bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantitative Assessment of Ventricular Septal Contour for Estimation of Right Ventricular Pressure
Authors: Watson Timotheus , McCracken Courtney E. , Slesnick Timothy , Kanaan Usama , Border William L. , Sachdeva Ritu
Published: September 2015

Background

Qualitative assessment of ventricular septal flattening is commonly used in pediatric patients with pulmonary hypertension (PH) who lack adequate tricuspid regurgitation (TR) Doppler signal. We sought to determine the relation between quantitative measures of septal flattening including the eccentricity index (EIs) and a novel marker, the septal flattening angle (SFA) with right ventricular systolic pressure (RVSP).

Methods

Subjects (≤18 years) with an anatomically normal heart, an adequate TR signal to obtain a peak velocity, and a simultaneous systemic systolic blood pressure (SBP) was included. RVSP was derived using TR gradient. Eccentricity index (EIs) and the SFA in systole were measured offline and correlated with RVSP/SBP.

Results

Of the 108 subjects, RVSP/SBP was < 50% in 77 and ≥ 50% in 31. In those with RVSP/SBP ≥50%, the median SFA was significantly lower (7.4° vs. 22°, p < 0.0001), and the median EIs was higher (1.61 vs. 1.07, p < 0.0001). SFA and EIs had a significant correlation with RVSP/SBP (rs = −0.70 and 0.61, respectively). Area under the curve was higher for SFA compared to EIs (0.92 and 0.85, respectively). The sensitivity and specificity of SFA for predicting an RVSP/SBP ≥ 50% using a cut point of 16° was 84% and 95% and for an EIs cut point of 1.35 was 74.2% and 96.1%, respectively.

Conclusion

Septal flattening angle and EIs are quantitative measures of ventricular septal flattening that correlate well with RVSP/SBP and should be considered more routinely in clinical practice, especially in patients with inadequate TR Doppler signal.
Unraveling the consequences of the terminal Pleistocene megafauna extinction on mammal community assembly
Authors: Smith Felisa A. , Tomé Catalina P. , Elliott Smith Emma A. , Lyons S. Kathleen , Newsome Seth D. , Stafford Thomas W.
Published: September 2015

Recent studies connecting the decline of large predators and consumers with the disintegration of ecosystems often overlook that this natural experiment already occurred. As recently as 14 ka, tens of millions of large‐bodied mammals were widespread across the American continents. Within 1000 yr of the arrival of humans, ∼ 80% were extinct including all > 600 kg. While the cause of the late Pleistocene (LP) extinction remains contentious, largely overlooked are the ecological consequences of the loss of millions of large‐bodied animals. Here, we examine the influence of the LP extinction on a local mammal community. Our study site is Hall's Cave in the Great Plains of Texas, which has unparalleled fine‐grained temporal resolution over the past 20 ka, allowing characterization of the community before and after the extinction. In step with continental patterns, this community lost 80% of large‐bodied herbivores and 20% of apex predators at the LP extinction. Using tightly constrained temporal windows spanning full glacial to modern time periods and comprehensive faunal lists, we reconstruct mammal associations and body size distributions over time. We find changes in alpha and beta diversity, and in the statistical moments associated with periods of climate change as well as with the LP extinction event. Additionally, there is a fundamental change in the composition of herbivores, with grazers being replaced by frugivores/granivores starting about 15 ka; the only large‐bodied grazer remaining today is the bisonBison bison. Moreover, the null model program PAIRS reveals interesting temporal patterns in the disassociation or co‐occurrence of species through the terminal Pleistocene and Holocene. Extinct species formed more significant associations than modern ones, and formed more aggregated pairs than do modern species. Further, negative species associations were about three times stronger than positive ones, suggesting that competitive interactions or environmental filtering are a strong force in community structure.
Oral surgery in the European Union: challenges of diversity in training and practice
Authors: Nasseripour M. N. , Hervé C. , Meningaud J.‐P.
Published: September 2015

Introduction

At the crossroads of medicine and dentistry, oral surgery with orthodontics are the only recognised dental specialties by the European Union. The goal of our study is to evaluate the current state of oral surgery in Europe from its teaching to its practice, the hypothesis being that a notable diversity persists despite European Union harmonisation process.

Materials and methods

To understand the impact of this diversity applied to European Union freedom of movement and its ethical implications for the practice of oral surgery, English and French questionnaires were sent by email to universities and organisations delivering authorisation to practise in France, Germany, Spain, Sweden and United Kingdom chosen based upon inclusion and exclusion criteria. An analysis of documents on these organisations' official websites was also conducted. Demographic information was obtained from the aforementioned organisations.

Results

The profile of practising oral surgeons is different dependent on the country. The university and hospital trainings conform to European recommendations and span 3–4 years. European Board certification is not required. Continuing education is mandatory only in France, Germany and United Kingdom. As for curricula and scope of practice, no consensus can be derived.

Discussion

There is potential conflict of interest between European Union principles of freedom of movement and protection of all citizens, as member countries do not uniformly apply Directives and recommendations. A new survey of all European Union oral surgery programmes as well as organisations delivering authorisation to practise is necessary to implement across the board harmonisation of training and practice to insure patient safety in light of the migration of European Union practitioners.
Virtual courses: enhancing a curriculum
Authors: Bateman H. L. , Ellis J. S. , Thomason J. M.
Published: September 2015

Introduction

Providers of education programmes are required to demonstrate to students, staff and external regulators the content of the programme and how this aligns to key outcomes. Whilst many programme themes are straightforward to illustrate, other integral themes prove challenging to demonstrate independently.

Innovation

A virtual course takes elements within the current programme relating to a specific theme, repackages and maps them to provide clear signposting by highlighting each occasion the theme is taught, experienced and assessed. The individual elements remain within their current course, so there is no disruption to the established curriculum, but there is an enhancement in terms of transparently displaying linkages within a theme.

Discussion

Using the concept of virtual courses we have found we can respond to new initiatives and requirements of external regulators, as well as providing improved signposting for staff and students. This can be undertaken without the need to redesign a whole curriculum.

Conclusion

In well‐designed and currently effective curricula, we would like to recommend that virtual course development can enhance programme transparency, demonstrate external regulatory requirements and promote quality assurance without disruption to current content.
Cardiac function in survivors of childhood acute myeloid leukemia treated with chemotherapy only: a NOPHO‐AML study
Authors: Jarfelt Marianne , Andersen Niels H. , Glosli Heidi , Jahnukainen Kirsi , Jónmundsson Guðmundur K. , Malmros Johan , Nysom Karsten , Hasle Henrik ,   the Nordic Society of Pediatric Hematology and Oncology (NOPHO)
Published: September 2015

Objectives

We report cardiac function of patients treated for Childhood acute myeloid leukemia with chemotherapy only according to three consecutive Nordic protocols.

Methods

Ninety‐eight of 138 eligible patients accepted examination with standardized echocardiography. Results were compared with age‐ and sex‐matched controls.

Results

The median age was 3 yr at diagnosis (range 0–15), and the median time from diagnosis to study was 11 yr (4–25). All but one patient had received doxorubicin and 90% had received mitoxantrone. The median cumulative dose of daunorubicin equivalents was 300 mg/m2 (210–525). Left ventricular fractional shortening (LVFS) and ejection fraction (LVEF) were lower in patients than in controls (32.6% (SD 4.0) vs. 35.2% (SD 3.4), P = 0.002 and 59.9% (SD 5.5) vs. 64.2% (SD 4.4), P = 0.001). The myocardial performance index (MPI) was higher in patients than in controls (0.32 (SD 0.081) vs. 0.26 (SD 0.074), P < 0.0001). Cumulative dose of doxorubicin but not mitoxantrone was related to lower LVFS (P = 0.037) and LVEF (P = 0.016). Longer follow‐up was associated with lower LVFS (P = 0.034). Higher MPI was associated with young age at diagnosis (P = 0.04) and longer follow‐up (P = 0.031).

Conclusions

In this study, most patients had cardiac function within normal limits and reported very few cardiac symptoms. However, compared with healthy controls, they had significantly reduced left ventricular function.
Impact of a change in protected environment on the occurrence of severe bacterial and fungal infections in children undergoing hematopoietic stem cell transplantation
Authors: Libbrecht Clara , Goutagny Marie‐Pierre , Bacchetta Justine , Ploton Christine , Bienvenu Anne‐Lise , Bleyzac Nathalie , Mialou Valérie , Bertrand Yves , Domenech Carine
Published: September 2015

Background

Allogeneic hematopoietic stem cell transplantation (alloHSCT) is a procedure with a high infection risk. Strict isolation of patients is the rule to prevent such condition.

Objective

We compared the occurrence of severe infections (bacteremia and invasive fungal infection, IFI) in children undergoing alloHSCT before and after the move to a new protected unit with decreases in isolation methods.

Methods

The study was conducted over a 10‐year period. Unit 1 (2002–2007) consisted of laminar airflow rooms where caregivers were required to wear a sterile outfit (gown, gloves, hat, and mask). Unit 2 (2008–2012) included spacious positive air pressure rooms with HEPA filters where only a clean gown and mask were required to be worn.

Results

Two hundred eighty‐six alloHSCTs were performed (144 in Unit 1 and 142 in Unit 2). We reported a total incidence of 4.78 infections/1000 hospital‐days including 4.4 episodes of bacteremia and 0.38 episodes of IFI. There was no statistical difference in the incidence of infections: n = 4.98/1000 hospital‐days in Unit 1 vs. n = 4.6/1000 in Unit 2 (P = 0.63).

Conclusion

The lack of difference in the occurrence of severe infection supports our decision to decrease unnecessary high protection in alloHSCT units to improve children's daily life.
Can Mediterranean cephalopod stocks be managed at MSY by 2020? The Balearic Islands as a case study
Authors: Quetglas A. , Keller S. , Massutí E.
Published: September 2015

According to the Common Fisheries Policy (CFP), all European fish stocks should be brought to a state where they can produce at MSY by 2015 wherever possible or by 2020 at the latest. Despite the high socio‐economical importance of cephalopods in the Mediterranean and the increased availability of stock assessments during the recent past, only few European cephalopod stocks have been assessed to date. Surplus production models were applied to analyse the exploitation state of octopus and cuttlefish stocks from the Balearic Islands (western Mediterranean) to estimate how far away they were from the MSY target established by the CFP using a long‐term data series (1977–2013). The stocks were overexploited (cuttlefish) or about to be overexploited (octopus) during the late 1970s; this state remains even now and will only recover from overexploitation by 2020 if severe measures are taken.
Implications of using small meshed gillnets for the sustainability of fish populations: a theoretical exploration based on three case studies
Authors: Wolff M. , Taylor M. H. , Tesfaye G.
Published: September 2015

The study explores the impacts of varying gillnet mesh size and fishing level on yield per recruit (Y/R), escapement spawning stock (ESS) and mega‐spawners (MS) of three widely distributed freshwater fishery target species. Y/R is maximised when the optimal length of capture (Lcap) is above the size of maturity (L50). However, the unimodal shape of gillnet selectivity results in lower impacts to ESS and MS with both smaller and larger mesh sizes. Under conditions of moderate exploitation, the fraction of MS was significantly larger if small meshed gillnets were used. This is due to the relatively smaller cumulative vulnerability from small mesh sizes through time, as they target a smaller size range of fish, which also grow more quickly through the vulnerable window due to higher growth rates. Therefore, unlike trawls and beach seines, which select all size classes beyond the minimum length of capture (Lc), small meshed gillnets are not necessarily destructive and may rather promote sustained production by allowing a higher proportion of the spawning biomass to remain in the stock. The work also helps to explain the observation of sustained fish production in many developing countries despite the persistent use of gillnets of small mesh size that target small, under‐sized individuals.
Population dynamics and stock assessment of Colossoma macropomum caught in the Manacapuru Lake system (Amazon Basin, Brazil)
Authors: Campos C. P. , Costa Sousa R. G. , Catarino M. F. , de Albuquerque Costa G. , Freitas C. E. C.
Published: September 2015

Colossoma macropomum is the second largest scaled fish in the Amazon basin. Reduced harvests in recent decades suggest that populations of this species are already overexploited in some areas. In this study, the population dynamics of C. macropomum was investigated using length and weight data for fish caught in the Manacapuru Lake system, a large ria lake located along the lower reach of the Solimões River. A total of 1270 individuals of C. macropomum with standard lengths varying from 17 to 62 cm and mean length of 31.0 ± 6.7 cm were sampled. Weights varied from 165 to 8195 g, and mean weight was 1148.3 ± 883.8 g. Maximum sustainable yield was estimated at 285.8 g recruit−1, corresponding to a fishing mortality of 0.51 year−1. A scenario analysis based on changes in fishing mortality and age at first capture, two parameters potentially addressed by fishing management strategies, suggested that any improvement in fishing yield depends on increases in age at first capture.
Full carbon and greenhouse gas balances of fertilized and nonfertilized reed canary grass cultivations on an abandoned peat extraction area in a dry year
Authors: Järveoja Järvi , Peichl Matthias , Maddison Martin , Teemusk Alar , Mander Ülo
Published: September 2015

Bioenergy crop cultivation on former peat extraction areas is a potential after‐use option that provides a source of renewable energy while mitigating climate change through enhanced carbon (C) sequestration. This study investigated the full C and greenhouse gas (GHG) balances of fertilized (RCG‐F) and nonfertilized (RCG‐C) reed canary grass (RCG; Phalaris arundinacea) cultivation compared to bare peat (BP) soil within an abandoned peat extraction area in western Estonia during a dry year. Vegetation sampling, static chamber and lysimeter measurements were carried out to estimate above‐ and belowground biomass production and allocation, fluxes of carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O) in cultivated strips and drainage ditches as well as the dissolved organic carbon (DOC) export, respectively. Heterotrophic respiration was determined from vegetation‐free trenched plots. Fertilization increased the above‐ to belowground biomass production ratio and the autotrophic to heterotrophic respiration ratio. The full C balance (incl. CO2, CH4 and DOC fluxes from strips and ditches) was 96, 215 and 180 g C m−2 yr−1 in RCG‐F, RCG‐C and BP, respectively, suggesting that all treatments acted as C sources during the dry year. The C balance was driven by variations in the net CO2 exchange, whereas the combined contribution of CH4 and DOC fluxes was <5%. The GHG balances were 3.6, 7.9 and 6.6 t CO2 eq ha−1 yr−1 in RCG‐F, RCG‐C and BP, respectively. The CO2 exchange was also the dominant component of the GHG balance, while the contributions of CH4 and N2O were <1% and 1–6%, respectively. Overall, this study suggests that maximizing plant growth and the associated CO2 uptake through adequate water and nutrient supply is a key prerequisite for ensuring sustainable high yields and climate benefits in RCG cultivations established on organic soils following drainage and peat extraction.
‘EPIGONEN’ OR ‘PROGONEN’? SHORT PROSE AND YOUNG GERMANS
Authors: Hutchinson Ben
Published: September 2015

In his introduction to the 1959 edition of Die verspätete Nation, the sociologist Helmuth Plessner famously suggested that modern Germany is defined as a nation‐state by its ‘belatedness’. Yet this belatedness, Plessner remarks, is not only to be understood in purely negative terms: it may be ‘eine Ungunst des Geschicks’, but it is also ‘eine schöpferische Möglichkeit’. Much the same ambiguity could be said to apply to German literature of the 1830s, where the sense of arriving too late, of arriving after the golden age of Goethe and Schiller, can be understood as both contingent and conceptual. This essay reflects on this tension by considering two main modes of shorter prose in the 1830s: critique, and the novella. Surveying the Young German critics on the one hand, and Alexander von Ungern‐Sternberg's paradigmatic novella Die Zerrissenen on the other, it considers short prose not only as an aesthetic vehicle of this tension, but also as its generic expression, in as much as it reacts against Romantic and Goethean models of genre with a conscious insistence on ‘Selbstverkleinerung’. Is Hegel's ‘age of prose’ in the 1830s more specifically an age of short prose?

Der Soziologe Hellmuth Plessner hat das moderne Deutschland bekanntlich als ‘verspätet’ bezeichnet. Diese Verspätung sei jedoch nicht nur negativ zu bewerten: Sie möge zwar ‘eine Ungunst des Geschicks’ sein, sie bilde aber auch ‘eine schöpferische Möglichkeit’. Die deutsche Literatur der 1830er Jahre könnte man als ebenso zweideutig verstehen: Der damals herrschende Eindruck zu spät geboren zu sein – nach dem goldenen Zeitalter von Goethe und Schiller – ließe sich sowohl auf kontingente wie auf konzeptuelle Weise verstehen. Der vorliegende Aufsatz untersucht diese Spannung durch zwei Hauptformen der Kurzposa der 1830er, nämlich die Kritik und die Novelle. Unter Anspielung zum einen auf die jungdeutschen Kritiker, zum anderen auf Alexander von Ungern‐Sternbergs Novelle Die Zerrissenen, wird die Kurzprosa nicht nur als ästhetisches Vehikel dieser Spannung, sondern auch als deren gattungsspezifischer Ausdruck verstanden: Auf die romantischen und goetheschen Gattungsmodelle folgt, so das Argument des Aufsatzes, eine Ära der ‘Selbstverkleinerung’. Ob das Zeitalter der Prosa nicht besser als ein Zeitalter der Kurzprosa zu verstehen wäre?
POETIC REALISM, THE GERMAN NOVELLE AND THE LEGACY OF GERMAN IDEALIST AESTHETICS: FRANZ GRILLPARZER'S DER ARME SPIELMANN
Authors: Walker John
Published: September 2015

Grillparzer's Der arme Spielmann exemplifies the truth that the nineteenth‐century German novella, although informed by the philosophical and cultural legacy of German idealist aesthetics, also embodies a narrative critique of it. The poetic realist novella in German should therefore be read in the context of German idealist aesthetics but never reduced to the terms which that aesthetics defines. This essay challenges, through a detailed analysis of Grillparzer's text, the view that German poetic realism expresses an idea of art which is supposed to be transcendent of the world of economic necessity and social facts. On the contrary, Grillparzer's novella is shown to highlight the contradiction between that world and the way its central character experiences ‘art’. Unlike the major modes of idealist aesthetics, and despite its concern with the ‘formless art’ of music, this text does not endorse an idea of artistic creation derived from the non‐verbal arts, in which art more embodies than represents the real. Grillparzer's text does not hide but rather foregrounds the process of literary creation. It emphasises the distance between any supposedly disengaged realism and the actuality of experience. The essay both argues this thesis in detail in relation to Grillparzer's Der arme Spielmann and shows its relevance to the reassessment of German poetic realism in German as a whole.

In diesem Beitrag wird Grillparzers Der arme Spielmann als paradigmatisches Exempel gedeutet für das Spannungsverhältnis der deutschen Novelle des neunzehnten Jahrhunderts zur Erbschaft der deutschen idealistischen Ästhetik. Die deutsche Novelle des poetischen Realismus ist zwar durch die idealistische Tradition entschieden geprägt, verkörpert aber auch eine literarische Kritik an deren Voraussetzungen. In Grillparzers Novelle wird die Präsenz des Erzählers nicht verborgen, sondern betont. Dadurch wird der Wahrheitsgehalt und der humane Bezug jeder ‘objektiven’ Narration in Frage gestellt. Obwohl Grillparzers Text gerade von der ‘wortlosen Kunst’ der Musik handelt, wird der Widerspruch zwischen einer solchen Idee der Kunst und der gesellschaftlich‐wirklichen Welt aufs schärfste hervorgehoben. Im Gegensatz zur Ästhetik des deutschen Idealismus bzw. poetischen Realismus, wo der realistische Roman in den Schatten der bildenden Kunst bzw. der Musik gestellt wird, gilt hier gerade das entgegengesetzte Prinzip: Durch eine realistische Erzählung wird der Widerspruch einer solchen Kunstauffassung zur unmittelbaren Lebenswelt des ‘armen Spielmanns’ in den Vordergrund gerückt. Im Beitrag werden diese Thesen durch eine detaillierte Analyse von Grillparzers Der arme Spielmann belegt und auf die größere Problematik der Ortsbestimmung des deutschsprachigen poetischen Realismus bezogen.
THEODOR STORM AND DISENCHANTMENT
Authors: Cooper Ian
Published: September 2015

This essay examines Theodor Storm as a practitioner of the novella in the context of ideas about ‘disenchantment’ – a concept given prominence by Max Weber and later taken up by Adorno and Horkheimer. The comparison proceeds from Storm's recognised relation to currents of nineteenth‐century thought from which the philosophical discourse of disenchantment emerged. In the perspectival complexity of Der Schimmelreiter Storm gives expression to problems of narrative legitimation which Weber sees as characteristic of rationalisation; for Adorno and Horkheimer such problems underlie the self‐alienation of the ‘enlightened’ world view, which they understand as becoming mythic. Storm anticipates these tensions in his spectrally infused treatment of nature, which allows him to grasp the crisis of myth and enlightenment as continuous with a discursive primacy of the aesthetic. His text throws such primacy into critical relief as inadequate to the claim of realist narrative art.

Der Beitrag untersucht die Novellenpraxis Theodor Storms vor dem Hintergrund des von Max Weber prominent gemachten, später von Adorno und Horkheimer weiterentwickelten Begriffs der ‘Entzauberung’. Die literaturgeschichtliche Grundlage des Vergleichs bildet der belegte Kontakt Storms zu intellektuellen Strömungen seiner Zeit, aus denen der philosophische Diskurs der Entzauberung hervorging. Es wird gezeigt, wie die erzählerische Komplexität des Schimmelreiters jene Problematik der narrativen Legitimation manifestiert, die Weber als Merkmal der Rationalisierung kennzeichnet und Adorno und Horkheimer zur Selbstentfremdung einer ‘aufklärerischen’, damit in den Mythos umschlagenden Weltsicht stilisieren. Diese Spannungen antizipiert Storm im Horizont einer spektralen Naturthematik, die es ihm erlaubt, die krisenhafte Identität von Mythos und Aufklärung als Parallelbewegung zu einem – durch seine Novelle relativierten – diskursiven Vorrang des Ästhetischen zu begreifen, der dem Anspruch einer realistischen Erzählkunst nicht gerecht wird.
A multicentre validation of Metasin: a molecular assay for the intraoperative assessment of sentinel lymph nodes from breast cancer patients
Authors: Sai‐Giridhar Priya , Al‐Ramadhani Salma , George Dilushana , Gopinath Preethi , Andrews William , Jader Samar , Brown Shelley , Findlay Alison , Arkoumani Evdokia , Al‐Sam Salam , McKenzie Jolanta G , Bradpiece Howard , Jenkins Stephanie , Aylwin Anthony , Holt Simon , Sharaiha Yousef , Yiangou Constantinos , Agrawal Avi , McDowell Amanda , Gabriel Francis G , Jeffrey Margaret , Agrawal Neerja , Cree Ian A , Mansel Robert E , Keshtgar Mo , McDermott Nuala , El Sheikh Soha , Wellsted David , Collard Jade , Chaplin Hema , Landt Olfert , Bustin Stephen , Sundaresan Maryse , Sundaresan Vasi
Published: September 2015

Aims

Treatment strategies for breast cancer continue to evolve. No uniformity exists in the UK for the management of node‐positive breast cancer patients. Most centres continue to use conventional histopathology of sampled sentinel lymph nodes (SLNs), which requires delayed axillary clearance in up to 25% of patients. Some use touch imprint cytology or frozen section for intraoperative testing, although both have inherent sensitivity issues. An intraoperative molecular diagnostic approach helps to overcome some of these limitations. The aim of this study was to assess the clinical effectiveness of Metasin, a molecular method for the intraoperative evaluation of SLNs.

Methods and results

RNA from 3296 lymph nodes from 1836 patients undergoing SLN assessment was analysed with Metasin. Alternate slices of tissue were examined in parallel by histology. Cases deemed to be discordant were analysed by protein gel electrophoresis. There was concordance between Metasin and histology in 94.1% of cases, with a sensitivity of 92% [95% confidence interval (CI) 88–94%] and a specificity of 97% (95% CI 95–97%). Positive and negative predictive values were 88% and 98%, respectively. Over half of the discordant cases (4.4%) were ascribed to tissue allocation bias (TAB).

Conclusions

Clinical validation of the Metasin assay suggests that it is sufficiently sensitive and specific to make it fit for purpose in the intraoperative setting.
Impact of falling reimbursement rates on physician preferences regarding drug therapy for osteoarthritis using a discrete choice experiment
Authors: Berchi Celia , Degieux Pierre , Halhol Hafid , Danel Brigitte , Bennani Mohammed , Philippe Caroline
Published: September 2015

Objectives

In the European context of falling reimbursement rates for some osteoarthritis (OA) treatments, we performed a study to determine whether the cost covered by patients influenced the decisions of their physicians' prescriptions for medication.

Methods

The study involved 106 general practitioners (GPs) and 82 rheumatologists. Preferences were elicited using a discrete choice experiment. Scenarios were generated including seven treatment attributes with associated different levels: pain relief, improvement in function, retardation of joint degradation, risk of moderate side effects, risk of serious side effects, cost borne by the patient and degree of patient acceptance of the treatment.

Key findings

OA treatment choices were significantly influenced by pain relief (β = 1.1533, P < 0.0001 for GPs and β = 0.5043, P = 0.0024 for rheumatologists), improvement in function (β = 1.2140 for GPs and β = 0.7192 for rheumatologists, P < 0.0001), annual cost to the patient (β = −0.0054 for GPs and β = −0.0038 for rheumatologists, P < 0.0001) and serious side effects (β = −0.5524 for GPs and β = −0.4268 for rheumatologists, P < 0.0001). The risk of moderate side effects only had an impact on GP decision making (β = 0.0282, P = 0.0028). All physicians were willing to make patients bear an extra annual cost of: (1) €225 among GPs and €189 among rheumatologists so that they could benefit from one unit improvement in function; and (2) €214 among GPs and €133 among rheumatologists so that they could benefit from a one unit improvement in pain relief.

Conclusion

When making decisions about which treatment to prescribe, physicians take into account the cost to patients. Changes in reimbursement rates for some OA treatments may lead to changes in prescribing practices.
H‐likelihood Predictive Intervals for Unobservables
Authors: Lee Youngjo , Kim Gwangsu
Published: September 2015

Inferences about unobserved random variables, such as future observations, random effects and latent variables, are of interest. In this paper, to make probability statements about unobserved random variables without assuming priors on fixed parameters, we propose the use of the confidence distribution for fixed parameters. We focus on their interval estimators and related probability statements. In random‐effect models, intervals can be formed either for future (yet‐to‐be‐realised) random effects or for realised values of random effects. The consistency of intervals for these two cases requires different regularity conditions. Via numerical studies, their finite sampling properties are investigated.
Comparison of Consolidation Routes for Mo–Si–B Materials Prepared by Using Nitride Containing Powders
Authors: Wiltner Almut , Klöden Burghardt , Hilger Isabell , Weißgärber Thomas , Kieback Bernd
Published: September 2015

Pressureless sintering is a well‐established powder metallurgical route for processing and consolidation of mixed materials. Especially materials exhibiting a high melting point could be densified without tool abrasion by this sintering technique. As the sintering temperatures are often higher compared to pressure‐assisted techniques care must be taken by means of grain growth. In our studies we used a ternary compound mixture to obtain Mo‐based alloys. Consolidation applying pressure‐assisted methods (hot pressing, spark plasma sintering) and pressureless sintering were used, respectively. The densities reached and the microstructures obtained were compared. These Mo–Si–B alloys were processed using a nitride‐powder‐based route offering lower impurity contents due to short processing times by avoiding time consuming mixing / milling steps. The sintering conditions depending on the powder particle size as well as the sample shape will be presented in detail. The composition investigated in this article offered a continuous α‐Mo matrix with intermetallic islands consisting of Mo3Si and Mo5SiB2 (T2) phases. The combination of a ductile α‐Mo matrix and intermetallic phases embedded within offered an enhanced mechanical behavior at room temperature compared to MoSi2 or other intermetallic alloys. Moreover, the intermetallic compounds as well as Mo are candidates for high‐temperature applications. As the high‐temperature behavior could be strongly influenced by the respective microstructure we present here the processing and the microstructure obtained.
Stereotyped behaviours as precursors of self‐injurious behaviours: a longitudinal study with infants and toddlers at risk for developmental delay
Authors: Rojahn J. , Barnard‐Brak L. , Medeiros K. , Schroeder S. R.
Published: September 2015

Background

The notion that stereotypic behaviours may be precursors of self‐injurious behaviour (SIB) has been considered in the past, but the available empirical evidence is still inconsistent and ambiguous.

Method

In a longitudinal study, we collected data on stereotypic behaviour and SIB from 160 infants and toddlers who were at‐risk for developmental delay. Interviews were conducted with parents at three time points during a one‐year span using the Behaviour Problems Inventory‐01 which contains subscales for SIB and stereotyped behaviour. We used growth modelling to estimate linear trends in several models. Model fit was evaluated according to a combination of fit statistics as is recommended in structural equation or latent variable modelling approaches such as latent growth modelling.

Results

In examining the relationship between stereotyped behaviours and SIB across time, the model that represented earlier stereotyped behaviour as predicting later SIB fit the data better than the other models.

Conclusions

The findings corroborate the notion that stereotyped behaviour can be a precursor of SIB. If replicated by other studies, it makes a case for considering early intervening with stereotyped behaviour as a SIB prevention strategy.
Regulation of Certified Nurse‐Midwife Scope of Practice: Change in the Professional Practice Index, 2000 to 2015
Authors: Beal Margaret W. , Batzli Mara E. , Hoyt Alex
Published: September 2015

Introduction

Certified nurse‐midwives (CNMs) across the United States are educated in the same core competencies, yet scope of practice varies with state regulation. The Health Resources and Services Administration (HRSA) funded studies published in 1994 and 2004 on the professional practice environment of CNMs, nurse practitioners, and physician assistants, and developed the Certified Nurse‐Midwife Professional Practice Index (CNMPPI), a 100‐point scoring system of state regulation focusing on 3 domains: legal status, reimbursement, and prescriptive authority. The purpose of this study was to examine changes to CNM regulation between 2000 and 2015 by updating scores to the CNMPPI.

Methods

Individual state CNMPPI scores from 2000 were updated for every year through 2015 by reviewing data published in the American College of Nurse‐Midwives (ACNM) quarterly publication Quickening, the annual advanced practice registered nurse legislative updates in the journal Nurse Practitioner, and the ACNM State Legislative and Regulatory Guidance.

Results

Mean state scores increased 18%, from 69.7 in 2000 to 79.8 in 2015, and variation between state scores fell. Increases were seen in all 3 domains, with the greatest increase in the domain of prescriptive authority and the smallest in the legal domain. Individual state CNMPPI scores tend to be correlated with scores of adjacent states.

Discussion

The CNMPPI can be used to document changes in practice authority of CNMs. The increase in state CNMPPI scores and decrease in variance across states can be interpreted as indicating growth of professional authority and increasing consensus regarding the CNM role. The scoring system needs to be updated to reflect the current health systems environment and to include certified midwives and other midwives meeting the International Confederation of Midwives definition of a midwife. Applications of the CNMPPI to future research are discussed.
Practitioner and Practice Characteristics of Certified Professional Midwives in the United States: Results of the 2011 North American Registry of Midwives Survey
Authors: Cheyney Melissa , Olsen Christine , Bovbjerg Marit , Everson Courtney , Darragh Ida , Potter Brynne
Published: September 2015

Introduction

No data describing certified professional midwives (CPMs) currently exist in the literature, although CPMs attend the majority of home births in the United States. This study addresses this gap by assessing the demographics, education levels, routes to certification, and practice characteristics of currently practicing CPMs.

Methods

Data were collected from a survey of CPMs conducted by the North American Registry of Midwives (NARM) between July and October 2011. In order to assess generalization to the entire population of practicing CPMs, we also completed a nonresponse bias analysis. We examined midwives’ demographic, education, certification, and practice characteristics using descriptive and nonparametric, bivariable statistics.

Results

More than 90% of the 568 respondents attended at least some college, and 47.1% hold a bachelor's degree or greater. CPMs spent a median of 3 years (interquartile range, 2‐5 years) in training before attending births as a primary midwife. However, 38.9% of currently practicing CPMs had less than 3 years of training. Regarding pathways to certification, 48.5% utilized the portfolio evaluation process (PEP); 36.9% graduated from a Midwifery Education and Accreditation Council (MEAC)‐accredited school; 14.5% were already licensed by a state as a direct‐entry midwife; and 0.7% were already a certified nurse‐midwife or certified midwife, although many CPMs reported a blended education pathway. One‐fifth (21%) of respondents identified as midwives of color. Whereas nearly one‐third (31.8%) of CPM respondents reported that 95% or more of their clients were white, 5.2% serve populations that are 90% or more nonwhite. CPMs of color are significantly more likely to serve clients of color (P < .001).

Discussion

Training and nonmidwifery education levels of most CPMs practicing in the United States align with the Global Standards for Midwifery Education established by the International Confederation of Midwives, although there are still clear areas for improvement.
Pharmacodynamic Effects When Clopidogrel is Given Before Cangrelor Discontinuation
Authors: Schneider David J. , Agarwal Zubin , Seecheran Naveen , Gogo Prospero
Published: September 2015

Objective

To determine whether initiation of clopidogrel before discontinuation of cangrelor would impact on the recovery of platelet reactivity.

Background

The active metabolite of clopidogrel cannot bind to P2Y12 when cangrelor occupies the receptor. Pharmacodynamic studies have shown that this interaction is avoided when clopidogrel is given at the end of the cangrelor infusion. We found that antiplatelet effects of another thienopyridine, prasugrel, were apparent when prasugrel was administered 0.5 hour before cangrelor was stopped.

Methods

Platelet function studies (light transmission aggregometry, VerifyNow, and flow cytometry) were performed on blood from patients with stable coronary artery disease who were taking aspirin when a loading dose of clopidogrel (600 mg) was given during a cangrelor infusion (0.5 and 1 hour before cangrelor was stopped). Results were compared with those obtained when clopidogrel was given immediately after cangrelor was stopped.

Results

Administration of clopidogrel 0.5 and 1 hour before discontinuation of the cangrelor infusion did not prevent recovery of platelet reactivity more effectively than administration at the end of the infusion.

Conclusion

Our results support the previously established strategy of administering clopidogrel immediately after discontinuation of cangrelor. Earlier administration increases the recovery of platelet function. (J Interven Cardiol 2015;28:415–419)
Comparative Accuracy of Facial Models Fabricated Using Traditional and 3D Imaging Techniques
Authors: Lincoln Ketu P. , Sun Albert Y. T. , Prihoda Thomas J. , Sutton Alan J.
Published: September 2015

Purpose

The purpose of this investigation was to compare the accuracy of facial models fabricated using facial moulage impression methods to the three‐dimensional printed (3DP) fabrication methods using soft tissue images obtained from cone beam computed tomography (CBCT) and 3D stereophotogrammetry (3D‐SPG) scans.

Materials and Methods

A reference phantom model was fabricated using a 3D‐SPG image of a human control form with ten fiducial markers placed on common anthropometric landmarks. This image was converted into the investigation control phantom model (CPM) using 3DP methods. The CPM was attached to a camera tripod for ease of image capture. Three CBCT and three 3D‐SPG images of the CPM were captured. The DICOM and STL files from the three 3dMD and three CBCT were imported to the 3DP, and six testing models were made. Reversible hydrocolloid and dental stone were used to make three facial moulages of the CPM, and the impressions/casts were poured in type IV gypsum dental stone. A coordinate measuring machine (CMM) was used to measure the distances between each of the ten fiducial markers. Each measurement was made using one point as a static reference to the other nine points. The same measuring procedures were accomplished on all specimens. All measurements were compared between specimens and the control. The data were analyzed using ANOVA and Tukey pairwise comparison of the raters, methods, and fiducial markers.

Results

The ANOVA multiple comparisons showed significant difference among the three methods (p < 0.05). Further, the interaction of methods versus fiducial markers also showed significant difference (p < 0.05). The CBCT and facial moulage method showed the greatest accuracy.

Conclusions

3DP models fabricated using 3D‐SPG showed statistical difference in comparison to the models fabricated using the traditional method of facial moulage and 3DP models fabricated from CBCT imaging. 3DP models fabricated using 3D‐SPG were less accurate than the CPM and models fabricated using facial moulage and CBCT imaging techniques.
INSURANCE DEMAND UNDER PROSPECT THEORY: A GRAPHICAL ANALYSIS
Authors: Schmidt Ulrich
Published: September 2015

ABSTRACT

This article analyzes insurance demand under prospect theory in a simple model with two states of the world and fair insurance contracts. We argue that two different reference points are reasonable in this framework, state‐dependent initial wealth or final wealth after buying full insurance. Applying the value function of Tversky and Kahneman (), we find that for both reference points subjects will either demand full insurance or no insurance at all. Moreover, this decision depends on the probability of the loss: the higher the probability of the loss, the higher is the propensity to take up insurance. This result can explain empirical evidence that has shown that people are unwilling to insure rare losses at subsidized premiums and at the same time take up insurance for moderate risks at highly loaded premiums.
Melatonin attenuates neurogenic pulmonary edema via the regulation of inflammation and apoptosis after subarachnoid hemorrhage in rats
Authors: Chen Jingyin , Qian Cong , Duan Hongyu , Cao Shenglong , Yu Xiaobo , Li Jianru , Gu Chi , Yan Feng , Wang Lin , Chen Gao
Published: September 2015

Neurogenic pulmonary edema (NPE) is a serious non‐neurological complication that can occur after a subarachnoid hemorrhage (SAH) and is associated with decreased survival and a poor neurological outcome. Melatonin is a strong antioxidant that has beneficial effects against SAH in rats, including reduced mortality and reduced neurological deficits. The molecular mechanisms underlying these clinical effects in the SAH model, however, have not been clearly identified. This study was undertaken to determine the influence of melatonin on SAH‐induced NPE and the potential mechanism of these effects using the filament perforation model of SAH in male Sprague Dawley rats. Either melatonin (150 mg/kg) or a vehicle was given via an intraperitoneal injection 2 hr after an SAH induction. Lung samples were extracted 24 hr after SAH. The results show that the melatonin treatment attenuated SAH‐induced NPE by preventing alveolar–capillary barrier dysfunctions via inhibiting the disruption of tight junction proteins (ZO‐1 and occludin). Moreover, the treatment downregulated the levels of mature interleukin (IL) ‐1β, myeloperoxidase (MPO), and matrix metallopeptidase (MMP) 9 expression/activation, which were increased in the lung; also, melatonin treatment improved neurological deficits. Furthermore, the melatonin treatment markedly reduced caspase‐3 activity and the number of TUNEL‐positive cells in the lung. Taken together, these findings show that administration of melatonin attenuates NPE by preventing alveolar–capillary barrier dysfunctions via repressing the inflammatory response and by anti‐apoptosis effects after SAH.
Chloroplast phylogenomics resolves key relationships in ferns
Authors: Lu Jin‐Mei , Zhang Ning , Du Xin‐Yu , Wen Jun , Li De‐Zhu
Published: September 2015

Studies on chloroplast genomes of ferns and lycophytes are relatively few in comparison with those on seed plants. Although a basic phylogenetic framework of extant ferns is available, relationships among a few key nodes remain unresolved or poorly supported. The primary objective of this study is to explore the phylogenetic utility of large chloroplast gene data in resolving difficult deep nodes in ferns. We sequenced the chloroplast genomes from Cyrtomium devexiscapulae (Koidz.) Ching (eupolypod I) and Woodwardia unigemmata (Makino) Nakai (eupolypod II), and constructed the phylogeny of ferns based on both 48 genes and 64 genes. The trees based on 48 genes and 64 genes are identical in topology, differing only in support values for four nodes, three of which showed higher support values for the 48‐gene dataset. Equisetum L. was resolved as the sister to the Psilotales–Ophioglossales clade, and Equisetales–Psilotales–Ophioglossales clade was sister to the clade of the leptosporangiate and marattioid ferns. The sister relationship between the tree fern clade and polypods was supported by 82% and 100% bootstrap values in the 64‐gene and 48‐gene trees, respectively. Within polypod ferns, Pteridaceae was sister to the clade of Dennstaedtiaceae and eupolypods with a high support value, and the relationship of Dennstaedtiaceae–eupolypods was strongly supported. With recent parallel advances in the phylogenetics of ferns using nuclear data, chloroplast phylogenomics shows great potential in providing a framework for testing the impact of reticulate evolution in the early evolution of ferns.
Sexual Concerns after (Pelvic) Radiotherapy: Is There Any Role for the Radiation Oncologist?
Authors: Krouwel Esmée M. , Nicolai Melianthe P. , van der Wielen Gerard J. , Putter Hein , Krol Augustinus D.G. , Pelger Rob C.M. , Incrocci Luca , Elzevier Henk Willem
Published: September 2015

Introduction

Sexual function is an important aspect of quality of life, and may be impaired after (pelvic) radiation.

Aim

The aim of this study was to identify practice, responsibility attitudes, knowledge, and barriers of Dutch radiation oncologists regarding sexual counseling.

Methods

A cross-sectional survey was performed using a 28-item questionnaire sent to all members of the Dutch Society for Radiotherapy and Oncology.

Main Outcome Measures

Self-reported practice, knowledge, barriers, need for training and responsibility attitudes in regard to demographic characteristics.

Results

Of the surveyed sample, 54.6% of the radiation oncologists completed the instrument (n = 119). Frequency of discussing sexual function was fluctuating, depending on the type of tumor. The majority of the responding radiation oncologists (75%) agreed that discussing sexual function is their responsibility, about one-third (33.6%) pointed at the involved specialist (surgeon, urologist, gynecologist, or oncologist), a fifth also considered the general practitioner responsible (21%). Additional training about discussing sexuality was required according to 44.4%, the majority agreed that sexual counseling should be a regular component of radiation oncology residency (n = 110, 94%). Barriers most mentioned included patient is too ill (36.2%), no angle or reason for asking (32.4%), advanced age of the patient (27%) and culture/religion (26.1%). For prostate cancer patients, phosphodiesterase 5 inhibitor information was supplied regularly (49.2%) and often (40.7%).

Conclusions

Radiation oncologists generally perform sexual counseling in case of pelvic radiation therapy, but not consistently in case of gastrointestinal, breast, and other cancers. The majority of radiation oncologists considered counseling on sexual functioning as a part of their job, some also pointed at the referring specialist or general practitioner. The findings suggest that awareness about sexual dysfunction is present among radiation oncologists, but responsibility for active counseling is uncertain. Results emphasize the need for providing educational and practical training, as well as a list for specialized referral.