bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety and Efficacy of Warfarin plus Aspirin Combination Therapy for Giant Coronary Artery Aneurysm Secondary to Kawasaki Disease: A Meta-Analysis
Authors: Su Danyan , Wang Kai , Qin Suyuan , Pang Yusheng
Published: August 2014

Objective: To compare the safety and efficacy of warfarin plus aspirin versus aspirin alone for the treatment of children with giant coronary artery aneurysm (CAA) secondary to Kawasaki disease (KD). Methods: We searched the PubMed, EMBASE, Cochrane Library, CNKI, WANFAN and VIP databases. We selected case-controlled trials of warfarin plus aspirin versus aspirin alone for the treatment of children with giant CAA secondary to KD. Results: Six retrospective studies met our inclusion criteria. There was no significant difference between the warfarin plus aspirin and aspirin alone groups in the rate of CAA regression (OR 1.38, 95% CI 0.52-3.68, p = 0.52) or the incidence of persistent CAA (OR 2.34, 95% CI 0.16-33.50, p = 0.53), coronary artery stenosis (OR 0.55, 95% CI 0.18-1.72, p = 0.30) or thrombus formation (OR 0.50, 95% CI 0.15-1.69, p = 0.26). There was evidence that warfarin plus aspirin reduced the incidence of coronary artery occlusion (OR 0.08, 95% CI 0.02-0.29, p < 0.0001), cardiac infarction (OR 0.27, 95% CI 0.11-0.63, p = 0.003) and death (OR 0.18, 95% CI 0.04-0.88, p = 0.03). Conclusion: Warfarin plus aspirin therapy reduced the incidence of occlusion, cardiac infarction and death in children with giant CAA secondary to KD.
Adverse Remodeling of the Electrophysiological Response to Ischemia–Reperfusion in Human Heart Failure Is Associated With Remodeling of Metabolic Gene Expression
Authors: Ng Fu Siong , Holzem Katherine M. , Koppel Aaron C. , Janks Deborah , Gordon Fabiana , Wit Andrew L. , Peters Nicholas S. , Efimov Igor R.
Published: August 2014

Background—

Ventricular arrhythmias occur more frequently in heart failure during episodes of ischemia–reperfusion although the mechanisms underlying this in humans are unclear. We assessed, in explanted human hearts, the remodeled electrophysiological response to acute ischemia–reperfusion in heart failure and its potential causes, including the remodeling of metabolic gene expression.

Methods and Results—

We optically mapped coronary-perfused left ventricular wedge preparations from 6 human end-stage failing hearts (F) and 6 donor hearts rejected for transplantation (D). Preparations were subjected to 30 minutes of global ischemia, followed by 30 minutes of reperfusion. Failing hearts had exaggerated electrophysiological responses to ischemia–reperfusion, with greater action potential duration shortening (
P
<0.001 at 8-minute ischemia;
P
=0.001 at 12-minute ischemia) and greater conduction slowing during ischemia, delayed recovery of electric excitability after reperfusion (F, 4.8±1.8 versus D, 1.0±0 minutes;
P
<0.05), and incomplete restoration of action potential duration and conduction velocity early after reperfusion. Expression of 46 metabolic genes was probed using custom-designed TaqMan arrays, using extracted RNA from 15 failing and 9 donor hearts. Ten genes important in cardiac metabolism were downregulated in heart failure, with
SLC27A4
and
KCNJ11
significantly downregulated at a false discovery rate of 0%.

Conclusions—

We demonstrate, for the first time in human hearts, that the electrophysiological response to ischemia–reperfusion in heart failure is accelerated during ischemia with slower recovery after reperfusion. This can enhance spatial conduction and repolarization gradients across the ischemic border and increase arrhythmia susceptibility. This adverse response was associated with downregulation of expression of cardiac metabolic genes.
Examination of the Treatment Selection Process in a Multicenter Observational Study
Authors: Anstrom Kevin J. , Brennan J. Matthew , Eisenstein Eric L. , Federspiel Jerome J , Dai David , Peterson Eric D. , Douglas Pamela S.
Published: August 2014

Background—

Many multicenter clinical trials use permuted-block randomization to create balanced treatment allocations within clinical centers. Unlike randomized trials, observational studies do not control treatment allocation, and statistical models are used to adjust for measured confounders. For many observational data analyses, the variability in the treatment selection process within clinical centers is ignored. Furthermore, there is no consensus on the best approach for dealing with variability in the treatment selection process across clinical centers.

Methods and Results—

Individuals aged ≥65 years receiving either drug-eluting stents or bare metal stents were included. A cohort of 262 700 patients from 650 CathPCI Registry sites was followed up for a median of 15 months. Propensity score models were estimated to describe the process used to select drug-eluting stents across the study population. Substantial variability in the use of drug-eluting stents at the clinical center level was observed—even after accounting for differences in patient and clinical center characteristics. By refitting and matching propensity scores within clinical centers, a balanced cohort on treatment allocation and prognostic factors was obtained. This approach generated an estimated hazard ratio that was qualitatively similar to standard regression models and other propensity score approaches.

Conclusions—

Substantial variability in treatment selection existed between clinical centers. Matching recalibrated propensity scores within clinical centers has the potential to reduce a source of bias in multicenter observational studies. This methodology cannot eliminate all potential for biases; however, it removes the potential bias from site-level factors.
Early Pregnancy Prediction of Preeclampsia in Nulliparous Women, Combining Clinical Risk and Biomarkers
Authors: Kenny Louise C. , Black Michael A. , Poston Lucilla , Taylor Rennae , Myers Jenny E. , Baker Philip N. , McCowan Lesley M. , Simpson Nigel A.B. , Dekker Gus A. , Roberts Claire T. , Rodems Kelline , Noland Brian , Raymundo Michael , Walker James J. , North Robyn A.
Published: August 2014

More than half of all cases of preeclampsia occur in healthy first-time pregnant women. Our aim was to develop a method to predict those at risk by combining clinical factors and measurements of biomarkers in women recruited to the Screening for Pregnancy Endpoints (SCOPE) study of low-risk nulliparous women. Forty-seven biomarkers identified on the basis of (1) association with preeclampsia, (2) a biological role in placentation, or (3) a role in cellular mechanisms involved in the pathogenesis of preeclampsia were measured in plasma sampled at 14 to 16 weeks’ gestation from 5623 women. The cohort was randomly divided into training (n=3747) and validation (n=1876) cohorts. Preeclampsia developed in 278 (4.9%) women, of whom 28 (0.5%) developed early-onset preeclampsia. The final model for the prediction of preeclampsia included placental growth factor, mean arterial pressure, and body mass index at 14 to 16 weeks’ gestation, the consumption of ≥3 pieces of fruit per day, and mean uterine artery resistance index. The area under the receiver operator curve (95% confidence interval) for this model in training and validation cohorts was 0.73 (0.70–0.77) and 0.68 (0.63–0.74), respectively. A predictive model of early-onset preeclampsia included angiogenin/placental growth factor as a ratio, mean arterial pressure, any pregnancy loss <10 weeks, and mean uterine artery resistance index (area under the receiver operator curve [95% confidence interval] in training and validation cohorts, 0.89 [0.78–1.0] and 0.78 [0.58–0.99], respectively). Neither model included pregnancy-associated plasma protein A, previously reported to predict preeclampsia in populations of mixed parity and risk. In nulliparous women, combining multiple biomarkers and clinical data provided modest prediction of preeclampsia.
Plasma Magnesium and Risk of Ischemic Stroke Among Women
Authors: Adebamowo Sally N. , Jiménez Monik C. , Chiuve Stephanie E. , Spiegelman Donna , Willett Walter C. , Rexrode Kathryn M.
Published: August 2014

Background and Purpose—

Lower plasma magnesium levels may be associated with higher blood pressure and endothelial dysfunction, but sparse prospective data are available for stroke.

Methods—

Among 32 826 participants in the Nurses’ Health Study who provided blood samples in 1989 to 1990, incident ischemic strokes were identified and confirmed by medical records through 2006. We conducted a nested case–control analysis of 459 cases, matched 1:1 to controls on age, race/ethnicity, smoking status, date of blood draw, fasting status, menopausal status, and hormone use. We used conditional logistic regression models to estimate the multivariable adjusted association of plasma magnesium and the risk of ischemic stroke and ischemic stroke subtypes.

Results—

Median magnesium levels did not differ between ischemic stroke cases and controls (median, 0.86 mmol/L for both;
P
=0.14). Conditional on matching factors, women in the lowest magnesium quintile had a relative risk of 1.34 (95% confidence interval, 0.86–2.10;
P
trend=0.13) for total ischemic stroke compared with women in the highest quintile. Additional adjustment for risk factors and confounders did not substantially alter the risk estimates for total ischemic stroke. Women with magnesium levels <0.82 mmol/L had significantly greater risk of total ischemic stroke (multivariable relative risk, 1.57; 95% confidence interval, 1.09–2.27;
P
=0.01) and thrombotic stroke (multivariable relative risk, 1.66; 95% confidence interval, 1.03–2.65;
P
=0.03) compared with women with magnesium levels ≥0.82 mmol/L. No significant effect modification was observed by age, body mass index, hypertension, or diabetes mellitus.

Conclusions—

Lower plasma magnesium levels may contribute to higher risk of ischemic stroke among women.
Effects of Surgical Revascularization on Cerebral Oxygen Metabolism in Patients With Moyamoya Disease
Authors: Kuroda Satoshi , Kashiwazaki Daina , Hirata Kenji , Shiga Tohru , Houkin Kiyohiro , Tamaki Nagara
Published: August 2014

Background and Purpose—

This prospective study was aimed to evaluate the effects of surgical revascularization on cerebral oxygen metabolism in moyamoya disease.

Methods—

This study included totally 69 hemispheres of 42 patients who underwent superficial temporal artery to middle cerebral artery anastomosis and indirect bypass for moyamoya disease between 2000 and 2011. There were 12 children and 30 adults. MRI and
15
O-gas positron emission tomography were performed before and 3 to 4 months after surgery. Hemodynamic and metabolic parameters were precisely quantified and statistically analyzed.

Results—

Preoperative positron emission tomographic scans revealed that cerebral blood flow was decreased, cerebral blood volume was increased, and cerebral metabolic rate for oxygen was decreased in both pediatric and adult patients. Cerebral metabolic rate for oxygen reduction was observed in ≈80% of pediatric (16/21; 76%) and adult hemispheres (38/48; 79%). Surgical revascularization resolved hemodynamic compromise in all operated hemispheres. Cerebral metabolic rate for oxygen significantly improved in pediatric patients without parenchymal lesions (n=8), but not those with parenchymal lesions (n=8). Multivariate analysis revealed that cerebral metabolic rate for oxygen significantly improved in younger adult patients without parenchymal lesions (
P
=0.0264; odds ratio, 0.88; 95% confidence interval, 0.79–0.99).

Conclusions—

Cerebral oxygen metabolism is significantly depressed in ≈80% of the involved hemispheres of moyamoya disease and improves in pediatric and younger adult patients without parenchymal lesions after bypass surgery. Cerebral oxygen metabolism may be reversibly depressed in response to cerebral ischemia in them although the underlying mechanisms are still unclear.
Between History, Memory, and Law: Courtroom Methods in Mexico
Authors: Megged Amos
Published: August 2014

A deep reading of testimony delivered at the Spanish colonial court of the Audiencia uncovers distinctive speech formulas, nonverbal cues, and conceptual constructs that throw light on the intentions and goals, as well as the cultural predispositions, of communities and individuals. Historians can employ a similar methodology to derive patterns of “cognitive schemata” from testimony in other legal settings of the early modern era.
Ideal Types and Negotiated Identities: A Comparative Approach to the City-State
Authors: Martoccio Michael Paul
Published: August 2014

Historians often leave the comparative analysis of the city-state in Europe to their colleagues in political science and sociology. But two recent volumes—Scott, The City-State in Europe, and Gamberini and Lazzarini (eds.), The Italian Renaissance State—address a number of traditional assumptions about the differences between Italian and transalpine cities and the differences between princely and republican regimes. Both volumes show how historians can make a valuable interdisciplinary contribution to comparative analysis by paying attention to diverse historical trajectories and contingencies—along the way revealing the resilience of urban forms of political life long thought to have declined with the rise of the territorial state.
The Ebb and Flow of the Foreign-Born: Changing Conditions for Collective Identities
Authors: Ueda Reed
Published: August 2014

Winders’ Nashville in the New Millennium is a study of the local effects of the new immigration in areas that had historically experienced a paucity of immigrants and international culture. By employing a methodology based on participant observation, personal interviews, and oral histories, Winders demonstrates that a surge of immigrants in a local community can produce a complex challenge to epistemologies of collective identity based on historically entrenched ethnic categories and popular memories. Her research is a fresh addition to a field of scholarship that has produced illuminating interdisciplinary studies about the effects of the changing flows of immigrants on communities, generations, and minority groups.
Three new species of Crinipellis and one new variety of Moniliophthora (Basidiomycota, Marasmiaceae) described from the Republic of Korea
Authors: ANTONÍN VLADIMÍR , RYOO RHIM , KA KANG-HYEON , SOU HONG-DUCK
Published: August 2014

Three new species of Crinipellis (Basidiomycota, Marasmiaceae), and one new variety of Moniliophthora are described from the Republic of Korea. Crinipellis birhizomorpha is characterized as having a short stipe arising from both substrate and rhizomorphs, and as forming rhizomorphs of two types, one forming abortive pilei; C. pallidipilus has golden brown, then distinctly pallescent pileus hairs, very long, hairy rhizomorphs of one type, and rather wide basidiospores in comparison with other species described here; and C. wandoensis has a brown to dark brown pileus, hairy rhizomorphs of one type, and both non-dextrinoid and slightly dextrinoid basidiospores. A new combination, Moniliophthora conchata is proposed. A new variety, Moniliophthora conchata var. brevispora differs from the type variety in having smaller basidiospores. Their detailed macro- and microscopic descriptions are given, and their taxonomic positions were confirmed using DNA studies. A key to the identification of Crinipellis and Moniliophthora taxa recorded in this country is also provided.
Recognition of two morpho-types in eastern South American brackens (Pteridium—Dennstaedtiaceae—Polypodiopsida)
Authors: SCHWARTSBURD PEDRO B. , DE MORAES PEDRO L. R. , LOPES-MATTOS KARINA L. B.
Published: August 2014

In this work we propose the recognition of two well defined morpho-types of Pteridium from eastern South America: P. arachnoideum subsp. arachnoideum s. str., wide-spread from north-eastern Brazil southwards to north-eastern Argentina and Uruguay, and P. arachnoideum subsp. campestre, comb. et stat. nov., endemic to north-eastern Brazil. Inevitably, we propose a narrower circumscription for P. arachnoideum subsp. arachnoideum, being restricted to eastern South America and characterized by free lobes between the distal segments, veins abaxially lanose with lax arachnoid hairs, and laminar tissue between the veins abaxially without farinose appearance, glabrous and visible (total absence of gnarled hairs). This morphological pattern is constant and stable in all 191 specimens studied (including living specimens), and geographically related. Plants from western South America and Central America, previously ascribed to P. arachnoideum s.l., shall be better reclassified into at least one other subspecies—for which no published name is current available. This is morphologically distinct and geographically segregated from P. arachnoideum subsp. arachnoideum s. str. by the South American Dry Diagonal. Based on stomatal guard-cells length, the two morpho-types from eastern South America are presumably diploid. We provide lectotypifications for the two taxa, complete and new synonymies, descriptions, illustrations, light microscopy images, distribution maps, and detailed information about the Pteridium specimens gathered in Brazil by Maximilian, the Prince of Wied, in the early 19th Century. We also indicate overlooked morphological characteristics with taxonomical value within the genus.
A new paludicolous species of Malaxis (Orchidaceae) from Argentina and Uruguay
Authors: Salazar JOSÉ RADINS , SALAZAR GERARDO A. , CABRERA LIDIA I. , JIMÉNEZ-MACHORRO ROLANDO , BATISTA JOÃO A. N.
Published: August 2014

Malaxis irmae, a new orchid species from the Paraná and Uruguay river basins in northeast Argentina and Uruguay, is described and illustrated. It is similar in size and overall floral morphology to Malaxis cipoensis, a species endemic to upland rocky fields on the Espinhaço range in Southeastern Brazil, which is its closest relative according to a cladistics analysis of nuclear (ITS) and plastid (matK) DNA sequences presented here. However, M. irmae is distinguished from M. cipoensis by inhabiting lowland marshy grasslands, possessing 3−5 long-petiolate leaves per shoot (vs. 2 shortly petiolate leaves), cylindrical raceme (vs. corymbose), pale green flowers (vs. green-orange flowers) and less prominent basal labellum lobules. Malaxis irmae is morphologically also similar to the Brazilian M. warmingii, which differs in its much larger plants and prominent basal labellum lobes.
Poculum pseudosydowianum, sp. nov. (Rutstroemiaceae, Ascomycota) from Japan and its endophytic occurrence
Authors: Hosoya Tsuyoshi , Zhao Yan-Jie , Degawa Yousuke
Published: August 2014

Sequences of several isolates obtained from fresh leaves of Quercus crispula in Japan showed high similarity with those of Poculum sydowianum in NCBI. Apothecia of P. sydowianum-like fungus were found from Q. cripula leaves as a result of field survey. A detailed morphological examination elucidated the difference between P. sydowianum and this fungus, including the remarkable pigmentation prior to the ascospore germination. Sequences obtained from isolates from Q. crispula leaves, those from ascosporous isolates, and those from isolates of P. sydowianum preserved in CBS was compared. The ITS sequences were almost identical within the Japanese isolates and European isolates, respectively, but differed up to 10% between the groups, supporting that they belong to different species. A new species P. pseudosydowianum is described.
Studies on Wrightoporia from China 3. Wrightoporia subavellanea sp. nov. based on morphological characters and rDNA sequence data
Authors: CHEN JIA-JIA , Cui Bao-Kai
Published: August 2014

Wrightoporia subavellanea sp. nov. is described and illustrated from southern China on the basis of morphological characters and molecular data. It is characterized by an annual growth habit, resupinate basidiocarps with white rhizomorphs, large pores, narrow and strongly dextrinoid skeletal hyphae, broadly ellipsoid to subglobose, thick-walled, finely asperulate and strongly amyloid basidiospores (3.8–4.2 × 2.8–3.2 µm), and presence of gloeoplerous hyphae in trama. A molecular study based the combined ITS (internal transcribed spacer region) and nLSU (the large nuclear ribosomal RNA subunit) dataset supported the position of the new species in Wrightoporia. A key to accepted species of Wrightoporia in China is provided.
Comments on the priority of Fryxelliella paciﬁca over Fryxelliella sepulvedana (Eupodiscaceae, Bacillariophyta)
Authors: Hernández-Becerril David U. , Barón-Campis Sofía A.
Published: August 2014

In 2008 two new species of the diatom genus Fryxelliella A.K.S. Prasad, Riddle et Livingston (1997: 306) were independently described from the tropical Mexican Pacific Ocean: Fryxelliella pacifica Hernández-Becerril et Barón-Campis (Hernández-Becerril & Barón-Campis 2008: 150) and F. sepulvedana Meave, Zamudio et Fernandes (Meave et al. 2008: 179). The types of both species were collected at Salina Cruz, Oaxaca, Mexico.
Revision of the Oriental genus Horniella Raffray (Coleoptera, Staphylinidae, Pselaphinae)
Authors: YIN ZI-WEI , LI LI-ZHEN
Published: August 2014

The Oriental pselaphine genus Horniella Raffray, 1905 (tribe Tyrini: subtribe Somatipionina) is redefined and revised. Twenty-five new species are described: H. centralis Yin & Li, sp. n., H. confragosa Yin & Li, sp. n., H. dao Yin & Li, sp. n., H. hongkongensis Yin & Li, sp. n., H. nakhi Yin & Li, sp. n., H. schuelkei Yin & Li, sp. n., H. sichuanica Yin & Li, sp. n., H. simplaria Yin & Li, sp. n., and H. tianmuensis Yin & Li, sp. n. from China, H. himalayica Yin & Li, sp. n. from Nepal and North India, H. asymmetrica Yin & Li, sp. n., H. burckhardti Yin & Li, sp. n., H. intricata Yin & Li, sp. n., H. kaengkrachan Yin & Li, sp. n., H. khaosabap Yin & Li, sp. n., H. loebli Yin & Li, sp. n., H. phuphaman Yin & Li, sp. n., H. prolixo Yin & Li, sp. n., and H. schwendingeri Yin & Li, sp. n. from Thailand, H. philippina Yin & Li, sp. n. from the Philippines, H. awana Yin & Li, sp. n., H. gigas Yin & Li, sp. n., H. pilosa Yin & Li, sp. n., and H. smetanai Yin & Li, sp. n. from Malaysia, and H. cibodas Yin & Li, sp. n. from Indonesia. The two previously described species, H. hirtella Raffray, 1901 (type species) from Sri Lanka and H. falcis Yin & Li, 2010 from China are redescribed, and a lectotype is designated for H. hirtella. Illustrations of habitus and important diagnostic features, an identification key, and distributional maps for all species are provided. Eleven unidentified species represented only by females are left unnamed. Illustrations of the habitus and the genital complex, and label data of these species are given to facilitate future study. All available data indicates that species of Horniella typically inhabit leaf litter of various kinds of forests, and can be most efficiently collected by sifting and use of Winkler-Moczarski extractors.
New species and new records of hydroids (Cnidaria: Hydrozoa) from Chile
Authors: GALEA HORIA R. , SCHORIES DIRK , FÖRSTERRA GÜNTER , HÄUSSERMANN VERENA
Published: August 2014

A large collection of shallow-water hydroids from various Chilean provinces, ranging from Taltal (25° S) in the North, to the Strait of Magellan (53° S) in the South, was studied, and a total of 30 species are discussed in the present report. Of these, eleven are new to science: Candelabrum valdiviensis, Halecium erratum, H. humeriformis, H. maximum, H. modestum, H. platythecum, Hydrodendron chilense, Sertularella asymmetra, S. curta, S. pauciramosa, and Symplectoscyphus semper. The nominal species Halecium flexile Allman, 1888, included for many decades in the synonymy of H. delicatulum Coughtrey, 1876, is resurrected based on distinctive features displayed by its newly discovered female gonothecae. A thorough discussion is provided on several morphologically related species of the genus from various localities around the world, and data on the nematocyst complement are emphasized, allowing the distinction of an as yet undescribed species, H. tristaniensis, from Tristan da Cunha, South Atlantic, and the resurrection of H. balei Fraser, 1911 from southern Australia. Halecium tehuelchum (d’Orbigny, 1842), a poorly known species considered as of doubtful validity, is redescribed based on fertile material of both sexes. A discussion on the taxonomy of several members of the genus Hydrodendron Hincks, 1874, including the first comprehensive account of their cnidome, is provided. The male and female gonothecae of Halopteris plumosa Galea & Schories, 2012 are described for the first time. A discussion on the genus Silicularia Meyen, 1834 is provided, and three subantarctic species are provisionally recognized based on the material in hand, viz. S. bilabiata (Coughtrey, 1875), S. rosea Meyen, 1834, and S. hemisphaerica (Allman, 1888). Four hydroids are new records for Chile: Halecium corrugatissimum Trebilcock, 1928, Parascyphus simplex (Lamouroux, 1816), Symplectoscyphus unilateralis (Lamouroux, 1824), and Aglaophenia divaricata Busk, 1852, the last two being accompanied by comments on their synonymy. Two additional hydroids are only tentatively identified, viz. Hebella cf. scandens (Bale, 1888) and the allusive benthic stage of Phialella falklandica (Browne, 1902).
Key to Chinese species of the leafhopper genus Drabescus (Hemiptera: Cicadellidae: Deltocephalinae) with description of a new species
Authors: SHANG SUQIN , WEBB M. D. , ZHANG YALIN
Published: August 2014

A new species, Drabescus quadrispinosus sp. nov., is described and illustrated. A checklist to the Chinese species of Drabescus is given and a key provided for identification of males. Specimens tentatively identified as D. ineffectus (Walker) from China are discussed and figured.
Energetics of Multidecadal Atlantic Ocean Variability
Authors: Dijkstra Henk A. , Saenz Juan A. , McC. Hogg Andrew
Published: August 2014

Oscillatory behavior of the Atlantic meridional overturning circulation (MOC) is thought to underlie Atlantic multidecadal climate variability. While the energy sources and sinks driving the mean MOC have received intense scrutiny over the last decade, the governing energetics of the modes of variability of the MOC have not been addressed to the same degree. This paper examines the energy conversion processes associated with this variability in an idealized North Atlantic Ocean model. In this model, the multidecadal variability arises through an instability associated with a so-called thermal Rossby mode, which involves westward propagation of temperature anomalies. Applying the available potential energy (APE) framework from stratified turbulence to the idealized ocean model simulations, the authors study the multidecadal variability from an energetics viewpoint. The analysis explains how the propagation of the temperature anomalies leads to changes in APE, which are subsequently converted into the kinetic energy changes associated with variations in the MOC. Thus, changes in the rate of generation of APE by surface buoyancy forcing provide the kinetic energy to sustain the multidecadal mode of variability.
Alteration of Conserved Alternative Splicing in AMELX Causes Enamel Defects
Authors: Cho E.S. , Kim K.-J. , Lee K.-E. , Lee E.-J. , Yun C.Y. , Lee M.-J. , Shin T.J. , Hyun H.-K. , Kim Y.-J. , Lee S.-H. , Jung H.-S. , Lee Z.H. , Kim J.-W.
Published: August 2014

Tooth enamel is the most highly mineralized tissue in vertebrates. Enamel crystal formation and elongation should be well controlled to achieve an exceptional hardness and a compact microstructure. Enamel matrix calcification occurs with several matrix proteins, such as amelogenin, enamelin, and ameloblastin. Among them, amelogenin is the most abundant enamel matrix protein, and multiple isoforms resulting from extensive but well-conserved alternative splicing and postsecretional processing have been identified. In this report, we recruited a family with a unique enamel defect and identified a silent mutation in exon 4 of the AMELX gene. We show that the mutation caused the inclusion of exon 4, which is almost always skipped, in the mRNA transcript. We further show, by generating and characterizing a transgenic animal model, that the alteration of the ratio and quantity of the developmentally conserved alternative splicing repertoire of AMELX caused defects in enamel matrix mineralization.
Effect of multilevel laboratory rat caging system on the well-being of the singly-housed Sprague Dawley rat
Authors: Wheeler R R , Swan M P , Hickman D L
Published: August 2014

Current regulations emphasize that good husbandry practices allow animals to engage in species appropriate postural adjustments without touching the enclosure walls. This study evaluated the well-being of rats housed in a commercially available multilevel rat caging system, with or without access to the upper level of the caging. The evaluation methodologies included assessment of behavioral observations in the home cage, physiological assessment of metabolism and immune function, and determination of the affective state using a spatial cognitive bias assay. The study determined that rats that were provided access to the full multilevel cage during testing after initial restriction to the lower level of the cage demonstrated behavioral changes consistent with a positive affective state, while those with no changes to their housing situation had no significant differences in their affective states. Rats that were consistently housed with access restricted to the lower level of the cage exhibited a tendency to increased neutrophil:lymphocyte ratios as compared with those provided with access to all levels of the multilevel cage. There were no differences in body weight demonstrated between the experimental groups. Overall use of the cage space, as documented through analysis of behavioral observations in the home cage, demonstrated no significant differences in preferred location in the cage during the light or dark cycles, though rats with access to both levels of the cage were significantly more active during the light cycle. The results of this study suggest that the use of a multilevel caging system may improve the well-being of rats used in research.
In Vivo Application of Short-Lag Spatial Coherence and Harmonic Spatial Coherence Imaging in Fetal Ultrasound
Authors: Kakkad Vaibhav , Dahl Jeremy , Ellestad Sarah , Trahey Gregg
Published: August 2014

Fetal scanning is one of the most common applications of ultrasound imaging and serves as a source of vital information about maternal and fetal health. Visualization of clinically relevant structures, however, can be severely compromised in difficult-to-image patients due to poor resolution and the presence of high levels of acoustical noise or clutter. We have developed novel coherence-based beamforming methods called Short-Lag Spatial Coherence (SLSC) imaging and Harmonic Spatial Coherence imaging (HSCI), and applied them to suppress the effects of clutter in fetal imaging. This method is used to create images of the spatial coherence of the backscattered ultrasound as opposed to images of echo magnitude. We present the results of a patient study to assess the benefits of coherence-based beamforming in the context of first trimester fetal exams. Matched fundamental B-mode, SLSC, harmonic B-mode, and HSCI images were generated using raw radio frequency data collected on 11 volunteers in the first trimester of pregnancy. The images were compared for qualitative differences in image texture and target conspicuity as well as using quantitative imaging metrics such as signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and contrast. SLSC and HSCI showed statistically significant improvements across all imaging metrics compared with B-mode and harmonic B-mode, respectively. These improvements were greatest for poor quality B-mode images where contrast of anechoic targets was improved from 15 dB in fundamental B-mode to 27 dB in SLSC and 17 dB in harmonic B-mode to 30 dB in HSCI. CNR improved from 1.4 to 2.5 in the fundamental images and 1.4 to 3.1 in the harmonic case. These results exhibit the potential of coherence-based beamforming to improve image quality and target detectability, especially in high noise environments.
Choice, blind spots and free will
Authors: Devellennes Charles
Published: August 2014

This article shows that the concept of choice is central to Isaiah Berlin’s liberalism. It argues that his valuing of choice is anchored in a particular conception of human nature, one that assumes and presupposes free will. Berlin’s works sketch a metaphysics of choice, and his reluctance to situate himself openly in the debate on free will is unconvincing. By introducing the theory of autopoiesis, this article further suggests that there is a way to take Berlin’s value pluralism seriously, by considering sets of values as autopoietic conscious systems. Drawing on the works of Maturana and Varela in biology and Luhmann in sociology, autopoiesis strengthens value pluralism and acts as a critique of liberalism. By putting objectivity in parenthesis, autopoiesis finally allows for value systems to coexist side by side in a stronger sense than Berlin’s liberalism ever could.
Factors Associated With Hospitalizations Among HIV-Infected Adults in the United States
Authors: Price Valisha , Swanson Barbara , Phillips Janice , Swartwout Kathryn , Fog Louis , Jegier Briana
Published: August 2014

Although improving health outcomes in human immunodeficiency virus (HIV)-infected persons has been identified as a national priority, little is known about the factors associated with hospitalizations of HIV-infected persons in the highly active antiretroviral therapy (HAART) era. Since the introduction of HAART in 1996, there has been a dramatic increase in the life expectancy of HIV-infected persons. However, aging and the long term use of HIV medications have led to an increased incidence of chronic, non-HIV-related illnesses. To improve patient outcomes, the factors that contribute to co-morbidities in HIV-infected persons need to be identified. As a first step, we will summarize the current literature on causes and contributing factors of hospitalizations in adults infected with HIV in the HAART era.
What is customary about customary care? How Dutch welfare policy defines what citizens have to consider ‘normal’ care at home
Authors: Grootegoed Ellen , Van Barneveld Eva , Duyvendak Jan Willem
Published: August 2014

In most welfare states, home care for elderly and disabled persons relies on a combination of private and public responsibilities, with gatekeepers adjudicating access to publicly funded care. Unlike other governments, the Dutch government has codified an explicit ‘customary care principle’ that defines the ‘normal daily care that partners, parents, co-resident children or other household members are supposed to offer each other’ (CIZ, 2013a) to calculate entitlements to publicly funded care. But the norms set by the Dutch government do not always mirror what citizens consider normal. Using national statistics and interviews with family care-givers, care recipients and assessors, we find that while the norm of customary care can sometimes protect citizens from taking on too much responsibility, it has an enforcing element for many others who do not agree with its norms. We discuss the implications of this coercive element for principles of equality, particularly in times of austerity.
Acoustic reflectors are visible in the right heart during radiofrequency ablation of varicose veins
Authors: Sounderajah V , Moore HM , Thapar A , Lane TRA , Fox K , Franklin IJ , Davies AH
Published: August 2014

Objective

Cerebrovascular events have been noted after foam sclerotherapy for varicose veins. One hypothesis is migration of microemboli to the brain through a cardiac septal defect. The aim of this study was to identify whether acoustic reflectors are found in the right side of the heart during radiofrequency ablation of varicose veins, as neurological events are not reported during these procedures.

Methods

Transthoracic echocardiography was performed during local anaesthetic radiofrequency ablation (VNUS ClosureFast) of the great saphenous vein in 14 patients. An apical view was captured at the start of the procedure, during each cycle of heating and at 1 min post-treatment. Patients were monitored for 1 h. Video loops were read by an independent cardiologist. The presence of acoustic reflectors was classified as: 0 = absent, 1 = occasional, 2 = stream, 3 = complete opacification.

Results

Loops were of diagnostic quality in 11/14 (79%) patients. After the second cycle of heating, acoustic reflectors moving through the right heart were seen in 5/11 (45%) patients. These were classified as grade 1 in four patients and grade 2 in one patient. No acoustic reflectors were seen in the left heart. No neurological symptoms were reported.

Conclusion

Acoustic reflectors in the right heart are a common finding during radiofrequency ablation of varicose veins. Considering the prevalence of cardiac septal defects (17%), more neurological events would be expected if these particles were indeed responsible for these events. Further work is required to elicit the mechanisms underlying neurological complications following sclerotherapy.
What is the incidence of patients with palliative care needs presenting to the Emergency Department? A critical review
Authors: Wong Joanne , Gott Merryn , Frey Rosemary , Jull Andrew
Published: August 2014

Background:

Given the context of ageing populations globally, there are a growing number of patients with chronic conditions, some of whom are in the final stages of their disease trajectory, presenting to Emergency Departments.

Aim:

The aim was to estimate the incidence of patients with palliative care needs presenting to the department.

Methods:

Three databases (MEDLINE, CINAHL and Embase) were systematically searched up to August 2012. The reference lists of included articles were searched as well as Google and Google Scholar. Only studies in English were included. Two reviewers independently reviewed studies at the abstract and full-body stages. A critical review using systematic methods was undertaken as statistical analysis could not be done because of a lack of information.

Results:

Only 10 of 1427 identified records met the inclusion criteria. Different definitions of palliative care were evident. One article provided an incidence density for patients with non-small cell lung cancer, and we calculated the mean presentations to be 52.5 per 100 person-months. Two articles focussed on patients known to palliative care services; we estimated that 2.5 in 1000 Emergency Department visits were made by these patients. The review demonstrated that the studies were so different it was not possible to compare the data.

Conclusion:

There is an absence of evidence regarding the incidence of patients with palliative care needs presenting to the Emergency Department. Further research needs to be undertaken in this area to ensure both clinicians and policymakers have sufficient information for service provision.
An Agent-based Simulation Model for Clostridium difficile Infection Control
Authors: Codella James , Safdar Nasia , Heffernan Rick , Alagoz Oguzhan
Published: August 2014

Background. Control of Clostridium difficile infection (CDI) is an increasingly difficult problem for health care institutions. There are commonly recommended strategies to combat CDI transmission, such as oral vancomycin for CDI treatment, increased hand hygiene with soap and water for health care workers, daily environmental disinfection of infected patient rooms, and contact isolation of diseased patients. However, the efficacy of these strategies, particularly for endemic CDI, has not been well studied. The objective of this research is to develop a valid, agent-based simulation model (ABM) to study C. difficile transmission and control in a midsized hospital. Methods. We develop an ABM of a midsized hospital with agents such as patients, health care workers, and visitors. We model the natural progression of CDI in a patient using a Markov chain and the transmission of CDI through agent and environmental interactions. We derive input parameters from aggregate patient data from the 2007–2010 Wisconsin Hospital Association and published medical literature. We define a calibration process, which we use to estimate transition probabilities of the Markov model by comparing simulation results to benchmark values found in published literature. Results. In a comparison of CDI control strategies implemented individually, routine bleach disinfection of CDI-positive patient rooms provides the largest reduction in nosocomial asymptomatic colonization (21.8%) and nosocomial CDIs (42.8%). Additionally, vancomycin treatment provides the largest reduction in relapse CDIs (41.9%), CDI-related mortalities (68.5%), and total patient length of stay (21.6%). Conclusion. We develop a generalized ABM for CDI control that can be customized and further expanded to specific institutions and/or scenarios. Additionally, we estimate transition probabilities for a Markov model of natural CDI progression in a patient through calibration.
STAR—People-Powered Prioritization
Authors: Airoldi Mara , Morton Alec , Smith Jenifer A. E. , Bevan Gwyn
Published: August 2014

The aim of cost effectiveness analysis (CEA) is to inform the allocation of scarce resources. CEA is routinely used in assessing the cost-effectiveness of specific health technologies by agencies such as the National Institute for Health and Clinical Excellence (NICE) in England and Wales. But there is extensive evidence that because of barriers of accessibility and acceptability, CEA has not been used by local health planners in their annual task of allocating fixed budgets to a wide range of types of health care. This paper argues that these planners can use Socio Technical Allocation of Resources (STAR) for that task. STAR builds on the principles of CEA and the practice of program budgeting and marginal analysis. STAR uses requisite models to assess the cost-effectiveness of all interventions considered for resource reallocation by explicitly applying the theory of health economics to evidence of scale, costs, and benefits, with deliberation facilitated through an interactive social process of engaging key stakeholders. In that social process, the stakeholders generate missing estimates of scale, costs, and benefits of the interventions; develop visual models of their relative cost-effectiveness; and interpret the results. We demonstrate the feasibility of STAR by showing how it was used by a local health planning agency of the English National Health Service, the Isle of Wight Primary Care Trust, to allocate a fixed budget in 2008 and 2009.
Low-dose CT for patients with clinically suspected acute appendicitis: optimal strength of sinogram affirmed iterative reconstruction for image quality and diagnostic performance
Authors: Kim Seung Ho , Yoon Jung-Hee , Lee Jang Hee , Lim Yun-Jung , Kim Ok Hwa , Ryu Ji Hwa , Son Jung-Hee
Published: August 2014

Background

As there is increased concern over the radiation exposure particularly in adolescents and young adults, computed tomography (CT) dose reduction is needed in the diagnosis of acute appendicitis.

Purpose

To evaluate the optimal strength of sinogram affirmed iterative reconstruction (SAFIRE) to obtain the best image quality on a 30-mAs applied low-dose CT (LDCT30mAs) and to compare the diagnostic performances of the LDCT30mAs with different SAFIRE strengths with that of the 100-mAs applied LDCT (LDCT100mAs) for the diagnosis of acute appendicitis.

Material and Methods

A total of 102 consecutive patients (47 men, 55 women; mean age, 41.2 years; range, 15–82 years) with right lower quadrant pain underwent abdominal-pelvic CT, consisting of arterial phase LDCT100mAs and portal venous phase LDCT30mAs under a fixed 120 kV. LDCT30mAs images were reconstructed separately with five strength levels (S1–S5). Two blinded radiologists recorded scores for the subjective image quality of the LDCT30mAs dataset (S0–S5) and confidence scores for the diagnosis of acute appendicitis on each dataset and LDCT100mAs. CT image noise was measured for each set.

Results

The study population consisted of 58 patients with confirmed appendicitis and 44 without appendicitis. There was no significant difference in diagnostic performance between LDCT100mAs and LDCT30mAs with any strength for both readers (AUC for reader 1, LDCT30mAs with S0–S5 = 0.97, LDCT100mAs = 0.93, P = 0.0936; for reader 2, LDCT30mAs with S0–S5 = 0.96, LDCT100mAs = 0.97, P = 0.128). The measured noise decreased as the strength increased from S0 to S5 (mean, 20.8 > 17.7 > 15.6 > 13.5 > 11.5 > 9.5, P < 0.0001). However, overall subjective image quality on S3 was better than the other strengths for both readers (S0 < S1 < S2 < S3 > S4 > S5, P < 0.0001).

Conclusion

Although measured noise declined as SAFIRE strength increased, S3 seems optimal for the best subjective image quality on LDCT30mAs. The diagnostic performance of LDCT30mAs with any strength is comparable to that of LDCT100mAs for the diagnosis of acute appendicitis.
Too Loud to Hear the Train! Noise Assessment, Implications, and Mitigation Strategies on Light Rail Platforms
Authors: Loukaitou-Sideris Anastasia , Schaffer Alexander
Published: August 2014

Transit planners often place light rail station platforms in the middle of freeways to avoid land acquisition costs and neighborhood opposition. However, waiting for the rail at these platforms is unpleasant and may present a health risk. The study measures, compares, and contrasts noise levels at such “freeway stations” with noise levels encountered at non-freeway stations. It identifies the factors contributing to noise in both types of stations and presents recommendations for quieter light rail station platforms.
Hypoglycaemic role of wheatgrass and its effect on carbohydrate metabolic enzymes in type II diabetic rats
Authors: Shakya Garima , Randhi Praveen Kumar , Pajaniradje Sankar , Mohankumar Kumaravel , Rajagopalan Rukkumani
Published: August 2014

Diabetes mellitus (DM) is a leading cause of morbidity and mortality in the world. Insulin resistance and insulin insufficiency is the major factor for the prognosis of type II diabetes. Consistent high glucose level leads to multiple secondary complications in diabetic patients. Hence, hypoglycaemic drugs are of significance for reducing the risk of secondary complications in type II diabetes. Various hypoglycaemic drugs are already available in the market, but they are associated with several side effects. Therefore, traditional herbs have emerged as safer alternative for effective hypoglycaemic treatment. The juvenile grass of common wheat is known as wheatgrass (WG). It is commonly used as a health drink and has potent antioxidant efficacy. It has been used to cure DM in folk medicine. The current study was planned to test the hypoglycaemic effect and pathways regulated by WG on DM. We analysed the glucose and insulin levels in plasma, the activity of glucose oxidative enzymes, hexokinase and glucose 6 phosphate dehydrogenase, in serum and glycogen levels in liver of the male albino Wistar rats. Activity of glucose oxidative enzymes and the levels of insulin and liver glycogen were decreased in rats with diabetes, but they were reversed on treatment with WG. Hence, we conclude that WG can act as a potent anti-hyperglycaemic agent.