bluuebunny/crossref_metadata_2025 huggingface dataset:
Inappropriateness of fresh frozen plasma for abnormal coagulation tests
Authors: S Pybus  , MacCormac A , Houghton A , Martlew V , Thachil J
Published: December 2012

Background: There is increasing evidence to suggest that the use of fresh frozen plasma (FFP) as a prophylaxis to bleeding is ineffective. However, a high proportion of FFP transfusions still occur in non-bleeding patients despite the high risk of adverse events. The aim of the study was to assess compliance with current prophylactic FFP guidelines at a large tertiary centre.

Methods: Data were collected retrospectively over a 16-month period from May 2010 to August 2011. Information collected included patient characteristics, indications for and details of FFP use, and the ordering of coagulation screens before and after transfusion.

Results: Over this period, FFP was used in a total of 573 transfusion episodes, 88 of which were prophylactic. This use deviated from the British Committee for Standards in Haematology guidelines in three main areas: indications for FFP use (89%), dose prescribed (49%) and the measurement of prothrombin time (PT) and activated partial thromboplastin time (APTT) after transfusion (66%).

Conclusions: There were no significant differences in compliance with guidelines between different hospital departments, suggesting a culture of widespread inappropriate FFP use and a general lack of understanding among clinicians. Physician training and increased enforcement of existing guidelines could reduce FFP usage and expenditure.
Chronic opioid use: a risk factor for central sleep apnoea and successful therapy with adaptive pressure support servo-ventilation
Authors: Fahim A , Johnson AO
Published: December 2012

Sleep apnoea is a global health problem with significant morbidity. Obesity is a well-known risk factor for this condition, however chronic intake of opioids as a risk factor for central sleep apnoea is under-recognised. We report a case of a 47-year-old man who developed significant sleep-disordered breathing secondary to opioid use for chronic pain. A sleep study demonstrated a picture of complex sleep apnoea with a prominent central sleep apnoea component. He had no significant improvement with conventional continuous positive airway pressure therapy. However, adaptive servo-ventilation had a dramatic effect on his symptoms and compliance. This case highlights the significant risk of central sleep apnoea with opioid use and illustrates the importance of adaptive servo-ventilation in the management of sleep-disordered breathing secondary to impaired central respiratory drive.
Sezary syndrome: diagnosis and management
Authors: Ogilvie C , Jackson R , Leach M , McKay P
Published: December 2012

We describe a case of a delayed diagnosis of Sezary syndrome in a patient with longstanding generalised pruritus, erythroderma, alopecia and nail dystrophy. We highlight some of the difficulties in diagnosis despite the fact that all patients have a characteristic circulating malignant T-cell lymphocyte in peripheral blood. These cells with cerebriform nuclei should be sought in peripheral blood films and further evaluated using flow cytometry in all patients with an erythrodermatous presentation. We summarise current treatment options although, as with all rare diseases, there are few randomised controlled clinical trials to inform decisions on optimal therapy for each individual patient.
Our approach to the diagnosis and treatment of polymyalgia rheumatica and giant cell (temporal) arteritis
Authors: Quick V , Kirwan JR
Published: December 2012

We believe there is a strong case for formalised collaborative care between GPs and rheumatologists in the management of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA), which can be difficult conditions to diagnose and manage. Our rapid access diagnostic care pathways allow early referral of patients who appear to have PMR or GCA, before glucocorticoids are prescribed. Using set referral criteria, we identify patients with PMR who can follow our slow-reduction glucocorticoid regimen without recurrence or exacerbation in about 80% of cases, a much lower relapse rate than that reported using more rapid reduction regimens. We have a low threshold for performing a temporal artery biopsy in GCA and where possible defer treatment until this is done. Using this approach, we can establish a secure diagnosis in the vast majority of patients and refer them back to primary care for our standardised treatment regimens.
A sceptic and an empiric in medicine: George Young (1692–1757) and the beginnings of the Scottish medical Enlightenment
Authors: Macintyre IMC
Published: December 2012

The Edinburgh surgeon-apothecary and physician George Young was an empiric who emphasised observation, practical experience and a sceptical approach to evidence in medicine. He was an early member of the Rankenian Club, a group of young intellectuals whose ideas were to be at the heart of Scottish Enlightenment thinking. Young certainly influenced his pupil Robert Whytt, who went on to make important contributions to the understanding of nerve and muscle function. James Hill, Young’s apprentice, to whom he emphasised the importance of experience and observation, would later advance thinking and practice in the management of head injury. Young was an important, but to date relatively neglected, figure in the early years of the Edinburgh Medical School and the Scottish Enlightenment. This paper describes what is known of his life and work, aims to assess his legacy and suggests that he deserves greater recognition and appreciation.
‘A box of chymical medicines’: an Italian medicine chest presented to Sir John Clerk of Penicuik in 169
Authors: Dingwall H , Worling P
Published: December 2012

In December 1698 Sir John Clerk, second baronet of Penicuik, visited Cosimo III of Medici, Grand Duke of Tuscany, while on his Grand Tour of Europe – an essential part of the broader education of the gentleman at this time. The Duke presented him with a wooden medicine chest, in which the original medicines in their labelled containers are still to be found. The chest is Italian in origin, but many of the preparations it contains existed in various forms in European – including Scottish – formulations from that time. This paper outlines the context of the period, the state of medicine and pharmacy in Scotland, and examines the contents of the box. It is rare for such a complete chest to survive from this period in Scotland – most surviving examples date from at least the mid-eighteenth century. It offers a unique opportunity to investigate some of the medicines of the period.
Avaliação de modelos matemáticos para resolução de Job Shop Problem com utilização de recursos humanos especialistas em projetos
Authors: Penha Renato , Kniess Cláudia Terezinha , Bergmann Daniel Reed , Biancolino César Augusto
Published: December 2012

Um projeto pode ser definido como um sistema complexo que exige o emprego de recursos (recursos humanos, materiais, tecnologia, entre outros), alocados entre fins alternativos, como meio de atingir objetivos específicos, mediante a presença de restrições de diferentes ordens. O planejamento, a alocação e a priorização de recursos humanos, inclusive Recursos Humanos Especialistas (RHE) são realizados por meio do gerenciamento de projetos de forma individual. Esse tratamento pode causar disputa interna pela utilização do mesmo recurso ou até mesmo a sua subutilização. Isso pode ser mais pronunciado em ambientes de desenvolvimento de softwares devido ao alto grau de interdependência, de incerteza e de risco de cada projeto. Tal necessidade está relacionada ao chamado Job Shop Problem (JSP). Nesse contexto, o objetivo deste trabalho é avaliar modelos matemáticos de algoritmo genético e de otimização e suas contribuições para a resolução de Job Shop Problem em projetos de desenvolvimento de software com a utilização de Recursos Humanos Especialistas.
METHODS TO DETERMINE ECOTOUHRISM SUITABILITY OF FOREST AREAS
Authors: Pérez-Vivar Marcelino A. , González-Guillén Manuel de J. , Valdez-Lazalde J. René
Published: December 2012

Una iniciativa de ecoturismo debe basarse en las características biofísicas perceptuales del espacio y en la capacidad del medio para sostener sus actividades. Diversos estudios han planteado metodolo¬gías para abordar esta capacidad (aptitud); sin embargo, pocos han abordado un análisis comparativo para determinar su utilidad práctica. El objetivo del presente trabajo fue analizar los métodos emplea¬dos en la determinación de la aptitud ecoturística de áreas forestales para la orientación de trabajos futuros. En el análisis se encontraron métodos cualitativos que describen la información relacionada con el problema de estudio, y métodos cuantitativos que se basan en la medición de variables y pro¬cesos estadísticos para su análisis. Los métodos cuantitativos presentan ventajas amplias sobre los cualitativos al caracterizar la actividad ecoturística de interés a través de criterios naturales, económi¬cos y sociales e indicadores asociados como topografía, vegetación, hidrografía, geología, cercanía a las poblaciones, e infraestructura. Además, los métodos cuantitativos también generan un valor de aptitud con fines comparativos, siendo así los más deseables para evaluar la aptitud ecoturística. El conocimiento de las cualidades de ambos métodos proporciona un elemento de valoración metodoló¬gica adicional a trabajos futuros en el tema.
BIOMASA DE RAÍCES EN UN BOSQUE TEMPLADO CON Y SIN MANEJO FORESTAL EN HIDALGO, MÉXICO
Authors: Pavón Numa P. , Moreno Claudia E. , Ramírez-Bautista Aurelio
Published: December 2012

Las raíces son buenos indicadores funcionales del ecosistema ya que constituyen gran parte de la biomasa viva del suelo y ejercen un control sobre los procesos de pedogénesis, la producción de materia orgánica y la dinámica de los nutrientes. En este trabajo se comparó la biomasa de raíces gruesas y finas entre un bosque conservado y un bosque con manejo forestal de corte selectivo. La biomasa promedio de raíces no difirió significativamente entre sitios (P = 0.185). La biomasa en el bosque con manejo forestal fue de 3.05 Mg·ha-1 (E. E. = 0.25) y de 3.39 Mg·ha-1 (E. E. = 0.24) en el bosque conservado. Las raíces finas ocuparon el mayor porcentaje de la biomasa en ambos tipos de bosque, aunque sus valores no difirieron significativamente entre sitios (P = 0.095). De acuerdo con los resultados, al parecer, el manejo forestal de tipo de corte selectivo mantiene las condiciones ambientales y en particular del suelo, lo que permite contener una biomasa similar a la de un bosque conservado bajo condiciones naturales.
FERTILIZANTES DE LIBERACIÓN CONTROLADA APLICADOS AL ESTABLECIMIENTO DE Pinus radiata D. DON EN CHILE
Authors: Reyes-Millalón Javier , Gerding Víctor , Thiers-Espinoza Oscar
Published: December 2012

El uso de fertilizantes de liberación controlada (FLC) es incipiente y no se han publicado resultados de su uso en Chile. Se evaluó una aplicación de FLC al momento del establecimiento de Pinus radiata sobre un suelo ultisol en Valdivia, Chile. El estudio se realizó en tres sitios (año 2006) con variaciones del suelo donde se aplicaron seis tratamientos de FLC (10-20 g·planta-1), un fertilizante tradicional hidrosoluble y un testigo sin fertilizar. Los datos se analizaron en un diseño de bloques al azar. La evaluación (2006-2010) consideró la supervivencia, el crecimiento de los árboles y la cobertura de malezas. La supervivencia fue 84 a 96 %, sin diferencias entre tratamientos (P > 0.05). Los FLC produjeron respuestas superiores en crecimiento que el testigo y similares a las del fertilizante hidro- soluble. Los mayores rendimientos de los árboles al cuarto año se obtuvieron con FLC (+42 % factor de producción). Los FLC dieron mejor respuesta con dosis mayores o periodos de liberación más pro- longados. La respuesta fue diferente entre sitios, tanto por la estructura del suelo como por su oferta nutritiva. El crecimiento fue mermado con una cobertura de malezas mayor al 30 % en la plantación.
ESTIMACIÓN DE LA DISOCIACIÓN DE Agave cupreata A SU HÁBITAT IDÓNEO DEBIDO AL CAMBIO CLIMÁTICO
Authors: Sáenz-Romero Cuauhtémoc , Martínez-Palacios Alejandro , Gómez-Sierra Juan M. , Pérez-Nasser Nidia , Sánchez-Vargas Nahum M.
Published: December 2012

Los individuos maduros de Agave cupreata son cosechados para producir mezcal, una bebida alcohólica artesanal. El objetivo de este trabajo fue estimar el desfasamiento potencial del hábitat apropiado, debido al cambio climático, entre las poblaciones y el clima al cual están adaptados. Para ello, se estimó el clima contemporáneo (promedio 1961-1990) y futuro (año 2030) de 12 localidades donde se distribuyen las poblaciones naturales. Las estimaciones se hicieron utilizando un modelo climático “spline”, basado en resultados del modelo de circulación global canadiense, escenario de emisiones intermedio A1B. La estimación de la temperatura promedio de las 12 procedencias para el clima contemporáneo fue 19.1 °C y la estimación de la precipitación fue 961 mm. La predicción para el año 2030 fue 20.5 °C y 833 mm, con un incremento de temperatura de 1.4 °C y un decremento de precipitación de 13.3 %. Los resultados indican que el clima propicio para A. cupreata ocurrirá entre 175 y 225 m de altitud mayor que las localidades en donde actualmente se encuentran las poblaciones. Por tanto, se sugiere establecer plantaciones de conservación ex situ y comerciales bajo las condiciones mencionadas, como una medida de manejo de migración asistida para adaptarse al cambio climático predicho.
Towards the use of dynamic growing seasons in a chemical transport model
Authors: Sakalli A. , Simpson D.
Published: December 2012

Abstract. Chemical transport models (CTMs), used for the prediction of, for example, nitrogen deposition or air quality changes, require estimates of the growing season of plants for a number of reasons. Typically, the growing seasons are defined in a very simplified way in CTMs, using fixed dates or simple functions. In order to explore the importance of more realistic growing season estimates, we have developed a new and simple method (the T5 method) for calculating the start of the growing season (SGS) of birch (which we use as a surrogate for deciduous trees), suitable for use in CTMs and other modelling systems. We developed the T5 method from observations, and here we compare with these and other methodologies, and show that with just two parameters T5 captures well the spatial variation in SGS across Europe. We use the EMEP MSC-W chemical transport model to illustrate the importance of improved SGS estimates for ozone and two metrics associated with ozone damage to vegetation. This study shows that although inclusion of more realistic growing seasons has only small effects on annual average concentrations of pollutants such as ozone, the metrics associated with vegetation risk from ozone are significantly affected. This work demonstrates a strong need to include more realistic treatments of growing seasons in CTMs. The method used here could also be suitable for other types of models that require information on vegetation cover, such as meteorological and regional climate models. In future work, the T5 and other methods will be further evaluated for other forest species, as well as for agricultural and grassland land covers, which are important for emissions and deposition of reactive nitrogen compounds.
Influence of chemosynthetic ecosystems on nematode community structure and biomass in the deep eastern Mediterranean Sea
Authors: Lampadariou N. , Kalogeropoulou V. , Sevastou K. , Keklikoglou K. , Sarrazin J.
Published: December 2012

Abstract. Mud volcanoes are a special type of cold seeps where life is based on chemoautotrophic processes. They are considered as extreme environments and are characterised by unique megafaunal and macrofaunal communities. However, very few studies on mud volcanoes taking into account the smaller meiobenthic communities have been carried out. Two mud volcanoes were explored during the MEDECO cruise (2007) with the Remotely Operated Vehicle (ROV) Victor-6000; Amsterdam, located south of Turkey between 1700 and 2000 m depth (Anaximander mud field) and Napoli, south of Crete, located along the Mediterranean Ridge at about 2000 m depth (Olimpi mud field). The major aim of this study was to describe distributional patterns of meiofaunal communities and nematode assemblages from different seep microhabitats. Meiofaunal taxa and nematode assemblages at both mud volcanoes differed significantly from other Mediterranean sites in terms of standing stocks, dominance and species diversity. Density and biomass values were significantly higher at the seep sites, particularly at Amsterdam. Nematodes, the dominant meiofaunal taxon, displayed deeper penetration vertically into the sediment at the seep areas, indicating that biological rather than physicochemical factors are responsible for their vertical distribution. Patterns of nematode diversity varied, displaying both very high or very low species richness and dominance, depending on the habitat studied. The Lamellibrachia periphery and mussel bed of Napoli exhibited the highest species richness while the reduced sediments of Amsterdam yielded a species-poor nematode community, dominated by two successful species; one belonging to the genus Aponema and the other to the genus Sabatieria. Analysis of β-diversity showed that habitat heterogeneity of mud volcanoes contributed substantially to the total nematode species richness in the eastern Mediterranean Sea. These observations indicate a strong influence of mud volcanoes and cold-seep ecosystems on the meiofaunal communities and nematode assemblages.
A method for sea ice thickness and concentration analysis based on SAR data and a thermodynamic model
Authors: Karvonen J. , Cheng B. , Vihma T. , Arkett M. , Carrieres T.
Published: December 2012

Abstract. An analysis of ice thickness distribution is a challenge, particularly in a seasonal sea ice zone with a strongly dynamic ice motion field, such as the Gulf of St. Lawrence off Canada. We present a novel automated method for ice concentration and thickness analysis combining modeling of sea ice thermodynamics and detection of ice motion on the basis of space-borne Synthetic Aperture Radar (SAR) data. Thermodynamic evolution of sea ice thickness in the Gulf of St. Lawrence was simulated for two winters, 2002–2003 and 2008–2009. The basin-scale ice thickness was controlled by atmospheric forcing, but the spatial distribution of ice thickness and concentration could not be explained by thermodynamics only. SAR data were applied to detect ice motion and ice surface structure during these two winters. The SAR analysis is based on estimation of ice motion between SAR image pairs and analysis of the local SAR texture statistics. Including SAR data analysis brought a significant added value to the results based on thermodynamics only. Our novel method combining the thermodynamic modeling and SAR yielded results that well match with the distribution of observations based on airborne Electromagnetic Induction (EM) method. Compared to the present operational method of producing ice charts for the Gulf of St. Lawrence, which is based on visual interpretation of SAR data, the new method reveals much more detailed and physically based information on spatial distribution of ice thickness. The algorithms can be run automatically, and the final products can then be used by ice analysts for operational ice service. The method is globally applicable to all seas where SAR data are available.
Perspectives of Speech-Language Pathologists on the Use of Telepractice in Schools: Quantitative Survey Results
Authors: Tucker Janice K.
Published: December 2012

This research surveyed 170 school-based speech-language pathologists (SLPs) in one northeastern state, with only 1.8% reporting telepractice use in school-settings. These results were consistent with two ASHA surveys (2002; 2011) that reported limited use of telepractice for school-based speech-language pathology. In the present study, willingness to use telepractice was inversely related to age, perhaps because younger members of the profession are more accustomed to using technology.  Overall, respondents were concerned about the validity of assessments administered via telepractice; whether clinicians can adequately establish rapport with clients via telepractice; and if therapy conducted via telepractice can be as effective as in-person speech-language therapy. Most respondents indicated the need to establish procedures and guidelines for school-based telepractice programs.
Promising Practices in E-Supervision: Exploring Graduate Speech-Language Pathology Interns’ Perceptions
Authors: Carlin Charles H. , Milam Jennifer L. , Carlin Emily L. , Owen Ashley
Published: December 2012

E-supervision has a potential role in addressing speech-language personnel shortages in rural and difficult to staff school districts. The purposes of this article are twofold: to determine how e-supervision might support graduate speech-language pathologist (SLP) interns placed in rural, remote, and difficult to staff public school districts; and, to investigate interns’ perceptions of in-person supervision compared to e-supervision. The study used a mixed methodology approach and collected data from surveys, supervision documents and records, and interviews. The results showed the use of e-supervision allowed graduate SLP interns to be adequately supervised across a variety of clients and professional activities in a manner that was similar to in-person supervision. Further, e-supervision was perceived as a more convenient and less stressful supervision format when compared to in-person supervision. Other findings are discussed and implications and limitations provided.
The Multi-faceted Implementation of Telepractice to Service Individuals with Autism
Authors: Boisvert Michelle , Hall Nerissa , Andrianopoulos Mary , Chaclas Jeanne
Published: December 2012

Telepractice is a method of service delivery in which professionals provide intervention, assessment and consultation services to individuals through the use of telecommunication technologies.  In response to the nationwide school-based shortage of speech-language pathologists, telepractice has emerged as a viable way to reach underserved clients. Telepractice has the potential to extend to populations in need of services, including those diagnosed with autism.  This paper examines an evidence-based clinical model for the delivery of telepractice services and describes the policies and procedures required for assessing individual need, confidentiality, technology, training and documentation within a telepractice program.  Two clinical case studies involving individuals diagnosed with autism are described and provide initial evidence for the use of telepractice as a practical method for direct and consultative service delivery. Results indicated that both the student receiving direct services, and the treating clinician receiving consultative services via telepractice, demonstrated an increased skill level in target domains.
Accessible Table of Contents
Authors: Cohn Ellen R.
Published: December 2012

Accessible Table of Contents
Editors' Note
Authors: Cohn Ellen R. , Cason Jana
Published: December 2012

.
Oligo(∊-caprolactone)-Based Polymer Networks Prepared by Photocrosslinking in Solution
Authors: Friess Fabian , Wischke Christian , Behl Marc , Lendlein Andreas
Published: December 2012

Purpose

Polymer networks with adjustable properties prepared from endgroup-functionalized oligoesters by UV-crosslinking in melt have evolved into versatile multifunctional biomaterials. In addition to the molecular weight or architecture of precursors, the reaction conditions for crosslinking are pivotal for the polymer network properties. Crosslinking of precursors in solution may facilitate low-temperature processes and are compared here to networks synthesized in melt.

Methods

Oligo(∊-caprolactone)-(z)methacrylate (oCL-(z)IEMA) precursors with a linear (z = di) or a four-armed star-shaped (z = tetra) architecture were crosslinked by radical polymerization in melt or in solution with UV irradiation. The thermal, mechanical, and swelling properties of the polymer networks obtained were characterized.

Results

Crosslinking in solution resulted in materials with lower Young's moduli (E), lower maximum stress (σmax), and higher elongation at break (∊B) as determined at 70 °C. Polymer networks from 8 kDa star-shaped precursors exhibited poor elasticity when synthesized in the melt, but can be established as stretchable materials with a semi-crystalline morphology, a high gel- content, and a high elongation at break when prepared in solution.

Conclusions

The crosslinking condition of methacrylate functionalized precursors significantly affected network properties. For some types of precursors such as star-shaped telechelics, synthesis in solution provided semi-crystalline elastic materials that were not accessible from crosslinking in melt.
Prevention of Oncological Diseases: Primary and Secondary Prevention
Authors: Chow Louis Wc , Yip Adrian Ys , Ng Elizabeth Ly
Published: December 2012

Cancer is the leading cause of death worldwide. Because there is presently no cure for cancer, the best strategy to combat oncological diseases is through early detection and prevention. The methods currently available are vaccines to target specific viruses (primary prevention), in combination with screening (secondary prevention), use of biomarkers, and administration of adjuvant therapy (tertiary prevention). Modifiable lifestyle-related risk factors are also important in cancer prevention. Vaccination has been proven to be highly effective against targeted diseases leading to the development of cancer, particularly if the vaccination is given in the early years of life. The need for regular screening (for breast cancer, cervical cancer, etc.) should not be neglected and should be followed to detect unusual changes or abnormalities in the body. With discoveries as targeted therapies, adjuvant treatment becomes a secure component of tertiary prevention in the betterment of disease management. The discovery of biomarkers and subsequent targeted therapies has led to personalized medicine as the current trend in cancer care.
The clinical trials of the Organisation for Oncology and Translational Research (OOTR)
Authors: Chow Louis Wc , Toi Masakazu
Published: December 2012

The Organisation for Oncology and Translational Research (OOTR) was established in 2002 by Dr Louis WC Chow and Dr Masakazu Toi to gather medical professionals from different countries to work together in translational research as one of the missions of the organisation. Therefore, we seek to create networking among oncologists and develop effective interaction among the most advanced academic institutions throughout the world in order to conduct clinical trials and translational research together. Several clinical trials evaluating the use of neoadjuvant therapy for breast cancer have been designed and conducted for the past 10 years in the OOTR. The design of these studies has shifted from evaluating the efficacy and safety of new anticancer therapies and exploring new predictive and prognostic biomarkers to overcoming and unveiling the mechanism of tumor resistance as well as compiling predictive models for treatment response. This article briefly summarizes the concept and development of the OOTR clinical trial designs.
Aplicación de la teoría de la decisión en la elección de compañero en una residencia de ancianos
Authors: Bernal María Elena , Barbero María Isabel
Published: December 2012

El trabajo que se presenta forma parte de un estudio más amplio que se está llevando a cabo con el fin de profundizar en un campo tan importante como es el de la calidad de vida de los ancianos y, sobre todo, de los ancianos que viven en residencias asistidas. Creemos que es nuestra obligación tratar de analizar cuales son sus inquietudes y necesidades para, en la medida de lo posible, darles la solución adecuada. Pensamos que uno de los factores que podrían contribuir a mejorar su calidad de vida es la mejora de su relación con el entorno que consideren más adecuado; pero la realidad y la experiencia muestran que los criterios que se suelen utilizar en las residencias para crear áreas asistenciales no suelen tener en cuenta las preferencias y opiniones de los ancianos. Por eso, onsideramos que hace falta una revisión de los criterios que guían la práctica asistencial para adecuar, en la medida de lo posible, la dinámica institucional a las necesidades de las personas mayores, y con ello contribuir a mejorar su calidad de vida. La Residencia de Tercera Edad Mixta de Almería, en el momento de iniciarse este trabajo, estaba pendiente de que tanto el personal de la misma como los residentes se trasladaran en bloque a un nuevo edificio. Esta situación ofreció la posibilidad de revisar el sistema organizativo para tratar de adecuarlo a la actual conceptualización de atención integral al anciano residente, entendiendo como tal la atención de sus necesidades bio-psico-sociales.
Editorial
Authors: Marzal Felici Javier , Casero Ripollés Andreu
Published: December 2012

Editorial y presentación de los contenidos del número 4.
Una aproximación al estudio del infoentretenimiento en Internet: origen, desarrollo y perspectivas futuras
Authors: Berrocal Gonzalo Salomé , Redondo García Marta , Campos Domínguez Eva
Published: December 2012

El fenómeno del infoentretenimiento es señalado, por algunos autores, como la «mega tendencia» más acusada del periodismo actual (Prado, 2003:178-186). Los contenidos televisivos, radiofónicos e incluso los de la prensa seria buscan cada vez más resultar entretenidos, lo que lleva a despreciar o dedicar menos espacio a los tradicionales temas de interés público para buscar nuevos asuntos que despierten la curiosidad del receptor. Partiendo de esta premisa, esta investigación se basa en una revisión cualitativa de la literatura publicada en el ámbito nacional e internacional hasta la fecha sobre el infoentretenimiento político en Internet, con el objetivo de conocer cómo y qué se investiga en nuestro país sobre este fenómeno novedoso de la actividad comunicacional. Los resultados muestran que, a pesar de que en los últimos años han ido surgiendo investigaciones, dentro y fuera de España, aún son precisos nuevos estudios que exploren la forma, contenido y consecuencias del infoentretenimiento político en la red. El objetivo de este estudio es, por tanto, establecer un estado del la cuestión, conocer qué dimensión investigadora tiene este fenómeno en la academia española e intentar definir nuevas líneas de estudio y exploración futura de un fenómeno que, según apunta la propia literatura, continuará en progresión, tanto en Internet como en los formatos tradicionales.
The Interpersonal Process in Tissue Donation Requests with “Undecided” Next of Kin
Authors: Dorflinger Lindsey , Auerbach Stephen M. , Siminoff Laura A.
Published: December 2012

Context

Although recent studies have demonstrated that tissue requesters' behavior during conversations about tissue donation affects consent rates, the link between requesters' behavior and consent rates remains unclear.

Objective

To examine whether positive/collaborative requester behaviors elicit complementary behaviors from next of kin who were initially undecided about their willingness to donate their deceased family member's tissues.

Design

Audio recordings of requests were coded to assess for interpersonal behavior of each interactant.

Setting

Audio recordings were gathered from a national sample of tissue banks.

Participants

One hundred and two requester–next-of-kin dyads, consisting of 102 relatives and 53 requesters.

Main Outcome Measures

Tissue requester and next-of-kin affiliation and interpersonal control were assessed. Tissue requesters' persuasion, confirmation (eg, approval, empathy, reassurance) and disapproval, as well as next-of-kin approval and disapproval, were examined.

Results

Tissue requesters and next of kin tended to match one another on affiliation and complement one another on interpersonal control. “Key topics,” which may affect the next of kin's decision, are discussed in only about one-third of requests. Next of kin were less affiliative and more disapproving when requesters were also more disapproving. Interpersonal behavior of the tissue requester, such as affiliation, statements of disapproval, and persuasion, as well as discussion of key topics, was a significant predictor of the interpersonal behavior of the next of kin.

Conclusions

Positive requester behaviors elicited a positive response from undecided next of kin. Because many next of kin have limited knowledge about tissue donation before the request, the communication process may affect the next of kin's perceptions of donation and thus affect the likelihood of consent. Findings could potentially inform communication skills training for tissue requesters; future research could examine effects of such training on consent rates.
Alemtuzumab for Cytolytic Induction of Immunosuppression in Heart Transplant Recipients
Authors: Cahoon William D. , Ensor Christopher R. , Shullo Michael A.
Published: December 2012

Objective

To review available evidence about the safety and efficacy of alemtuzumab for induction of immunosuppression in heart transplant recipients.

Data sources

Searches of MEDLINE, EMBASE, and Cochrane databases were conducted. Key search terms included alemtuzumab, Campath-1H, CD52, lymphocyte, cytolytic, induction, immunosuppression, rejection, and cardiac transplantation. Additional pertinent data were identified through a search of abstracts from major transplant meetings.

Study Selection and Data Extraction

All English-language articles and abstracts identified from the data sources were evaluated. All primary data were eligible for inclusion if they evaluated the safety or efficacy of alemtuzumab for induction of immunosuppression in heart transplant patients. One retrospective cohort, 1 case series, 1 case-control series, and 1 open-label trial were identified and included for review.

Data Synthesis

Acute cellular rejection occurs in 40% to 70% of heart transplant recipients within the first 6 months after transplant and is associated with significant morbidity and mortality. Depleting and nondepleting antibodies have displayed positive outcomes in inducing immunosuppression; however, the ideal induction strategy that balances efficacy and toxicity remains elusive. Alemtuzumab, a cytolytic anti-CD52 antibody, has been used to induce immunosuppression in kidney, pancreas, liver, intestine, and lung transplant recipients, and its use in heart transplant has been investigated. Studies of use of alemtuzumab to induce immunosuppression in heart transplant patients have shown low rates of rejection; however, it has not been directly compared with other immunosuppression-inducing agents and safety data are limited.

Conclusions

Although alemtuzumab may be a practical option for inducing immunosuppression, data are insufficient to recommend its routine use in deference to more established agents. Large, randomized clinical trials with extended durations of follow-up must be conducted to characterize its efficacy and safety further.
Fatal Pulmonary Embolism in a Patient with Thromboembolism of the Internal Jugular Vein after Liver Transplant
Authors: Tan Wen-Fei , Ma Hong
Published: December 2012

A patient with acute liver failure and thromboembolism of the internal jugular vein subsequently had a massive pulmonary embolism and died 25 days after orthotopic liver transplant. The primary cause of death was massive pulmonary embolus. This case report highlights the need for clinicians to be aware that fatal embolic events can occur in liver transplant recipients, even when routine prophylactic procedures are implemented. The benefits and risks of invasive strategies, including placement of superior vena cava filters, should be considered on a case-by-case basis.
Chronic Pain among Liver Transplant Candidates
Authors: Madan Alok , Barth Kelly S. , Balliet Wendy E. , Hernandez-Tejada Melba A. , Borckardt Jeffrey J. , Malcolm Robert , Willner Ira , Koch David , Reuben Adrian
Published: December 2012

Context

Little systematic research has been conducted to understand pain among persons with end-stage liver disease, especially among liver transplant candidates. Appropriate pain assessment and management are important areas of consideration as treatment options are limited.

Objective

To describe the nature of chronic pain in patients with end-stage liver disease, the extent to which pain affects daily level of functioning, and the variety and effectiveness of current treatments.

Design

Retrospective chart review.

Setting

Academic medical center in the Southeastern United States.

Patients

Data were collected from 108 consecutive adult liver transplant candidates.

Results

Most (77%) reported having experienced moderate levels of bodily pain within the past 24 hours. Patients with only alcoholic cirrhosis reported less pain than patients with cirrhosis due to other causes (alcoholism and hepatitis C, nonalcoholic steatohepatitis, only hepatitis C). Pain interfered significantly across all 10 functional domains assessed. Although 90% reported being prescribed a variety of analgesic agents (most commonly short-acting opioids), patients reported experiencing only 33% pain relief.

Conclusions

Pain is a significant problem among liver transplant candidates, and current pain treatments are perceived to be relatively ineffective. Increased understanding is needed to safely and effectively evaluate and treat such medically complicated patients.
Variability in Infection Control Measures for the Percutaneous Lead among Programs Implanting Long-Term Ventricular Assist Devices in the United States
Authors: Cannon Anne , Elliott Tonya , Ballew Carole , Cavey Julie , O'Shea Genevieve , Franzwa Jennifer , Puhlman Mark , Bennett Jami , Ryan Timothy , Lockard Kathleen , Avrahami Neshama , Brennan Pamela , Kurien Sudha , Andrus Shauna , Dick Sara , Davis Erin
Published: December 2012

Ventricular assist devices (VADs) are a surgical treatment for heart failure. These devices may be implanted as a bridge to transplant or as destination therapy. After surgical recovery and education regarding device care, patients are discharged home. Meticulous care of the driveline must be taken to prevent infection and trauma of the site throughout the perioperative event and for the duration of support. Currently a standardized protocol for care of the driveline and exit site does not exist. VAD coordinators from across the country discussed the variability in care at different centers in the United States through a series of conference calls. A survey consisting of 16 questions was developed. The survey included questions on preoperative antibiotic recommendations, driveline placement and exit site suturing, frequency of dressing changes, and showering practices. VAD coordinators shared center-specific dressing protocols and any driveline success stories. This survey was sent to 73 centers; 38 centers (52%) responded. The purpose of the survey was to define current practice in order to move toward a standard of practice or protocol based on expert opinion for VAD driveline care and to assess the need for future studies.
The Lived Experience of Parents and Guardians Providing Care for Child Transplant Recipients
Authors: Williams Laurel , Eilers June , Heermann Judith , Smith Karen
Published: December 2012

Context

Little has been published about the caregiving experiences of the parents or guardians of children receiving liver or liver/intestinal transplants.

Objective

To describe the lived experiences of parents and guardians as they prepared for and provided postdischarge care to a child who received an isolated intestine or a liver/intestinal transplant and to assess the impact of transplants on parents' stress levels.

Design

Semistructured, audio-taped phone interviews of parents' and guardians' perceptions of their experiences preparing to and providing care to a child transplant recipient were transcribed verbatim and analyzed by the research team using established qualitative research methods.

Participants

Five parents or guardians (3 mothers, 1 foster mother, and 1 grandfather) of children who received a transplant between 2000 and 2008 at age 11 months to 6.7 years.

Results

Responses to the interviews gravitated toward 3 focal points: the parents' and guardians' perceptions of their interactions with the transplant team, their interactions with the local health care systems, and caring for themselves and their child at home.

Conclusion

In preparing parents and guardians to care for their children after discharge from the hospital, transplant teams need to be aware of differences between what we think we communicate and how it is interpreted by the parents and guardians, the relationships built between parents and guardians and health care teams, parents' attitudes and levels of stress, and the impact these factors have on care and the parents' and guardians' experience.
Use of Social Media and College Student Organizations to Increase Support for Organ Donation and Advocacy: A Case Report
Authors: D'Alessandro Anthony M. , Peltier James W. , Dahl Andrew J.
Published: December 2012

This report focuses on the University of Wisconsin Hospital and Clinics organ procurement organization's efforts to increase deceased organ and tissue donation by using social media and personalized messages targeting members of university student organizations, their families, and their friends. A grant from the US Department of Health and Human Services funded a 2-year study to (1) identify barriers/opportunities for increasing awareness, attitudes, and behaviors related to organ and tissue donation; (2) implement an intervention using social media and personalized message to increase knowledge, support, and donor registrations; (3) measure impact on awareness and attitudinal and behavioral changes within the organization; and (4) assess behavioral measures across a host of social media analytics and organ donor registrations. The results show increases in knowledge about and support for organ donation, including a 20% increase in donor registration. As a result, funding was secured to continue the project for an additional 2 years.
Characterization of fat distribution in Prader–Willi syndrome: Relationships with adipocytokines and influence of growth hormone treatment
Authors: Tanaka Yuriko , Abe Yoshiko , Oto Yuji , Itabashi Hisashi , Shiraishi Masahisa , Yoshino Atsunori , Obata Kazuo , Murakami Nobuyuki , Nagai Toshiro
Published: December 2012

Marked anthropometric changes are seen in Prader–Willi syndrome (PWS). Emaciation is observed during infancy, whereas severe obesity is found in older children and adults. Growth hormone (GH) treatment modifies the anthropometric changes in PWS patients. In this study, we examined changes in the body composition of 51 PWS patients (age range, 6–54 years; median, 16.5 years), with a focus on the amount of abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), VAT/SAT ratio, and serum levels of adipocytokines (adiponectin, leptin, and resistin). The relationships between VAT, SAT, and adipocytokines, and lipid abnormalities and type 2 diabetes in 24 patients with obese PWS were also evaluated. With increasing age, SAT and VAT both increased markedly, but in 18 patients receiving GH treatment, VAT remained low at ≤30 cm2. In the GH‐completed patients (n = 19), VAT and SAT increased with age to levels similar to those in non‐GH‐treated patients (n = 14). In the obese group, adiponectin decreased as VAT increased (r = –0.35, P = 0.11). Leptin (r = 0.67, P < 0.001) and resistin (r = 0.45, P = 0.04) showed positive correlations with SAT. Total cholesterol, low‐density lipoprotein, and triglyceride levels correlated negatively with adiponectin (r = –0.59, r = –0.56, r = –0.56, respectively, P < 0.05) and hemoglobin A1c (r = –0.42, P = 0.08). To maintain lower VAT and prevent cardiovascular disease risk factors, GH treatment may be advisable even in adult patients with PWS. © 2012 Wiley Periodicals, Inc.
“It's about having the choice”: Stakeholder perceptions of population‐based genetic carrier screening for fragile X syndrome
Authors: Archibald Alison D. , Hickerton Chriselle L. , Jaques Alice M. , Wake Samantha , Cohen Jonathan , Metcalfe Sylvia A.
Published: December 2012

This project explored, the views of key stakeholders regarding population‐based genetic carrier screening for fragile X syndrome (FXS). Interviews and focus groups were conducted with healthcare providers, relatives of individuals with FXS and members of the general population. Data were transcribed verbatim and coded into themes. 188 individuals took part in this study. Perceived benefits of carrier screening included: learning the risk of having a child with FXS; learning the risk of fragile X‐associated primary ovarian insufficiency; and the opportunity for carriers to access reproductive options. Concerns included: the emotional impact of screening and receiving a carrier result; the predictive testing nature of the carrier test with respect to fragile X‐associated tremor/ataxia syndrome; potential confusion created by receiving an intermediate result; and implications of genetic screening for society. Overall, population‐based genetic carrier screening was perceived to be acceptable provided it is optional and offered at an appropriate stage of life. With the support of the participants to promote individual choice by offering a population‐based carrier screening program for FXS, it is essential to carefully consider how screening might be offered in order to ensure broad accessibility and facilitation of decision‐making. © 2012 Wiley Periodicals, Inc.
The practice of adult genetics: A 7‐year experience from a single center
Authors: Eble Tanya N. , Nagamani Sandesh C.S. , Franco Luis M. , Plon Sharon E. , Blazo Maria , Dhar Shweta U.
Published: December 2012

The purpose of our study is to familiarize the reader with genetic disorders commonly seen in adults and identify challenges and barriers that limit provision of services. We conducted a retrospective chart analysis of patients seen in the adult Genetics clinics from January 2004 to December 2010 in a metropolitan medical center consisting of an academic private clinic and a county hospital clinic. During the study period, a total of 1,552 patients (n = 1,108 private clinic patients; n = 444 county clinic patients) were evaluated and managed. Of these, 790 and 280 were new patient visits at the private clinic and county clinic, respectively. Approximately 35% (374/1,070) of new patients were seen for cancer‐related indications, while neurological indications accounted for approximately 14% (153/1,070) in both clinics. Cardiology‐related indications accounted for approximately 13% (145/1,070) of patients, followed closely by chromosomal and syndromic indications for which almost 9% (96/1,070) of new patients were seen. Approximately 8% (90/1,070) of new patients were seen for musculoskeletal indications. We saw increased clinic growth during the study period and found that the most common indications for referral are: (1) Personal/family history of cancer (2) neurological (3) cardiovascular (CV) (4) chromosomal/syndromic and (5) musculoskeletal. A number of challenges were identified, including coordination of services, feasibility of testing, and an overall higher complexity of care with increased clinic scheduling time requirements. Through this review, we demonstrate the demand for adult genetics services and propose some guidelines to address the challenges of management in the adult genetics patient population. © 2012 Wiley Periodicals, Inc.