bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Smartphones on Pharmacist-Physician Clinical Communication
Authors: Wilson Charlene , Wu Robert , Lo Vivian , Wong Gary G , Fernandes Olavo A , Tomlinson George , Summa-Sorgini Claudia
Published: September 2013

Background:

Clinical pharmacist interventions are associated with improved patient outcomes and cost savings. Expanded interprofessional communication strategies may improve the efficiency and quality of the communication of these interventions.

Objective:

To determine the impact of smartphone device use on pharmacists' efficiency when communicating clinical interventions and to determine factors related to smartphone use that improve and impede communication.

Methods:

A prospective, 2-phase, observational study was completed. In phase 1, work shadowing observations involved general internal medicine (GIM) pharmacists who communicated interventions to a physician's smartphone (BlackBerry device) and multiorgan transplant (MOT) pharmacists who used traditional modes of communication (paging, phone call, face-to-face). On each ward, various aspects of the interventions were documented for a total of 20 hours. In phase 2, 10 interviews were conducted with GIM pharmacists and physicians to gain their perspectives on BlackBerry device communication.

Results:

In phase 1, no significant difference was found in median time to resolution (order change or drug information response given) between accepted interventions from the smartphone group (15.5 minutes) versus traditional modes of communication in the GIM group (4 minutes) and the MOT group (8.5 minutes) (p = 0.74). In phase 2, themes that emerged across the different clinical groups included perceived improvements in communication processes (efficiency, decreased wait times, and triaging of issues), concerns for potential miscommunication (use of tone in the emails), and recommendations regarding BlackBerry best practices (dealing with urgent/nonurgent issues and establishment of pharmacist-physician interprofessional relationships).

Conclusions:

Despite no significant difference in median time to resolution of pharmacists' interventions communicated through physician BlackBerry devices compared to traditional modes, the majority of interviewees perceived this device to be a positive communication tool resulting in improved efficiency of team communication.
Therapeutic Management of Accidental Epinephrine Injection
Authors: Cluck David B , Odle Brian , Rikhye Somi
Published: September 2013

Objective:

To review the literature regarding therapeutic options for accidental epinephrine exposure via EpiPen (Mylan Specialty Inc.) autoinjector devices and to suggest a treatment algorithm based on the most common approaches found therein.

Data Sources:

A literature search of MEDLINE (1950-March 2012) was conducted, using the search term accidental epinephrine injection in combination with the terms adrenaline, EpiPen, anaphylaxis, autoinjector, and treatment. Case reports, case series, and systematic reviews were evaluated for efficacy and safety data. In addition, the references of the reviewed articles were examined to identify additional reports or data.

Study Selection and Data Extraction:

All English-language articles describing accidental exposure to epinephrine were identified. Our search included both pediatric and adult patient populations. Articles were excluded if the exposure to epinephrine was purposeful and the EpiPen described in the report was being used as intended or the outcome was not clear. Individual case reports were described in detail whereas case series and systematic reviews were included but were not described in detail. To our knowledge, there have been no clinical trials that describe or compare therapeutic options for accidental exposure to epinephrine.

Data Synthesis:

Accidental exposure to epinephrine is an underreported phenomenon that could warrant medical attention. The importance of this issue has recently been emphasized with the legislative requirement of many schools to store epinephrine (EpiPen) autoinjector devices. The available therapeutic options can be divided into pharmacologic and nonpharmacologic categories. The most common pharmacologic options described in the literature include phentolamine, subcutaneous terbutaline, topical nitrates, and calcium channel blockers. Nonpharmacologic options include observation and/or warm water soaks. Treatment recommendations in our proposed algorithm were based solely on the available data that we describe in our review.

Conclusions:

The literature did not provide clear guidance on the most appropriate management of accidental epinephrine injection. However, if pharmacologic therapy is necessary, phentolamine appears to be considered the most effective. Guidelines may be helpful in improving the management of accidental epinephrine injection, as well as in preventing unnecessary therapy.
The Impact of an Infectious Diseases Transition Service on the Care of Outpatients on Parenteral Antimicrobial Therapy
Authors: Keller Sara C. , Ciuffetelli Danielle , Bilker Warren , Norris Anne , Timko Daniel , Rosen Alex , Myers Jennifer S. , Hines Janet , Metlay Joshua
Published: September 2013

Background: Many hospitalized patients with complicated infections are discharged on outpatient parenteral antimicrobial therapy (OPAT). However, little is known about how to improve the postdischarge care of OPAT patients. Objective: The impact of an infectious diseases transitions service (IDTS) on OPAT patient readmissions, as well as on processes of care, was evaluated. Methods: We performed a controlled, quasi-experimental evaluation over 15 months in an academic medical center. Intervention-arm patients, before and after the introduction of an IDTS, were seen by the general infectious diseases consult teams, while control-arm patients (discharged on OPAT after hospitalization with bacteremia) were not. The IDTS prospectively tracked all OPAT patients and coordinated follow-up. The impact of the IDTS was calculated using a differences-in-differences approach where the interaction between time (before vs after the IDTS intervention) and study arm (intervention vs control arm) was the variable of interest. The control arm was used only in primary outcome analyses (readmissions and emergency department visits). Secondary outcomes included process of care measures and non-readmission clinical outcomes. Results: Of 488 consecutive patients requiring OPAT, 362 were in the intervention arm (215 pre-intervention and 147 post-intervention) and 126 in the control arm (70 pre-intervention and 56 post-intervention). Compared to the control arm, the IDTS was not associated with changes in 60-day readmissions and/or emergency department visits (adjusted odds ratio [OR] = 0.48; 95% confidence interval [CI] = 0.13-1.79). In the intervention arm, implementation of the IDTS was associated with fewer antimicrobial therapy errors (OR = 0.062; 95% CI = 0.015-0.262), increased laboratory test receipt (OR = 27.85; 95% CI = 12.93-59.99), and improved outpatient follow-up (OR = 2.44; 95% CI = 1.50-3.97). Conclusions: In a controlled evaluation, the IDTS did not affect readmissions despite improving process of care measures for targeted patients. Care coordination services may improve OPAT quality of care, but their relationship to readmissions is unclear.
About a submucosal tracheal tumor
Authors: Serraj Mounia , Lakranbi Marouane , Ghalimi Jamal , Ouadnouni Yassine , Tizniti Siham , Smahi Mohamed
Published: September 2013

The authors report the case of 46-year-old man with recurrent hemoptysis. Bronchoscopy revealed a submucosal tumor protruding into the tracheal lumen. Transbronchial biopsy failed to obtain a conclusive diagnosis; only surgery allowed complete resection of the tumor and confirmed the diagnosis of tracheal mucoepidermoid carcinoma. We discuss the unusual submucosal presentation of this tumor, and the contribution of surgery for diagnosis and therapy.
Carcinoma ex pleomorphic adenoma of the upper lip: a case of an unusual malignant component of squamous cell carcinoma
Authors: Mitate Eiji , Kawano Shintaro , Kiyoshima Tamotsu , Kawazu Toshiyuki , Chikui Toru , Goto Yuichi , Matsubara Ryota , Nakamura Seiji
Published: September 2013

Background

Squamous cell carcinoma (SCC) as the malignant component of carcinoma ex pleomorphic adenoma (CXPA) occurring in upper lip is rare.

Case report

A 55-year-old male patient presented with an asymptomatic mass of the upper lip that had noticed 8 years previously. The mass was clinically suspected to be a benign salivary gland tumor based on palpation and magnetic resonance imaging findings. A needle biopsy was then carried out, and the pathological diagnosis was pleomorphic adenoma. The tumor was removed under general anesthesia. Histopathological examination revealed well-demarcated tumor tissues showing typical histologic features of pleomorphic adenoma. However, SCC tissue with several mitotic figures was found in the central area of the tumor tissue. The tumor was finally diagnosed as CXPA. There was no evidence of recurrence or metastasis 6 years postoperatively.

Conclusion

This is the first report of CXPA of the upper lip with an unusual malignant component of SCC.
Fabrication and photoresponse of ZnO nanowires/CuO coaxial heterojunction
Authors: Wu Jen-Kai , Chen Wei-Jen , Chang Yuan Huei , Chen Yang Fang , Hang Da-Ren , Liang Chi-Te , Lu Jing-Yu
Published: September 2013

The fabrication and properties of n-ZnO nanowires/p-CuO coaxial heterojunction (CH) with a photoresist (PR) blocking layer are reported. In our study, c-plane wurtzite ZnO nanowires were grown by aqueous chemical method, and monoclinic CuO (111) was then coated on the ZnO nanowires by electrochemical deposition to form CH. To improve the device performance, a PR layer was inserted between the ZnO buffer layer and the CuO film to serve as a blocking layer to block the leakage current. Structural investigations of the CH indicate that the sample has good crystalline quality. It was found that our refined structure possesses a better rectifying ratio and smaller reverse leakage current. As there is a large on/off ratio between light on and off and the major light response is centered at around 424 nm, the experimental results suggest that the PR-inserted ZnO/CuO CH can be used as a good narrow-band blue light detector.
mGluR2/3 blockade produces rapid and long-lasting reversal of anhedonia caused by chronic stress exposure
Authors: Dwyer Jason M , Lepack Ashley E , Duman Ronald S
Published: September 2013

Background

Depression is a prevalent neuropsychiatric disorder that affects an estimated 350 million people worldwide. Currently available treatments for depression are lacking in both speed of onset and efficacy. Recent pharmacological efforts have targeted the glutamatergic neurotransmitter system using the N-methyl-D-aspartate (NMDA) receptor antagonist ketamine to produce rapid and robust antidepressant effects, however the widespread clinical use of ketamine is limited due to side effects and abuse liability. More recently, work evaluating metabotropic mGluR2/3 receptor antagonists has demonstrated many similarities with ketamine.

Methods

Male, Sprague–Dawley rats were exposed to a chronic unpredictable stress paradigm, which produces decreased sucrose preference, a measure of anhedonia. Rats were then treated with vehicle or a single injection of the mGluR2/3 antagonist LY341495 (3 mg/kg, i.p.) and tested at 24 hrs, 48 hrs or 10 days after a single treatment.

Results

We demonstrate that a single treatment with LY341495 produces a rapid (within 1–2 days) and long-lasting (10 days) reversal of anhedonia caused by chronic unpredictable stress in rats. This model provides a rigorous test of rapid-acting agents as typical antidepressants require several weeks of treatment to produce a response.

Conclusions

These data suggest that LY341495 has the ability to produce rapid and robust antidepressant effects similar to ketamine. Together, the results highlight the potential for similar compounds to produce rapid and lasting efficacy for the treatment of depression.
Effect of Donor KIR2DL1 Allelic Polymorphism on the Outcome of Pediatric Allogeneic Hematopoietic Stem-Cell Transplantation
Authors: Bari Rafijul , Rujkijyanont Piya , Sullivan Erin , Kang Guolian , Turner Victoria , Gan Kwan , Leung Wing
Published: September 2013

Purpose

Killer-cell immunoglobulin-like receptors (KIRs) that regulate natural-killer cells are highly polymorphic. Some KIR2DL1 alleles encode receptors that have stronger signaling function than others. We tested the hypothesis that the clinical outcomes of allogeneic hematopoietic stem-cell transplantation (HSCT) could be affected by donor KIR2DL1 polymorphism.

Patients and Methods

All 313 pediatric patients received allogeneic HSCT at a single institution. Donor KIR2DL1 functional allele typing was retrospectively performed using single nucleotide polymorphism assay.

Results

Patients who received a donor graft containing the functionally stronger KIR2DL1 allele with arginine at amino acid position 245 (KIR2DL1-R245) had better survival (P = .0004) and lower cumulative incidence of disease progression (P = .001) than those patients who received a donor graft that contained only the functionally weaker KIR2DL1 allele with cysteine at the same position (KIR2DL1-C245). The effect of KIR2DL1 allelic polymorphism was similar in patients with acute myeloid leukemia or acute lymphoblastic leukemia among all allele groups (P ≥ .71). Patients who received a KIR2DL1-R245–positive graft with HLA-C receptor-ligand mismatch had the best survival (P = .00003) and lowest risk of leukemia progression (P = .0005) compared with those who received a KIR2DL1-C245 homozygous graft.

Conclusion

Donor KIR2DL1 allelic polymorphism affects recipient outcomes after allogeneic HSCT. These findings have substantial implications for prognostication and donor selection.
Improving the Relative Dose Intensity of Systemic Chemotherapy in a Community-Based Outpatient Cancer Center
Authors: Vavra Kari L. , Saadeh Claire E. , Rosen Alisha L. , Uptigrove Christine E. , Srkalovic Gordan
Published: September 2013

Improvements in relative dose intensity were demonstrated in a community-based cancer center through staff education, adherence to existing policies, and development of a febrile neutropenia risk assessment tool.
Using the Delphi Technique to Improve Clinical Outcomes Through the Development of Quality Indicators in Renal Cell Carcinoma
Authors: Wood Lori , Bjarnason Georg A. , Black Peter C. , Cagiannos Ilias , Heng Daniel Yick Chin , Kapoor Anil , Kollmannsberger Christian K. , Mohammadzadeh Forough , Moore Ronald B. , Rendon Ricardo A. , Soulieres Denis , Tanguay Simon , Venner Peter , Jewett Michael , Finelli Antonio
Published: September 2013

The authors used a systematic, consensus-based approach to determine relevant quality indicators in renal cell carcinoma care.
Cost Concerns of Patients With Cancer
Authors: Stump Tammy K. , Eghan Naa , Egleston Brian L. , Hamilton Olivia , Pirollo Melanie , Schwartz J. Sanford , Armstrong Katrina , Beck J. Robert , Meropol Neal J. , Wong Yu-Ning
Published: September 2013

Cost concerns are common among patients with cancer who have health insurance. Health care providers may alleviate concerns by discussing cost-related concerns with all patients, not only those of lower socioeconomic status or those without insurance.
The regulation of Hox gene expression during animal development
Authors: Mallo Moisés , Alonso Claudio R.
Published: September 2013

Hox genes encode a family of transcriptional regulators that elicit distinct developmental programmes along the head-to-tail axis of animals. The specific regional functions of individual Hox genes largely reflect their restricted expression patterns, the disruption of which can lead to developmental defects and disease. Here, we examine the spectrum of molecular mechanisms controlling Hox gene expression in model vertebrates and invertebrates and find that a diverse range of mechanisms, including nuclear dynamics, RNA processing, microRNA and translational regulation, all concur to control Hox gene outputs. We propose that this complex multi-tiered regulation might contribute to the robustness of Hox expression during development.
Polyunsaturated fatty acyl-coenzyme As are inhibitors of cholesterol biosynthesis in zebrafish and mice
Authors: Karanth Santhosh , Tran Vy My , Kuberan Balagurunathan , Schlegel Amnon
Published: September 2013

Lipid disorders pose therapeutic challenges. Previously we discovered that mutation of the hepatocyte β-hydroxybutyrate transporter Slc16a6a in zebrafish causes hepatic steatosis during fasting, marked by increased hepatic triacylglycerol, but not cholesterol. This selective diversion of trapped ketogenic carbon atoms is surprising because acetate and acetoacetate can exit mitochondria and can be incorporated into both fatty acids and cholesterol in normal hepatocytes. To elucidate the mechanism of this selective diversion of carbon atoms to fatty acids, we fed wild-type and slc16a6a mutant animals high-protein ketogenic diets. We find that slc16a6a mutants have decreased activity of the rate-limiting enzyme of cholesterol biosynthesis, 3-hydroxy-3-methylglutaryl-coenzyme A reductase (Hmgcr), despite increased Hmgcr protein abundance and relative incorporation of mevalonate into cholesterol. These observations suggest the presence of an endogenous Hmgcr inhibitor. We took a candidate approach to identify such inhibitors. First, we found that mutant livers accumulate multiple polyunsaturated fatty acids (PUFAs) and PUFA-CoAs, and we showed that human HMGCR is inhibited by PUFA-CoAs in vitro. Second, we injected mice with an ethyl ester of the PUFA eicosapentaenoic acid and observed an acute decrease in hepatic Hmgcr activity, without alteration in Hmgcr protein abundance. These results elucidate a mechanism for PUFA-mediated cholesterol lowering through direct inhibition of Hmgcr.
Fault Detection in Wind Turbine: A Systematic Literature Review
Authors: Purarjomandlangrudi Afrooz , Nourbakhsh Ghavameddin , Esmalifalak Mohammad , Tan Andy
Published: September 2013

Wind power has become one of the popular renewable resources all over the world and is anticipated to occupy 12% of the total global electricity generation capacity by 2020. For the harsh environment that the wind turbine operates, fault diagnostic and condition monitoring are important for wind turbine safety and reliability. This paper employs a systematic literature review to report the most recent promotions in the wind turbine fault diagnostic, from 2005 to 2012. The frequent faults and failures in wind turbines are considered and different techniques which have been used by researchers are introduced, classified and discussed.
Accuracy Assessment of Thermoacoustic Instability Models Using Binary Classification
Authors: Hoeijmakers Maarten , Arteaga Ines Lopez , Kornilov Viktor , Nijmeijer Henk , de Goey Philip
Published: September 2013

We apply binary classification theory to assess the (in)stability prediction accuracy of thermoacoustic models. It is shown that by applying such methods to compare a large set of stability predictions and experiments it is possible to gain valuable qualitative insight in different aspects of prediction quality. The approach is illustrated with a 2-port model and a large experimental data set. The presented framework provides an unified and practical tool to answer questions such as (i) What is the chance that a stable prediction will be correct? and (ii) How conservative is the model? It is shown that the most suitable quality indicator is strongly dependent on the actual purpose of the model. The method provides a solid starting point for model comparison and optimization.
Knowledge Management Systems and Human Resource Management Policies for Innovation Benchmarking: a Study of ST Ericsson
Authors: Søilen Klaus , Tontini Gerson
Published: September 2013

This paper shows in theory how a knowledge management system can be built as a human resource management (HRM) function. The solution builds on the notion of innovation benchmarking. A case study from the company ST Ericsson illustrates the discrepancy between what the company needs to do and what the HRM function is able to support when it comes to innovation. The study shows the ability of employees in the company to innovate within key success factors. More worryingly, it also shows key areas where the company is not able to compete and where it is not getting any support from the HRM function. At the end, we identify a number of directions for future research in the field of innovation benchmarking as it relates to HRM policies.
The logical way of being true: Truth values and the ontological foundation of logic
Authors: Shramko Yaroslav
Published: September 2013

In this paper I reject the normative interpretation of logic and give reasons for a realistic account based on the ontological treatment of logical values.
The Effect of Giving It All Up on Valuation: A New Look at the Endowment Effect
Authors: Schurr Amos , Ritov Ilana
Published: September 2013

In three experiments we show that the endowment effect—the tendency to demand more money for relinquishing owned goods than one is willing to pay for the same goods—fails to emerge when sellers are not fully depleted of their endowment. This finding is incompatible with prospect theory's account of the effect as stemming primarily from aversion to loss relative to the individual's current state. We suggest a new account of the endowment effect as reflecting the human aversion to “giving it all up” rather than simply an aversion to incurring any loss relative to the status quo. Experiments 1 and 2 show the effect employing a pricing paradigm. Experiment 3 examines what constitutes “all” in the giving-it-all-up effect.

This paper was accepted by Uri Gneezy, behavioral economics.
Growth Pattern, an Important Pathologic Prognostic Parameter for Clear Cell Renal Cell Carcinoma
Authors: Fukatsu Akitoshi , Tsuzuki Toyonori , Sassa Naoto , Nishikimi Toshinori , Kimura Tohoru , Majima Tsuyoshi , Yoshino Yasushi , Hattori Ryohei , Gotoh Momokazu
Published: September 2013

Objectives:

To assess the validity of growth pattern as a unique prognostic parameter for clear cell renal cell carcinoma (ccRCC).

Methods:

In total, 561 patients with pathologic tumor stage 1 (pT1), pT2, and pT3a ccRCC without preoperative metastasis were evaluated. Clinicopathologic parameters, including pathologic tumor stage, Fuhrman grade, tumor necrosis, lymphovascular invasion, and growth pattern, were analyzed to predict disease-free survival (DFS) and cancer-specific survival (CSS).

Results:

Growth patterns were defined as follows: expansive included tumors with well-circumscribed margins without normal renal tissue in the tumor, and infiltrative involved tumors with ill-circumscribed margins or normal renal tissue in the tumors. In multivariate analysis, Fuhrman grade, tumor necrosis, and growth pattern were useful predictors of DFS, whereas Fuhrman grade and growth pattern were useful predictors of CSS, although only 30 cases showed the infiltrative pattern.

Conclusions:

Growth pattern can be considered a new prognostic parameter for ccRCC.
What's the harm in paraphrasing?
Authors: Doye Chris
Published: September 2013

An opinion piece that suggests teaching students to paraphrase can have a negative effect on their ability to use sources in writing.
Improving Prelaunch Diffusion Forecasts: Using Synthetic Networks as Simulated Priors
Authors: Trusov Michael , Rand William , Joshi Yogesh V.
Published: September 2013

Although the role of social networks and consumer interactions in new product diffusion is widely acknowledged, such networks and interactions are often unobservable to researchers. What may be observable, instead, are aggregate diffusion patterns for past products adopted within a particular social network. The authors propose an approach for identifying systematic conditions that are stable across diffusions and thus are “transferrable” to new product introductions within a given network. Using Facebook applications data, the authors show that incorporation of such systematic conditions improves prelaunch forecasts. This research bridges the gap between the disciplines of Bayesian statistics and agent-based modeling by demonstrating how researchers can use stochastic relationships simulated within complex systems as meaningful inputs for Bayesian inference models.
Field-Scale Column-Supported Embankment Test Facility
Authors: Sloan J. A. , Filz G. M. , Collin J. G.
Published: September 2013

Column-supported embankments (CSEs) have seen increasing use in recent years where new embankments or widening of existing embankments is required over soft ground. The primary advantages of CSEs are more rapid single-phase construction and protection of adjacent facilities and embankments, but their use is limited because of lack of consensus on CSE design procedures. Investigations into CSE performance in the literature include bench-scale testing, centrifuge testing, case histories with instrumented test sections, numerical modeling, and a few examples of field-scale research test sections. This paper describes a field-scale CSE test facility that employs a unique approach where expanded polystyrene geofoam and its subsequent dissolution are used to model the soft soil beneath the CSE. The properties of the geofoam are similar to those of soft clay, although the geofoam layer is thin. The geofoam is dissolved after embankment construction using an environmentally friendly solvent to represent a worst-case scenario where there is zero soft soil support. Some field applications can approximate this condition. Based on an extensive literature review, the authors believe that this is the first published use of geofoam for temporary support of a column-supported test embankment, where the geofoam is later dissolved to remove support between columns. In addition to investigation of CSE behavior, the facility, instrumentation, and test concept have broader applications for investigation of other arching phenomenon including: localized loss of support beneath portions of other geotechnical structures such as mechanically stabilized earth walls, sinkhole mitigation, tunneling, and mining engineering. This paper focuses on description of the CSE test facility, materials, test procedures, and instrumentation. The results from one of the CSE tests are presented to illustrate the capabilities of the facility and data that can be collected. Future publications will present results from the entire CSE test program and make recommendations for CSE design.
Carl Philipp Emanuel Bach, Portraits, and the Physiognomy of Music History
Authors: Richards Annette
Published: September 2013

Taking as its point of departure C. P. E. Bach's extensive, and newly reconstructed, portrait collection, this essay explores the ways in which history in the late eighteenth century was conceived at the meeting point between the portrait collector, the physiognomist, and the anecdotist. Exploring the network of ideas and cultural practices by focusing on the collecting of individual countenances and their visual and literary representations, this article argues that anecdote, annotation, physiognomical analysis, and the visual discipline of portraiture were fundamental to the late eighteenth-century conception of music history. Further, it argues that C. P. E. Bach's activity as a portrait collector may be understood as a significant music-historiographical project in its own right, one which played an important role in the work of contemporary, and later, music historians.
Functional characteristics of neonatal rat β cells with distinct markers
Authors: Martens G A , Motté E , Kramer G , Stangé G , Gaarn L W , Hellemans K , Nielsen J H , Aerts J M , Ling Z , Pipeleers D
Published: September 2013

Neonatal β cells are considered developmentally immature and hence less glucose responsive. To study the acquisition of mature glucose responsiveness, we compared glucose-regulated redox state, insulin synthesis, and secretion of β cells purified from neonatal or 10-week-old rats with their transcriptomes and proteomes measured by oligonucleotide and LC-MS/MS profiling. Lower glucose responsiveness of neonatal β cells was explained by two distinct properties: higher activity at low glucose and lower activity at high glucose. Basal hyperactivity was associated with higher NAD(P)H, a higher fraction of neonatal β cells actively incorporating3H-tyrosine, and persistently increased insulin secretion below 5 mM glucose. Neonatal β cells lacked the steep glucose-responsive NAD(P)H rise between 5 and 10 mM glucose characteristic for adult β cells and accumulated less NAD(P)H at high glucose. They had twofold lower expression of malate/aspartate-NADH shuttle and most glycolytic enzymes. Genome-wide profiling situated neonatal β cells at a developmental crossroad: they showed advanced endocrine differentiation when specifically analyzed for their mRNA/protein level of classical neuroendocrine markers. On the other hand, discrete neonatal β cell subpopulations still expressed mRNAs/proteins typical for developing/proliferating tissues. One example, delta-like 1 homolog (DLK1) was used to investigate whether neonatal β cells with basal hyperactivity corresponded to a more immature subset with high DLK1, but no association was found. In conclusion, the current study supports the importance of glycolytic NADH-shuttling in stimulus function coupling, presents basal hyperactivity as novel property of neonatal β cells, and provides potential markers to recognize intercellular developmental differences in the endocrine pancreas.
Adipogenesis: new insights into brown adipose tissue differentiation
Authors: Carobbio Stefania , Rosen Barry , Vidal-Puig Antonio
Published: September 2013

Confirmation of the presence of functional brown adipose tissue (BAT) in humans has renewed interest in investigating the potential therapeutic use of this tissue. The finding that its activity positively correlates with decreased BMI, decreased fat content, and augmented energy expenditure suggests that increasing BAT mass/activity or browning of white adipose tissue (WAT) could be a strategy to prevent or treat obesity and its associated morbidities. The challenge now is to find a safe and efficient way to develop this idea. Whereas BAT has being widely studied in murine models bothin vivoandin vitro, there is an urgent need for human cellular models to investigate BAT physiology and functionality from a molecular point of view. In this review, we focus on the latest insights surrounding BAT development and activation in rodents and humans. Then, we discuss how the availability of murine models has been essential to identify BAT progenitors and trace their lineage. Finally, we address how this information can be exploited to develop human cellular models for BAT differentiation/activation. In this context, human embryonic stem and induced pluripotent stem cells-based cellular models represent a resource of great potential value, as they can provide a virtually inexhaustible supply of starting material for functional genetic studies, -omics based analysis and validation of therapeutic approaches. Moreover, these cells can be readily genetically engineered, opening the possibility of generating patient-specific cellular models, allowing the investigation of the influence of different genetic backgrounds on BAT differentiation in pathological or in physiological states.
Mutation of FAS, XIAP, and UNC13D Genes in a Patient With a Complex Lymphoproliferative Phenotype
Authors: Boggio Elena , Aricò Maurizio , Melensi Matteo , Dianzani Irma , Ramenghi Ugo , Dianzani Umberto , Chiocchetti Annalisa
Published: September 2013

This article presents a case report for a child presenting with mixed clinical features of autoimmune lymphoproliferative syndrome (ALPS), familial hemophagocytic lymphohistiocytosis (FHL), and X-linked lymphoproliferative (XLP) disease. From 6 months, he exhibited splenomegaly and lymphoadenopathy and from 4 years, he showed recurrent severe autoimmune hemocytopenia and sepsislike bouts of fever, from which he eventually died at the age of 12. Intriguingly, the patient carried mutations in FAS, XIAP, and UNC13D genes, which are involved in ALPS, XLP disease, and FHL, respectively. These mutations were inherited from the mother, who had rheumatoid arthritis but no signs of ALPS. A role for other modifying genes was suggested by the finding that the healthy father exhibited defective Fas function, without mutation of the FAS gene, and had transmitted to the patient an osteopontin (OPN) gene variant previously associated with ALPS. Therefore, several genes might influence the disease outcome in this family. In vitro analyses revealed that the FAS and the XIAP mutations decreased expression of the corresponding proteins, and the UNC13D mutation decreased granule secretion and Munc interaction with Rab-27a. These findings suggest that overlap may exist between ALPS, FHL, and XLP disease, in accordance with the notion that FHL and XLP disease are due to defective natural killer (NK)/NK T–cell function, which involves Fas. Therefore, we propose that NK cell defects should be evaluated in patients with ALPS-like characteristics, and hematopoietic stem cell transplantation should be considered in individuals with severe refractory cytopenia and FHL-like manifestations.
Thyroid “Vise” in an Infant With Neonatal Graves’ Disease
Authors: Regelmann Molly O. , Sullivan Corinne K. , Rapaport Robert
Published: September 2013

On the rare occasion when neonatal goiter is the cause of airway compromise, it typically presents with a palpable neck mass. In the setting of maternal Graves’ disease (GD), fetal and neonatal goiters are most commonly caused by maternal treatment with antithyroid medication, and the goiter resolves within days of initiation of thyroxine replacement in the neonate. We describe an atypical presentation of a patient with severe neonatal GD born to a euthyroid mother at 35 weeks’ gestational age with respiratory compromise, symptoms of hyperthyroidism, and a nonpalpable thyroid gland. The mother had a history of GD treated with radioactive iodine ablation; during the pregnancy she was treated with levothyroxine throughout and propylthiouracil beginning at 5 months’ gestation, for fetal tachycardia. Laboratory testing after birth confirmed neonatal GD. The patient was treated with methimazole, Lugol’s solution, and levothyroxine, and the patient remained euthyroid from day of life 10. After multiple extubation attempts failed, the patient was found on visualization studies to have a large, predominantly posterior, “vise-like” goiter encasing the larynx and upper trachea. The patient was successfully extubated, and all medications were discontinued on day of life 60. The patient remained euthyroid 1 month after discontinuation of treatment. The patient’s atypical presentation illustrates the need for early neck imaging in patients with neonatal GD and respiratory distress, especially when the thyroid gland is not palpable. Treatment options for resolving a goiter due to neonatal GD are not clear.
Trends in Physical Activity, Sedentary Behavior, Diet, and BMI Among US Adolescents, 2001–2009
Authors: Iannotti Ronald J. , Wang Jing
Published: September 2013

OBJECTIVE:

The high prevalence of adolescent obesity in the United States has been attributed to population changes in physical activity (PA), sedentary behaviors, and dietary behaviors. This study examines 8-year trends in these behaviors in US adolescents ages 11 to 16.

METHODS:

Nationally representative samples of US students in grades 6 to 10 were recruited during the 2001–2002 (N = 14 607), 2005–2006 (N = 9150), and 2009–2010 (N = 10 848) school years by using multistage stratified designs, with census regions and grades as strata, and school districts as the primary sampling units. African-American and Hispanic students were oversampled to obtain better estimates for those groups. Using the Health Behavior in School-aged Children quadrennial surveys, identical questions assessed BMI, PA, and sedentary and dietary behaviors at each school year. Logistic and linear regression analyses were conducted taking into account the sampling design and controlling for age, gender, race/ethnicity, and family affluence.

RESULTS:

Across the quadrennial surveys, significant increases were identified in number of days with at least 60 minutes of PA, daily consumption of fruits and vegetables, eating breakfast on weekdays and weekends, and BMI. Television viewing and consumption of sweets and sweetened beverages decreased across this same period. These same patterns were seen in all racial/ethnic groups.

CONCLUSIONS:

These patterns suggest that public health efforts to improve the obesity-related behaviors of US adolescents may be having some success. However, alternative explanations for the increase in BMI over the same period need to be considered.
Examples of positive suggestions given to patients undergoing orthopaedic surgeries
Authors: Szeverényi Csenge , Csernátony Zoltán , Balogh Ágnes , Varga Katalin
Published: September 2013

In the Department of Orthopaedic Surgery in the University of Debrecen, Debrecen, Hungary, we examined the effectiveness of positive suggestions used in the perioperative period in hip and knee arthroplasties performed under spinal anaesthesia. The goal of the suggestions was to reduce the need for red blood cell transfusion and for analgesics, and to increase the patients’ satisfaction. The objective of this article is to present our method with concrete examples of positive suggestions which were given first before the surgery (via personal conversation), then during the operation as well (via audiotaped method). We hope that our article will contribute to the wide-spread awareness of this relatively easy to learn communication method.
Adaptação e validação de conteúdo da versão brasileira do Posttraumatic Cognitions Inventory
Authors: Sbardelloto Gabriela , Schaefer Luiziana Souto , Justo Alice Reuwsaat , Lobo Beatriz de Oliveira Meneguelo , Kristensen Christian Haag
Published: September 2013

OBJETIVO: Realizar a tradução, adaptação e validação de conteúdo da versão brasileira do Posttraumatic Cognitions Inventory . MÉTODOS: O processo de tradução e adaptação das instruções iniciais e dos itens do PTCI envolveu cinco etapas: (1) tradução; (2) retradução; (3) correção e adaptação semântica; (4) validação do conteúdo por profissionais da área (juízes); e (5) teste da versão final, por meio de uma escala verbal-numérica. Como indicadores de desempenho para a compreensão, foram computados os escores de tendência central (média) e dispersão (desvio padrão) para cada item na etapa 5. Definiu-se escore médio ≥ 3 para compreensão satisfatória. RESULTADOS: As 36 questões e as instruções iniciais foram traduzidas e adaptadas para compor a versão brasileira do Posttraumatic Cognitions Inventory . Quarenta e cinco adultos responderam aos itens do Posttraumatic Cognitions Inventory na etapa teste da versão final, mostrando compreensão adequada do instrumento na escala verbal-numérica (M = 4,13; dp = 0,11). CONCLUSÕES: O Posttraumatic Cognitions Inventory é um instrumento de fácil compreensão e semanticamente válido. Estudos posteriores são necessários para a verificação e adequação da avaliação de suas propriedades psicométricas na população brasileira.
Causas externas e mortalidade materna: proposta de classificacao
Authors: Alves Mercia Maria Rodrigues , Alves Sandra Valongueiro , Antunes Maria Bernadete de Cerqueira , Santos Dirce Luiza Pereira dos
Published: September 2013

OBJETIVO: Analisar os óbitos por causas externas e causas mal definidas em mulheres em idade fértil ocorridos na gravidez e no puerpério precoce. MÉTODOS: Foram estudados 399 óbitos de mulheres em idade fértil de Recife, PE, de 2004 a 2006. A pesquisa utilizou o método Reproductive Age Mortality Survey e um conjunto de instrumentos de investigação padronizados. Foram usados como fontes de dados laudos do Instituto Médico Legal, prontuários hospitalares e da Estratégia Saúde da Família e entrevistas com os familiares das mulheres falecidas. Óbitos por causa externa na gravidez foram classificados de acordo com a circunstância da morte usando-se o código O93 e calculadas as razões de mortalidade materna antes e depois da classificação. RESULTADOS: Foram identificados 18 óbitos na presença de gravidez. A maioria das mulheres tinha entre 20 e 29 anos, de quatro a sete anos de estudo, eram negras, solteiras. Quinze óbitos foram classificados com o código O93 como morte relacionada à gravidez (13 por homicídio - O93.7; dois por suicídio - O93.6) e três mortes maternas obstétricas indiretas (uma homicídio - O93.7 e duas por suicídio - O93.6). Houve incremento médio de 35,0% nas razões de mortalidade materna após classificação. CONCLUSÕES: Os óbitos por causas mal definidas e no puerpério precoce não ocorrem por acaso e sua exclusão dos cálculos dos indicadores de mortalidade materna aumentam os níveis de subinformação.
Mortalidade infantil evitavel e barreiras de acesso a atencao basica no Recife, Brasil
Authors: Vanderlei Lygia Carmen de Moraes , Navarrete Maria Luisa Vazquez
Published: September 2013

OBJETIVO: Analisar os fatores que influenciam na mortalidade infantil evitável na perspectiva dos protagonistas envolvidos. MÉTODOS: Estudo qualitativo crítico-construtivista de análise do acesso das crianças à atenção e à mortalidade infantil evitável por ações e serviços no Distrito Sanitário I do Recife, PE, entre fevereiro de 2007 e fevereiro de 2008. Desenhou-se amostra teórica em duas etapas: I) instituições prestadoras de serviços de saúde infantil; II) informantes: gestores (11); profissionais da Estratégia de Saúde da Família e do Programa de Agentes Comunitários de Saúde (48); profissionais das policlínicas (12), mães (20), com tamanho definido por saturação dos discursos. Foram realizadas entrevistas individuais semiestruturadas e estudo de caso de óbito infantil evitável. Utilizou-se análise temática de conteúdo com geração mista de categorias (emergentes e roteiro). RESULTADOS: Houve posições de conflito entre grupos de atores, refletindo o papel desempenhado na rede assistencial. Os participantes institucionais relacionavam os óbitos infantis à ausência/má divulgação das políticas de saúde infantil e das ações intersetoriais; profissionais e mães destacaram dificuldades de acesso por insuficiência global de recursos, principalmente a falta de médicos na Estratégia de Saúde da Família, deslocando a assistência para enfermeiras. Ausência de médicos, rechaço às doenças agudas, atenção desumanizada e/ou de má qualidade técnica foram os principais fatores relacionados aos óbitos pelas mães. Os participantes da Estratégia de Saúde da Família, do Programa de Agentes Comunitários de Saúde e mães identificaram a condição de exclusão social e negligência materna com os óbitos enquanto o estudo de caso de óbito mostrou sua associação à baixa qualidade da atenção ofertada. CONCLUSÕES: Numerosas barreiras de acesso apontam a insuficiente implantação do Sistema Único de Saúde e falta de resolubilidade da principal porta de entrada, a Estratégia de Saúde da Família. Melhorias dos fatores estruturais e organizacionais da oferta são necessárias, sobretudo mecanismos de incentivo à contratação de médicos para a Estratégia de Saúde da Família e de formação/capacitação profissional da equipe compatível com o modelo de atenção para o cumprimento das políticas de atenção à saúde da criança e prevenção das mortes infantis evitáveis.
A prediction model for autogenous shrinkage of high-performance concrete in bridge engineering
Authors: Wang Zonglin , Li Guodong
Published: September 2013

Based on an experimental method of studying the autogenous shrinkage of high-performance concrete (HPC) in a mould of low-density flexible corrugated pipe, this paper presents experimental results and a prediction model for autogenous shrinkage of HPC with respect to water to cementitious materials ratio, replacement ratio of fly ash, air content and aggregate to cementitious materials paste ratio. Reasonably good agreement is observed between the experimental and predicted autogenous shrinkage, thus indicating that the proposed model can be successfully used to estimate the effects of the studied parameters on the development of autogenous shrinkage in HPC.
Condom Access in San Antonio, Texas: The “Three A's” and HIV/STI Incidence
Authors: Biasiolli April , Vaughn Mercedes , Brown Christopher , Scott Anthony A.
Published: September 2013

Condoms are highly effective at reducing STI transmission. Access is a critical precursor to use. This socio-ecologic study operationalizes the concept of condom access by defining it in terms of availability, affordability, and affect, and explores the relationship between these and STI incidence. Three pairs of zip codes, each with similar demographics but different Chlamydia and HIV incidence rates, were identified. Supermarkets, convenience stores, and pharmacies ( N = 102) were evaluated for the three A's. Nonparametric methods were used to compare the moderate-Chlamydia areas to the high-incidence areas. High-Chlamydia areas were significantly less likely to have 12-packs available compared to moderate-Chlamydia areas. Prices averaged over $1 per condom and did not vary by incidence. High-incidence areas were significantly less likely to allow patrons to select condoms unassisted. High-HIV areas placed more positively-connoted items near condoms. Improving these factors may improve condom acquisition and in turn reduce STI and HIV incidence rates.
Editorial
Authors: Gray J A
Published: September 2013

After 220 years of journalistic infertility, the Royal Medical Society has given birth to Res Medica and it is appropriate enough that nearly nine months have elapsed since the end of last Session when the idea was first conceived. Previous attempts to publish the Transactions of the Society have on the whole been abortive, and the idea of a regularly produced Journal never seems to have been seriously entertained.
Modern Concepts of Breast Carcinoma
Authors: Porritt Sir Arthur
Published: September 2013

Twenty years ago, it was generally considered that breast cancer was readily accessible to radical surgery and that radical surgery had more to offer here than perhaps anywhere else in the body. In the intervening years, this pseudo-complacency has suffered a series of rude shocks, until to-day the pendulum has swung full distance and radical mastectomy plays but a minor role in the treatment of carcinoma of the breast. The now obvious gaps in our armamentarium have been filled by X-ray therapy, with or without local surgery, by the use of the sex endocrines and the cortico-steroids and by what may be termed “ physiological” operations on various endocrine glands.
Full issue , Res Medica, Summer 1959, Volume 1, Number 4
Authors: Swann Prof Michael , Turner F W , Craddock A B , Malcolm-Smith Nigel , Scott Richard , Boddy F A , Turner J H , Dudley H A. F. , Crombie A L , Mailer C M , Clark David J
Published: September 2013

TABLE OF CONTENTSEDITORIAL GROWTH NORMAL AND ABNORMAL: Professor Michael Swann SPONTANEOUS SUBARACHNOID HAEMORRHAGE: SOME ASPECTS OF ITS PATHOGENESIS AND MANAGEMENT: F. W. TurnerTHE DIAGNOSIS OF HYSTERIA: A. B. Craddock GOINGS-ON DURING THE 222ND SESSION: Nigel Malcolm-SmithFAMILY MEDICINE: Richard Scott, M.D. , D.P.H.THE CHANGING FACE OF MEDICAL PRACTICE: F. A. Boddy THE DIAGNOSIS OF CHEST DISEASE: J. H. TurnerELECTROLYTE IMBALANCE: H.A.F. Dudley, CH.M., F .R.C.S.E.ROCKETS, MEN AND MEDICINE: A. L. Crombie AN APPRAISAL OF ULCERATIVE COLITIS: C. M. Mailer