bluuebunny/crossref_metadata_2025 huggingface dataset:
The Ace of Spades: Reverse Takotsubo Cardiomyopathy in the Context of Angiographic Embolization of Recurrent Metastatic Serotonin-Positive Neuroendocrine Tumour of the Pancreas
Authors: Mazzetti Ian A. , Marcaccio Michael J. , Boutross-Tadross Odette , Salehian Omid , Demers Catherine
Published: February 2013

A 62-year-old woman undergoing embolization of recurrent neuroendocrine tumor, positive for serotonin, developed chest pain and bradycardia with lateral ST-segment depression. Cardiac biomarkers were elevated, and echocardiography revealed akinesis of all basal segments with a normally contracting apex. The absence of flow-limiting coronary disease on angiography confirmed the presence of reverse Takotsubo cardiomyopathy. After optimal medical therapy for six weeks, left ventricular function returned to normal. Takotsubo cardiomyopathy has been described across a wide variety of hyperadrenergic states; the description of the reverse-type Takotsubo cardiomyopathy in the setting of embolization of recurrent neuroendocrine with serotonergic positivity tumour is novel.
Evaluation of Allele Frequency Estimation Using Pooled Sequencing Data Simulation
Authors: Guo Yan , Samuels David C. , Li Jiang , Clark Travis , Li Chung-I , Shyr Yu
Published: February 2013

Next‐generation sequencing (NGS) technology has provided researchers with opportunities to study the genome in unprecedented detail. In particular, NGS is applied to disease association studies. Unlike genotyping chips, NGS is not limited to a fixed set of SNPs. Prices for NGS are now comparable to the SNP chip, although for large studies the cost can be substantial. Pooling techniques are often used to reduce the overall cost of large‐scale studies. In this study, we designed a rigorous simulation model to test the practicability of estimating allele frequency from pooled sequencing data. We took crucial factors into consideration, including pool size, overall depth, average depth per sample, pooling variation, and sampling variation. We used real data to demonstrate and measure reference allele preference in DNAseq data and implemented this bias in our simulation model. We found that pooled sequencing data can introduce high levels of relative error rate (defined as error rate divided by targeted allele frequency) and that the error rate is more severe for low minor allele frequency SNPs than for high minor allele frequency SNPs. In order to overcome the error introduced by pooling, we recommend a large pool size and high average depth per sample.
Distributed Drives Monitoring and Control: A Laboratory Setup
Authors: Sreejeth Mini , Kumar Parmod , Singh Madhusudan
Published: February 2013

A laboratory setup of distributed drives system comprising a three-phase induction motor (IM) drive and a permanent magnet synchronous motor (PMSM) drive is modeled, designed, and developed for the monitoring and control of the individual drives. The integrated operation of IM and PMSM drives system has been analyzed under different operating conditions, and their performance has been monitored through supervisory control and data acquisition (SCADA) system. The necessary SCADA graphical user interface (GUI) has also been created for the display of drive parameters. The performances of IM and PMSM under parametric variations are predicted through sensitivity analysis. An integrated operation of the drives is demonstrated through experimental and simulation results.
Incidental Intracranial Aneurysm in a Dog Detected by 16-Multidetector Row Computed Tomography Angiography
Authors: Bertolini Giovanna
Published: February 2013

This paper describes a small intracranial aneurysm incidentally found in a 24-month-old Nova Scotia Duck Tolling Retriever evaluated for a recent history of lethargy, fever, and cervical pain. The clinicopathological analysis revealed leukocytosis, and increased haptoglobin and C-reactive protein consistent with severe flogistic process. Nonenhanced computed tomography of the brain and cervical spine showed a diffuse encephalopathy and moderate cervical syringohydromyelia. Computed tomography angiography series of the brain showed a small saccular dilation at the joining point of the two rostral cerebral arteries consistent with a small aneurysm. Cerebrospinal fluid examination led to the final diagnosis of aseptic meningitis. The dog was discharge with a long-term corticosteroid therapy for the meningitis. At two-month follow-up evaluation, the cerebrospinal fluid examination was normal and the computed tomography of the brain showed no abnormalities except for the stable aneurysm. To our knowledge, this is the first description of a spontaneous cerebral aneurysm in dogs and serves to broaden the spectrum of cerebrovascular diseases in this species.
Typical Asthmatic Presentation of Congenital Vascular Ring Can Masquerade a General Physician
Authors: Swami Naveen , Koshy Georgey , Jamal Maan , Abdulla Thair S. , Alkhulaifi Abdulaziz
Published: February 2013

A 24-year-old woman was referred to pulmonologist with worsening breathlessness and wheeze. During childhood, she was diagnosed with asthma and subsequent exacerbations were treated with bronchodilators for many years. The chest X-ray and a spirometry testing raised a doubt of extrinsic tracheal compression and a subsequent enhanced chest CT (computerized tomogram) scan confirmed a right-sided aortic arch and a vascular ring anomaly compressing the trachea. Standard surgical division of ligamentum arteriosum was able to relieve the trachea and so the symptoms.
Thyroid Autoimmunity and Behçet’s Disease: Is There a Significant Association?
Authors: Cebeci Filiz , Onsun Nahide , Pekdemir Ayşe , Uras Ahmet R. , Kayataş Kadir
Published: February 2013

Background. Behcet’s disease (BD) could be regarded as an autoimmune disease in many aspects. Autoimmune thyroid disease (ATD) is frequently accompanied by other various autoimmune diseases. Nevertheless, there is not still enough data showing the association between BD and ATD. In addition, no controlled study is present in the PubMed, which evaluates thyroidal autoimmunity using antithyroid peroxidase antibody in a large series of patients with BD. Methods. We aimed to investigate the frequency of ATD in patients with BD. The study included 124 patients with BD and 99 age‐ and sex‐matched healthy volunteers. Results. Autoimmune thyroiditis was noted in 21 cases (16.9%) with BD. In the control group, 22 cases (22.22%) were diagnosed as autoimmune thyroiditis. There was no difference between the groups in respect to thyroid autoantibodies (P > 0.05). There were no statistically significant differences between baseline TSH levels of the BD patients and of the controls (P > 0.05). Statistically, the mean serum free T4 levels of the patients with BD were higher than those of the controls (P < 0.001). Conclusions. No association could be found between BD and ATD. Therefore, it is not of significance to investigate thyroid autoimmunity in BD.
Molecular Pathways: Radiation-Induced Cognitive Impairment
Authors: Greene-Schloesser Dana , Moore Elizabeth , Robbins Mike E.
Published: February 2013

Each year, approximately 200,000 patients in the United States will receive partial- or whole-brain irradiation for the treatment of primary or metastatic brain cancer. Early and delayed radiation effects are transient and reversible with modern therapeutic standards; yet, late radiation effects (≥6 months postirradiation) remain a significant risk, resulting in progressive cognitive impairment. These risks include functional deficits in memory, attention, and executive function that severely affect the patient's quality of life. The mechanisms underlying radiation-induced cognitive impairment remain ill defined. Classically, radiation-induced alterations in vascular and neuroinflammatory glial cell clonogenic populations were hypothesized to be responsible for radiation-induced brain injury. Recently, preclinical studies have focused on the hippocampus, one of two sites of adult neurogenesis within the brain, which plays an important role in learning and memory. Radiation ablates hippocampal neurogenesis, alters neuronal function, and induces neuroinflammation. Neuronal stem cells implanted into the hippocampus prevent the decrease in neurogenesis and improve cognition after irradiation. Clinically prescribed drugs, including PPARα and PPARγ agonists, as well as RAS blockers, prevent radiation-induced neuroinflammation and cognitive impairment independent of improved neurogenesis. Translating these exciting findings to the clinic offers the promise of improving the quality of life of brain tumor patients who receive radiotherapy. Clin Cancer Res; 19(9); 2294–300. ©2013 AACR.
Implementation of Certified Endometriosis Centers: 5-Year Experience in German-Speaking Europe
Authors: Ebert A.D. , Ulrich U. , Keckstein J. , Müller M. , Schindler A.E. , Sillem M. , Tinneberg H.-R. , De Wilde R.L. , Schweppe K.-W. ,   on behalf of the Endometriosis Research Foundation, and the European Endometriosis League
Published: February 2013

The idea of quality improvement in the management of endometriosis has been brought to attention throughout Europe. This - first and foremost - includes the implementation of centers specialized in treating endometriosis. This leads to qualification of both physicians and other medical staff, enforcement of research efforts, and informing the patients, the public, politicians, healthcare providers, and industry. Given limited budgets, focusing on the existing national commitment may be the first step.
Prevention of Syncope Through Permanent Cardiac Pacing in Patients With Bifascicular Block and Syncope of Unexplained Origin
Authors: Santini Massimo , Castro Antonio , Giada Franco , Ricci Renato , Inama Giuseppe , Gaggioli Germano , Calò Leonardo , Orazi Serafino , Viscusi Miguel , Chiodi Leandro , Bartoletti Angelo , Foglia-Manzillo Giovanni , Ammirati Fabrizio , Loricchio Maria L. , Pedrinazzi Claudio , Turreni Federico , Gasparini Gianni , Accardi Francesco , Raciti Giovanni , Raviele Antonio
Published: February 2013

Background—

Syncope in patients with bifascicular block (BFB) is a common event whose causes might be difficult to assess.

Methods and Results—

Prevention of syncope through permanent cardiac pacing in patients with bifascicular block (PRESS) is a multicenter, prospective, randomized, single-blinded study designed to demonstrate a reduction in symptomatic events in patients with bifascicular block and syncope of undetermined origin implanted with permanent pacemaker. Device programming mode (NASPE/BPEG code) at DDD with a lower rate of 60 ppm is compared with backup pacing at DDI with a lower rate of 30 ppm. The end point consisted of (1) syncope, (2) symptomatic presyncopal episodes associated with a device intervention (ventricular pacing), and (3) symptomatic episodes associated with intermittent or permanent atrioventricular block (any degree). One hundred one patients were enrolled and randomized. Primary end point events at 2 years were observed in 23 patients, with a significant lower incidence in the study group (hazard ratio, 0.32; 95% confidence interval [CI], 0.10–0.96;
P
=0.042). Reduction of any symptoms, associated or not with device intervention, was superior in DDD60 compared with DDI30 (hazard ratio, 0.4; 95% confidence interval, 0.25–0.78;
P
=0.0053). Fourteen patients developed other rhythm diseases and met class I indication for pacing. The annual incidence of rhythm disease development was 7.4%.

Conclusions—

In patients with bifascicular block and syncope of undetermined origin, the use of a dual chamber pacemaker programmed to DDD60 led to a significant reduction of syncope or symptomatic events associated with a cardioinhibitory origin, compared with DDI30 programming. Symptoms associated with a new onset of rhythm disease were found in 15% of the population at 2 years.
Predictors of Incident Heart Failure Hospitalizations Among Patients With Impaired Glucose Tolerance
Authors: Wong Yee Weng , Thomas Laine , Sun Jie-Lena , McMurray John J.V. , Krum Henry , Hernandez Adrian F. , Rutten Guy E.H.M. , Leiter Lawrence A. , Standl Eberhard , Haffner Steven M. , Mazzone Theodore , Martinez Felipe A. , Tognoni Gianni , Giles Thomas , Califf Robert M.
Published: February 2013

Background—

Impaired glucose tolerance and metabolic syndrome are associated with increased risk of heart failure (HF). However, predictors associated with the increased risk of incident HF have not been well characterized. We aimed to identify independent predictors of incident HF hospitalization among patients with impaired glucose tolerance.

Methods and Results—

In Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR), 9306 research participants with impaired glucose tolerance and ≥1 cardiovascular risk factors were randomized to valsartan versus placebo and nateglinide versus placebo in a 2×2 factorial manner, with a median follow-up of 6.5 years. Using a multivariable Cox proportional hazards model, we analyzed the relationships among baseline clinical factors and the outcome of incident HF hospitalization in patients without history of HF. Significant predictors were identified by forward selection. Increasing age, history of coronary heart disease, and atrial fibrillation or flutter were among several known independent predictors of incident HF hospitalization. Increased waist circumference (hazard ratio per 10 cm, 1.37; 95% confidence interval, 1.21–1.55;
P
<0.001) and increased urinary albumin–creatinine ratio (
P
<0.001) were identified as novel predictors. The predictive model for incident HF hospitalization showed good discrimination, with an optimism-corrected C-index of 0.79.

Conclusions—

Among research participants with impaired glucose tolerance, there are several easily identifiable predictors of incident HF hospitalization, including traditional risk factors and novel indices of central adiposity and increased urinary albumin–creatinine ratio, which enable further risk stratification and help distinguish patients who could benefit from more aggressive risk factor management.
Ca
2+
/Calmodulin-Dependent Protein Kinase II δ Mediates Myocardial Ischemia/Reperfusion Injury Through Nuclear Factor-κB
Authors: Ling Haiyun , Gray Charles B.B. , Zambon Alexander C. , Grimm Michael , Gu Yusu , Dalton Nancy , Purcell Nicole H. , Peterson Kirk , Brown Joan Heller
Published: February 2013

Rationale:

Ca
2+
/calmodulin-dependent protein kinase II (CaMKII) has been implicated as a maladaptive mediator of cardiac ischemic injury. We hypothesized that the inflammatory response associated with in vivo ischemia/reperfusion (I/R) is initiated through CaMKII signaling.

Objective:

To assess the contribution of CaMKIIδ to the development of inflammation, infarct, and ventricular dysfunction after in vivo I/R and define early cardiomyocyte–autonomous events regulated by CaMKIIδ using cardiac-specific knockout mice.

Methods and Results:

Wild-type and CaMKIIδ knockout mice were subjected to in vivo I/R by occlusion of the left anterior descending artery for 1 hour followed by reperfusion for various times. CaMKIIδ deletion protected the heart against I/R damage as evidenced by decreased infarct size, attenuated apoptosis, and improved functional recovery. CaMKIIδ deletion also attenuated I/R-induced inflammation and upregulation of nuclear factor-κB (NF-κB) target genes. Further studies demonstrated that I/R rapidly increases CaMKII activity, leading to NF-κB activation within minutes of reperfusion. Experiments using cyclosporine A and cardiac-specific CaMKIIδ knockout mice indicate that NF-κB activation is initiated independent of necrosis and within cardiomyocytes. Expression of activated CaMKII in cardiomyocytes leads to IκB kinase phosphorylation and concomitant increases in nuclear p65. Experiments using an IκB kinase inhibitor support the conclusion that this is a proximal site of CaMKII-mediated NF-κB activation.

Conclusions:

This is the first study demonstrating that CaMKIIδ mediates NF-κB activation in cardiomyocytes after in vivo I/R and suggests that CaMKIIδ serves to trigger, as well as to sustain subsequent changes in inflammatory gene expression that contribute to myocardial I/R damage.
Early Magnetic Resonance Imaging in Transient Ischemic Attack and Minor Stroke
Authors: Moreau François , Modi Jayesh , Almekhlafi Mohammed , Bal Simer , Goyal Mayank , Hill Michael D. , Coutts Shelagh B.
Published: February 2013

Background and Purpose—

The use of magnetic resonance imaging (MRI) after transient ischemic attack (TIA) or minor stroke may be affected by the relative timing of imaging. We measured the impact of scanning an individual patient late versus early after TIA and minor stroke.

Methods—

Two hundred sixty-three TIA or minor stroke (National Institute of Health Stroke Scale score ≤3) patients with a baseline MRI completed within 24 hours of symptom onset and a follow-up MRI at 90 days were included. Baseline and 90-day scans were assessed independently for the presence of any stroke lesions that could explain the presenting symptoms. The presence and pattern of any stroke lesions were compared at the 2 time points.

Results—

The presence of a stroke (acute or chronic) in any location was more common on baseline MRI versus 90-day MRI (68% vs 56%;
P
=0.005). Thirty percent of subjects with negative scans at 90 days had a clearly identifiable stroke at baseline. When interpreted blinded to the baseline scan, the presumed relevant lesion on the 90-day MR scan was the correct lesion in only 53% patients. One-third (34%) of patients had a different lesion pattern on the baseline scan compared with the 90-day scan. Ninety percent (80/89) of these patients had more lesions on the baseline MRI and 10% (9/89) had new lesions on the 90-day MRI.

Conclusions—

Delayed MRI after TIA or minor stroke reduces the diagnostic yield and results in missed understanding of the lesion pattern. MRI of minor stroke and TIA patients should occur early after symptom onset, and delayed imaging should be interpreted with caution.
Global energy institutions. Russia at the IEA can tip the scale, assuring enhanced governance
Authors: Tita Alberto
Published: February 2013

International cooperation on energy had momentum in 2012. So far fragmented in multiple initiatives and agencies, the global dialogue about energy can now undergo some rationalization. Such innovation takes move from Russia action, as one of the key energy exporters, in multilateral venues. Last summer Moscow either entered the WTO, either got the pro-tempore Presidency of the G8/G20. Moreover, Russia is at the OECD doorstep for joining it as a full-fledged member, with a view to entering the OECD affiliate, the Paris-based International Energy Agency (IEA).

All these hubs of international cooperation are the core of global economic governance and hugely involved in energy regulation. For their strict interrelation, the role that Moscow can simultaneously play at the junction of such institutions will result essential to favour the centrality of the IEA. With beneficial effects over international energy regulation and, in the end, on global governance as well. … From Russia with … law?
The status of Plumularia lagenifera Allman, 1885 (Cnidaria, Hydrozoa) and related species
Authors: SCHUCHERT PETER
Published: February 2013

The current status of Plumularia lagenifera Allman, 1885, a common thecate hydroid of the west coast of the USA and Canada, is problematic as it is difficult to distinguish from the near cosmopolitan and very variable Plumularia setacea. Type material of P. lagenifera and newly collected material of P. lagenifera and P. setacea from the region of the type locality of the former was used to compare it to P. setacea from the Atlantic. Measurements of a number of morphological traits were made and analysed using principal components analyses. Type material of the Californian Plumularia palmeri Nutting, 1900 was also included in the comparisons and confirmed the view of earlier workers that it is indistinguishable from P. setacea. Additionally, South African material referred to P. lagenifera by Millard (1975) was compared to the ma-terial from the NE Pacific. Plumularia lagenifera remains difficult to separate from P. setacea. The convex outer wall of the hydrotheca offers the only operational character to distinguish P. lagenifera from P. setacea, which always has straight or even concave hydrothecae. For morphological and biogeographic reasons, South African P. lagenifera sensu Millard (1975) should be referred to P. gaimardi (Lamouroux, 1924).
New or amended data on Mediterranean Amphipoda: genera Dexamine, Ericthonius and Stenothoe
Authors: KRAPP-SCHICKEL T.
Published: February 2013

The Mediterranean amphipod species Dexamine filiola n. sp. and Ericthonius didymus n. sp. were discovered by their ovigerous females which differ in length from morphologically similar species. An error in the description of Stenothoe dollfusi Chevreux could finally be cleared up, and the Mediterranean material called Stenothoe gallensis Walker in reality belongs to Stenothoe cattai Stebbing.
A review of the Chinese species of the genus Picromerus Amyot and Serville, with description of a new species (Hemiptera: Heteroptera: Pentatomidae: Asopinae)
Authors: ZHAO QING , LIU GUOQING , BU WENJUN
Published: February 2013

Six species of the genus Picromerus Amyot and Serville from China were reported, in which, Picromerus elevatus sp. nov. fromYunnan province, was described as new to science. Drawings and photographs of genital characters, photo-graphs of imagoes in dorsal and ventral views, and some diagnostic characters were provided, together with a detailed key to the six species occurring inChina. The type specimens were deposited in theInstitute ofEntomology, Nankai Univer-sity,Tianjin,China, except noted.
Asterinid seastars from the Mozambique Channel (Echinodermata: Asteroidea: Asterinidae)
Authors: O’LOUGHLIN P. MARK , MACKENZIE MELANIE
Published: February 2013

A new fissiparous asterinid seastar Aquilonastra chantalae sp. nov. is described from Europa Island, one of the Scattered Islands (Les îles Éparses) in the Mozambique Channel. It is compared with the fissiparous asterinid Aquilonastra conan-dae O’Loughlin & Rowe from the Mascarene Islands. A table of distinguishing diagnostic characters is provided. The as-terinid Aquilonastra richmondi O’Loughlin & Rowe is reported forEuropaIsland.
Electromagnetically shielding composite made from carbon fibers, glass fibers, and impact-resistant polypropylene
Authors: Lin Ching-Wen , Lou Ching-Wen , Huang Chen-Hung , Huang Chien-Lin , Lin Jia-Horng
Published: February 2013

In order to create polymer composites that can shield machine and instrument casings from electromagnetism and to reclaim waste material, this study melt-blended impact-resistant polypropylene (PP) chips, carbon fibers (CFs; 5, 10, 15, or 20 wt%), and glass fibers (GFs; 0, 5, 7 wt%). This process used a single-screw extruder to make electrically conductive composites. The resulting composites were then evaluated in terms of mechanical properties, electromagnetic shielding effectiveness (EMSE), and surface resistivity. According to experimental results, an increase in CF content increased PP/CF composites’ tensile strength to 29.31 MPa and flexural strength to 38.93 MPa but decreased the impact strength to 49.04 MPa. When the CFs were increased to 15 wt%, the EMSE and surface resistivity of PP/CF composites were above 20 db and 3.3 × 103 Ω/square. For PP/CF/GF composites, with an increase in GF content, the EMSE decreased and the surface resistivity increased.
Research into the possible causes of squealing brake-drums
Authors: Bombek Gorazd , Pevec Miha , Vranešević Darko
Published: February 2013

This paper presents a problem-solving procedure regarding brake-drum noise issues performed by engineers within a short time period and additional measures to be taken for avoiding similar issues in the future. Cimos TAM Ai company is a member of Cimos Group, which is a component producer in the automotive industry. We have taken the production of the rear brake-drums during the phase of the car manufacturing (transfer of production). Soon after the instigation of this production, the customer reported squealing issues with the brake-drums. No detailed information was received about the issue except that it occurred on new cars during everyday operation. It was our goal to find the root cause, fix the issue and take some preventive actions. Research was based on comparing the Cimos brake-drum (B) with the brake-drum of previous supplier (A). The research was focused on resonant frequency of the brake-drum as the most likely parameter connected to the squealing. First the natural frequency of drums A and B was determined by impact-hammer test. Then a numerical simulation was carried out with the goal of detecting the most problematic surface of the drum for causing the squealing. A weakness was found in the brake-drum design where no thickness or tolerance was specified at the critical area, and large deviations existed between the finished brake-drums. The problem was solved by changing the machining parameters. Besides solving the noise problem, an in-depth investigation was conducted into the gray cast-iron modulus of elasticity, in order to find a representative value for those small deformations occurring in cases dealing with noise-emission issues. This value proved to be higher than in the case of larger deformations as considered during mechanical and temperature behavior simulations.
Circadian rhythm of urinary potassium excretion during treatment with an angiotensin receptor blocker
Authors: Ogiyama Yoshiaki , Miura Toshiyuki , Watanabe Shuichi , Fuwa Daisuke , Tomonari Tatsuya , Ota Keisuke , Kato Yoko , Ichikawa Tadashi , Shirasawa Yuichi , Ito Akinori , Yoshida Atsuhiro , Fukuda Michio , Kimura Genjiro
Published: February 2013

Introduction:

We have reported that the circadian rhythm of urinary potassium excretion (UKV) is determined by the rhythm of urinary sodium excretion (UNaV) in patients with chronic kidney disease (CKD). We also reported that treatment with an angiotensin receptor blocker (ARB) increased the UNaV during the daytime, and restored the non-dipper blood pressure (BP) rhythm into a dipper pattern. However, the circadian rhythm of UKV during ARB treatment has not been reported.

Materials and methods:

Circadian rhythms of UNaV and UKV were examined in 44 patients with CKD undergoing treatment with ARB.

Results:

Whole-day UNaV was not altered by ARB whereas whole-day UKV decreased. Even during the ARB treatment, the significant relationship persisted between the night/day ratios of UNaV and UKV ( r=0.56, p<0.0001). Whole-day UKV/UNaV ratio ( p=0.0007) and trans-tubular potassium concentration gradient ( p=0.002) were attenuated but their night/day ratios remained unchanged. The change in the night/day UKV ratio correlated directly with the change in night/day UNaV ratio ( F=20.4) rather than with the changes in aldosterone, BP or creatinine clearance.

Conclusions:

The circadian rhythm of UKV was determined by the rhythm of UNaV even during ARB treatment. Changes in the circadian UKV rhythm were not determined by aldosterone but by UNaV.
Reducing residual risk: modern pharmacochemistry meets old-fashioned lifestyle and adherence improvement
Authors: Kones Richard
Published: February 2013

Despite remarkable advances in identifying and managing coronary heart disease, the global burden of cardiovascular (CV) risk and levels of undetected, subclinical heart disease remain enormous. Substantial numbers of patients do not reach their therapeutic goals, others are unable to tolerate the treatments, half may fail to adhere to their programs, and in those who do attain their targets, major cardiovascular events may continue. Well-known risk factors, such as obesity and diabetes, have now gained the upper hand, with no evidence-based remedy capable of reversing this trend. All told, less than 1% of American adults and adolescents qualify for ideal CV health; world-wide, the growing prevalence of CV risk factors in children is imposing. A number of novel emerging drug therapies are in development, some recently approved for use in patients with familial hypercholesterolemia.

Hopefully, they will contribute significantly to the current therapeutic armamentarium. However, for meaningful improvement in total and residual CV risk, an optimal mix of all available modalities will likely be necessary, including earlier and more effective prevention, aggressive medical care, revascularization and device implantation, judicious use of novel agents, and reengineering of the environment.
Development and Validation of the Elbow Demand Rating Scale
Authors: Nissen Carl W. , O’Hara Emily A. , McCarthy Mark , Kostyun Regina
Published: February 2013

Background:

Overhead sports place the greatest strain on the elbow of any of the upper extremity joints. Unfortunately, athlete-specific functional outcome tools do not exist for the elbow.

Hypotheses:

The Elbow Demand Rating Scale (EDS) will demonstrate strong reliability and validity properties: (1) test-retest reliability with a 2-week EDS administration, (2) internal reliability of the subscales, and (3) construct validity through lower scores for patients with elbow injuries.

Study Design:

Prospective case-control study.

Methods:

Patients with (n = 19) and without elbow injuries (n = 19) completed the EDS during their routine clinical appointment and 2 weeks later. Clinicians completed the functional portion of the EDS.

Results:

The EDS demonstrated strong test-retest reliability and construct validity. Internal reliability was moderate (α = 0.50). Exploratory analyses further supported construct validity using demographic survey questions regarding elbow pain and symptoms.

Conclusion:

Overall, the EDS demonstrated moderate to strong psychometric properties in a patient population with elbow injuries, and its use is supported for young athletes.

Clinical Relevance:

The EDS provides clinicians working with adolescent and young adult athletes a scale to direct care and determine intervention success or failure.
The Importance of Fertility Awareness in the Assessment of a Woman's Health a Review
Authors: Vigil Pilar , Blackwell Leonard F. , Cortés Manuel E.
Published: February 2013

Fertility awareness constitutes fundamental knowledge for every woman and is an important tool for health professionals. The objective of this review is to show how fertility awareness can be useful in the assessment of a woman's health. The main techniques for detecting ovulation are explained, and then the events that characterize a normal menstrual cycle are discussed. The relevance of cervical mucus from the perspective of female fertility is highlighted. Finally, the usefulness of fertility awareness 1) to identify fertile and infertile periods, 2) to help to detect several pathologies, and 3) in regards to how it exerts an important role in the success of programs in education for affectivity and sexuality are discussed.
Comparing Current, Former, and Never Users of Natural Family Planning An Analysis of Demographic, Socioeconomic, and Attitudinal Variables
Authors: Bertotti Andrea M. , Christensen Sinead M.
Published: February 2013

This project examines how women who currently use natural family planning (NFP), those who formerly used NFP, and those who have never used NFP compare along demographic, socioeconomic, and attitudinal variables. Bivariate analyses of data from the National Survey of Family Growth 2006–2010 (N = 10,598 female respondents) suggest that current NFP users varied socioeconomically and demographically from former NFP users, but differences were more prominent between current NFP users and never NFP users. In many cases, there was little variation between former NFP users and never NFP users. Current NFP users were less likely to be black and more likely to be Hispanic or other race, married, Catholic or other religion, have a bachelor's degree, and earn higher income than the other two groups. Understanding how current NFP users differ from those who formerly used NFP and those who have never tried NFP provides important clues about which populations to target for promotional efforts.
Noninvasive Prenatal Genetic Diagnosis and Eugenic Aims
Authors: González-Melado Fermín J. , Di Pietro María L.
Published: February 2013

The use of techniques of analysis of fetal nucleic acid present in maternal peripheral blood for noninvasive prenatal genetic diagnosis (NIPD) is a reality in clinical practice in the case of certain diseases. In the coming years, it will become part of routine prenatal screening and diagnostic techniques for fetal diagnosis. A bioethical reflection on the possible difficulties and problems of the use of these techniques is necessary. On one hand, these techniques will result in reduced costs of screening, an increase in the number of disabled fetuses detected, and a decrease in the number of indirect abortions caused by invasive techniques. On the other hand, the widespread use of NIPD could decrease the autonomy of women in the decision-making process; health authorities could use NIPD as a means of eugenic prevention of genetic diseases, for example, in Down syndrome cases; and finally, NIPD could increase the image of the disabled person as an individual that has to be excluded from society. For this reason physicians play an important role in the process of pre-diagnosis and post-diagnosis genetic counseling. As a result, we conclude that the use of NIPD to diagnose the existence of genetic diseases in the fetus in order to decide—in the case of a positive result—whether or not to perform an abortion implies and includes in itself the conditions that characterize a negative moral assessment.
Metaphysical and Moral Status of Cryopreserved Embryos
Authors: Eberl Jason T.
Published: February 2013

Those who oppose human embryonic stem cell research argue for a clear position on the metaphysical and moral status of human embryos. This position does not differ whether the embryo is present inside its mother's reproductive tract or in a cryopreservation tank. It is worth examining, however, whether an embryo in “suspended animation” has the same status as one actively developing in utero. I will explore this question from the perspective of Thomas Aquinas's metaphysical account of human nature. I conclude that a cryopreserved human embryo counts, both metaphysically and morally, as a person; and thus the utilization of such embryos for inherently destructive research purposes is impermissible.
Personhood and Embryo Adoption
Authors: Nelson Thomas K.
Published: February 2013

The morality of embryo adoption, or heterologous embryo transfer for rescue, remains controversial despite the issuance of Dignitas personae (2008). When evaluating such bioethical controversies, it is crucial to take account of the personal order. Personalism provides a fresh and heretofore underdeveloped perspective toward resolving this polarized issue in bioethics. I will argue that it is not discriminatory to oppose embryo adoption on the basis of the heterology between rescuer and embryo because the lack of genetic relatedness reflects a more profound lack of personal relatedness. The persons involved in embryo adoption are not meant for the bodily relationship of pregnancy because of the incommunicability of relationships that involve the total gift of the human body. From the perspective of biology, pregnancy is natural life support for the embryo. From the perspective of personhood, pregnancy is fundamentally a relationship of embodied persons, one that is irreplaceable and radically exclusive. The clinical implications of this analysis will be discussed.
What Should be One's Moral Response to the HHS “Contraceptive Mandate”?
Authors: Jerome Bracken W.
Published: February 2013

This article asks how one should morally respond to the HHS contraceptive mandate which is now law and part of the Patient Protection and Affordable Care Act. This article first presents the historical background of the Obama Administration altering the government's ‘final rule’ for providing health services and protecting conscience rights. The mandate compels individuals and religious groups to provide insurance coverage for contraceptive, abortifacient, and sterilization services even though they are contrary to their values, and it narrowly defines what constitutes a religious group so fewer of them can claim exemption. Hence, the question is: Can individuals and religious groups obey the law without acting against their moral values or denying their religious identity? Using Church documents, the article answers that one cannot formally cooperate in evil but under certain conditions one can materially cooperate. The article uses the Summa Theologiae of Aquinas to explain what constitutes formal cooperation and how obeying the law can be material but not formal cooperation. It then examines whether the present conditions warrant material cooperation. It concludes that they do not and that religious groups are called to act as martyrs and give witness to their religious identity and moral values by resisting the law.
Personhood: An Essential Characteristic of the Human Species
Authors: White Frederick J.
Published: February 2013

This essay postulates that human social order recognizes the personhood of human beings within two competing constructs—an existential construct that personhood is a state of being inherent and essential to the human species, and a relational construct that personhood is a conditional state of value defined by society. These competing constructs establish personhood in both individual and interpersonal contexts. Within the individual context existential personhood may be posited as a distinctly human state within the natural order, intrinsic to human life, and independent of the status of the human being. In the interpersonal context the existential construct holds that personhood is not a creation of the society, is not a right, and may not be altered or removed by human fiat. Relational theory presents contra assertions in these two contexts. The Christian view is taken as a particular case of existential personhood. Arguments concerning the nature of human personhood are metaphysical and consist of philosophical beliefs which may be properly asserted in either construct. The interpersonal context of personhood lends itself to comparative analysis of the empirical results associated with both the existential and the relational constructs. This essay provides an overview analysis of the existential and relational constructs of personhood in the interpersonal context and finds a broad range of results that are manifestly superior under existential theory. Such empiricism supports a normative conclusion that the good rests in the existential construction of human personhood, and gives credence to a claim of truth that personhood is an essential characteristic of the human species and is not a conditional state dependent upon circumstance, perception, cognition, or societal dictum.
Divergent Practices among Catholic Hospitals in Provision of Direct Sterilization
Authors: Hapenney Sandra
Published: February 2013

Background

The Ethical and Religious Directives for Catholic Health Catholic Care Services (ERDs) are designed to promote uniform practice of health care in accordance with human and Catholic values. The aim of this study was to determine whether the ERDs are being uniformly interpreted and applied. Directive 53 prohibits the provision of direct sterilization. Hospital data were reviewed to determine whether direct sterilizations on women are being performed within Catholic hospitals and their frequency. A significant diversity of practice regarding sterilization would indicate that the ERDs are not uniformly interpreted and applied by Catholic hospitals in the United States.

Methods

All Catholic hospitals in seven states—California, Illinois, Indiana, New Jersey, New York, Texas, and Washington—were studied to determine whether diversity of practice existed in the provision of direct female sterilization. Inpatient discharge data were requested from the respective departments of health for each state for three years (2007–2009). Data from 1,734 hospitals, secular and Catholic, within the states were procured and analyzed.

Results

Of the hospitals from the seven states, 239 Catholic hospitals were identified of which 176 provided obstetric services. The patient records of these 176 hospitals were searched for those records containing the diagnostic code from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding system for sterilization for contraceptive management. Eighty-five or 48 percent of these hospitals provided a total of 20,073 direct sterilizations in violation of the ERDs. The entire results of the study are available on the website catholichospitals.org .

Conclusion

There is a significant diversity of practice in the provision of direct female sterilization within Catholic hospitals. Such diversity of practice indicates that there is no uniform interpretation or application of the ERDs by Catholic hospitals. Uniformity could be fostered if the ERDs mandated best practices for accountability and made use of the ICD-9-CM codes where possible to monitor actual practices. In the case of direct sterilizations reference to ICD-9-CM codes in the ERDs would minimize subjective criteria in the implementation of the ERDs.
Physiological Signs of Ovulation and Fertility Readily Observable by Women
Authors: Owen Martin
Published: February 2013

Introduction

Confirmation of ovulation can be difficult in clinical practice, as gold standard methods including serial transvaginal ultrasonography, serum luteinizing hormone (LH) measurements, or laparoscopic follicular observation are impractical. Numerous surrogate markers have been proposed and evaluated in relation to these gold standards that have more practical clinical applications.

Purpose

To review the evidence on physiological signs of ovulation timing and fertility in order to determine valid markers that can be easily identified by women.

Methods

A literature review of primary resources in Ovid Medline was undertaken to identify studies examining physiological signs as they relate to gold standard assessment of ovulation. Studies examining the efficacy/effectiveness of different types of natural family planning were excluded.

Results

The most commonly encountered physiological signs were urine LH, cervical mucus, and basal body temperature (BBT). Urine LH as assessed by home monitoring systems indicated ovulation 91 percent of the time during the 2 days of peak fertility on the monitor and 97 percent during the 2 peak days plus 1. Cervical mucus peak characteristics were identified 78 percent of the time ±1 day, and 91 percent of the time ±2 days of LH surge indicating ovulation. Further research supports the importance of cervical mucus in overall fertility, as conception rates were more closely related to mucus quality than to timing of intercourse related to ovulation. As a lone indicator of ovulation, BBT is at best a retrospective marker, and functions best in conjunction with other signs of ovulation. Additionally, salivary ferning, salivary and vaginal fluid electrical potential, finger–finger electrical potential, and differential skin temperature were postulated as possible indicators, but were not found to be temporally related to ovulation. The research on differential skin temperature is promising, but minimal thus far in number, and has not been evaluated as an adjunct to BBT as yet.

Conclusion

Home urinary LH monitors are becoming more widely available and less expensive giving women the potential to assess the ovulatory status of their cycle in real time. Cervical mucus observation is an effective and cost-efficient method, but requires some teaching to increase the confidence of users. In conjunction, LH monitors and cervical mucus can give the best indication of fertility and ovulation timing.
Persons and Evidence for Death: A Reply to Bulzacchelli
Authors: Napier Stephen
Published: February 2013

This article is a reply to Bulzacchelli's argument via two routes. First, I argue that Bulzacchelli has not clarified what he means by the two key terms in his argument: person and reduction. Second, and more importantly, I argue that Bulzacchelli's argument involves a contradiction. He seems to think that determining death on the basis of physiological evidence (i.e. the cessation of organismic functioning) is reductionistic. But he also endorses arguments against whole brain death (WBD) and those arguments maintain that because organ systems function (with external support) in the setting of WBD, the person still exists. But to say that the person still exists simply in virtue of organ systems still functioning is the very reduction Bulzacchelli intimates is a problem.
Case Reports of the Marquette Method
Authors: Peck Rebecca
Published: February 2013

The Marquette method (MM) is a flexible system whereby patients can use cervical mucus and temperature observations in conjunction with the ClearBlue Fertility Monitor (CBFM) an algorithm to clarify the beginning, peak, and end of the fertile window. Two cases are presented which illustrate useful aspects of the MM. The first case involves a couple who have not had success with a Diocesan sympto-themal method and find the objective nature of the CBFM to be critical in sustaining their commitment to natural family planning (NFP). The second case examines a couple in the breastfeeding/weaning period using the Marquette Breastfeeding Protocol. It is the author's hope that these case presentations increase the Catholic Physician's desire to learn more about NFP.
From Clothing for Sport to Sportswear and the American Style: The Movies Carried the Message, 1912–1940
Authors: Warner Patricia Campbell
Published: February 2013

When I hear the words ‘fashion’ and ‘sport’ together, what immediately comes to mind is sportswear — that casual collection of menswear-styled separates that the world now lives in. The history of its development as the essence of American Style covered some thirty to forty years. These were the same years that American movies were taking over the imagination of the world. In my opinion, this was not a coincidence. The movies are unique in the twentieth century for being both an unparalleled reflection of and influence on who we are at any given moment. Sportswear, as the foundation of American Style, developed hand in hand with the growing influence of American movies. Movies, in fact, carried this new look almost instantaneously to the rest of the world, creating a demand that few acknowledged or even realized at the time. As we will see, many influences came together to create this twentieth- century phenomenon. It all began with women's enthusiasm for sport in the mid-nineteenth century.
Vivienne Westwood's ‘Seditionaries’ Clothes and the Change in Japanese Girls' Cute Fashions in the Early 1990s
Authors: Kurokawa Yuko
Published: February 2013

A major change overtook Japanese girls' fashion in the early 1990s. Influenced by the fashion magazine Cutie, a version of the young girl-oriented subculture publication Takarajima, girls began to aggressively express themselves with individualistic clothing that did not go out of its way to pander to the opposite sex. Girls' fashions up until then tended to be imbued with a very Japanese childlike girlishness, but the ‘new’ cute look added boyish elements. This early 1990s trend in Japanese fashion was related to the popularity among Japanese youth at that time of the ‘Seditionaries’ clothing line created by British designer Vivienne Westwood in the late 1970s.