bluuebunny/crossref_metadata_2025 huggingface dataset:
Reducing heart failure admission rates in England 2004–2011 are not related to changes in primary care quality: national observational study
Authors: Brettell Rachel , Soljak Michael , Cecil Elizabeth , Cowie Martin R. , Tuppin Philippe , Majeed Azeem
Published: July 2013

Aims

Heart failure (HF) is an important clinical problem. Expert consensus has defined HF as a primary care‐sensitive condition for which the risk of unplanned admissions may be reduced by high quality primary care, but there is little supporting evidence. We analysed time trends in HF admission rates in England and risk and protective factors for admission.

Methods and results

We used Hospital Episodes Statistics to produce indirectly standardized HF admission counts by general practice for 2004–2011. Clustered negative binomial regression analysis produced admission risk ratios and assessed the significance of potential explanatory covariates. These included population factors (deprivation; HF, coronary heart disease, and smoking prevalence), primary care resourcing [access; general practitioner (GP) supply], and primary care quality (‘Quality and Outcomes Framework’ indicator.) There were 327 756 HF admissions of patients registered with 8405 practices over the study period. There was a significant reduction in admissions over time, from 6.96/100 000 in 2004 to 5.60/100 000 in 2010 (P < 0.001). Deprivation and HF prevalence were risk factors for admission. GP supply and access protected against admission. However, these effects were small and did not explain the large and highly significant annual trend in falling admission rates.

Conclusions

The observed fall in admissions over time cannot be explained by the primary care covariates we included. This analysis suggests that the potential for further significant reduction in emergency HF admissions by improving clinical quality of primary care (as currently measured) may be limited. Further work is required to identify the reasons for the reduction in admissions.
Cyclosporine-inhibitable Blood–Brain Barrier Drug Transport Influences Clinical Morphine Pharmacodynamics
Authors: Meissner Konrad , Avram Michael J. , Yermolenka Viktar , Francis Amber M. , Blood Jane , Kharasch Evan D.
Published: July 2013

Background:

The blood–brain barrier is richly populated by active influx and efflux transporters influencing brain drug concentrations. Morphine, a drug with delayed clinical onset, is a substrate for the efflux transporter P-glycoprotein in vitro and in animals. This investigation tested whether morphine is a transporter substrate in humans.

Methods:

Fourteen healthy volunteers received morphine (0.1 mg/kg, 1-h IV infusion) in a crossover study without (control) or with the infusion of validated P-glycoprotein inhibitor cyclosporine (5 mg/kg, 2-h infusion). Plasma and urine morphine and morphine glucuronide metabolite concentrations were measured by mass spectrometry. Morphine effects were measured by miosis and analgesia.

Results:

Cyclosporine minimally altered morphine disposition, increasing the area under the plasma morphine concentration versus time curve to 100 ± 21 versus 85 ± 24 ng/ml·h (P < 0.05) without changing maximum plasma concentration. Cyclosporine enhanced (3.2 ± 0.9 vs. 2.5 ± 1.0 mm peak) and prolonged miosis, and increased the area under the miosis–time curve (18 ± 9 vs. 11 ± 5 mm·h), plasma effect-site transfer rate constant (ke0, median 0.27 vs. 0.17 h−1), and maximum calculated effect-site morphine concentration (11.5 ± 3.7 vs. 7.6 ± 2.9 ng/ml; all P < 0.05). Analgesia testing was confounded by cyclosporine-related pain.

Conclusions:

Morphine is a transporter substrate at the human blood–brain barrier. Results suggest a role for P-glycoprotein or other efflux transporters in brain morphine access, although the magnitude of the effect is small, and unlikely to be a major determinant of morphine clinical effects. Efflux may explain some variability in clinical morphine effects.
Assessment of Abdominal Pain Through Global Outcomes and Recent FDA Recommendations in Children
Authors: Mohammad Saeed , Di Lorenzo Carlo , Youssef Nader N. , Miranda Adrian , Nurko Samuel , Hyman Paul , Saps Miguel
Published: July 2013

Objectives:

Irritable bowel syndrome is a multisymptom construct, with abdominal pain (AP) acting as the driving symptom of patient‐reported severity. The Food and Drug Administration considers a >30% decrease in AP as satisfactory improvement, but this has not been validated in children. We investigated the correspondence of 2 measures for AP assessment, ≥30% improvement in AP and global assessment of improvement.

Methods:

Secondary analysis of data from 72 children who completed a randomized clinical trial for abdominal pain–associated functional gastrointestinal disorders. Children completed daily assessment of AP intensity, functional disability inventory (FDI), question regarding pain's interference with activities, and 2 global assessment questions. We measured the extent to which ≥30% improvement of AP and global assessment questions correlated with each other and with disability.

Results:

The global questions correlated with each other (r = 0.74; P < 0.0001) and with a ≥30% improvement in AP (P < 0.01). Global outcomes were satisfaction with treatment was inversely related to the child's report of interference with activities (P < 0.01) and symptom relief was positively associated with ≥30% improvement in FDI scores (P < 0.009). A 30% change in FDI scores was associated with global questions of symptom relief (P = 0.009) but not with satisfaction with treatment (P = 0.07). The association of AP improvement with interference with activities (P = 0.14) or change in FDI scores (P = 0.27) did not reach significance.

Conclusions:

Currently used global assessments are significantly associated with decreased pain intensity, decreased interference with daily activities, and a ≥30% change in FDI scores, whereas recommended 30% improvement in pain intensity is not as comprehensive.
Chromosome Aberrations and Gene Mutations in Patients With Esophageal Atresia
Authors: Bednarczyk Damian , Sasiadek Maria M. , Smigiel Robert
Published: July 2013

Esophageal atresia (EA) is one of the most frequent congenital malformations of the gastrointestinal tract. Many genetic alterations in patients with EA have been described in the literature. It is thought that the etiology of EA is heterogeneous. This review of the literature provides detailed information about chromosomal aberrations, gene mutations, and clinical features of neonates with EA, and serves as an excellent source to compare newly diagnosed patients with those described in the literature.
Dirubidium hexaaquacobalt(II) tetrakis(hydrogen phthalate) tetrahydrate and coordination modes of the hydrogen phthalate anion
Authors: Poleti Dejan , Rogan Jelena
Published: July 2013

The title compound, Rb2[Co(H2O)6](C8H5O4)4·4H2O, consists of nearly regular octahedral [Co(H2O)6]2+cations with the CoIIcations on the inversion centre (special position 2a), Rb+cations, hydrogen phthalate (Hpht−) anions and disordered water molecules. The Rb+cation is surrounded by nine O atoms from Hpht−anions and water molecules, with a strongly deformed pentagonal–bipyramidal geometry and one apex split into three positions. The crystal packing is governed by numerous hydrogen bonds involving all water molecules and Hpht−anions. In this way, layers parallel to theabplane are formed, with the aromatic rings of the Hpht−anions esentially directed along thecaxis. While Hpht−anions form the outer part of the layers, disordered water molecules and Rb+cations alternate with [Co(H2O)6]2+cations in the inner parts. The only interactions between the layers are van der Waals forces between the atoms of the aromatic rings. A search of the Cambridge Structural Database for coordination modes and types of hydrogen-bonding interaction of the Hpht−anion showed that, when uncoordinated Hpht−anions are present, compounds with intermolecular hydrogen bonds are more numerous than compounds with intramolecular hydrogen bonds. For coordinated Hpht−anions, chelating and bridging anions are almost equally common, while monodentate anions are relatively scarce. The same coordination modes appear for Hpht−anions with or without intramolecular hydrogen bonds, although intramolecular hydrogen bonds are less common.
Determination of the electron density in methyl (±)-(1S,2S,3R)-2-methyl-1,3-diphenylcyclopropanecarboxylate using refinements with X-ray scattering factors from wavefunction calculations of the whole molecule
Authors: Bacsa John , Briones John
Published: July 2013

The molecule of the title compound, C18H18O2, is a substituted cyclopropane ring. The electron density in this molecule has been determined by refining single-crystal X-ray data using scattering factors derived from quantum mechanical calculations. Topological analysis of the electron densities in the three cyclopropane C—C bonds was carried out. The results show the effects of this substitution on these C—C bonds.
Triple ring contraction of a [2+2] macrocyclic ligand
Authors: Knapton Matthew , McKee Vickie
Published: July 2013

Schiff base condensation of 2,6-diformylpyridine and 1,3-diaminopropan-2-ol in the presence of a BaIItemplate ion yields a complex containing a [2+2] macrocycle, [Ba2(μ1,2-ClO4)2(H2L1)2], where H2L1 is 3,7,15,19,25,26-hexaazatricyclo[19.3.1.19,13]hexacosa-1(25),2,7,9(26),10,12,14,19,21,23-decaene-5,17-diol. On transmetallation with CuIIcations, the macrocycle undergoes three successive ring contractions, yielding crystals of (acetato-κO)[26,28-dioxa-3,7,15,19,25,27-hexaazahexacyclo[19.3.1.12,5.19,13.117,10.03,8]octacosa-1(25),9(27),10,12,14,21,23-heptaene-κ5N]copper(II) perchlorate, [Cu(CH3COO)(C20H22N6O2)]ClO4or [Cu(CH3COO)(L2)]ClO4, in which the macrocycle ring size has been reduced from 20 members in H2L1 to 16 inL2.
Collaboration networks and innovation: does corporate lobbying matter?
Authors: Ozer Mine , Demirkan Irem , Gokalp Omer N.
Published: July 2013

Purpose

This study aims to investigate how corporate lobbying affects the relationship between collaboration networks and innovation.

Design/methodology/approach

The study incorporates insights from the corporate political strategy perspective into the social network research to examine how firms utilize non‐market mechanisms as a way to manage uncertainty. In particular, using data from 291 US pharmaceutical firms, the authors study the moderating effects of corporate lobbying on the relationship between collaboration networks and firm innovativeness.

Findings

The results show that corporate lobbying moderates the relationship between network centrality, structural holes, and network size, and firm innovativeness.

Originality/value

The study integrates social network and corporate political strategy research in the case of collaboration networks. Integrating social network and corporate political strategy literatures provides us with new insights into what determines success of firm innovativeness. The study shows that in addition to network structures, firms must consider other variables such as government regulation in fostering their innovativeness.
Advisors’ role in cross‐border acquisitions: new challenges and opportunities
Authors: Caiazza Rosa
Published: July 2013

Purpose

Current events have led academics and practitioners to rethink cross‐border M&A challenges in a tumultuous global business environment and the role of advisors in supporting the deals. The article aims to discuss current trend in M&A and presents some cases to evidence the relevance of advisors’ role in cross‐border M&A.

Design/methodology/approach

Exploratory field interviews were conducted with M&A advisors, as well as a diligent scanning of local and international articles to evidence advisors’ roles in cross‐border M&A

Findings

This article evidences new direction in cross‐border M&A research for reinterpreting advisors’ role in facing them.
A new model of strategic thinking competency
Authors: Nuntamanop Polboon , Kauranen Ilkka , Igel Barbara
Published: July 2013

Purpose

This paper seeks to present new insights into strategic thinking, proposing a model of strategic thinking competency.

Design/methodology/approach

To find new knowledge, the research applies the Straussian grounded theory research method using multiple sources and techniques of data inquiry: in‐depth interviews, observations, literature review, and related published documents. The sample cases are business leaders of leading high growth companies in their respective markets, representing eleven different industries in Thailand.

Findings

Among many new knowledge, the study found seven characteristics of strategic thinking that impacts strategy formulation, strategic actions, and business performance: conceptual thinking ability, visionary thinking, analytical thinking ability, synthesizing ability, objectivity, creativity, and learning ability. This set of abilities and skilled are termed “strategic thinking competency”.

Research limitations/implications

In‐depth interview data inquiry method has potential bias towards positive information. Although the study covers many industries, the small number of sample cases limits degree of generalization. A constraint of qualitative research method in interpretation of the results is reduced by comparing empirical results to the literature.

Practical implications

The “strategic thinking competency” model offers a framework for developing strategic thinking of business leaders and managers which contributes to better strategy and better business performance. Human resource developers may apply the model for designing training programs to develop better strategic thinkers.

Social implications

Better strategic thinking could help improving efficiency and effectiveness of business and general management.

Originality/value

The study introduces a model of “Strategic Thinking Competency” with seven characteristics, proposing a new way of defining strategic thinking.
Translating strategy into practice: the role of communities of practice
Authors: Macpherson Allan , Antonacopoulou Elena
Published: July 2013

Purpose

This empirical paper aims to show how communities of practice have been used as a tractable management tool to operationalize strategy in practice. The analysis shows how CoPs can be used in business to find traction in order to achieve strategic goals.

Design/methodology/approach

A two‐year longitudinal case study approach was adopted employing semi‐structured interviews, participant observations and document analysis for data collection. The findings were verified with the participants in the study during feedback events organised for that purpose.

Findings

The study provides in‐depth insights into the challenges of translating strategy into practice in complex work settings. In this case, uneven outcomes were attributed to three critical contributing factors: the leadership and governance structures, the meaningful ways in which members can participate and interact with others; and their identity and sense of belonging.

Research limitations/implications

Although a single case study only provides indications of potential generalisations, it does give access to issues that cannot be identified without an in‐depth analysis.

Practical implications

The authors encourage executives to consider concepts of identity, participation and governance as useful heuristics for the analysis of practices of communities. Potential inconsistencies in community practices could have implications for the way strategy is translated into action.

Originality/value

Unlike most community of practice studies, which focus on the community aspect of the concept, this study analyses the practices of communities. In doing so, it adds value to our understanding of the forces that shape social interactions embedded in the implementation of strategy in practice.
Managing access to the internet in public libraries
Authors: Pautz Hartwig
Published: July 2013

Purpose

The purpose of this paper is to discuss the management of internet access in the public library. It stresses how important professional access management is, addresses practical and ethical challenges and dilemmas with regard to managing access, highlights management strategies and emphasises the librarian's enduring ethical principles in the “internet age”.

Design/methodology/approach

The paper is based on a critical literature review.

Findings

First, there is not necessarily a difference between managing internet access and “traditional” stock selection. Second, managing internet access must not be understood as synonymous with limiting the information that is accessible through it. Third, the librarian must be aware of the risks that filters and other “technological fixes” pose to the library and the librarian's principles. Fourth, a number of strategies exist which protect these principles and allow information literacy and user independence to develop.

Practical implications

The paper highlights practical challenges to a librarian's everyday work and provides a discussion that is relevant to public librarians everywhere. It raises awareness of the potentials and pitfalls of a number of internet access management tools and assures the librarian of their important position as an enabler to information access and its use.

Originality/value

The paper raises awareness of important issues pertaining to internet access and its management in the public library. It asks pertinent and timely questions of relevance to the practical work of the librarian.
3D printing and the library
Authors: Massis Bruce E.
Published: July 2013

Purpose

The purpose of this column is to examine the current environment of 3D printing and its suitability for use in the library.

Design/methodology/approach

Literature review and commentary on this topic that has been addressed by professionals, researchers and practitioners.

Findings

The library is more than its collection. As 3D printing joins the technology selections available in the library, it offers patrons the opportunity to create and further develop their skills, in order to explore and potentially innovate, in a welcoming environment of intellectual stimulation and experimentation.

Originality/value

The value in addressing this issue is to present the basic details around this new technology and suggest that it has value for its inclusion into the current array of library services.
Aligning planning with outcomes
Authors: Sayed Ellen N.
Published: July 2013

Purpose

This paper aims to describe the process of identifying, applying and assessing the balanced scorecard model on a five‐year, strategic plan in an academic, medical library two years into the five‐year period. The existing strategic plan consisted of eight inter‐connected pathways with multiple goals and objectives, generating a high volume of data, which made it difficult to track the implementation of the plan.

Design/methodology/approach

A research query seeking an alternative to the current strategic plan framework was developed and researched. This process identified the balanced scorecard as a possible successful alternative to the eight inter‐connected pathways in place. After the application of the balanced scorecard, a second query, with assessment criteria, was developed to determine if the balanced scorecard did, in fact, provide a better framework than the original plan.

Findings

The balanced scorecard restructured the eight pathways into four perspectives to create an aligned, cause‐and‐effect strategy. The original plan had too many themes to manage and lacked a cohesive strategy. Performance measures proved more meaningful and manageable in measuring the success of the strategic plan than the high volume of project management data. It was concluded that the balanced scorecard met the assessment criteria as a better framework for the strategic plan.

Practical implications

Aligning goals and objectives to form strategy simplified the implementation of the strategic plan. Performance measures focus on the performance of the organization, creating a process of continuous improvement.

Originality/value

While the balanced scorecard has been applied in academic libraries, this project successfully applied the model on a strategic plan two years after its implementation.
A strategic approach to making sense of the “wicked” problem of ERM
Authors: McLeod Julie , Childs Sue
Published: July 2013

Purpose

The purpose of this paper is to provide an approach to viewing the “wicked” problem of electronic records management (ERM), using the Cynefin framework, a sense‐making tool. It re‐conceptualises the ERM challenge by understanding the nature of the people issues. This supports decision making about the most appropriate tactics to adopt to effect positive change.

Design/methodology/approach

Cynefin was used to synthesise qualitative data from an empirical research project that investigated strategies and tactics for improving ERM.

Findings

ERM may be thought of as a dynamic, complex challenge but, viewed through the Cynefin framework, many issues are not complex; they are simple or complicated and can be addressed using best or good practice. The truly complex issues need a different approach, described as emergent practice. Cynefin provides a different lens through which to view, make sense of and re‐perceive the ERM challenge and offers a strategic approach to accelerating change.

Research limitations/implications

Since Cynefin has been applied to one data set, the findings are transferrable not generalisable. They, and/or the approach, can be used to further test the propositions.

Practical implications

The resultant ERM framework provides a practical example for information and records managers to exploit or use as a starting point to explore the situation in particular organisational contexts. It could also be used in other practical, teaching and/or research‐related records contexts.

Originality/value

This paper provides a new strategic approach to addressing the wicked problem of ERM, which is applicable for any organisational context.
Decision making under extreme uncertainty: blending quantitative modeling and scenario planning
Authors: Kennedy Peter J. , Avila Robert J.
Published: July 2013

Purpose

This disguised case aims to describe a scenario planning project to improve decision making for a manufacturer operating in Brazil's confusing, unpredictable politico‐economic environment. “BrasilAuto's” management team faced a range of complex choices related to capacity, vehicle mix, pricing, distribution, dealer relationships, exports, labor and government relations.

Design/methodology/approach

The consultants used a combination of scenario planning and quantitative analysis to answer the company's two key questions: where is the country headed and how many vehicles can we expect to sell, looking across a range of business environments?

Findings

As a result of the scenario exercise, company execs had a better idea of what to watch for in the political sphere and how to anticipate the actual market impact of changing economic policy options. Having looked at the range of plausible business environments hard and carefully, their uncertainty was significantly less unsettling or paralyzing than it had been.

Practical implications

The consultants discuss the lessons learned – for the client and for improving the process.

Originality/value

It's rare to have an insider's view of a scenario process that attempts to produce both quantitative and qualitative insights into a range of distinctly different political/economic futures and their impact on an industry.
Transatlantic steerage fares, British and Irish migration, and return migration, 1815–60
Authors: Killick John
Published: July 2013

This article argues that the massive increase in transatlantic British and Irish emigration after 1840 was enabled by declining fares and ocean travel costs. New series of transatlantic steerage fares drawn from the unique Cope Line records at the Historical Society of Pennsylvania (HSP) show westward fares fell rapidly from 1830. Adjusted for British and US manual wages, westward travel costs, including provisions, almost halved between 1847 and 1851–3, when Irish migration peaked. Hence although the Irish had to leave Ireland, they might not otherwise have gone so extensively to North America. Eastward travel costs also fell after 1830, encouraging an unexpectedly large return migration to Britain in the late1850s, and maybe earlier.
Influences of rennet and container types on proteolysis of traditional Kurdish cheese during the ripening
Authors: Hashemi Majid , Tabatabaee Yazdi Farideh , Yavarmanesh Masoud , Milani Elnaz , Pasban Atena
Published: July 2013

The effect of rennet and container types was evaluated on proteolysis of traditional Kurdish cheese during 60 days ripening. The enzymes involved were commercial chymosin and traditional rennet from lamb abomasum. Goat skin (traditional container) and plastic containers were used as storage containers. The trend of proteolysis was determined by measuring the content of nitrogen (N) in compounds soluble in water, 12% trichloroacetic acid and 5% phosphotungstic acid along with the urea–polyacrylamide gel electrophoresis method. The results showed that the nitrogen in compounds soluble in water, 12% trichloroacetic acid and 5% phosphotungstic acid was higher in ripened cheeses into plastic containers; however, the containers had no significant effect on the breakdown of α‐ and β‐caseins (P < 0.05). Using commercial rennet caused the breakdown of α‐ and β‐caseins and the level of nitrogen in compounds soluble in water to increase. Finally, however, the amount of α‐ and β‐caseins breakdown was trivial, and α‐casein was decreased more than β‐casein in all samples.
Implementation of the INTERGROWTH‐21st Project in the United States
Authors: Dighe MK , Frederick IO , Andersen HF , Gravett MG , Abbott SE , Carter AA , Algren H , Rocco DA , Waller SA , Sorensen TK , Enquobahrie D , Blakey I , Knight HE , Cheikh Ismail L ,   for the International Fetal and Newborn Growth Consortium for the 21 Century (INTERGROWTH‐21)
Published: July 2013

The North American site in the INTERGROWTH‐21st Project was North Seattle, Washington State, USA. The majority of the data were collected from within Seattle City, which has approximately 12 300 births per year. The sample for the Newborn Cross‐Sectional Study (NCSS) was drawn from two hospitals (Swedish Medical Center and the University of Washington) covering almost 80% of deliveries within the target population. The Fetal Growth Longitudinal Study (FGLS) sample was recruited from several antenatal clinics serving the University of Washington Medical Center and Providence Everett Medical Center. Special activities to encourage participation and raise awareness of the studies included furnishing the recruitment sites with fliers designed by the Project Coordinating Unit, and presenting the studies to clinical staff to encourage providers to refer appropriate patients. One of the major challenges at this site was the low recruitment rate in the early phase of the FGLS because of the high rates of smoking, maternal age >35 years and body mass index >30 years. This was remedied by the inclusion of other ancillary clinics, as well as increased advertising among the general public.
Standardisation and quality control of ultrasound measurements taken in the INTERGROWTH‐21st Project
Authors: Sarris I , Ioannou C , Ohuma EO , Altman DG , Hoch L , Cosgrove C , Fathima S , Salomon LJ , Papageorghiou AT ,   for the International Fetal and Newborn Growth Consortium for the 21 Century (INTERGROWTH‐21)
Published: July 2013

Meticulous standardisation and ongoing monitoring of adherence to measurement protocols during data collection are essential to ensure consistency and to minimise systematic error in multicentre studies. Strict ultrasound fetal biometric measurement protocols are used in the INTERGROWTH‐21st Project so that data of the highest quality from different centres can be compared and potentially pooled. A central Ultrasound Quality Unit (USQU) has been set up to oversee this process. After initial training and standardisation, the USQU monitors the performance of all ultrasonographers involved in the project by continuously assessing the quality of the images and the consistency of the measurements produced. Ultrasonographers are identified when they exceed preset maximum allowable differences. Corrective action is then taken in the form of retraining or simply advice regarding changes in practice. This paper describes the procedures used, which can form a model for research settings involving ultrasound measurements.
Effective Governance of Global Financial Markets: an Evolutionary Plan for Reform
Authors: Avgouleas Emilios
Published: July 2013

Two questions remain widely open when it comes to global financial markets. First, what is the raison d'être of open global markets? Second, is it possible to foster open markets without an international governance structure supervising them? Post‐crisis regulatory reform presents an acute paradox. While the content of international financial regulation is changing rapidly, the reform of governance structures is painfully slow. There is no formal governance structure dealing with cross‐border supervision of global financial institutions. In addition, there is no crystallized institutional capacity at the international level dealing with cross‐border crises and the resolution of global institutions. Other areas of concern are the global supervision of systemic risk and the absence of a reliable finance research watchdog dealing with the production of regulatory standards. This article outlines an international governance framework to deal effectively with these concerns. The adoption of the proposed plan would lead to breaking down the territorial link in the supervision of large financial institutions and of systemic risk, without causing intolerable loss of sovereignty. In addition, the proposed structure is premised on a set of explicit values. These would provide a strong signal to global markets that they need to shift their focus from speculation to development goals.
Macroeconomic Stabilisation in the Eurozone: Lessons from Failure
Authors: Wren‐Lewis Simon
Published: July 2013

Three forms of macroeconomic stabilisation in the eurozone are considered: national macroeconomic stabilisation, debt discipline and eurozone‐wide macroeconomic stabilisation. The eurozone started with an architecture that ignored the first, which it hoped – despite advice to the contrary – would look after itself. This article explores what subsequently happened before the financial crisis, during the Great Recession and after 2010. It argues that the failure to address the issue of national macroeconomic stabilisation was a crucial factor behind what became an existential crisis for the eurozone. However, the crisis has a silver lining. The rationale behind union‐wide controls to limit fiscal deficits (the SGP and now the Fiscal Compact) no longer exists. Since 2010 it has become clear that eurozone members face greater market discipline on fiscal deficits than do countries with their own currency. As a result, fiscal controls and institutions to support them can and should reside at the national level, and can therefore focus on national stabilisation as well as the more long‐term control of government debt. It is argued that this alternative to the current architecture is both more feasible and more desirable than a move towards fiscal union.
European Intervention Mechanisms for Growth: Budget and the European Investment Bank
Authors: Kollatz‐Ahnen Matthias
Published: July 2013

The EU's handling of the recent financial crisis gives much more weight to fiscal consolidation than to growth stimulus. Because the fiscal multipliers during crisis periods are significantly higher than previously estimated, the consolidation policy requires a second pillar for growth to avoid a vicious downward spiral. The first elements of this second pillar were adopted by the EU summit in June 2012, but the scope of the programme for growth and employment is not sufficient nor has it been implemented with the necessary speed and scope. This article calls for a systematic approach to increase the public intervention capacity to ignite sustainable growth. The main public financial instruments are the budget and the promotional bank at each level in Europe. The contribution of the promotional banks has grown since the eve of the great crisis. Volume and impact can be increased further. The main objectives are revolving funds, combined financial products bringing together loans and budget, focusing on viable projects and attracting private capital for projects where suitable. An optimisation of the budget for better leverage, better allocation efficiency and viable projects improves the impact significantly within given volumes. Even more enforcement seems possible if the budget grows to some extent to enlarge the anticrisis capacity.
The epidemiology of substance use among street children in resource‐constrained settings: a systematic review and meta‐analysis
Authors: Embleton Lonnie , Mwangi Ann , Vreeman Rachel , Ayuku David , Braitstein Paula
Published: July 2013

Aims

To compile and analyze critically the literature published on street children and substance use in resource‐constrained settings.

Methods

We searched the literature systematically and used meta‐analytical procedures to synthesize literature that met the review's inclusion criteria. Pooled‐prevalence estimates and 95% confidence intervals (CI) were calculated using the random‐effects model for life‐time substance use by geographical region as well as by type of substance used.

Results

Fifty studies from 22 countries were included into the review. Meta‐analysis of combined life‐time substance use from 27 studies yielded an overall drug use pooled‐prevalence estimate of 60% (95% CI = 51–69%). Studies from 14 countries contributed to an overall pooled prevalence for street children's reported inhalant use of 47% (95% CI = 36–58%). This review reveals significant gaps in the literature, including a dearth of data on physical and mental health outcomes, HIV and mortality in association with street children's substance use.

Conclusions

Street children from resource‐constrained settings reported high life‐time substance use. Inhalants are the predominant substances used, followed by tobacco, alcohol and marijuana.
Fish movement strategies in an ephemeral river in the Simpson Desert, Australia
Authors: Kerezsy Adam , Balcombe Stephen R. , Tischler Max , Arthington Angela H.
Published: July 2013

Arid zone catchments experience extreme hydrological variability and some rivers are entirely ephemeral, replenished only by intermittent flooding. The ecological roles of ephemeral systems are rarely studied. This paper describes movement patterns of fish in the Mulligan River, an ephemeral system in the Lake Eyre Basin, central Australia. Several sites were sampled along a temporal gradient encompassing floods and dry periods. After a single major flood in 2007 up to seven fish species were found at sites up to 300 km from the closest permanent waterhole. Following a series of floods (when waterholes were replenished and remained wet between 2009 and 2011) a further five species were recorded including the first records for the Lake Eyre hardyhead, Craterocephalus eyresii, from the rivers of far western Queensland. The presence of all species known from the parent catchment (the Georgina, where permanent waterholes occur) in the ephemeral catchment (the Mulligan) suggests that many fish species present in the river systems of central Australia are capable of dispersing long distances following the opening of movement pathways during flooding. However, two distinct groups of species were identified: extreme dispersing species, that move as far as possible into intermittently wetted habitats, and conservative dispersing species, that do not move as far, tending to inhabit deeper waterholes within mid‐reaches of the river that are more likely to hold water for longer. Preservation of the natural flow regime of Australia's arid‐zone rivers is important for maintaining these fish communities and facilitating study of their adaptations to ephemerality.
Hypnosis as sole anaesthesia for skin tumour removal in a patient with multiple chemical sensitivity
Authors: Facco E. , Pasquali S. , Zanette G. , Casiglia E.
Published: July 2013

A female patient with multiple chemical sensitivity and previous anaphylactoid reactions to local anaesthetics was admitted for removal of a thigh skin tumour under hypnosis as sole anaesthesia. The hypnotic protocol included hypnotic focused analgesia and a pre‐operative pain threshold test. After inducing hypnosis, a wide excision was performed, preserving the deep fascia, and the tumour was removed; the patient's heart rate and blood pressure did not increase during the procedure. When the patient was de‐hypnotised, she reported no pain and was discharged immediately. Our case confirms the efficacy of hypnosis and demonstrates that it may be valuable as a sole anaesthetic method in selected cases. Hypnosis can prevent pain perception and surgical stress as a whole, comparing well with anaesthetic drugs.
Effects of high positive end‐expiratory pressure on haemodynamics and cerebral oxygenation during pneumoperitoneum in the Trendelenburg position
Authors: Jo Y. Y. , Lee J. Y. , Lee M. G. , Kwak H. J.
Published: July 2013

We investigated the effects of 10 cmH2O positive end‐expiratory pressure on cerebral haemodynamics and cerebral oxygenation in patients undergoing laparoscopic lower abdominal surgery in the 30° Trendelenburg position during desflurane anaesthesia. Twenty‐six patients were enrolled in this study. After anaesthesia induction, pneumoperitoneum was applied in Trendelenburg position. Twenty minutes later, positive end‐expiratory pressure was applied. There was no change in regional cerebral oxygen saturation (p = 0.376). Cerebral perfusion pressure decreased significantly over time (p < 0.001) and positive end‐expiratory pressure caused a further decrease in cerebral perfusion pressure (p = 0.036). The application of 10 cmH2O positive end‐expiratory pressure during pneumoperitoneum in the Trendelenburg position preserved regional cerebral oxygen saturation, but cerebral perfusion pressure decreased significantly due to its secondary haemodynamic effects.
Anxiety and decreased social support underline poorer quality of life of parent living kidney donors
Authors: Chen Pinhong , Luo Qidong , Peng Longkai
Published: July 2013

Introduction

A growing body of published work suggests that the parent–child relationship can be inherently coercive, such that the expectation that a living parent will not hesitate to donate a kidney to their children, makes informed consent difficult if not impossible to ascertain. The present study was designed to explore whether the emotional response and social resources have a similar effect on health‐related quality of life among parent and sibling living kidney donors.

Methods

This was a cross‐sectional study. A total of 98 living kidney donors (60 parent donors, 38 sibling donors) completed an assessment including emotional response, social support and quality of life.

Results

Depression, anxiety, subjective social support and quality of life scores were much poorer for parent than sibling donors. Parent donors also showed more anxiety and poorer physical functioning than their counterparts in the general population. Hierarchical multiple regression analyses suggested that anxiety and decreased social support in the parent group were negatively associated with physical and mental function. In the sibling group, the main indicator of improved physical state was higher education level.

Discussion

Current results raised new concerns for the quality of life of parent donors as emotional response and social support differentially affected parent versus sibling quality of life. Therefore, stricter standards for physical selection, as well as emotional and supportive intervention, are needed for parent donors.
Ethical Review of Research on Human Subjects at Unilever: Reflections on Governance
Authors: Sheehan Mark , Marti Vernon , Roberts Tony
Published: July 2013

This article considers the process of ethical review of research on human subjects at a very large multinational consumer products company. The commercial context of this research throws up unique challenges and opportunities that make the ethics of the process of oversight distinct from mainstream medical research. Reflection on the justification of governance processes sheds important, contrasting light on the ethics of governance of other forms and context of research.
The influence of teachers’ conceptions on their students’ learning: Children's understanding of sheet music
Authors: López‐Íñiguez Guadalupe , Pozo Juan Ignacio
Published: July 2013

Background

Despite increasing interest in teachers’ and students’ conceptions of learning and teaching, and how they influence their practice, there are few studies testing the influence of teachers’ conceptions on their students’ learning.

Aims

This study tests how teaching conception (TC; with a distinction between direct and constructive) influences students’ representations regarding sheet music.

Sample

Sixty students (8–12 years old) from music conservatories: 30 of them took lessons with teachers with a constructive TC and another 30 with teachers shown to have a direct TC.

Methods

Children were given a musical comprehension task in which they were asked to select and rank the contents they needed to learn. These contents had different levels of processing and complexity: symbolic, analytical, and referential. Three factorial ANOVAs, two‐one‐way ANOVAs, and four 2 × 3 repeated‐measures ANOVAs were used to analyse the effects of and the interaction between the independent variables TC and class, both for/on total cards selected, their ranking, and each sub‐category (the three processing levels).

Results

ANOVAs on the selection and ranking of these contents showed that teachers’ conceptions seem to mediate significantly in the way the students understand the music.

Conclusions

Students from constructive teachers have more complex and deep understanding of music. They select more elements for learning scores than those from traditional teachers. Teaching conception also influences the way in which children rank those elements. No difference exists between the way 8‐ and 12‐year‐olds learn scores. Children's understanding of the scores is more complex than assumed in other studies.
The role of climate variation in delta architecture: lessons from analogue modelling
Authors: Bijkerk J. F. , ten Veen J. , Postma G. , Mikeš D. , van Strien W. , de Vries J.
Published: July 2013

Sequence‐stratigraphic models for fourth to sixth order, glacio‐eustatic sequences based only on relative sea‐level variations result in simplified and potentially false interpretations. Glacio‐eustatic sea‐level variations form only one aspect of cyclic climate variation; other aspects, such as variations in fluvial water discharge, vegetation cover, weathering and sediment supply can lead to variable sediment yield, thus adding complexity to sequence‐stratigraphic patterns normally attributed to sea‐level variations. Analogue flume models show a significant impact of water discharge on the timing and character of sequence boundaries, and on changes in the relative importance of systems tracts, as expressed in sediment volumes. Four deltas, generated under the influence of an identical sea‐level curve, and affected by different water‐discharge cycles were generated in the Eurotank facility: (1) constant discharge; (2) high‐frequency discharge variations (HFD); (3) discharge leading sea level by a quarter phase; (4) discharge lagging sea level by a quarter phase. HFD shift the parasequence stacking pattern consistently but do not alter large‐scale delta architecture. Water‐discharge changes that lead sea‐level changes result in high sediment yield during sea‐level rise and in the poor development of maximum flooding surfaces. Delta‐front erosion during sea‐level fall is expressed by multiple, small channels related to upstream avulsions, and does not result in an incised valley that efficiently routs sediment to the shelf edge. When water‐discharge changes lag sea‐level changes, sediment yield is high during falling sea level and results in rapid progradation during forced regression. Erosion from incised valleys is strong on the proximal delta top and dissipates towards the delta front. The combination of high discharge and sea‐level fall provides the most efficient mode of valley incision and sediment transport to the shelf edge. During sea‐level rise, low water discharge results in sediment starvation and well‐developed maximum flooding surfaces. Water‐discharge variations thus alter sequence‐stratigraphic patterns and provide an alternative explanation to the amplitude of sea‐level fall for generating either type 1 or 2 erosional unconformities.
Selenite supplementation in euthyroid subjects with thyroid peroxidase antibodies
Authors: Eskes Silvia A. , Endert Erik , Fliers Eric , Birnie Erwin , Hollenbach Birgit , Schomburg Lutz , Köhrle Josef , Wiersinga Wilmar M.
Published: July 2013

Context

Euthyroid thyroid peroxidase (TPO‐Ab)‐positive subjects are at risk for progression to subclinical and overt autoimmune hypothyroidism. Previous studies have shown a decrease in TPO‐Ab and improvement of quality‐of‐life (QoL) in L‐T4‐treated hypothyroid patients upon selenium supplementation.

Objectives

To evaluate in euthyroid TPO‐Ab‐positive women without thyroid medication whether selenite decreases TPO‐Ab and improves QoL.

Design

Randomized, placebo‐controlled, double‐blind study.

Patients and methods

Euthyroid (TSH 0·5–5·0 mU/l, FT4 10–23 pm) women with TPO‐Ab ≥ 100 kU/l were randomized to receive 200 mcg sodium selenite daily (n = 30) or placebo (n = 31) for 6 months. TSH, FT4, TPO‐Ab, selenium (Se), selenoprotein P (SePP) and QoL were measured at baseline, 3, 6 and 9 months.

Results

There were no differences in baseline characteristics between the Se group and the placebo group. During selenite supplementation, serum Se and SePP did not change in the placebo group, but increased in the Se group. TPO‐Ab and TSH did not change significantly in any group. TPO‐Ab in the Se group were 895 (130–6800) at baseline, 1360 (60–7050) kU/l at 6 months, in the placebo group 1090 (120–9200) and 1130 (80–9900) kU/l, respectively (median values with range). TSH in the Se group was 2·1 (0·5–4·3) at baseline, 1·7 (0·0–5·3) mU/l at 6 months, in the placebo group 2·4 (0·7–4·4) and 2·5 (0·2–4·3) mU/l, respectively. QoL was not different between the groups.

Conclusion

Six months selenite supplementation increased markers of selenium status but had no effect on serum TPO‐Ab, TSH or quality‐of‐life in euthyroid TPO‐Ab‐positive women.
Whole‐exome sequencing expands the phenotype of Hunter syndrome
Authors: Nikkel S.M. , Huang L. , Lachman R. , Beaulieu C.L. , Schwartzentruber J. ,   FORGE Canada Consortium, Majewski J. , Geraghty M.T. , Boycott K.M.
Published: July 2013

Whole‐exome sequencing (WES) has proven its utility in finding novel genes associated with rare conditions and its usefulness is being further demonstrated in expanding the phenotypes of well known diseases. We present here a family with a previously undiagnosed X‐linked condition characterized by progressive restriction of joint range of motion, prominence of the supraorbital ridge, audiology issues and hernias. They had an average stature, normal occipitofrontal circumference and intelligence, absence of dysostosis multiplex and otherwise good health. A diagnosis of Hunter syndrome was determined using WES and further supported by biochemical investigations. The phenotype of this family does not correspond to either the severe or attenuated clinical subtypes of Hunter syndrome. As further atypical families are reported, this classification will need to be modified. Our findings highlight the utility of WES in expanding the recognized phenotypic spectrum of known syndromes.