bluuebunny/crossref_metadata_2025 huggingface dataset:
Circulating vitamin D binding protein levels are not associated with relapses or with vitamin D status in multiple sclerosis
Authors: Smolders Joost , Peelen Evelyn , Thewissen Mariëlle , Menheere Paul , Damoiseaux Jan , Hupperts Raymond
Published: August 2013

Background:

A low vitamin D status has been associated with multiple sclerosis (MS). Most circulating vitamin D metabolites are bound to vitamin D binding protein (DBP).

Objectives:

The purpose of this study was to explore whether there is an association between MS and DBP.

Methods:

We compared DBP concentrations in blood samples of controls ( n = 30) and subjects with relapsing–remitting MS (RRMS) during remission ( n = 29) and relapse ( n = 15). Furthermore, we explored correlations of DBP with 25- hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D levels (1,25(OH)2D), and the effect of high-dose vitamin D3 supplementation on DBP levels in RRMS patients ( n = 15).

Results:

DBP-concentration did not differ between the sub-groups measured, and there was no correlation between DBP and vitamin D metabolite concentration within the physiological range. Upon supplementation of high doses vitamin D3, DBP concentration remained unaltered. After supplementation, serum 1,25(OH)2D( R = 0.517, p = 0.049), but not 25(OH)D, correlated positively with DBP.

Conclusions:

We found no association between DBP, MS, and vitamin D status within the physiological range. After high - dose vitamin D supplementation, DBP concentrations may be relevant for vitamin D metabolism.
Computer-assisted rehabilitation of attention in patients with multiple sclerosis: results of a randomized, double-blind trial
Authors: Amato MP , Goretti B , Viterbo RG , Portaccio E , Niccolai C , Hakiki B , Iaffaldano P , Trojano M
Published: August 2013

Background:

There is controversial information on the efficacy of cognitive rehabilitation in multiple sclerosis (MS).

Objective:

The objective of this paper is to test a home-based computerized program for retraining attention dysfunction in MS.

Methods:

Relapsing–remitting patients who failed > 2 tests of attention on an extensive neuropsychological battery were randomized to specific or nonspecific computerized training (ST, n-ST), in one-hour sessions, twice a week for three months. Outcome measures included neuropsychological assessment, depression, fatigue, everyday activities and a visual analogue scale assessing attentive performance (VAS). Assessments were repeated after the interventions and after a further three months. Statistical analysis included the analysis of variance (ANOVA) for repeated measures.

Results:

Eighty-eight out of 102 randomized patients completed the study (69 women, age 40.9 ± 11.5 years, disease duration 13.0 ± 8.7 years, Expanded Disability Status Scale score 2.7 ± 1.5). Fifty-five patients were randomized to ST, 33 to n-ST. A benefit of the ST was observed on the Paced Auditory Serial Addition Test ( p < 0.002). However, patient self-report did not reveal differences between ST and n-ST patient groups.

Conclusion:

Although our program trained different attention components, we could detect some improvements exclusively on tasks of sustained attention. Moreover, patient self-perceived results may be independent of the training program.
Referral quality and the cooperation between hospital physicians and general practice: The role of physician and primary care factors
Authors: Martinussen Pål E.
Published: August 2013

Aims: It has been shown that referral letters from GPs often are of poor quality, but research in this field is scarce, and few efforts have been made to investigate the factors that may help explain the variation in referral quality. Methods: Combining a survey among 1298 Norwegian hospital physicians (response rate: 52%) with information on the hospitals and the communities they are serving, this study investigates how they view the general quality of patient referrals received from GPs, and the extent to which insufficient information in referrals and inappropriate referrals is considered a problem for cooperation with GPs. Results: Only 15.6% of the hospital physicians perceived the quality of the referrals to be “usually good”, and both lack of information in referrals and inappropriate referrals are seen as important barriers to cooperation with GPs. Of the individual factors, former GP practice is associated with a positive view on referral quality, while regular meetings between hospital physicians and GPs seem to reduce the problems of inappropriate and incomplete referrals. Furthermore, both average number of patients on GPs’ lists and lack of free capacity in nursing and care institutions in the hospital catchment area was found to be negatively associated with perceived referral quality. Conclusions: There is a need to increase the knowledge on how contextual, institutional and professional factors affect coordination of care. The main contribution of this study lies in the attempt to address the macro and micro barriers of obtaining good referral care.
The impact of organizational culture on the outcome of hospital care: After the implementation of person-centred care
Authors: J. Alharbi Tariq Saleem , Olsson Lars-Eric , Ekman Inger , Carlström Eric
Published: August 2013

Aims: To measure the effect of organizational culture on health outcomes of patients 3 months after discharge. Methods: a quantitative study using Organizational Values Questionnaire (OVQ) and a health-related quality of life instrument (EQ-5D). A total of 117 nurses, 69% response rate, and 220 patients answered the OVQ and EQ-5D, respectively. Results: The regression analysis showed that; 16% ( R2 = 0.02) of a decreased health status, 22% ( R2 = 0.05) of pain/discomfort and 13% ( R2 = 0.02) of mobility problems could be attributed to the combination of open system (OS) and Human Relations (HR) cultural dimensions, i.e., an organizational culture being dominated by flexibility. Conclusions: The results from the present study tentatively indicated an association between an organizational culture and patients’ health related quality of life 3 months after discharge. Even if the current understanding of organizational culture, which is dominated by flexibility, is considered favourable when implementing a new health care model, our results showed that it could be hindering instead of helping the new health care model in achieving its objectives.
A Nordic Charter for Universal Design
Authors: Björk Evastina
Published: August 2013

Aims: The aim of this paper is to present the result of a pioneer project; A Nordic Charter for Universal Design, which was initiated by the Norwegian Directorate for Children, Youth and Family Affairs in 2011. The purpose of the Charter was to present rationales that stated prerequisites for successful investment in Universal Design, and to establish a platform for further research and good practice. It was also meant to contribute to spreading of information and knowledge about the importance of guidance by the concept of Universal Design of initiatives with effects on the public arena. Method: A Nordic group of researchers and professionals in the field ended up after 8 months of work with a written document: “A Nordic Charter for Universal Design”, which was presented at the International Conference in Universal Design in Oslo, Norway (UD 2012). Result: A Nordic Charter for Universal Design. Conclusions: Persons with disabilities often experience the public arenas environments, products and services as poorly-designed to fit their abilities and/or their needs. Together with the demographic changes in the Nordic societies with an increasing number of elderly people, it needs initiatives to improve independence, accessibility and participation in society. A strategy which aims to make design and composition of different environments, products, communication, information technology and services accessible, usable and understandable to as many as possible is Universal Design.
Indoor airborne microbial burden and risk of acute respiratory infections among children under five in Ibadan, Nigeria
Authors: Ana G. R. , Fakunle G. A. , Ogunjobi A. A.
Published: August 2013

Acute respiratory infection is the fourth major cause of morbidity and mortality among under-five children globally. However, the profile of microbial burden that could contribute to these infections among under-five children in the indoor environments has not been extensively studied particularly in developing countries like Nigeria. This study was designed to determine the burden of airborne microbes in indoor environment that predispose under-five children to acute respiratory infections. A prospective case–control design was employed for this study. Two hundred and twenty under-five children each with acute respiratory infection (cases) and without acute respiratory infection (controls) were selected from children visiting Oni-memorial Children Hospital and University College Hospital, Ibadan. A follow-up of 66 consented cases and controls each was carried out to assess the burden of indoor airborne microbes using a non-volumetric method, and the total counts per cubic metre were compared with the American Industrial Hygiene Association guideline. Data were analysed using descriptive statistics, t-test and Spearman’s rank correlation. Mean indoor total bacterial count for cases (9.6 × 102 cfu/m3) was significantly higher than the permissible limit recommended by the American Industrial Hygiene Association (≤500 cfu/m3) as compared to controls (3.5 × 102 cfu/m3) (p < 0.05). Educating mothers of under-five children on improved ventilation, good housing and indoor sanitary practices to reduce indoor microbial load is therefore advocated.
Upper Cervical Spine Fusion in Children With Skeletal Dysplasia
Authors: Pakkasjärvi N. , Mattila M. , Remes V. , Helenius I.
Published: August 2013

Background:

Skeletal dysplasias have been associated with upper cervical instability. Many patients are initially asymptomatic, but the instability may progress to subluxation and dislocation and complications thereof, including death. Surgery is hampered by petite osseous structures and low bone formation rate.

Aim:

To review the outcomes of surgical fusion of upper cervical instability in children with rare skeletal dysplasias.

Material and Methods:

A retrospective study of eight children with five different rare skeletal dysplasias needing upper cervical instrumented stabilization. Cases were evaluated for clinical, radiologic, and quality-of-life outcomes, with median follow-up time of 5 years.

Results:

Six patients underwent posterior, segmental cervical spine instrumentation and fusion (three C1/C2 fusions, three occipitocervical fusions), one anterior cervical instrumented spinal fusion, and one anteroposterior fusion. Autogenous bone grafting was used in all patients, and seven were immobilized using a halo body jacket. Nonunion in occipitocervical fusions was common in these patients (3/8 patients). Rib autograft from occiput to cervical spine with recombinant human BMP-2 was used to salvage nonunions.

Conclusions:

Surgical fixation in the pediatric cervical spine is hampered by fragile posterior structures. A postoperative immobilization by halo vest for 4 months is customary. Selective anterior corpectomy and plate fixation is not recommended in pediatric patients with skeletal dysplasias.

Level of Evidence:

Level 4, Case Series
Surgery, Surgeon, and Measurement of Value and Quality of Surgeons’ Work
Authors: Sayek I.
Published: August 2013

Surgery has undergone a significant change and development entering the 21st century. The changes and development have been technology driven, both in therapy and diagnosis. There have been significant changes in the health-care systems as well universally. The changes have created a significant challenge both for the profession and the surgeon. The surgeon should be prepared for further developments and innovations and adapt himself or herself to survive practicing surgery and conserving the humanistic approach of medicine and professionalism including respect to professional values. The profession needs to prepare itself for the future to train good surgeons accordingly for better community health.
Effects of Intra-Arterial Octreotide on Pancreatic Texture: A Randomized Controlled Trial
Authors: Belyaev O. , Polle C. , Herzog T. , Munding J. , Chromik A. M. , Meurer K. , Tannapfel A. , Bergmann U. , Müller C. A. , Uhl W.
Published: August 2013

Background and Aims:

Octreotide is suggested to harden the pancreas, thus facilitating the construction of a pancreatic anastomosis and lowering the risk of postoperative fistula. We tested the hypothesis that intra-arterial application of octreotide in the gastroduodenal artery during pancreatectomy may increase pancreatic hardness.

Material and Methods:

A single-center, prospective, double-blinded, randomized controlled trial with parallel assignment was conducted. Patients planned for a pancreatoduodenectomy or a total pancreatectomy, who had a palpatory and durometer proven (<40 Shore units) soft pancreas, were assigned to receive intraoperatively either 5 mL 500µg octreotide or 5 mL 0.9% saline solution as a bolus injection in the gastroduodenal artery. Pancreatic hardness was measured before, early, and late after intervention. The investigator performing the durometer measurements and pathologist were masked to group assignment. The primary outcome was increased pancreatic hardness. Analysis was by intention to treat. This trial is registered at http://www.clinicaltrials.gov (ID NCT01400100).

Results:

A total of 12 patients received octreotide and 13 received saline solution. Pancreatic hardness marginally increased in the octreotide group: 0.67 ± 2.3 Shore units, whereas it decreased in the control group: −2.15 ± 2.7 Shore units. The difference was statistically significant, p = 0.029 (95% confidence interval = −4.87 to −0.77). Histology did not find any correlate for this clinically irrelevant hardening effect.

Conclusions:

A single bolus application of octreotide did not deliver a clinically relevant increase in pancreatic hardness. Future studies on the hardening effect of octreotide should employ repeated or continuous preoperative administration of this drug.
Feasibility of Radical Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy For Pseudomyxoma Peritonei of Appendiceal Origin
Authors: Järvinen P. , Ristimäki A. , Kantonen J. , Lepistö A.
Published: August 2013

Background and Aims:

We analyzed the feasibility of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei.

Material and Methods:

A prospective database comprised 90 consecutive patients with demonstrable pseudomyxoma peritonei collected during 48 months. These patients, referred to our unit for consideration for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, received both cytoreductive surgery and hyperthermic intraperitoneal chemotherapy if possible. We evaluated the factors associated with a successful procedure.

Results:

Hyperthermic intraperitoneal chemotherapy was successfully delivered to 56 of 90 patients (62%) with demonstrable pseudomyxoma peritonei. Tumor morphology of low grade (p = 0.013), age under 65 years (p = 0.004), and serum carcinoembryonic antigen level under 5.0 µg/L (p = 0.003) were associated with successful administration of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Mean peritoneal cancer index was lower (18.9 vs 32.6, p < 0.001) and age was younger (54.3 vs 61.6, p = 0.003) in patients who underwent hyperthermic intraperitoneal chemotherapy than in patients who did not. Four patients had complete cytoreductive surgery alone, and 20 patients underwent palliative debulking, but 10 were ineligible for this operation.

Conclusions:

Although the combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is currently suggested the standard practice for pseudomyxoma peritonei, not all patients are eligible for this protocol. In this study, hyperthermic intraperitoneal chemotherapy was suitable for 62% of patients with pseudomyxoma peritonei of appendiceal origin.
Fenestrated and Chimney Endografts for Juxtarenal Aneurysms: Early and Midterm Results
Authors: Suominen V. , Pimenoff G. , Salenius J.
Published: August 2013

Aim:

To assess the early and short-term outcome of fenestrated and chimney grafting for juxtarenal aortic aneurysms.

Material and Methods:

A prospective vascular registry of 28 patients who had undergone elective primary endovascular repair for abdominal aortic aneurysm between December 2007 and August 2011 with infrarenal neck anatomy unacceptable for conventional endovascular repair. Fenestrated endografts were designed based on reconstructed computed tomography (CT) data by the authors. Off-the-shelf grafts and stents were used for chimney cases. Patients were followed up until 31 May 2012.

Results:

A total of 21 (75%) patients were treated with fenestrated endografts, while 7 (25%) received chimney grafts. The mean aneurysm diameter was 65 mm (standard deviation = 7 mm) and the median neck length 2.5 mm (range: 0–10 mm). Altogether, 63 (mean = 2.3/patient) visceral arteries were incorporated (42 renal, 21 superior mesenteric arteries). The overall primary technical success rate was 93% (one type I and one type III endoleak). The mean follow-up was 22 months (standard deviation: 14 months). The primary type III endoleak resolved spontaneously with thrombosis of the target vessel, while the patient with primary type I endoleak died of acute myocardial infarction 3 weeks after the procedure. Two late endoleaks developed: one type II endoleak without aneurysm sac growth remains under surveillance, while in another patient, multiple attempts to treat type I endoleak proved unsuccessful and the patient later died of gastrointestinal bleeding. A total of 4 (14%) patients so far required additional procedures. Two patients died within 30 days of the device implantation and another six during the follow-up. No rupture occurred. The cumulative survival for patients with fenestrated endografts was 85% at 1 year and for those treated with chimney technique 57%.

Conclusions:

The treatment of juxtarenal aortic aneurysms seems to be feasible by exploiting various endovascular techniques. Even with a low volume of cases, good immediate and short-term results can be achieved, especially with fenestrated endografts.
The Effect Of Different Bearing Surfaces On Metal Ion Levels In Urine Following 28 Mm Metal-On-Metal And 28 Mm Metal-On-Polyethylene Total Hip Arthroplasty
Authors: Tiusanen H. , Mäkelä K. , Kiilunen M. , Sarantsin P. , Sipola E. , Pesola M.
Published: August 2013

Background and Aims:

Recent advancements in manufacturing technology have enabled more precise tolerances and surface finishes using metal-on-metal bearing surfaces in total hip arthroplasty. The aim of this study was to compare the level of metal ions in urine after implantation of a 28-mm metal-on-metal bearing manufactured from high-carbon wrought alloy and a 28-mm metal-on-polyethylene bearing.

Material and Methods:

A total of 92 total hip arthroplasty patients were prospectively randomized into two groups: those receiving metal-on-metal bearings and those receiving metal-on-polyethylene bearings. Chromium, cobalt, and molybdenum ion levels in urine were measured preoperatively and at 1 year and 2 years postoperatively.

Results:

In the metal-on-polyethylene group, there was a slight increase in mean chromium and cobalt concentrations at 2-year follow-up compared to the preoperative level (p = 0.02 for both chromium and cobalt). In the metal-on-metal group, there was a 15-fold increase in chromium and a 26-fold increase in cobalt at 2-year follow-up compared to the preoperative level (p < 0.001 for both chromium and cobalt). However, the quantity of chromium and cobalt in urine from the metal-on-metal group was not higher at 2-year follow-up than at 1-year follow-up (p = 0.5 and p = 0.6, respectively).

Conclusions:

The 28-mm metal-on-metal bearings yield chromium and cobalt concentrations in urine that can be higher than those recommended for occupational exposure. However, our results also indicate that a steady state in wear and ion production using metal-on-metal total hip arthroplasty can occur.
Complicated Liver Echinococcosis: 30 Years of Experience from an Endemic Area
Authors: Symeonidis N. , Pavlidis T. , Baltatzis M. , Ballas K. , Psarras K. , Marakis G. , Sakantamis A.
Published: August 2013

Background and Aims:

Although declining, cystic echinococcosis is still a serious public health issue in Greece. This study evaluated the clinical features, management, and short-term outcome of patients with complicated liver echinococcosis.

Material and Methods:

A total of 227 patients who were operated on for 322 echinococcal cysts of the liver were retrospectively evaluated. Patients were divided into those with complicated disease (53.7%) and those with noncomplicated disease (46.3%). Intrabiliary rupture (34.4%), cyst infection (32.7%), and their combination (24.5%) were the most common complications. Demographic characteristics, previous hydatid cyst surgery, cyst multiplicity and location, presenting symptoms and signs, types of complicated disease, operative procedures performed, postoperative complications, and hospital stay were assessed.

Results:

Patient demographics and cyst characteristics demonstrated no significant difference between the two groups. The complicated disease group had significantly more pronounced clinical presentations and higher postoperative morbidity. Choice of surgical procedure depended upon cyst location and surgeon preference. Both conservative and radical procedures were performed, supplemented with additional management of the biliary tree when indicated.

Conclusions:

Complicated liver echinococcosis demonstrates several distinct features that differentiate it from the noncomplicated disease. Frequently severe clinical manifestations, complexity of surgical management, and the increased postoperative complications characterize complicated liver echinococcal disease.
Declining Cholecystectomy Rate During the Era of Statin Use in Finland: A Population-Based Cohort Study Between 1995 and 2009
Authors: Suuronen S. , Niskanen L. , Paajanen P. , Paajanen H.
Published: August 2013

Background and Aims:

Aging with comorbidities, obesity, and rapid recovery from operation may increase the need for laparoscopic cholecystectomy, but long-term use of statins may be associated with a decreased risk of gallstones. This population-based cohort study presents the changing rate and causative factors of laparoscopic cholecystectomy in Finland during the era of statin use.

Materials and Methods:

Age structure of the population, changes in body mass index and diabetes, and the number of all cholecystectomies in 1995–2009 were retrieved from the registers of National Institute for Health and Welfare. Additionally, these results were supplemented by a population-based retrospective cohort (1581 laparoscopic cholecystectomy) in one community-based hospital area. The risk factors for laparoscopic cholecystectomy, use of statins, and surgical outcome were analyzed.

Results:

During the 15 years, 123,794 cholecystectomies were performed in Finland, of which 94,740 (76.5%) were performed using laparoscopic technique. The median rate of laparoscopic cholecystectomy varied between 110 and 140 operations per 100,000 inhabitants. In 1995–2009, the annual number of cholecystectomies decreased from 8600 to 7500, the number of laparoscopic cholecystectomies increased by 10%, and the number of open cholecystectomies declined by 60%. In a cohort of 1581 laparoscopic cholecystectomies, the proportion of elderly (>65 years of age), obese (body mass index > 30 kg/m2), and diabetic patients increased from 17% to 28%, 9% to 34%, and 4% to 8%, respectively. Use of statins increased more than fourfold during the 15 years.

Conclusions:

The rates of all cholecystectomies decreased despite marked increase in laparoscopic cholecystectomies performed. The increase in risk factors for gallstones in Finland implied more marked increase in laparoscopic cholecystectomies. The possible role of statins on gallstone disease is discussed.
Surgery Cancelation on the Day of Surgery in Same-Day Admission in a Finnish Hospital
Authors: Laisi J. , Tohmo H. , Keränen U.
Published: August 2013

Background and Aims:

Surgery cancelations cause inappropriate use of hospital resources and additional financial and psychological stress to patients. Cancelation rates have been described to be even more than 10% of scheduled cases. Preoperative anesthesia evaluation clinics have been initialized to decrease cancelation rates. At Hyvinkää hospital, 95% of elective surgical patients are admitted on the morning of operation, and only 25% of these patients visit preoperative anesthesia evaluation clinic prior to surgery. Cancelation rate in Finnish hospitals has not been described.

Material and Methods:

We studied retrospectively 12,205 scheduled elective same-day admission surgical cases at Helsinki and Uusimaa Hospital District, Hyvinkää hospital for a period of 2 years. Obstetric cases, emergency cases, and a few inpatient cases were excluded. A case was considered as canceled if surgery was canceled after the finalization of operation room schedule for the next day. Cancelation rates among different specialties and reasons for cancelation were analyzed.

Results:

A total of 12,205 surgeries were scheduled during the study period, and 551 (4.5%) of these were canceled. The highest cancelation rate was in hand surgery, with 8.2% of scheduled cases, followed by orthopedic surgery with 5.4%, and pediatric surgery with 5.1% cancelation rate. Endocrinology had no cancelations, and breast, urology, and vein surgery also had less than 2% of canceled cases. Patient-related issues caused 72.4% of cancelations, and operation no longer being necessary caused 26% of all cancelations.

Conclusions:

Day of surgery cancelation rate was low in same-day admission, although it varied between specialties. Specialties having explicit surgery indications had fewer cancelations than specialties having surgery indications based on more subjective diagnostic. Process improvements need to be considered continuously to further decrease cancelation rate.
Preventive Strategies for Atrial Fibrillation After Cardiac Surgery in Nordic Countries
Authors: Maaroos M. , Tuomainen R. , Price J. , Rubens F. D. , Jideus R. L. , Halonen J. , Hartikainen J. , Hakala T.
Published: August 2013

Background and Aims:

Atrial fibrillation is a common arrhythmia after cardiac surgery. It increases morbidity, length of hospital stay, and costs of operative treatment. Beta-blockers, sotalol, amiodarone, corticosteroids, and biatrial pacing have been shown to be efficient in the prevention of postoperative atrial fibrillation. The aim of this study was to find out how widely different prophylactic strategies for postoperative atrial fibrillation are used in Scandinavian countries.

Material and Methods:

An online link for a questionnaire was emailed to (214) cardiac surgeons in Finland, Sweden, Norway, Denmark, and Estonia to assess the use of prophylactic methods for postoperative atrial fibrillation.

Results:

A total of 97 surgeons responded to the survey. Oral beta-blockers were routinely used for atrial fibrillation prophylaxis by 62% of responders. The main reasons for nonuse of beta-blockers were that responders were unconvinced of the evidence of benefit or they preferred some alternative prophylaxis. Intravenous beta-blockers were used frequently by 6% of responders. Amiodarone was used for prophylaxis by 18% of responders. Nonusers were unconvinced of its efficacy, were afraid of its complications, or found its use too cumbersome. Other prophylactic atrial fibrillation strategies that were used are as follows: sotalol by 2%, magnesium by 17%, corticosteroids by 1%, and atrial pacing by 11% of respondents.

Conclusions:

There is still widely varying implementation of strategies for atrial fibrillation prophylaxis among Scandinavian cardiac surgeons. Lack of confidence in the efficacy of these approaches is the main rationale for nonimplementation.
Application of Computational Fluid Dynamics to study the effects of Sprue Base Geometry on the Surface and Internal Turbulence in gravity casting
Authors: Baghani Amir , Bahmani Ahmad , Davami Parviz , Varahram Naser , Shabani Mohsen Ostad
Published: August 2013

The effects of sprue base size and design on flow pattern during aluminum gravity casting have been investigated by employing different sprue base sizes and using computational fluid dynamics. Calculations were carried out using SUTCAST simulation software based on solving Navier–Stokes equation and tracing the free surface using SOLA-volume of fluid algorithm. Flow pattern was analyzed with focus on streamlines and velocity distribution in sprue base, runner and ingate. Increasing well size produced a vortex flow at the bottom of sprue base, which increased the surface velocity of liquid metal in runner. Using a rather big sprue well could eliminate vena contracta but ingate velocity was observed to be independent of well size. It is assumed that ingate velocity may be more influenced by other casting considerations. Using a curved sprue base could remove vortex flow at the bottom of sprue while keeping a nearly full contact between liquid metal and runner wall.
The nature of empowerment in a consumer education program initiated by a supermarket chain
Authors: Davidson Shosh
Published: August 2013

This article aims to contribute to an understanding of the phenomenon of the commercialization of education, through an analysis of the messages of a consumer education curriculum which was initiated by the Ribua Ha-kahol chain of supermarkets for junior high schools in Israel. The fieldwork included an ethnographic study and revealed two prominent images of the consumer in the program’s contents and activities: “the wise consumer” and “the enterprising self.” The article reflects upon the nature of empowerment that is presented through the utilitarian–individualistic figure of the consumer and probes the way the consumer choice ideology masks power relations. Conversely, the article presents an alternative, feminist approach that places emphases on the “relational self” and rejects the assumption that people act first and foremost as selfish and efficient agents. Finally, the article calls for a relational approach that will inspire an “encumbered empowerment” to consumer education and will urge pupils to infuse their self-reflecting thoughts, based on their own consumer experiences.
Identifying Election Fraud Using Orphan and Low Propensity Voters
Authors: Christensen Ray , Schultz Thomas J.
Published: August 2013

Although voter ID laws have become a hot topic of political debate, existing scholarship has failed to produce conclusive evidence concerning the existence or frequency of electoral fraud, especially the type of fraud that would be prevented by photo identification laws and signature verification protocols for voting by mail. We propose a new method of measuring election fraud, especially identity fraud, that is superior to previous measurement efforts because it measures actual instances of fraud rather than waiting for conclusive proof of fraud produced in a criminal prosecution. We test our method in multiple jurisdictions, including two known cases of electoral fraud, and we find no additional cases of fraud. We speculate that public access to voting and registration records play an important role in preventing this type of election fraud, suggesting that these practices are perhaps more important than voter ID laws in preventing election fraud.
Side by Side, Worlds Apart
Authors: Mitchell Dona-Gene , Hibbing Matthew V. , Smith Kevin B. , Hibbing John R.
Published: August 2013

The degree to which people desire policy change is a function of two factors: preferences for future policies and perceptions of current policies. Political scientists, pollsters, and pundits know a good deal about people’s policy preferences but surprisingly little about the distance of those preferences from policy perceptions. In this article, we assess the distance between policy perceptions and policy preferences to calculate the amount of policy change desired. The data come from an original survey tapping respondents’ preferred and perceived policies and from those few National Election Surveys where parallel items on policy preferences and perceptions were posed. By incorporating policy perceptions alongside of preferences, our findings provide a better indication of the gulf between the policy change desired by liberals and the policy change desired by conservatives. The findings help explain polarization in the United States where differences in policy preferences alone often do not indicate extreme diversity.
Reduction in Allogeneic Blood Products With Routine Use of Autotransfusion in Open Elective Infrarenal Abdominal Aortic Aneurysm Repair
Authors: Courtemanche Karim , Elkouri Stephane , Dugas Jean-Philippe , Beaudoin Nathalie , Bruneau Luc , Blair Jean-François
Published: August 2013

Background and objectives:

Concern about allogeneic blood product cost and complications has prompted interest in blood conservation techniques. Intraoperative autotransfusion (IAT) is currently not used routinely by vascular surgeons in open elective infrareanl abdominal aortic aneurysm (AAA) repair. The objective of this study is to review our experience with IAT and its impact on blood transfusion.

Methods:

We retrospectively reviewed the medical records of consecutive patients treated electively over a 4-year period and compared 2 strategy related to IAT, routine use IAT (rIAT) versus on-demand IAT (oIAT). Outcomes measured were number of units of allogeneic red blood cells and autologous red blood cells transfused intraoperatively and postoperatively, preoperative, postoperative, and discharge hemoglobin levels; postoperative infections; length of postoperative intensive care stay; and length of hospital stay. T-independent and Fisher exact test were used.

Results:

A total of 212 patients were included, 38 (18%) in the rIAT and 174 (82%) in the oIAT. Groups were similar except for an inferior creatinine and a superior mean aneurysm diameter for the rIAT group. Patients in the rIAT group had a lower rate of transfusion (26% vs 54%, P = .002) and a lower mean number of blood unit transfused (0.8 vs 1.8, P = .048). These findings were still more significant for AAA larger than 60 mm (18% rIAT vs 62% oIAT, P = .0001). Postoperative hemoglobin was superior in the rIAT group (107 vs 101 g/L, P = .01). Mean postoperative intensive care length of stay was shorter for the rIAT group (1.1 vs 1.8 days, P = .01). No difference was noted for infection, mortality, or hospital length of stay.

Conclusion:

The rIAT reduced the exposure to allogeneic blood products by more than 50%, in particular for patients with AAA larger than 60 mm. These results support the use of rIAT for open elective infrarenal AAA repair.
A single-walled carbon nanotube thin film solar microcell with V-groove array structure
Authors: Chang Yiyang , Liu Peng , Zhang Jinwen
Published: August 2013

This article reports an exploratory single-walled carbon nanotube thin film solar microcell with V-groove array structure on Si (100) substrate. Single-walled carbon nanotube thin film–Si heterojunction serves as energy conversion part in solar microcells, including electron–hole pair generation, carrier collection and transportation. V-groove was designed and prepared on silicon substrate by KOH anisotropic wet-etching for improving the performance of solar microcell. Simple solution–evaporation method was used to achieve conformal single-walled carbon nanotube thin film on V-groove silicon substrate. Under 100 mW/cm2 solar illumination, our solar microcell with V-groove arrays shows open-circuit voltage (VOC) of 195 mV, short-circuit current density (JSC) of 4.76 µA/cm2 and fill factor of 24.8%. The VOC and JSC are, respectively, enhanced by 387.5% and 217.3% compared to the microcell without V-groove arrays. It is proved that the V-groove structure can improve the performance of single-walled carbon nanotube thin film solar microcell.
Corneal Langerhans cell and dry eye examinations in ankylosing spondylitis
Authors: Marsovszky László , Németh János , Resch Miklós D , Toldi Gergely , Legány Nóra , Kovács László , Balog Attila
Published: August 2013

APCs of the ocular surface, including corneal Langerhans cells (LCs), offer the opportunity to gain insight into the activity of innate immunity. We examined corneal LCs and dry eye parameters in ankylosing spondylitis (AS). Twenty-four AS patients with varying degrees of disease activity and 24 healthy participants were enrolled. Central and peripheral LC numbers, and Langerhans cell morphology (LCM) were assessed with in vivo laser confocal microscopy. In addition, ocular surface disease index, lid parallel conjunctival folds, tear break up time, and Schirmer test were evaluated. LC densities and central LCM were greater in AS patients than in the controls. Moreover, LCM was significantly greater in patients with higher systemic inflammation according to elevated C-reactive protein (CRP). Also, tear production was greatly suppressed in patients with more severe onset of the systemic inflammation according to the Bath Ankylosing Spondylitis Disease Activity Index and elevated CRP. Greater corneal LC density and LCM in AS may reflect an increased activation state of the innate immune system of the cornea in AS, which correlates with the systemic activity of AS even without ocular symptoms. Nonetheless, higher systemic inflammation might impair tear production, and it might partly explain the dry eye mechanism.
Reinventing Real Estate
Authors: Meehan James
Published: August 2013

The community land trust (CLT) is a social invention designed to solve several problems in land ownership, from affordability to preservation. This article traces the history of the CLT from concept to implementation, through a network of theorists and activists, and discusses the present extent of CLTs in the United States. It concludes with a case study of the Dudley Street Neighborhood Initiative (DSNI), a community development organization in Boston, that has used the CLT model as part of its holistic strategy to redevelop a neighborhood that has suffered from redlining, arson, and abandonment. DSNI is perhaps the only community organization in the United States to have attained the power of eminent domain to acquire land for housing development.
A Fatal Gastrointestinal Hemorrhage From Colonic Mucormycosis After a Short Course of Steroids
Authors: Esolen Lisa M. , Kubilay N. Zeynep , Zhang Xiaohong M. , Layon A. Joseph
Published: August 2013

We discuss a fatal infection with colonic mucormycosis in a patient with short-term corticosteroid use and no other form of immunosuppression. The patient was a 75-year-old woman admitted with an acute respiratory decompensation and bilateral pulmonary infiltrates of unclear etiology. When infectious etiologies were ruled out she was started on high-dose corticosteroids. On hospital day 23, the patient developed lower gastrointestinal bleeding and on colonoscopy she was found to have developed colonic ulcerations. Biopsy of these ulcerations demonstrated fungal forms consistent with invasive gastrointestinal mucormycosis. The patient refused surgery and after 10 days of aggressive antifungal therapy, she expired.
Radical prostatectomy outcomes during prostate-specific antigen era in Ireland compared to a matched American population
Authors: McGuire Barry B , Anglim Breffini , Loeb Stacy , Helfand Brian T , Grainger Ronald , Flynn Robert , McDermott Ted , Hu Qiaoyan , Cooper Phillip R , Fennell Andrew , Catalona William J , Thornhill John
Published: August 2013

Objectives:

To examine temporal trends in clinico-pathological outcomes following radical prostatectomy (RP) in Ireland over time, and perform matched comparison of between Ireland and the USA based upon initiation of prostate-specific antigen (PSA) screening.

Methods:

Between 2000–2010, 651 RPs were carried out at a single institution in Ireland. Clinic-pathologic tumor features were compared to 1302 men treated in the USA from the same time interval (matching on year of diagnosis, 1:2 ratio). As historical comparison, we included a separate group of 150 USA men who underwent RP during the early PSA era (1990–1992).

Results:

We observed a downward migration in biopsy tumor burden ( p=0.002), RP tumor volume ( p<0.001) and pathologic stage ( p=0.001) in Irish men. In comparison to USA men (same interval), Irish patients had higher percentage Gleason 7–10 prostate cancer ( p=0.003), higher median tumor volume (20% versus 8%, p<0.0001), and marginally higher stage disease (pT3 20% versus 16.7%, p=0.06). In comparison to USA men from the early PSA era (1990–1992) Irish men are younger ( p<0.001), have more high-grade disease on both biopsy ( p=0.001) and RP ( p<0.001) specimens. Although there is no significant difference between tumor volumes between both eras, Irish men are more likely to have organ-confined disease ( p=0.02).

Conclusions:

During the past decade of increasing PSA utilization in Ireland, we found evidence of pathological stage migration. In comparison to a USA population, Irish men have worse pathological characteristics, however, in comparison to the early USA PSA era, Irish men are more likely to have organ-confined disease.
Is postoperative epidural analgesia better than patient-controlled analgesia for radical cystectomy?
Authors: Autran Gomez Ana Marie , Clarke Colin , Smith David , Yutkin Vladimir , Alzahrani Ali , Izawa Jonathan I
Published: August 2013

Background:

The purpose of this study was to evaluate postoperative epidural analgesia (EPA) and intravenous patient-controlled analgesia (PCA) in terms of morbidity and mortality in patients undergoing radical cystectomy for bladder cancer.

Methods:

A retrospective study on patients undergoing radical cystectomy for clinical Tis-4N0M0 urothelial carcinoma of the bladder was performed. Patients were separated into two groups: primary EPA or PCA for postoperative analgesia. The surgical complication severity was determined according to the Clavien system. Mann-Whitney U tests, χ2 with Yates’ correction, or Fisher’s exact test were used. Predictive risk factors were explored using univariable and multivariable Cox regression models.

Results:

Of the 274 patients studied, 209 (76%) received EPA and 65 (24%) had PCA. Baseline balance was observed. Similar complication rates were observed between the EPA (36%) and PCA (34%) ( p=0.382). Patients greater than 70 years of age had more complications (35% vs 21%, p=0.002). PCA patients had higher rates of high-grade complications compared with EPA patients [40% vs 20% ( p=0.0007)]. Only age at time of surgery ( p=0.032) was associated with complications. Patients with pulmonary disease had a higher risk of complications ( p=0.001). EPA or PCA were not predictors for overall survival.

Conclusions:

There does not appear to be a significant difference in terms of morbidity or mortality between EPA and PCA following radical cystectomy (RC). Rare, catastrophic complications specific to EPA may occur. Standardized reporting of surgical complications is essential to compare studies and appropriately counsel patients.
Denileukin diftitox (ONTAK) induces a tolerogenic phenotype in dendritic cells and stimulates survival of resting Treg
Authors: Baur Andreas S. , Lutz Manfred B. , Schierer Stephan , Beltrame Luca , Theiner Gabi , Zinser Elisabeth , Ostalecki Christian , Heidkamp Gordon , Haendle Ina , Erdmann Michael , Wiesinger Manuel , Leisgang Waltraud , Gross Stefanie , Pommer Ansgar J. , Kämpgen Eckhart , Dudziak Diana , Steinkasserer Alexander , Cavalieri Duccio , Schuler-Thurner Beatrice , Schuler Gerold
Published: August 2013

Key Points

ONTAK blocks DC maturation by coreceptor downmodulation and inhibition of Stat3 phosphorylation to induce a tolerogenic phenotype. ONTAK kills activated CD4 T cells but stimulates antiapoptosis in resting Treg by engagement and stimulation through CD25.
Comprehensive mutational profiling in advanced systemic mastocytosis
Authors: Schwaab Juliana , Schnittger Susanne , Sotlar Karl , Walz Christoph , Fabarius Alice , Pfirrmann Markus , Kohlmann Alexander , Grossmann Vera , Meggendorfer Manja , Horny Hans-Peter , Valent Peter , Jawhar Mohamad , Teichmann Martina , Metzgeroth Georgia , Erben Philipp , Ernst Thomas , Hochhaus Andreas , Haferlach Torsten , Hofmann Wolf-Karsten , Cross Nicholas C. P. , Reiter Andreas
Published: August 2013

Key Points

Additional genetic aberrations apart from KIT D816V are found in advanced systemic mastocytosis. Additional genetic aberrations apart from KIT D816V are associated with a significant reduction of overall survival.
Complete mitogenome sequences of four flatfishes (Pleuronectiformes) reveal a novel gene arrangement of L-strand coding genes
Authors: Shi Wei , Dong Xiao-Li , Wang Zhong-Ming , Miao Xian-Guang , Wang Shu-Ying , Kong Xiao-Yu
Published: August 2013

Background

Few mitochondrial gene rearrangements are found in vertebrates and large-scale changes in these genomes occur even less frequently. It is difficult, therefore, to propose a mechanism to account for observed changes in mitogenome structure. Mitochondrial gene rearrangements are usually explained by the recombination model or tandem duplication and random loss model.

Results

In this study, the complete mitochondrial genomes of four flatfishes, Crossorhombus azureus (blue flounder), Grammatobothus krempfi, Pleuronichthys cornutus, and Platichthys stellatus were determined. A striking finding is that eight genes in the C. azureus mitogenome are located in a novel position, differing from that of available vertebrate mitogenomes. Specifically, the ND6 and seven tRNA genes (the Q, A, C, Y, S

1

, E, P genes) encoded by the L-strand have been translocated to a position between tRNA-T and tRNA-F though the original order of the genes is maintained.

Conclusions

These special features are used to suggest a mechanism for C. azureus mitogenome rearrangement. First, a dimeric molecule was formed by two monomers linked head-to-tail, then one of the two sets of promoters lost function and the genes controlled by the disabled promoters became pseudogenes, non-coding sequences, and even were lost from the genome. This study provides a new gene-rearrangement model that accounts for the events of gene-rearrangement in a vertebrate mitogenome.
Molecular signatures of mammalian hibernation: comparisons with alternative phenotypes
Authors: Xu Yichi , Shao Chunxuan , Fedorov Vadim B , Goropashnaya Anna V , Barnes Brian M , Yan Jun
Published: August 2013

Background

Mammalian hibernators display phenotypes similar to physiological responses to calorie restriction and fasting, sleep, cold exposure, and ischemia-reperfusion in non-hibernating species. Whether biochemical changes evident during hibernation have parallels in non-hibernating systems on molecular and genetic levels is unclear.

Results

We identified the molecular signatures of torpor and arousal episodes during hibernation using a custom-designed microarray for the Arctic ground squirrel (Urocitellus parryii) and compared them with molecular signatures of selected mouse phenotypes. Our results indicate that differential gene expression related to metabolism during hibernation is associated with that during calorie restriction and that the nuclear receptor protein PPARα is potentially crucial for metabolic remodeling in torpor. Sleep-wake cycle-related and temperature response genes follow the same expression changes as during the torpor-arousal cycle. Increased fatty acid metabolism occurs during hibernation but not during ischemia-reperfusion injury in mice and, thus, might contribute to protection against ischemia-reperfusion during hibernation.

Conclusions

In this study, we systematically compared hibernation with alternative phenotypes to reveal novel mechanisms that might be used therapeutically in human pathological conditions.