bluuebunny/crossref_metadata_2025 huggingface dataset:
Complete Expulsion of Testicular Prosthesis via the Scrotum: A Case-Based Review of the Preventive Surgical Strategies
Authors: Donati-Bourne Jack , Deb A. , Jay Mathias Suresh , Fraser Saxby Mark , Fernando Herman
Published: June 2015

Testicular prostheses are regularly used in urological surgery and are important for postoperative psychological well-being in many patients undergoing orchiectomy. One of the recognised complications of this procedure is graft extrusion, which can result in significant morbidity for patients and require operative reintervention. Whilst most cases of extrusion involve upward graft migration to the external inguinal ring or direct displacement through the scrotal skin, we present an unusual case of complete expulsion of testicular implant three weeks postoperatively through a previously healthy scrotum. During surgical insertion of testicular prostheses, the urological surgeon must carefully consider the different surgical strategies at each step of the operation to prevent future extrusion of the graft. A stepwise review of the preventive surgical strategies to reduce the risk of graft extrusion encompasses the choice of optimal surgical incision, the technique of dissection to create the receiving anatomical pouch, the method of fixation of the implant within the receiving hemiscrotum, and the adoption of good postoperative care measures in line with the principles of sound scrotal surgery.
Nanofibrillated Cellulose and Copper Nanoparticles Embedded in Polyvinyl Alcohol Films for Antimicrobial Applications
Authors: Zhong Tuhua , Oporto Gloria S. , Jaczynski Jacek , Jiang Changle
Published: June 2015

Our long-term goal is to develop a hybrid cellulose-copper nanoparticle material as a functional nanofiller to be incorporated in thermoplastic resins for efficiently improving their antimicrobial properties. In this study, copper nanoparticles were first synthesized through chemical reduction of cupric ions on TEMPO nanofibrillated cellulose (TNFC) template using borohydride as a copper reducing agent. The resulting hybrid material was embedded into a polyvinyl alcohol (PVA) matrix using a solvent casting method. The morphology of TNFC-copper nanoparticles was analyzed by transmission electron microscopy (TEM); spherical copper nanoparticles with average size of 9.2 ± 2.0 nm were determined. Thermogravimetric analysis and antimicrobial performance of the films were evaluated. Slight variations in thermal properties between the nanocomposite films and PVA resin were observed. Antimicrobial analysis demonstrated that one-week exposure of nonpathogenicEscherichia coliDH5αto the nanocomposite films results in up to 5-log microbial reduction.
Triaxial Accelerometer Error Coefficients Identification with a Novel Artificial Fish Swarm Algorithm
Authors: Gao Yanbin , Guan Lianwu , Wang Tingjun
Published: June 2015

Artificial fish swarm algorithm (AFSA) is one of the state-of-the-art swarm intelligence techniques, which is widely utilized for optimization purposes. Triaxial accelerometer error coefficients are relatively unstable with the environmental disturbances and aging of the instrument. Therefore, identifying triaxial accelerometer error coefficients accurately and being with lower costs are of great importance to improve the overall performance of triaxial accelerometer-based strapdown inertial navigation system (SINS). In this study, a novel artificial fish swarm algorithm (NAFSA) that eliminated the demerits (lack of using artificial fishes’ previous experiences, lack of existing balance between exploration and exploitation, and high computational cost) of AFSA is introduced at first. In NAFSA, functional behaviors and overall procedure of AFSA have been improved with some parameters variations. Second, a hybrid accelerometer error coefficients identification algorithm has been proposed based on NAFSA and Monte Carlo simulation (MCS) approaches. This combination leads to maximum utilization of the involved approaches for triaxial accelerometer error coefficients identification. Furthermore, the NAFSA-identified coefficients are testified with 24-position verification experiment and triaxial accelerometer-based SINS navigation experiment. The priorities of MCS-NAFSA are compared with that of conventional calibration method and optimal AFSA. Finally, both experiments results demonstrate high efficiency of MCS-NAFSA on triaxial accelerometer error coefficients identification.
Human Umbilical Cord Mesenchymal Stem Cells: A New Therapeutic Option for Tooth Regeneration
Authors: Chen Yuanwei , Yu Yongchun , Chen Lin , Ye Lanfeng , Cui Junhui , Sun Quan , Li Kaide , Li Zhiyong , Liu Lei
Published: June 2015

Tooth regeneration is considered to be an optimistic approach to replace current treatments for tooth loss. It is important to determine the most suitable seed cells for tooth regeneration. Recently, human umbilical cord mesenchymal stem cells (hUCMSCs) have been regarded as a promising candidate for tissue regeneration. However, it has not been reported whether hUCMSCs can be employed in tooth regeneration. Here, we report that hUCMSCs can be induced into odontoblast-like cellsin vitroandin vivo. Induced hUCMSCs expressed dentin-related proteins including dentin sialoprotein (DSP) and dentin matrix protein-1 (DMP-1), and their gene expression levels were similar to those in native pulp tissue cells. Moreover, DSP- and DMP-1-positive calcifications were observed after implantation of hUCMSCsin vivo. These findings reveal that hUCMSCs have an odontogenic differentiation potency to differentiate to odontoblast-like cells with characteristic deposition of dentin-like matrixin vivo. This study clearly demonstrates hUCMSCs as an alternative therapeutic cell source for tooth regeneration.
Analysis and Implementation of Kidney Stone Detection by Reaction Diffusion Level Set Segmentation Using Xilinx System Generator on FPGA
Authors: Viswanath Kalannagari , Gunasundari Ramalingam
Published: June 2015

Ultrasound imaging is one of the available imaging techniques used for diagnosis of kidney abnormalities, which may be like change in shape and position and swelling of limb; there are also other Kidney abnormalities such as formation of stones, cysts, blockage of urine, congenital anomalies, and cancerous cells. During surgical processes it is vital to recognize the true and precise location of kidney stone. The detection of kidney stones using ultrasound imaging is a highly challenging task as they are of low contrast and contain speckle noise. This challenge is overcome by employing suitable image processing techniques. The ultrasound image is first preprocessed to get rid of speckle noise using the image restoration process. The restored image is smoothened using Gabor filter and the subsequent image is enhanced by histogram equalization. The preprocessed image is achieved with level set segmentation to detect the stone region. Segmentation process is employed twice for getting better results; first to segment kidney portion and then to segment the stone portion, respectively. In this work, the level set segmentation uses two terms, namely, momentum and resilient propagation (Rprop) to detect the stone portion. After segmentation, the extracted region of the kidney stone is given to Symlets, Biorthogonal (bio3.7, bio3.9, and bio4.4), and Daubechies lifting scheme wavelet subbands to extract energy levels. These energy levels provide evidence about presence of stone, by comparing them with that of the normal energy levels. They are trained by multilayer perceptron (MLP) and back propagation (BP) ANN to classify and its type of stone with an accuracy of 98.8%. The prosed work is designed and real time is implemented on both Filed Programmable Gate Array Vertex-2Pro FPGA using Xilinx System Generator (XSG) Verilog and Matlab 2012a.
Slip Effects on Peristaltic Transport of a Particle-Fluid Suspension in a Planar Channel
Authors: Kamel Mohammed H. , Eldesoky Islam M. , Maher Bilal M. , Abumandour Ramzy M.
Published: June 2015

Peristaltic pumping induced by a sinusoidal traveling wave in the walls of a two-dimensional channel filled with a viscous incompressible fluid mixed with rigid spherical particles is investigated theoretically taking the slip effect on the wall into account. A perturbation solution is obtained which satisfies the momentum equations for the case in which amplitude ratio (wave amplitude/channel half width) is small. The analysis has been carried out by duly accounting for the nonlinear convective acceleration terms and the slip condition for the fluid part on the wavy wall. The governing equations are developed up to the second order of the amplitude ratio. The zeroth-order terms yield the Poiseuille flow and the first-order terms give the Orr-Sommerfeld equation. The results show that the slip conditions have significant effect within certain range of concentration. The phenomenon of reflux (the mean flow reversal) is discussed under slip conditions. It is found that the critical reflux pressure is lower for the particle-fluid suspension than for the particle-free fluid and is affected by slip condition. A motivation of the present analysis has been the hope that such theory of two-phase flow process under slip condition is very useful in understanding the role of peristaltic muscular contraction in transporting biofluid behaving like a particle-fluid mixture. Also the theory is important to the engineering applications of pumping solid-fluid mixture by peristalsis.
Comparative Study of Metaheuristics for the Curve-Fitting Problem: Modeling Neurotransmitter Diffusion and Synaptic Receptor Activation
Authors: Montes Jesús , LaTorre Antonio , Muelas Santiago , Merchán-Pérez Ángel , Peña José M.
Published: June 2015

Synapses are key elements in the information transmission in the nervous system. Among the different approaches to study them, the use of computational simulations is identified as the most promising technique. Simulations, however, do not provide generalized models of the underlying biochemical phenomena, but a set of observations, or time-series curves, displaying the behavior of the synapse in the scenario represented. Finding a general model of these curves, like a set of mathematical equations, could be an achievement in the study of synaptic behavior. In this paper, we propose an exploratory analysis in which selected curve models are proposed, and state-of-the-art metaheuristics are used and compared to fit the free coefficients of these curves to the data obtained from simulations. Experimental results demonstrate that several models can fit these data, though a deeper analysis from a biological perspective reveals that some are better suited for this purpose, as they represent more accurately the biological process. Based on the results of this analysis, we propose a set of mathematical equations and a methodology, adequate for modeling several aspects of biochemical synaptic behavior.
Polymer Adsorption on Iron Oxide Nanoparticles for One‐Step Amino‐Functionalized Silica Encapsulation
Authors: Maurizi Lionel , Claveau Alexis , Hofmann Heinrich
Published: June 2015

This paper presents an original method to obtain, in one step, core/shell nanoparticles grafted covalently with polymer and functionalized with amino groups. By combining polyvinyl alcohol (PVA) and silica precursors, we were able to obtain silica‐coated and amino‐functionalized iron oxide nanoparticles (SPIONs) cross‐linked with PVA. We also showed that using silica and amino‐silica precursors together significantly increased the amount of PVA covalently bonded to the SPION surface compared to using only silica precursors. This original and interesting method has high potential for the industrial development of biocompatible functionalized nanoparticles for targeting nanomedicine.
A Novel Device to Exploit the Smartphone Camera for Fundus Photography
Authors: Russo Andrea , Morescalchi Francesco , Costagliola Ciro , Delcassi Luisa , Semeraro Francesco
Published: June 2015

Purpose. To construct an inexpensive, convenient, and portable attachment for smartphones for the acquisition of still and live retinal images.Methods. A small optical device based on the principle of direct ophthalmoscopy was designed to be magnetically attached to a smartphone. Representative images of normal and pathological fundi were taken with the device.Results. A field-of-view up to ~20° was captured at a clinical resolution for each fundus image. The cross-polarization technique adopted in the optical design dramatically diminished corneal Purkinje reflections, making it possible to screen patients even through undilated pupils. Light emission proved to be well within safety limits.Conclusions. This optical attachment is a promising, inexpensive, and valuable alternative to the direct ophthalmoscope, potentially eliminating problems of poor exam skills and inexperienced observer bias. Its portability, together with the wireless connectivity of smartphones, presents a promising platform for screening and telemedicine in nonhospital settings.Translational Relevance. Smartphones have the potential to acquire retinal imaging for a portable ophthalmoscopy.
Global Scheduling Heuristics for Multicore Architecture
Authors: Kiran D. C. , Gurunarayanan S. , Misra Janardan Prasad , Nawal Abhijeet
Published: June 2015

This work discusses various compiler level global scheduling techniques for multicore processors. The main contribution of the work is to delegate the job of exploiting fine grained parallelism to the compiler, thereby reducing the hardware overhead and the programming complexity. This goal is achieved by decomposing a sequential program into multiple subblocks and constructing subblock dependency graph (SDG). The proposed schedulers select subblocks from the SDG and schedules it on different cores, by ensuring the correct order of execution of subblocks. In conjunction with parallelization techniques, locality optimizations are performed to minimize communication overhead between the cores. The results observed are indicative of better and balanced speed-up per watt.
Thermoregulatory Responses to Graded Exercise Differ among Sasang Types
Authors: Pham Duong Duc , Lee Jeong Hoon , Park Eun Seok , Baek Hyun Sung , Kim Ga Yul , Lee Young Boum , Ku BonCho , Kim Jong Yeol , Leem Chae Hun
Published: June 2015

We compared sweat rate and variables such as workload (We), metabolic heat production (Hprod), and temperature increment load (Tinc) across Sasang types. 304 apparently healthy participants aged 20–49 years with their Sasang type determined were enrolled. Local sweat rates on the chest (LSRchest) and back (LSRback) were measured using a perspiration meter during a maximum treadmill exercise test. Oxygen uptake was measured continuously using a breath-by-breath mode indirect calorimeter. The TaeEum (TE) type had a larger body size, a higher percent body fat, and a lower body area surface area (BSA) to body mass compared with the other Sasang types, particularly the SoEum (SE) type. The TE type tended to have a shorter exercise time to exhaustion and lower maximal oxygen uptake (mL·kg−1·min−1) than the other types.LSRchestin TE types was greater than that of the SE and SoYang (SY) types in men, whereasLSRbackwas higher in the TE type than that of the other types in women. After normalizing LSR forWe,Hprod,Tinc, and BSA, this tendency still remained. Our findings suggest that the thermoregulatory response to graded exercise may differ across Sasang types such that the TE type was the most susceptible to heat stress.
Management of Second Trimester Fetal Demise in a Noncommunicating Uterine Horn
Authors: Hillman R. Tyler , Chin Homer G. , Mody Sheila K.
Published: June 2015

Müllerian anomalies are uncommon but when present they can increase the risk of obstetrical complications. Anomalies such as bicornuate and unicornuate uterus can also increase the surgical risks of pregnancy termination. The diagnostic approach and surgical management must be individualized for each patient so that the termination procedure is safe and preserves fertility. We present a case of a patient with a 17-week pregnancy with fetal demise in a noncommunicating right uterine horn. Laparotomy and hysterotomy were required for evacuation of the fetus. The use of appropriate imaging studies to diagnose suspected uterine anomalies and a flexible and individualized operative strategy are essential for reducing complications associated with the termination of abnormal or unintended pregnancies in women with Müllerian anomalies.
Association between Body Mass Index and Mortality for Colorectal Cancer Survivors: Overall and by Tumor Molecular Phenotype
Authors: Campbell Peter T. , Newton Christina C. , Newcomb Polly A. , Phipps Amanda I. , Ahnen Dennis J. , Baron John A. , Buchanan Daniel D. , Casey Graham , Cleary Sean P. , Cotterchio Michelle , Farris Alton B. , Figueiredo Jane C. , Gallinger Steven , Green Roger C. , Haile Robert W. , Hopper John L. , Jenkins Mark A. , Le Marchand Loïc , Makar Karen W. , McLaughlin John R. , Potter John D. , Renehan Andrew G. , Sinicrope Frank A. , Thibodeau Stephen N. , Ulrich Cornelia M. , Win Aung Ko , Lindor Noralane M. , Limburg Paul J.
Published: June 2015

Background: Microsatellite instability (MSI) and BRAF mutation status are associated with colorectal cancer survival, whereas the role of body mass index (BMI) is less clear. We evaluated the association between BMI and colorectal cancer survival, overall and by strata of MSI, BRAF mutation, sex, and other factors.

Methods: This study included 5,615 men and women diagnosed with invasive colorectal cancer who were followed for mortality (maximum: 14.7 years; mean: 5.9 years). Prediagnosis BMI was derived from self-reported weight approximately one year before diagnosis and height. Tumor MSI and BRAF mutation status were available for 4,131 and 4,414 persons, respectively. Multivariable hazard ratios (HR) and 95% confidence intervals (CI) were estimated from delayed-entry Cox proportional hazards models.

Results: In multivariable models, high prediagnosis BMI was associated with higher risk of all-cause mortality in both sexes (per 5-kg/m2; HR, 1.10; 95% CI, 1.06–1.15), with similar associations stratified by sex (Pinteraction: 0.41), colon versus rectum (Pinteraction: 0.86), MSI status (Pinteraction: 0.84), and BRAF mutation status (Pinteraction: 0.28). In joint models, with MS-stable/MSI-low and normal BMI as the reference group, risk of death was higher for MS-stable/MSI-low and obese BMI (HR, 1.32; P value: 0.0002), not statistically significantly lower for MSI-high and normal BMI (HR, 0.86; P value: 0.29), and approximately the same for MSI-high and obese BMI (HR, 1.00; P value: 0.98).

Conclusions: High prediagnosis BMI was associated with increased mortality; this association was consistent across participant subgroups, including strata of tumor molecular phenotype.

Impact: High BMI may attenuate the survival benefit otherwise observed with MSI-high tumors. Cancer Epidemiol Biomarkers Prev; 24(8); 1229–38. ©2015 AACR.
Histone Deacetylase Inhibitor Entinostat Inhibits Tumor-Initiating Cells in Triple-Negative Breast Cancer Cells
Authors: Schech Amanda , Kazi Armina , Yu Stephen , Shah Preeti , Sabnis Gauri
Published: June 2015

Mortality following breast cancer diagnosis is mainly due to the development of distant metastasis. To escape from the primary site, tumor cells undergo the epithelial-to-mesenchymal transition (EMT), which helps them acquire a more motile and invasive phenotype. In our previous study, we showed that class I selective HDAC inhibitor entinostat reverses the EMT phenotype through reversal of epigenetic repression of E-cadherin. Recent evidence suggests that a subset of cells within a breast tumor may drive the metastatic outgrowth following escape from the primary site. These cells, termed tumor-initiating cells (TIC), represent a great threat to overall prognosis. They are critical in terms of drug resistance and tumor initiation at metastatic sites. Acquisition of EMT traits has also been shown to impart TIC phenotype to the cells, making EMT a “dual-threat” for prognosis. In the current study, we show that entinostat treatment can reduce the percentage of TIC cells from triple-negative breast cancer (TNBC) cells. Entinostat treatment was able to reduce the CD44high/CD24low cell population, ALDH-1 activity, as well as protein and mRNA expression of known TIC markers such as Bmi-1, Nanog, and Oct-4. Next, we inoculated MDA-MB-231 cells transfected with firefly luciferase (231/Luc) in mammary fat pad of NSG mice. The mice were then treated with entinostat (2.5 mg/kg/d), and tumor development and formation of metastasis were assessed by bioluminescence imaging. Treatment with entinostat significantly reduced tumor formation at the primary site as well as lung metastasis. As such, entinostat may help prevent development of distant metastasis. Mol Cancer Ther; 14(8); 1848–57. ©2015 AACR.
Nonvisualization of the Fetal Gallbladder: Can Levels of γ-Glutamyl Transpeptidase in Amniotic Fluid Predict Fetal Prognosisγ
Authors: Bardin Ron , Ashwal Eran , Davidov Bella , Danon David , Shohat Mordechai , Meizner Israel
Published: June 2015

Objective: In cases of nonvisualization of the fetal gallbladder (NVFGB), we investigated whether amniotic fluid levels of γ-glutamyl transpeptidase (GGTP) can distinguish normal development or benign gallbladder agenesis from severe anomaly such as biliary atresia. Methods: This is a retrospective cohort study of pregnancies in which the gallbladder was not visualized in the second-trimester fetal anatomy scan. Levels of GGTP in amniotic fluid were analyzed prior to 22 weeks of gestation by amniocentesis. Data were collected regarding other fetal malformations, fetal karyotype, and screening results for cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations. Results: Of 32 cases of NVFGB, 27 (84%) had normal GGTP levels and a normal CFTR gene screening, and 1 of them had an abnormal karyotype. Three of the 5 cases with low GGTP were diagnosed with extrahepatic biliary atresia, proven by histopathological examination following termination of pregnancy. The fourth case had hepatic vasculature abnormality and the fifth isolated gallbladder agenesis. In 22 of 32 cases (68.7%), the gallbladder was detected either later in pregnancy or after delivery. Conclusion: The findings support low levels of GGTP in amniotic fluid, combined with NVFGB, as a sign of severe disease, mainly biliary atresia. Normal GGTP levels, concomitant with isolated NVFGB, carry a good prognosis.
Prospective Randomized Long-Term Study on the Efficacy and Safety of UV-Free Blue Light for Treating Mild Psoriasis Vulgaris
Authors: Pfaff Stephanie , Liebmann Jörg , Born Matthias , Merk Hans F. , von Felbert Verena
Published: June 2015

Background: Blue light irradiation reduces the proliferation of keratinocytes and modulates T-cell immune response in vitro and has been shown to reduce the severity of psoriasis vulgaris (Pv) in two clinical trials. Objective: Evaluation of safety and efficacy of long-term UV-free blue light treatment at home for mild Pv. Methods: Forty-seven patients with mild Pv were randomized for receiving high-intensity blue light treatment (HI: 453 nm LED, 200 mW/cm2, n = 24) and low-intensity treatment (LI: 453 nm LED, 100 mW/cm2, n = 23) of one Pv plaque for 12 weeks. A contralateral control plaque remained untreated. Results: Patient compliance and satisfaction were high. The primary endpoint, change from baseline (CfB) of the Local Psoriasis Severity Index, revealed a significant improvement of the target compared to the control plaques (ΔCfB for the HI group: -0.92 ± 1.10, p = 0.0005; for the LI group: -0.74 ± 1.18, p = 0.0064). Conclusion: UV-free blue light home treatment is safe and improves Pv plaques.
Integrating a Web-Based Whole-Slide Imaging System and Online Questionnaires in a National Cytopathology Peer Comparison Educational Program in Taiwan
Authors: Hang Jen-Fan , Liang Wen-Yih , Hsu Chih-Yi , Lai Chiung-Ru
Published: June 2015

Objective: In a peer comparison educational program, transferring glass slides between laboratories and collecting responses are time- and cost-consuming. Integrating a web-based whole-slide imaging (WSI) system and online questionnaires may serve as a promising solution. Study Design: Five gynecologic Papanicolaou-stained smears and 5 nongynecologic slides were selected. The 10 whole-slide images were acquired by a Leica SCN-400 system and released via an Aperio eSlide Manager. Online questionnaires generated by Google Forms with access to the 10 whole-slide images were released to all the practitioners in Taiwan by e-mail. After closing the program, an online posttest feedback survey was conducted. Results: A total of 302 participants joined the gynecologic test, and 291 joined the nongynecologic test. The correct interpretation rates were 81.8-93.7% in the former and 28.5-93.1% in the latter. In the posttest feedback survey, there were 63.2% of the participants reporting first-time WSI experience, and 97.9% of them said they would like to participate in a similar program again. Conclusion: Integrating a web-based WSI system and online questionnaires is an easy method to access nationwide practitioners. Participants can make interpretations using WSI even without prior experience. The model is valuable for those who want to initiate a large-scale cytopathology peer comparison educational program.
Hypothermic Machine Perfusion in DCD Kidney Transplantation: A Single Center Experience
Authors: Yao Liyu , Zhou Honglan , Wang Yuantao , Wang Gang , Wang Weigang , Chen Mo , Zhang Kun , Fu Yaowen
Published: June 2015

Introduction: Donation after cardiac death (DCD) began in 2011 after the program hosted by the First Affiliated Hospital of Sun Yat-sen University in China. The aim of this study is to report on our experience regarding the method of preserving donated kidneys for DCD kidney transplantation. Material and Methods: A total of 37 donors and 73 primary kidney transplant recipients during the period 2011-2014 in the Urology Center of the First Hospital of Jilin University were enrolled in the study. Recipients were assigned to traditional static cold storage (SCS) group and hypothermic machine perfusion (HMP) group based on the preservation environment of donated kidneys after organ harvest. Clinical data were collected for each group. Result: The HMP group had a lower rate of delayed graft function (DGF), better postoperative recovery and kidney function compared with that of SCS group. There is no significant difference in postoperative rejection incidence between the 2 groups. Conclusions: DCD kidneys stored by hypothermic machine contribute to a lower rate of DGF and promoted the rehabilitation progress.
Long-Term Outcomes With Cardiac Resynchronization Therapy in Patients With Mild Heart Failure With Moderate Renal Dysfunction
Authors: Daimee Usama A. , Moss Arthur J. , Biton Yitschak , Solomon Scott D. , Klein Helmut U. , McNitt Scott , Polonsky Bronislava , Zareba Wojciech , Goldenberg Ilan , Kutyifa Valentina
Published: June 2015

Background—

We aimed to determine the impact of renal function on long-term outcomes with cardiac resynchronization therapy with defibrillator among patients with mild heart failure (HF).

Methods and Results—

We stratified 1820 Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy patients by QRS morphology into those with and without left bundle-branch block. Subgroups within each QRS morphology category were created based on glomerular filtration rate (GFR): GFR <60 and ≥60 mL/min per 1.73 m
2
. Primary end point was death; secondary end points were HF/death and HF events alone during long-term follow-up. Among 1274 left bundle-branch block patients, 413 (32%) presented with GFR <60 (mean, 48.1±8.3) mL/min per 1.73 m
2
. Relative to the 861 (68%) patients with GFR ≥60 (mean, 79.6±16.0) mL/min per 1.73 m
2
, low-GFR patients experienced higher risk of death (hazard ratio [HR], 2.09; 95% confidence interval [CI], 1.53–2.86;
P
<0.01) and HF/death (HR, 1.46; 95% CI, 1.17–1.82;
P
<0.01). In both GFR groups, cardiac resynchronization therapy with defibrillator was associated with reduction in death (GFR <60: HR, 0.66; 95% CI, 0.44–1.00;
P
=0.05 and GFR ≥60: HR, 0.68; 95% CI, 0.44–1.05;
P
=0.08) and HF/death (GFR <60: HR, 0.49; 95% CI, 0.36–0.67;
P
<0.01 and GFR ≥60: HR, 0.50; 95% CI, 0.38–0.66;
P
<0.01). In the low-GFR group, there was greater absolute reduction in risk of death (GFR <60: 14% and GFR ≥60: 6%) and HF/death (GFR <60: 25 and GFR ≥60: 15%). Among non–left bundle-branch block patients, low GFR predicted outcomes; however, no benefit from cardiac resynchronization therapy with defibrillator was observed.

Conclusions—

In patients with mild HF, moderate renal dysfunction is associated with higher risk of death and HF during long-term follow-up. Patients with left bundle-branch block, regardless of baseline renal function, derive long-term benefit from cardiac resynchronization therapy with defibrillator, with greater absolute risk reduction in death and HF among those with moderate renal dysfunction.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifiers: NCT00180271, NCT01294449, and NCT02060110.
Characterization of Right Ventricular Remodeling in Pulmonary Hypertension Associated With Patient Outcomes by 3-Dimensional Wall Motion Tracking Echocardiography
Authors: Ryo Keiko , Goda Akiko , Onishi Tetsuari , Delgado-Montero Antonia , Tayal Bhupendar , Champion Hunter C. , Simon Marc A. , Mathier Michael A. , Gladwin Mark T. , Gorcsan John
Published: June 2015

Background—

Adverse right ventricular (RV) remodeling has significant prognostic and therapeutic implications to patients with pulmonary hypertension (PH). However, differentiating RV adaption from adverse remodeling associated with poor outcomes is difficult. We hypothesized that novel 3-dimensional (3D) wall motion tracking echocardiography can differentiate morphological features of RV adaption from adverse remodeling heralding an unfavorable short-term prognosis in patients with PH.

Methods and Results—

We studied 112 subjects: 92 patients with PH and 20 normal controls with 3D wall motion tracking for RV end-systolic volume index (ESVi), RV ejection fraction (EF), and RV global area strain. Patients with PH also had invasive hemodynamic measurements. Pressure–volume relations classified patients with PH into 3 groups, such as RV adapted, RV adapted–remodeled, and RV adverse–remodeled. The predefined combined end point was PH-related hospitalization, death, or lung surgery (lung transplantation or pulmonary endarterectomy) during 6 months. The 92 patients with PH had significantly larger RV volumes, lower RVEF and global area strain than normal controls as expected. Patients with PH classified as RV adapted (ESVi,
≤
72 mL/m
2
) had a more favorable clinical outcome than those classified as RV adapted–remodeled (ESVi, 73–113 mL/m
2
) or RV adverse–remodeled (ESVi,
≥
114 mL/m
2
): hazard ratio, 0.15; 95% confidence intervals, 0.07 to 0.39;
P
<0.0001. RV adverse–remodeled patients (ESVi,
≥
114 mL/m
2
) had worse short-term outcome than the RV adapted–remodeled patients: hazard ratio, 2.2; 95% confidence interval, 0.91 to 5.39;
P
=0.04.

Conclusions—

Quantitative 3D echocardiography in patients with PH demonstrated morphological subsets of RV adaption and remodeling associated with clinical outcomes.
Early Medication Nonadherence After Acute Myocardial Infarction
Authors: Mathews Robin , Peterson Eric D. , Honeycutt Emily , Chin Chee Tang , Effron Mark B. , Zettler Marjorie , Fonarow Gregg C. , Henry Timothy D. , Wang Tracy Y.
Published: June 2015

Background—

Nonadherence to prescribed evidence-based medications after acute myocardial infarction (MI) can contribute to worse outcomes and higher costs. We sought to better understand the modifiable factors contributing to early nonadherence of evidence-based medications after acute MI.

Methods and Results—

We assessed 7425 acute MI patients treated with percutaneous coronary intervention at 216 US hospitals participating in TReatment with ADP receptor iNhibitorS: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome (TRANSLATE-ACS) between April 2010 and May 2012. Using the validated Morisky instrument to assess cardiovascular medication adherence at 6 weeks post MI, we stratified patients into self-reported high (score, 8), moderate (score, 6–7), and low (score, <6) adherence groups. Moderate and low adherence was reported in 25% and 4% of patients, respectively. One third of low adherence patients described missing doses of antiplatelet therapy at least twice a week after percutaneous coronary intervention. Signs of depression and patient-reported financial hardship because of medication expenses were independently associated with a higher likelihood of medication nonadherence. Patients were more likely to be adherent at 6 weeks if they had follow-up appointments made before discharge and had a provider explain potential side effects of their medications. Lower medication adherence may be associated with a higher risk of 3-month death/readmission (adjusted hazard ratio, 1.35; 95% confidence interval, 0.98–1.87) although this did not reach statistical significance.

Conclusions—

Even early after MI, a substantial proportion of patients report suboptimal adherence to prescribed medications. Tailored patient education and pre discharge planning may represent actionable opportunities to optimize patient adherence and clinical outcomes.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01088503.
Age and Sex Differences in Long‐Term Outcomes Following Implantable Cardioverter‐Defibrillator Placement in Contemporary Clinical Practice: Findings From the Cardiovascular Research Network
Authors: Masoudi Frederick A. , Go Alan S. , Magid David J. , Cassidy‐Bushrow Andrea E. , Gurwitz Jerry H. , Liu Taylor I. , Reynolds Kristi , Smith David H. , Reifler Liza M. , Glenn Karen A. , Fiocchi Frances , Goldberg Robert , Gupta Nigel , Peterson Pamela N. , Schuger Claudio , Vidaillet Humberto , Hammill Stephen C. , Greenlee Robert T.
Published: June 2015

Background

Patient sex and age may influence rates of death after receiving an implantable cardioverter‐defibrillator for primary prevention. Differences in outcomes other than mortality and whether these differences vary by heart failure symptoms, etiology, and left ventricular ejection fraction are not well characterized.

Methods and Results

We studied 2954 patients with left ventricular ejection fraction ≤0.35 undergoing first‐time implantable cardioverter‐defibrillator for primary prevention within the Cardiovascular Research Network; 769 patients (26%) were women, and 2827 (62%) were aged >65 years. In a median follow‐up of 2.4 years, outcome rates per 1000 patient‐years were 109 for death, 438 for hospitalization, and 111 for heart failure hospitalizations. Procedure‐related complications occurred in 8.36%. In multivariable models, women had significantly lower risks of death (hazard ratio 0.67, 95%
CI
0.56 to 0.80) and heart failure hospitalization (hazard ratio 0.82, 95% CI 0.68 to 0.98) and higher risks for complications (hazard ratio 1.38, 95% CI 1.01 to 1.90) than men; patients aged >65 years had higher risks of death (hazard ratio 1.55, 95% CI 1.30 to 1.86) and heart failure hospitalization (hazard ratio 1.25, 95% CI 1.05 to 1.49) than younger patients. Age and sex differences were generally consistent in strata according to symptoms, etiology, and severity of left ventricular systolic dysfunction, except the higher risk of complications in women, which differed by New York Heart Association classification (
P
=0.03 for sex–New York Heart Association interaction), and the risk of heart failure hospitalization in older patients, which differed by etiology of heart failure (
P
=0.05 for age–etiology interaction).

Conclusions

The burden of adverse outcomes after receipt of an implantable cardioverter‐defibrillator for primary prevention is substantial and varies according to patient age and sex. These differences in outcome generally do not vary according to baseline heart failure characteristics.
Marked Regional Variation in Acute Stroke Treatment Among Medicare Beneficiaries
Authors: Skolarus Lesli E. , Meurer William J. , Shanmugasundaram Krithika , Adelman Eric E. , Scott Phillip A. , Burke James F.
Published: June 2015

Background and Purpose—

Little is known about how regions vary in their use of thrombolysis (intravenous tissue-type plasminogen activator and intra-arterial treatment) for acute stroke. We sought to determine regional variation in thrombolysis treatment and investigate the extent to which regional variation is accounted for by patient demographics, regional factors, and elements of stroke systems of care.

Methods—

Retrospective cross-sectional study of all fee-for-service Medicare patients with ischemic stroke admitted via the Emergency Department from 2007 to 2010 who were assigned to 1 of 3436 hospital service areas. Multilevel logistic regression was used to estimate regional thrombolysis rates, determine the variation in thrombolysis treatment attributable to the region and estimate thrombolysis treatment rates and disability prevented under varied improvement scenarios.

Results—

There were 844 241 ischemic stroke admissions of which 3.7% received intravenous tissue-type plasminogen activator and 0.5% received intra-arterial stroke treatment without or without intravenous tissue-type plasminogen activator over the 4-year period. The unadjusted proportion of patients with ischemic stroke who received thrombolysis varied from 9.3% in the highest treatment quintile compared with 0% in the lowest treatment quintile. Measured demographic and stroke system factors were weakly associated with treatment rates. Region accounted for 7% to 8% of the variation in receipt of thrombolysis treatment. If all regions performed at the level of 75th percentile region, ≈7000 additional patients with ischemic stroke would be treated with thrombolysis.

Conclusions—

There is substantial regional variation in thrombolysis treatment. Future studies to determine features of high-performing thrombolysis treatment regions may identify opportunities to improve thrombolysis rates.
The Heated Condensation Framework. Part I: Description and Southern Great Plains Case Study
Authors: Tawfik Ahmed B. , Dirmeyer Paul A. , Santanello Joseph A.
Published: June 2015

This study extends the heated condensation framework (HCF) presented in Tawfik and Dirmeyer to include variables for describing the convective background state of the atmosphere used to quantify the contribution of the atmosphere to convective initiation within the context of land–atmosphere coupling. In particular, the ability for the full suite of HCF variables to 1) quantify the amount of latent and sensible heat energy necessary for convective initiation, 2) identify the transition from moistening advantage to boundary layer growth advantage, 3) identify locally originating convection, and 4) compare models and observations, directly highlighting biases in the convective state, is demonstrated. These capabilities are illustrated for a clear-sky and convectively active day over the Atmospheric Radiation Measurement Program Southern Great Plains central station using observations, the Rapid Update Cycle (RUC) operational model, and the North American Regional Reanalysis (NARR). The clear-sky day had a higher and unattainable convective threshold, making convective initiation unlikely. The convectively active day had a lower threshold that was attained by midafternoon, reflecting local convective triggering. Compared to observations, RUC tended to have the most difficulty representing the convective state and captured the threshold for the clear-sky case only because of compensating biases in the moisture and temperature profiles. Despite capturing the observed moisture profile very well, a stronger surface inversion in NARR returned overestimates in the convective threshold. The companion paper applies the HCF variables introduced here across the continental United States to examine the climatological behavior of convective initiation and local land–atmosphere coupling.
Place and Institutional Work
Authors: Lawrence Thomas B. , Dover Graham
Published: June 2015

The places in which organizational life occurs can have profound impacts on actors, actions, and outcomes but are largely ignored in organizational research. Drawing on ideas from social geography, we explore the roles that places play in institutional work. The context for our study is the domain of housing for the hard-to-house, within which we conducted two qualitative case studies: the establishment of Canada’s first residential and day-care facility for people living with HIV/AIDS, and the creation of a municipal program to provide temporary overnight accommodation for homeless people in local churches. In examining these cases, we found that places played three key roles: places contained, mediated, and complicated institutional work. Each of these roles was associated with a distinct ontology of place: places as social enclosures, as signifiers, and as practical objects. Our findings have significant implications for how we understand the relationship between location and organizations and allow us to develop a process model of places, institutions, and institutional work.
Potential Drivers of Terrorism out to the Year 2020
Authors: Jensen Carl J.
Published: June 2015

While no one can predict the future, informed forecasting can provide decision makers with information and intelligence to establish realistic and achievable goals. Gazing out to the year 2020, I envision four drivers of change that will likely affect the trajectory of terrorist groups and movements: (a) Rapidly evolving technology will offer benefits for both terrorist entities and the authorities who work to curtail their activities; (b) Increasing globalization and political upheaval will produce new and interesting alliances between groups with seemingly little in common (e.g., White supremacists and Mexican drug cartels); (c) The most successful terrorist movements will be those that adopt hybrid structures, integrating both hierarchical and networked structures to achieve maximum success; and (d) The blurring of boundaries on many fronts will make it increasingly difficult to find meaningful differences between gangs, criminal enterprises, political actors, and terrorists.
Raised circulating Neurokinin A predicts prognosis in metastatic small bowel neuroendocrine tumours. Lowering Neurokinin A indicates improved prognosis
Authors: Ardill Joy ES , McCance David R , Stronge Wendy V , Johnston Brian T
Published: June 2015

Background

Assessing prognosis is important in patients with neuroendocrine tumours of the small bowel as disease progression and survival is variable. We previously identified raised Neurokinin A as an independent indicator of poor prognosis and have shown that prognosis worsens when circulating Neurokinin A rises ≥50 ng/L. In the present study we have examined survival in relation to Neurokinin A concentrations.

Methods

Patients in whom Neurokinin A rose ≥50 ng/L between January 1989 and December 2010 were identified. All circulating Neurokinin A concentrations were recorded and survival was followed up to 31 December 2014 or to death.

Results

Median survival, from the date when Neurokinin A was first ≥50 ng/L was 11.1 (2.0–117.8) months if Neurokinin A remained ≥50 ng/L and 72.4 (4.8–152.6) months when Neurokinin A was reduced below 50 ng/L and controlled below that concentration for ≥3 months (P < 0.001). Survival was significantly better for patients attending the neuroendocrine tumour specialist clinic than for those not attending (P = 0.009). Comparing patients identified during 1989–2000, and those during 2001–2010, Neurokinin A was successfully reduced in the earlier period in 30.3% patients with median survival 23.2 (2.0–152.6) months and this improved in 58.1% with median survival of 43.3 (2.0–141.1) months in the later period (P = 0.019). Significance was greater between the earlier and later periods when only patients attending the neuroendocrine tumour clinic were compared (P = 0.016).

Conclusions

Circulating Neurokinin A ≥ 50 ng/L is a strong indicator of poor prognosis when Neurokinin A remains above this concentration. Lowering Neurokinin A below 50 ng/L indicates a significant improvement in prognosis (P < 0.001). This prognostic indicator reflects improved treatment and survival in more recent years.
How learning styles and preferences of first-year nursing and midwifery students change
Authors: Mitchell Eleanor KL , James Santhamma , D’Amore Angelo
Published: June 2015

It is important that educators understand learning styles as an evolving individual characteristic. We investigate the changes in learning styles and preferences of first-year undergraduate nursing/midwifery students after six months of preliminary testing. Curry’s ‘onion ring model’ proposes a stable inner ‘Information processing’ style (assessed by instruments such as Kolb Learning Style Inventory) compared to the outer ‘Instructional preference’ style (assessed by the VARK (Visual/Aural/Read–Write/Kinaesthetic) questionnaire), which is more easily influenced by external factors. Therefore, re-examining students after one semester of teaching should result in an increase in multimodal VARK learning with lesser changes to the LSI results. A cross-sectional survey with pre-post design ( n = 96) showed 45% of students remaining in the same VARK mode, 30% becoming more multimodal and 25% showing changes. Surprisingly, the LSI questionnaire showed similar results with 45% of students remaining in the same learning modality and 55% of students changing. This research highlights the dynamic changes within students’ information processing and instructional preferences.
Factors That Influence School Board Policy Making
Authors: Diem Sarah , Frankenberg Erica , Cleary Colleen
Published: June 2015

Purpose: This article examines factors that affect school board policy making about student diversity within two southern urban-suburban school districts experiencing changing demographics: Jefferson County Public Schools and the Wake County Public School System. Both districts have a history of voluntary integration efforts, and research shows that racially diverse countywide districts can make integration more feasible. However, as courts constrain mechanisms used in policies to establish/maintain racial integration, it is crucial to examine how school boards make policy decisions while navigating the politics of their communities and competing conceptions surrounding racial diversity. Research Method/Approach: This study employed qualitative case study methods to understand under what circumstances school boards are creating policy, paying particular attention to the local sociopolitical and geographic contexts. Data collected consisted of 37 interviews with school district officials and community stakeholders. Mainstream and specialty media articles, legal documents, and policy documents from the districts or other governmental bodies also helped frame the local contexts. Findings and Lessons Learned: The two districts in our study illustrate political and legal factors that create complex environments to pursue school-level diversity even in districts with a long history of diversity policies. Our study also illustrates the difficult role of the superintendent and school boards in leading diverse communities with different histories and experiences as they navigate the local politics of diversity amid a variety of competing policy goals. We conclude with implications including the importance of remaining vigilant about student diversity efforts and perfecting technical details to minimize politicization about diversity policies.