bluuebunny/crossref_metadata_2025 huggingface dataset:
Australian diadromous fishes – challenges and solutions for understanding migrations in the 21st century
Authors: Miles N. G. , Walsh C.T. , Butler G. , Ueda H. , West R. J.
Published: October 2013

Diadromous fishes are a frequent but poorly understood component of coastal riverine fish communities in Australia. There are ~33 diadromous fishes found in Australian waters, mainly catadromous and amphidromous species. An extensive review of the literature identified major information gaps about the lifecycles and ecology of many of these species, with information on facultative diadromy, navigation, marine and early life stages being particularly limited. In many cases, this lack of information has led to poor management decisions and consequently many of the Australian diadromous species are under increasing threat from a range of environmental impacts. Much of the required information is difficult to obtain with traditional field surveys and, as a result, new and improved research tools and technologies, including telemetry, otolith chemistry, stable-isotope analysis (SIA) and functional magnetic resonance imaging (fMRI) are increasingly being applied. Key areas for research on Australian diadromous fishes should involve: (1) use of telemetry and otolith chemistry to determine the level of facultative diadromy and variation in diadromous movements across a species range; (2) use of otolith chemistry and SIA to gain a greater understanding of larval and juvenile marine life stages of catadromous and amphidromous species; and (3) use of fMRI or traditional techniques such as electroolfactogram (EOG) to determine the role of olfaction in spawning and migration, and the impact of impoundments and agricultural run-off on these critical life history stages.
The Roles of the Central Executive and Visuospatial Storage in Mental Arithmetic: A Comparison across Strategies
Authors: Hubber Paula J. , Gilmore Camilla , Cragg Lucy
Published: October 2013

Previous research has demonstrated that working memory plays an important role in arithmetic. Different arithmetical strategies rely on working memory to different extents—for example, verbal working memory has been found to be more important for procedural strategies, such as counting and decomposition, than for retrieval strategies. Surprisingly, given the close connection between spatial and mathematical skills, the role of visuospatial working memory has received less attention and is poorly understood. This study used a dual-task methodology to investigate the impact of a dynamic spatial n-back task (Experiment 1) and tasks loading the visuospatial sketchpad and central executive (Experiment 2) on adults’ use of counting, decomposition, and direct retrieval strategies for addition. While Experiment 1 suggested that visuospatial working memory plays an important role in arithmetic, especially when counting, the results of Experiment 2 suggested this was primarily due to the domain-general executive demands of the n-back task. Taken together, these results suggest that maintaining visuospatial information in mind is required when adults solve addition arithmetic problems by any strategy but the role of domain-general executive resources is much greater than that of the visuospatial sketchpad.
‘Intruders,’ ‘animal roots’ and ‘Mother Earth’: tracking the art complex in the work of Emily Carr
Authors: Fidyk Alexandra L.
Published: October 2013

In highlighting symbolic events in the life of Canadian artist Emily Carr – her loss, her growing pains, her joys and her achievements – a case is made for a transformative relationship with the art complex. These events are initially narrated providing a backdrop to the first half of her life. At age 56, however, she had a numinous encounter that symbolized the transition to the second half of life, ushering in a new relationship with an autonomous intruder. For the next decade, her psychological maturation was reflected in developing her own painting methods, writing, and a more conscious relationship to self. In tracking these events and her accompanying psychological states, feelings and emotions, there is support for Jung's claim that the only genuine cure for neurosis is to grow out of it by attending individuation and thus to embrace ‘the approach to the numinous’. For Carr, such experiences arose through her relationship with ‘Mother Earth’, with the wildness of the Canadian west coast.
Nutrient-sensing pathways and metabolic regulation in stem cells
Authors: Ochocki Joshua D. , Simon M. Celeste
Published: October 2013

Stem cells exert precise regulation to maintain a balance of self-renewal and differentiation programs to sustain tissue homeostasis throughout the life of an organism. Recent evidence suggests that this regulation is modulated, in part, via metabolic changes and modifications of nutrient-sensing pathways such as mTOR and AMPK. It is becoming increasingly clear that stem cells inhibit oxidative phosphorylation in favor of aerobic glycolysis for energy production. Recent progress has detailed the molecular mechanisms of this metabolic phenotype and has offered insight into new metabolic pathways that may be involved in stem cell homeostasis.
Whole-genome screening identifies proteins localized to distinct nuclear bodies
Authors: Fong Ka-wing , Li Yujing , Wang Wenqi , Ma Wenbin , Li Kunpeng , Qi Robert Z. , Liu Dan , Songyang Zhou , Chen Junjie
Published: October 2013

The nucleus is a unique organelle that contains essential genetic materials in chromosome territories. The interchromatin space is composed of nuclear subcompartments, which are defined by several distinctive nuclear bodies believed to be factories of DNA or RNA processing and sites of transcriptional and/or posttranscriptional regulation. In this paper, we performed a genome-wide microscopy-based screening for proteins that form nuclear foci and characterized their localizations using markers of known nuclear bodies. In total, we identified 325 proteins localized to distinct nuclear bodies, including nucleoli (148), promyelocytic leukemia nuclear bodies (38), nuclear speckles (27), paraspeckles (24), Cajal bodies (17), Sam68 nuclear bodies (5), Polycomb bodies (2), and uncharacterized nuclear bodies (64). Functional validation revealed several proteins potentially involved in the assembly of Cajal bodies and paraspeckles. Together, these data establish the first atlas of human proteins in different nuclear bodies and provide key information for research on nuclear bodies.
Ecological and evolutionary effects of harvesting: lessons from the candy-fish experiment
Authors: Diaz Pauli Beatriz , Heino Mikko
Published: October 2013

Diaz Pauli, B., and Heino, M. 2013. Ecological and evolutionary effects of harvesting: lessons from the candy-fish experiment. – ICES Journal of Marine Science, 70: . Understanding the challenges of sustainable fisheries management is not easy for non-specialists, and even many specialists fail to appreciate the potential evolutionary consequences of harvest. We propose candy-fish experiments as a savoury approach to teaching and disseminating the key principles of applied ecology and evolution to students, practitioners and the general public. We performed a simple experiment where the resource was represented by fish-shaped candy of distinct colours and flavours (strawberry and liquorice). Typically, harvesting was neither ecologically sustainable (55% of the populations were extinct by the end of the experiment) nor evolutionarily sustainable (most surviving populations had liquorice fish only). This harvest-induced evolution went apparently unnoticed. Somewhat encouragingly, the harvest was most likely ecologically sustainable when a person spontaneously took the role of a stock manager.
Assessment of Paraspinal Muscle Cross-sectional Area After Lumbar Decompression
Authors: Bresnahan Lacey E. , Smith Justin S. , Ogden Alfred T. , Quinn Steven , Cybulski George R. , Simonian Narina , Natarajan Raghu N. , Fessler Richard D. , Fessler Richard G.
Published: October 2013

Study Design:

A retrospective, blinded analysis of imaging studies.

Summary of Background Data:

To evaluate changes in paraspinal muscle cross-sectional area (CSA) after surgical treatment for lumbar stenosis and to compare these changes between minimally invasive and standard open approaches. The open approach to lumbar stenosis is effective, but it involves retraction and resection of muscle from the spinous process, which can result in ischemia and denervation of paraspinal musculature and may lead to muscle atrophy and pain.

Objective:

It is hypothesized that the microendoscopic decompression of stenosis (MEDS) technique will better preserve the paraspinal muscles compared with the open procedure.

Materials and Methods:

A total of 18 patients underwent a 1-level posterior decompression for lumbar stenosis, (9 open, 9 MEDS). Lumbar magnetic resonance imaging was obtained before surgery and after surgery (open approach average 16.3 mo; MEDS average 16.6 mo). CSA of paraspinal muscles were averaged over the distance of the surgical site.

Results:

The mean age of patients treated with the open and MEDS approaches were 55.2 and 66.4 years, respectively (P=0.07). Paraspinal muscle CSA decreased by an average of 5.4% (SD=10.6%; range, −24.5% to +7.7%) in patients treated with the open approach and increased by an average of 9.9% (SD=14.4%; range, −9.8% to +33.1%) in patients treated with MEDS (P=0.02). For the open approach, changes in CSA did not differ significantly between the left and right sides for erector spinae (P=0.35) or multifidus muscles (P=0.90). After the MEDS approach there were no significant differences between the dilated and contralateral sides with regard to change in CSA for erector spinae (P=0.85) or multifidus muscles (P=0.95).

Conclusions:

Compared with the open approach for lumbar stenosis, MEDS had significantly less negative impact on the paraspinal muscle CSA. Previous reports have documented negative effects of paraspinal muscle injury, including weakness, disability, and pain. Collectively, these data suggest that the MEDS approach for lumbar decompression is less destructive to the paraspinous muscles than the open approach and may facilitate better clinical outcomes.
Toilet Refusal Syndrome in Preschool Children
Authors: Niemczyk Justine , Equit Monika , El Khatib Diana , von Gontard Alexander
Published: October 2013

Objectives:

Toilet refusal syndrome (TRS) is a common, benign disorder in toddlers defined by the use of diapers and refusal of toilet for defaecation, but has not been described systematically in preschool children yet. The aim of the study was to analyse and identify possible subgroups of TRS.

Methods:

Retrospective analysis of all of the consecutive children with TRS presented as outpatients in a clinic for elimination disorders. Patients had received a detailed paediatric and child psychiatric assessment, including the Child Behavior Checklist questionnaire. Three typical case vignettes are presented of TRS with constipation, oppositional defiant disorder, and sibling rivalry.

Results:

Twenty‐five children (10 boys) with a mean age of 5.2 (3.4–7.3) years were included—representing 2.5% of all of the children (n = 1001) presented. They had high rates of constipation (60%) and elimination disorders (24%–44%). Child psychiatric International Classification of Diseases‐10th Edition disorders were common (40%) and heterogeneous, with significantly more boys affected, but no differences between children with and without constipation.

Conclusions:

This study shows that TRS occurs also in older preschool (and even school) children. At this later age, it is associated with constipation and behavioural disorders. The case vignettes show differences in therapy and may represent different subgroups of TRS. TRS is associated with constipation, elimination disorders, and psychiatric disorders. Owing to this variety of comorbid disorders, different therapeutic approaches are needed. A general screening for behavioural symptoms is recommended.
Implementing mixed methods research in supply chain management
Authors: Golicic Susan L. , Davis Donna F.
Published: October 2013

Purpose

The purpose of this paper is to describe how to implement mixed methods research in supply chain management.

Design/methodology/approach

A review of past journal analyses on research methods used in supply chain management‐related disciplines is conducted to demonstrate the low incidence of mixed methods research in supply chain management. Drawing from literature on multiple and mixed methods research, the paper provides guidelines for designing and reporting such studies.

Findings

Knowledge development in logistics and supply chain management relies primarily on single‐method quantitative research designs, while mixed methods approaches are rarely used. Thus, there is a significant opportunity to advance the discipline through the rigorous application of mixed methods research.

Research limitations/implications

Supply chain management phenomena are complex and dynamic. Thus, the application of mixed methods research would serve the advancement of the discipline as these approaches provide richer understanding and more robust explanations of such phenomena.

Practical implications

If supply chain research is to keep up with the dynamic business environment, research methods must be applied with the capability to fully explain supply chain phenomena. The application of a single‐method research approach is not always adequate for this task.

Originality/value

This paper is the first to draw on research from various disciplines to investigate the use of mixed methods in logistics and supply chain management research. It examines its prevalence in the discipline, provides examples of its application from the supply chain management literature, prescribes how to implement mixed methods research, and describes the benefits and limitations of such designs.
Moving beyond the systems approach in SCM and logistics research
Authors: Nilsson Fredrik , Gammelgaard Britta
Published: October 2013

Purpose

The purpose of this paper is to provide a paradigmatic reflection on theoretical approaches recently identified in logistics and supply chain management (SCM); namely complex adaptive systems and complexity thinking, and to compare it to the dominant approach in logistics and SCM research, namely the systems approach. By analyzing the basic assumptions of the three approaches, SCM and logistics researchers are guided in their choice of research approaches which increases their awareness of the consequences different approaches have on theory and practice.

Design/methodology/approach

The point of departure for the research presented is conceptualization based on literature reviews. Furthermore, years of observations, discussions and empirical studies of logistics operations and management have also influenced the design of this research.

Findings

With a discourse set in relation to the dominant approach in SCM and logistics research, the systems approach, it is concluded that the underlying assumptions of complex adaptive systems and complexity thinking are more appropriate than systems approach for contemporary challenges of organizational complexity in SCM and logistics. It is found that the two complexity‐based approaches can advance SCM and logistics research and practice especially when focusing on innovation, learning and sense‐making.

Research limitations/implications

Reflections of underlying assumptions when considering and selecting methodological approaches have implications for research results. This paper provides both a framework for and an analysis of such reflection which contributes to the further development of SCM and logistics research. Future research is needed to empirically provide insights on how complexity approaches can advance the area of SCM and logistics.

Practical implications

For logistics researchers and practitioners dealing with creativity, innovation, learning and sense‐making and other human‐related aspects, the complexity approaches, with underlying assumptions, presented will provide reflection, inspiration and guidance for further development.

Originality/value

This paper contributes to the further development of SCM and logistics research and practice by providing a reflective analysis and discussion of established and new research approaches with potential benefits for the SCM and logistics community.
Using the “documentary method” to analyse qualitative data in logistics research
Authors: Trautrims Alexander , Grant David B. , Cunliffe Ann L. , Wong Chee
Published: October 2013

Purpose

This paper aims to examine the use of a qualitative data analysis technique, the documentary method, in the development of knowledge in logistics. The value of the method is illustrated through an example of its application in a study of in‐store logistics processes at six leading European retail stores.

Design/methodology/approach

Extant literature is outlined regarding philosophical underpinnings of the documentary method and is followed by an explanation of the method and its application. Finally, an illustration is provided of its adaptation and use in a logistics research project.

Findings

Drawing on a social constructionist approach, the documentary method can add to the development of logistics research by providing rich descriptions of actual practice, problems and issues in logistic processes – compared with the stated goals of such processes.

Research limitations/implications

The documentary method is not suitable for all areas of logistics research and will need certain adaptations and adjustments when transferred into particular research contexts. In addition, the research question, philosophical stance, and knowledge of qualitative methodologies will ultimately determine the appropriateness of the technique.

Originality/value

The paper presents the first application of the documentary method in the field of logistics.
Interferometric interpolation of sparse marine data
Authors: Hanafy Sherif M. , Schuster Gerard T.
Published: October 2013

We present the theory and numerical results for interferometrically interpolating 2D and 3D marine surface seismic profiles data. For the interpolation of seismic data we use the combination of a recorded Green's function and a model‐based Green's function for a water‐layer model. Synthetic (2D and 3D) and field (2D) results show that the seismic data with sparse receiver intervals can be accurately interpolated to smaller intervals using multiples in the data. An up‐ and downgoing separation of both recorded and model‐based Green's functions can help in minimizing artefacts in a virtual shot gather. If the up‐ and downgoing separation is not possible, noticeable artefacts will be generated in the virtual shot gather. As a partial remedy we iteratively use a non‐stationary 1D multi‐channel matching filter with the interpolated data. Results suggest that a sparse marine seismic survey can yield more information about reflectors if traces are interpolated by interferometry. Comparing our results to those of f‐k interpolation shows that the synthetic example gives comparable results while the field example shows better interpolation quality for the interferometric method.
Optimized arrays for 2D cross‐borehole electrical tomography surveys
Authors: Loke M.H. , Wilkinson P.B. , Chambers J.E. , Strutt M.
Published: October 2013

The use of optimized arrays generated using the ‘Compare R’ method for cross‐borehole resistivity measurements is examined in this paper. We compare the performances of two array optimization algorithms, one that maximizes the model resolution and another that minimizes the point spread value. Although both algorithms give similar results, the model resolution maximization algorithm is several times faster. A study of the point spread function plots for a cross‐borehole survey shows that the model resolution within the central zone surrounded by the borehole electrodes is much higher than near the bottom end of the boreholes. Tests with synthetic and experimental data show that the optimized arrays generated by the ‘Compare R’ method have significantly better resolution than a ‘standard’ measurement sequence used in previous surveys. The resolution of the optimized arrays is less if arrays with both current (or both potential) electrodes in the same borehole are excluded. However, they are still better than the ‘standard’ arrays.
Locating microseismic events using borehole data
Authors: Jones G.A. , Kendall J.‐M. , Bastow I.D. , Raymer D.G.
Published: October 2013

Constraining microseismic hypocentres in and around hydrocarbon reservoirs and their overburdens is essential for the monitoring of deformation related to hydraulic fracturing, production and injection and the assessment of reservoir security for CO2 and wastewater storage. Microseismic monitoring in hydrocarbon reservoirs can be achieved via a variety of surface and subsurface acquisition geometries. In this study we use data from a single, subsurface, vertical array of sensors. We test an existing technique that uses a 1D velocity model to constrain locations by minimizing differential S‐to‐P arrival times for individual sensors. We show that small errors in either arrival time picks or the velocity model can lead to large errors in depth, especially near velocity model discontinuities where events tend to cluster. To address this issue we develop two methods that use all available arrival times simultaneously in the inversion, thus maximizing the number of potential constraints from to N, where N is the number of phase picks. The first approach minimizes all available arrival time pairs whilst the second approach, the equal distance time (EDT) method defines the hypocentre as the point where the maximum number of arrival time surfaces intersect. We test and compare the new location procedures with locations using differential S‐to‐P times at each individual sensor on a microseismic data set recorded by a vertical array of sensors at the Ekofisk reservoir in the North Sea. Specifically, we test each procedure's sensitivity to perturbations in measured arrival times and the velocity model using Monte Carlo analysis. In general, location uncertainties increase with increasing raypath length. We show that errors in velocity model estimates are the most significant source of uncertainty in source location with these experiments. Our tests show that hypocentres determined by the new procedures are less sensitive to erroneous measurements and velocity model uncertainties thus reducing the potential for misinterpretation of the results.
Multiridge Euler deconvolution
Authors: Florio Giovanni , Fedi Maurizio
Published: October 2013

Potential field interpretation can be carried out using multiscale methods. This class of methods analyses a multiscale data set, which is built by upward continuation of the original data to a number of altitudes conveniently chosen. Euler deconvolution can be cast into this multiscale environment by analysing data along ridges of potential fields, e.g., at those points along lines across scales where the field or its horizontal or vertical derivative respectively is zero. Previous work has shown that Euler equations are notably simplified along any of these ridges. Since a given anomaly may generate one or more ridges we describe in this paper how Euler deconvolution may be used to jointly invert data along all of them, so performing a multiridge Euler deconvolution. The method enjoys the stable and high‐resolution properties of multiscale methods, due to the composite upward continuation/vertical differentiation filter used. Such a physically‐based field transformation can have a positive effect on reducing both high‐wavenumber noise and interference or regional field effects. Multiridge Euler deconvolution can also be applied to the modulus of an analytic signal, gravity/magnetic gradient tensor components or Hilbert transform components. The advantages of using multiridge Euler deconvolution compared to single ridge Euler deconvolution include improved solution clustering, increased number of solutions, improvement of accuracy of the results obtainable from some types of ridges and greater ease in the selection of ridges to invert. The multiscale approach is particularly well suited to deal with non‐ideal sources. In these cases, our strategy is to find the optimal combination of upward continuation altitude range and data differentiation order, such that the field could be sensed as approximately homogeneous and then characterized by a structural index close to an integer value. This allows us to estimate depths related to the top or the centre of the structure.
Scoping reviews in occupational therapy: The what, why, and how to
Authors: McKinstry Carol , Brown Ted , Gustafsson Louise
Published: October 2013

Background/aim

Scoping reviews are a method of identifying, locating, analysing and summarising relevant empirical literature and research findings on a nominated topic. A description of scoping reviews is provided with examples that have been published in the occupational therapy and related literature and outline of the uses of scoping reviews for research and in evidence‐based practice.

Methods

Recent occupational therapy literature was searched to identify occupational therapy‐related scoping reviews published in the refereed literature and to identify the methodologies used and topics covered.

Results

A limited range of scoping reviews was located and a summary of their results is provided as examples of scoping reviews in the occupational therapy field.

Conclusion

The scoping review methodology is an efficient and effective approach for locating, analysing, summarising and presenting available literature and research findings on a particular topic. In comparison to a systematic review, it does not have the same high level of rigour, however does provide a general overview of the literature using a structured methodology to ensure consistency. The methodology of scoping reviews is effective for researchers where there is limited high level evidence available about a topic that would be required by a systematic review and provides an efficient way of identifying previous research and current knowledge gaps. Although there has been some scoping reviews published, it is predicted that there will be an increase in the future when the use of scoping reviews in occupational therapy is more fully realised and operationalised.
Practical compassions: repertoires of practice and compassion talk in acute mental healthcare
Authors: Brown Brian , Crawford Paul , Gilbert Paul , Gilbert Jean , Gale Corinne
Published: October 2013

This article reports an exploratory study of the concept of compassion in the work of 20 mental health practitioners in a UK Midlands facility. Using notions of practice derived from phenomenology and Bourdieusian sociology and notions of emotional labour we identify two contrasting interpretive repertoires in discussions of compassion. The first, the practical compassion repertoire, evokes the practical, physical and bodily aspects of compassion. It involves organising being with patients, playing games, anticipating disruption and taking them outside for cigarettes. Practitioners described being aware that these practical, bodily activities could lead to patients ‘opening up’, disclosing their interior concerns and enabling practical, compassionate mental health work to take place. In contrast, the second, organisational repertoire, concerns organisational constraints on compassionate practice. The shortage of staff, the record‐keeping and internal processes of quality control were seen as time‐greedy and apt to detract from contact with patients. The findings are discussed in relation to Bourdieu and Merleau‐Ponty's phenomenological accounts of practice and habit and set in context in the growing interest in placing compassion centrally in healthcare. We also explore how the exercise of compassion in the way our participants describe it can afford the more effective exercise of medical power.
Yeast or mushrooms? Productivity patterns across Swedish manufacturing industries, 1869–1912
Authors: Prado Svante
Published: October 2013

This article applies Harberger's yeast versus mushrooms dichotomy to Swedish manufacturing industries in the four decades prior to the First World War. The evidence, broken down to cover five sub‐periods, points to a growth process resembling that of mushrooms more than that of yeast. In addition, it is argued that a yeast‐like (even) pattern of productivity growth rates invites one to search for a general purpose technology at work, whereas mushroom‐like progress leads one to dismiss the idea that a small number of technologies spilled over to a large number of manufacturing processes. The era under investigation coincides with the peak of the use of steam power and the infancy of electricity. The evidence makes it unlikely that steam in Sweden was a general purpose technology with the potential to affect the progress in productivity across industries in a yeast‐like fashion. The rampant spread of electricity may have contributed to the yeast‐like pattern in the last sub‐period preceding the First World War.
A mirror of history: China's bond market, 1921–42
Authors: Ho Chun‐Yu , Li Dan
Published: October 2013

This article provides a quantitative assessment of contemporary beliefs about historical events by econometrically identifying ‘break points’ in China's domestic bond market from 1921 to 1942. We find that these ‘break points’ usually coincided with the events highlighted by the Shanghai Newspaper—an influential daily newspaper produced during the time of the Republic of China. These events are also generally considered to be crucial by historians—for example, the Japanese invasion of Manchuria and the outbreak of the Second Sino‐Japanese War. However, some events to which historians attach great importance, such as the conflicts between Nationalists and Communists in the 1930s, were not reflected in the bond market and did not attract much media attention. Some events, such as the Sino‐Japanese ceasefire in Tanggu in 1933, were thought to be crucial by contemporaries, but have been downplayed by later observers.
The selection bias in court records: settlement and trial in eighteenth‐century Ottoman Kastamonu
Authors: Coşgel Metin M. , Ergene Boğaç A.
Published: October 2013

Court records are used extensively in historical research. Preserved as summaries of daily legal proceedings, they give historians a unique opportunity to access information about the names, characteristics, and socio‐economic status of individuals and the laws, local customs, and legal institutions of societies. Although researchers have noted various limitations of these records, the problem of selection bias has not been systematically studied. Since litigants would probably settle disputes in which one side is likely to be a clear winner, the cases that go to trial are more likely to be the difficult and uncertain ones that comprise a non‐random subset of all disputes. This article presents a study of selection bias in Ottoman courts in the town of Kastamonu in northern Anatolia, from the late seventeenth and the eighteenth centuries. Disputes are categorized by type and the distribution of court participants is studied according to composition, gender, and socio‐religious status. A regression analysis is run to determine the factors affecting the likelihood of cases being tried in court. The results indicate that the cases that ended up in court were selected systematically. If the selection bias is ignored, research based on Ottoman court records may be seriously flawed in its ability to yield general conclusions.
Development of a Composite Measure of State‐Level Malpractice Environment
Authors: Chung Jeanette W. , Sohn Min‐Woong , Merkow Ryan P. , Oh Elissa H. , Minami Christina , Black Bernard S. , Bilimoria Karl Y.
Published: October 2013

Objective

To develop a composite measure of state‐level malpractice environment.

Data Sources

Public use data from the National Practitioner Data Bank, Medical Liability Monitor, the National Conference of State Legislatures, and the American Bar Association.

Study Design

Principal component analysis of state‐level indicators (paid claims rate, malpractice premiums, lawyers per capita, average award size, and malpractice laws), with indirect validation of the composite using receiver‐operating characteristic curves to determine how accurately the composite could identify states with high‐tort activity and costs.

Principal Findings

A single composite accounted for over 73 percent of total variance in the seven indicators and demonstrated reasonable criterion validity.

Conclusion

An empirical composite measure of state‐level malpractice risk may offer advantages over single indicators in measuring overall risk and may facilitate cross‐state comparisons of malpractice environments.
New emergency department quality measure: From access block to National Emergency Access Target compliance
Authors: Khanna Sankalp , Boyle Justin , Good Norm , Lind James
Published: October 2013

Objectives

The study aims to investigate the effect of time of day and ED occupancy on the ability of EDs to admit or discharge patients within 4 h in accordance with the National Emergency Access Target (NEAT), and to compare this with corresponding levels of access block, the measure for ED performance before NEAT.

Methods

This is a retrospective analysis of 5 years of ED data from 30 reporting public hospitals in Queensland, Australia. Relationships between these and variations in time of day and occupancy were explored using a Poisson generalised linear model. The main outcome measures are cases of NEAT non‐compliance (ED length of stay >4 h for all patients [i.e. admitted and non‐admitted] leaving the ED) and access block (ED length of stay >8 h for admitted patients).

Results

NEAT performance is found to be dependent on hospital size, and levels vary significantly for admitted and non‐admitted patients. A higher proportion of patients breach NEAT during early mornings and low occupancy periods, a trend not observed with the previous access block metric. NEAT non‐compliance is also found to rise between 13.00 hours and 17.00 hours, a period when the proportion of access block cases typically drops.

Conclusions

EDs face rising levels of NEAT non‐compliance at times when corresponding access block levels have traditionally not been a concern. A higher proportion of patients breach the target during periods that would intuitively not be flagged as flow bottlenecks. The findings support the need for service level analysis and new solutions to guide workflow reform and maximise NEAT compliance.
Evaluation and outcomes of patients admitted to a tertiary medical assessment unit with acute chest pain of possible coronary origin
Authors: Sander Rebecca L , Scott Ian A , Aggarwal Leena
Published: October 2013

Objectives

The study aims to (i) profile clinical characteristics, risk estimates of acute coronary syndrome (ACS), use and yield of non‐invasive cardiac testing, discharge diagnosis and 30‐day outcomes among patients admitted with acute chest pain of possible coronary origin; and (ii) construct a risk stratification algorithm that informs management decisions.

Methods

This is a retrospective cohort study of 130 consecutive patients admitted to a tertiary hospital medical assessment unit between 24 January and 22 March 2012. Estimates of ACS risk were based on Australian guidelines and Thrombolysis in Myocardial Infarction (TIMI) scores.

Results

Patients were of mean age 61 years, 45% had known coronary artery disease (CAD), 58% presented with typical ischaemic pain, 82% had intermediate to high ACS risk and 61% underwent testing. Myocardial ischaemia was cardiologist‐confirmed discharge diagnosis in 29% of patients, and was associated with known CAD, typical pain, multiple risk factors and high TIMI risk scores (P < 0.001 for all associations). Of 98 non‐invasive investigations, 9% (95% CI, 5–17%) were positive for myocardial ischaemia. Major adverse event rate at 30 days was 0.8% (95% CI, <0.1–6%). An algorithm was constructed that integrates known CAD, ACS risk and TIMI scores in identifying low‐risk patients capable of rapid discharge from EDs without further investigation, and classifying the remainder into risk groups that informs choice of investigations and need for telemetry.

Conclusions

In patients with indeterminate chest pain, clinical features and risk scores identify most with myocardial ischaemia. An algorithm is presented that might inform triaging, early discharge, choice of testing and need for telemetry.
Focal Thalamic Degeneration from Ethanol and Thiamine Deficiency is Associated with Neuroimmune Gene Induction, Microglial Activation, and Lack of Monocarboxylic Acid Transporters
Authors: Qin Liya , Crews Fulton T.
Published: October 2013

Background

Wernicke's encephalopathy‐Korsakoff syndrome (WE‐KS) is common in alcoholics, caused by thiamine deficiency (TD; vitaminB1) and associated with lesions to the thalamus (THAL). AlthoughTDalone can causeWE, the high incidence in alcoholism suggests thatTDand ethanol (EtOH) interact.

Methods

Mice in control,TD, or EtOH groups alone or combined were studied after 5 or 10 days of treatment. THAL and entorhinal cortex (ENT) histochemistry andmRNAwere assessed.

Results

Combined EtOH‐TDtreatment for 5 days (EtOH‐TD5) showed activated microglia, proinflammatory gene induction andTHALneurodegeneration that was greater than that found withTDalone (TD5), whereas 10 days resulted in markedTHALdegeneration and microglial‐neuroimmune activation in both groups. In contrast, 10 days ofTDdid not causeENTdegeneration. Interestingly, inENT,TD10 activated microglia and astrocytes more than EtOH‐TD10. InTHAL, multiple astrocytic markers were lost consistent with glial cell loss.TDblocks glucose metabolism more than acetate. Acetate derived from hepatic EtOH metabolism is transported by monocarboxylic acid transporters (MCT) into both neurons and astrocytes that use acetyl‐CoA synthetase (AcCoAS) to generate cellular energy from acetate.MCTand AcCoASexpression inTHALis lower thanENTprompting the hypothesis that focalTHALdegeneration is related to insufficientMCTand AcCoASinTHAL. To test this hypothesis, we administered glycerin triacetate (GTA) to increase blood acetate and found it protected theTHALfromTD‐induced degeneration.

Conclusions

Our findings suggest that EtOHpotentiatesTD‐inducedTHALdegeneration through neuroimmune gene induction. The findings support the hypothesis thatTDdeficiency inhibits global glucose metabolism and that a reduced ability to process acetate for cellular energy results inTHALfocal degeneration in alcoholics contributing to the high incidence of Wernicke‐Korsakoff syndrome in alcoholism.
Do Brief Alcohol Motivational Interventions Work Like We Think They Do?
Authors: Bertholet Nicolas , Palfai Tibor , Gaume Jacques , Daeppen Jean‐Bernard , Saitz Richard
Published: October 2013

Background

Questions remain about how brief motivational interventions (BMIs) for unhealthy alcohol use work, and addressing these questions may be important for improving their efficacy. Therefore, we assessed the effects of various characteristics of BMIs on drinking outcomes across 3 randomized controlled trials (RCTs).

Methods

Audio recordings of 314 BMIs were coded. We used the global rating scales of the Motivational Interviewing Skills Code (MISC) 2.1: counselor's acceptance, empathy, and motivational interviewing (MI) spirit, and patient's self‐exploration were rated. MI proficiency was defined as counselor's rating scale scores ≥5. We also used the structure, confrontation, and advice subscale scores of the Therapy Process Rating Scale and the Working Alliance Inventory. We examined these process characteristics in interventions across 1 U.S. RCT of middle‐aged medical inpatients with unhealthy alcohol use (n = 124) and 2 Swiss RCTs of young men with binge drinking in a nonclinical setting: Swiss‐one (n = 62) and Swiss‐two (n = 128). We assessed the associations between these characteristics and drinks/d reported by participants 3 to 6 months after study entry.

Results

In all 3 RCTs, mean MISC counselor's rating scales scores were consistent with MI proficiency. In overdispersed Poisson regression models, most BMI characteristics were not significantly associated with drinks/d in follow‐up. In the U.S. RCT, confrontation and self‐exploration were associated with more drinking. Giving advice was significantly associated with less drinking in the Swiss‐one RCT. Contrary to expectations, MI spirit was not consistently associated with drinking across studies.

Conclusions

Across different populations and settings, intervention characteristics viewed as central to efficacious BMIs were neither robust nor consistent predictors of drinking outcome. Although there may be alternative reasons why the level of MI processes was not predictive of outcomes in these studies (limited variability in scores), efforts to understand what makes BMIs efficacious may require attention to factors beyond intervention process characteristics typically examined.
Survival Results After Implantation of Intrapericardial Third‐Generation Centrifugal Assist Device: An INTERMACS‐Matched Comparison Analysis
Authors: Dell'Aquila Angelo M. , Schneider Stefan R.B. , Stypmann Jörg , Ellger Björn , Redwan Bassam , Schlarb Dominik , Martens Sven , Sindermann Jürgen R.
Published: October 2013

Reports on third‐generation centrifugal intrapericardial pumps (HeartWare International, Inc., Framingham, MA, USA) have shown better survival results than the previous‐generation devices. However, outcomes depending on the preoperative level of stability can substantially differ, resulting in a limited analysis of potentialities and drawbacks of a given device. In the present study we sought to compare in our single‐center experience the survival results of this third‐generation device with previous left ventricular systems taking into account the different preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) levels. Between February 1993 and March 2012, 287 patients underwent assist device implantation in our university hospital (INTERMACS Level 1‐2 = 158 patients; INTERMACS Level 3‐4‐5 = 129 patients). Assist devices implanted were: Group A (HVAD HeartWare, n = 52), group B (previous continuous‐flow ventricular assist device [VAD], InCor [Berlin Heart, Berlin, Germany], n = 37; VentrAssist [VentraCor, Inc., Chatswood, NSW, Australia], n = 7; DeBakey [MicroMed Cardiovascular, Inc., Houston, TX, USA], n = 32), and group C (pulsatile systems, n = 159). After cumulative support duration of 54 436 days and a mean follow‐up of 6.21 ± 7.46 months (range 0–45.21 months), log‐rank analysis revealed a survival for group A of 82.0%, 70.4%, and 70.4%; for group B of 84.0%, 48.2%, 33.7%; and for group C of 71.6%, 46.1%, 33.8%, at 1, 12, and 24 months respectively, with a significantly (P = 0.013) better outcome for group A. When stratifying the survival on the basis of INTERMACS level, no significant survival improvement was observed among all patients who underwent VAD implantation in INTERMACS 1‐2 (P = 0.47). However, among patients who underwent elective VAD implantation (INTERMACS 3‐4‐5), group A had a significantly better outcome (P = 0.005) compared with the other INTERMACS‐matched groups (B,C) with a survival rate of 88.8% in group A versus 34.2% in group B and 45.6% in group C at 24 months, respectively. Elective HVAD system implantation shows improved survival benefit over the other INTERMACS‐matched devices. Moreover, preoperative unstable hemodynamics resulted in a poor prognosis independently from the pump generation.
An Original Versatile Nonocclusive Pressure‐Regulated Blood Roller Pump for Extracorporeal Perfusion
Authors: Durandy Yves , Wang Shigang , Ündar Akif
Published: October 2013

Currently, only a small number of centrifugal pumps are being used for hemodynamic and/or respiratory support, but all of them have limitations. This article aims to present the Rhône‐Poulenc 06 nonocclusive pressure‐regulated blood pump. This pump was developed in France in the 1970s and used for decades in perfusion for cardiopulmonary bypass procedures, cardiac or lung assist as well as venovenous bypass during liver transplant. The intrinsic properties of this pump allowed us to describe a new technique for extracorporeal lung support in the 1980s, using a single cannula tidal flow venovenous bypass. This pump compared favorably with conventional pumps in terms of flow and pressure, hemolysis, pulsatility, safety, and cost‐effectiveness. We believe that this simple pump could be an alternative to more sophisticated and expensive devices.
Modeling Individual Specific Fish Length from Capture–Recapture Data Using the von Bertalanffy Growth Curve
Authors: Schofield Matthew R. , Barker Richard J. , Taylor Peter
Published: October 2013

We use Bayesian methods to explore fitting the von Bertalanffy length model to tag-recapture data. We consider two popular parameterizations of the von Bertalanffy model. The first models the data relative to age at first capture; the second models in terms of length at first capture. Using data from a rainbow trout Oncorhynchus mykiss study we explore the relationship between the assumptions and resulting inference using posterior predictive checking, cross validation and a simulation study. We find that untestable hierarchical assumptions placed on the nuisance parameters in each model can influence the resulting inference about parameters of interest. Researchers should carefully consider these assumptions when modeling growth from tag-recapture data.
Doubly-Robust Estimators of Treatment-Specific Survival Distributions in Observational Studies with Stratified Sampling
Authors: Bai Xiaofei , Tsiatis Anastasios A. , O'Brien Sean M.
Published: October 2013

Observational studies are frequently conducted to compare the effects of two treatments on survival. For such studies we must be concerned about confounding; that is, there are covariates that affect both the treatment assignment and the survival distribution. With confounding the usual treatment-specific Kaplan–Meier estimator might be a biased estimator of the underlying treatment-specific survival distribution. This article has two aims. In the first aim we use semiparametric theory to derive a doubly robust estimator of the treatment-specific survival distribution in cases where it is believed that all the potential confounders are captured. In cases where not all potential confounders have been captured one may conduct a substudy using a stratified sampling scheme to capture additional covariates that may account for confounding. The second aim is to derive a doubly-robust estimator for the treatment-specific survival distributions and its variance estimator with such a stratified sampling scheme. Simulation studies are conducted to show consistency and double robustness. These estimators are then applied to the data from the ASCERT study that motivated this research.