bluuebunny/crossref_metadata_2025 huggingface dataset:
Is Forgetting Caused by Inhibition?
Authors: Raaijmakers Jeroen G. W. , Jakab Emőke
Published: June 2013

A well-known finding in memory research is the forgetting effect that occurs because of practicing some Item A on the recall of a related Item B. The traditional explanation for such interference effects is based on the notion of competition. According to the inhibition theory of forgetting, however, such forgetting is due to an inhibitory control process that operates whenever the retrieval of specific target information is hindered by competition from related information. The suppression of the related information is a longer lasting phenomenon that may show up on later testing. We report several experiments that were carried out to test 2 fundamental assumptions of the inhibition theory: the interference dependence and retrieval specificity assumptions. The results of these experiments do not support the predictions of the inhibition theory. Instead, the results are more compatible with the standard account that attributes the forgetting to competition at the time of the later testing.
Conflict Templates
Authors: Halevy Nir , Katz James J.
Published: June 2013

Subjective perceptions of outcome interdependence play a critical role in conflict situations. People who subscribe to different beliefs about outcome interdependence in conflict essentially play different games, with different sets of rules. Because they think they are playing different games, they experience conflict differently, behave differently, and obtain different outcomes for themselves and their counterparts. In our research, we investigated how different perceptions of outcome interdependence relate to individuals’ worldviews, motivational goals, conflict behavior, and social relations. We found that a small set of recurring patterns captures how most people think about their outcome interdependence in conflict. These subjective perceptions of outcome interdependence—that is, conflict templates—predicted conflict behavior (e.g., unethical negotiation behavior), social relations (e.g., workplace conflict and ostracism), and sociopolitical attitudes (e.g., national identification, right-wing authoritarianism) in various conflicts. Our research also shows that these perceptions can be altered by manipulating the accessibility of different motivational goals. Knowing people’s conflict templates aids in predicting the course and outcomes of their interactions and provides a simple yet powerful tool for effective conflict management.
Fidelity in After-School Program Intervention Research
Authors: Maynard Brandy R. , Peters Kristen E. , Vaughn Michael G. , Sarteschi Christine M.
Published: June 2013

Objective:

This study examined whether and to what extent researchers addressed intervention fidelity in research of after-school programs serving at-risk students.

Method:

Systematic review procedures were used to search, retrieve, select, and analyze studies for this review. Fifty-five intervention studies were assessed on the following components of intervention fidelity: strategies to enhance fidelity, measurement of fidelity, and use of fidelity data in data analysis and interpretation.

Results:

Of the 55 studies examined, only 55% reported well-defined intervention procedures, 42% used an intervention manual, 33% provided training on the intervention, 24% provided supervision for the implementers, 29% measured fidelity, only 4% used fidelity data in their analysis, and no studies reported the reliability of fidelity measures.

Conclusion:

Findings indicate an overall lack of attention to and reporting of intervention fidelity in after-school intervention studies. Implications for practice, policy, and research are discussed.
Navicular Subluxation as a Radiographic Finding in Charcot Neuroarthropathy
Authors: Estess Allyson , Marquand Nicole , Charlton Timothy P. , Thordarson David B.
Published: June 2013

Background:

Treatment of patients with Charcot midfoot destruction is a difficult and increasingly common clinical problem. The pathoanatomical features of Charcot neuropathy have been evaluated in only a few studies. This study evaluated whether medial navicular subluxation (adduction of the navicular on the talus) is a radiographic finding present in patients with Charcot neuroarthropathy.

Methods:

A retrospective review of 143 consecutive patients diagnosed with Charcot arthropathy of the foot from January 2004 to May 2011 was performed. Patients were identified based on a clinical diagnosis code 713.5 during an outpatient clinic visit with 2 surgeons at a single institution. After exclusion criteria were applied, a series of radiographs of 50 feet in 40 patients were compared with radiographs from an age-matched control group. Radiographic data including talonavicular coverage angle and talonavicular uncoverage percentage were collected.

Results:

The mean talonavicular coverage angle of the Charcot arthropathy group was 1.5 degrees and of the control group 12.1 degrees ( P < .05). The talonavicular uncoverage value for the Charcot arthropathy group was 12.2% and for the control group 22.0% ( P < .001).

Conclusions:

Medial navicular subluxation was a radiographic finding that was more commonly present in patients with Charcot arthropathy than in a matched control group. It is theorized that this finding is attributable to an unopposed pull of the posterior tibial tendon on the destabilized navicular.

Level of Evidence:

Level IV, retrospective case series.
Personality and Psychopathology
Authors: van der Heijden Paul T. , Egger Jos I. M. , Rossi Gina M. P. , van der Veld William M. , Derksen Jan J. L.
Published: June 2013

This study investigates the relationship between the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and the Temperament and Character Inventory (TCI) in a combined data set ( N = 491) of patients with a broad range of psychiatric disorders ( n = 286) as well as alcohol use disorder ( n = 205). We examined bivariate correlations between both measures. The MMPI-2-RF scales relate to the TCI dimensions as was hypothesized, and relationships between both measurements were largely similar for psychiatric patients and alcohol-dependent patients. Theoretical and clinical implications are considered.
Maine Coon renal screening: ultrasonographical characterisation and preliminary genetic analysis for common genes in cats with renal cysts
Authors: Gendron Karine , Owczarek-Lipska Marta , Lang Johann , Leeb Tosso
Published: June 2013

The objective of this study was to assess the prevalence of renal cysts and other renal abnormalities in purebred Maine Coon cats, and to characterise these through genetic typing. Voluntary pre-breeding screening programmes for polycystic kidney disease (PKD) are offered for this breed throughout Switzerland, Germany and other northern European countries. We performed a retrospective evaluation of Maine Coon screening for renal disease at one institution over an 8-year period. Renal ultrasonography was performed in 187 healthy Maine Coon cats. Renal changes were observed in 27 of these cats. Renal cysts were found in seven cats, and were mostly single and unilateral (6/7, 85.7%), small (mean 3.6 mm) and located at the corticomedullary junction (4/6, 66.7%). Sonographical changes indicating chronic kidney disease (CKD) were observed in 10/187 (5.3%) cats and changes of unknown significance were documented in 11/187 (5.9%) cats. All six cats genetically tested for PKD1 were negative for the mutation, and gene sequencing of these cats did not demonstrate any common genetic sequences. Cystic renal disease occurs with a low prevalence in Maine Coons and is unrelated to the PKD observed in Persians and related breeds. Ultrasonographical findings compatible with CKD are not uncommon in juvenile Maine Coons.
Limited utility of current MRI criteria for distinguishing multiple sclerosis from common mimickers: primary and secondary CNS vasculitis, lupus and Sjogren’s syndrome
Authors: Kim Susan S , Richman David P , Johnson Wesley O , Hald John K , Agius Mark A
Published: June 2013

Background:

Magnetic resonance imaging (MRI) criteria play an important role in making an earlier diagnosis of multiple sclerosis (MS) in patients presenting with clinically isolated syndrome.

Objective:

The objective of this paper is to determine whether MRI criteria may be used to distinguish MS from primary and secondary central nervous system (CNS) vasculitis, lupus, and Sjogren’s syndrome.

Methods:

MRI criteria were applied retrospectively to images for patients with clinically definite MS (CDMS), primary CNS vasculitis, secondary CNS vasculitis, and autoimmune disorders including systemic lupus erythematosus (SLE) and Sjogren’s syndrome. Classical statistics and Bayesian analyses were performed.

Results:

Overall modified Barkhof’s MRI criteria were statistically significant in distinguishing CDMS (60%) from SLE/Sjogren’s syndrome (17%, p = 0.0173) but not in distinguishing CDMS from primary CNS vasculitis (50%, p = 0.7376) or secondary CNS vasculitis (58%, p = 1.0000). Four of the five other MRI criteria tested were demonstrated to be superior to modified Barkhof’s criteria in predicting MS: nine or more T2 lesions (a component of Barkhof’s criteria), one or more ovoid periventricular T2 lesions, one or more perpendicular periventricular T2 lesions, and one or more T2 lesions larger than 6 mm.

Conclusions:

MRI criteria, including the modified Barkhof’s criteria, were unsuccessful in distinguishing MS from primary CNS vasculitis or secondary CNS vasculitis and mildly successful in distinguishing MS from SLE/Sjogren’s syndrome.
The association between health care spending and quality of care for stroke patients in Japan
Authors: Lee Jason , Morishima Toshitaka , Park Sungchul , Otsubo Tetsuya , Ikai Hiroshi , Imanaka Yuichi
Published: June 2013

Objective

To elucidate the association between health care spending and the quality of care in ischaemic stroke patients in Kyoto prefecture, Japan.

Methods

Municipalities in Kyoto were categorized into quartiles based on age–sex adjusted spending for ischaemic stroke admissions. We used logistic regression models to analyse if patients from lower spending municipalities were less likely to obtain high-quality care. The sample consisted of patients admitted to hospitals in Kyoto prefecture due to ischaemic stroke between February 2009 and March 2010. Quality measures included process indicators such as diagnostic tests, recommended medications, and rehabilitation services; and outcome measures of in-hospital mortality and 30-day mortality rates.

Results

Mean health care spending per patient ranged from 9749 US dollars (USD) to USD 14,303 from the lowest to highest municipalities. Patients from municipalities in the lowest spending quartile were significantly associated with poorer performance in the majority of the process indicators but had similar mortality rates to patients from high-spending municipalities.

Conclusions

Spending was found to be unevenly associated with the quality of care provided and may be indicative of an insufficient provision of resources and specialist expertise in the lower spending municipalities. Further efforts must be made to improve the quality of care in lower spending regions in Japan.
Behavioural simulations in health care policy: Current uses and future developments
Authors: Cohen Daniel , Darzi Ara , Vlaev Ivo
Published: June 2013

The process and consequences of change to a health care system can have unintended, detrimental effects. Various types of simulations have been developed in order to try to predict the effects of change in a health care system. Such methods are in widespread use in industrial, military and higher educational institutions. This review essay focuses on participatory behavioural simulations, in which multiple participants are placed into a realistic, interactive simulation environment and asked to respond to a given set of circumstances, such as a change in policy. The processes and outcomes are driven by the actions and interactions of the participants and not by chance, allowing participants to see the consequences of their actions in a safe environment. The use of simulation in health care policy is presented, together with the evidence for its contribution to policy prediction, education and behaviour change among those designing and implementing health care policies. A method based on best evidence for design, implementation and evaluation of future simulations and participants is proposed.
Pure plays and hybrids: Acute trust management profile and capacity
Authors: Buchanan David
Published: June 2013

Objectives

To identify the management populations of acute hospitals, and to consider how the composition of this critical but criticized group affects managerial capacity.

Methods

A multi-method study of six acute trusts, involving 1200 managers in setup interviews, focus groups and a survey. Interviews with senior managers identified the key middle management groups in their trusts. The workforce information offices at two trusts estimated the management numbers from their databases. The findings were compared with the NHS Information Centre data on the number of ‘managers and senior managers’ across the service.

Results

The management population of an acute trust includes ‘pure plays’, whose roles are mainly managerial, and ‘hybrids’, whose roles combine managerial and clinical duties. Together, pure plays and hybrids comprise around 30% of staff in an acute trust, and even this may be an underestimate. Hybrid managers typically outnumber pure plays by four to one. NHS Information Centre data indicate that only 3% of all NHS employees are ‘managers and senior managers’.

Conclusions

In a climate of cost reductions and radical change, acute trusts have challenging management agendas. Policy to ‘cut management’, if focused on pure plays, increases the managerial burden on hybrids, diluting their clinical focus, and potentially jeopardizing the change agenda along with quality and safety of patient care. To strengthen management capacity, acute trust leadership and management development programmes must target the full ‘hybrids and pure plays’ population, and particularly hybrids who comprise the majority.
A normative perspective on discounting health outcomes
Authors: Oliver Adam
Published: June 2013

The debate on the appropriate discounting of future outcomes has a long history, with normative deliberation identifying several different considerations. It is suggested here that only two considerations are appropriate in the discounting of health outcomes. First, discounting ought to account for the possibility of future catastrophic events. Second, it is arguably legitimate for democratically elected governments to weight disproportionately their current constituency over future constituencies. It is adjudged that accounting for both of these factors should lead to a maximum annual discount rate of 0.5%, substantially lower than the rates currently recommended by public authorities.
Environmentally sustainable health and social care: Scoping review and implications for the English NHS
Authors: Naylor Chris , Appleby John
Published: June 2013

Objectives

To review the evidence on environmental sustainability in health and social care, describe what the implications of sustainability might be for service models and policy, and explore the connection between environmental and financial sustainability.

Methods

Literature review of 78 published articles and qualitative analysis of 28 semi-structured interviews.

Results

Provision of health and social care has a substantial impact on the environment, and opportunities exist at a number of levels to deliver services in a more sustainable way. While there is some scope to improve efficiency at the operational level, significant improvements in sustainability may require a more fundamental transformation in service models, for example, with a stronger emphasis on prevention. The current policy framework in England is perceived to create a number of barriers that discourage professionals from redesigning services in ways which could promote both environmental and financial sustainability.

Conclusions

Increasingly, health and social care will need to be delivered in ways that are not only financially sustainable, but environmentally sustainable too. Close conceptual connections exist with improving productivity – focusing on cost-effectiveness, value and prevention of avoidable activity could enhance sustainability from both an environmental and a financial perspective. Priorities for health care organisations could include prevention, exploring the opportunities presented by new technologies, and improving medicines management and prescribing practices. Policy-makers need to explore what changes are needed to create a more enabling environment, as well as how existing policies can be delivered in the most sustainable way.
Feeding forward to a ‘miracle day’ – a pilot study of video feedforward in reactive attachment disorder
Authors: Gorski Charlotta , Minnis Helen
Published: June 2013

Video feedforward is a solution-focused intervention used to improve desired behaviour. We present two case studies of using video feedforward in reactive attachment disorder. Children with reactive attachment disorder, their caregivers and their clinician completed storyboards of behaviours desired during a ‘miracle day’ and filmed the individual scenes. These scenes were edited to a prolonged sequence of successful behaviour which was fed back to the child and their caregiver using principles of video interaction guidance. Families reported major improvements in the targeted behaviours, usually within a week of filming the ‘miracle day’.
Targeted group-based interventions in schools to promote emotional well-being: A systematic review
Authors: Cheney Gemma , Schlösser Annette , Nash Poppy , Glover Lesley
Published: June 2013

The school environment offers significant opportunities to deliver psychological interventions to groups of young people in the UK. However, the nature and effectiveness of programmes are not consistently documented. This systematic review aimed to identify and examine group-based interventions delivered in UK schools. Sixteen papers describing eight interventions were included. It was found that nurture groups have an immediate positive impact on the social and emotional well-being of young people. Results from follow-up studies are less clear, and limited by a high level of sample attrition. The findings reported in relation to social and emotional aspects of learning, cognitive, behavioural and social skills based interventions were limited as each intervention is only evaluated by one paper. The review highlighted a need to implement well-designed, longitudinal studies with larger samples in order to evaluate which interventions are effective in UK schools.
Approach to identifying a sudden continuous emission pollutant source based on single sensor with noise
Authors: Pang Liping , Wang Wei , Qu Hongquan , Hu Tao , Zhang Yu
Published: June 2013

Accidental pollution events often threaten people’s health and lives, and it is necessary to identify a pollutant source rapidly so that prompt actions can be taken. An approach to identify a sudden continuous emission pollutant source based on the sensor measurement noise distribution model is developed in this paper. This approach attempts to locate a source in a steady velocity field while considering the impact of sensor measurement noise. This approach identifies a source by comparing the characteristic distance of the sensor-measured concentration sequence and the multiple hypothetical measured concentration sequences at the sensor position. A location probability function is established to show the location results based on the sensor measurement noise distribution model. Some important influential factors, time interval for identification, source position or sensor position, and mesh size, are discussed in detail. Additionally, a local fine-mesh source search strategy based on prior coarse-mesh location probabilities is presented to improve the efficiency of identification. In order to verify the practical application of the identification approach, an experimental system simulating pollutant transmission is set up and some experiments are conducted. The research results show that the proposed approach is able to identify a sudden pollutant source in a steady flow field by using the measured data with noise.
Is a two-tier trauma team activation system the most effective way to manage trauma in the UK?
Authors: Jenkins P , Kehoe A , Smith JE
Published: June 2013

This review describes the evidence exploring the use of a two-tier trauma team activation system, reviewing the background, history, data available and potential benefits and downsides. The current evidence suggests that a two-tier system may be a lean, cost-effective system, focussed on patient outcome, which could be implemented throughout the UK. Despite its current use in some hospitals, there is limited data from similar systems supporting this in a UK setting. Specific activation criteria need to be validated to ensure appropriate activation of trauma teams, ensuring optimal patient outcome and ensuring best practice.
The management of blunt splenic injury with active bleeding: A review
Authors: Diepenhorst Joel , Hatzifotis Michael , Wall Daryl
Published: June 2013

Blunt splenic injuries are a common management problem facing general surgeons. It has been suggested that management of blunt splenic injuries should take into account the presence of active bleeding and the Organ Injury Scale (OIS grade); where active bleeding is more significant with OIS grade IV and V injuries. This paper aims to review our management of blunt splenic injuries with active bleeding in the haemodynamically stable patient. The trauma databases of two tertiary referral centres in Queensland were reviewed for patients admitted with blunt abdominal injuries since 2006. The management of patients with splenic injury and active bleeding was reviewed. A total of 173 patients were admitted after 2006. Twenty-six of these patients had active bleeding and nine were treated conservatively. Four patients failed conservative management and required further intervention. Three patients with OIS grades IV or V were managed conservatively and failed this management requiring further intervention. Our results indicate that conservative management is not possible for OIS grades IV and V injuries. Furthermore, splenic artery embolisation augments the success of conservative management and reduces the need for splenectomy. These findings are consistent with the current literature suggesting that management of blunt splenic injury must take into consideration factors other than the Organ Injury Scale.
Introduction: QUALIA
Authors: Chumley Lily Hope , Harkness Nicholas
Published: June 2013

This special issue proposes that the semiotically theorized concept of ‘qualia’ is useful for anthropologists working on problems of the senses, materiality, embodiment, aesthetics, and affect. Qualia are experiences of sensuous qualities (such as colors, textures, sounds, and smells) and feelings (such as satiety, anxiety, proximity, and otherness). The papers in this issue, first presented in a conference in honor of Nancy Munn and her groundbreaking book, The Fame of Gawa: A Symbolic Study of Value Transformation in a Massim Society (1986) , offer ethnographic accounts of the discursive, historical, and political conditions under which sensations come to be understood as being sensations of qualities – the qualia of softness, lightness, clarity, pain, stink, etc. – and in which those qualia are endowed with cultural value, whether positive or negative. The papers in this issue demonstrate that qualia are not just subjective mental experiences but rather sociocultural events of ‘qualic’ – and qualitative – orientation and evaluation. These papers thus provide models for the analysis of experience by calling into question what counts for social groups as the senses, materiality or immateriality, interiority, embodiment, or exteriority.
An ecology of sensibility: The politics of scents and stigma in Japan
Authors: Hankins Joseph Doyle
Published: June 2013

The smell of real leather: as you slide on new shoes, or slip into a new car. Luxury. Refinement. Juxtapose this with the person who inappropriately smells of leather, of animal flesh. The nose curls with even the thought: contagion and filth, a different kind of person. These divergent sensibilities of the smell of leather exist alongside each other in contemporary Japan, each requiring a discriminating nose to demarcate sets of smell and sets of people. Set against this backdrop of aromatic bivalency, this paper examines how smell and the capacity for olfaction become key elements in the identification of stigma in Japan. I explore the ecology of interrelating sensibilities that compose the politics of stigma. The Buraku people have historically been marginalized in Japan because of associations with stigmatized industries such as leather and meat production. Since the 1970s, the groundwork for asserting such associations has been dramatically reconfigured. This paper focuses on the changing practices by which such attribution occurs, the demands these practices make on capacities for olfaction and the qualities of scent, and the role ceded to private detectives as purveyors of evidence.
The transporter, the agitator, and the kamanguista: Qualia and the in/visible materiality of diamonds
Authors: Calvão Filipe
Published: June 2013

This article examines the qualitative dimensions invoked and procured by smugglers, traders, and agitators in events of transporting and trading diamonds in Angola. The experience of qualities generally attributed to diamonds is exhibited and embodied in indexical and iconic relation to organized semiotic qualisigns of speed and slowness, secure and insecure bodies, mobility and immobility. In other words, ‘qualia’ orient objects and people by displaying a connection to the experience of diamonds’ qualities of visibility and hiddenness, and allow in turn for the articulation of disparate social processes implicating both the materiality of carbon-based stones and the social relations inscribed in the labor of extraction and exchange.
Vascular angiotensin II type 2 receptor attenuates atherosclerosis via a kinin/NO-dependent mechanism
Authors: Takata Hiroki , Yamada Hiroyuki , Kawahito Hiroyuki , Kishida Sou , Irie Daisuke , Kato Taku , Wakana Noriyuki , Miyagawa Sonoko , Fukui Kensuke , Matsubara Hiroaki
Published: June 2013

Introduction:

The angiotensin II (Ang II) type 1 receptor exerts pro-atherogenic action by augmenting oxidative stress, whereas the Ang II type 2 receptor (AT2)-mediated effect on atherosclerosis remains controversial.

Materials and methods:

AT2 transgenic (AT2-Tg) mice, which overexpress AT2 in their vascular smooth muscle cells, were crossed with apoE-deficient (apoE-/-) mice to generate AT2 transgenic apoE-/- mice (AT2-Tg/apoE-/-).

Results:

A subpressor dose of Ang II infusion exaggerated atherosclerosis development in apoE-/- mice, which was markedly suppressed in AT2-Tg/apoE-/- mice. Inhibitors of nitric oxide (NO) synthase (L-NAME) or bradykinin type 2 receptor completely abolished AT2-mediated anti-atherogenic actions. The vascular cell adhesion molecule-1 expression levels and degree of monocyte/macrophage accumulation in the intima were also considerably reduced in AT2-Tg/apoE-/- mice; these phenomena were completely reversed by L-NAME treatment. Ang II infusion significantly enhanced the accumulation of dihydroethidium-positive mononuclear cells in the intima and mRNA expression levels of Nox2, a phagocytic cell-type NADPH oxidase subunit in apoE-/- mice, which was completely inhibited in AT2-Tg/apoE-/- mice.

Conclusions:

Vascular AT2 stimulation exerts anti-atherogenic actions in an endothelial kinin/NO-dependent manner, and its anti-oxidative effect is likely to be exerted by inhibiting the accumulation of superoxide-producing mononuclear leukocytes.
“I Will Own You”
Authors: Stabile Carol
Published: June 2013

Although most massively multiplayer online games (MMOs) remain entrenched in a binary system of gendered avatars, the limited representational framework of avatar creation is only one among many different strategies for what sociologists refer to as “doing gender.” This essay explores how a doing gender approach might be useful for analyzing the interactive dimensions of gender play in the rich communicative environments of MMOs. Specifically, this essay explores how players do (or do not) hold one another accountable to sex category membership through their interactions, in so doing either reproducing or resisting normative forms of gender. A doing gender approach, I argue, holds out the promise of being held accountable to a different set of rules for doing gender—of doing gender differently or, in a more utopian sense, perhaps doing away with it altogether.
Isolated Percutaneous Transluminal Angioplasty of the Profunda Femoris Artery for Limb Ischemia
Authors: Davies Robert S. M. , Rashid Sidi H. , Adair William , Bolia Amman , Fishwick Guy , McCarthy Mark J. , Sayers Robert D.
Published: June 2013

Objective:

To compare the outcome of endovascular profunda femoral artery revascularization (ePFR) with ePFR and concurrent endovascular femoropopliteal revascularization (eFPR).

Methods:

A retrospective review of the consecutive patients with PFA and femoropopliteal vaso-occulsive disease who underwent ePFR or ePFR + eFPR for severe limb ischemia was performed.

Results:

A total of 18 ePFRs and 26 ePFR + eFPRs were performed; 17 (94%) ePFRs and 22 (85%) ePFR + eFPRs were technically successful. The 12-month survival free from amputation and reintervention rates following isolated ePFR were 78% and 72%, respectively, and following ePFR + eFPR were 96% and 81%, respectively. There was no significant difference in the survival free from amputation ( P = .4) or reintervention ( P = .91) rates between the 2 groups.

Conclusion:

These contemporary data suggest isolated ePFRs and ePFR + eFPRs are associated with good and comparable early limb salvage rates.
Fingertip replantation at the eponychial level with venous anastomosis: an anatomic study and clinical application
Authors: Cheng L. , Chen K. , Chai Y.-M. , Wen G. , Wang C.-Y.
Published: June 2013

We present an anatomic study of the vein distribution at the eponychial level, in order to standardize outpatient fingertip replantation. The cross sectional anatomy of 100 fingers was studied by dissection following dye injection. The distribution of the veins >0.3 mm was recorded on a pie-chart. Thirty fingers in 27 patients with fingertip amputations at the eponychial level were replanted by anastomosis of the palmar subcutaneous veins, to reconstruct the venous reflux of the amputated digits. The operations were aided by the anatomical study and confirmed that the palmar area is the preferred site for venous anastomosis Following a distal finger amputation at the level of the eponychial fold we propose starting the search for veins between the 3 to 5 o’clock or 7 to 9 o’clock positions, as these are the areas where there are most likely to be suitable veins.
Enhanced GP training – a spiral of learning
Authors: Simon Chantal , Riley Ben
Published: June 2013

The RCGP believes that an enhanced and extended GP training programme is a necessary way to equip new GPs for their future NHS roles, but how will that be delivered? This article describes the spiral model of incremental skill acquisition and application that enhanced and extended GP training will use for the new 4-year GP specialty training programme. As GPs travel from their early general practice experience towards their roles as fully fledged independently practising ‘expert generalists’, they will gain a firm foundation of skills, honed to the general practice environment.
Enhanced GP training – the need for change
Authors: Simon Chantal , Riley Ben
Published: June 2013

In April 2012, the Medical Programme Board of Medical Education England approved the RCGP’s educational case for extended and enhanced GP training. This article explores the reasons why enhanced GP training is needed and why improved training cannot be achieved without an extension of the duration of training.
Enhanced GP training – goals and aspirations
Authors: Simon Chantal , Riley Ben
Published: June 2013

To produce the case for enhancing and extending GP training, the Royal College of General Practitioners (RCGP) sought evidence and submissions from a wide range of professionals, patients and organizations. This evidence was collated and reviewed by an expert group to identify the priority challenges for future general practice, resulting in the identification of a number of key outcomes where future GP training needs to be improved. These outcomes are based on the core roles of the GP in the modern NHS and form the goals and aspirations of enhanced GP training.
Chlamydia trachomatis infection
Authors: Twohig Helen
Published: June 2013

C hlamydia trachomatis is the most common sexually transmitted infection in developed countries. Infection occurs most frequently in women aged 16–19 years and in men aged 20–24 years. In England, 10% of sexually active women under the age of 25 may be currently infected. However, the infection is frequently asymptomatic in both men and women and often goes unrecognized, helping to sustain ongoing transmission in the community. GPs are in a prime position to identify and manage Chlamydia infection, as they are involved in the majority of contraceptive care and cervical screening, are able to provide integrated, holistic care and can opportunistically promote good sexual health.
Primary prevention of osteoporosis
Authors: Griffin Sarah
Published: June 2013

Osteoporosis is a chronic condition characterized by progressive loss of both bone mass and density. It is the most common bone disease, affecting 70% of women over the age of 80 years, and renders bones brittle and vulnerable to fracture. One in every two women and one in every five men sustain an osteoporosis-related fracture within their lifetime. Most of these fractures occur before a formal diagnosis of osteoporosis has been made; thus there is a clear role for primary prevention in preosteoporotic patients. There are numerous established risk factors for the development of osteoporosis, ranging from age, ethnicity and gender to specific medical conditions, medications, family history and lifestyle. Considering these as part of a primary care assessment allows patients at risk to be identified. Appropriate interventions can then be offered with the view to delaying, or ideally preventing, the onset of osteoporosis and its symptoms.
Causes and management of dyspareunia
Authors: Corden Catherine
Published: June 2013

Dyspareunia is defined as pain on sexual intercourse. It can affect both sexes, but is more common in females. It is difficult to estimate the number of patients suffering from dyspareunia as the condition is vastly under-reported, but research suggests the point prevalence to be up to 20% of women and 2% of men. It is an important condition requiring prompt assessment, as it can be the cause of emotional distress and relationship disharmony. A range of conditions, many of which are treatable, cause dyspareunia. This article aims to highlight the important causes and their initial management in primary care. An approach to completing an assessment of a patient presenting with dyspareunia is also discussed.
Breast cancer: diagnosis and overview of treatment
Authors: Khan Mohsin , Ives Charlotte , Green Michael
Published: June 2013

Breast cancer is the most common cancer in women in the UK. GPs with a list of 2000 patients can expect to see one new patient with breast cancer per year, although they will see many more women with symptomatic breast disease who do not have cancer. Breast cancer is the second-most-common cause of cancer-related death in women, causing over 10 000 deaths a year. Early diagnosis and improved treatments have substantially improved survival rates. This article aims to increase confidence in recognising sinister breast pathology, as well as to provide an overview of breast cancer management.
Polymyalgia rheumatica and giant cell arteritis
Authors: Ahmed Azeem A.
Published: June 2013

Polymyalgia rheumatica is an inflammatory condition characterised by pain and stiffness in the neck, shoulder girdle and pelvic girdle. Giant cell arteritis is a vasculitis involving large and medium vessels. Both disorders affect patients over the age of 50. Both disorders are characterised by an inflammatory response and respond to corticosteroid therapy. They are self-limiting disorders that settle after two to three years from disease onset. Giant cell arteritis is a major cause of irreversible visual loss. Ophthalmic complications can occur in up to 30% of patients. Significant morbidity can result from corticosteroid side-effects which remains the cornerstone of therapy. This article aims to highlight the current evidence-based management of polymyalgia rheumatica and giant cell arteritis from clinical suspicion to treatment.
Annual health checks for people with learning disability
Authors: Maddams Jessica , Pearson David
Published: June 2013

Annual health checks for adults with learning disabilities are now being offered in general practices across the UK, to improve access to mainstream primary healthcare and detection of unmet health needs. This article will cover the rationale behind annual health checks and the evidence regarding the health benefits of comprehensive health checking in this group. We will also summarise the requirements for annual health checks specified in the learning disabilities Directed Enhanced Service (DES) in England, before discussing the barriers to and strategies for undertaking effective health checks in general practice.
Diagnosis of COPD
Authors: Dutta Nina
Published: June 2013

Chronic obstructive pulmonary disease (COPD) is a lung disease characterised by airflow limitation that is not fully reversible. It is considered to be widely underdiagnosed, with an estimated 2 million undiagnosed patients in the United Kingdom. In June 2010 the National Institute of Health and Clinical Excellence (NICE) published guidelines regarding the primary and secondary care management of COPD in adults. This guideline detailed the steps that are needed to make a diagnosis of COPD and to distinguish it from its differential diagnoses, such as asthma. It is these guidelines that will form the basis of this article.
Reducing the Risks of Delegation
Authors: Shannon Robin Adair , Kubelka Suzanne
Published: June 2013

School nurses are challenged by Federal Civil Rights Laws and the Standards of School Nursing Practice to care for a burgeoning population of students with special healthcare needs. Due to the realities of current school nurse-to-student ratios, school nurses are frequently responsible for directing unlicensed assistive personnel (UAPs) to support the health and safety needs of students, where State Nurse Practice Acts, state legislation, and local policy mandates allow. The delegation of health care tasks to UAPs poses many professional, ethical, and legal dilemmas for school nurses. One strategy to reduce the risks of delegation is through the use of procedure skills checklists, as highlighted by the experience of one large urban school district. Part 1 of this two-part article (Shannon & Kubelka, 2013) explored the scope of the problem and the principles of delegation, including legal and ethical considerations. Part 2 discusses the use of procedure skills checklists by school nurses as a strategy to reduce the risks of delegation of student special health care tasks to UAPs.
When the Going Gets Tough
Authors: Wohl Michael J. A. , Branscombe Nyla R. , Lister Jamey J.
Published: June 2013

We examined the impact of anticipating poor economic conditions on financial risk taking. In Experiment 1, the salience of poor future economic prospects was manipulated among young adults. Those who were reminded of their poor future economic prospects were more likely to take the opportunity to gamble with their money than those in the control condition. In Experiment 2, we once again manipulated the salience of poor economic prospects. Extending the results of Experiment 1, participants who were reminded of their poor economic prospects bet more money on a spin of a roulette wheel than those in a control condition. Importantly, we show that the relationship between poor economic prospects and gambling is mediated by belief in the necessity of taking financial risks to make money. Implications of economic downturns for gambling and other forms of risk taking are discussed.
Once Bitten, Twice Shy
Authors: Newark Daniel A. , Flynn Francis J. , Bohns Vanessa K.
Published: June 2013

Four studies examined help-seekers’ beliefs about how past refusals affect future compliance. In Study 1, help-seekers were more likely than potential helpers to believe that a previous refusal would lead a potential helper to deny a subsequent request of similar size. Study 2 replicated this effect and found that help-seekers underestimated the actual compliance rate of potential helpers who had previously refused to help. Studies 3 and 4 explain this asymmetry. Whereas potential helpers’ willingness to comply with a subsequent request stems from the discomfort of rejecting others not once, but twice, help-seekers rely on dispositional attributions of helpfulness to estimate the likelihood of hearing “yes” from someone who has previously told them “no.”
A Survey of a Small Sample of Emergency Department and Admitted Patients Asking Whether They Expect to Be Tested for HIV Routinely
Authors: McAfee Lisa , Tung Chester , Espinosa-Silva Yaminah , Rahman Munira , Fatima Khuteja , Clark Ryan , Wang Zhijun , Pearce Daniel
Published: June 2013

Objectives:

Many US HIV-positive patients are unaware of their infection. Although there are multiple studies assessing the acceptance of testing, there are none that assess the patient’s expectations of routine HIV testing.

Methods:

Through a prospective, cross-sectional, unfunded, convenience sample survey, we assessed the patient’s expectation of testing at a regional medical center serving an indigent population. Also, we compared the providers’ predictions of the proportion of patients expecting a test.

Results:

Of the 69 patients, 23% expected a test. The only factor that correlated with this was their desire to be tested ( P = .004). Providers’ (N = 59) mean prediction was that 21% of the patients expected a test (range: 0%-100%). The proportion of emergency department (ED) patients wanting a test was 52% (of 30) and internal medicine inpatients were 44% (of 39).

Conclusions:

Nearly a quarter of patients expected routine HIV testing. This finding should encourage a review of policies promoting HIV testing, especially within the ED.
Elevated Testosterone Levels in HIV-Infected Men
Authors: Phongtankuel Veerawat , Schrank Gregory , Campbell Erica N. , Holtzman Carol , Gaughan John P. , van den Berg-Wolf Mary
Published: June 2013

Little is known about HIV-infected patients with serum testosterone levels in high normal to elevated ranges. An HIV-infected patient with hepatitis C and unexplained high serum testosterone levels prompted a retrospective chart review into the association of hepatitis C and serum testosterone levels greater than 1000 ng/mL in our clinic. The charts of 1419 male HIV patients were reviewed. Out of 1419 patients, 159 (11%) met the criteria for data analysis. A total of 8 patients had serum testosterone levels greater than 1000 ng/mL. There was no significant correlation between hepatitis C antibody positivity or presence of hepatitis C viremia as measured by viral load, nor was there any significant correlation with CD4+ cell counts. We found a weak positive association between years since reported diagnosis of HIV and high testosterone levels.
A far downstream enhancer for murine Bcl11b controls its T-cell specific expression
Authors: Li Long , Zhang Jingli A. , Dose Marei , Kueh Hao Yuan , Mosadeghi Ruzbeh , Gounari Fotini , Rothenberg Ellen V.
Published: June 2013

Key Points

A conserved enhancer, needed for Bcl11b expression in early T cells and developmentally activated in parallel with it, lies 850 kb downstream. This enhancer binds TCF-1 and loops to the differentially methylated Bcl11b promoter to mediate lineage-specific activation and silencing.
Runx3 deficiency results in myeloproliferative disorder in aged mice
Authors: Wang Chelsia Qiuxia , Motoda Lena , Satake Masanobu , Ito Yoshiaki , Taniuchi Ichiro , Tergaonkar Vinay , Osato Motomi
Published: June 2013

Key Points

Runx3 conditional knockout mice develop a myeloproliferative disorder when aged. Runx3-deficient cells show hypersensitivity to G-CSF.
STAT3 mediates oncogenic addiction to TEL-AML1 in t(12;21) acute lymphoblastic leukemia
Authors: Mangolini Maurizio , de Boer Jasper , Walf-Vorderwülbecke Vanessa , Pieters Rob , den Boer Monique L. , Williams Owen
Published: June 2013

Key Points

STAT3 activity is necessary for TEL-AML1 leukemia maintenance. TEL-AML1 induces STAT3 activation via RAC1 and leading to induction of MYC expression.
Salmonella engineered to express CD20-targeting antibodies and a drug-converting enzyme can eradicate human lymphomas
Authors: Massa Paul E. , Paniccia Aida , Monegal Ana , de Marco Ario , Rescigno Maria
Published: June 2013

Key Points

Salmonella is engineered to specifically infect tumor cells based on recognition of a tumor antigen by a bacterial-expressed antibody. Once inside, Salmonella can transfer cytotoxic cargos to destroy human tumors even in the absence of an adaptive immune response.
Expression of the secondary granule proteins major basic protein 1 (MBP-1) and eosinophil peroxidase (EPX) is required for eosinophilopoiesis in mice
Authors: Doyle Alfred D. , Jacobsen Elizabeth A. , Ochkur Sergei I. , McGarry Michael P. , Shim Kevin G. , Nguyen David T. C. , Protheroe Cheryl , Colbert Dana , Kloeber Jake , Neely Joseph , Shim Kelly P. , Dyer Kimberly D. , Rosenberg Helene F. , Lee James J. , Lee Nancy A.
Published: June 2013

Key Points

The loss of the two most abundant eosinophil granule proteins disrupts the production of blood eosinophils from marrow progenitors. Knockout animals deficient for both MBP-1 and EPX represent a novel strain of mice with a specific and congenital loss of eosinophils.