bluuebunny/crossref_metadata_2025 huggingface dataset:
Sustained Release of Triamcinolone Acetonide from an Intratympanically Applied Hydrogel Designed for the Delivery of High Glucocorticoid Doses
Authors: Honeder Clemens , Engleder Elisabeth , Schöpper Hanna , Gabor Franz , Reznicek Gottfried , Wagenblast Jens , Gstoettner Wolfgang , Arnoldner Christoph
Published: April 2014

The pharmacokinetic properties and tolerability of a triamcinolone acetonide poloxamer 407 hydrogel for intratympanic application were investigated in a guinea pig model. Evaluation of in vivo release kinetics showed very high initial perilymph drug levels, with clinically relevant levels present for a minimum of 10 days. Assessment of auditory brainstem response thresholds showed a minimal, delayed and transient threshold shift, which was apparent on day 3 and resolved by day 10. No relevant histological changes of the middle and inner ear structures were noted, and hair cell counts showed no significant differences between treated and untreated ears. Thus, the triamcinolone-acetonide-loaded poloxamer 407 hydrogel is an effective vehicle for sustained high-dose inner ear glucocorticoid delivery.
Remote Ischemic Postconditioning During Percutaneous Coronary Interventions
Authors: Lavi Shahar , D’Alfonso Sabrina , Diamantouros Pantelis , Camuglia Anthony , Garg Pallav , Teefy Patrick , Jablonsky George , Sridhar Kumar , Lavi Ronit
Published: April 2014

Background—

Remote ischemic preconditioning may result in reduction in infarct size during percutaneous coronary intervention (PCI). It is unclear whether remote ischemic postconditioning (RIPost) will reduce the incidence of myocardial injury after PCI, and whether ischemic conditioning of a larger remote organ (thigh versus arm) would provide further myocardial protection.

Methods and Results—

We randomized 360 patients presenting with stable or unstable angina (28% of patients) and negative Troponin T at baseline to 3 groups: 2 groups received RIPost (induced by ischemia to upper or lower limb), and a third was the control group. RIPost was applied during PCI immediately after stent deployment, by three 5-minute cycles of blood pressure cuff inflation to >200 mm Hg in the arm or thigh (20 mm Hg in the control) with 5-minute breaks between each cycle. The primary end-point was the proportion of patients with Troponin T levels >3×ULN postprocedure (at 6 or 18–24 hours), where ULN stands for upper limit of normal. A total of 120 patients were randomized to each group. There were no differences in baseline characteristics between the 3 groups. The primary outcome occurred in 30%, 35%, and 35% of the arm, thigh, and control groups, respectively (
P
=0.64). There were no differences in creatine kinase or high sensitivity C-reactive protein levels after PCI or in the incidence of acute kidney injury between the groups.

Conclusions—

RIPost during PCI did not reduce the incidence of periprocedural myocardial injury. Similar effect was obtained when remote ischemia was induced to the upper or lower limb.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00970827.
Stroke After Aortic Valve Surgery
Authors: Messé Steven R. , Acker Michael A. , Kasner Scott E. , Fanning Molly , Giovannetti Tania , Ratcliffe Sarah J. , Bilello Michel , Szeto Wilson Y. , Bavaria Joseph E. , Hargrove W. Clark , Mohler Emile R. , Floyd Thomas F. ,   The Determining Neurologic Outcomes from Valve Operations (DeNOVO) investigators include, Acker Michael A. , Bavaria Joseph E. , Floyd Thomas F. , Giovanetti Tania , Hargrove W. Clark , Kasner Scott E. , Messé Steven R. , Matthai William H. , Mohler Emile R. , Morris Rohinton J. , Pochettino Alberto A. , Price Catherine E. C. , Ratcliffe Sarah J. , Selnes Ola A. , Szeto Wilson Y. , Woo Y. Joseph , Desai Nimesh D. , Augostides John G. , Cheung Albert T. , Hanson C. William , Horak Jiri , Kohl Benjamin A. , Kukafka Jeremy D. , Levy Warren J. , Mickler Thomas A. , Milas Bonnie L. , Savino Joseph S. , Vernick William J. , Weiss Stuart J.
Published: April 2014

Background—

The incidence and impact of clinical stroke and silent radiographic cerebral infarction complicating open surgical aortic valve replacement (AVR) are poorly characterized.

Methods and Results—

We performed a prospective cohort study of subjects ≥65 years of age who were undergoing AVR for calcific aortic stenosis. Subjects were evaluated by neurologists preoperatively and postoperatively and underwent postoperative magnetic resonance imaging. Over a 4-year period, 196 subjects were enrolled at 2 sites (mean age, 75.8±6.2 years; 36% women; 6% nonwhite). Clinical strokes were detected in 17%, transient ischemic attack in 2%, and in-hospital mortality was 5%. The frequency of stroke in the Society for Thoracic Surgery database in this cohort was 7%. Most strokes were mild; the median National Institutes of Health Stroke Scale was 3 (interquartile range, 1–9). Clinical stroke was associated with increased length of stay (median, 12 versus 10 days;
P
=0.02). Moderate or severe stroke (National Institutes of Health Stroke Scale ≥10) occurred in 8 (4%) and was strongly associated with in-hospital mortality (38% versus 4%;
P
=0.005). Of the 109 stroke-free subjects with postoperative magnetic resonance imaging, silent infarct was identified in 59 (54%). Silent infarct was not associated with in-hospital mortality or increased length of stay.

Conclusions—

Clinical stroke after AVR was more common than reported previously, more than double for this same cohort in the Society for Thoracic Surgery database, and silent cerebral infarctions were detected in more than half of the patients undergoing AVR. Clinical stroke complicating AVR is associated with increased length of stay and mortality.
Bartsia lydiae, a new species of Bartsia sect. Laxae (Orobanchaceae) from the southern Peruvian Andes with a revised key to Bartsia sect. Laxae
Authors: Sylvester Steven Paul
Published: April 2014

A new species of Bartsia sect. Laxae is described and illustrated from the Cordillera Vilcanota, southern Peru. The species is distinct from all other members of sect. Laxae in being covered with persistent glandular hairs and having a reddish purple corolla. The species is a common element of undisturbed puna vegetation in the Cordillera Vilcanota, being associated with Polylepis forests. A revised key to Bartsia sect. Laxae is included to accommodate this new species.
Global-to-Regional Nested Grid Climate Simulations in the GFDL High Resolution Atmospheric Model
Authors: Harris Lucas M. , Lin Shian-Jiann
Published: April 2014

A two-way nested grid version of the Geophysical Fluid Dynamics Laboratory High Resolution Atmosphere Model (HiRAM) has been developed that uses simple methods for providing nested grid boundary conditions and mass-conserving nested-to-global communication. Nested grid simulations over the Maritime Continent and over North America were performed, each at two different resolutions: a 110-km mean grid cell width refined by a factor of 3, and a 50-km mean grid cell width refined by a factor of 2. Nested grid simulations were compared against uniform-resolution simulations, and against reanalyses, to determine the effect of grid nesting on both the modeled global climate and the simulation of small-scale features.

Orographically forced precipitation was robustly found to be simulated with more detail and greater realism in a nested grid simulation compared with when only the coarse grids were simulated alone. Tropical precipitation biases were reduced in the Maritime Continent region when a nested grid was introduced. Both results were robust to changes in the nested grid parameterization tunings. In North America, cold-season orographic precipitation was improved by nesting, but precipitation biases in the central and eastern United States were little changed. Improving the resolution through nesting also allowed for more intense rainfall events, greater Kelvin wave activity, and stronger tropical cyclones. Nested grid boundary artifacts were more pronounced when a one-way, noninteractive nested grid was used.
AUV Observations of the Diurnal Surface Layer in the North Atlantic Salinity Maximum
Authors: Hodges Benjamin A. , Fratantoni David M.
Published: April 2014

Autonomous underwater vehicle (AUV) surveys of temperature, salinity, and velocity in the upper 10 m of the ocean were carried out in low-wind conditions near the North Atlantic surface salinity maximum as part of the Salinity Processes in the Upper Ocean Regional Study (SPURS) project. Starting from a well-mixed state, the development, deepening, and decay of a warm salty diurnal surface layer was observed at <1-h resolution. The evaporation rate deduced from the freshwater anomaly of the layer corroborates measurements at a nearby flux mooring. Profiles within a few hundred meters of the stationary research vessel showed evidence of mixing, highlighting the effectiveness of AUVs for collecting uncontaminated time series of near-surface thermohaline structure. A two-dimensional horizontal subsurface survey within the diurnal warm layer revealed coherent warm and cool bands, which are interpreted as internal waves on the diurnal thermocline.
Multiplicative and Additive Incremental Variational Data Assimilation for Mixed Lognormal–Gaussian Errors
Authors: Fletcher Steven J. , Jones Andrew S.
Published: April 2014

An advance that made Gaussian-based three- and four-dimensional variational data assimilation (3D- and 4DVAR, respectively) operationally viable for numerical weather prediction was the introduction of the incremental formulation. This reduces the computational costs of the variational methods by searching for a small increment to a background state whose evolution is approximately linear. In this paper, incremental formulations for 3D- and 4DVAR with lognormal and mixed lognormal–Gaussian-distributed background and observation errors are presented. As the lognormal distribution has geometric properties, a geometric version for the tangent linear model (TLM) is proven that enables the linearization of the observational component of the cost functions with respect to a geometric increment. This is combined with the additive TLM for the mixed distribution–based cost function. Results using the mixed incremental scheme with the Lorenz’63 model are presented for different observational error variances, observation set sizes, and assimilation window lengths. It is shown that for sparse accurate observations the scheme has a relative error of ±0.5% for an assimilation window of 100 time steps. This improves to ±0.3% with more frequent observations. The distributions of the analysis errors are presented that appear to approximate a lognormal distribution with a mode at 1, which, given that the background and observational errors are unbiased in Gaussian space, shows that the scheme is approximating a mode and not a median. The mixed approach is also compared against a Gaussian-only incremental scheme where it is shown that as the z-component observational errors become more lognormal, the mixed approach appears to be more accurate than the Gaussian approach.
Ketorolac After Free Tissue Transfer
Authors: Schleiffarth J. Robert , Bayon Rodrigo , Chang Kristi E. , Van Daele Douglas J. , Pagedar Nitin A.
Published: April 2014

Objective:

We sought to compare postoperative pain and complications in patients undergoing free tissue transfer for reconstruction of head and neck defects with and without ketorolac.

Methods:

In this retrospective cohort study, we identified patients who underwent head and neck free tissue transfer procedures at the University of Iowa between July 2010 and December 2012. A subset of patients received ketorolac as an anti-platelet agent. Main outcome measures include postoperative analgesic use, pain scores, and bleeding complications.

Results:

We identified 138 free tissue transfers, with 42 procedures in the ketorolac cohort. In the first 7 postoperative days, patients in the ketorolac and non-ketorolac cohorts received equivalent narcotic doses (morphine equivalents, 48.9 mg/day vs 46.6 mg/day, P = .72). The ketorolac group reported higher mean pain scores (3.1 vs 2.4, P = .004). Ketorolac use was not associated with need for transfusion ( P = .86) or number of days with neck drains ( P = .79).

Conclusion:

Ketorolac did not demonstrate a significant analgesic effect in this group of patients in terms of pain scores and opioid requirements. However, there also was no evidence to suggest a higher likelihood of bleeding complications. Ketorolac may be safely used as an anti-platelet agent, with narcotic requirements unchanged.
A Novel Device for the Clinical Assessment of Intranasal Trigeminal Sensitivity
Authors: Naka Asami , Wolf Axel , Renner Bertold , Mueller Christian A.
Published: April 2014

Objective:

Despite the significance of trigeminal pathology, practical clinical tests that accurately evaluate intranasal trigeminal function are scarce. The aim of the present study is to introduce a practical procedure for the assessment of intranasal trigeminal sensitivity.

Methods:

We developed a device to stimulate the nasal mucosa using carbon dioxide, which is self-administered intranasally by holding down a timed button until the required sensory response has been triggered. The trigeminal sensitivity is derived from the measured administration time in conjunction with the concentration of carbon dioxide administered. Sixty-three healthy participants were used to validate the device, after which the new device was compared with a standard lateralization task in an additional 16 participants. In 20 participants, the experiment was repeated to verify test–retest reliability.

Results:

Statistical analysis showed significant consistency in administration-duration in healthy individuals, including those in the test–retest group. Those participants with higher scores in the lateralization task were found to show higher intranasal sensitivity measured by the new device.

Conclusion:

Herein, we present the design and validation of a novel device for the practical assessment of intranasal trigeminal sensitivity. In this study, we demonstrate the efficacy and reliability of this device.
Hoarseness Misattributed to Reflux
Authors: Sulica Lucian
Published: April 2014

Objective:

This study aimed to identify voice disorders commonly misidentified as reflux and sources of such misattribution.

Study Design:

Retrospective chart review.

Methods:

Twenty-six patients carrying a diagnosis of reflux alone presenting for second-opinion evaluation were identified from among 381 new patients presenting with a chief complaint of hoarseness over an 8-month period. Patients specifically referred for further workup were excluded.

Results:

Average duration of reflux treatment was 10.6 ± 9.0 weeks. In no case was reflux alone the cause of hoarseness. Eleven (42%) had phonotraumatic lesions, 9 (34%) had neurologic disorders, 5 (19%) had age-related changes, and 1 (4%) was infectious. Twenty-two (85%) abnormalities were diagnosed by dynamic laryngeal examination with improved optics, including stroboscopy. Only 4 (15%) represented disorders routinely diagnosed with flexible fiberoptic laryngoscopy.

Conclusion:

Hoarse patients with no apparent cause for dysphonia other than reflux after flexible laryngoscopy, or who fail to improve with appropriate treatment, may benefit from further laryngeal investigation rather than continued empiric treatment or further reflux evaluation.
Reducing the Negative Vocal Effects of Superficial Laryngeal Dehydration With Humidification
Authors: Levendoski Elizabeth Erickson , Sundarrajan Anusha , Sivasankar M. Preeti
Published: April 2014

Objectives:

Environmental humidification is a simple, cost-effective method believed to reduce superficial laryngeal drying. This study sought to validate this belief by investigating whether humidification treatment would reduce the negative effects of superficial laryngeal dehydration on phonation threshold pressure (PTP). Phonation threshold pressure data analysis may be vulnerable to bias because of lack of investigator blinding. Consequently, this study investigated the extent of PTP analysis reliability between unblinded and blinded investigators.

Methods:

Healthy male and female adults were assigned to a vocal fatigue (n = 20) or control group (n = 20) based on their responses to a questionnaire. PTP was assessed after 2 hours of mouth breathing in low humidity (dehydration challenge), following a 5-minute break in ambient humidity, and after 2 hours of mouth breathing in high humidity (humidification).

Results:

PTP significantly increased following the laryngeal dehydration challenge. After humidification, PTP returned toward baseline. These effects were observed in both subject groups. PTP measurements were highly correlated between the unblinded and blinded investigator.

Conclusions:

Humidification may be an effective approach to decrease the detrimental voice effects of superficial laryngeal dehydration. These data lay the foundation for future investigations aimed at preventing and treating the negative voice changes associated with chronic, surface laryngeal drying.
Relational Health, Ethnic Identity, and Well-Being of College Students of Color
Authors: Schmidt Christa K. , Piontkowski Sarah , Raque-Bogdan Trisha L. , Ziemer Kathryn Schaefer
Published: April 2014

Within the framework of relational-cultural theory, the current study examined how relational health and ethnic identity contribute to overall well-being in a sample of college students of color. A total of 229 students completed measures of relational health, ethnic identity, indicators of subjective well-being (SWB), and perceptions of physical health. Canonical correlation analyses revealed two patterns of relationships between the variable sets: (a) students who reported lower scores in ethnic identity and in peer, mentor, and community relationships, also demonstrated lower SWB and fewer days in good health, and (b) students who reported high relational health in peer and mentor domains, but lower scores for ethnic identity, had higher reports of both positive and negative affect, as well as both good and poor health. These preliminary findings reflect the complexity of how ethnic identity and relational health differentially predict the well-being of college students of color. The implications of these findings for counseling psychologists are discussed.
Critical Secret Disclosure in Psychotherapy With Korean Clients
Authors: Han Young-Joo , O’Brien Karen M.
Published: April 2014

Korean clients who had completed counseling in Korea and viewed the therapy as successful were interviewed about critical secret disclosure during their therapy. In-depth interviews along with grounded theory-informed analyses in a methodological hermeneutic framework revealed that many Korean clients reported that despite initial fears and needing to test their counselors, sharing their secrets was a powerful experience that deepened their connection to their counselor, facilitated positive life changes, and enhanced their relationships with others. We present a hierarchy of categories that explains the meaning and process of critical secret disclosure in therapy. The results are discussed in the context of Korean culture and how these findings can inform therapy with Korean clients.
Reduction of Spinal Loads Through Adjustable Interventions at the Origin and Destination of Palletizing Tasks
Authors: Ramsey Todd , Davis Kermit G. , Kotowski Susan E. , Anderson Vern P. , Waters Thomas
Published: April 2014

Objective:

This article evaluates the effectiveness of two interventions: a self-leveling pallet carousel designed to position the loads vertically and horizontally at origin, and an adjustable cart designed to raise loads vertically at destination to reduce spine loads.

Background:

Low back disorders among workers in manual material handling industries are very prevalent and have been linked to manual palletizing operations. Evidence into the effectiveness of ergonomic interventions is limited, with no research that investigates interventions with adjustable load location.

Method:

Thirteen males experienced in manual material handling participated in simulated order selecting tasks where spine loads were quantified for each intervention condition: carousel to traditional cart, pallet to traditional cart, pallet to adjustable cart, and carousel to adjustable cart.

Results:

The results showed that combining both devices results in reduction in spine compression (61%), anterior-posterior shear (72%), and lateral shear (63%) compared to traditional palletizing conditions. Individually, the carousel was responsible for the greatest reductions, but the lowest values were typically achieved by combining the adjustable cart and carousel.

Conclusion:

The combination of the interventions (self-leveling carousel and adjustable cart) was most effective in reducing the spine loads when compared to the traditional pallet-cart condition. The individual interventions also reduced the loads compared to the traditional condition.

Application:

With de-palletizing/palletizing tasks being a major source of low back injuries, the combination of self-leveling carousel and adjustable cart has been found to be effective in reducing the peak spine loading as compared to traditional pallet on floor and nonadjustable flat cart conditions.
Role of Social-Ecological Systems in Forest and Woodland Conservation in Zimbabwean Resettlement Areas
Authors: Mukwada Geoffrey , Taru Phillip , Chingombe Wisemen
Published: April 2014

This study investigates the importance of social-ecological systems in the conservation of forest and woodland resources in a planned resettlement area in Zimbabwe. The study uses methodological integration, comprising a questionnaire survey and participatory rural appraisal that were conducted on five randomly selected farms to explore the way resettled communities interact with tree resources and the cultural and traditional practices that they employ to conserve the resources. The study concludes that forest and woodland resource conservation is a function of complex and dynamically linked processes that are not only embedded in biophysical space but also connected to socio-economic and political realms depicting the livelihoods, social needs and culture of members of the resettled communities. This knowledge is important for designing conservation strategies in future resettlement areas.
Analysis of the shear-out failure mode for CFRP connections joined by forming
Authors: Wilhelm Maximilian F , Fuessel Uwe , Richter Thomas , Riemer Matthias , Foerster Martin
Published: April 2014

In this paper, we look at the shear-out failure of carbon fiber reinforced plastics connections in the automotive industry. Contrary to the aircraft industry, the boundary conditions of automotive applications favor this failure mode strongly. Moreover, the use of other joining technologies than that used in the aircraft industry, such as joining by forming, leads to new challenges. The different influences, typical for joining by forming, on ultimate shear-out strength were first investigated separately and then transferred and validated on connections related to praxis by an analytical model. Special attention was given to effects that resulted from oversized pre-holes, acting clamping forces, and the reduced quality of the laminates in the immediate vicinity of the joint due to the joining process.
In situ characterization of direction-dependent cure-induced shrinkage in thermoset composite laminates with fiber-optic sensors embedded in through-thickness and in-plane directions
Authors: Minakuchi Shu
Published: April 2014

This study develops a fiber-optic-based technique for in situ characterization of direction-dependent cure-induced shrinkage in thermoset fiber-reinforced composites. A procedure is established to embed fiber Bragg grating (FBG) sensors in composite out-of-plane directions and to measure key through-thickness chemical cure shrinkage directly under practical curing conditions. First, sensitivity of the proposed method is evaluated through comparison with a standard technique (i.e. thermo-mechanical analysis (TMA)), and the effect of sensor tail length on measurement sensitivity is discussed considering shear-lag effect. Next, combined with double-sided vacuum bagging and demolding during curing, FBG sensors embedded in through-thickness and in-plane directions clarify direction-dependent cure-induced shrinkage in autoclaved unidirectional carbon/epoxy. Finally, the feasibility of characterizing through-thickness shear strain, which is important in complex-shaped parts but cannot be measured using conventional techniques, is confirmed. The developed technique will be a powerful tool for evaluating cure shrinkage in complex-shaped parts and for validating process-simulation tools based on internal strain.
Micro-scale finite element analysis of stress concentrations in steel fiber composites under transverse loading
Authors: Sabuncuoglu Baris , Orlova Svetlana , Gorbatikh Larissa , Lomov Stepan V , Verpoest Ignaas
Published: April 2014

Steel fibers, with their high stiffness and high ductility, have a potential to provide a new range of properties in polymer composites, in comparison with carbon and glass fiber composites. However, the high stiffness contrast between the steel fiber and the polymer matrix plus the fiber’s non-circular cross-section are likely to generate high stress concentrations in a composite under transverse loading. In the present study, these stress concentrations are analyzed using finite element modeling and compared with the case of carbon and glass fiber composites. The study is performed for an isolated fiber and multiple fibers in hexagonal and random packings with 40% and 60% of fiber volume fractions. According to the results, in spite of a high contrast between the stiffness values of steel and glass fibers, no significant difference between the transverse stress concentrations was observed for steel and glass fibers in the hexagonal packing due to the difference in material properties. Differences in stress concentrations were noted for the case of randomly packed fibers. The polygonal cross-section of steel fibers was found to introduce extreme stress concentrations.
The dynamics of cyber conflict between rival antagonists, 2001–11
Authors: Valeriano Brandon , Maness Ryan C
Published: April 2014

Much discussion of the concept of cyberwar, cyber conflict, and the changing dynamic of future security interactions is founded upon the study of what could be, conjured through spectacular flights of the imagination. The goal of this research article is to exhaustively collect information on cyber interactions between rival states in the last decade so that we can delineate the patterns of cyber conflict as reflected by evidence at the international level. The field of cyber security needs a clear return to social science in order to be able to definitively engage the cyber debate with facts, figures, and theory. To that end we provide a dataset of cyber incidents and cyber disputes that spans from 2001 to 2011. Our data include 110 cyber incidents and 45 cyber disputes. Further, we test our theory of cyber conflict which argues that restraint and regionalism should be expected, counter-intuitive to conventional wisdom. We find here that the actual magnitude and pace of cyber disputes among rivals does not match with popular perception; 20 of 126 active rivals engaged in cyber conflict. The interactions that are uncovered are limited in terms of magnitude and frequency suggesting cyber restraint. Further, most of the cyber disputes that are uncovered are regional in tone, defying the unbounded nature of cyberpower. The coming era of cyber conflict may continue to exhibit these patterns despite fears mentioned in the discourse by the media and cyber security professionals.
The impact of a managed clinical network on referral patterns of sarcoma patients in Grampian
Authors: McCullough AL , Scotland TR , Dundas SR , Boddie DE
Published: April 2014

In 2004, the Scottish Sarcoma Managed Clinical Network (SSMCN) was established with the aim of optimising the management of patients diagnosed with sarcoma in Scotland. Clinical, radiological, oncological and pathological details of all bone and soft tissue sarcomas presenting in Scotland are registered and cases discussed in a weekly multi-centre, tele-link multidisciplinary team (MDT) forum. Sarcoma surgery and pathology assessment is undertaken in three specialist centres, Aberdeen, Edinburgh and Glasgow with oncological services provided within these units as well as in Dundee and Inverness. The aim of this study was to establish any difference in referral patterns, time to specialist review, preoperative magnetic resonance imaging scanning and whether complete margins were achieved on formal resection before and after establishment of the Scottish Sarcoma Network. A database was established of all patients presenting with sarcomas of the trunk or extremity in Grampian between 1991 and 2009. Notes for 158 patients were available for review. Seventy-nine (50%) patients presented prior to the establishment of the Scottish Sarcoma Network. Cohort analysis reveals that the establishment of the SSMCN has had a positive impact on the management of sarcoma. The number of patients undergoing formal resection by the specialist surgical team has significantly increased while the waiting time from referral to assessment by the sarcoma service has decreased.
Adenoid cystic carcinoma of the lacrimal gland metastatic to the kidney: case report and review of the literature
Authors: Bacalja Jasna , Magazin Maja , Ulamec Monika , Rako Duje , Trnski Davor , Krušlin Božo
Published: April 2014

Introduction:

Adenoid cystic carcinoma (ACC) is a malignant neoplasm that arises within secretory glands. It rarely occurs in the lacrimal gland. Kidney metastases are very rare.

Case presentation:

We report a case of a 76-year-old female patient treated with right radical nephrectomy because of the tumour mass of the right kidney. Well-circumscribed, firm, grey mass was found on the lower pole of the kidney. Histologically, tumour was considered to be ACC. Retrospective history data showed ACC of the lacrimal gland surgically treated 14 years before with metastasis to the lung operated seven years before. Our diagnosis was metastatic ACC to the kidney.

Conclusion:

ACC has a remarkable capacity for recurrence. To our knowledge, in the English-speaking area (PubMed), 10 cases of ACC metastatic to the kidney have been described to date, and this is the second reported case of kidney metastasis from primary lacrimal ACC.
Developing Climate Change Maps for Tourism
Authors: Becken Susanne , Zammit Christian , Hendrikx Jordy
Published: April 2014

Climate change adaptation is a pressing need. However, local level stakeholders often find themselves overwhelmed with climate change information presented at both small temporal and spatial scales. To address this gap, and using a case study from New Zealand’s Southern Lakes region, this research links tourism operators’ information requirements with climate change projections. Interviews with 42 stakeholders provided exemplary storylines and insights into the climate parameters that would be useful for their planning (mean precipitation, extreme wind conditions, mean temperature, and frost days). These findings were then used to generate sector-relevant maps. Climate change maps were produced based on global and regional models to generate detailed climate projection information for the A2 emission scenario in the form of regional scale, color-coded maps. A final stakeholder workshop confirmed the usefulness of the maps as a planning tool but also highlighted a number of future challenges for climate change communication.
Parenthood as a Terror Management Mechanism
Authors: Yaakobi Erez , Mikulincer Mario , Shaver Phillip R.
Published: April 2014

Six studies examined the hypothesis that parenthood serves a terror management function, with effects that are moderated by attachment orientations. In Studies 1 and 2, mortality salience, as compared with control conditions, increased the self-reported vividness and implicit accessibility of parenthood-related cognitions. In Studies 3 and 4, activating parenthood-related thoughts reduced death-thought accessibility and romantic intimacy following mortality salience. In Study 5, heightening the salience of parenthood-related obstacles increased death-thought accessibility. Across the five studies, the effects were significant mainly among participants who scored relatively low on avoidant attachment. In Study 6, avoidant people also reacted to mortality salience with more positive parenthood-related cognitions following an experimental manipulation that made parenthood compatible with their core strivings. Overall, the findings suggest that parenthood can have an anxiety-buffering effect that is moderated by attachment-related avoidance.
‘I prefer to go back the day before tomorrow, but I cannot’: Paternalistic migration policies and the ‘global exile’
Authors: Pande Amrita
Published: April 2014

In this paper I extend the literature on ‘illegal’ migrant workers by connecting the macro-level discussion on policies to the lived experiences of migrant domestic workers (MDWs) in Lebanon. I analyse two seemingly contrasting categories of ‘illegal’ migrant workers. First, the MDWs working illegally and desperate to return home, who are unable to return because of the system of migration in Lebanon. Second, MDWs banned by their state from migrating to Lebanon but who choose devious ways to make the journey. I argue that despite their apparently disparate subject positions, both sets of migrant workers are ‘illegal’ because of an underlying paternalism in the policies of nation-states towards MDWs – the gendered construction of MDWs as workers who need both protection and surveillance. This paternalism, in turn, produces a class of ‘global exiles’ who are working and living in prolonged separation from their home. They are abandoned by their home countries but trapped without any rights as either workers or citizens in the host country.
The business of the NHS: The rise and rise of consumer culture and commodification in the provision of healthcare services
Authors: Sturgeon David
Published: April 2014

The implementation of market reforms has transformed the National Health Service (NHS) from a single national healthcare provider to a complex conglomeration of national and private organisations providing healthcare under the umbrella of the NHS brand. Private and state-run organisations compete to provide services to increasingly knowledgeable and entrepreneurial healthcare consumers. As a result, the NHS has become more and more business-like and is subject to the same consumer drivers that can be identified elsewhere in society. Healthcare consumers are not typical ‘customers’, however, since most consume NHS services out of necessity and the state funds the care they receive. Yet it is this ‘necessity’ of consumption that makes contracts to provide services on behalf of the NHS such a valuable commercial opportunity for private providers. This paper examines how consumer culture has influenced attitudes towards health and dying and is contributing to the creeping commodification of healthcare consumers themselves.
‘Stubbornly unchanged’: A longitudinal study of news practices in the Israeli press
Authors: Reich Zvi
Published: April 2014

The article summarizes three consecutive studies (2001, 2006, 2011) in which national Israeli press reporters detailed how they obtained random samples of their recently published items ( N = 1003): first, in order to explore the public interest in whether the standards of news production are deteriorating, improving or staying put; second, to indicate whether journalists adjust to the transforming news ecosystem; and third, to resolve the theoretical dilemma regarding the openness of news practices to change. While showing a general trend of conservatism, data indicate some statistically significant changes across time, not always in the expected directions. Reporters rely more often on ordinary citizens (who remain a marginal source), and public relations practitioners intervene more broadly in their items. They not only question their sources’ credibility more often, but also rely on slightly more sources per item and more cross-checking, mainly thanks to older contacts rather than to new voices.
Web-based physiotherapy for people moderately affected with Multiple Sclerosis; quantitative and qualitative data from a randomized, controlled pilot study
Authors: Paul Lorna , Coulter Elaine H , Miller Linda , McFadyen Angus , Dorfman Joe , Mattison Paul George G
Published: April 2014

Objective:

To explore the effectiveness and participant experience of web-based physiotherapy for people moderately affected with Multiple Sclerosis (MS) and to provide data to establish the sample size required for a fully powered, definitive randomized controlled study.

Design:

A randomized controlled pilot study.

Setting:

Rehabilitation centre and participants’ homes.

Subjects:

Thirty community dwelling adults moderately affected by MS (Expanded Disability Status Scale 5-6.5).

Interventions:

Twelve weeks of individualised web-based physiotherapy completed twice per week or usual care (control). Online exercise diaries were monitored; participants were telephoned weekly by the physiotherapist and exercise programmes altered remotely by the physiotherapist as required.

Main measures:

The following outcomes were completed at baseline and after 12 weeks; 25 Foot Walk, Berg Balance Scale, Timed Up and Go, Multiple Sclerosis Impact Scale, Leeds MS Quality of Life Scale, MS-Related Symptom Checklist and Hospital Anxiety and Depression Scale. The intervention group also completed a website evaluation questionnaire and interviews.

Results:

Participants reported that website was easy to use, convenient, and motivating and would be happy to use in the future. There was no statistically significant difference in the primary outcome measure, the timed 25ft walk in the intervention group ( P=0.170), or other secondary outcome measures, except the Multiple Sclerosis Impact Scale ( P=0.048). Effect sizes were generally small to moderate.

Conclusion:

People with MS were very positive about web-based physiotherapy. The results suggested that 80 participants, 40 in each group, would be sufficient for a fully powered, definitive randomized controlled trial.
A study of noninvasive positive-pressure mechanical ventilation in the treatment of acute lung injury with a complex critical care ventilator
Authors: Zhang Jing , Cao Jie , Feng Jing , Wu Qi , Chen Bao-Yuan
Published: April 2014

Objective

* These authors contributed equally to this work. To test the hypothesis that there would be better clinical outcomes following the treatment of patients with acute lung injury (ALI) using noninvasive positive-pressure mechanical ventilation (NIPPV) delivered via a complex critical care ventilator compared with a conventional mini-ventilator.

Methods

Patients with ALI who required NIPPV were prospectively enrolled and randomly divided between three intervention groups: group A was ventilated using a mini-ventilator; groups B and C were ventilated using a complex critical care ventilator using different settings. Clinical parameters were recorded before and after 8 h of mechanical ventilation.

Results

A total of 51 patients with ALI were enrolled in the study. Clinical parameters in groups B and C underwent greater improvements than those in group A. Group C demonstrated the lowest treatment failure rate (23.5%). Failure rates were highest in group A (58.8%).

Conclusion

The findings of this present study suggest that there were more satisfactory clinical outcomes following the treatment of patients with ALI when NIPPV was delivered using a complex critical care ventilator compared with a conventional mini-ventilator.
The analgesic efficacy and safety of nefopam in patient-controlled analgesia after cardiac surgery: A randomized, double-blind, prospective study
Authors: Kim Kyungmi , Kim Wook-Jong , Choi Dae-Kee , Lee Yoon Kyung , Choi In-Cheol , Sim Ji-Yeon
Published: April 2014

Objective

The efficacy and side-effects of nefopam were prospectively compared with those of fentanyl for patient-controlled analgesia (PCA) following cardiac surgery.

Methods

Patients scheduled to undergo cardiac surgery were randomly assigned between three PCA groups (nefopam, fentanyl or nefopam + fentanyl). Pain was assessed at rest and during movement at 12, 24, 36, 48 and 72 h after surgery using a visual analogue scale (VAS). Total infused PCA volume, number of rescue drug injections, duration of intubation and length of stay in the intensive care unit were recorded. The incidence of adverse effects was noted at 48 h postoperatively.

Results

There were no significant between-group differences in VAS score, total PCA infusion volume or number of rescue injections ( n = 92 per group). Nausea was significantly more common in the fentanyl group compared with both other groups.

Conclusions

PCA with nefopam alone provides suitable postoperative analgesia after cardiac surgery.
The Effect of Mechanical Load on Tendon-to-Bone Healing in a Rat Model
Authors: Hettrich Carolyn M. , Gasinu Selom , Beamer Brandon S. , Stasiak Mark , Fox Alice , Birmingham Patrick , Ying Olivia , Deng Xiang-Hua , Rodeo Scott A.
Published: April 2014

Background:

Joint motion is commonly prescribed after tendon repair surgeries such as rotator cuff repairs; however, the ideal rehabilitation program to optimize tendon-to-bone healing is unknown.

Hypotheses:

(1) Delayed loading would result in a mechanically stronger and better organized tendon-to-bone interface compared with prolonged immobilization or immediate loading. (2) Low-magnitude load would lead to superior healing compared with high-magnitude load.

Study Design:

Controlled laboratory study.

Methods:

A total of 192 rats underwent unilateral patellar tendon detachment and repair followed by placement of a custom external fixator. Rats were assigned to immobilization, immediate postoperative loading, or delayed-onset loading (4- or 10-day delay). Loading was controlled using a specially designed motorized device to apply constant strain until 3 N (low load) or 6 N (high load) of axial tensile force was reached through the healing bone-tendon complex for 50 cycles per day. Rats were sacrificed at 4, 10, 21, or 28 days postoperatively for histomorphometric, immunohistochemical, radiographic, molecular, and biomechanical analyses.

Results:

The load to failure was significantly higher in the immobilized group compared with the immediate and delayed loading groups ( P < .05). Compared with loaded specimens, the immobilized specimens had significantly less fibrocartilage (at 4, 10, and 28 days), significantly better collagen fiber organization (at 4, 10, and 21 days), decreased expression of matrix metalloproteinase-13 (at 10, 21, and 28 days), and significantly fewer apoptotic cells (at 21 and 28 days). Micro–computed tomographic analyses showed that the 3-N immediate load group had significantly less total volume ( P = .012), bone volume ( P = .012), and bone mineral density ( P = .023) for cortical bone, and the immobilized group had significantly more specimens with new bone formation at the enthesis (100%; P = .001).

Conclusion:

Immobilization results in a stronger tendon-bone complex, with less scar tissue and a more organized tendon-bone interface compared with all loading regimens in this study.

Clinical Relevance:

Given the relatively high rate of failure after rotator cuff and other tendon-to-bone repairs, identification of optimal rehabilitation programs postoperatively is an important research goal.
Ankara, Tehran, Baghdad
Authors: Houston Christopher
Published: April 2014

Kemalism has been the guiding and justifying ideology of the Turkish Republic since its institution in 1923. That Kemalism is exclusive to Turkey is a mainstay of Kemalist self-perception. But was (or is) Kemalism as political practice pursued by other regimes in the region? This paper argues that Kemalism should also be understood as a project of urbanism, and that urban interventions into Ankara, Tehran and Baghdad in the 20th century transformed all three into Kemalist cities. To illustrate, I describe certain features of their spatial, symbolic and sensory re-organization. My concluding remarks address the radically divergent fate of Kemalist urbanism in the contemporary cities of Baghdad, Tehran and Ankara.
Bankrupted Detroit
Authors: Desan Mathieu Hikaru
Published: April 2014

The recent declaration of the largest municipal bankruptcy in US history has propelled Detroit’s plight into the international spotlight. Though a victim of the general decline of US manufacturing, drawing on Thomas Sugrue’s pioneering work I argue that Detroit’s crisis is better understood as a specifically urban crisis. The city’s concentrated poverty and desolation and its fiscal straits are not reducible to broader economic trends, nor are they exclusively the product of political mismanagement. Rather, they are the outcome of a long history of economic decentralization and racial segregation, made worse by a politico-administrative arrangement that distributes wealth and services unequally across the metropolitan area. By imposing municipal austerity, Detroit’s bankruptcy is unlikely to do much to address these fundamental inequalities. Any plan to revitalize the city must move beyond boosterism and tackle head on the problems of racial and economic segregation that continue to affect Detroit’s 700,000 residents.
On the verge of displacement
Authors: Yunianto Tunggul
Published: April 2014

Jakarta is a city of high aspirations of the entrepreneurial and professional middle classes. For the rich, this brave new world of malls, office parks, and apartments represents an optimistic economy. The displaced poor, however, express an emotional economy of fear and anger that begets a politics of resistance. This study seeks to grasp the new urbanisms that uncover this ‘structure of feeling’ among the poor. I suggest that the urban imaginary of Jakarta is co-constituted by a symbiosis of optimism and ambitions on the one hand and, on the other, by pessimism, fear, and anger materialized in the resistance of the occluded and expressed through processes of questioning and cursing the profit-seeking dreams that are transforming the cityscapes. Exploring the making of Jakarta in this way can lead to a fuller understanding of the politics of urban transformation – one that moves away from assuming globalizing neoliberalism is the sole or primary force shaping the urban world.
Benjamin, Adorno and modern-day flânerie
Authors: Biron Dean
Published: April 2014

The flâneur has remained little more than a hazy, nostalgic figure since first described in detail by Baudelaire in 19th-century Paris. Here, the work of Walter Benjamin, who did more than any other to advance the notion of flânerie post-Baudelaire, is considered alongside that of his friend and critic Theodor Adorno, in an attempt to conceive of a modern-day version of the type. The many critical exchanges between Adorno and Benjamin are envisioned as a moving dialectic: a constant interplay between anticipation and suspicion. What results is a concept of flânerie that mingles a tentatively optimistic Benjamin with a perpetually sceptical Adorno, in order to conjure up an image of the individual strolling and wandering about the margins of contemporary urbanity, balanced on the cusp of hope and hopelessness.