bluuebunny/crossref_metadata_2025 huggingface dataset:
Two-year Results of an Open Pilot Study of a 2-treatment Course with Rituximab in Patients with Early Systemic Sclerosis with Diffuse Skin Involvement
Authors: SMITH VANESSA , PIETTE YVES , VAN PRAET JENS T. , DECUMAN SASKIA , DESCHEPPER ELLEN , ELEWAUT DIRK , DE KEYSER FILIP
Published: November 2012

Objective.

To study safety and potential efficacy of a 2-treatment course (month 0/6) with rituximab (RTX) in early diffuse systemic sclerosis (dcSSc).

Methods.

Two years’ followup (open-label study) was done of 8 patients with early dcSSc. Patients received an infusion of 1000 mg RTX 2 times at months 0 and 6, with 100 mg methylprednisolone. Clinical measurements, Disease Activity Score, functional status, and CD19+ peripheral blood count were performed at months 0, 3, 6, 12, 15, 18, and 24 and histopathological evaluation of the skin at months 0, 3, 12, and 24.

Results.

There was a clinically significant change in skin score, with a mean Modified Rodnan skin score of 24.8 at baseline (SD 3.4) and 13.6 at Month 24 [SD 5.6; mixed models analyses (MMA) p < 0.0001] and a significant decrease in Disease Activity Score (DAS), with a median of 4.5 at baseline (range 1.5–7.5) and 0.5 at Month 24 (range 0.0–5.5; MMA p < 0.0001). Indices of internal organ involvement remained stable throughout the study. RTX induced effective B cell depletion at baseline and Month 6 (< 5 CD19+ cells/μl blood). The blindly assessed hyalinized collagen score changed significantly over time (MMA p = 0.009), with a mean of 69.3 at baseline (SD 22.8) and 33.1 at 24 months (SD 27.0). Five serious adverse events were considered unrelated to the RTX treatment.

Conclusion.

A 2-treatment course (months 0/6) with RTX appears to be well tolerated and may have potential efficacy for skin disease and stabilization of internal organ status in early dcSSc. Clinical Trials Registration NCT00379431.
La liberté d'association au regard de l'adhésion des mineurs
Authors: Alfandari Elie
Published: October 2012

Résumé Deux approches complémentaires, politique et juridique, permettent d’appréhender la liberté d’association. Cette liberté de s’associer, d’adhérer à une association, est-elle applicable aux mineurs ? Sans doute, au titre de la liberté individuelle, avec plus de difficulté, en référence à la liberté de contracter qui demande d’avoir la capacité de le faire, l’incapacité des mineurs peut alors se présenter comme une restriction à la liberté individuelle. Heureusement, il existe des tempéraments apportés à l’incapacité des mineurs. L’auteur montre, en conclusion, comment le recours à la notion « d’intérêt supérieur de l’enfant » permet de résoudre cette question complexe.
Mutation du volontariat à long terme au sein des compagnons bâtisseurs
Authors: Loustalot Arnaud
Published: October 2012

Résumé En cinquante années d’existence, le volontariat à long terme aux Compagnons bâtisseurs s’est construit en tant qu’expérience d’engagement. Mis en place pour répondre à des impératifs d’encadrement technique des chantiers, il évolua sous l’influence des vagues successives de volontaires qui virent en lui un service religieux, une alternative au salariat, un moyen de lutte contre les injustices sociales... Cette construction collective d’un service long terme a conduit à l’élaboration progressive d’un modèle (volontariat pour l’habitat des familles défavorisées), confronté ces dernières années à la mise en place de dispositifs reconnaissant le volontariat.
Partir pour grandir ou ne pas grandir ? Le volontariat de solidarité internationale
Authors: Bosselut Clémence
Published: October 2012

Résumé Chaque année, des individus, en majorité de jeunes adultes, partent vers des pays du Sud ou de l’Est comme volontaires de solidarité internationale. Cette expérience à caractère symbolique et initiatique s’inscrit dans des stratégies individuelles complexes et contribue, entre autres, au passage à l’âge adulte. À partir d’une enquête réalisée auprès de jeunes volontaires partant avec la Délégation catholique pour la coopération, trois types d’expériences de volontariat ont été distingués : la transition initiatique vers l’âge adulte, le moratoire et la simple ponctuation dans la construction identitaire de l’être adulte.
Éducateur sportif voile : du saisonnier au transitoire
Authors: Duceux Yann
Published: October 2012

Résumé Faire de sa passion un métier représente un projet de vie plutôt attirant et prometteur. Mais si les nombreux métiers du sport et du loisir semblent offrir cette perspective réjouissante, l’activité professionnelle d’éducateur sportif reste pourtant souvent transitoire. Cet article s’intéresse aux trajectoires professionnelles des éducateurs sportifs travaillant dans le nautisme, un terrain d’investigation qui est le fruit d’une histoire complexe où l’État, à travers ses institutions de formation, a joué un rôle important et novateur. Il s’agit ainsi de s’interroger sur la possibilité de se situer durablement dans une activité professionnelle qui a pour objet le loisir d’autrui.
La souffrance de l'autonomie
Authors: Gaviria Sandra
Published: October 2012

L’objet de cet article est de s’interroger sur le sentiment des jeunes au moment et à la suite du premier départ de chez leurs parents. Il s’agit d’en montrer les aspects bénéfiques, positifs, valorisés par ces jeunes, comme l’autonomie et la liberté, mais aussi les aspects négatifs comme le sentiment de solitude. Lorsque la situation devient insoutenable la souffrance s’installe et certains retournent chez leurs parents. Cette analyse permet de préciser le modèle français de construction de soi où l’individu doit apprendre à être seul afin de devenir complètement autonome.
Les « jeunes vulnérables » : essai de définition
Authors: Becquet Valérie
Published: October 2012

Dans quelle mesure la notion de vulnérabilité contribue-t-elle à une meilleure compréhension de la situation des jeunes ? C’est à cette question que tente de répondre cet article en confrontant les définitions et les analyses de la vulnérabilité et de la jeunesse. L’auteure souligne tout d’abord la plasticité de la notion de vulnérabilité dont la définition est discutée, puis propose une présentation des principales conclusions des travaux sur la jeunesse mettant en évidence le fait que les situations de vulnérabilité traversent la période juvénile et s’incarnent dans des configurations particulières.
Les appellations d'origine contrôlée comme ordre négocié
Authors: Compagnone Claude
Published: October 2012

Résumé Pour voir le jour, une appellation d’origine contrôlée (AOC) demande à ce qu’un collectif d’acteurs à même de porter le projet soit constitué et qu’un travail de définition du produit soit réalisé. Le but de cet article est de rendre compte de la façon dont les négociations inhérentes à la constitution d’une AOC prennent localement forme en fonction de l’ordre social dans lequel elles s’inscrivent. Nous faisons l’hypothèse que, selon la complexité de la situation, des types différents de processus de négociation, intégratif ou distributif, vont se déployer et se succéder. Sur la base de quatre études de cas réalisées en région Bourgogne sur des AOC en cours d’élaboration, nous montrons que la nature des acteurs impliqués, leur niveau d’interdépendance et le degré de définition du produit jouent un rôle prépondérant dans la forme prise par le processus de négociation.
La RSE négociée : règles du jeu et contenus. Le cas d'ISO 26000
Authors: Ruwet Coline
Published: October 2012

Résumé Le développement par des organisations privées d’instruments destinés à définir, mettre œuvre ou évaluer la RSE introduit une série de contraintes nouvelles sur les négociations à ce sujet. L’attention accordée à des exigences de légitimité, d’inclusion et de transparence devient un passage obligé pour les producteurs de normes privées en la matière. Cet article se penche sur le processus d’élaboration d’ISO 26000, norme internationale sur la responsabilité sociétale des organisations publiée en novembre 2010. Ce cas est particulièrement intéressant à étudier car les négociations ont porté non seulement sur le contenu de la norme mais également sur sa procédure d’élaboration. Plutôt que d’analyser les négociations en tentant d’identifier les objectifs des catégories de stakeholders déterminées a priori, nous analysons parallèlement les débats sur le contenu et l’incidence des nouvelles règles sur les négociations. Des enjeux clefs dans l’élaboration d’ISO 26000 (sa source, son degré de contrainte et son champ d’application) sont mis en relation avec des modifications apportées à la procédure visant à améliorer la légitimité, l’inclusion et la transparence. Un examen des règles de procédure mises en place en dit long, en amont, sur les principaux enjeux au cœur du processus et, en aval, sur les poids respectifs accordés aux exigences en termes d’efficacité et de justice.
La Société des nations,la crise des années 1930 et la santé
Authors: Borowy Iris
Published: October 2012

Résumé L’Organisation d’hygiène de la Société des nations fut surprise par la crise économique de 1929. Même quand il paraissait clair que les circonstances auraient forcément un effet négatif sur la santé publique, cet effet n’était pas évident à repérer dans les données de mortalité, ce qui rendait la situation difficile à interpréter. L’organisation initia alors une série de programmes conçus pour identifier les conséquences sanitaires de la crise et élabora des stratégies pour les aborder. Elle mit ainsi au point des méthodes statistiques pour étudier les effets de la crise sur la santé publique, fournit des recommandations pour les systèmes sanitaires avec protection sociale et établit un programme à grand échelle sur la nutrition. C’est ainsi que la médecine sociale devint partie intégrante des activités sanitaires internationales, ce qu’elle est encore aujourd’hui.
Les conséquences de la crise économique sur l'hôpital
Authors: Vincent Gérard , Arcos Cédric , Prigent Alice
Published: October 2012

Résumé La crise économique et financière qui sévit depuis 2008 est lourde de conséquences pour les hôpitaux. Financés majoritairement par l’assurance maladie publique, ils sont confrontés à une contraction de leurs ressources qui se traduit par des plans de réduction des effectifs, des difficultés de trésorerie et un affaiblissement de leur capacité d’investissement. Sans méconnaître les menaces que la crise économique fait planer sur les hôpitaux publics (et à plus long terme sur l’état de santé de la population), il convient de saisir l’opportunité unique induite par la crise pour engager les réformes indispensables permettant d’assurer la pérennité du système de santé. Il s’agit pour les dirigeants politiques de saisir ce moment décisif pour inventer un nouveau système, moderne et adapté au nouvel environnement démographique, épidémiologique, médical ou encore technique.
Developing Nurse Educator Competency in the Pedagogy of Simulation
Authors: Jeanette McNeill , Parker Ramona Ann , Nadeau Julie , Pelayo Lula W. , Cook Jennifer
Published: October 2012

Faculty development is needed for nurse educators to effectively use simulation as a learning tool. A synthesis of research evidence regarding current practices in preparing educators to use simulation provided a foundation for faculty development. Implementation of a two-pronged approach within a regional collaboration of four schools of nursing is described; results of the evaluation of the approaches are presented. Use of the National League for Nursing
Core Competencies of Nurse Educators
as the organizing framework and Roger’s Diffusion of Innovations Model as the theoretical framework is discussed. An overview is provided of the two prongs: (a) a short course for novice educators, and (b) examples of continuing education programming for experienced faculty members new to simulation to enhance effective application of this pedagogy. Recommendations include designing faculty development for simulation within a framework for systems change, maintaining flexibility to meet diverse needs, and using existing online resources.
Developmental Evaluation of Preschool Children: A Service-Learning Experience for Nursing Students
Authors: Gaylord Nan , Chyka Deborah L. , Lawley Grace
Published: October 2012

Service-learning is a practice that is beneficial for both students and community participants. This article presents the service-learning experience of senior-level undergraduate nursing students at a southeastern U.S. university. Nursing students were taught how to administer the Denver II Developmental Screening Test (DDST-II), and they then evaluated high-risk preschool children during a clinical nursing experience. A total of 1,030 children were screened between 2008 and 2012. Early detection of developmental delays promotes earlier intervention for concerns, and the implementation of this service-learning project using a valid and sensitive screening tool aids in the cost-effective identification of preschool children who are at risk for developmental delays. Student evaluations of the experience were positive, and examples of the knowledge acquired are provided.
Trophic model of the outer continental shelf and upper slope demersal community of the southeastern Brazilian Bight
Authors: Nascimento Marcela C. , Velasco Gonzalo , Okey Thomas A. , Christensen Villy , Z. Amaral A. Cecília
Published: October 2012

It is increasingly recognized that demersal communities are important for the functioning of continental shelf and slope ecosystems around the world, including tropical regions. Demersal communities are most prominent in areas of high detritus production and transport, and they link benthic and pelagic biological communities. To understand the structure and role of the demersal community on the southeastern Brazilian Bight, we constructed a trophodynamic model with 37 functional groups to represent the demersal community of the outer continental shelf and upper slope of this area, using the Ecopath with Ecosim 6 (EwE) approach and software. The model indicates high production and biomass of detritus and benthic invertebrates, and strong linkages of these components to demersal and pelagic sub-webs. The level of omnivory indexes in this ecosystem was high, forming a highly connected trophic web reminiscent of tropical land areas. Although high levels of ascendency may indicate resistance and resilience to disturbance, recent and present fisheries trends are probably degrading the biological community and related ecosystem services.
Latitudinal variation in the reproductive cycle of two bivalves with contrasting biogeographical origin along the Humboldt Current Upwelling Ecosystem
Authors: Uribe Roberto A. , Oliva Marcelo E. , Aguilar Silvia , Yamashiro Carmen , Riascos José M.
Published: October 2012

Argopecten purpuratus (Lamarck, 1819) and Mesodesma donacium (Lamarck, 1818) are bivalves that inhabit the Humboldt Current Upwelling Ecosystem. They have contrasting biogeographical origins, suggesting that their responses to exogenous factors should differ. Using circular statistics, we examine synchrony/asynchrony in the reproductive cycle between populations of each species. The results indicate that there is reproductive asynchrony in both species along their distributional range. However, there was synchrony for A. purpuratus in several location-pairs, including Paita-Chimbote, Chimbote-Callao, Callao-Pisco and Pisco-Antofagasta. For M. donacium, there were only two synchronic groups: Camaná-Capellanía-Mehuín and Hornitos-Peñuelas-Longotoma-La Ligua-Cucao-Quilanlar. A. purpuratus showed gametogenenic activity throughout the year. In contrast, M. donacium showed strong seasonality, with gametogenesis in winter and spawning in spring/summer. In conclusion, the patterns observed for these sympatric species suggest that on a large scale the reproductive cycles follow the expected patterns for the contrasting biogeographic origin of each species, so it could be argued that they are modulated by endogenous factors. However, at a local scale, the reproductive cycles of these species show variation, likely determined by local oceanographic or hydrographic processes.
Reproductive biology of the sea cucumber Holothuria sanctori (Echinodermata: Holothuroidea)
Authors: Navarro Pablo G. , García-Sanz Sara , Tuya Fernando
Published: October 2012

The reproductive biology of the sea cucumber Holothuria sanctori was studied over 24 months (February 2009 to January 2011) at Gran Canaria through the gonad index and a combination of macro- and microscopic analysis of the gonads. Holothuria sanctori showed a 1:1 sex ratio and a seasonal reproductive cycle with a summer spawning: the mean gonad index showed a maximum (3.99±0.02) in summer (June-July) and a minimum (0.05±0.04) between late autumn (November) and early spring (March). Females had significantly wider gonad tubules than males. First maturity occurred at a size of 201 to 210 mm, a gutted body weight of 101 to 110 g and a total weight of 176 to 200 g. Holothuria sanctori shows a typical temperate species reproduction pattern. These results could be useful for managing current extractions of H. sanctori in the Mediterranean and in case a specific fishery is started in the eastern Atlantic region.
Assessing the effects of a trawling ban on diet and trophic level of hake, Merluccius merluccius, in the southern Tyrrhenian Sea
Authors: Sinopoli Mauro , Fanelli Emanuela , D’Anna Giovanni , Badalamenti Fabio , Pipitone Carlo
Published: October 2012

This study assesses the effects of a trawling ban on the diet and trophodynamics of the hake Merluccius merluccius by comparing stomach contents and stable isotopes (δ15N and δ13C) in two trawled gulfs and one untrawled gulf in northern Sicily (western Mediterranean). Comparisons were made for three size classes of hake encompassing 60 to 410 mm total length. Fish were collected from 50 to 200 m depth on muddy bottoms. The diets of hake of small and medium size were similar overall but more selective in the untrawled gulf. Greater differences were detected between the diets of larger specimens from trawled and untrawled areas. In the untrawled gulf large hake mainly preyed on clupeoid fish, while in the trawled gulfs other fish prey were found in the stomach contents. δ15N values of hake did not vary significantly between trawled and untrawled areas, while there was a clear effect of size, with larger individuals being significantly more enriched than juveniles. Conversely, δ13C values were generally more depleted for individuals collected in the untrawled area, suggesting a more pelagic source of carbon. The results from the mixing model agree fairly well with the known feeding habits found for each size class in each area.
Prenatal Diagnosis of Lethal Multiple Pterygium Syndrome Using Two-and Three-Dimensional Ultrasonography
Authors: Barros Fernanda S , Júnior Edward Araujo , Rolo Liliam Cristine , Nardozza Luciano Marcondes Machado
Published: October 2012

Lethal multiple pterygium (LMP) is a series of disorders of fetal formation with a heterogeneous range of manifestations that generally include cystic hygroma, pulmonary hypoplasia, cleft palate, cryptorchidism, joint contractures, fetal akinesia, heart defects, growth restriction, and intestinal malrotation. The prenatal diagnosis of this syndrome is suspected when two-dimensional ultrasound (2DUS) scan shows several malformations.. The three-dimensional ultrasound (3DUS) in rendering mode permits the spatial visualization of these malformations, allowing better understanding of this anomaly by parents. We report a case of a fetus in the second trimester with multiple abnormalities suggestive of LMP that were identified using 2DUS, and emphasize the importance of 3DUS in counseling the parents.
Physician Counseling of Older Adults about Physical Activity: The Importance of Context
Authors: Weiss Deborah R. , Wolfson Christina , Yaffe Mark J. , Shrier Ian , Puts Martine T. E.
Published: October 2012

Purpose.

Physicians are encouraged to discuss physical activity with their older adult patients. Studies of physician-initiated counseling have yielded inconsistent results, perhaps because older adults' perceptions and concerns about such counseling have not been addressed. The objective of the present work was therefore to explore such perceptions and their implications.

Design.

Qualitative study, using a grounded theory approach. Data were collected using both focus groups and semistructured interviews.

Setting.

Data were collected in several settings, including a fitness center and physicians' offices.

Subjects.

In a first sample, 56 adults aged 65 and older participated in one of six focus group sessions examining physical activity and exercise. Subsequently, 16 older adults participated in one of two focus groups comprising a second, validation sample. Individual semistructured interviews were conducted with a sample of five physicians.

Methods.

Data collection and analysis took place concurrently. Transcripts were analyzed using the constant comparative method. Recruitment, data collection, and analysis were informed by grounded theory.

Results.

Inactive older adults experiencing a health problem were more receptive than their healthy counterparts to receiving physical activity counseling from their physicians. Those who were receptive appeared to find such an intervention useful in leading to behavior change.

Conclusion.

This study suggests that physicians' efforts in physical activity counseling may have the best impact when provided in the context of a health problem.
Addressing Weight Gain in Smoking Cessation Treatment: A Randomized Controlled Trial
Authors: Bush Terry , Levine Michele D. , Beebe Laura A. , Cerutti Barbara , Deprey Mona , McAfee Tim , Boeckman Lindsay , Zbikowski Susan
Published: October 2012

Purpose.

To evaluate the effectiveness of a cognitive behavioral treatment (CBT) addressing cessation-related weight concerns delivered via a tobacco quitline that does not address weight concerns.

Design.

Randomized controlled trial, blinded 6-month follow-up.

Setting.

The Oklahoma Tobacco Helpline (OKHL).

Subjects.

All 7998 smokers who called the OKHL were screened; 4240 were eligible; 2000 were randomized to the standard quitline (STD) or the brief version of the CBT weight concerns program (WCP).

Intervention.

Telephone counseling to help people quit smoking and address concerns about cessation-related weight gain.

Measures.

Demographics, weight, tobacco status, weight concerns, self-efficacy in quitting, and quitting without weight gain.

Analysis.

Descriptive statistics and logistic regression.

Results.

Of those randomized, 1002 participants completed the 6-month survey (response rates = 53.2% for STD, 47% for WCP). Compared with STD, WCP led to reduced weight concerns (p < .01) and less weight gain among quitters (1.8 vs. −3.4 pounds; p = .01). Although not significant, participants in the WCP were more likely to report 30-day abstinence (33.3% vs. 36.8%, p = .24; intent to treat = 17.7 vs. 17.3).

Conclusion.

The WCP was successfully delivered via a quitline and resulted in improved attitudes about weight and decreased cessation-related weight gain without harming quit rates. Promotion of a quitline focused on addressing weight in conjunction with quitline treatment for smoking cessation may improve cessation and weight outcomes. Study limitations include use of self-report and survey response.
Caregiver Burden and Nonachievement of Healthy Lifestyle Behaviors among Family Caregivers of Cardiovascular Disease Patients
Authors: Mochari-Greenberger Heidi , Mosca Lori
Published: October 2012

Purpose.

To determine whether caregiver burdens are associated with lifestyle behaviors 1 year following the hospitalization of a family member with cardiovascular disease (CVD).

Design.

Prospective follow-up study of National Heart Lung and Blood Institute sponsored Family Intervention Trial for Heart Health participants.

Setting.

Hospital-based recruitment/baseline visit with 1-year follow-up.

Subjects.

Family members of hospitalized CVD patients (N = 423; 67% female; 36% racial/ethnic minority; mean age 49 years).

Measures.

Systematic evaluation at 1 year to determine heart-healthy diet (defined as <10% kcal from saturated fat; Block 98 Food Frequency Questionnaire) and physical activity (defined as ≥4d/wk; Behavioral Risk Factor Surveillance System Survey) behaviors and caregiver burdens (five domains: employment, financial, physical, social, and time; Caregiver Strain Questionnaire).

Analysis.

Logistic regression adjusted for covariates.

Results.

Heart-healthy diet was less frequent among caregivers citing feeling overwhelmed (odds ratio [OR] = .50; 95% confidence interval [CI] = .26–.97), sleep disturbance (OR = .51; 95% CI = .27–.96), financial strain (OR = .41; 95% CI = .20–.86), upsetting behavior (OR = .48; 95% CI = .25–.92), and/or time demands (OR = .47; 95% CI = .26–.85) as burdens. Physical activity was less frequent among caregivers reporting financial strain (OR = .32; 95% CI = .13–.81) or upsetting patient behavior (OR = .33; 95% CI = .15–.76) as burdens. The most commonly cited caregiver burdens included changes in personal plans (39%), time demands (38%), and sleep disturbance (30%).

Conclusion.

Caregiver burdens were associated with nonachievement of heart-healthy diet and physical activity behaviors among family caregivers 1 year after patient discharge. When developing heart-health promotion interventions, caregiver burden should be considered as a possible barrier to prevention among family members of CVD patients.
Impact of a Prototype Visualization Tool for New Information in EHR Clinical Documents
Authors: Farri O. , Rahman A. , Monsen K.A. , Zhang R. , Pakhomov S.V. , Pieczkiewicz D.S. , Speedie S.M. , Melton G.B.
Published: October 2012

Background: EHR clinical document synthesis by clinicians may be time-consuming and error-prone due to the complex organization of narratives, excessive redundancy within documents, and, at times, inadvertent proliferation of data inconsistencies. Development of EHR systems that are easily adaptable to the user’s work processes requires research into visualization techniques that can optimize information synthesis at the point of care.

Objective: To evaluate the effect of a prototype visualization tool for clinically relevant new information on clinicians’ synthesis of EHR clinical documents and to understand how the tool may support future designs of clinical document user interfaces.

Methods: A mixed methods approach to analyze the impact of the visualization tool was used with a sample of eight medical interns as they synthesized EHR clinical documents to accomplish a set of four pre-formed clinical scenarios using a think-aloud protocol.

Results: Differences in the missing (unretrieved) patient information (2.3±1.2 [with the visualization tool] vs. 6.8±1.2 [without the visualization tool], p = 0.08) and accurate inferences (1.3±0.3 vs 2.3±0.3, p = 0.09) were not statistically significant but suggest some improvement with the new information visualization tool. Despite the non-significant difference in total times to task completion (43±4 mins vs 36±4 mins, p = 0.35) we observed shorter times for two scenarios with the visualization tool, suggesting that the time-saving benefits may be more evident with certain clinical processes. Other observed effects of the tool include more intuitive navigation between patient details and increased efforts towards methodical synthesis of clinical documents.

Conclusion: Our study provides some evidence that new information visualization in clinical notes may positively influence synthesis of patient information from EHR clinical documents. Our findings provide groundwork towards a more effective display of EHR clinical documents using advanced visualization applications.

Citation: Farri O, Rahman A, Monsen KA, Zhang R, Pakhomov SV, Pieckiewicz DS, Speedie SM, Melton GB. Impact of a prototype visualization tool for new information in EHR clinical documents. Appl Clin Inf 2012; 3: 404–418

http://dx.doi.org/10.4338/ACI-2012-05-RA-0017
Central Vertigo
Authors: Strupp Michael , Brandt Thomas
Published: October 2012

Central vertigo can clinically manifest in three ways: Acute onset of vertigo and dizziness, recurrent attacks and chronic central vertigo. In patients with acute onset of symptoms it is essential to differentiate between central and peripheral vertigo because this has major diagnostic and therapeutic implications. A differentiation can most often be achieved by a careful neuroophthalmological and neuro-otological bedside examination. One should look in particular for the following five signs of central lesions: skew deviation/vertical divergence (as a component of the ocular tilt reaction), gaze-evoked nystagmus contralateral to a spontaneous nystagmus, saccadic smooth pursuit, acute nystagmus in combination with a nonpathological head-impulse test and central fixation nystagmus. The most frequent forms of central vertigo with recurrent attacks are vestibular migraine and episodic ataxia type 2. Clinically relevant types of chronic or chronic progressive central vertigo are neurodegenerative disorders affecting the cerebellum which are often associated with cerebellar ocular motor dysfunction, in particular downbeat nystagmus. Treatments of choice for a prophylactic therapy of vestibular migraine are betablocker, topiramate or valproic acid. A new treatment option for episodic ataxia type 2 and downbeat nystagmus are aminopyridines (potassium channel blockers).

How to cite this article

Strupp M, Brandt T. Central Vertigo. Otorhinolaryngol Clin Int J 2012;4(2):71-76.
Current Perspectives in the Pharmacotherapy of Vertigo
Authors: Singh Manmohan , Singh Kanchan Rao
Published: October 2012

Vertigo is a symptom encountered very commonly in clinical practice due to a disorder in the vestibular system. In addition to dizziness it is very often accompanied by nausea and vomiting. Pharmacotherapy plays an important role in the management of vertigo. Vestibular suppressants and drugs to control nausea and vomiting constitute the mainstay of the pharmacotherapy of vertigo. Specific drug therapy can be given in patients where the underlying disease process causing the vertigo has been identified. Despite the availability of many classes of drugs, there are no definitive, universally accepted guidelines for the treatment of vertigo which makes it even more difficult to follow first-, second- and third-line therapies when treating patients. It is difficult to establish guidelines or a generally acceptable consensus in the treatment of vertigo due to the complexity of vertigo and lack of adequate randomized clinical studies.

How to cite this article

Singh KR, Singh M. Current Perspectives in the Pharmacotherapy of Vertigo. Otorhinolaryngol Clin Int J 2012;4(2):81-85.
Clinical Research: Comprehension of the Patient Information Leaflet and the Consent Form
Authors: Shafiq Nusrat , Malhotra Samir
Published: October 2012

Informed consent process is an integral component of conducting clinical research ethically. Prior to giving an informed consent to participate in clinical research, it is important that the participant has fully understood all the components of a patient information leaflet and the consent form. The issue of comprehension of informed consent form and patient information leaflet has acquired particular importance in view of research being carried out in developing countries and in vulnerable population. The present review addresss this issue by discussing the need for addressing comprehension of research process by the participant, the tools for assessing the same and various ways in which these tools have been used.

How to cite this article

Shafiq N, Malhotra S. Clinical Research: Comprehension of the Patient Information Leaflet and the Consent Form. J Postgrad Med Edu Res 2012;46(3):122-125.
Ethical Issues in Prospective Studies in Children: The many Shades of Gray
Authors: Singh Meenu , LNU Madhusudan
Published: October 2012

Children being a vulnerable, unique, yet heterogenous population, pose varied ethical questions in clinical research. These need to be actively recognized and addressed in order to strike the right balance between ‘individual’ good and 'societal’ good. Certain general principles which can be streamlined into guidelines specific for each population and study is the need of the hour.

How to cite this article

Singh M, Madhusudan. Ethical Issues in Prospective Studies in Children: The many Shades of Gray. J Postgrad Med Edu Res 2012;46(3):126-128.
Research Output and Publications Impact of Postgraduate Institute of Medical Education and Research Chandigarh (1999-2008)
Authors: Sharma RK , Thakur JS , Kumar Raj , Gupta BM , Baidwan Kiran , Goyal Adrash Bala
Published: October 2012

This paper attempts to analyze the research activities of the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh as reflected in its 10 years cumulative (1999-2008) publications output covered in Scopus International multidisciplinary bibliographical database. The present study analyses the broad characteristics of 4,771 research papers published by the faculty members of PGIMER, Chandigarh by focusing on its publication growth characteristics, format and media of communication, research impact and quality, patterns of research collaboration, broad and narrow areas of research focus and characteristics of its high cited papers.

How to cite this article

Kumar R, Gupta BM, Thakur JS, Sharma RK, Baidwan K, Goyal AB. Research Output and Publications Impact of Postgraduate Institute of Medical Education and Research Chandigarh (1999-2008). J Postgrad Med Edu Res 2012;46(3):129-137.
Epidemiological Pattern of Foot Injuries in India: Preliminary Assessment of Data from a Tertiary Hospital
Authors: Dhillon Mandeep , Aggarwal Sameer , Jain Manuj , Dhatt Sarvdeep
Published: October 2012

Foot injuries are an often disabling, especially when the diagnosis is delayed and treatment is inappropriate; this becomes significant in polytrauma where diagnosis maybe missed, and in young adults who are injured in the prime of life. No data on foot injury is available from India or any other developing country; we undertook a prospective 1 year study to evaluate incidence and epidemiology of foot injuries seen at our center. One hundred and thirty-four feet were injured in 1,765 patients, with 82% being males, and the average age being 30.8 years. Road accident was predominant cause (73.8%) in contrast to the published literature, with two-third being open injuries; 47% were polytrauma victims. The surgical delay averaged 3.14 days, reasons for which were multifactorial. This high incidence of foot injury (7.59%) in men in their most productive years assumes significance when residual disability occurs due to mismanagement. A high index of suspicion needs to be maintained in road accident victims and polytrauma cases, so that foot injury is not missed and treatment is not inordinately delayed.

How to cite this article

Dhillon MS, Aggarwal S, Dhatt S, Jain M. Epidemiological Pattern of Foot Injuries in India: Preliminary Assessment of Data from a Tertiary Hospital. J Postgrad Med Edu Res 2012;46(3):144-147.
Immunological Response to Post-trauma Bone Remodeling
Authors: Srivastava RN , Singh Ajai , Ali Sabir , Verma NS
Published: October 2012

Bone-related immunology (osteoimmunology) is an interdisciplinary translational research field combining orthopaedics and immunology. This review gives an in-depth knowledge in the relationship between the bone trauma and the corresponding changes in host immune system. It also summarizes the most recent developments occuring into this complex field. It has been found that osteoblasts play important role in the maintenance of the hematopoietic stem cell niche and in lymphocyte development as well as the functions of immune cells participating in osteoblast and osteoclast development. Various recent researches are directed to establish the role of cytokines, chemokines, transcription factors and costimulatory molecules, which are shared by both skeletal and immune systems. The understanding of this part of research may open new horizons in the management of bone trauma and that of inflammatory and autoimmune diseases.

How to cite this article

Singh A, Ali S, Srivastava RN, Verma NS. Immunological Response to Post-trauma Bone Remodeling. J Postgrad Med Edu Res 2012;46(3):148-151.
Air-snow transfer of nitrate on the East Antarctic Plateau – Part 1: Isotopic evidence for a photolytically driven dynamic equilibrium
Authors: Erbland J. , Vicars W. C. , Savarino J. , Morin S. , Frey M. M. , Frosini D. , Vince E. , Martins J. M. F.
Published: October 2012

Abstract. Here we report the measurement of the comprehensive isotopic composition (δ15N, Δ17O and δ18O) of nitrate at the air–snow interface at Dome C, Antarctica (DC, 75° 06' S, 123° 19' E) and in snow pits along a transect across the East Antarctic Ice Sheet (EAIS) between 66° S and 78° S. For each of the East Antarctic snow pits in most of which nitrate loss is observed, we derive apparent fractionation constants associated with this loss as well as asymptotic values of nitrate concentration and isotopic ratios below the photic zone. Nitrate collected from snow pits on the plateau have average apparent fractionation constants of (−59±10)‰, (+2.0±1.0)‰ and (+8.7±2.4)‰, for δ15N, Δ17O and δ18O, respectively. In contrast, snow pits sampled on the coast show distinct isotopic signatures with average apparent fractionation constants of (−16±14)‰, (−0.2±1.5)‰ and (+3.1±5.8)‰, for δ15N, Δ17O and δ18O, respectively. From a lab experiment carried out at DC in parallel to the field investigations, we find that the 15N/14N fractionation associated with the physical release of nitrate is (−8.5±2.5)‰, a value significantly different from the modelled estimate previously found for photolysis (−48‰, Frey et al., 2009) when assuming a Rayleigh-type process. Our observations corroborate that photolysis is the dominant nitrate loss process on the East Antarctic Plateau, while on the coast the loss is less pronounced and could involve both physical release and photochemical processes. Year-round isotopic measurements at DC show a close relationship between the Δ17O of atmospheric nitrate and Δ17O of nitrate in skin layer snow, suggesting a photolytically-driven isotopic equilibrium imposed by nitrate recycling at this interface. The 3–4 weeks shift observed for nitrate concentration in these two compartments may be explained by the different sizes of the nitrate reservoirs and by deposition from the atmosphere to the snow. Atmospheric nitrate deposition may lead to fractionation of the nitrogen isotopes and explain the almost constant shift on the order of 25‰ between the δ15N values in the atmospheric and skin layer nitrate at DC. Asymptotic δ15N(NO3−) values and the inverse of snow accumuation rates are correlated (ln(δ15N(as.) + 1) = (5.76±0.47) · (kg m−2 a−1/A) + (0.01±0.02)) confirming the strong relationship between the snow accumulation rate on the residence time of nitrate in the photic zone and the degree of isotopic fractionation, consistent with with previous observations by Freyer et al. (1996). Asymptotic Δ17O(NO3−) values on the plateau are smaller compared to the values found in the skin layer most likely due to oxygen isotope exchange between the nitrate photo-products and water molecules from the surrounding ice. However, the overall fractionation in Δ17O is small thus allowing the preservation of an atmospheric signal.
Depolarization ratio of Polar Stratospheric Clouds in coastal Antarctica: profiling comparison analysis between a ground-based Micro Pulse Lidar and the space-borne CALIOP
Authors: Córdoba-Jabonero C. , Guerrero-Rascado J. L. , Toledo D. , Parrondo M. , Yela M. , Gil M. , Ochoa H. A.
Published: October 2012

Abstract. Polar Stratospheric Clouds (PSCs) play an important role in polar ozone depletion. In particular ice clouds, type PSC-II, with respect to the type PSC-I (nitric acid clouds) produce the most significant effects. Therefore PSC characterization, mainly focused on PSC-II discrimination is needed. The backscattering (R) and volume linear depolarization (δV) ratios are the parameters usually used in lidar measurements for PSC detection and identification. In this work, an improved version of the standard NASA/Micro Pulse Lidar (MPL-4), which includes a built-in depolarization detection module, has been used for PSC observations above the coastal Antarctic Belgrano II station (Argentina, 77.9° S 34.6° W, 256 m a.s.l.) since 2009. Examination of the MPL-4 δV feature as a suitable index for PSC-type discrimination is based on the analysis of the two-channel data, i.e. the parallel (p-) and perpendicular (s-) polarized MPL signals. This study focuses on the comparison of simultaneous δV-profiles as obtained from ground-based MPL-4 measurements during three Antarctic winters with those reported from the space-borne lidar CALIOP aboard the CALIPSO satellite in the same period (48 simultaneous cases are analysed for 2009–2011 austral winter times). Two different variables are considered for the comparison analysis between both lidar datasets in order to test the degree of agreement: the correlation coefficient (CC) and the percentage difference (BIAS). Results indicate a relatively good correlation between the δV-profiles once MPL-4 depolarization calibration parameters are applied. This correlation is based on the linear fitted height-range of the layered structure, obtaining CC values higher than 0.5 for 54% (26 cases) out of all the analysed cases (48 in total). However, less satisfactory results are found when the BIAS test is used in the comparison procedure to test the degree of agreement between the lidar datasets. A predominance of negative BIAS values are observed showing that the MPL-4 δV values are underestimated with respect to CALIOP data; however, differences between the MPL-4 datasets are no greater than an 11% (absolute value) with respect to CALIOP values. Moreover, the agreement appears to be unexpectedly independent of the CALIPSO ground-track overpass distance from the Belgrano II station. Consequently, differences between the δV datasets are not dominated by spatial inhomogeneity of the PSC field.
Mercury dynamics in the Rocky Mountain, Colorado, Snowpack
Authors: Faïn X. , Helmig D. , Hueber J. , Obrist D. , Williams M. M.
Published: November 2012

Abstract. Gaseous Elemental Mercury (GEM) was monitored at the Niwot Ridge (NWT) long-term ecological research (LTER) site (Colorado, USA, 40° N) from interstitial air extracted from the snowpack at depths ranging from the snow surface to 10 cm above the soil. A highly dynamic cycling of mercury (Hg) in this mid-latitude snowpack was observed. Patterns were driven by both GEM production in surface snow and GEM destruction in the deeper snowpack layers. Thorough mixing and vertical transport processes were observed through the snowpack. GEM was photochemically produced near the snow-air interface leading to enhanced GEM levels in interstitial air of surface snow of up to 8 ng m−3. During low wind periods, GEM in surface snow layers remained significantly above ambient air levels at night as well, which may indicate a potential weak GEM production over night. Analysis of vertical GEM gradients in the snowpack show that surface GEM enhancements efficiently propagated down the snowpack, with a temporal lag in peak GEM levels observed with increasing depth. Downward diffusion was responsible for much of these patterns, although vertical advection also contributed to vertical redistribution. Destruction of GEM in the lower snowpack layers was attributed to dark oxidation of GEM. Analysis of vertical GEM/CO2 flux ratios indicated that this GEM destruction occurred in the snow and not in the underlying soil. The strong, diurnal patterns of photochemical GEM production at the surface ultimately lead to re-emission losses of deposited Hg back to the atmosphere. The NWT data show that highest of GEM production and emission occur shortly after fresh snowfall, indicating that fresh snow possibly resupplies photoreducible Hg to the snowpack.
COnstructing Proxy Records from Age models (COPRA)
Authors: Breitenbach S. F. M. , Rehfeld K. , Goswami B. , Baldini J. U. L. , Ridley H. E. , Kennett D. J. , Prufer K. M. , Aquino V. V. , Asmerom Y. , Polyak V. J. , Cheng H. , Kurths J. , Marwan N.
Published: October 2012

Abstract. Reliable age models are fundamental for any palaeoclimate reconstruction. Available interpolation procedures between age control points are often inadequately reported, and very few translate age uncertainties to proxy uncertainties. Most available modeling algorithms do not allow incorporation of layer counted intervals to improve the confidence limits of the age model in question. We present a framework that allows detection and interactive handling of age reversals and hiatuses, depth-age modeling, and proxy-record reconstruction. Monte Carlo simulation and a translation procedure are used to assign a precise time scale to climate proxies and to translate dating uncertainties to uncertainties in the proxy values. The presented framework allows integration of incremental relative dating information to improve the final age model. The free software package COPRA1.0 facilitates easy interactive usage.
The last interglacial (Eemian) climate simulated by LOVECLIM and CCSM3
Authors: Nikolova I. , Yin Q. , Berger A. , Singh U. K. , Karami M. P.
Published: October 2012

Abstract. This paper presents a detailed analysis of the climate of the last interglacial simulated by two climate models of different complexities, LOVECLIM and CCSM3. The simulated surface temperature, hydrological cycle, vegetation and ENSO variability during the last interglacial are analyzed through the comparison with the simulated Pre-Industrial (PI) climate. In both models, the last interglacial period is characterized by a significant warming (cooling) over almost all the continents during boreal summer (winter) leading to a largely increased (reduced) seasonal contrast in the northern (southern) hemisphere. This is mainly due to the much higher (lower) insolation received by the whole Earth in boreal summer (winter) during this interglacial. The arctic is warmer than PI through the whole year, resulting from its much higher summer insolation and its remnant effect in the following fall-winter through the interactions between atmosphere, ocean and sea ice. In the tropical Pacific, the change in the SST annual cycle is suggested to be related to a minor shift towards an El Nino, slightly stronger for MIS-5 than for PI. Intensified African monsoon and vegetation feedback are responsible for the cooling during summer in North Africa and Arabian Peninsula. Over India precipitation maximum is found further west, while in Africa the precipitation maximum migrates further north. Trees and grassland expand north in Sahel/Sahara. A mix of forest and grassland occupies continents and expand deep in the high northern latitudes. Desert areas reduce significantly in Northern Hemisphere, but increase in North Australia. The simulated large-scale climate change during the last interglacial compares reasonably well with proxy data, giving credit to both models and reconstructions. However, discrepancies exist at some regional scales between the two models, indicating the necessity of more in depth analysis of the models and comparisons with proxy data.