bluuebunny/crossref_metadata_2025 huggingface dataset:
Interspecific variation in the size‐dependent resprouting ability of temperate woody species and its adaptive significance
Authors: Shibata Rei , Shibata Mitsue , Tanaka Hiroshi , Iida Shigeo , Masaki Takashi , Hatta Fumika , Kurokawa Hiroko , Nakashizuka Tohru
Published: October 2013

Resprouting of woody species after above‐ground damage may help plants to persist longer at a given site and quickly reoccupy disturbed sites, thereby strongly influencing forest dynamics. Resprouting has been discussed from two adaptation perspectives: recovery from damage by catastrophic disturbance and survival in frequently disturbed shaded understorey. However, few studies have comprehensively dealt with both adaptation types to understand resprouting strategies.

To understand the adaptive significance of resprouting, we assessed the size dependence of resprouting ability after stem clipping for 24 deciduous broad‐leaved species, including shrubs, sub‐canopy and canopy trees, in a cool‐temperate forest in Japan. The community assembly includes species adapted to past catastrophic disturbances (e.g. fire, logging) and to stable forest with intermittent treefall (currently the dominant disturbance). We correlated resprouting ability with life‐history strategies based on demographic parameters and plant functional traits, such as leaf mass per area (LMA), leaf toughness and wood density.

All the studied species could resprout in juveniles, and resprouting ability increased as stump size increased. Most sub‐canopy and canopy trees lost their ability to resprout after attaining a particular stump size, whereas shrub species retained the ability to resprout throughout their lifetimes.

The relative growth rate, LMA and foliar nitrogen did not greatly influence the resprouting ability of a species. In contrast, species with smaller maximum size, lower leaf toughness and lower wood density had better juvenile resprouting ability. This better resprouting ability may have evolved because these characteristics make them more vulnerable to shaded understorey. However, species with larger maximum size and lower leaf toughness retained their ability to resprout to a larger size.

Synthesis. A better resprouting ability is related to the ability to survive frequent disturbances, in juveniles, which are characteristics of both forest understorey and frequent fire or drought. To retain resprouting ability until grown seems to be an adaptation to survive infrequent large disturbances. Light‐demanding species, which generally have better resprouting ability than shade‐tolerants both in juveniles and adults, are adapted to disturbances of various scale and frequency; however, shade‐tolerants could survive well in the understorey due to a combination of stronger physical defences and resprouting ability.
Pilot testing a self‐administered dietary assessment website with school‐age children and adolescents under laboratory and free‐living conditions
Authors: Probst Yasmine , Cufer Sarah , Lin Shannon
Published: October 2013

Aim

To evaluate the experiences and data of children using the DietAdvice website in a controlled and a free‐living environment.

Methods

Observational pilot study under laboratory conditions with face‐to‐face interviews and a community‐based nutrition and exercise intervention program. The laboratory trial consisted of n = 17 children (aged 9–16 years) and the intervention program consisted of n = 34 adolescents (aged 12–16 years). Thematic analysis of observation/interview notes and χ2 tests and independent samples t‐tests (P < 0.05) to compare responses and mean times, respectively, between age groups (group 1 (primary school): 9–12 years; group 2 (secondary school/adolescent): 13–16 years). Frequency and time of use analyses for the intervention group with comparisons to group 2 of the laboratory observation.

Results

Children had an intermediate (41.2%) or advanced level (58.8%) of computer knowledge and used computers 5.29 ± 2.31 days. There were no significant differences between age groups and time taken to complete website sections, observable behaviours and required assistance. A total of 71% of children found the website easy to complete and understand, yet expressed confusion to complete amount/frequency of food eaten (71%). Adolescents did not appear to be interested in using the website when it was an optional component of their participation. The adolescents in the intervention took one hour and 41 minutes to use the website.

Conclusion

Children and adolescents have the required abilities to use the DietAdvice website; however, improvements to the website to engage their interests may further assist completion. Research into how these age groups report the foods eaten using an electronic medium is also needed.
Hand bone mineral density reference values in a Turkish healthy female population
Authors: Alioglu Kenan , Dogu Beril , Sirzai Hulya , Yilmaz Figen , Kuran Banu
Published: October 2013

Aim

In this study we aimed at identifying the bone mineral density (BMD) reference values of hands, according to age, measured by dual‐energy X‐ray absorptiometry (DEXA) and assessing the correlation of these values with lumbar and femoral BMD values.

Method

A total of 403 healthy women aged between 20 and 70 participated in our study. All BMD measurements are performed by DEXA method on both hands, anteroposterior lumbar spine (L2–L4) and right femur (femoral neck, total femur) regions. BMD results of all the patients were divided to 10‐year age categories and evaluated in five subgroups in total (20–30 to 61–70).

Results

Among the 10‐year age categories we found both dominant and non‐dominant hand peak bone mass values in the 31–40 years age group (0.423 ± 0.039 g/cm², 0.410 ± 0.043 g/cm², respectively). Statistically significant positive correlation was defined between dominant and non‐dominant hand BMD values and L2‐L4 spine, femur neck and total femur values (for dominant hand r = 0.636, P = 0.0001; r = 0.645, P = 0.0001; r = 0.623; P = 0.0001; for non‐dominant hand r = 0.624, P = 0.0001; r = 0.637, P = 0.0001, r = 0.623, P = 0.0001, respectively). Regarding the relationship of age and menopause with BMD results, a negative statistical relationship was observed among dominant and non‐dominant hand, L2‐L4 spine, femoral neck and total femur BMD values (P = 0.0001).

Conclusion

Our study has provided hand BMD reference values in women aged between 20–70 years; further studies are needed to investigate the role of these values in identifying diseases causing osteoporosis in the hand and in evaluating treatment.
Induction of proliferation and pro‐inflammatory cytokine production in rheumatoid arthritis peripheral blood mononuclear cells by a 65 KDa chondrocyte membrane‐specific, constitutive target autoantigen (CH65)
Authors: Alsalameh Rayya J. , Casey Rachael C. , Mollenhauer Jürgen , Kalden Joachim R. , Burmester Gerd R. , Alsalameh Saifeddin M.
Published: October 2013

Objective

To analyze proliferation and pro‐inflammatory cytokine production of peripheral blood mononuclear cells (PBMC) from rheumatoid arthritis (RA) patients following stimulation with a purified chondrocyte membrane‐associated autoantigen (CH65).

Methods

CH65 was highly purified from bovine chondrocyte membranes by solubilization and ion exchange chromatography. PBMC of RA patients (n = 37; 28 seropositive, nine seronegative) and non‐arthritic donors (n = 20) were isolated by ficoll centrifugation and used in cell proliferation assays. The levels of interleukin (IL)‐1, tumo necrosis factor (TNF) and IL‐6 produced after stimulation with CH65 were determined by enzyme‐linked immunosorbent assay (ELISA). Statistical analysis was performed using Mann–Whitney U‐test and Spearman rank test and the software SPSS 13.0TM (SPSS Inc.; Chicago, IL, USA).

Results

Peripheral blood mononuclear cells exhibited a strong proliferative response to purified CH65 in approximately 50% of the RA patients (seropositive > seronegative), with a maximum reactivity at 0.15 or 0.30 μg/mL culture medium. In contrast, PBMC from normal donors did not show a proliferative response to CH65 at any dose. The proliferative response in RA patients peaked at days 7–9 and returned to control levels at day 13, indicating an antigen‐driven process. CH65‐stimulated RA PBMC produced moderate to high amounts of IL‐1, TNF and IL‐6. This was comparable to the response after exposure to isolated whole chondrocyte membranes or purified collagen type II.

Conclusion

These results demonstrate a significant cellular immune response to CH65 protein in RA patients. Given the high similarity between bovine and human CH65, the results suggest a pathogenetic involvement of this molecule as a cartilage‐specific potential target autoantigen in RA.
Derivation of an Abbreviated Instrument For Use in Emergency Department Low Back Pain Research: The Five‐item Roland Morris Questionnaire
Authors: Friedman Benjamin W. , Schechter Clyde B. , Mulvey Laura , Esses David , Bijur Polly E. , John Gallagher E.
Published: October 2013

Objectives

Low back pain (LBP) is a common reason for emergency department (ED) visits in the United States. Pain and functional outcomes after ED visits for LBP tend to be poor. ED‐based clinical LBP research is hampered by complexity of available outcome instruments, which can be time‐consuming to administer. The purpose of this investigation was to determine if a shorter version of the well‐validated and commonly used Roland Morris Disability Questionnaire (RMDQ) would retain the original 24‐item instrument's ability to assess functional outcomes accurately in ED patients with LBP.

Methods

The authors used deidentified data obtained from a prospective LBP cohort study, which enrolled 674 patients during index ED visits for LBP, and followed them by telephone 1 week and 3 months later. Five items were selected from the original 24 items of the RMDQ using regression techniques. Internal consistency of the abbreviated scale was measured using Cronbach's alpha. The strength of association between the five‐item scale (RM5) and the parent scale was determined at baseline, 1 week, and 3 months. The association between change in the parent scale and change in the RM5 and the change in RM5 that was most closely associated with a minimum clinically significant difference on the RMDQ were also determined.

Results

The Cronbach's alpha for the RM5 was 0.88 (95% confidence interval [CI] = 0.87 to 0.89) at baseline, 0.96 (95% CI = 0.96 to 0.96) at 7 days, and 0.97 (95% CI = 0.97 to 0.97) at 3 months. The Pearson correlation coefficient for the RM5 versus the parent scale was 0.93 (R2 = 0.86) at baseline, 0.98 (R2 = 0.96) at 1 week, and 0.98 (R2 = 0.96) at 3 months. The correlations between change from baseline in the abbreviated scale and the parent scale were 0.95 (R2 = 0.90) and 0.96 (R2 = 0.92) at 7 days and 3 months, respectively. A one‐point change in the RM5 has a sensitivity of 96% (95% CI = 93% to 98%) and a specificity of 92% (95% CI = 89% to 94%) for the minimum clinically significant change on the RMDQ.

Conclusions

An abbreviated five‐item version of the RMDQ was developed. Pending independent validation, this shortened instrument should streamline ED‐based low back pain research.
U.S. Trends in Computed Tomography Use and Diagnoses in Emergency Department Visits by Patients With Symptoms Suggestive of Pulmonary Embolism, 2001–2009
Authors: Feng Lisa B. , Pines Jesse M. , Yusuf Hussain R. , Grosse Scott D.
Published: October 2013

Objectives

Using computed tomography (CT) to evaluate patients with chest symptoms is common in emergency departments (EDs). This article describes recent trends of CT use in U.S. EDs for patients presenting with symptoms common to acute pulmonary embolism (PE).

Methods

The 2001–2009 National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationally representative survey of U.S. ED encounters, was used for data collection. Patients with at least one of three complaints (chest pain, dyspnea, or hemoptysis) were categorized into the chest symptom study (CSS) group. The yearly increases in CT use for the complaints were tabulated first, then linear regression analysis was used to calculate average rates of increases in CT use between 2001 and 2007, the years where CT use increased, for the overall population and among specific subgroups. The ratios of the number of visits when CT was ordered and there was a target diagnosis relative to the total number of visits with CT in the CSS group (diagnosis/CT ratio) were calculated for PE and pneumonia.

Results

Annual CT rates for the CSS group increased from 2.6% in 2001 to 13.2% in 2007, subsequently leveling off at approximately 12.5% in 2008 and 2009. The average growth rate of CT use for the CSS group was 28.1% (95% confidence interval [CI] = 20.9% to 35.7%) per year between 2001 and 2007. Testing rates for all subgroups increased. The lowest growth rate was among Hispanic patients, whose CT rates grew 14.2% (95% CI = 5.7% to 23.5%) per year. The highest growth rate was in nonurban hospitals, at 43.1% (95% CI = 15.2% to 77.8%) per year. Patients triaged as nonurgent received the fewest CTs, compared to those who should be seen in 2 hours or less. With regard to sources of payment, the self‐pay subgroup experienced the highest rate of increase at 35.1% (95% CI = 18.6% to 53.9%). The PE diagnosis/CT ratio from 2002 to 2009 was 2.7% for the CSS group. The pneumonia diagnosis/CT ratio grew from 5.8% in 2002 to 2005 to 7.8% in 2006 to 2009.

Conclusions

Computed tomography use in ED visits by patients with chest symptoms increased dramatically from 2001 to 2007 and seems to have leveled off in subsequent years. The low PE diagnosis‐to‐CT ratio suggests that EDs may need to promote evidence‐based use of CT.
Negative Predictive Value of Acetaminophen Concentrations Within Four Hours of Ingestion
Authors: Froberg Blake A. , King Kerry J. , Kurera Theomal D. , Monte Andrew A. , Prosser Jane M. , Walsh Steven J. , Riffenburgh Robert H. , Rusyniak Daniel E. , Tanen David A.
Published: October 2013

Objectives

The objective was to ascertain whether acetaminophen (APAP) concentrations less than 100 μg/mL obtained between 1 and 4 hours after acute ingestion accurately predict a nontoxic 4‐hour concentration.

Methods

The authors performed a multicenter, prospective cohort study involving five emergency departments (EDs) participating in the ToxIC Research Network. Data were collected from May 2009 to December 2011. Patients with APAP concentrations <100 μg/mL drawn between 1 and 4 hours after acute ingestions, and concentrations drawn 4 or more hours after ingestions, were included in the study. Exclusion criteria included initial concentration >100 μg/mL, initial APAP concentration drawn prior to 1 hour, two undetectable APAP concentrations, the second concentration drawn prior to 4 hours, and unknown time of ingestion. Toxic concentrations 4 or more hours after ingestion were defined as concentrations that plotted above the 150 μg/mL line on the Rumack‐Matthew nomogram.

Results

Data were collected on 83 patients who met inclusion criteria. Of the 83 patients with APAP concentrations <100 μg/mL between 1 and 4 hours, one patient (1.2%) had a ≥ 4‐hour toxic concentration. Negative predictive value (NPV) for an APAP concentration <100 μg/mL obtained between 1 and 4 hours after an acute ingestion was 98.8% (95% confidence interval [CI] = 93.5% to 99.8%).

Conclusions

An APAP concentration of <100 μg/mL obtained between 1 and 4 hours after ingestion has a high NPV for excluding toxic ingestion. We do not recommend reliance on concentrations obtained between 1 and 4 hours to exclude toxicity, because of a potential false‐negative rate of 6.5%.
Intranasal Ketamine for Analgesia in the Emergency Department: A Prospective Observational Series
Authors: Andolfatto Gary , Willman Elaine , Joo Daniel , Miller Philip , Wong Wai‐Ben , Koehn Martha , Dobson Raea , Angus Eric , Moadebi Susanne
Published: October 2013

Objectives

The objective was to examine the feasibility, effectiveness, and adverse effect profile of intranasal ketamine for analgesia in emergency department (ED) patients.

Methods

This was a prospective observational study examining a convenience sample of patients aged older than 6 years experiencing moderate or severe pain, defined as a visual analog scale (VAS) score of 50 mm or greater. Patients received 0.5 to 0.75 mg/kg intranasal ketamine. Pain scores were recorded on a standard 100‐mm VAS by trained investigators at baseline, then every 5 minutes for 30 minutes, and then every 10 minutes for an additional 30 minutes. The primary outcome was the number and proportion of patients experiencing clinically significant reductions in VAS pain scores, defined as VAS reductions of 13 mm or more, within 30 minutes. Secondary outcomes included the median reduction in VAS, the median time required to achieve a 13 mm reduction in VAS, vital sign changes, and adverse events. Continuous data are reported with medians and interquartile ranges (IQRs). The Wilcoxon signed‐ranks test was used to assess changes in VAS scores. Adverse effects are reported with proportions and 95% confidence intervals (CIs).

Results

Forty patients were enrolled with a median age of 47 years (IQR = 36 to 57 years; range = 11 to 79 years) for primarily orthopedic injuries. A reduction in VAS of 13 mm or more within 30 minutes was achieved in 35 patients (88%). The median change in VAS at 30 minutes was 34 mm (44%). Median time required to achieve a 13 mm VAS reduction was 9.5 minutes (IQR = 5 to 13 minutes; range = 5 to 25 minutes). No serious adverse effects occurred. Minor adverse effects included dizziness (21 patients, 53%; 95% CI = 38% to 67%), feeling of unreality (14 patients, 35%; 95% CI = 22% to 50%), nausea (four patients, 10%; 95% CI = 4% to 23%), mood change (three patients, 8%; 95% CI = 3% to 20%), and changes in hearing (one patient, 3%; 95% CI = 0% to 13%). All adverse effects were transient and none required intervention. There were no changes in vital signs requiring clinical intervention.

Conclusions

Intranasal ketamine reduced VAS pain scores to a clinically significant degree in 88% of ED patients in this series. Adverse effects were minor and transient. Intranasal ketamine may have a role in the provision of effective, expeditious analgesia to ED patients.
How Do Founder CEOs Create Value?
Authors: Johnson William C. , Yi Sangho
Published: October 2013

We examine the value impact of founder CEOs and explore possible mechanisms whereby founder CEOs' unique characteristics affect their firms' value and long‐term market performance. We find that founder CEOs' status is positively related to market valuation and long‐term stock performance of firms. Furthermore, a lower likelihood of involuntary turnover for founder CEOs is positively associated with market valuation. We also find that CEOs are most likely to generate positive abnormal returns when protected from takeover markets. Our paper suggests that founder CEOs create value by strengthening a firm's stakeholder relationships and alleviating information asymmetry in financial markets, when other certifying entities do not participate in initial public offerings.
How Does Diversification Impact Bank Stability? The Role of Globalization, Regulations, and Governance Environments
Authors: Hsieh Meng‐Fen , Chen Pei‐Fen , Lee Chien‐Chiang , Yang Shih‐Jui
Published: October 2013

This paper examines the impact of bank diversification on stability, using bank‐level data for 22 Asian countries over the period from 1995 to 2009. We empirically investigate whether country characteristics, economic structure, regulatory and governance environments, and globalization have affected the degree of banking stability in Asia. This study takes on two measures for banking diversification ‐ asset and income diversities ‐ and adopts a broad set of variables as a proxy for bank stability. We apply dynamic panel data techniques and show different results from the U.S. and Europe. Our results first reveal that in Asia asset diversity is not sufficient enough to improve bank stability. However, bank stability can be enhanced through a strategy of income diversity. Second, a higher degree of globalization decreases bank stability through income diversity, but stability rises through asset diversity. Third, a country with a higher level of corporate governance reduces the agency problem, thus further increasing stability through diversity. Finally, a country with a higher level of economic development will support asset diversity so that banks can obtain higher profit accompanied by lower risk.
China's Strategic Censorship
Authors: Lorentzen Peter
Published: October 2013

While it is often assumed that authoritarian regimes inevitably fear and restrict media independence, permitting watchdog journalism can actually help such regimes maintain power by improving governance. Yet such a strategy risks facilitating a coordinated uprising if discontent is revealed to be widespread. A formal model shows that under some conditions, a regime optimally permits investigative reporting on lower‐level officialdom, adjusting how much reporting is allowed depending on the level of underlying social tensions. This strategy yields many of the benefits of free media without risking overthrow. An extension shows why an increase in uncontrollable information, such as from the Internet, may result in a reduction in media freedom. The model sheds light on important aspects of China's media policy and its evolution and on authoritarian media control more broadly.
The clinical significance of drug–drug interactions in the era of direct‐acting anti‐viral agents against chronic hepatitis C
Authors: Maasoumy B. , Port K. , Calle Serrano B. , Markova A. A. , Sollik L. , Manns M. P. , Cornberg M. , Wedemeyer H.
Published: October 2013

Background

Drug–drug interactions (DDIs) in the treatment of chronic hepatitis C infection became a potential challenge with the introduction of direct‐acting anti‐virals (DAAs). Both currently approved DAAs, the protease inhibitors (PIs) telaprevir (TVR) and boceprevir (BOC), are substrates and inhibitors of P‐glycoprotein and the cytochrome P450 3A4, which are regularly involved in DDIs.

Aim

To analyse the risk for DDIs in patients with chronic HCV genotype 1 infection considered for PI treatment at a tertiary referral centre.

Methods

The first 115 consecutive patients selected for a PI therapy at Hannover Medical School were included. All changes to co‐medication before and during PI treatment were documented. Drugs were checked for DDIs with TVR and BOC using DDI websites and the respective prescribing information.

Results

Out‐patient medication contained 116 different drugs. Median number of drugs/patient was 2 (range 0–11). The risk for DDIs was substantial for 38% of the drugs affecting 49% of patients. Only 4% of the drugs were strictly contraindicated. DDIs between a PI and drugs newly prescribed during anti‐viral therapy were considerable in 42% of the patients. Suspected DDIs were managed by dose adjustments and discontinuation of co‐medication in 7% and 21% of the patients respectively.

Conclusions

Many patients with chronic HCV genotype 1 infection are affected by potential DDIs if treated with a protease inhibitor, but only in a minority of cases co‐medication is strictly incompatible. Overall, the challenge of DDIs is time‐consuming, but well manageable by a careful review of the patient's drug chart and monitoring during treatment.
Rates and predictors of response to anti‐viral treatment for hepatitis C virus inHIV/HCVco‐infection in a nationwide study of 619 patients
Authors: Ioannou G. N. , Scott J. D. , Yang Y. , Green P. K. , Beste L. A.
Published: October 2013

Background

The effectiveness of anti‐viral treatment for hepatitis C virus (HCV) inHIV/HCVco‐infected patients in ‘real world’, clinical practice is unclear.

Aims

To determine the rates and predictors of sustained virological response (SVR) to anti‐viral treatment forHCVwith pegylated interferon (PEG‐IFN) and ribavirin inHIV/HCVco‐infected patients.

Methods

We identified allHIV/HCVco‐infected patients who received anti‐viral treatment with PEG‐IFN and ribavirin in the Veterans Affairs healthcare system nationally between 2002 and 2009 (n = 665).

Results

Sustained virological response was achieved in 21.6% overall, 16.7% among patients with genotype 1HCV(n = 491) and 44% among patients with genotype 2 or 3HCV(n = 116). Among genotype 1‐infected patients, characteristics that were negatively associated withSVRindependently included baselineHCVviral load >2 million IU/mL [adjusted odds ratio (AOR) 0.41, 95%CI0.2–0.7], Black race [AOR0.56 (0.3–0.96)], diabetes [AOR0.42 (0.2–0.9)], baseline anaemia [AOR0.42 (0.2–0.97)], serum aspartate aminotransferase/alanine aminotransferase ratio ≥1.2 [AOR0.48 (0.2–0.97)] and use of zidovudine [AOR0.41 (0.2–0.9)]; characteristics positively associated withSVRincluded a starting dose of ribavirin ≥1000–1200 mg/day [AOR2.0 (1.1–3.7)] and erythropoietin use during treatment [AOR2.9 (1.6–5.0)]. Among genotype 2 or 3 infected patients, only erythropoietin use was an independent predictor ofSVR[AOR3.1 (1.2–7.8)], while a starting dose of ribavirin >800 mg/day was not associated withSVR.

Conclusions

Sustained virological response rates achieved with PEG‐IFN and ribavirin inHIV/HCVco‐infected patients are low in clinical practice. The use of erythropoietin was the most important, modifiable factor associated withSVR.
Patients with prostate cancer continue to have excess mortality up to 15 years after diagnosis
Authors: Husson Olga , van Steenbergen Liza N. , Koldewijn Evert L. , Poortmans Philip M. , Coebergh Jan Willem W. , Janssen‐Heijnen Maryska L.G.
Published: October 2013

Objective

To estimate the population‐based conditional 5‐year relative survival rates for patients with prostate cancer (PCa).

Patients and Methods

All 98 672 patients, aged 45–89 years, diagnosed in the Netherlands with PCa (clinical T stage 1–4) in the period 1989–2008 were selected from the Netherlands Cancer Registry and followed up until 2010.

The conditional 5‐year relative survival rate was estimated for every subsequent year of survival up to 15 years after diagnosis.

Results

The conditional 5‐year relative survival rate decreased with survival time from diagnosis. Excess mortality (conditional 5‐year relative survival rate <95%) for patients with clinical T1 stage only became manifest 5 years after diagnosis and increased to almost 10% after 10 years.

Patients with more advanced disease (cT2–cT4) were found to have an excess mortality rate of 6–12% at diagnosis, which increased to 15–22% after 10 years.

Excess mortality occurred earlier for the older age groups.

The 5‐year relative survival rate at diagnosis was <90% for all age groups of patients with cT3/cT4 disease and excess mortality for this group increased to >20% for those who had already survived for 5 years since diagnosis.

Conclusions

Patients with PCa were found to have excess mortality within 10 years of diagnosis. Excess mortality was found at an earlier timepoint for patients with a more advanced stage and for older age groups.

Quantitative insight into conditional survival is useful for caregivers to help plan optimum cancer treatment and surveillance and to inform patients about their actual prognosis during follow‐up, taking the current condition of the patient into account.
Quality of life and associated factors in persons with chronic rhinosinusitis in the general population: A prospective questionnaire and clinical cross‐sectional study
Authors: Lange B. , Holst R. , Thilsing T. , Baelum J. , Kjeldsen A.
Published: October 2013

Objectives

The European Position Paper on Rhinosinusitis and Nasal Polyps describes methods to perform population‐based and clinical studies on chronic rhinosinusitis in a standardised way, and it also describes how to clinical investigate CRS. The aim of this cross‐sectional study was to evaluate quality of life and objective findings in persons with chronic rhinosinusitis recruited from the general population.

Design

As part of a trans‐European study, selected respondents to a survey questionnaire were invited for a clinical visit. Subjective symptoms and rhinoscopy were used for the clinical diagnosis of chronic rhinosinusitis, and persons with and without chronic rhinosinusitis were compared.

Setting

This research took place in the department of Otolaryngology, Odense University Hospital.

Participants

A total of 366 persons participated at the clinical visit, and of these, 91 were diagnosed with chronic rhinosinusitis, 271 without chronic rhinosinusitis and four persons were excluded.

Main outcome measures

Severity of symptoms and disease‐specific quality of life were measured using the Sino‐Nasal Outcome Test 22, and generic quality of life was measured using European quality of life – 5 dimensions including an index score and a visual analogue scale.

Results

The prevalence of chronic rhinosinusitis was 9%, and the prevalence of polyps was 4%. Persons with chronic rhinosinusitis had significantly reduced disease‐specific quality of life (P = 0.00) and generic quality of life (P = 0.04 and 0.01) compared with persons without chronic rhinosinusitis. Having chronic rhinosinusitis was correlated to age, allergic rhinitis and smell.

Conclusion

This study gives insight into health‐related quality of life and objective findings in persons with chronic rhinosinusitis recruited from the general population.
Optimal plane for nerve sparing total mesorectal excision, immunohistological study and 3D reconstruction: an embryological study
Authors: Bertrand M. M. , Alsaid B. , Droupy S. , Benoit G. , Prudhomme M.
Published: October 2013

Aim

Genito‐urinary complications are frequent after rectal surgery and are often due to nerve damage. The relationship between the pelvic nerves and surgical planes are unclear. The aim of the study was to determine the relationship between the inferior hypogastric plexus and the fascia of the lateral pelvic wall and between Denonvilliers’ fascia and the efferent branches of the inferior hypogastric plexus.

Method

Computer‐assisted anatomical dissection was used. Serial histological sections were made from six human foetuses and a male adult. Sections were stained with haematoxylin and eosin, Masson's trichrome and immunostainings. The sections were then digitalized and reconstructed in three dimensions.

Results

The inferior hypogastric plexus was situated in a virtual space between the fascia propria of the rectum and the fascia on the upper surface of the levator ani. During the lateral dissection, the optimal surgical plane is the plane of the fascia propria of the rectum. We located Denonvilliers’ fascia in three dimensions. It plays the role of a protective sheet for the neurovascular bundle. The optimal plane for nerve preservation is situated behind Denonvilliers’ fascia.

Conclusion

This study has enabled a clear visualization of the optimal planes to perform total mesorectal excision while ensuring nerve preservation. Three‐dimensional visualization clearly helps to bridge the gap between histological examination and the findings of surgery.
Utility and pattern of positivity of p40 in the diagnosis of squamous cell carcinoma of the lung by cytology: the first study on fine needle aspiration smears
Authors: Jain D. , Mathur S. R. , Guleria R. , Iyer V. K.
Published: October 2013

Objective

Immunohistochemistry for p40 has emerged as a clinically applicable tool with high sensitivity and specificity to distinguish lung adenocarcinoma and squamous cell carcinoma (SCC). It appears to be an excellent marker for squamous differentiation. Although application of p40 in cell blocks has been reported, its expression has not been described in cytology smears. The aim was to study the expression of p40 in fine needle aspirates of SCC of the lung and to analyse differences in immunoreactivity in variably differentiated SCC.

Methods

The study used aspirates of lung masses diagnosed as SCC over a period of 2 years. p40 immunocytochemistry was performed on destained Papanicolaou smears. Nuclear staining was semi‐quantitatively evaluated as 0, 1 + , 2 +  and 3 +  based on the percentage positivity of tumour cells and was correlated with differentiation of the tumour. Adequate unmatched histology (50 biopsies) and cytology (25 smears) controls were taken for comparison.

Results

A total of 45 cases of primary and five cases of metastatic pulmonary SCC were identified. There were 17 well, 24 moderately and nine poorly differentiated SCC. p40 immunoreactivity was 2–3 +  in all moderate and poorly differentiated tumours, however, negative to 1 +  in all well‐differentiated carcinomas (P < 0.0001).

Conclusion

p40 immunostain is a valuable stain in identifying lung SCCs and works well in aspiration smears. The pattern of positivity varies with the differentiation of the tumour and is seen prominently in higher grade SCC where in practice the need arises for distinguishing them from either poorly differentiated adenocarcinomas or non‐small cell carcinoma, not otherwise specified.
Gender‐Related Changes of the Epicardial Fat Thickness and Leptin in Obstructive Sleep Apnea
Authors: Akilli Hakan , Kayrak Mehmet , Bekci Taha Tahir , Erdogan Halil İbrahim , Aribas Alpay , Yildirim Oguzhan , Taner Alpaslan , Erer Murat , Unlu Ali
Published: October 2013

Background

Epicardial fat thickness (EFT), an indicator of visceral obesity, and leptin are 2 novel markers for studying the obstructive sleep apnea (OSA) population. This study aimed to investigate the effects of gender on leptin levels and EFT, and the relation with OSA severity.

Methods

A total of 149 patients with OSA (female/male 55/94 and mean age 50.8 ± 9.2 years) and 50 control patients (female/male 24/26 and mean age 48.9 ± 8.8 years) were included in the study. The study population was divided into 4 groups according to apnea/hypopnea index (AHI) as control (AHI <5), the mild OSA (AHI 5–14), the moderate OSA (AHI 15–29), and the severe OSA (AHI ≥30). EFT was obtained from parasternal long‐axis and parasternal short‐axis echocardiographic images.

Results

Leptin levels among females were significantly higher than among males (10.5 [7.8] vs. 5.4 [4.5] ng/mL, P = 0.001, respectively). Among women, leptin levels were significantly higher in the severe OSA group compared to the control group (9.8 [9.0] vs. 15.5 [10.1] ng/mL, P = 0.05, respectively). Conversely, no relation was observed between OSA severity and the leptin levels among men. EFT was not significantly different between the 2 genders (P > 0.05). EFT was thicker in the severe OSA group than in the control and mild OSA groups among women, whereas EFT was not changed according to OSA severity among males (P > 0.05).

Conclusion

Leptin and EFT may be a valuable parameter in the evaluation of OSA severity in women than in men.
Is MC1 dispensable for regulation of cutaneous inflammatory and immune responses?
Authors: Böhm Markus , Luger Thomas A. , Steingräber Annika K. , Goerge Tobias
Published: October 2013

The melanocortin‐1 receptor (MC1) – being most abundantly expressed in the skin by melanocytes – has a physiological role for melanin pigmentation in many vertebrate species. MC1 has also been implicated in regulation of skin inflammation as this receptor is detectable in the majority of non‐melanocytic cell types and its ligand α‐melanocyte‐stimulating hormone (α‐MSH) exerts immunoregulatory and anti‐inflammatory effects. However, in vivo studies on mice with targeted disruption of MC1 have been missing in the context of skin inflammation until recently. Wolnicka‐Glubisz et al. now reported that the course of ultraviolet (UV)‐induced inflammation, contact hypersensitivity, neonatal immune tolerance and UV‐induced immunosuppression is similar in MC1 signal‐deficient (C57BL/6‐Mc1re/e) and wild‐type mice. These unexpected findings are supported by own observations in experimentally induced immune‐complex‐mediated vasculitis: Mc1re/e mice exhibited a similar extent of the reverse passive cutaneous Arthus reaction compared with wild‐type animals. Future studies are thus needed to clarify whether these findings are due to limitations in the chosen mouse model and/or point to additional MC subtypes that may regulate inflammatory and immune responses in the skin.
A non‐coding mutation in the 5′ untranslated region of patched homologue 1 predisposes to basal cell carcinoma
Authors: Tietze Julia K. , Pfob Martina , Eggert Marlene , von Preußen Anna , Mehraein Yasmin , Ruzicka Thomas , Herzinger Thomas
Published: October 2013

Mutations in the human homolog of the Drosophila patched gene, patched homologue 1 (PTCH‐1), are responsible for most hereditary and sporadic basal cell carcinomas. Here, we present a father and daughter with a high propensity for the development of basal cell carcinoma who were heterozygous for a non‐coding germline mutation in the 5′ untranslated region (UTR) of PTCH‐1 (insertion of a surplus CGG triplet at the site of a seven times CGG repeat). We analysed the impact of this mutation on PTCH translation using a luciferase‐based reporter vector. Insertion of an eighth CGG in the 5′ UTR repressed protein translation dramatically when compared to the wild‐type sequence. Our results suggest that this non‐coding variant in the 5′ UTR represents a mutation predisposing to basal cell carcinoma.
On the Value of Municipal Bond Insurance: An Empirical Analysis
Authors: Lai Van Son , Zhang Xueying
Published: October 2013

Using a large sample of municipal bond data from 2001 to 2010 in the U.S., this paper documents the time variation of the value of municipal bond insurance, estimated from the insured and uninsured bonds yield at issue differentials. We find that insured municipal bonds carry significant lower yields at issue compared to those of the equivalent uninsured bonds before 2008. However, this cost saving disappeared with the aftermath of the subprime credit crisis. We find that the supply of bonds and the level of market interest rates to have significant positive impacts on the time‐varying value of bond insurance. We also detect asymmetric response of these yield differentials to rises and declines of market interest rates. Economic intuition suggests that the value of municipal bond insurance is a function of business cycles but our tests support the contrary, which may be explained by the habitat preference of municipal bonds issues.
High‐frequency fire alters C : N : P stoichiometry in forest litter
Authors: Toberman Hannah , Chen Chengrong , Lewis Tom , Elser James J
Published: October 2013

Fire is a major driver of ecosystem change and can disproportionately affect the cycling of different nutrients. Thus, a stoichiometric approach to investigate the relationships between nutrient availability and microbial resource use during decomposition is likely to provide insight into the effects of fire on ecosystem functioning. We conducted a field litter bag experiment to investigate the long‐term impact of repeated fire on the stoichiometry of leaf litter C, N and P pools, and nutrient‐acquiring enzyme activities during decomposition in a wet sclerophyll eucalypt forest in Queensland, Australia. Fire frequency treatments have been maintained since 1972, including burning every 2 years (2yrB), burning every 4 years (4yrB) and no burning (NB). C : N ratios in freshly fallen litter were 29–42% higher and C : P ratios were 6–25% lower for 2yrB than NB during decomposition, with correspondingly lower 2yrB N : P ratios (27–32) than for NB (34–49). Trends in litter soluble and microbial N : P ratios were similar to the overall litter N : P ratios across fire treatments. Consistent with these, the ratio of activities for N‐acquiring to P‐acquiring enzymes in litter was higher for 2yrB than NB, whereas 4yrB was generally intermediate between 2yrB and NB. Decomposition rates of freshly fallen litter were significantly lower for 2yrB (72 ± 2% mass remaining at the end of experiment) than for 4yrB (59 ± 3%) and NB (62 ± 3%), a difference that may be related to effects of N limitation, lower moisture content, and/or litter C quality. Results for older mixed‐age litter were similar to those for freshly fallen litter although treatment differences were less pronounced. Overall, these findings show that frequent fire (2yrB) decoupled N and P cycling, as manifested in litter C : N : P stoichiometry and in microbial biomass N : P ratio and enzymatic activities. Furthermore, these data indicate that fire induced a transient shift to N‐limited ecosystem conditions during the postfire recovery phase.
Autumn warming reduces the CO2 sink of a black spruce forest in interior Alaska based on a nine‐year eddy covariance measurement
Authors: Ueyama Masahito , Iwata Hiroki , Harazono Yoshinobu
Published: October 2013

Nine years (2003–2011) of carbon dioxide (CO2) flux were measured at a black spruce forest in interior Alaska using the eddy covariance method. Seasonal and interannual variations in the gross primary productivity (GPP) and ecosystem respiration (RE) were associated primarily with air temperature: warmer conditions enhanced GPP and RE. Meanwhile, interannual variation in annual CO2 balance was controlled predominantly by RE, and not GPP. During these 9 years of measurement, the annual CO2 balance shifted from a CO2 sink to a CO2 source, with a 9‐year average near zero. The increase in autumn RE was associated with autumn warming and was mostly attributed to a shift in the annual CO2 balance. The increase in autumn air temperature (0.22 °C yr−1) during the 9 years of study was 15 times greater than the long‐term warming trend between 1905 and 2011 (0.015 °C yr−1) due to decadal climate oscillation. This result indicates that most of the shifts in observed CO2 fluxes were associated with decadal climate variability. Because the natural climate varies in a cycle of 10–30 years, a long‐term study covering at least one full cycle of decadal climate oscillation is important to quantify the CO2 balance and its interaction with the climate.
Tooth loss, chewing efficiency and cognitive impairment in geriatric patients
Authors: Elsig Fanny , Schimmel Martin , Duvernay Elena , Giannelli Sandra V. , Graf Christoph E. , Carlier Sabrina , Herrmann François R. , Michel Jean‐Pierre , Gold Gabriel , Zekry Dina , Müller Frauke
Published: October 2013

Background

Patients with dementia have poorer oral health and fewer teeth than their peers without cognitive impairment.

Objective

The hypothesis of this study is that the number of natural teeth and the chewing efficiency are associated with cognitive functioning.

Methods

This cross‐sectional study included 29 patients diagnosed with dementia aged 75 years or older and 22 controls who were either cognitively normal (n = 19) or with mild cognitive impairment (n = 3). Neuropsychological, nutritional and dental assessments were performed. The chewing efficiency was evaluated with a two‐colour mixing test.

Results

Demented patients and controls presented with a mean of 4.9 and 6.5 teeth, respectively (n.s.). The number of natural teeth was not associated with dementia (p = 0.553). Same results were found for age (p = 0.746) and sex (p = 0.901). The chewing efficiency by visual inspection proved worse in participants with dementia than in the controls (p < 0.011) and explained 9.3% of the variance in the diagnosis of dementia. Neither dental state nor chewing efficiency was related to the nutritional state.

Conclusion

Chewing efficiency seems stronger associated with cognitive impairment than the number of teeth. Hence, in a more holistic approach for the geriatric assessment, the dental examination may be complemented by a chewing efficiency test.
The Social Protection Floors Recommendation, 2012 (No. 202): Can a six‐page document change the course of social history?
Authors: Cichon Michael
Published: October 2013

In June 2012, the global community made an important step to firmly establish social protection as part of national and global development strategies. The International Labour Conference unanimously adopted the Recommendation concerning national floors of social protection, 2012 (No. 202), providing concrete content to the human right to social security. This article puts the Recommendation into its historical standard setting and development policy context, reviews the emergence of the social protection floor concept, and analyses the contents of the new Recommendation and some of its political hotspots. It then explores whether the new instrument has the potential to change the social reality in the 185 ILO member States. It concludes that its adoption is an unprecedented demonstration of good will and far‐reaching global social policy consensus. However, in order to help create space for national policy change, the campaign to achieve at least a minimum of social security for all needs to continue and has to be kept on the international agenda. In closing, the article lists strategies that the global coalition behind this campaign needs to pursue for social security to remain or become an inalienable objective in national and international development strategies.
Financing social protection floors: Considerations of fiscal space
Authors: Harris Elliott
Published: October 2013

The effectiveness of social protection in combating poverty and vulnerability, cushioning shocks, attenuating inequality, and supporting long‐term growth is well‐established, but effective social protection systems have long been seen as an unaffordable luxury in many developing and low‐income countries. The social protection floor concept aims at providing a guaranteed minimum of social protection at a reasonable cost, even in resource‐constrained circumstances, serving as a platform for the gradual implementation of a full social protection system. Introducing and maintaining or extending the floor requires the mobilization of fiscal space, both immediately and in the future. The article argues that efforts to generate fiscal space must carefully consider issues of predictability, as well as the impact of present funding choices on fiscal and debt sustainability, macroeconomic stability, inequality, poverty reduction and growth, and hence on future fiscal space. It examines from this perspective some of the implications of generating fiscal space through additional domestic resource mobilization, expenditure reallocation or efficiency gains, reduction of debt service, or external funding. The article also presents some evidence of a wide range of recent interventions that have been financed at reasonable cost on a sustainable basis in countries at different levels of income and development, using both own resources and external funds.
Modeling and Predicting the Biofilm Formation of Different Salmonella Strains
Authors: Karaca Başar , Buzrul Sencer , Tato Veli , Akçelik Nefise , Akçelik Mustafa
Published: October 2013

Biofilm formations of 25 Salmonella strains belonging to 19 serotypes were monitored with respect to time at a constant temperature. Two (DMC8 and DMC73) out of 25 strains had low biofilm formation ability and were not included in the modeling study. One (SL1344) strain had awkward biofilm formation which could not be described by a mathematical model, whereas biofilm formation of three strains (DMC33, DMC85 and DMC93) could be described by an exponential model. The modified Gompertz equation with high adjusted determination coefficient (R2adj) and low mean square error values produced reasonable fits for the biofilm formation of 19 Salmonella strains. It was also possible to predict the biofilm formation of these strains at two different time values by use of the modified Gompertz equation. Although more studies should be carried out to evaluate different mathematical models under both iso‐ and nonisothermal conditions, this study reveals that describing and predicting the biofilm formation could be possible.

Practical Application

Many Salmonella strains are capable of adhering and forming biofilm on certain surfaces. Biofilm formed in food processing environments may lead to food spoilage or transmission of diseases. Therefore, it is of vital importance to understand the formation of biofilm on different surfaces. It could be possible to describe and predict the biofilm formation with respect to time by using common modeling techniques.