bluuebunny/crossref_metadata_2025 huggingface dataset:
How the Provenance of Electronic Health Record Data Matters for Research: A Case
Example Using System Mapping
Authors: Johnson Karin E. , Kamineni Aruna , Fuller Sharon , Olmstead Danielle , Wernli Karen J.
Published: April 2014

Introduction: The use of electronic health records (EHRs) for research is
proceeding rapidly, driven by computational power, analytical techniques, and policy.
However, EHR-based research is limited by the complexity of EHR data and a lack of
understanding about data provenance, meaning the context under which the data were
collected. This paper presents system flow mapping as a method to help researchers more
fully understand the provenance of their EHR data as it relates to local workflow. We
provide two specific examples of how this method can improve data identification,
documentation, and processing.Background: EHRs store clinical and administrative data,
often in unstructured fields. Each clinical system has a unique and dynamic workflow and
EHR, which may be influenced by broader context such as documentation required for
billing.Methods: We present a case study with two examples of using system flow mapping
to characterize EHR data for a local colorectal cancer screening
process.Findings: System flow mapping demonstrated that information entered into the EHR
during clinical practice required interpretation and transformation before it could be
accurately applied to research. We illustrate how system flow mapping shaped our
knowledge of the quality and completeness of data in two examples: 1) determining
colonoscopy indication as recorded in the EHR, and 2) discovering a specific EHR form
that captured family history.Discussion: Researchers who do not consider data provenance
risk compiling data that are systematically incomplete or incorrect. For example,
researchers who are not familiar with the clinical workflow under which data were
entered might miss or misunderstand patient information or procedure and diagnostic
codes.Conclusions/Next steps: Data provenance is a fundamental characteristic of
research data from EHRs. Given the diversity of EHR platforms and system workflows,
researchers need tools for evaluating and reporting data availability, quality, and
transformations. Our case study illustrates how system mapping can inform researchers
about the provenance of their data as it pertains to local workflows.
Preparation of steroidal hormones with an emphasis on transformations of phytosterols and cholesterol - a review
Authors: Al Jasem Yosef , Khan Mubashar , Taha Ahmed , Thiemann Thies
Published: April 2014

Today, there is a big market for steroidal hormones as well as for their derivatives. This review traces the development in steroidal production from the first milligram-scale isolation of the products to their semi-synthesis from sapogenins, their total synthesis and finally their microbial enzymatic preparation from phytosterols.
Lentiform Fork Sign: A Magnetic Resonance Finding in a Case of Acute Metabolic Acidosis
Authors: Grasso Daniela , Borreggine Carmela , Perfetto Francesco , Bertozzi Vincenzo , Trivisano Marina , Specchio Luigi Maria , Grilli Gianpaolo , Macarini Luca
Published: April 2014

We report a 33 year-old woman addicted to chronic unspecified solvents abuse with stupor, respiratory disorders, tetraplegia and severe metabolic acidosis. On admission an unenhanced cranial CT scan showed symmetrical hypodensities of both lentiform nuclei. MR imaging performed 12 hours after stupor demonstrates bilateral putaminal hemorrhagic necrosis, bilateral external capsule, corona radiata and deep cerebellar hyperintensities with right cingulate cortex involvement. DWI reflected bilateral putaminal hyperintensities with restricted water diffusion as to citotoxic edema and development of vasogenic edema in the external capsule recalling a fork. On day twenty, after specific treatments MRI demonstrated a bilateral putaminal marginal enhancement. Bilateral putaminal necrosis is a characteristic but non-specific radiological finding of methanol poisoning. Lentiform Fork sign is a rare MRI finding reported in literature in 22 patients with various conditions characterized by metabolic acidosis. Vasogenic edema may be due to the differences in metabolic vulnerability between neurons and astrocytes. We postulate that metabolic acidosis could have an important role to generate this sign.
Idiopathic Brain Herniation
Authors: Koc Gonca , Doganay Selim , Bayram Ayse Kacar , Gorkem Sureyya Burcu , Dogan Mehmet Sait , Per Huseyin , Coskun Abdulhakim
Published: April 2014

‘Idiopathic’ herniation of the brain is a rare entity previously reported in 13 cases. It may be incidentally encountered in neuroimaging studies acquired for various clinical indications. We herein describe two cases of idiopathic brain herniation that were incidentally diagnosed. A 12-year-old boy presented with a six-month history of daytime sleepiness and sudden spells of sleep. Herniation of the left inferior temporal gyrus was revealed in MRI acquired with the suspicion of epilepsy. His overnight polysomnogram and multiple sleep latency tests were compatible with the diagnosis of narcolepsy. The other case, a two-year-old girl, was transferred from an outside hospital due to partial seizures with the fever. Herniation of the precuneal gyrus was encountered in MRI acquired after controlling her seizures with the initiation of phenytoin. The brain herniations of both patients were considered to be inconsistent with their medical conditions, so that they were symptom-free with only medical treatment for following three and six months, respectively. This is a rare presentation of idiopathic brain herniation as an incidental finding that accompanied narcolepsy and epilepsy. Awareness of this entity would avoid excessive surgical and medical treatments.
Bilateral adrenal incidentalomas differ from unilateral adrenal incidentalomas in subclinical cortisol hypersecretion but not in potential clinical implications
Authors: Vassilatou Evangeline , Vryonidou Andromachi , Ioannidis Dimitrios , Paschou Stavroula A , Panagou Maria , Tzavara Ioanna
Published: April 2014

Objective

To investigate the possibility of a different prevalence of subclinical Cushing's syndrome (SCS) and potentially related morbidities between patients with unilateral adrenal incidentalomas (UAI) and bilateral adrenal incidentalomas (BAI), as existing data are few and controversial.

Design

Prospective observational study.

Methods

Clinical examination, biochemical tests, and hormonal evaluation were performed in 298 consecutive patients with adrenal incidentalomas, unilateral in 224 patients (75.2%), bilateral in 74 patients (24.8%), with apparently benign masses based on imaging characteristics and after exclusion of overt endocrine disease. The diagnosis of SCS was based on a post-dexamethasone suppression test (2 mg dexamethasone/24 h for 48 h), with serum cortisol level ≥1.8 μg/dl combined with at least one abnormal result of the other hormonal measurements.

Results

SCS was diagnosed in 66 out of 298 (22.1%) patients, being more frequent in patients with BAI (35.1 vs 17.9%,P=0.003, for BAI and UAI respectively). Hypertension, type 2 diabetes mellitus, impaired glucose tolerance, and dyslipidemia were of a similar frequency in both groups. SCS patients with UAI and BAI did not differ in age, gender, BMI, waist circumference, and mass size. Factors related to SCS were the presence of BAI (OR, 3.24; 95% CI, 2.31–4.54) and mass size (OR, 2.63; 95% CI, 1.31–5.26).

Conclusion

BAI patients present more often with SCS when compared with UAI patients; however, morbidities potentially related to subtle cortisol hypersecretion were of a similar frequency in both groups. Further studies are needed to clarify whether this difference in hormonal activity may be related to different pathophysiologies.
Cross-sectional and longitudinal relation of IGF1 and IGF-binding protein 3 with lipid metabolism
Authors: Eggert Marie-Luise , Wallaschofski Henri , Grotevendt Anne , Nauck Matthias , Völzke Henry , Samietz Stefanie , Friedrich Nele
Published: April 2014

Background

Previous intervention studies in patients with GH disorders suggested an impact of IGF1 and IGF-binding protein 3 (IGFBP3) on lipid metabolism, whereas population-based studies revealed conflicting results. Therefore, we aimed to assess the cross-sectional and longitudinal associations between IGF1 or IGFBP3 serum levels and lipids (total, LDL, or HDL cholesterol and triglycerides) in a large-scale study.

Methods

Data of 2935 subjects (1356 women) from the population-based Study of Health in Pomerania (SHIP) were used. ANOVA, quantile regression, and logistic regression models adjusted for age, waist circumference, physical activity, and alcohol consumption were performed.

Results

In cross-sectional analyses, we detected that IGF1 and IGFBP3 levels were positively related to total and LDL cholesterol and inversely related to HDL cholesterol in both sexes. Furthermore, IGFBP3 levels showed a positive relationship to triglycerides. In total, IGFBP3 levels were more strongly associated to lipids than IGF1. In longitudinal analysis, we found no influence of baseline IGF1 or IGFBP3 serum concentration on incidentally elevated or reduced lipid levels. However, the positive relationship between IGFBP3 and incidentally elevated triglycerides barely missed statistical significance in women.

Conclusion

The present study showed strong cross-sectional associations between IGF1 or IGFBP3 and lipids, whereas no longitudinal relationships were revealed. Therefore, our findings suggest IGF1 and IGFBP3 as a risk marker rather than a risk factor for alterations in lipid metabolism. Further studies are needed to elucidate the mechanisms underlying the association between the GH/IGF axis and lipid metabolism.
Tissue-specific dysregulation of 11β-hydroxysteroid dehydrogenase type 1 in overweight/obese women with polycystic ovary syndrome compared with weight-matched controls
Authors: Gambineri Alessandra , Fanelli Flaminia , Tomassoni Federica , Munarini Alessandra , Pagotto Uberto , Andrew Ruth , Walker Brian R , Pasquali Renato
Published: April 2014

Context

Abnormal cortisol metabolism in polycystic ovary syndrome (PCOS) has been invoked as a cause of secondary activation of the hypothalamic–pituitary–adrenal axis and hence androgen excess. However, this is based on urinary excretion of cortisol metabolites, which cannot detect tissue-specific changes in metabolism and may be confounded by obesity.

Objective

To assess cortisol clearance and whole-body and tissue-specific activities of 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1 (HSD11B1)) in PCOS.

Design

Case–control study.

Setting

Medical center.

Patients

A total of 20 overweight–obese unmedicated Caucasian women with PCOS, aged 18–45 years, and 20 Caucasian controls matched for age, BMI, body fat distribution, andHSD11B1genotypes (rs846910 and rs12086634).

Main outcome measures

Cortisol metabolites were measured in 24 h urine. During steady-state 9,11,12,12-[2H]4-cortisol infusion, cortisol clearance was calculated and whole-body HSD11B1 activity was assessed as the rate of appearance of 9,12,12-2H3-cortisol (d3-cortisol). Hepatic HSD11B1 activity was quantified as the generation of plasma cortisol following an oral dose of cortisone. Subcutaneous adipose HSD11B1 activity andHSD11B1mRNA were measured,ex vivo, in biopsies.

Results

Urinary cortisol metabolite excretion, deuterated cortisol clearance, and the rate of appearance of d3-cortisol did not differ between patients with PCOS and controls. However, hepatic HSD11B1 conversion of oral cortisone to cortisol was impaired (P<0.05), whereas subcutaneous abdominal adipose tissueHSD11B1mRNA levels and activity were increased (P<0.05) in women with PCOS when compared with controls.

Conclusions

Tissue-specific dysregulation of HSD11B1 is a feature of PCOS, over and above obesity, whereas increased clearance of cortisol may result from obesity rather than PCOS.
DIAGNOSIS OF ENDOCRINE DISEASE: Thyroglobulin measurement using highly sensitive assays in patients with differentiated thyroid cancer: a clinical position paper
Authors: Giovanella Luca , Clark Penelope M , Chiovato Luca , Duntas Leonidas , Elisei Rossella , Feldt-Rasmussen Ulla , Leenhardt Laurence , Luster Markus , Schalin-Jäntti Camilla , Schott Matthias , Seregni Ettore , Rimmele Herald , Smit Jan , Verburg Frederik A
Published: April 2014

Differentiated thyroid cancer (DTC) is the most common endocrine cancer and its incidence has increased in recent decades. Initial treatment usually consists of total thyroidectomy followed by ablation of thyroid remnants by iodine-131. As thyroid cells are assumed to be the only source of thyroglobulin (Tg) in the human body, circulating Tg serves as a biochemical marker of persistent or recurrent disease in DTC follow-up. Currently, standard follow-up for DTC comprises Tg measurement and neck ultrasound combined, when indicated, with an additional radioiodine scan. Measurement of Tg after stimulation by endogenous or exogenous TSH is recommended by current clinical guidelines to detect occult disease with a maximum sensitivity due to the suboptimal sensitivity of older Tg assays. However, the development of new highly sensitive Tg assays with improved analytical sensitivity and precision at low concentrations now allows detection of very low Tg concentrations reflecting minimal amounts of thyroid tissue without the need for TSH stimulation. Use of these highly sensitive Tg assays has not yet been incorporated into clinical guidelines but they will, we believe, be used by physicians caring for patients with DTC. The aim of this clinical position paper is, therefore, to offer advice on the various aspects and implications of using these highly sensitive Tg assays in the clinical care of patients with DTC.
Social capital, sociopolitical instability, and economic development: A general equilibrium model
Authors: Alcántar-Toledo Javier , Venieris Yannis P.
Published: April 2014

This essay describes the main features of a general equilibrium model of social capital and social conflict. According to the model, agents decide to participate in a number of conflict events while, at the same time, accumulate social capital. In the process, the government interacts with the economic actors by discouraging civil disobedience and social violence. The results show that social conflict is decreasing with the accumulation of physical capital, human capital, social capital, and government expenses on social development programs. Output growth in the economy depends positively upon accumulation of all types of capitals and social development funding, and negatively upon social conflict. More importantly, social capital is found to have a considerable positive effect on growth not only directly via investment, as suggested by recent empirical literature, but also indirectly by reducing the levels of social conflict. The model shows that the growth trajectories of the economy display a history-dependent pattern of growth with multiple-equilibria where countries converge to a nontrivial stable steady-state in the long-run. We also provide evidence in favor of the “club convergence” hypothesis which is predicated upon the initial levels of all types of capitals and the underlying level of social conflict.
Symposium on peace and security in India: An introduction
Authors: Gupta Rupayan
Published: April 2014

The World Health Organization categorizes violence as including self-harm such as suicide, interpersonal violence such as domestic violence and violent crime, and collective violence such as inter-communal violence and international war. Peace and security issues in India abound in all of these categories. To name a few, they range from cases of farmer suicides, violence against women and female infanticide, religious, communal, and political violence, land-acquisition disputes, crime, policing, regional disputes between Indian states and other groups over scarce natural resources, separatist movements, military expenditure and policy, and territorial disputes and arms races with neighboring countries. This symposium focuses on points of interpersonal and inter-communal violence, largely restricting its attention to India’s internal rather than external concerns.
Gender, poverty, and domestic violence in rural Bengal: The Jeevika Development Society’s journey through women’s rights-based microcredit programs
Authors: Sengupta Nilanjana , Ganguly Dolon
Published: April 2014

To understand the nature of the links among gender, poverty, and violence in specific sociocultural contexts, this article unravels a complex web of interactions among the Jeevika Development Society, the communities in which its members live, and women’s individual initiatives. It also examines the process by which ruptures are made in these links through women’s active participation in the Society. The article asks whether economic outcomes facilitated by the organization have any impact, or are impacted upon, by gender relations at home, which manifest themselves through different forms of violence. It further explores whether dimensions of participation that are more social than economic, such as voluntary work with anti-violence forums as well as positions of leadership in the Society, create possibilities of empowerment that are stronger and more direct than the possibilities that may emerge through economic gains alone.
Hub port potential of Marmara region in Turkey by network-based modelling
Authors: Bolat Firat , Guler Nil
Published: April 2014

The increase in the efficiency of main hub ports is a result of home base theory. Put another way, a network comprising linked nodes that are in collaboration is the issue of concern. In a sense, the bases and facilities of the main hub port serve as the trans-shipment and assembling centres for the departure destination flows. Based on this theory, this study puts forth the main hub port potentials for the Marmara region ports in Turkey by analysing the connection-rich nodes in the region through a transition from a random graph network structure to a non-scaled network structure using the port connectivity index and the port collaboration index.
Combination of Adsorption on Activated Carbon and Oxidative Photocatalysis on TiO2 for Gaseous Toluene Remediation
Authors: Matos Juan , Garcia Andreína , Chovelon Jean-Marc , Ferronato Corinne
Published: April 2014

The influence of activated carbon on the activity of TiO2 in toluene photooxidation was studied to verify the
efficiency of both materials working ensemble. Results showed that surface pH and more strongly the surface area of
activated carbon influence the TiO2 photoactivity. Results suggest that toluene adsorbed on carbon diffuses to TiO2 where
photooxidation takes place. In conclusion, TiO2-activated carbon was able to perform the photooxidation of toluene for at
least two consecutive runs more efficiently than TiO2 alone. Combination of adsorption on activated carbon and oxidative
photocatalysis on TiO2 is a promising direction for removal of pollutant from air
Modeling of Phase Transformation in Induction Hardening
Authors: Palaniradja K. , Alagumurthi N. , Soundararajan V.
Published: April 2014

Mechanical properties of machined components are controlled by inducing phase transformations in the outer layer of the materials. Induction hardening is one such manufacturing process where the surface hardness is enhanced while the core is retained with the original structure and characteristics. In this study, a mathematical model had been developed to predict the hardness and the volume fraction of martensite present in the hardened surface. Experiments applying induction hardening were conducted on the following specimen materials AISI 1040, AISI 4140, AISI 4340, AISI 1055, AISI 6150 and AISI 9255. The microstructures obtained from the experiment showed a moderate phase transformation of austenite to martensite. The hardness and the volume fraction of martensite estimated from the experiments were found to match the results of mathematical modeling as well as the theoretical model using regression analysis.
Crisis, Power, and Policymaking in the New Europe
Authors: Firat Bilge
Published: April 2014

At a time when European integration faces many crises, the efficacy of public policies decided in Brussels, and in member state capitals, for managing the everyday lives of average Europeans demands scrutiny. Most attuned to how global uncertainties interact with local realities, anthropologists and ethnographers have paid scant attention to public policies that are created by the EU, by member state governments and by local authorities, and to the collective, organised, and individual responses they elicit in this part of the world. Our critical faculties and means to test out established relations between global–local, centre–periphery, macro–micro are crucial to see how far the EU's normative power and European integration as a governance model permeates peoples' and states' lives in Europe, broadly defined. Identifying the strengths and shortcomings in the literature, this review essay scrutinises anthropological scholarship on culture, power and policy in a post-Foucaultian Europe.
Reproductive Governance in the New Europe
Authors: Mishtal Joanna
Published: April 2014

While the European Union currently lacks a mandate to govern reproductive health services and policies, reproductive governance is increasingly debated both at the EU and the nation-state levels. The EU has taken formal positions to promote access to comprehensive reproductive health services. In tension with the EU's position is the Vatican, which promotes the use of conscientious objection to decline the provision of certain health services. Currently, the use of conscientious objection is mostly unregulated, prompting debates about supranational regulation at the Parliamentary Assembly of the Council of Europe (PACE) meeting in Paris in 2010. This article uses the lens of the PACE meeting debate to consider the cultural, historical and political specificities and agendas that give shape to competing arguments about rights, health and state sovereignty. I argue that political rationalities directed towards reproduction locally and the supranational rights debates work synergistically to paralyse European reproductive health policymaking.
'I Listen to the Soundtrack and I'm Back There in the Day'
Authors: Weiglhofer Magdalena
Published: April 2014

This article addresses the function of public presentations of personal memory in a post-conflict context and explores whether they may contribute to a preservation of that conflict. In particular, it examines the reception of performed memories of violence and its aftermath by audiences who have lived through similar experiences. To do this, it will discuss observations from empirical research on a verbatim theatre production in Northern Ireland, Heroes with Their Hands in the Air, that used interviews with relatives of those killed or wounded in an incident that came to be known as 'Bloody Sunday'. Drawing on the responses to the stories portrayed, it argues that, although such performative re-enactment of memory may contribute to an affirmation of collective identity and thus to preserving boundaries, it allows a community of memory to examine past events of suffering and explore impacts that reach into the present.
Review of The Transatlantic Century: Europe and America
Authors: Pajo Judith
Published: April 2014

Mary Nolan (2012), The Transatlantic Century: Europe and America, 1890–2010 (New York: Cambridge University Press), 403 pp., Pb: U.S.$27.99, ISBN: 9780521692212.
Minimally invasive versus open transforaminal lumbar interbody fusion: comparison of clinical outcomes among obese patients
Authors: Terman Samuel W. , Yee Timothy J. , Lau Darryl , Khan Adam A. , La Marca Frank , Park Paul
Published: April 2014

Object

Minimally invasive (MI) transforaminal lumbar interbody fusion (TLIF) has been demonstrated in previous studies to offer improvement in pain and function comparable to those provided by the open surgical approach. However, comparative studies in the obese population are scarce, and it is possible that obese patients may respond differently to these two approaches. In this study, the authors compared the clinical benefit of open and MI TLIF in obese patients.

Methods

The authors conducted a retrospective cohort study based on review of electronic medical records at a single institution. Eligible patients had a body mass index (BMI) ≥ 30 kg/m2, were ≥ 18 years of age, underwent single-level TLIF between 2007 and 2011, and outcome was assessed at a minimum 6 months postoperatively. The authors categorized patients according to surgical approach (open vs MI TLIF). Outcome measures included postoperative improvement in visual analog scale (VAS), Oswestry Disability Index (ODI), estimated blood loss (EBL), and hospital length of stay (LOS).

Results

A total 74 patients (21 open and 53 MI TLIF) were studied. Groups had similar baseline characteristics. The median BMI was 34.4 kg/m2(interquartile range 31.6–37.5 kg/m2). The mean follow-up time was 30 months (range 6.5–77 months). The mean improvement in VAS score was 2.8 (95% CI 1.9–3.8) for the open group (n = 21) and 2.4 (95% CI 1.8–3.1) for the MI group (n = 53), which did not significantly differ (unadjusted, p = 0.49; adjusted, p = 0.51). The mean improvement in ODI scores was 13 (95% CI 3–23) for the open group (n = 14) and 15 (95% CI 8–22) for the MI group (n = 45), with no significant difference according to approach (unadjusted, p = 0.82; adjusted, p = 0.68). After stratifying by BMI (< 35 kg/m2and ≥ 35 kg/m2), there was still no difference in either VAS or ODI improvement between the approaches (both unadjusted and adjusted, p > 0.05). Complications and EBL were greater for the open group than for the MI group (p < 0.05).

Conclusions

Obese patients experienced clinically and statistically significant improvement in both pain and function after undergoing either open or MI TLIF. Patients achieved similar clinical benefit whether they underwent an open or MI approach. However, patients in the MI group experienced significantly decreased operative blood loss and complications than their counterparts in the open group.
Low risk for subsequent subarachnoid hemorrhage for emergency department patients with headache, bloody cerebrospinal fluid, and negative findings on cerebrovascular imaging
Authors: Thomas Lisa E. , Czuczman Amanda D. , Boulanger Alyson B. , Peak David A. , Miller Emily S. , Brown David F. M. , Marill Keith A.
Published: April 2014

Object

When patients present to the emergency department (ED) with acute headache concerning for subarachnoid hemorrhage (SAH) and a lumbar puncture (LP) shows blood in the CSF, it is difficult to distinguish the results of a traumatic LP from those of SAH. CT angiography (CTA) is often performed, but the long-term outcome for patients with a positive LP and normal neurovascular imaging remains uncertain. The primary objective of this study was to determine whether patients who presented to the ED with acute headache and had red blood cells (RBCs) in their CSF on LP but negative cerebrovascular imaging suffered subsequent SAH.

Methods

A case series study of consecutive adult ED patients who incurred charges for LP between 2001 and 2009 was performed from 2010 through 2011. Inclusion criteria were: headache, > 5 RBCs/mm3 in CSF, noncontrast head CT with no evidence of hemorrhage, and cerebrovascular CTA or MRA without aneurysm or vascular lesion within 2 weeks of the ED visit. Patients with less than 6 months of available follow-up were excluded. The primary outcomes were 1) subsequent nontraumatic SAH and 2) new vascular lesion. Secondary outcomes were complications related to SAH, or LP or angiography.

Results

Of 4641 ED patients billed for an LP, 181 patients (mean age 42 years) were included in this study. Over a median follow-up of 53 months, 0 (0%) of 181 patients (95% CI 0%–2.0%) had a subsequent SAH or new vascular lesion identified. Although not the primary outcome, there was 1 patient who was ultimately diagnosed with vasculitis. Eighteen (9.9%) of 181 patients (95% CI 6.0%–15.3%) had an LP-related complication and 0 (0%) of 181 patients (95% CI 0%–2.0%) had an angiography-related complication.

Conclusions

Patients who present to the ED with acute headache concerning for SAH and have a finding of bloody CSF on LP but negative findings on cerebrovascular imaging are at low risk for subsequent SAH and thus are likely to be safe for discharge. Replacement of the CT/LP with a CT/CTA diagnostic algorithm merits further investigation.
Revascularization and pediatric aneurysm surgery
Authors: Kalani M. Yashar S. , Elhadi Ali M. , Ramey Wyatt , Nakaji Peter , Albuquerque Felipe C. , McDougall Cameron G. , Zabramski Joseph M. , Spetzler Robert F.
Published: April 2014

Object

Aneurysms are relatively rare in the pediatric population and tend to include a greater proportion of large and giant lesions. A subset of these large and giant aneurysms are not amenable to direct surgical clipping and require complex treatment strategies and revascularization techniques. There are limited data available on the management of these lesions in the pediatric population. This study was undertaken to evaluate the outcome of treatment of large and giant aneurysms that required microsurgical revascularization and vessel sacrifice in this population.

Methods

The authors retrospectively identified all cases in which pediatric patients (age < 18 years) with aneurysms were treated using cerebral revascularization in combination with other treatment modalities at their institution between 1989 and 2013.

Results

The authors identified 27 consecutive patients (19 male and 8 female) with 29 aneurysms. The mean age of the patients at the time of treatment was 11.5 years (median 13 years, range 1–17 years). Five patients presented with subarachnoid hemorrhage, 11 with symptoms related to mass effect, 2 with stroke, and 3 with seizures; in 6 cases, the aneurysms were incidental findings. Aneurysms were located along the internal carotid artery (n = 7), posterior cerebral artery (PCA) (n = 2), anterior cerebral artery (n = 2), middle cerebral artery (MCA) (n = 14), basilar artery (n = 2), vertebral artery (n = 1), and at the vertebrobasilar junction (n = 1). Thirteen were giant aneurysms (45%). The majority of the aneurysms were fusiform (n = 19, 66%), followed by saccular (n = 10, 34%). Three cases were previously treated using microsurgery (n = 2) or an endovascular procedure (n = 1). A total of 28 revascularization procedures were performed, including superficial temporal artery (STA) to MCA (n = 6), STA to PCA (n = 1), occipital artery to PCA (n = 1), extracranial-intracranial (EC-IC) bypass using radial artery graft (n = 3), EC-IC using a saphenous vein graft (n = 7), STA onlay (n = 3), end-to-end anastomosis (n = 1), and in situ bypasses (n = 6). Perioperative stroke occurred in 4 patients, but only one remained dependent (Glasgow Outcome Scale [GOS] score 3). At a mean clinical follow-up of 46 months (median 14 months, range 1–232 months), 26 patients had a good outcome (GOS score 4 or 5). There were no deaths. Five patients had documented occlusion of the bypass graft. The majority of aneurysms (n = 24) were obliterated at last follow-up. There was a single case of a residual aneurysm and one case of recurrence. Angiographic follow-up was unavailable in 3 cases.

Conclusions

Cerebral revascularization remains an essential tool in the treatment of complex cerebral aneurysms in children.
Use of New Generation Antiepileptic Drugs in Children
Authors: Rahman Md Mizanur
Published: April 2014

DOI: http://dx.doi.org/10.3329/bjch.v37i3.18615 Bangladesh J Child Health 2013; Vol.37(3): 136-137
Infant Feeding Practice of Mother attending Pediatric out Patients Department in A Tertiary Care Center
Authors: Begum Tamanna , Hoque SK Azimul , Islam Md Rafiqul , Katoon Soofia , Shah Azanta Rani
Published: April 2014

Background: Appropriate breastfeeding and complementary feeding practices are the fundamental to childrens nutrition, health and survival during the first year of life. WHO and UNICEF have articulated a global strategy for poor infant feeding practices directly and indirectly contributes to under nutrition, morbidity and mortality in infant. Objective: This study was designed to determine the breast feeding (BF) and complementary feeding (CF) practices in study population. Methodology: This descriptive cross sectional study was carried out in Pediatrics out patients department (OPD) of Shahid Surhawardy Medical College and Hospital, from January 2009 to December 2009. Feeding history of total 250 babies age >6 months to <1 year was taken from mothers. Results: Among 250 total babies, prelacteal feed was given in 29.2%(73/250), colostrum was given in 79.2%(198/250) and exclusive breast feeding upto six months was given in 24%(60/250) babies. CF was started in 242 babies and it was too early before six months in 29.6%(74/250) cases. Amount of CF was adequate in 66.9%(162/ 242) and composition of CF was good enough in 58.3%(141/242) babies. Conclusion: In this study CF was introduced before 6 months in one third babies and amount was inadequate in same numbers of children. There is need for promotion and protection of optimal infant feeding practices for improving nutritional status of our children. DOI: http://dx.doi.org/10.3329/bjch.v37i3.18616 Bangladesh J Child Health 2013; Vol.37(3): 138-141
Seroprevalence of Hepatitis B, Hepatitis C and Human Immunodeficiency Virus Among Multitransfused Thalassaemic Children in Dhaka, Bangladesh
Authors: Karim AKM Rezaul , Islam Afiqul , Jamal Choudhury Yakub , Matin Abdul , Hossain Md Monir , Shafiullah Mohammad , Urmi Rehnuma
Published: April 2014

Background: Thalassaemia is a congenital hemolytic disease caused by defective globin chain synthesis of haemoglobin and largely treated by repeated blood transfusions. Transfusion-transmitted infections still make a great challenge in the management of patients with thalassaemia major. The most important worldwide transfusion transmitted infections (TTI) are hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Despite concern about a possible increase in the incidence of these infections there are no recent data about the prevalence of HBV, HCV and HIV from Bangladesh. Objectives: To evaluate the prevalence of hepatitis B, hepatitis C and human immunodeficiency virus in multi-transfused thalassaemia patients (MTP), to identify the possible risk factors and to evaluate the effect of compulsory screening of blood to prevent these infections. Methodology: This cross-sectional study was conducted during 2011 to 2012 on 100 consecutive multi-transfused thalassaemic patients who were interviewed using a structured questionnaire and tested for serological markers of hepatitis B virus (HBsAg), hepatitis C virus (Anti-HCV) and human immunodeficiency virus (Anti-HIV 1+2). Results: The overall prevalence of HCV, HBV, HIV and co-infection among (MTP) were 31%, 3%, 0% and 1%, respectively. Children who developed infection had a higher incidence of receiving transfusion from professional donors or unknown donors than the non-infected ones. Infected children had a higher frequency of receiving transfusions without screening and receiving more number of transfusions than their counterpart. Other non-transfusion related (NTR) risk factors such as surgical operation, dental procedures, needle stick injury were significantly higher in patients who acquired transfusion transmitted infections (TTI). Conclusions: HCV infection was the most prevalent transfusion transmitted infection (TTI) among multi-transfused thalassaemia patients (MTP) and remains a major health problem for these patients. Children who received transfusion from professional donors and received unscreened blood had more chance of getting infection with transfusion transmitted infection. DOI: http://dx.doi.org/10.3329/bjch.v37i3.18618 Bangladesh J Child Health 2013; Vol.37(3): 146-153
Neurologic Wilsons Disease and its Management - An Update
Authors: Kundu GK
Published: April 2014

Wilsons disease is an inborn error of copper metabolism caused by mutations in the ATP7B gene. The disease has an autosomal recessive mode of inheritance and is characterized by excessive copper deposition, predominantly in the liver and brain. Clinical manifestations of neurologic Wilsons disease include variable combinations of dysarthria, dystonia, tremor, and choreoathetosis. Among neurodegenerative disorders. WD is preventable and treatable if they are diagnosed treated early. Untreated case of Wilsons disease progresses to severe neurologic disability and death, while those adequately treated have normal life spans. The traditional treatment for WD is based on copper chelation with agents such as D-penicillamine, but use of this drug has been questioned because of reported side effects. The use of agents such as Zinec, trientine and ammonium tetrathiomolybdate has been advocated, although results of long-term trials are awaited. This review focuses on the neurologic features of Wilsons disease and treatment options. DOI: http://dx.doi.org/10.3329/bjch.v37i3.18620 Bangladesh J Child Health 2013; Vol.37(3): 158-169
Des contes cambodgiens
Authors: Anthoine-Milhomme Joséphine
Published: April 2014

Ce témoignage porte sur l’intérêt de l’usage des contes pour la clinique interculturelle. A travers différentes approches du Cambodge (recherche pour un DEA de psychologie auprès de la « jeune génération » cambodgienne installée à Paris, mise en place d’un atelier conte dans un dispensaire du XIII e arrondissement à Paris auprès de patients asiatiques, mise en place de groupes contes au Cambodge auprès de patients, thèse en Ethnologie et Anthropologie sociale sur le conte cambodgien), cet article montre l’utilité de dispositifs spécifiques dans la pratique de la clinique interculturelle.
G-NO-TECS
Authors: Rosenorn-Lanng Deborah J
Published: April 2014

This chapter examines the concept of non-technical skills and how deficiencies in this arena can result in medical error.
Using a Virtual Learning Environment within Simulation to Enhance Inter-Professional Team Working Skills
Authors: Humphreys Melanie , Rosenorn-Lanng Deborah J. , Bracegirdle Luke
Published: April 2014

This chapter details a collaborative teaching and learning evaluative project between Nursing and Midwifery, Pharmacy, and Medicine at Keele University to explore the development of team working skills (NOTECH) and debrief within an inter-professional active virtual learning environment (KAVE). The virtual ward and NOTECH training provided within the KAVE are thought to be the first of their kind within the UK. The project has recently been presented within Australia and Italy, and been very positively received. KAVE is a physical room where three-dimensional “stereoscopic” visuals display on three walls and the floor to create a computer-generated virtual environment. A student wears active 3D glasses and a lightweight head and hand-tracking device. The computer-generated visuals respond to position in the KAVE and allow the student to “pick up” and interact with digital objects such as care plans, prescription charts, observation charts, etc. The virtual ward is able to simulate observation and diagnostic skills training. ECG monitors' provide information regarding the status of each virtual patient within the ward. The virtual ward clinical simulation enabled the students to rehearse professional behaviours in a risk-free environment, whilst providing opportunities for non-technical skills practice prior to real-world patient encounters. Early evaluations received from students have been very positive.
Computerisation of Clinical Pathways
Authors: Tehrani Jasmine
Published: April 2014

Patient safety incidents are becoming more common in medical situations. The challenge of achieving significant improvements in patient safety is one of the key tasks facing healthcare at the start of the 21st century. Clinical pathways and clinical guidelines provide a measure of standardisation to help reduce medical error, but are often manually created and also prone to human error. This chapter explores the error issues regarding clinical pathways. It presents a method for generating clinical pathways from a semiotic perspective that can addresses social and informal/safety factors which conspire to influence the outcome of patient interaction and safety.
Health IT Policy in the UK
Authors: Currie Wendy L.
Published: April 2014

The challenge to provide a nation-wide integrated health service is part of a UK government policy to transform healthcare using information and communications technology. The National Programme for Information Technology launched in 2002 is the largest, non-military, non-scientific government-funded IT programme, with an estimated total cost exceeding £20 bn. This chapter is a longitudinal study of the National Care Record Service, which is the largest part of the programme, aimed to provide 50 million UK (English) citizens with an electronic health record. Using episodic interviewing techniques over ten years and secondary source material, the findings reveal a serious mismatch between health IT policy and the failure to rollout electronic health records on time and within budget. Key stakeholders, notably clinicians and patient groups, continuously question the policy and merits of the programme, not merely as a “technical challenge” but as a means of transforming working practices in healthcare. This study suggests that government agencies therefore need to extend their health technology assessment criteria to include cultural, social, and economic issues, as imposing centrist, top-down health IT policy needs to secure the “buy-in” from diverse and influential groups and individuals to ensure the successful adoption and implementation of health technologies.
The Internet of Things and Opportunities for Pervasive Safety Monitored Health Environments
Authors: Michell Vaughan
Published: April 2014

This chapter discusses the opportunities for new ubiquitous computing technologies, with concentration on the Internet of Things (IoT), to improve patient safety and quality. The authors focus on elective or planned surgical interventions, although the technology is applicable to primary and trauma care. The chapter is divided into three main sections with section 1 covering medical error issues and mechanisms, section 2 introducing Internet of Things, and section 3 discussing how IoT capabilities may address and reduce medical errors. The authors explore the existing theory of errors expounded by Reason (Reason, 2000, 1998; Leape, 1994) to identify perception-, decision-, and knowledge-based medical errors and related processes, environments, and cultural drivers causing error. The authors then introduce the technology of the Internet of Things and identify a range of capabilities from sensing, tracking, control, cooperative, and semantic reasoning. They then show how these new capabilities might be applied to reduce the errors expounded by the discussed error theories. They identify that: IoT enables augmentation of objects, which provides a massive increase in information transfer, thus improving clinician perception and support for decision-making and problem solving; IoT provides a host of additional observers and opportunities, which can shift the focus of overworked clinicians from constant monitoring to undertaking complex actions, such as decision making and care; IoT networks of sensors and actuators, through the addition of semantic and contextual rules, support decision making and facilitate automated monitoring and control of pervasive safety-monitored health environments, thus reducing clinician workload.
The Ubiquitous Internet
Authors: van Wessel Robert , de Vries Henk J.
Published: April 2014

We all take the ubiquity of the Internet for granted: anyone, anywhere, anytime, any device, any connection, any app…but for how long? Is the future of the Internet really at stake? Discussions about control of the Internet, its architecture and of the applications running on it started more than a decade ago (Blumenthal & Clark, 2001). This topic is becoming more and more important for citizens, businesses, and governments across the world. In its original set-up, the architecture of the Internet did not favor one application over another and was based on the net neutrality principle (Wu, 2003). However, architectures should be understood an “alternative way of influencing economic systems” (Van Schewick, 2010), but they should not be a substitute for politics (Agre, 2003). The architecture is laid down in standards and therefore discussions about the future of the Internet should also address the role of standards. This is what this chapter aims to do.
Multicriteria Queuing Model to Improve Intra-User Multi-Flow QoS in Wireless Cellular Networks
Authors: Hanini Mohamed , Haqiq Abdelkrim , Berqia Amine
Published: April 2014

This chapter tackles the challenging task of QoS evaluation and improvement in cellular networks. Initially, the authors provide a classification based on four criteria of the queuing models used in the literature. In a second step, an analysis of technologies shows that combining queue management and scheduling mechanisms may lead to improvement in QoS. Hence, the authors propose design of queuing models that meet all the classification criteria, with the goal of improving the various QoS parameters required by the different classes of flows (real time and non-real time) transmitted to an end user in a cell. These models have been mathematically and numerically analyzed, and their impact on end-to-end QoS in a mobile cellular network has been proved.
Data Gathering Algorithms and Sink Mobility Models for Wireless Sensor Networks
Authors: Meghanathan Natarajan
Published: April 2014

In the first half of the chapter, the authors provide a comprehensive description of two broad categories of data gathering algorithms for wireless sensor networks: the classical energy-unaware algorithms and the modern energy-aware algorithms, as well as presented an exhaustive performance comparison of representative algorithms from both these categories. While the first half of the chapter focuses on static sink (that is located outside on the network boundary), the second half of the chapter explores the use of mobile sinks that gather data by stopping at the vicinity of the sensor nodes. As a first step, the authors investigate the performance of three different strategies to develop sink mobility models for delay and energy-efficient data gathering in static wireless sensor networks. The three strategies differ on the approach to take to determine the next stop for data gathering: randomly choosing a sensor node that is yet to be covered (Random), choose the sensor node that has the maximum number of uncovered neighbor nodes (Max-Density), and choose the sensor node that has the largest value for the product of the maximum number of uncovered neighbor nodes and the residual energy (Max-Density-Energy). Based on the simulation results, the authors recommend incorporating the random node selection-based strategy to be a better strategy for sink mobility models (with minimal deployment overhead) rather than keeping track of the number of uncovered neighbor nodes per node and the residual energy available at the nodes.