bluuebunny/crossref_metadata_2025 huggingface dataset:
Competition between plant functional types in the Canadian Terrestrial Ecosystem Model (CTEM) v. 2.0
Authors: Melton J. R. , Arora V. K.
Published: June 2015

Abstract. The Canadian Terrestrial Ecosystem Model (CTEM) is the interactive vegetation component in the Earth system model of the Canadian Centre for Climate Modelling and Analysis. CTEM models land–atmosphere exchange of CO2 through the response of carbon in living vegetation, and dead litter and soil pools, to changes in weather and climate at timescales of days to centuries. Version 1.0 of CTEM uses prescribed fractional coverage of plant functional types (PFTs) although, in reality, vegetation cover continually adapts to changes in climate, atmospheric composition, and anthropogenic forcing. Changes in the spatial distribution of vegetation occur on timescales of years to centuries as vegetation distributions inherently have inertia. Here, we present version 2.0 of CTEM which includes a representation of competition between PFTs based on a modified version of the Lotka–Volterra (L–V) predator–prey equations. Our approach is used to dynamically simulate the fractional coverage of CTEM's seven natural, non-crop PFTs which are then compared with available observation-based estimates. Results from CTEM v. 2.0 show the model is able to represent the broad spatial distributions of its seven PFTs at the global scale. However, differences remain between modelled and observation-based fractional coverages of PFTs since representing the multitude of plant species globally, with just seven non-crop PFTs, only captures the large scale climatic controls on PFT distributions. As expected, PFTs that exist in climate niches are difficult to represent either due to the coarse spatial resolution of the model, and the corresponding driving climate, or the limited number of PFTs used. We also simulate the fractional coverages of PFTs using unmodified L–V equations to illustrate its limitations. The geographic and zonal distributions of primary terrestrial carbon pools and fluxes from the versions of CTEM that use prescribed and dynamically simulated fractional coverage of PFTs compare reasonably well with each other and observation-based estimates. The parametrization of competition between PFTs in CTEM v. 2.0 based on the modified L–V equations behaves in a reasonably realistic manner and yields a tool with which to investigate the changes in spatial distribution of vegetation in response to future changes in climate.
TopREML: a topological restricted maximum likelihood approach to regionalize trended runoff signatures in stream networks
Authors: Müller M. F. , Thompson S. E.
Published: June 2015

Abstract. We introduce topological restricted maximum likelihood (TopREML) as a method to predict runoff signatures in ungauged basins. The approach is based on the use of linear mixed models with spatially correlated random effects. The nested nature of streamflow networks is taken into account by using water balance considerations to constrain the covariance structure of runoff and to account for the stronger spatial correlation between flow-connected basins. The restricted maximum likelihood (REML) framework generates the best linear unbiased predictor (BLUP) of both the predicted variable and the associated prediction uncertainty, even when incorporating observable covariates into the model. The method was successfully tested in cross-validation analyses on mean streamflow and runoff frequency in Nepal (sparsely gauged) and Austria (densely gauged), where it matched the performance of comparable methods in the prediction of the considered runoff signature, while significantly outperforming them in the prediction of the associated modeling uncertainty. The ability of TopREML to combine deterministic and stochastic information to generate BLUPs of the prediction variable and its uncertainty makes it a particularly versatile method that can readily be applied in both densely gauged basins, where it takes advantage of spatial covariance information, and data-scarce regions, where it can rely on covariates, which are increasingly observable via remote-sensing technology.
Ocean modelling for aquaculture and fisheries in Irish waters
Authors: Dabrowski T. , Lyons K. , Cusack C. , Casal G. , Berry A. , Nolan G. D.
Published: June 2015

Abstract. The Marine Institute, Ireland, runs a suite of operational regional and coastal ocean models. Recent developments include several tailored products that focus on the key needs of the Irish aquaculture sector. In this article, an overview of the products and services derived from the models are presented. A shellfish model that includes growth and physiological interactions of mussels with the ecosystem and is fully embedded in the 3-D numerical modelling framework has been developed at the Marine Institute. This shellfish model has a microbial module designed to predict levels of coliform contamination in mussels. This model can also be used to estimate the carrying capacity of embayments, assess impacts of pollution on aquaculture grounds and help to classify shellfish waters. The physical coastal model of southwest Ireland provides a three day forecast of shelf water movement in the region. This is assimilated into a new harmful algal bloom alert system used to inform end-users of potential toxic shellfish events and high biomass blooms that include fish killing species. Further services include the use of models to identify potential sites for offshore aquaculture, to inform studies of potential cross-contamination in farms from the dispersal of planktonic sea lice larvae and other pathogens that can infect finfish and to provide modelled products that underpin the assessment and advisory services on the sustainable exploitation of the marine fisheries resources. This paper demonstrates that ocean models can provide an invaluable contribution to the sustainable blue growth of aquaculture and fisheries.
Exploring the Relationship between Market Value and Accounting Numbers of Firms in Pakistan
Authors: Riaz Salman , Liu Yangping , Khan Sajjad Hussain
Published: June 2015

This study examines the relationship between accounting numbers and market prices for the Pakistani cement industry. The study covers a time span of nine years from 2005-2014. We study the influence of book value of share, breakup value of share, earning per share, gearing ratio and dividend to equity ratio on market value of share. After applying different econometric techniques we found that book value of share and earnings per share have statistically significant influence on the market price of share.  
DMEK Lenticule Preparation using an Air Dissection Technique: Central versus Peripheral Injection
Authors: Feizi Sepehr , Javadi Mohammad Ali
Published: June 2015

Purpose

To compare 2 sites of air injection to prepare donor lenticules for Descemet membrane (DM) endothelial keratoplasty.

Methods

Fifty-one human corneoscleral buttons from donors aged 4 to 57 years were used. Corneoscleral buttons were placed endothelial side up and a 27-G needle was inserted just outside Schwalbe line and advanced immediately beneath the endothelium. Air was injected centrally inside the 8-mm zone (group 1) or peripherally approximately 1 mm in front of the limbus (group 2). Air injection was continued to extend the DM detachment as far as possible into the corneal periphery. Comparisons of central versus peripheral air injection were performed for reproducibility, the rate of usable tissue, and the type and diameter of the acquired bubble.

Results

The mean donor age was 30.0 ± 12.9 years. A big bubble was achieved following central or peripheral air injection in all cases. A usable donor lenticule (≥8.0 mm) was achieved in 95.7% of cases in group 1 and 89.3% of cases in group 2 (p>0.99). Both injection sites were comparable with regard to the diameter of the achieved bubbles (9.57 ± 2.11 mm versus 10.22 ± 2.34 mm, respectively, p = 0.32), the chance of complete DM detachment (39.1% versus 53.6%, respectively, p = 0.25), and the risk of bubble bursting (4.4% versus 7.1%, respectively, p = 0.41). The odds of a type 2 bubble increased by 11.86 for peripheral air injections compared to central injections (p = 0.01).

Conclusions

Both injection sites exhibited comparable rates of usable donor lenticules. However, peripheral air injection was more likely to yield stroma-free grafts.
Prognostic Factors for Mid-Term Symptom Relief after Open Surgical Correction for Femoroacetabular Impingement
Authors: Hingsammer Andreas M. , Stelzeneder David , Kalish Leslie A. , Millis Michael B. , Kim Young-Jo
Published: June 2015

Background

We sought to identify, which patient and radiographic factors at preoperative and 1-year follow up will predict patient symptom relief at mid-term.

Materials and methods

A total of 50 hips in 47 patients with symptomatic FAI were included in this retrospective study. We stratified the hips into “success” and “failure” groups based on the change from baseline to mid-term follow up WOMAC pain score (mean follow up of 5.8 years). An attempt was made to identify factors that are predictive of mid-term outcome among preoperative radiographic measures, dGEMRIC index, range of motion and WOMAC score as well as 1-year follow-up range of motion, radiographic measures, and WOMAC pain scores.

Results

At 1-year follow up, the success rate was 72% (36/50) and at mid-term follow the success rate increased to 82% (41/50). There were no significant associations between mid-term pain scores and baseline factors (all p-values ≥0.10). One-year pain score and hip internal rotation was associated with poor mid-term pain scores but only the 1-year pain score was associated with the mid-term success/failure outcome.

Conclusions

We did not identify clear preoperative predictors of mid-term results but patients with poor pain scores and limited hip internal rotation at 1-year follow-up are less likely to do well at mid-term.
Two-Stage Management of the Infected Total Hip Arthroplasty
Authors: Sandiford Nemandra A. , Duncan Clive P. , Garbuz Donald S. , Masri Bassam A.
Published: June 2015

There is currently no consensus on the optimal management of the infected total hip arthroplasty. Multiple management techniques have been described in contemporary literature.

This paper focuses on 2-stage revision for the infected total hip arthroplasty. We discuss the rationale and examine the current evidence for the use of this technique.
Enhanced Drug Delivery of Antibiotic-Loaded Acrylic Bone Cements Using Calcium Phosphate Spheres
Authors: Qin Tao , López Alejandro , Öhman Caroline , Engqvist Håkan , Persson Cecilia , Xia Wei
Published: June 2015

Background

Local infection near an implant may pose a serious problem for patients. Antibiotic delivery from acrylic (poly(methyl methacrylate)-based) cements is commonly used to prevent and treat infections in the proximity of, e.g., hip joint implants. However, at present, the drug release properties of PMMA cements are not optimal. An initial burst followed by very slow release means that an unnecessarily large amount of antibiotic needs to be added to the cement, increasing the risk of bacterial resistance. The main purpose of this study was to enhance drug delivery from PMMA cements without influencing the mechanical properties.

Methods

We incorporated strontium-doped calcium phosphate spheres (SCPS) into PMMA cement to enhance the antibiotic release and potentially improve the bone-cement integration. The release of strontium and vancomycin was investigated using inductively coupled plasma atomic emission spectroscopy and UV spectrophotometry, respectively.

Results

It was found that incorporating SCPS into PMMA could enhance the antibiotic release and deliver strontium ions to the surroundings. The incorporation of SCPS also increased the radiopacity as well as the working time of the cement. The compressive strength and Young's modulus were not affected.

Conclusions

Our results showed that SCPS/PMMA antibiotic-loaded cement had enhanced antibiotic release, delivered strontium ions and maintained mechanical properties, indicating that the SCPS additive could be a good alternative for controlling the drug-delivery properties of PMMA cement.
Color and Structural Changes of a Maxillofacial Elastomer: The Effects of Accelerated Photoaging, Disinfection and Type of Pigments
Authors: Griniari Panagiota , Polyzois Gregory , Papadopoulos Triantafillos
Published: June 2015

Purpose

The aim of this study was to investigate the color and structural changes of a maxillofacial silicone colored with 2 different pigments, after photoaging and immersion in disinfectants.

Methods

Ninety-six cylindrical specimens were fabricated and divided into 3 equal groups. The specimens of the first group consisted of unpigmented silicone (Multisil Epithetik), those of the second group consisted of unpigmented silicone, colored with red functional liquid pigment (Cosmesil Reactive 0.2% wt). The specimens of the third group were fabricated using unpigmented silicone colored with red powder pigment Cosmesil Dry at 0.2% wt. Specimens of each group were divided into 4 equal subgroups (immersed in soap solution, ethanol 95° or distilled water or placed in a photoaging apparatus for 174 hours). Structural changes were examined by infrared spectroscopy (ATR-FTIR) before and after aging. Color changes (ΔΕ*) were measured using the CIE L*a*b* system. Two-way ANOVA and Tukey's test for post hoc comparison were used at a = 0.05.

Results

Infrared spectroscopy showed no structural changes after immersion in solutions and photoaging, for all the materials tested. No statistically significant differences for ΔΕ* among the tested groups were found.

Conclusions

It can be concluded that no structural changes of pigmented and unpigmented silicone elastomers were observed among all aging procedures. Recorded color changes for the materials tested were within the limits of clinical acceptability after all aging procedures. Immersion in distilled water presented the best color stability, whereas photoaging, the poorest, for all materials.
Circulating Endothelial Cells for Evaluation of Tumor Response in Non-Small Cell lung cancer patients receiving first-line chemotherapy
Authors: Najjar Fadi , Al-Massarani Ghassan , Banat Israa , Alammar Moosheer
Published: June 2015

Background

Circulating endothelial cells (CECs) reflect the neovascularization in the tumor mass. We therefore investigated the potential role of CEC kinetics after first-line chemotherapy in advanced non-small cell lung cancer (NSCLC) patients.

Methods

Peripheral blood samples were obtained from 45 healthy subjects and 51 naïve patients with advanced NSCLC. Quantification of CD146+ CECs was performed using immunomagnetic separation (IMS).

Results

Pretreatment and posttreatment CEC levels in NSCLC patients were significantly higher than in healthy subjects (p<0.0001). An objective response was achieved after chemotherapy with partial response (PR) or stable disease (SD) in 26 patients, whereas the remaining 25 patients had progressive disease (PD). Baseline CEC levels were significantly higher in PR/SD patients than in PD patients (p = 0.039). After chemotherapy, CEC count significantly decreased in PR/SD patients (p = 0.014) and increased in patients with PD (p = 0.019). Moreover, there was a significant difference in the percentage change of CEC counts between the 2 groups (p = 0.0016). No significant difference in the median progression-free survival and overall survival (OS) was observed between patients with high baseline CEC counts and those with low baseline CEC levels. However, patients with high percentage change in CEC count had longer OS than those with low percentage change after chemotherapy (p = 0.05).

Conclusions

Changes in CEC counts after chemotherapy reflect tumor response in advanced NSCLC patients. Moreover, high percentage changes in CEC counts after chemotherapy may predict longer OS in advanced NSCLC. High baseline CEC levels might be an indicator of tumor response in advanced NSCLC patients after first-line chemotherapy.
Serum Cripto-1 as a Clinical Marker for Lung Cancer
Authors: Xu Chun-Hua , Cao Lan , Wei Ying , Yu Li-Ke
Published: June 2015

Background

Cripto-1 (CR-1) plays an important role in angiogenesis related to tumor growth, in concert with vascular endothelial growth factor (VEGF), and enhanced expression of CR-1 has been reported in lung cancer tissue.

Methods

Patients with lung cancer (n = 156) and healthy volunteers (n = 60) were enrolled in the study. Serum CR-1 and VEGF concentrations were measured using enzyme-linked immunosorbent assay.

Results

Patients with lung cancer had higher serum CR-1 (4.03 ± 1.49 ng/mL vs. 1.13 ± 0.43 ng/mL, p<0.05) and VEGF (503.62 ± 112.74 pg/mL vs. 398.62 ± 117.84 pg/mL, p<0.05) levels than the control group. With stage progression in non-small cell lung cancer (NSCLC), serum CR-1 levels increased, and patients with distant metastasis had higher levels than those without metastasis (p<0.05). In NSCLC, the low CR-1 group (<1.54 ng/mL) had a better overall survival rate compared with the high CR-1 group (>1.54 ng/mL, p<0.05).

Conclusions

Our study suggests that serum CR-1 is a useful diagnostic and prognostic marker for NSCLC patients.
Retained Embolized Fragment of Totally Implantable Central Venous Catheter in Right Ventricle: It is Really Necessary to Remove?
Authors: Tazzioli Giovanni , Gargaglia Eleonora , Vecchioni Ilaria , Papi Simona , Di Blasio Petronilla , Rossi Rosario
Published: June 2015

Introduction

Central venous catheters are often required in oncologic patients for long-term safe administration of chemotherapeutic agents, antibiotics, and parenteral nutrition. Rupture of these devices and intracardiac migration is a rare complication.

Methods

We report one spontaneous rupture and embolization of a totally implantable vascular access device (TIVAD) in an asymptomatic patient.

Results

A 50-year-old woman received a TIVAD silicone catheter 8 FR for adjuvant chemotherapy. After 3 years of port time in situ, during a follow-up control, a catheter malfunction was found and radiologic investigations showed a rupture and migration of the catheter to the right ventricle. The attempt to remove the fragment under fluoroscopic control using the femoral route was unsuccessful. We did not try a surgical approach because of the complete absence of symptomatology and hemodynamic impairment.

Conclusions

The catheter rupture and intracardiac embolization is a rare complication associated with totally implantable or tunneled central venous catheters. When such an event happens, the patient should be managed by expert hemodynamists or interventional radiologists making an effort to remove the fragment without surgical measures. When the intravascular percutaneous route fails, the possibility to leave the fragmented catheter in heart chambers should be evaluated, being surgery questionable in asymptomatic patients.
Evaluation of the Correct Position of Peripherally Inserted Central Catheters: Anatomical Landmark vs. Electrocardiographic Technique
Authors: Baldinelli Francesco , Capozzoli Giuseppe , Pedrazzoli Roberta , Marzano Natascia
Published: June 2015

Purpose

The purpose of this study is to verify as early as possible the correct positioning of the peripherally inserted central catheter (PICC) tip in order to reduce complications due to possible malpositioning. The ECG-guided technique proved to be reliable, easy to carry out, straightforward, low-cost and allows us to recognize an incorrect or a suboptimal positioning throughout the procedure. The purpose of this study is to compare two methods used during the PICC insertion so as to prevent catheter malpositioning; the first study estimates the catheter length by the landmark method (based on cutaneous anatomical landmarks, CALs) with the addition of the postprocedural verification of tip location by chest X-Ray (CxR), whereas the second method of intraprocedural tip location is based on the observation of the morphological variations of the P wave (ECG-guided technique) with the addition of the postprocedural verification by CxR.

Methods

From 2010 to 2012, 90 PICCs were positioned, 48 using the anatomical landmarks and 42 using the ECG technique.

Results

Twenty-five percent of the catheters positioned with the anatomical landmark technique did not reach the correct position of the tip in SVC; of these, 6.25% were placed in an aberrant position and others in a suboptimal position. Of the 42 PICCs positioned with the ECG technique, only in three cases (equal to 7.14%), a suboptimal position of the tip was observed, whereas there was no case of aberrant positioning.

Conclusions

The ECG technique represents an accurate, low-cost and safe technique to verify the correct positioning of the tip. The use of the ECG allowed a more correct positioning in terms of catheter tip-carina distance and catheter tip-tracheobronchial angle, and in no patient was it necessary to place a catheter again.
Spontaneous migration of a peripherally inserted central catheter into the azygos vein in esophageal cancer patients during surgery
Authors: Zhang Hanfeng , Jiang Bin , Zhou Hong , Qin Ying , Wang Guorong
Published: June 2015

Introduction

A peripherally inserted central catheter (PICC) is widely used for long chemotherapy regimens or total parenteral nutrition. However, spontaneous migration of the catheter into the azygos vein after satisfactory initial placement has occurred in rare cases.

Methods

We discuss three such cases in esophageal cancer patients.

Results

In two patients, the migrated catheters were found during surgery and were repositioned without complications. However, in the third case, the migrated catheter had to be removed to avoid severe complications, as the catheter and the azygos vein were ligatured during operation without notice.

Conclusions

Migrations might be related to the material properties of silicone PICCs, the short insertion length, the left-sided placement, the changes of thoracic pressure and the intraoperative traction by thoracic surgeons. In conclusion, we recommend routine checks before cutting off the azygos vein during the operations for esophageal cancer patients with left-sided PICCs.
Higher Patency of Transposed Brachio-Basilic Arteriovenous Fistulas Compared to Brachio-Axillary Grafts for Hemodialysis Patients
Authors: Marques Guillaume , Sadaghianloo Nirvana , Fouilhé Laurent , Jean-Baptiste Elixène , Declemy Serge , Clément Claude , Hassen-Khodja Réda
Published: June 2015

Purpose

We compared outcomes of transposed brachio-basilic arteriovenous fistulas (BBAVF) with brachio-axillary prosthetic grafts (BAPG) for hemodialysis.

Methods

All consecutive patients who underwent creation of a BBAVF or a BAPG, in one of the two institutions, between January 2008 and December 2013 were retrospectively identified. We assessed functional patency and compared complication rates. Patency was also compared between one-stage and two-stage creation procedures for the BBAVF group.

Results

Two hundred and thirty-eight patients underwent the creation of a BBAVF (N = 136) or a BAPG (N = 102). Median follow-up was 17 months (range, 1-79). At 6, 12 and 24 months, patients in the BBAVF group had significantly higher primary patency (80%, 69%, 56% vs. 77%, 56%, 37%, respectively; p = 0.005), assisted primary patency (90%, 80%, 71% vs. 80%, 66%, 48%; p<0.0001) and secondary patency (93%, 84%, 72% vs. 94%, 87%, 62%; p = 0.006). Two-stage BBAVF had a significantly higher secondary patency (98%, 92%, 78% vs. 90%, 80%, 68%; p = 0.04) than one-stage BBAVF. The rate of infectious complications was significantly lower in the BBAVF group than in the BAPG group (0.8% vs. 6.9%; p = 0.03).

Conclusions

In this large cohort, BBAVF had a higher functional patency and lower rate of infectious complications than BAPG. After exhaustion of cephalic veins, we suggest creation of a BBAVF instead of BAPG, whenever anatomically feasible. The superiority of one-stage or two-stage BBAVF creation procedure must be further investigated.
Focused Simulation Training: Emergency Department Nurses’ Confidence and Comfort Level in Performing Ultrasound-Guided Vascular Access
Authors: Adhikari Srikar , Schmier Charles , Marx Jared
Published: June 2015

Study objectives

The objective of this study is to assess Emergency Department (ED) nurses’ confidence, comfort level, and competency in performing ultrasound-guided vascular access after a focused ultrasound simulation training session.

Methods

A cross-sectional study at an academic medical center. A simulation-based ultrasound training module was used to train ED nurses in ultrasound-guided intravenous (IV) access. The training module consisted of didactics followed by hands-on practice on human models and Blue Phantom ultrasound training block model. All subjects completed a questionnaire after completing the training module.

Results

A total of 40 nurses were enrolled. All subjects successfully demonstrated competency during the training session by identifying upper extremity sonographic vascular anatomy on a human model and performing real-time ultrasound-guided IV access on Blue Phantom ultrasound training block model. On a scale of 1-10, the average confidence level in performing the ultrasound-guided vascular access was 6.9 [95% confidence interval (95% CI) 6.3-7.46], with 98% (95% CI, 92-102%) reporting no difficulty in recognizing upper limb vascular anatomy on ultrasound. Ninety-two percent (95% CI, 84-100%) agreed that focused training in ultrasound-guided IV access was adequate to learn the procedure.

Conclusions

After a focused simulation training session, ED nurses had a high level of comfort using ultrasound for vascular access. Despite having a moderate degree of confidence, ED nurses were accurate in identifying vascular anatomy and performing ultrasound-guided vascular access.
Reduction of Risk of Dying from Tobacco-related Diseases after Quitting Smoking in Italy
Authors: Carreras Giulia , Pistelli Francesco , Falcone Franco , Carrozzi Laura , Martini Andrea , Viegi Giovanni , Gorini Giuseppe
Published: June 2015

Aims and Background

The aims of this paper are to compute the risks of dying of ischemic heart disease (IHD), lung cancer (LC), stroke, and chronic obstructive pulmonary disease (COPD) for Italian smokers by gender, age and daily number of cigarettes smoked, and to estimate the benefit of stopping smoking in terms of risk reduction.

Methods

Life tables by sex and smoking status were computed for each smoking-related disease based on Italian smoking data, and risk charts with 10-year probabilities of death were computed for never, current and former smokers.

Results

Men aged 45-49 years, current smokers, have a 8, 10, 3 and 1 in 1,000 chance of dying of IHD, LC, stroke and COPD, respectively, whereas women with the same characteristics have a 2, 6, 3 and 1 in 1,000 chance, respectively, for all smokers combined, i.e., independent of the smoking intensity. The risk reduction rates from quitting smoking are remarkable: a man who quits smoking at 45-49 years can reduce the risk of dying of IHD, LC, stroke and COPD in the next 10 years by 43%, 53%, 57% and 55%, respectively; a woman by 49%, 49%, 59% and 57%, respectively.

Conclusions

Estimates of risk reduction by quitting smoking are useful to provide a sounder scientific basis for public health messages and clinical advice.
Bevacizumab Treatment for Vestibular Schwannoma in a Patient with Neurofibromatosis Type 2: Hearing Improvement and Tumor Shrinkage
Authors: Sponghini Andrea P. , Platini Francesca , Rondonotti David , Soffietti Riccardo
Published: June 2015

Purpose

Neurofibromatosis type 2 (NF2) is a dominantly inherited genetic condition that clinically manifests through the appearance of multiple meningiomas, ependymomas and bilateral vestibular schwannomas (acoustic neuromas) which lead to progressive hearing loss. Neovascularization is necessary for tumor growth and is driven by tumor-produced angiogenic factors such as vascular endothelial growth factor (VEGF). Bevacizumab is a humanized monoclonal antibody that neutralizes the activity of VEGF. Recent data have shown that VEGF is produced by schwannoma tumor cells. Bevacizumab treatment in patients with NF2 who were considered poor candidates for surgery and radiation therapy was found to result in clinically meaningful hearing improvement and tumor volume reduction in previous studies.

Methods

We report the case of a 40-year-old woman with sudden right-sided hearing loss. Magnetic resonance imaging (MRI) revealed multiple meningiomas and neurinomas (C2 and L5 lesions) and a right-sided acoustic neurinoma, confirming the diagnosis of NF2. Bevacizumab was given as infusion every 2 weeks at a dose of 5.0 mg/kg body weight with MRI monitoring every 6 months.

Results

After 6 months from the start of therapy the patient reported progressive improvement of hearing response in audiometry, word recognition and face-to-face conversation. MRI evidenced reduction of the volume of the right vestibular schwannoma and the multiple meningiomas as well as attenuation of brain stem compression.

Conclusions

At the time of writing the patient is continuing treatment with bevacizumab without adverse events. She has good functional status and quality of life.
miRNA-214: Expression, Therapeutic and Diagnostic Potential in Cancer
Authors: He Hengpeng , Zhang Hao , Li Zhiguo , Wang Rui , Li Nuo , Zhu Li
Published: June 2015

MicroRNAs (miRNAs) are small noncoding RNAs that negatively regulate gene expression by binding to the 3' untranslated region of their target mRNAs. Recent work supports a role for miRNAs in the initiation and progression of human cancer. miRNA-214 not only mediates differentiation, senescence, angiogenesis, cell migration and virus replication but also acts as a tumor suppressor gene and oncogene. Increasing evidence indicates that miRNA-214 may serve as a biomarker in some cancer types. The aim of this review is to highlight and clarify the complexity of miRNA-214 activity, emphasizing its significant therapeutic and diagnostic potential.
Proteomic Analysis of a Nasopharyngeal Carcinoma Cell Line and a Nasopharyngeal Epithelial Cell Line
Authors: Huang Pei-Yu , Zeng Ting-Ting , Li Meng-Qing , Ban Xiaojiao , Zhu Ying-Hui , Zhang Bao-Zhu , Mai Hai-Qiang , Zhang Li , Guan Xin-Yuan , Li Yan
Published: June 2015

Background

Nasopharyngeal carcinoma (NPC) is an epithelial malignancy exhibiting a strong geographic preference and a close association with Epstein-Barr virus (EBV). The aim of this study was to investigate the precise mechanism of nasopharyngeal epithelial-to-NPC tumorigenesis and to identify possible biomarkers and targets for therapy.

Methods

Proteomic analysis was performed on the immortalized nasopharyngeal epithelial cell line NP69 and the NPC cell line C666.

Results

A comparative analysis of total lysates from the cell lines using 2-D gel electrophoresis–mass spectrometry resulted in the identification of 87 different protein spots. The different proteins were grouped into 5 main categories: (i) energy production and general metabolism, (ii) adaptation/stress tolerance, (iii) cell proliferation, (iv) cell structure and (v) epithelial-mesenchymal transition. The detection of metabolism-related proteins indicated that the NPC cells relied on aerobic glycolysis, with reduced use of the citric acid cycle. Glucose uptake and lactate secretion increased in the medium of C666 compared with NP69.

Conclusions

The present study revealed that glycolysis was up-regulated in the NPC cell lines compared with nasopharyngeal epithelial cells. A number of molecules involved in metabolism were identified, and further investigations will be needed to validate these potential biomarkers or targets.
Giant Cemento-ossifying Fibroma of the Maxilla
Authors: Unal Adnan , Yurtsever Kum Nurcan , Kum Rauf Oguzhan , Erdogan Aysun , Ciliz Deniz Sozmen , Guresci Servet , Ozcan Muge
Published: June 2015

Introduction

Fibro-osseous lesions of the skull and facial bones are benign tumors, but they can be mistaken for malignant tumors due to their clinically aggressive behavior. Cemento-ossifying fibroma (COF) is a benign fibro-osseous lesion characterized by slow growth and fibrous and calcified tissue content. COFs are locally destructive lesions causing deformities in the bones. The recurrence risk is high if they are not completely removed.

Case Report

In this case report we describe a giant COF mimicking chondrosarcoma in the oral cavity of a 55-year-old woman causing significant facial deformity and feeding problems.

Conclusions

Giant COF occurs rarely in the jaws and given that this lesion has similar imaging and clinical features to several other tumors, the diagnosis is always a challenge for clinicians, radiologists and pathologists.
Normativity and Expressive Agency in Hegel, Nietzsche, and Deleuze
Authors: Bowden Sean
Published: June 2015

This article synthesizes several different studies of Hegel's and Nietzsche's expressive conceptions of action and agency and identifies a related account in Deleuze's Logic of Sense. It argues that such conceptions not only challenge familiar voluntarist accounts of action and agency; they also demand a reassessment of standard approaches to the relation between norms and action. For the voluntarist, an agent's action is caused by the separate, prior intention of the agent. For expressivists, an agent's intention is inseparable from the action expressing it and nonisolatable from the expression of this intention-action in interpretative activity. For the voluntarist, the norms governing action can be thought of as more or less freestanding, entering into the prior formation of the agent's intention. For the expressivist, the norm or principle on which an agent acts will be produced over time, through the unfolding of the action expressing it, as well as through interpretative struggle over the meaning of that action, all of which takes place in a social space governed by more basic norms concerning the offering of act-descriptions, recognition, and social and hermeneutical struggle. A number of important differences among Hegel's, Nietzsche's, and Deleuze's accounts are identified, and their significance is explored.
Pyoderma gangrenosum following a routine caesarean section: Pseudo-infection in a caesarean wound
Authors: Radhika A.G. , Singal Archana , Radhakrishnan Gita , Singh Smita
Published: June 2015

A 22-year-old booked primigravida underwent lower segment caesarean section for breech presentation. She developed signs and symptoms of wound infection by the fourth postoperative day. This was initially managed with antibiotics and wound dressing, but debridement was later undertaken after consulting surgeons. This resulted in an alarming worsening of the wound with sudden and fast increase in its size along with systemic symptoms. Wound biopsy established the diagnosis of pyoderma gangrenosum. The patient's management included oral medication with prednisolone, cyclosporin and dapsone and wound care. There was a dramatic response to this treatment. The wound completely healed by the eighth postoperative month. The oral medications were tapered off slowly and stopped by that time.
Concentratietoezicht ACM in de ziekenhuissector
Authors: Kemp Ron , Leijh-Smit Marie-Louise , Schep Krijn
Published: June 2015

Concentratietoezicht ACM in de ziekenhuissector

In dit artikel gaan wij in op het beoordelingskader van ACM bij fusies tussen ziekenhuizen. Wij bespreken de marktafbakening, de disciplineringsmogelijkheden van zorgverzekeraars en de rol van patiënten. Wij reflecteren hierop aan de hand van onze persoonlijke ervaringen. Het doel hiervan is om een beter beeld te geven van het toezicht van ACM en de afwegingen die daarin een rol spelen. Wij concluderen dat het toezicht op ziekenhuisfusies baat kan hebben bij: (1) meer inzicht in de effecten van fusies, (2) een betere onderbouwing van de inbreng van vooral zorgverzekeraars en (3) betere beschikbaarheid van kwaliteitsinformatie over ziekenhuizen.
Prevenção quaternária: as bases para sua operacionalização na relação médico-paciente
Authors: Norman Armando Henrique , Tesser Charles Dalcanale
Published: June 2015

O objetivo deste artigo é apresentar as bases clínicas e conceituais para se operacionalizar a prevenção quaternária na prática dos serviços de Atenção Primária à Saúde e no ambiente de ensino e/ou programa de residência em medicina de família. Utilizou-se o modelo aprimorado de Calgary-Cambridge como substrato organizativo da consulta médica, de modo a inserir a prevenção quaternária em dois momentos: diagnóstico e plano de cuidados. Para fortalecer a prevenção quaternária nesses dois momentos da consulta discute-se: a) os eixos conceituais das doenças (anatomopatológico, fisiopatológico, semiológico e epidemiológico); b) as abordagens explicativas do fenômeno do adoecimento (ontológica e dinâmica); e c) o sofrimento em relação ao tempo (presente e futuro), diferenciando o sofrimento vivenciado no presente das preocupações com a saúde futura. Conclui-se que apesar das limitações da proposta, a formalização da prevenção quaternária no processo de consulta pode auxiliar a reduzir o automatismo diagnóstico e prescritivo que muito tem medicalizado as expressões do adoecer no cotidiano dos serviços da atenção primária à saúde.
Prescripción prudente y deprescripción de fármacos como herramientas para la prevención cuaternaria
Authors: Gómez Santana María del Carmen , Gavilán-Moral Enrique , Villafaina-Barroso Antonio , Jiménez-de Gracia Laura
Published: June 2015

Las consecuencias de una medicación inadecuada son diversas y con gran repercusión a nivel clínico: desde efectos adversos e interacciones a fracturas por caídas y aumento de morbi-mortalidad. Para evitar o mejorar dichas consecuencias, así como para abordar sus causas y con la seguridad del paciente en mente, nace la deprescripción para conseguir una prescripción más segura, más prudente y más humana. La atención primaria se sitúa en un lugar privilegiado para hacer frente a este reto que debería formar parte de cualquier estrategia de prevención cuaternaria.
The words of prevention, part II: ten terms in the realm of quaternary prevention
Authors: Jamoulle Marc , Gavilán Enrique , Cardoso Raquel Vaz , Mariño María Ana , Pizzanelli Miguel , Grosjean Julien , Darmoni Stéfan J.
Published: June 2015

Objective: This part II article about the ‘words of prevention’ presents in a terminological way the content of ten current concepts used in the prevention domain which are closely linked to quaternary prevention: (1) overinformation, (2) overdiagnosis, (3) medically unexplained symptoms, (4) overmedicalisation, (5) incidentaloma, (6) overscreening, (7) overtreatment,  (8) shared decision making, (9) deprescribing, and (10) disease mongering. Methods: with the support of the laboratory team of the University of Rouen, France, which is dedicated to medical terminology and semantic relationships, it was possible to utilize  a graphic user interface (called DBGUI) allowing the construction of links for each of chosen terms, and making automatic links to MeSH, if any. Those concepts are analyzed in their environment in current literature, as well as in their MeSH counterparts, if any, and related semantic online terminologies. Results and Discussion: The rules in terminological development aspire to cover the whole field of a concept and in the meantime, it helps to avoid the noise due to proxy and not exactly related issues. This refers to exhaustivity and specificity in information retrieval. Our finds show that referring to MeSH only in information retrieval in General Practice/Family medicine can induce much noise and poor adequacy to the subject investigated. Conclusion: Gathering concepts in specially prepared terminologies for further development of ontologies is a necessity to enter in the semantic web area and the era of distributed data.
Quaternary prevention: first, do not harm
Authors: Jamoulle Marc
Published: June 2015

Towards patient-doctor relationship based careClinical prevention, under the influence of public health, has been organised in a chronologicalmanner since the middle of the 20th century. A paradigm shift from a chronological to a constructivist relationship-based preventive pattern of care1 offers new insights into the practice of doctors. This paradigm shift brings to light the concept of quaternary prevention, a critical look at medical activities with an emphasis on the need not to harm. Quaternary prevention addresses the fundamental question of what constitutes too much or too little medicine. It is the fourth form of disease prevention, but also the fourth frame of action for family doctors (Figure 1). The shift from time-based prevention towards a relationship-based organisation offers new perspectives into physicians’ work. The physicians observe themselves and question the ethical limits of their activities. In this sense, quaternary prevention is aimed more at the doctor than the patient. Moreover, the four definitions of prevention, published in the Wonca Dictionary of Family Medicine,2 offer a structured way to discuss the activities of family doctors, including ethical considerations on the patient-doctor encounter. Quaternary prevention, also known as P4, is a new term for an old concept: first, do not harm. This concept enforces disciplines and attitudes such as evidence-based medicine, quality assurance, defensive medicine, avoiding abusive nosographic diagnoses and ethical issues including those linked to overinformation, and overmedicalisation.
Impact of quaternary prevention as a brief intervention in medical students’ clinical decisions: experience from Vietnam
Authors: Tran Thi Hoa Vi , Vo Thanh Liem
Published: June 2015

Objective: to evaluate undergraduate medical students’ clinical decision-making process after a brief intervention lecture on quaternary prevention (P4). Methods: quantitative self-controlled intervention study carried out with fifth-year medical students of Pham Ngoc Thach University, Hochiminhcity, Vietnam. The medical students were asked to list their eventual interventions based on three different simulated clinical scenarios. The survey was conducted before and after the intervention. Student’s propositions were classified into one of the four groups of prevention, according to Jamoulle’s model. Results: 115 students participated, resulting in 211 answered sheets. The interventions proposed by the students were mostly centered on prevention groups 1, 2 and 3; the three clinical scenarios partially explained student’s intentions of counseling, screening and palliative care. Comparing the data of second phase survey, the intervention was associated with changes in students’ aptitude on clinical decision-making, which was especially more important for prevention group 1 (OR = 7.5) and prevention group 4 (OR = 30.05). There was no statistically significant difference in changing students’ decision for prevention group 2 (OR = 0.95 p = 0.466) and prevention group 3 (OR = 2.29 p = 0.932). Conclusion: introducing quaternary prevention to the undergraduate medical course can help to steer clinical decisions toward primary prevention and to avoid inappropriate medical interventions.
AWWA Standards Development: Balancing Innovation and Historical Practices
Authors: Olson Paul J.
Published: June 2015

The AWWA Standards Council needs to ensure that AWWA standards continue to cover accepted and proven technologies, while fostering the incorporation of new technologies and advances.
Lawson Water Tower: A Local Treasure
Authors: Porter Mary G. , Miles Carol
Published: June 2015

Built more than 100 years ago in the style of a medieval watch tower, the Lawson Tower in Scituate, Mass., is the result of one couple's efforts to beautify their landscape. The tower has withstood changes in ownership, natural weathering, and renovations, and its bells still ring out today across the South Shore.
Financing Sources for Your Water Business
Authors: Maxwell Steve
Published: June 2015

One of the most critical challenges for any company ‐ young or old ‐ is developing and sustaining the proper financial backing and strength. Finding and securing the necessary funds to develop a new technology or new business line, to expand or perfect an existing product, or simply to sustain an ongoing business, is one of the most important tasks in running a business. Although there is a wide spectrum of financing sources ‐ and today, literally thousands of private equity investors who are excited about entering the water business ‐ attracting the right kind of capital and obtaining it at an acceptable “cost” can often be difficult and time‐consuming. This article reviews the different sources of financing that are available to entrepreneurs and owners in this industry, and some of the pros and cons of each.
Promoting Organ Donation through Challenge Campaigns
Authors: Feeley Thomas Hugh , Kruegler Joan
Published: June 2015

Context—

Four challenge campaigns in 2012 and 2013 were undertaken to promote organ donor registrations in New York State. Challenge campaigns relied on community advocates statewide to initiate month-long outreach efforts with top teams earning monetary rewards and public recognition.

Objective—

To significantly increase the number and proportion of New York residents who have consented to donation through the electronic registry.

Design—

Four month-long campaigns undertaken in fall and spring of 2012 and 2013.

Setting—

Statewide recruitment efforts organized by New York Alliance for Donation and the 4 organ procurement organizations in New York State.

Participants—

Adult residents of New York State.

Intervention—

Project staff recruited team leaders across New York State and used online and offline resources to recruit teams, educate team leaders, and bolster outreach efforts.

Main Outcome Measures—

Number of completed registration forms within month-long campaign periods. Also investigated were statistics on website use (eg, page views, new visitors) and interviews with team leaders regarding campaign activities after the campaign.

Results—

Across 4 campaigns, 107 teams were recruited and 2286 persons registered their consent to donate through the state system. Each team recruited a mean of 21 persons; 40% of teams registered 0 persons.
Evaluation of the Psychometric Properties of Self-Efficacy and Adherence Scales for Caregivers of Patients with a Left Ventricular Assist Device
Authors: Casida Jesus , Wu Horng-Shiuann , Harden Janet , Carie Austen , Chern Joy
Published: June 2015

Context—

No published instrument has been designed to measure caregivers' self-efficacy for and adherence to the complex home-care regimen of patients with a left ventricular assist device (LVAD).

Objective—

To evaluate the psychometric properties of 2 newly developed instruments: the LVAD Caregiver Self-Efficacy Scale (LCSS) and the LVAD Caregiver Home Management Adherence Scale (LCAS).

Methods—

A multistage design was employed for this instrumentation study. Of the 125 LVAD caregivers recruited from online support groups, 98 (78.4%) provided complete data. Participants were predominantly female (80%), aged 18 to 79 years, from 4 regions of the United States. They completed the following instruments: LCSS, LCAS, General Self-Efficacy Scale (GSE), and the confidence and maintenance subscales of the Caregiver Contribution to Self-Care of Heart Failure Index (CC-SCHFI). Item analyses, factorial construct validity, convergent validity, and internal consistency reliability of the scales were evaluated.

Results—

The analysis of the LCSS (21 items) revealed a 2-factor solution, which consisted of a 17-item routine factor and a 4-item anticipatory factor. Convergent validity of the LCSS was supported by moderate correlations among LCSS, GSE, and CC-SCHFI-confidence. The analysis of LCAS (17 items) revealed a 1-factor solution. Its convergent validity was supported by moderate correlation between LCAS and CC-SCHFI-maintenance. Internal consistency reliability coefficients of the LCSS and LCAS were α = 0.93 and α = 0.96, respectively. These data suggest that the 2 instruments are adequately valid and reliable measures of self-efficacy and adherence in the context of LVAD patient care managed by home caregivers. Further research is needed to support the applicability of these instruments in other research and practice settings.