins, oral agents, and noninsulin injectable agents used in the management of hyperglycemia in patients with diabetes. It also briefly reviews the pharmacological impact and salient side effects of these medications.
Personalized Diabetes Management: Moving from Algorithmic to Individualized Therapy
Authors: Subramanian Savitha , Hirsch Irl B.
Published: May 2014

In Brief

Management of individuals with type 2 diabetes involves complex decision-making to attain good glycemic control. A personalized approach to the care of these individuals provides a unique management plan for each patient. This article reviews some of the important variables that require consideration for management of individuals with type 2 diabetes. We also provide a scoring scale to help clinicians make appropriate decisions regarding A1C targets while caring for these patients.
Tobacco Cessation Counseling Training in US Entry-Level Physical Therapist Education Curricula: Prevalence, Content, and Associated Factors
Authors: Pignataro Rose M. , Gurka Matthew J. , Jones Dina L. , Kershner Ruth E. , Ohtake Patricia J. , Stauber William T. , Swisher Anne K.
Published: May 2014

Background

The US Public Health Service (USPHS) recommends tobacco cessation counseling (TCC) training for all health care professionals. Within physical therapist practice, smoking can have adverse effects on treatment outcomes in all body systems. In addition, people with physical disabilities have a higher smoking prevalence than the general population, creating a strong need for tobacco cessation among physical therapy clientele. Therefore, TCC training is an important component of entry-level physical therapist education.

Objective

The aims of this study were: (1) to determine need for TCC training within entry-level physical therapist education and (2) to identify potential barriers to implementation of USPHS guidelines in the academic environment.

Design

A descriptive cross-sectional survey was conducted.

Methods

Directors or academic coordinators of clinical education from entry-level physical therapist programs (N=204) were surveyed using an online instrument designed specifically for this study. Data regarding program and faculty characteristics, tobacco-related training content, and faculty opinions toward TCC in both physical therapist practice and education were analyzed descriptively.

Results

The response rate was 71%. A majority (60%) of programs indicated inclusion of tobacco-related training, most commonly 1 to 2 hours in duration, and of these programs, 40% trained students in the implementation of USPHS clinical guidelines for TCC.

Limitations

Data analyses were constrained by limited or missing data in some areas. A single faculty member completed the survey for each program.

Conclusions

There is a need for TCC training in entry-level physical therapist education. Inclusion may be facilitated by addressing perceived barriers toward TCC as a component of physical therapist practice and promoting the relevance of TCC as it relates to intended outcomes of physical therapy interventions.
Effectiveness of Peer Assessment for Implementing a Dutch Physical Therapy Low Back Pain Guideline: Cluster Randomized Controlled Trial
Authors: van Dulmen Simone A. , Maas Marjo , Staal J. Bart , Rutten Geert , Kiers Henri , Nijhuis-van der Sanden Maria , van der Wees Philip
Published: May 2014

Background

Clinical practice guidelines are considered important instruments to improve quality of care. However, success is dependent on adherence, which may be improved using peer assessment, a strategy in which professionals assess performance of their peers in a simulated setting.

Objective

The aim of this study was to determine whether peer assessment is more effective than case-based discussions to improve knowledge and guideline-consistent clinical reasoning in the Dutch physical therapy guideline for low back pain (LBP).

Design

A cluster randomized controlled trial was conducted.

Setting and Participants

Ten communities of practice (CoPs) of physical therapists were cluster randomized (N=90): 6 CoPs in the peer-assessment group (n=49) and 4 CoPs in the case-based discussion group (control group) (n=41).

Intervention

Both groups participated in 4 educational sessions and used clinical patient cases. The peer-assessment group reflected on performed LBP management in different roles. The control group used structured discussions.

Measurements

Outcomes were assessed at baseline and at 6 months. The primary outcome measure was knowledge and guideline-consistent reasoning, measured with 12 performance indicators using 4 vignettes with specific guideline-related patient profiles. For each participant, the total score was calculated by adding up the percentage scores (0–100) per vignette, divided by 4. The secondary outcome measure was reflective practice, as measured by the Self-Reflection and Insight Scale (20–100).

Results

Vignettes were completed by 78 participants (87%). Multilevel analysis showed an increase in guideline-consistent clinical reasoning of 8.4% in the peer-assessment group, whereas the control group showed a decline of 0.1% (estimated group difference=8.7%, 95% confidence interval=3.9 to 13.4). No group differences were found on self-reflection.

Limitations

The small sample size, a short-term follow-up, and the use of vignettes as a proxy for behavior were limitations of the study.

Conclusions

Peer assessment leads to an increase in knowledge and guideline-consistent clinical reasoning.
The Effects of Gendered Immigration Enforcement on Middle Childhood and Schooling
Authors: Gallo Sarah
Published: May 2014

Drawing from an ethnographic study on Mexican immigrant fathers and their second-grade children, this article examines the masked realities behind current immigration policies that equate “illegal” with “Mexican immigrant” and how the enforcement of these policies, which overwhelmingly target Mexican immigrant men, affect immigrant children and their elementary schooling. I empirically illustrate how this oversimplified criminalization of Mexican immigrant men led to father-child separations, incredible stress for children, and the positioning of children as mediators in high-stakes encounters between the police and their parents. I highlight the need to strip back these masks to address and build upon students’ real-world experiences, including their immigration practices and family-based hybrid language practices, for this younger generation of DREAMers and U.S. citizens.
Morbidity of repeat transsphenoidal surgery assessed in more than 1000 operations
Authors: Jahangiri Arman , Wagner Jeffrey , Han Sung Won , Zygourakis Corinna C. , Han Seunggu J. , Tran Mai T. , Miller Liane M. , Tom Maxwell W. , Kunwar Sandeep , Blevins Lewis S. , Aghi Manish K.
Published: May 2014

Object

While transsphenoidal surgery is associated with low morbidity, the degree to which morbidity increases after reoperation remains unclear. The authors determined the morbidity associated with repeat versus initial transsphenoidal surgery after 1015 consecutive operations.

Methods

The authors conducted a 5-year retrospective review of the first 916 patients undergoing transsphenoidal surgery at their institution after a pituitary center of expertise was established, and they analyzed morbidities.

Results

The authors analyzed 907 initial and 108 repeat transsphenoidal surgeries performed in 916 patients (9 initial surgeries performed outside the authors' center were excluded). The most common diagnoses were endocrine inactive (30%) or active (36%) adenomas, Rathke's cleft cysts (10%), and craniopharyngioma (3%). Morbidity of initial surgery versus reoperation included diabetes insipidus ([DI] 16% vs 26%; p = 0.03), postoperative hyponatremia (20% vs 16%; p = 0.3), new postoperative hypopituitarism (5% vs 8%; p = 0.3), CSF leak requiring repair (1% vs 4%; p = 0.04), meningitis (0.4% vs 3%; p = 0.02), and length of stay ([LOS] 2.8 vs 4.5 days; p = 0.006). Of intraoperative parameters and postoperative morbidities, 1) some (use of lumbar drain and new postoperative hypopituitarism) did not increase with second or subsequent reoperations (p = 0.3–0.9); 2) some (DI and meningitis) increased upon second surgery (p = 0.02–0.04) but did not continue to increase for subsequent reoperations (p = 0.3–0.9); 3) some (LOS) increased upon second surgery and increased again for subsequent reoperations (p < 0.001); and 4) some (postoperative hyponatremia and CSF leak requiring repair) did not increase upon second surgery (p = 0.3) but went on to increase upon subsequent reoperations (p = 0.001–0.02). Multivariate analysis revealed that operation number, but not sex, age, pathology, radiation therapy, or lesion size, increased the risk of CSF leak, meningitis, and increased LOS. Separate analysis of initial versus repeat transsphenoidal surgery on the 2 most common benign pituitary lesions, pituitary adenomas and Rathke's cleft cysts, revealed that the increased incidence of DI and CSF leak requiring repair seen when all pathologies were combined remained significant when analyzing only pituitary adenomas and Rathke's cleft cysts (DI, 13% vs 35% [p = 0.001]; and CSF leak, 0.3% vs 9% [p = 0.0009]).

Conclusions

Repeat transsphenoidal surgery was associated with somewhat more frequent postoperative DI, meningitis, CSF leak requiring repair, and greater LOS than the low morbidity characterizing initial transsphenoidal surgery. These results provide a framework for neurosurgeons in discussing reoperation for pituitary disease with their patients.
Surgical strategies and outcomes of spinal ependymomas of different lengths: analysis of 210 patients
Authors: Li Teng-yu , Chu Jun-sheng , Xu Yu-lun , Yang Jun , Wang James , Huang Yu-Hua , Kwan Aij-Lie , Wang Gui-Huai
Published: May 2014

Object

The aim of this study was to investigate the surgical strategies and outcomes for spinal ependymomas of different lengths.

Methods

The authors used data from 210 patients with spinal ependymomas (WHO Grades II and III) in this 10-year retrospective study (January 1999 to December 2008), dividing them into 3 different groups according to length (spinal ependymomas < 5 cm, 5–10 cm, and > 10 cm). All patients underwent tumor resection. The basic characteristics of the patients were reviewed and the functional status was assessed using the McCormick classification.

Results

There were 89, 81, and 40 patients, respectively, in the 3 groups (< 5 cm, 5–10 cm, and > 10 cm). Grosstotal resections (GTRs) were performed in 172 patients (81.9% overall, or 86.5%, 79.0%, and 77.5% in the 3 groups, respectively). Subtotal and partial resections were achieved in 38 patients (18.1%). Eight patients with medulla oblongata or upper cervical cord tumors received a tracheotomy postoperatively. The follow-up period ranged from 56 to 176 months. One hundred thirty-five patients (76.7%) experienced improvement, (88.2%, 83.8%, and 34.4% in the < 5 cm, 5–10 cm, and > 10 cm groups, respectively). Thirty-three patients (18.8%) maintained their pretreatment status, and 8 patients (4.5%) showed deterioration following tumor resection at 6 months. Tumor recurrence or progression was observed in 6 (2.9%) of the 210 patients. Among the 6 patients, recurrent tumors were located in the conus (n = 3), thoracic (n = 1), and medullocervical cord (n = 2).

Conclusions

Radical resection of spinal ependymomas could be performed in most patients, and the rate of GTR was significantly different in the different-length groups (< 10 cm vs > 10 cm, p = 0.032). Patients with longer tumors had worse surgical results compared with those with small tumors (p < 0.001), and more postoperative neuropathic pain and proprioceptive deficits could usually be observed in patients harboring larger tumors. Early diagnosis and timely operation are critical to achieving better neurological outcomes. For tumors with dense adhesions, complete removal should be performed cautiously because of the significant incidence of neurological deterioration.
Stent-assisted coil embolization of ruptured wide-necked aneurysms in the acute period: incidence of and risk factors for periprocedural complications
Authors: Chung Joonho , Lim Yong Cheol , Suh Sang Hyun , Shim Yu Shik , Kim Yong Bae , Joo Jin-Yang , Kim Bum-soo , Shin Yong Sam
Published: May 2014

Object

The purpose of this study was to report the authors' experiences in stent-assisted coil embolization (SAC) of ruptured wide-necked aneurysms in the acute period and to evaluate the incidence of and risk factors for periprocedural complications.

Methods

A total of 72 patients were recruited for this study between March 2007 and June 2012. All patients met the following criteria: 1) the presence of ruptured intracranial wide-necked saccular aneurysms, and 2) the patient underwent SAC for treatment of those aneurysms within 72 hours of rupture. All of the patients with clinically poor grades or acute hydrocephalus underwent external ventricular drainage (EVD) before SAC. The incidence of and risk factors for periprocedural complications were retrospectively evaluated.

Results

Of the 72 patients included in this study, periprocedural complications occurred in 14 (19.4%), including asymptomatic complications in 4 (5.6%) and symptomatic complications in 10 (13.9%); there were symptomatic thromboembolic complications in 5 patients (6.9%), and symptomatic hemorrhagic complications in 5 (6.9%). The authors observed no subacute or delayed thromboembolic complications during the follow-up period of 18.8 months. Use of EVD (OR 1.413, 95% CI 0.088–2.173; p = 0.046) was the only independent risk factor for periprocedural complications on multivariate logistic regression analysis.

Conclusions

The periprocedural complication rate during SAC was 19.4% among 72 patients. Because of the high complication rate, microsurgical clipping or endovascular treatment with another technique (multiple-microcatheter or balloon-assisted technique) may be a more appropriate option for first-line treatment than SAC, especially in patients requiring EVD.
Optic chiasm compression from mass effect and thrombus formation following unsuccessful treatment of a giant supraclinoid ICA aneurysm with the Pipeline device: open surgical bailout with STA-MCA bypass and parent vessel occlusion
Authors: Abla Adib A. , Zaidi Hasan A. , Crowley R. Webster , Britz Gavin W. , McDougall Cameron G. , Albuquerque Felipe C. , Spetzler Robert F.
Published: May 2014

Pipeline Embolization Devices (PEDs) have been shown to be effective for intracranial internal carotid artery (ICA) aneurysms, and are now approved by the FDA specifically for this use. Potential pitfalls, however, have not yet been described in the pediatric neurosurgical literature. The authors report on a 10-year-old boy who presented to the Barrow Neurological Institute after progressive visual decline. He had undergone placement of a total of 7 telescoping PEDs at another facility for a large ICA aneurysm. Residual filling of the aneurysm and significant expansion of intraaneurysmal thrombus with chiasmal compression on admission images were causes for concern. The patient underwent a surgical bailout with a superficial temporal artery–middle cerebral artery bypass, with parent artery occlusion. Postoperative vascular imaging was notable for successful occlusion of the parent vessel, with no evidence of filling of the aneurysm.

Reports on the pitfalls of PEDs in the neurosurgical literature are scarce. To the authors' knowledge this represents the first paper describing a successful open surgical bailout for residual aneurysmal filling and expansion of thrombus after placement of a PED.
Intraspinal lesions associated with sacrococcygeal dimples
Authors: Harada Atsuko , Nishiyama Kenichi , Yoshimura Junichi , Sano Masakazu , Fujii Yukihiko
Published: May 2014

Object

Sacrococcygeal dimples in the gluteal fold, also known as coccygeal pits, are observed in 2%–4% of newborns. Sacrococcygeal dimples are not generally considered to be associated with a significant risk of intraspinal anomalies and therefore are not thought to require further radiographic evaluation. Accordingly, the precise incidence and nature of intraspinal lesions that may be associated with sacrococcygeal dimples is unclear. This study was conducted to determine the incidence of intraspinal lesions in patients with intergluteal dimples.

Methods

In this study, the authors used MRI to evaluate 103 children who were seen at the Niigata University Medical and Dental Hospital between 2006 and 2011 because of skin abnormalities in the lumbosacral region. Of these children, 14 were excluded as having a subcutaneous fatty mass, and 5 were excluded because the dimples were above the gluteal fold or did not end at the coccyx. The remaining 84 patients were classified according to whether the bottom of the dimple was visible (shallow) or not (deep). The authors also retrospectively examined other skin abnormalities and coexisting anomalies.

Results

The mean age at the time of MRI evaluation was 11.7 months. Magnetic resonance imaging led to the identification of fibrolipoma of the terminal filum (FTF) in 14 cases (16.7%); 6 of these patients also had a low conus. Classified by depth, there were 58 cases with shallow and 26 with deep dimples. Fibrolipoma of the terminal filum was found in significantly more patients with deep dimples (9 [34.6%]) than in those with shallow dimples (5 [8.6%]). The frequency of other congenital anomalies was significantly higher in patients with FTF-associated dimples (6 [42.9%] of 14) than in those with dimples that were not associated with FTF (9 [12.9%] of 70).

Conclusions

Fibrolipoma of the terminal filum was identified by MRI in 16.7% of patients with sacrococcygeal dimples. The risk of FTF increased when the dimples were deeply excavated or were accompanied by congenital anomalies. Magnetic resonance imaging should be performed to identify intraspinal lesions when there are high risk factors for intraspinal abnormalities, or when an ultrasound screening suggests intraspinal abnormalities.
Treatment of cerebral aneurysms in children: analysis of the Kids' Inpatient Database
Authors: Alawi Aws , Edgell Randall C. , Elbabaa Samer K. , Callison R. Charles , Khalili Yasir Al , Allam Hesham , Alshekhlee Amer
Published: May 2014

Object

Endovascular coiling and surgical clipping are viable treatment options of cerebral aneurysms. Outcome data of these treatments in children are limited. The objective of this study was to determine hospital mortality and complication rates associated with surgical clipping and coil embolization of cerebral aneurysms in children, and to evaluate the trend of hospitals' use of these treatments.

Methods

The authors identified a cohort of children admitted with the diagnoses of cerebral aneurysms and aneurysmal subarachnoid hemorrhage from the Kids' Inpatient Database for the years 1998 through 2009. Hospital-associated complications and in-hospital mortality were compared between the treatment groups and stratified by aneurysmal rupture status. A multivariate regression analysis was used to identify independent variables associated with in-hospital mortality. The Cochrane-Armitage test was used to assess the trend of hospital use of these operations.

Results

A total of 1120 children were included in this analysis; 200 (18%) underwent aneurysmal clipping and 920 (82%) underwent endovascular coiling. Overall in-hospital mortality was higher in the surgical clipping group compared with the coil embolization group (6.09% vs 1.65%, respectively; adjusted odds ratio [OR] 2.52, 95% CI 0.97–6.53, p = 0.05). The risk of postoperative stroke or hemorrhage was similar between the two treatment groups (p = 0.86). Pulmonary complications and systemic infection were higher in the surgical clipping population (p < 0.05). The rate of US hospitals' use of endovascular coiling has significantly increased over the years included in this study (p < 0.0001). Teaching hospitals were associated with a lower risk of death (OR 0.13, 95% CI 0.03–0.46; p = 0.001).

Conclusions

Although both treatments are valid, endovascular coiling was associated with fewer deaths and shorter hospital stays than clip placement. The trend of hospitals' use of coiling operations has increased in recent years.
Posterior lumbar interbody fusion with total facetectomy for low-dysplastic isthmic spondylolisthesis: effects of slip reduction on surgical outcomes
Authors: Okuda Shinya , Oda Takenori , Yamasaki Ryoji , Haku Takamitsu , Maeno Takafumi , Iwasaki Motoki
Published: May 2014

Object

The management of isthmic spondylolisthesis remains controversial, especially with respect to reduction. There have been no reports regarding appropriate slip reduction. The purpose of this study was to investigate the following issues: 1) surgical outcomes of posterior lumbar interbody fusion (PLIF) with total facetectomy for low-dysplastic isthmic spondylolisthesis, including postoperative complications; 2) effects of slip reduction on surgical outcomes; and 3) appropriate slip reduction.

Methods

A total of 106 patients who underwent PLIF with total facetectomy for low-dysplastic isthmic spondylolisthesis and who were followed for at least 2 years were reviewed. The average follow-up period was 8 years. Surgical outcomes, including the scores assessed using the Japanese Orthopaedic Association scoring system, the recovery rate, and postoperative complications were investigated. As for radiographic evaluations, pre- and postoperative slip and disc height, instrumentation failure, and fusion status were also examined.

Results

The pre- and postoperative average Japanese Orthopaedic Association scores were 14 (range 3–25) and 25 (range 11–29) points, respectively. The average recovery rate was 73% (range 0%–100%). The average pre- and postoperative slip was 24% and 10%, respectively. A significant correlation between postoperative slip and clinical outcomes was found; clinical outcomes were better in proportion to slip reduction. Although no statistical difference was detected in clinical outcomes between postoperative slip of less than 10% and from 10% to 20%, patients with postoperative slip of more than 20% showed significantly worse clinical outcomes. Postoperative complications included neurological deficits in 7 patients (transient motor loss in 6 and permanent motor loss in 1), instrumentation failures in 7, adjacent-segment degeneration in 5, and nonunion in 4. Instrumentation failures occurred significantly more often in patients with more slip reduction, although slip reduction did not affect the other postoperative complications. All patients with instrumentation failure showed postoperative slip reduction within 10%.

Conclusions

The use of PLIF with total facetectomy for low-dysplastic isthmic spondylolisthesis appears to produce satisfactory clinical outcomes, with an average of 73% recovery rate and few postoperative complications. Although clinical outcomes were better in proportion to slip reduction, excessive reduction caused instrumentation failure, and patients with less reduction demonstrated worse clinical outcomes. Appropriate reduction resulted in a postoperative slip ranging from 10% to 20%.
Oxidative Stress Is Associated with Neuroinflammation in Animal Models of HIV-1 Tat Neurotoxicity
Authors: Louboutin Jean-Pierre , Agrawal Lokesh , Reyes Beverly , Van Bockstaele Elisabeth , Strayer David
Published: May 2014

HIV-1 trans-acting protein Tat, an essential protein for viral replication, is a key mediator of neurotoxicity. If Tat oxidant injury and neurotoxicity have been described, consequent neuroinflammation is less understood. Rat caudate-putamens (CPs) were challenged with Tat, with or without prior rSV40-delivered superoxide dismutase or glutathione peroxidase. Tat injection caused oxidative stress. Administration of Tat in the CP induced an increase in numbers of Iba-1- and CD68-positive cells, as well as an infiltration of astrocytes. We also tested the effect of more protracted Tat exposure on neuroinflammation using an experimental model of chronic Tat exposure. SV(Tat): a recombinant SV40-derived gene transfer vector was inoculated into the rat CP, leading to chronic expression of Tat, oxidative stress, and ongoing apoptosis, mainly located in neurons. Intra-CP SV(Tat) injection induced an increase in microglia and astrocytes, suggesting that protracted Tat production increased neuroinflammation. SV(SOD1) or SV(GPx1) significantly reduced neuroinflammation following Tat administration into the CP. Thus, Tat-induced oxidative stress, CNS injury, neuron loss and inflammation may be mitigated by antioxidant gene delivery.
Updates and Controversies in the Rapidly Evolving Field of Lung Cancer Screening, Early Detection, and Chemoprevention
Authors: Kathuria Hasmeena , Gesthalter Yaron , Spira Avrum , Brody Jerome , Steiling Katrina
Published: May 2014

Lung cancer remains the leading cause of cancer-related death in the United States. Cigarette smoking is a well-recognized risk factor for lung cancer, and a sustained elevation of lung cancer risk persists even after smoking cessation. Despite identifiable risk factors, there has been minimal improvement in mortality for patients with lung cancer primarily stemming from diagnosis at a late stage when there are few effective therapeutic options. Early detection of lung cancer and effective screening of high-risk individuals may help improve lung cancer mortality. While low dose computerized tomography (LDCT) screening of high risk smokers has been shown to reduce lung cancer mortality, the high rates of false positives and potential for over-diagnosis have raised questions on how to best implement lung cancer screening. The rapidly evolving field of lung cancer screening and early-detection biomarkers may ultimately improve the ability to diagnose lung cancer in its early stages, identify smokers at highest-risk for this disease, and target chemoprevention strategies. This review aims to provide an overview of the opportunities and challenges related to lung cancer screening, the field of biomarker development for early lung cancer detection, and the future of lung cancer chemoprevention.
Analysis of the Influence of Plot Size and LiDAR Density on Forest Structure Attribute Estimates
Authors: Ruiz Luis , Hermosilla Txomin , Mauro Francisco , Godino Miguel
Published: May 2014

This paper assesses the combined effect of field plot size and LiDAR density on the estimation of four forest structure attributes: volume, total biomass, basal area and canopy cover. A total of 21 different plot sizes were considered, obtained by decreasing the field measured plot radius value from 25 to 5 m with regular intervals of 1 m. LiDAR data densities were simulated by randomly removing LiDAR pulses until reaching nine different density values. In order to avoid influence of the digital terrain model spatial resolution, eight different resolutions were considered (from 0.25 to 2 m grid size) and tested. A set of per-plot LiDAR metrics was extracted for each parameter combination. Prediction models of forest attributes were defined using forward stepwise ordinary least-square regressions. Results show that the highest R2 values are reached by combining large plot sizes and high LiDAR data density values. However, plot size has a greater effect than LiDAR point density. In general, minimum plot areas of 500–600 m2 are needed for volume, biomass and basal area estimates, and of 300–400 m2 for canopy cover. Larger plot sizes do not significantly increase the accuracy of the models, but they increase the cost of fieldwork.
The Next Generation of Interoperability Agents in Healthcare
Authors: Cardoso Luciana , Marins Fernando , Portela Filipe , Santos Manuel , Abelha António , Machado José
Published: May 2014

Interoperability in health information systems is increasingly a requirement rather than an option. Standards and technologies, such as multi-agent systems, have proven to be powerful tools in interoperability issues. In the last few years, the authors have worked on developing the Agency for Integration, Diffusion and Archive of Medical Information (AIDA), which is an intelligent, agent-based platform to ensure interoperability in healthcare units. It is increasingly important to ensure the high availability and reliability of systems. The functions provided by the systems that treat interoperability cannot fail. This paper shows the importance of monitoring and controlling intelligent agents as a tool to anticipate problems in health information systems. The interaction between humans and agents through an interface that allows the user to create new agents easily and to monitor their activities in real time is also an important feature, as health systems evolve by adopting more features and solving new problems. A module was installed in Centro Hospitalar do Porto, increasing the functionality and the overall usability of AIDA.
In Vitro Treatment of Melanoma Brain Metastasis by Simultaneously Targeting the MAPK and PI3K Signaling Pathways
Authors: Daphu Inderjit , Horn Sindre , Stieber Daniel , Varughese Jobin , Spriet Endy , Dale Hege , Skaftnesmo Kai , Bjerkvig Rolf , Thorsen Frits
Published: May 2014

Malignant melanoma is the most lethal form of skin cancer, with a high propensity to metastasize to the brain. More than 60% of melanomas have the BRAFV600E mutation, which activates the mitogen-activated protein kinase (MAPK) pathway [1]. In addition, increased PI3K (phosphoinositide 3-kinase) pathway activity has been demonstrated, through the loss of activity of the tumor suppressor gene, PTEN [2]. Here, we treated two melanoma brain metastasis cell lines, H1_DL2, harboring a BRAFV600E mutation and PTEN loss, and H3, harboring WT (wild-type) BRAF and PTEN loss, with the MAPK (BRAF) inhibitor vemurafenib and the PI3K pathway associated mTOR inhibitor temsirolimus. Combined use of the drugs inhibited tumor cell growth and proliferation in vitro in H1_DL2 cells, compared to single drug treatment. Treatment was less effective in the H3 cells. Furthermore, a strong inhibitory effect on the viability of H1_DL2 cells, when grown as 3D multicellular spheroids, was seen. The treatment inhibited the expression of pERK1/2 and reduced the expression of pAKT and p-mTOR in H1_DL2 cells, confirming that the MAPK and PI3K pathways were inhibited after drug treatment. Microarray experiments followed by principal component analysis (PCA) mapping showed distinct gene clustering after treatment, and cell cycle checkpoint regulators were affected. Global gene analysis indicated that functions related to cell survival and invasion were influenced by combined treatment. In conclusion, we demonstrate for the first time that combined therapy with vemurafenib and temsirolimus is effective on melanoma brain metastasis cells in vitro. The presented results highlight the potential of combined treatment to overcome treatment resistance that may develop after vemurafenib treatment of melanomas.
Utilization of Acidic α-Amino Acids as Acyl Donors: An Effective Stereo-Controllable Synthesis of Aryl-Keto α-Amino Acids and Their Derivatives
Authors: Wang Lei , Murai Yuta , Yoshida Takuma , Okamoto Masashi , Tachrim Zetryana , Hashidoko Yasuyuki , Hashimoto Makoto
Published: May 2014

Aryl-keto-containing α-amino acids are of great importance in organic chemistry and biochemistry. They are valuable intermediates for the construction of hydroxyl α-amino acids, nonproteinogenic α-amino acids, as well as other biofunctional components. Friedel-Crafts acylation is an effective method to prepare aryl-keto derivatives. In this review, we summarize the preparation of aryl-keto containing α-amino acids by Friedel-Crafts acylation using acidic α-amino acids as acyl-donors and Lewis acids or Brönsted acids as catalysts.
Nutritive Value Response of Native Warm-Season Forage Grasses to Harvest Intervals and Durations in Mixed Stands
Authors: Temu Vitalis , Rude Brian , Baldwin Brian
Published: May 2014

Interest in management of native warm-season grasses for multiple uses is growing in southeastern USA. Forage quality response of early-succession mixed stands of big bluestem (BB, Andropogon gerardii), indiangrass (IG, Sorghastrum nutans), and little bluestem (SG, Schizachyrium scoparium) to harvest intervals (30-, 40-, 60-, 90 or 120-d) and durations (one or two years) were assessed in crop-field buffers. Over three years, phased harvestings were initiated in May, on sets of randomized plots, ≥90 cm apart, in five replications (blocks) to produce one-, two-, and three-year-old stands, by the third year. Whole-plot regrowths were machine-harvested after collecting species (IG and LB) sample tillers for leafiness estimates. Species-specific leaf area (SLA) and leaf-to-stem ratio (LSR) were greater for early-season harvests and shorter intervals. In a similar pattern, whole-plot crude protein concentrations were greatest for the 30-d (74 g·kg−1 DM) and the least (40 g·kg−1 DM) for the 120-d interval. Corresponding neutral detergent fiber (NDF) values were the lowest (620 g·kg−1 DM) and highest (710 g·kg−1 DM), respectively. In vitro dry matter and NDF digestibility were greater for early-season harvests at shorter intervals (63 and 720 g·kg−1 DM). With strategic harvesting, similar stands may produce quality hay for beef cattle weight gain.