bluuebunny/crossref_metadata_2025 huggingface dataset:
Refractory Cryptococcus neoformans Meningoencephalitis in an Immunocompetent Patient: Paradoxical Antifungal Therapy-Induced Clinical Deterioration Related to an Immune Response to Cryptococcal Organisms
Authors: Nakajima Hideto , Takayama Ayami , Fujiki Yohei , Ito Takumi , Kitaoka Haruko
Published: September 2015

We present a case of refractory Cryptococcus neoformans meningoencephalitis in an immunocompetent woman. Her clinical symptoms did not improve with 6 months of antifungal therapy, and MRI abnormalities, indicating severe meningeal and cerebral inflammation, persisted despite a decreasing cryptococcal antigen titer. The patient continued to deteriorate despite antifungal therapy, and her condition clearly improved following treatment with adjunctive corticosteroid. We postulate that the paradoxical antifungal therapy-related clinical deterioration was due to an immune response to cryptococcal organisms, which responded to corticosteroids. These observations provide rationale for a further evaluation of corticosteroids in the management of select cases of C. neoformans central nervous system infection.
Improving Anticoagulation Measurement
Authors: Razouki Zayd , Burgess James F. , Ozonoff Al , Zhao Shibei , Berlowitz Dan , Rose Adam J.
Published: September 2015

Background—

Percent time in therapeutic range (TTR) and international normalized ratio (INR) variability both measure warfarin control and are associated with outcomes independently. Here, we examine the advantages of a warfarin composite measure (WCM), which summarizes the 2 when measuring patient outcomes. We also examine how the measure chosen would affect anticoagulation clinic performance rankings.

Methods and Results—

We constructed WCM using an equally weighted method, adding standardized TTR to standardized log-transformed INR variability using 103 897 warfarin-experienced patients from 100 anticoagulation clinics. We examined the association of WCM with ischemic stroke, major bleeding, and fatal bleeding, using a subset of patients with atrial fibrillation (n=40 404). We divided patients into quintiles based on their level of control for TTR, log INR variability, and WCM. We calculated the hazard ratios for ischemic stroke, major bleeding, and fatal bleeding stratified by these quintiles. WCM hazard ratios for stroke and fatal bleeding showed the largest difference between excellent control and poorest control quintile compared with TTR and log INR variability, but not for major bleeding. In addition, we compared site rankings obtained using each of our 3 performance measures. Kappa scores for identifying outlier and nonoutlier clinics between WCM and its components were moderate (κ=0.56 for TTR and κ=0.62 for log INR variability) but was weak between TTR and log INR variability (κ=0.13).

Conclusions—

WCM produces the largest range of risk for warfarin complications, widening the floor ceiling effects that limit the use of TTR and INR variability as separate measures. Anticoagulation clinics ranking changed considerably according to the anticoagulation measure that was selected.
Differences Between US and UK Adults in Stroke Preparedness
Authors: Dombrowski Stephan U. , Ford Gary A. , Morgenstern Lewis B. , White Martin , Sniehotta Falko F. , Mackintosh Joan E. , Gellert Paul , Skolarus Lesli E.
Published: September 2015

Background and Purpose—

Although time-dependent treatment is available, most people delay contacting emergency medical services for stroke. Given differences in the healthcare system and public health campaigns, exploring between-country differences in stroke preparedness may identify novel ways to increase acute stroke treatment.

Methods—

A survey was mailed to population-based samples in Ingham County, Michigan, US (n=2500), and Newcastle upon Tyne, UK (n=2500). Surveys included stroke perceptions and stroke/nonstroke scenarios to assess recognition and response to stroke. Between-country differences and associations with stroke preparedness were examined using
t
tests and linear mixed models.

Results—

Overall response rate was 27.4%. The mean age of participants was 55 years, and 58% were female. US participants were better in recognizing stroke (70% versus 63%, d=0.27) and were more likely to call emergency medical services (55% versus 52%, d=0.11). After controlling for demographics and comorbidities, US participants remained more likely to recognize stroke but were not more likely to respond appropriately. A greater belief that medical treatment can help with stroke and understanding of stroke was associated with improved stroke recognition and response.

Conclusions—

Overall, stroke recognition and response were moderate. US participants were modestly better at recognizing stroke, although there was little difference in response to stroke. Future stroke awareness interventions could focus more on stroke outcome expectations and developing a greater understanding of stroke among the public.
Clinically Confirmed Stroke With Negative Diffusion-Weighted Imaging Magnetic Resonance Imaging
Authors: Makin Stephen D.J. , Doubal Fergus N. , Dennis Martin S. , Wardlaw Joanna M.
Published: September 2015

Background and Purpose—

We sought to establish whether the presence (versus absence) of a lesion on magnetic resonance imaging (MRI) with diffusion weighting (DWI-MRI) at presentation with acute stroke is associated with worse clinical outcomes at 1 year.

Methods—

We recruited consecutive patients with a nondisabling ischemic stroke and performed DWI-MRI. Patients were followed up at 1 year to establish stroke recurrence (clinical or on MRI), cognitive impairment (Addenbrooke Cognitive Assessment Revised,<88) and modified Rankin Scale.

Results—

A median of 4 days post stroke, one third (76/264; 29%) of patients did not have a DWI lesion (95% confidence interval, 23%–35%). There was no statistically significant difference between those with and without a DWI lesion with respect to age or vascular risk factors. Patients without a lesion were more likely to be women or have previous stroke. At 1 year, 11 of 76 (14%) patients with a DWI-negative index stroke had a clinical diagnosis of recurrent stroke or transient ischemic attack, 33% had cognitive impairment (Addenbrooke Cognitive Assessment Revised <88), and 40% still had modified Rankin Scale >1, no different from DWI-positive patients; DWI-positive patients were more likely to have a new lesion on MRI (14%), symptomatic or asymptomatic, than DWI-negative patients (2%;
P
=0.02). Our data were consistent with 6 other studies (total n=976), pooled proportion of DWI-negative patients was 21% (95% confidence interval, 12%–32%).

Conclusions—

Nearly one third of patients with nondisabling stroke do not have a relevant lesion on acute DWI-MRI. Patients with negative DWI-MRI had no better prognosis than patients with a lesion. DWI-negative stroke patients should receive secondary prevention.
Boko Haram, Asylum, and Memes of Africa
Authors: Lawrance Benjamin N.
Published: September 2015

This opinion piece examines evidence that Boko Haram is being invoked in asylum and refugee contexts. The author suggests that Boko Haram has emerged a meme of contemporary Africa, insofar as it appears to have become a cultural reference tool for wider anxieties and jeopardies, one that is transmitted by repetition and replication. The Boko Haram meme may benefit asylum-seekers and refugees who struggle to document their experiences or sustain their narratives of persecution, and has implications well beyond Nigeria and the continent of Africa.
Reflections on Religious Identity and Diversity in the Economy of Islamic Spirituality
Authors: Laude Patrick
Published: September 2015

This essay proposes a reflection on the questions of identity vs otherness and unity vs diversity in the context of Islam with a focus on Sufi metaphysics and spirituality. Taking as starting points the notions of islām, tawhīd, and shirk it sketches the ways in which four major Sufi figures—namely Hallāj, Ibn ‘Arabī, Rūmī and Shabistarī, have extracted from these cardinal concepts the principles of a universalist outlook that may allow one to address contemporary issues of pluralism and religious conflicts from the point of view of the very foundations of the tradition itself.
The “Islamic State” (is) as Proponent of Neo-ahl ḥadīth Manhaj on Gender Related Issues
Authors: Duderija Adis
Published: September 2015

It is the aim of this article to examine several gender related practices considered religiously normative by the is and deconstruct the religious justifications behind them. In the analysis I include the practices pertaining to the all-pervasive nature of gender segregation, obligatory nature of the face-veil (niqāb) and the institution of concubinage through means of enslavement of ‘pagan’ female war captives. In this context I will argue that from interpretational methodology point of view, the is’ stance on gender under discussion are identical with the neo-ahl ḥadīth approach to interpretation (manhāj) of the Qurʾān and Sunna as advocated by major contemporary Saudi Arabian scholars such as Al-Albānī (d. 1999), A. Bin Bāz (d. 1999), M. Al-ʿUthaymīn (d. 2001), Ṣ. al-Fawzān (b. 1933), M. Ṣ. Al-Munajjid (b. 1960), Ibn Jibrīn (d. 2014) and H.R. Al-Madhkhalī (b. 1931). I also briefly note that in many ways the broader Sunnī traditionalist approach as exemplified in “Open-letter to Baghdādī Document” which aims to refute is interpretation of the normative texts, shares many hermeneutically critical presuppositions, and therefor legal determinations, with that of the neo-ahl ḥadīth in relation to the gender issues under discussion.
Picturing the Invisible
Authors: Meyer Birgit
Published: September 2015

An understanding of religion as a practice of mediation has great potential to open up new methods and theories for a critical study of religion. Leading beyond the privileged medium of the text, this understanding approaches religion as a multi-media phenomenon that mobilizes the full sensorium. The central point of this article is that forms of visual culture are a prime medium of religion, and studying them offers deep insights into the genesis of worlds of lived experience. Pictorial media streamline and sustain religious notions of the visible and the invisible and involve embodied practices of seeing that shape what and how people see. Discussing the implications of the “pictorial turn” for the study of religion, I argue that a more synthesized approach is needed that draws these fields together. The methodological and theoretical implications of this approach are exemplified by turning to my research on video and representations of the “spiritual” in Southern Ghana.
Sexual Exploitation and Abuse on Peacekeeping Operations
Authors: Nguyen Athena M.
Published: September 2015

Allegations of sexual exploitation and abuse (sea) have been made against many United Nations (un) peacekeeping operations. Whilst it may be argued that the un should be held responsible for these violations, establishing the responsibility of the un under international law is not straight forward. This article will examine the extent to which the responsibility of the un can be established for sea on its peacekeeping operations. This article will begin by considering the status of the un as an international legal person and its legal rights and responsibilities. Then, the sources of law for the responsibility of international organisations will be discussed, including prohibitions against sea and the obligations that these prohibitions may create for the un. In particular, the Articles on the Responsibilities of International Organizations (ario) will be examined and the application of the ario to the case of sea on peacekeeping operations will be explored. It will be concluded that the international law in this area is far from settled and, hence, many challenges remain in being able to establish the un’s responsibility for acts of sea on its peacekeeping operations.
An Improved Algorithm for the Detection of Cirrus Clouds in the Tibetan Plateau Using VIIRS and MODIS Data
Authors: Xia L. , Zhao F. , Ma Y. , Sun Z. W. , Shen X. Y. , Mao K. B.
Published: September 2015

Cirrus clouds play an important role in the global radiation budget balance. However, the existing MODIS and Visible Infrared Imaging Radiometer Suite (VIIRS) cirrus cloud test algorithms struggle to provide accurate cirrus cloud information for the Tibetan Plateau region. In this study, the 1.38-μm cirrus cloud test was improved by adding 11-μm brightness temperature and a multiday average land surface temperature test. An algorithm sensitivity analysis indicated that the proposed algorithm lowered the threshold of the existing 1.38-μm algorithm to 0.005 in the winter and did not produce any observable misclassifications. Compared to the existing 1.38-μm cirrus test algorithm, the accuracy validation indicated that the improved algorithm detected 31.7% more cirrus clouds than the existing VIIRS 1.38-μm cirrus test and yielded 14% fewer misclassifications than the MODIS 1.38-μm cirrus test.
Air Oxygen Calibration of Oxygen Optodes on a Profiling Float Array
Authors: Johnson Kenneth S. , Plant Joshua N. , Riser Stephen C. , Gilbert Denis
Published: September 2015

Aanderaa optode sensors for dissolved oxygen show remarkable stability when deployed on profiling floats, but these sensors suffer from poor calibration because of an apparent drift during storage (storage drift). It has been suggested that measurement of oxygen in air, during the period when a profiling float is on the surface, can be used to improve sensor calibration and to determine the magnitude of sensor drift while deployed in the ocean. The effect of air calibration on oxygen measurement quality with 47 profiling floats that were equipped with Aanderaa oxygen optode sensors is assessed. Recalibrated oxygen concentration measurements were compared to Winkler oxygen titrations that were made at the float deployment stations and to the World Ocean Atlas 2009 oxygen climatology. Recalibration of the sensor using air oxygen reduces the sensor error, defined as the difference from Winkler oxygen titrations in the mixed layer near the time of deployment, by about tenfold when compared to errors obtained with the factory calibration. The relative error of recalibrated sensors is <1% in surface waters. A total of 29 floats were deployed for time periods in excess of one year in ice-free waters. Linear changes in the percent of atmospheric oxygen reported by the sensor, relative to the oxygen partial pressure expected from the NCEP air pressure, range from −0.9% to +1.3% yr−1 with a mean of 0.2% ± 0.5% yr−1. Given that storage drift for optode sensors is only negative, it is concluded that there is no evidence for sensor drift after they are deployed and that other processes are responsible for the linear changes.
Capabilities and Limitations of Convection-Permitting WRF Simulations of Lake-Effect Systems over the Great Salt Lake
Authors: McMillen John D. , Steenburgh W. James
Published: September 2015

Although previous studies suggest that the Weather Research and Forecasting (WRF) Model can produce physically realistic banded Great Salt Lake–effect (GSLE) precipitation features, the accuracy and reliability of these simulations for forecasting applications remains unquantified. The ability of the WRF to simulate nonbanded GSLE features is also unknown. This paper uses subjective, traditional, and object-based verification to evaluate convection-permitting (1.33-km grid spacing) WRF simulations of 11 banded and 8 nonbanded GSLE events. In all simulations, the WRF was configured with the Thompson microphysics and the Yonsei University (YSU) planetary boundary layer parameterizations. Subjectively, a majority of the simulations of banded GSLE events produce physically realistic precipitation features. In contrast, simulations of nonbanded GSLE events rarely produce physically realistic precipitation features and sometimes erroneously produce banded precipitation features. Simulations of banded GSLE events produce equitable threat scores (ETSs) comparable to other convective-storm verification studies, whereas simulations of nonbanded events exhibit lower ETSs. Object-based verification shows that the WRF tends to generate precipitation to the right (relative to the flow) and downstream of observed. These results, although based on a specific WRF parameterization suite, suggest that deterministic prediction of GSLE using convection-permitting models will prove challenging in practice with current numerical models. In addition, identifying and addressing the causes of the rightward and downstream precipitation bias is necessary to achieve optimal performance from future probabilistic and/or deterministic high-resolution forecast systems.
A relational, transformative and engaged approach to sustainable supply chain management: The potential of action research
Authors: Touboulic Anne , Walker Helen
Published: September 2015

This article describes how action research can advance sustainable supply chain management research. Most sustainable supply chain management research is empirical and little attention has been paid to reflecting upon how research is conducted in the field. Current research fails to make links with ideas of relationality, change and engagement proposed in broader sustainability research. We propose to address this gap by discussing how action research could help address current challenges in sustainable supply chain management. The article explores the proponents and application of action research as a relevant methodology for knowledge development in the field, based upon a critical analysis of sustainable supply chain management and action research, including a review of previous action research studies and insights from a research project in which action research was applied. Particular emphasis is put on exploring the links between the sustainability dimension of sustainable supply chain management and the foundations and practice of action research. The article does not reject other methodological approaches, but it shows that the pragmatic orientation of action research is particularly suitable for an applied field such as sustainable supply chain management where problems are often messy, cross-disciplinary and essentially concerned with the flourishing of individuals and organizations. Our article has broader implications for inter-organizational research.
Risk of Intestinal Malignancy in Patients With Short Bowel Syndrome
Authors: Thompson Jon S. , Weseman Rebecca A. , Mercer David F. , Rochling Fedja A. , Vargas Luciano M. , Grant Wendy J. , Langnas Alan N.
Published: September 2015

Background: Postresection intestinal adaptation is an augmented self‐renewal process that might increase the risk of malignant transformation in the intestine. Furthermore, patients with short bowel syndrome (SBS) have other characteristics that might increase this risk. Our aim was to determine the incidence of new intestinal malignancy in SBS patients. Methods: We reviewed the records of 500 adult SBS patients identified from 1982–2013. There were 199 men and 301 women ranging in age from 19–91 years. Follow‐up from the time of diagnosis of SBS ranged from 12–484 months. A total of 186 (37%) patients were followed >5 years. Results: The cause of SBS was postoperative in 35% of patients, malignancy/radiation in 19%, mesenteric vascular disease in 17%, Crohn's disease in 16%, and other in 13%. Twenty‐eight (6%) patients received growth stimulatory medications. Fifteen percent of patients had a prior total colectomy. Twenty‐eight (6%) patients underwent intestinal transplantation, and 115 (23%) patients had a previous abdominal malignancy, including colorectal cancer in 43 patients. Thirty‐six (7%) received radiation therapy. Recurrent colon cancer was found in 2 patients, one at a stoma and the other with lung metastases. New colon cancer was found in 1 patient (0.2%), a 62‐year‐old woman with long‐standing Crohn's disease. Conclusion: The incidence of colon cancer in this heterogenous group of patients with SBS was similar to that of the normal population. This suggests that the risk of developing a new colon cancer in patients with SBS is not increased.
Predictors of Nodal Metastasis in Parotid Malignancies
Authors: Xiao Christopher C. , Zhan Kevin Y. , White‐Gilbertson Shai J. , Day Terry A.
Published: September 2015

Objective

(1) To identify predictors of nodal disease in parotid malignancies using various clinical and pathologic variables. (2) To examine the effect of nodal disease on overall survival (OS) in parotid cancers

Study Design

Retrospective database review.

Setting

National Cancer Data Base (1998‐2012).

Subjects and Methods

We identified all cases of primary parotid malignancies in the United States between 1998 and 2012 in the National Cancer Data Base. Eight histopathologies, constituting >80% of all cases, were examined for nodal metastasis and survival.

Results

We identified 22,653 cases of primary parotid cancer. Eight major histologies were studied, with mucoepidermoid carcinoma (31%), acinic cell carcinoma (18%), adenocarcinoma (14%), and adenoid cystic carcinoma (9%) being most common. Regional nodal disease incidence was 24.4% overall and varied by histopathology. Salivary ductal carcinoma had the highest incidence of both nodal metastasis and occult lymph node metastasis. Overall, N0 patients lived significantly longer than N+ (5‐year OS, 79% vs 40%; P <. 001). Low‐grade disease had significantly better survival than high‐grade (5‐year OS, 88% vs 69%; P <. 001). Occult nodal disease was found in 10.2% and varied by histopathology.

Conclusion

Regional lymph node metastasis significantly decreases survival in many parotid malignancies. High‐grade cancers had higher incidences of regional disease than did low grade. Adenocarcinoma had the highest mortality when regional disease was present. Incidence of occult disease varied by histology, but incidence was <10% for all low‐grade disease. High T stage and grade are significant independent predictors of nodal disease for most histopathologies.
Musical choices during group free improvisation: A qualitative psychological investigation
Authors: Wilson Graeme B. , MacDonald Raymond A. R.
Published: September 2015

Group musical improvisation is a unique psychological phenomenon. Cognitive literature on jazz musicians argues that creativity in improvisation is constrained by stylistic conventions and facility with existing musical elements. However the expanding field of free improvisation is predicated on avoiding idiomatic expectations and familiar material. To model musical improvisation in its widest sense, 15 diverse free improvisers were video recorded performing in trios, and interviewed in-depth while reviewing the recording. Improvisers chose on an iterative basis whether to maintain what they were doing or change, either to initiate a new direction or to respond to another improviser. Responses were subjectively understood to adopt, augment or contrast the contributions of others. These choices were based on evaluative dimensions of texture, rate of initiatives, and degrees of novelty and diversity, as well as structural and practical concerns and experience of enjoyment. Improvisers did not perceive consistent agency for themselves while improvising, and their evaluations were influenced by constructions of the social context. Results highlight that new material is generated at a variable rate by any one individual during this collaborative creativity, and indicate that constraints on choices to cope with high cognitive demands are subjective and situation-specific rather than objective.
Effects of a frictionless hinge on internal forces, deflections, and load capacity of beam structures
Authors: Lubarda Vlado A
Published: September 2015

The redistribution of internal forces and deflections in a uniformly loaded propped cantilever and a fixed-end beam caused by the insertion of a frictionless hinge is evaluated for an arbitrary position of the hinge. This is accomplished by an extended use of the method of discontinuity functions to incorporate the slope discontinuity at the hinge, without the separation of structures into their constituting parts, as commonly done in other methods of analysis. It is shown that the insertion of a hinge in the middle of a propped cantilever increases the reactive moment at the fixed end two times. A hinge in the middle of a fixed-end beam increases its reactive moments by 50%, while the maximum deflection increases three times. The maximum allowable load is determined for all considered structures by using the classical and the limit design criteria. If a hinge is placed in a propped cantilever at the distance from its fixed end smaller than one-fourth of its span, the classical design criterion predicts that a hinged propped cantilever can transmit a greater distributed load than a propped cantilever without a hinge. However, according to the limit design criterion, the insertion of a hinge in a propped cantilever decreases the ultimate load for any location of a hinge. The insertion of a hinge in a fixed-end beam decreases the maximum load according to both, the classical and the limit design criteria. For the rectangular cross section, the ratio of the maximum loads according to the limit and the classical design criterion is constant and equal to 3/2 in the case of a hinge-relaxed propped cantilever, while it varies with the position of the hinge in the case of a hinge-relaxed fixed-end beam. The presented analysis and the obtained results are of interest for undergraduate engineering education in the courses of mechanics of materials and structural design.
Mechanisms of chromium hexavalent-induced apoptosis in rat testes
Authors: Marouani Neila , Tebourbi Olfa , Hallègue Dorsaf , Mokni Moncef , Yacoubi Mohamed Tahar , Sakly Mohsen , Benkhalifa Moncef , Rhouma Khémais Ben
Published: September 2015

Hexavalent chromium (CrVI)-containing compounds, present in industrial settings and in the environment, are known as carcinogens and mutagens. The present study is designed to test the hypothesis that oxidative stress mediates CrVI-induced apoptosis in testis. Male Wistar rats received an intraperitoneal injection of potassium dichromate at doses of 1 and 2 mg kg−1. Superoxide anion production was assessed by the determination of the reduction of cytochrome c and iodonitrotetrazolium, lipid peroxidation (LPO), metallothioneins (MTs), and catalase (CAT) activity. Apoptosis was evaluated by DNA fragmentation detected by agarose gel electrophoresis. Germinal cells apoptosis was detected by toluidine blue staining. The expression of Bax and Bcl-2 proteins (Pts) was also investigated. After 15 days of treatment, an increase of LPO and MT levels occurred, while CAT activity was decreased. Testicular tissues of treated rats showed pronounced degradation of the DNA into oligonucleotides as seen in the typical electrophoretic DNA ladder pattern. Intense apoptosis was observed in germinal cells of Cr-exposed rats. Bax Pt expression was induced in spermatogonia and spermatocytes cells of CrVI-treated rats. In contrast, Bcl-2 Pt was occasionally observed in germ cells of CrVI-exposed rats. These results clearly suggest that CrVI subacute treatment causes oxidative stress in rat testis leading to apoptosis.
Implementing a Financial Management Curriculum With Survivors of IPV
Authors: Silva-Martínez Elithet , Stylianou Amanda M. , Hoge Gretchen L. , Plummer Sara , McMahon Sheila , Postmus Judy L.
Published: September 2015

There is a clear need for financial literacy programs specific to survivors of intimate partner violence (IPV), as the skills and knowledge acquired during these programs stand to increase survivors’ ability to achieve economic independence. In order to understand advocates’ experiences in providing a financial literacy program, this study reports the findings of a qualitative study among 19 domestic violence advocates across 10 states. Findings revealed that advocates expressed complexities in providing financial literacy to survivors. Furthermore, advocates discussed the ways in which they incorporated the financial literacy curriculum into their own financial management behaviors. These findings provide critical information in regard to best practice approaches to incorporating financial literacy into IPV services.
Identifying Students With Mental Health Issues
Authors: Marsh Robbie J.
Published: September 2015

Child and adolescent mental health is a growing concern in schools. Students suffering from mental health conditions struggle in the school environment if their needs are not being met. Teachers play an important role in the identification of these students. This article highlights the distinctions between externalizing and internalizing behaviors related to mental health conditions and provides teachers with an introductory guide to assist them in identifying students with mental health issues.
Riker and Rokkan
Authors: Rovny Jan
Published: September 2015

This special issue studies the strategic interaction between major state-wide and regional parties in a political setting defined by multiple, potentially cross-cutting, political issues pertaining to the economy and the territorial organization of multi-national states. Through this framework, this special issue locates itself decisively in the behaviorist tradition of studying political competition. Stemming from the classical works of Riker and the Rochester school, and focusing on rational choice models, this tradition has influenced a lively literature on party strategies. This concluding article of the special issue argues that the findings of the substantive contributions create a bridge between the strategic, Rikerian literature they stem from and seek to engage with, and more sociological approaches to the study of political parties that focus on the structural features of politics reaching back to the works of Lipset and Rokkan. I suggest that, ultimately, this special issue demonstrates the socially, historically, and institutionally bounded opportunities of political parties. Fundamentally, the special issue makes a significant contribution to the strategic literature by suggesting structural limits to strategic behavior.
Using Remote Communication Technology in Insulin Pump Training
Authors: Parks Linda , Kim Tae Youn
Published: September 2015

Purpose:

This feasibility study was designed to examine if remote communication technology can be used in the technical training of an insulin pump in adults with diabetes who were familiar with insulin pump therapy.

Methods:

Surveys were emailed to 69 individuals who purchased an insulin pump and had been trained by the manufacturer’s diabetes educators. In consultation with providers, participants were given the choice of receiving training in a face-to-face meeting or via remote communication technology. The survey consisted of 27 questions asking participants’ characteristics, device proficiency, confidence, and their satisfaction with the insulin pump and the training method. Differences between the 2 groups were examined using bivariate analyses.

Results:

There were 17 participants in the remote group and 20 participants in the face-to-face group. Participants had a mean age of 40.9 ± 14.3 years, had diabetes for 24.3 ± 13.8 years, and used an insulin pump for 9.8 ± 4.9 years. The participants in both groups were not statistically different in age, diabetes history, years on insulin pump, device proficiency, confidence, or satisfaction with the training method. The remote group reported less graduate-level education ( P < .05) and higher satisfaction scores with the insulin pump training ( P < .05).

Conclusion:

Although this study has limitations associated with the small sample size and self-selection bias, the results suggest that remote communication technology may be an effective tool to provide technical training to adults who are familiar with insulin pump therapy. Additional research is required to determine the effectiveness of the remote insulin pump training.
Elevated Intact Proinsulin Levels During an Oral Glucose Challenge Indicate Progressive ß-Cell Dysfunction and May Be Predictive for Development of Type 2 Diabetes
Authors: Pfützner Andreas , Hermanns Iris , Ramljak Sanja , Demircik Filiz , Pfützner Anke H. , Kann Peter H. , Weber Matthias M.
Published: September 2015

Background:

Elevated fasting intact proinsulin is a biomarker of late-stage ß-cell-dysfunction associated with clinically relevant insulin resistance. In this pilot investigation, we explored the potential value of measuring intact proinsulin as a functional predictor of ß-cell exhaustion during an oral glucose tolerance test (OGTT).

Methods:

The study was performed with 31 participants, 11 of whom were healthy subjects (7 female, age: 59 ± 20 years), 10 had impaired glucose tolerance (IGT, 6 female, 62 ± 10 years), and 10 had known type 2 diabetes (T2DM, 5 female, 53 ± 11 years, HbA1c: 7.0 ± 0.6%, disease duration: 8 ± 5 years). During OGTT, blood was drawn after 0 hours, 1 hour, and 2 hours for determination of glucose and intact proinsulin. Five years later, patients were again contacted to assess their diabetes status and the association to the previous OGTT results was analyzed.

Results:

The OGTT (0 hours/1 hour/2 hours) results were as follows: healthy subjects: glucose: 94 ± 8 mg/dL/140 ± 29 mg/dL/90 ± 24 mg/dL, intact proinsulin: 3 ± 2 pmol/L/10 ± 7 pmol/L/10 ± 5 pmol/L); IGT: glucose: 102 ± 9 mg/dL/158 ± 57 mg/dL/149 ± 34 mg/dL, intact proinsulin: 7 ± 4 pmol/L/23 ± 8 pmol/L/28 ± 6 pmol/L; T2DM: glucose: 121 ± 20 mg/dL/230 ± 51 mg/dL/213 ± 34 mg/dL; intact proinsulin: 7 ± 7 pmol/L/26 ± 9 pmol/L/27 ± 10 pmol/L). Five years later, all of the IGT and 2 of the healthy subjects had developed T2DM and one had devloped IGT. All of them had elevated 2-hour proinsulin values in the initial OGTT, while patients with normal intact proinsulin results did not develop diabetes.

Conclusions:

Elevated 2-hour intact proinsulin levels during OGTT were predictive for later type 2 diabetes development. Further studies need to confirm our findings in larger populations.
Are Systematic Reviews and Meta-Analyses Appropriate Tools for Assessing Evolving Medical Device Technologies?
Authors: Price David , Graham Claudia , Parkin Christopher G. , Peyser Thomas A.
Published: September 2015

Systematic reviews and meta-analyses (SRMAs) provide unique insights into comparative effectiveness of diabetes treatments. However, use of these analyses may be inappropriate for assessing the value and utility of technologies that involve significant behavioral interventions and encompass rapidly evolving technologies such as real-time continuous glucose monitoring (RT-CGM). The rapid evolution of RT-CGM, compared with the time required for publication of clinical studies used in SRMAs, may preclude differentiation between past and current generations of devices. In addition, the effect of performance and usability differences between the various commercial devices on possible clinical outcomes associated with the devices are often not clearly discussed, and many of the RT-CGM studies assessed in SRMAs do not provide adequate information regarding whether and/or to what degree study subjects and clinicians were trained to use the RT-CGM and utilize the data to adjust therapy. Although numerous clinical studies have shown that the glycemic benefit of RT-CGM is related to the frequency and duration of use, a disproportionate number of RT-CGM studies included in recent SRMAs are based on the results of the intention-to-treat analyses and do not consider this fundamental behavioral component in their conclusions. Given these limitations, the generalizability of SRMA conclusions may be limited, and findings from these reports may significantly underestimate the potential glycemic benefit of current and future devices, posing challenges for coverage and reimbursement. We reviewed the potential limitations of the recent Cochrane Collaboration report on CGM, focusing on the 12 studies that assessed RT-CGM use in adults, children/adolescents or both.
Distinguishing between determinate and indeterminate growth in a long-lived mammal
Authors: Mumby Hannah S. , Chapman Simon N. , Crawley Jennie A. H. , Mar Khyne U. , Htut Win , Thura Soe Aung , Aung Htoo Htoo , Lummaa Virpi
Published: September 2015

Background

The growth strategy of a species influences many key aspects of its life-history. Animals can either grow indeterminately (throughout life), or grow determinately, ceasing at maturity. In mammals, continued weight gain after maturity is clearly distinguishable from continued skeletal growth (indeterminate growth). Elephants represent an interesting candidate for studying growth because of their large size, long life and sexual dimorphism. Objective measures of their weight, height and age, however, are rare.

Results

We investigate evidence for indeterminate growth in the Asian elephantElephas maximususing a longitudinal dataset from a semi-captive population. We fit growth curves to weight and height measurements, assess sex differences in growth, and test for indeterminate growth by comparing the asymptotes for height and weight curves. Our results show no evidence for indeterminate growth in the Asian elephant; neither sex increases in height throughout life, with the majority of height growth completed by the age of 15 years in females and 21 years in males. Females show a similar pattern with weight, whereas males continue to gain weight until over age 50. Neither sex shows any declines in weight with age.

Conclusions

These results have implications for understanding mammalian life-history, which could include sex-specific differences in trade-offs between size and reproductive investment.
Trends in hospital and intensive care admissions in the Netherlands attributable to the very elderly in an ageing population
Authors: Haas Lenneke E. M. , Karakus Attila , Holman Rebecca , Cihangir Sezgin , Reidinga Auke C. , de Keizer Nicolette F.
Published: September 2015

Introduction

The Dutch population is ageing and it is unknown how this is affecting trends in the percentage of hospital and intensive care unit (ICU) admissions attributable to patients aged 80 years or older, the very elderly.

Methods

We present data on the percentage of the very elderly in the general population and the percentage of hospital admissions attributable to the very elderly. We subsequently performed a longitudinal cross-sectional study on ICU admissions from hospitals participating in the National Intensive Care Evaluation registry for the period 2005 to 2014. We modeled the percentage of adult ICU admissions and treatment days attributable to the very elderly separately for ICU admissions following cardiac surgery and other reasons.

Results

The percentage of Dutch adults aged 80 years and older, increased from 4.5 % in 2005 to 5.4 % in 2014 (p-value < 0.0001) and with this ageing of the population, the percentage of hospital admissions attributable to very elderly increased from 9.0 % in 2005 to 10.6 % in 2014 (p-value < 0.0001). The percentage of ICU admissions following cardiac surgery attributable to the very elderly increased from 6.7 % in 2005 to 11.0 % in 2014 in nine hospitals (p-value < 0.0001), while the percentage of treatment days attributable to this group rose from 8.6 % in 2005 to 11.7 % in 2014 (p-value = 0.0157). In contrast, the percentage of very elderly patients admitted to the ICU for other reasons than following cardiac surgery remained stable at 13.8 % between 2005 and 2014 in 33 hospitals (p-value = 0.1315). The number of treatment days attributable to the very elderly rose from 11,810 in 2005 to 15,234 in 2014 (p-value = 0.0002), but the percentage of ICU treatment days attributable to this group remained stable at 12.0 % (p-value = 0.1429).

Conclusions

As in many European countries the Dutch population is ageing and the percentage of hospital admissions attributable to the very elderly rose between 2005 and 2014. However, the percentage of ICU admissions and treatment days attributable to very elderly remained stable. The percentage of ICU admissions following cardiac surgery attributable to this group increased between 2005 and 2014.
Incidence and predisposing factors for the development of disturbed glucose metabolism and DIabetes mellitus AFter Intensive Care admission: the DIAFIC study
Authors: Van Ackerbroeck Sofie , Schepens Tom , Janssens Karolien , Jorens Philippe G. , Verbrugghe Walter , Collet Sandra , Van Hoof Viviane , Van Gaal Luc , De Block Christophe
Published: September 2015

Introduction

Elevated blood glucose levels during intensive care unit (ICU) stay, so-called stress hyperglycaemia (SH), is a common finding. Its relation with a future diabetes risk is unclear. Our objective was to determine the incidence of disturbed glucose metabolism (DGM) post ICU admission and to identify predictors for future diabetes risk with a focus on stress hyperglycaemia.

Methods

This single center prospective cohort trial (DIAFIC trial) had a study period between September 2011 and March 2013, with follow-up until December 2013. The setting was a mixed medical/surgical ICU in a tertiary teaching hospital in Belgium. 338 patients without known diabetes mellitus were included for analysis. We assessed the level of glucose metabolism disturbance (as diagnosed with a 75 g oral glucose tolerance test (OGTT) and/or HbA1c level) eight months after ICU admission, and investigated possible predictors including stress hyperglycaemia.

Results

In total 246 patients (73 %) experienced stress hyperglycaemia during the ICU stay. Eight months post-ICU admission, 119 (35 %) subjects had a disturbed glucose metabolism, including 24 (7 %) patients who were diagnosed with diabetes mellitus. A disturbed glucose metabolism tended to be more prevalent in subjects who experienced stress hyperglycaemia during ICU stay as compared to those without stress hyperglycaemia (38 % vs. 28 %, P = 0.065). HbA1c on admission correlated with the degree of stress hyperglycaemia. A diabetes risk score (FINDRISC) (11.0 versus 9.5, P = 0.001), the SAPS3 score (median of 42 in both groups, P = 0.003) and daily caloric intake during ICU stay (197 vs. 222, P = 0.011) were independently associated with a disturbed glucose metabolism.

Conclusions

Stress hyperglycaemia is frequent in non-diabetic patients and predicts a tendency towards disturbances in glucose metabolism and diabetes mellitus. Clinically relevant predictors of elevated risk included a high FINDRISC score and a high SAPS3 score. These predictors can provide an efficient, quick and inexpensive way to identify patients at risk for a disturbed glucose metabolism or diabetes, and could facilitate prevention and early treatment.

Trial registration

At ClinicalTrials.gov NCT02180555. Registered 1 July, 2014.
Diagnosis and management of inhalation injury: an updated review
Authors: Walker Patrick F. , Buehner Michelle F. , Wood Leslie A. , Boyer Nathan L. , Driscoll Ian R. , Lundy Jonathan B. , Cancio Leopoldo C. , Chung Kevin K.
Published: September 2015

In this article we review recent advances made in the pathophysiology, diagnosis, and treatment of inhalation injury. Historically, the diagnosis of inhalation injury has relied on nonspecific clinical exam findings and bronchoscopic evidence. The development of a grading system and the use of modalities such as chest computed tomography may allow for a more nuanced evaluation of inhalation injury and enhanced ability to prognosticate. Supportive respiratory care remains essential in managing inhalation injury. Adjuncts still lacking definitive evidence of efficacy include bronchodilators, mucolytic agents, inhaled anticoagulants, nonconventional ventilator modes, prone positioning, and extracorporeal membrane oxygenation. Recent research focusing on molecular mechanisms involved in inhalation injury has increased the number of potential therapies.
Transoral laser microsurgery for the treatment of oropharyngeal cancer: The Dalhousie University experience
Authors: Melong Jonathan C. , Rigby Matthew H. , Bullock Martin , Hart Robert D. , Trites Jonathan R.B. , Taylor S. Mark
Published: September 2015

Objective

The optimal treatment strategy for oropharyngeal squamous cell carcinoma is highly debated. However, growing evidence supports the use of minimally invasive techniques, such as transoral laser microsurgery (TLM), as a first-line treatment modality for these carcinomas. The purpose of our study was to assess the efficacy and safety of TLM for the treatment of primary and recurrent oropharyngeal carcinomas.

Methods

All patients with oropharyngeal carcinoma undergoing TLM at the QEII Health Sciences Centre in Halifax, Nova Scotia were identified within a prospective database monitoring TLM outcomes. Kaplan-Meier survival analysis was used to evaluate the following end points at 36 months: local control (LC), disease-specific survival (DSS), and disease-free survival (DFS). Safety endpoints included complications following surgery and long term morbidity related to TLM.

Results

Between 2003 and 2014, 39 patients with oropharyngeal carcinoma underwent TLM resection. Twenty-eight (72 %) patients had primary carcinoma, nine (23 %) were radiation/chemoradiation (RT/CRT) failures, and two (5 %) had second primaries following previous RT/CRT. Three patients had stage I disease, 8 stage II, 5 stage III, and 23 stage IV disease. HPV status was available for 26 patients, of which 23 (88 %) had HPV positive disease. Kaplan-Meier estimates of 36-month LC, DSS, and DFS for primary oropharyngeal carcinomas were 85.5 % (SE 10.6 %), 85.7 % (SE 13.2 %) and 77.7 % (SE 12.5 %) respectively. Thirty-six-month outcomes for RT/CRT failures were 66.76 % (SE 15.7 %) for LC and 55.6 % (SE 16.6 %) for DSS and DFS. Three patients developed complications following surgery.

Conclusions

Observed 36-month efficacy and safety outcomes support the use of TLM for the treatment of primary and recurrent oropharyngeal carcinoma.
The Few Leading the Many: Foreign Affiliates and Business Cycle Comovement
Authors: Kleinert JÖrn , Martin Julien , Toubal Farid
Published: September 2015

This paper argues that the correlation of business cycles across countries is largely due to linkages between multinational firms and their foreign affiliates. There are very few foreign affiliates in France, but they contribute considerably to aggregate economic activities. We exploit the heterogeneity in the presence and origin of foreign affiliates across French regions to identify their impact on comovement. We find a positive impact of foreign affiliates' presence on the comovement of business cycles between their regions of location and their countries of origin. This effect is not primarily driven by foreign affiliates' trade with their countries of origin. (JEL E32, F14, F23, F44)
Rounding the Corners of the Policy Trilemma: Sources of Monetary Policy Autonomy
Authors: Klein Michael W. , Shambaugh Jay C.
Published: September 2015

A central result in international macroeconomics is that a government cannot simultaneously opt for open financial markets, fixed exchange rates, and monetary autonomy; rather, it is constrained to choosing no more than two of these three. This paper considers whether partial capital controls and limited exchange rate flexibility allow for full monetary policy autonomy. We find partial capital controls do not generally allow for greater monetary control than with open capital accounts, unless they are quite extensive, but a moderate amount of exchange rate flexibility does allow for some degree of monetary autonomy, especially in emerging and developing economies. (JEL E52, F32, F33)
Central banks interventions in the foreign exchange markets
Authors: Zbierzchowska Dorota
Published: September 2015

The paper aims at presenting objectives and kinds of foreign exchange interventions which are presently conducted by central banks. On the basis of literature and experience of selected countries one described here channels of influence of interventions on the foreign exchange rates. One has also presented here various kinds of market instruments utilized by central banks to conduct the interventions.