bluuebunny/crossref_metadata_2025 huggingface dataset:
Pour une approche géopoétique du récit de voyage
Authors: Bouvet Rachel , Marcil-Bergeron Myriam
Published: August 2013

Cet article présente les bases du mouvement initié par l’Institut international de géopoétique. La dimension transdisciplinaire de ce champ de recherche et de création, fondé par Kenneth White en 1989, de même que la prédominance de certains principes tels que le nomadisme, le dehors et la critique radicale, rejoignent plusieurs préoccupations propres au récit de voyage, situé au croisement de la littérature et de la géographie. L’approche géopoétique ouvre la réflexion aussi bien sur le pôle poétique, soit le rapport intrinsèque entre le voyage vécu et l’écriture du voyage, que sur le pôle de la lecture, qui implique de prendre en considération la subjectivité du lecteur et son propre rapport au monde. L’examen de certains récits des Écrits sur le sable d’Isabelle Eberhardt (appartenant à la fois aux littératures suisse, française et maghrébine) donne l’occasion d’explorer différentes notions importantes en géopoétique telles que le paysage, la polysensorialité et le mouvement.
Le « mouvement de la connaissance » selon la migration interdimensionnelle
Authors: Serruys Nicholas
Published: August 2013

Les Voyageurs malgré euxd’Élisabeth Vonarburg fait éclater les repères spatio-temporels selon la poétique de l’uchronie(l’histoire revisitée), sous-genre de la science-fiction (SF). Il s’agit de la présentation d’une histoire alternative de la Nord-Amérique. Les écarts entre l’univers du récit et le monde empirique se manifestent aux niveaux historique (acteurs et événements), politique (pouvoir établi et factions contestataires), démographique (situation physique et conditions socioéconomiques), géographique (à l’échelle urbaine et géologique), ainsi que scientifique et anthropologique (normalisation de dons paranormaux). La distanciation exploitée sert pourtant de rapprochement par analogie, et le récit se prête ainsi à une réévaluation des enjeux historiques et territoriaux du Québec, brouillant l’imaginaire et l’Histoire factuelle. Nous démontrons en quoi les parcours des personnages du roman constituent un métadiscours sur l’expérience de la littérature ; sa production et sa réception.
Mode de donation de l’espace « guidé » dans le discours des guides touristiques
Authors: Seoane Annabelle
Published: August 2013

Dans une démarche d’analyse du discours, nous analyserons l’institution d’un savoir partagé à travers la thématique de la spatialité dans deux guides touristiques, le Guide Gallimard et le Guide du Routard. Nous tâcherons d’établir que le locuteur s’adresse à un lecteur « ambulant » et à un lecteur « sédentaire », statique, et qu’il construit discursivement un espace « guidé » selon la visée didactique mais surtout pragmatique qui est la sienne. Cet angle prolongera la réflexion sur les liens entre l’objet extra-discursif et la représentation que s’en fait le lecteur. L’étude de quelques textes choisis révèlera que la notion d’espace s’élabore dans le discours par la mobilisation de représentations socioculturelles et que cet espace est également le lieu de la construction d’un positionnement spécifique du locuteur.
Entre la protection des salariés et la performance de l’entreprise : la gestation d’un droit français du télétravail
Authors: Desbarats Isabelle
Published: August 2013

La France est en retard : le taux de télétravailleurs y est bien inférieur à celui qui est en vigueur chez ses voisins européens. Et pourtant, l’utilisation accrue des technologies de l’information et de la communication (TIC) ainsi que la nécessité d’améliorer la flexibilité et la performance des entreprises sont autant de facteurs qui devraient favoriser l’essor de nouvelles formes de travail, dont le télétravail. En France, celui-ci est désormais au coeur de l’actualité, en raison de sa reconnaissance par la loi du 22 mars 2012. Quels sont, en droit français, la définition du télétravail et le statut du télétravailleur ? De quelle façon celui-ci a-t-il été amélioré pour accroître son attractivité, mais quels sont encore les obstacles à lever pour favoriser l’essor de cette organisation innovante du travail ? Quel est l’impact de cette forme de travail, notamment sur la santé du télétravailleur et le droit au respect de sa vie privée, à l’heure où se développent de nouveaux modes de contrôle par l’employeur ? Tels sont, en France, quelques-uns des enjeux juridiques du télétravail, dont l’essor dépend, entre autres, d’un réel équilibre entre l’intérêt de l’entreprise et la protection des droits des télétravailleurs.
Santé mentale au travail : l’échec du droit à épouser une approche systémique
Authors: Desjardins Annick , Giguère Céline
Published: August 2013

Dans le présent article, les auteures souhaitent mettre en lumière les lacunes de l’encadrement juridique au regard des problèmes de santé mentale au travail dans une perspective de santé publique. Tandis que des recherches dans le domaine de la santé au travail permettent de mettre en évidence des facteurs de risques et de connaître de mieux en mieux les pratiques de gestion à privilégier, le droit peine à appuyer ces efforts vers une meilleure gestion organisationnelle qui épouserait une approche préventive. Somme toute, le droit est tributaire, dans ce domaine, de l’interprétation jurisprudentielle, laquelle hésite, voire se refuse, à faire porter un fardeau supplémentaire aux entreprises en vue d’une meilleure prise en charge des problèmes de santé mentale des salariés. Les auteures illustrent leur propos à l’aide des développements jurisprudentiels en matière de droit à l’égalité et d’accommodement des déficiences d’ordre psychologique, ainsi qu’en matière de prévention du harcèlement psychologique au travail. Enfin, elles abordent succinctement les raisons pour lesquelles le régime de prévention en matière de santé et de sécurité du travail pourrait servir de levier à un virage vers une approche de prévention systémique.
L’insuffisance du droit de l’inaptitude à maintenir en emploi les salariés victimes de souffrances au travail
Authors: Fantoni-Quinton Sophie
Published: August 2013

Les pathologies mentales en milieu de travail recouvrent non seulement les troubles mentaux d’origine non professionnelle, mais également les nombreux cas de souffrances du fait du travail (dus à l’organisation et aux relations du travail). Concernant les souffrances dues au travail, le système juridique français a une double action. En amont, il impose à l’employeur d’améliorer dans un processus continu les conditions de travail de chacun des travailleurs pour prévenir une altération ou une détérioration de l’état de santé du salarié. En aval de la survenue d’une altération de la santé mentale des salariés, il existe, dans le droit français de l’(in)aptitude, des outils incitatifs, voire coercitifs, pour imposer à l’employeur l’adaptation du poste de travail d’un salarié en difficulté et son reclassement en cas d’inaptitude au poste antérieur ou de handicap avérés. Cependant, ce droit de l’(in)aptitude qui concerne chaque salarié recèle des limites inhérentes à la question même de la santé mentale au travail.
Quand la sécurité nationale américaine fait fléchir le principe de la non-discrimination en droit canadien : le cas de l’International Traffic in Arms Regulations (ITAR)
Authors: Bendaoud Maroine
Published: August 2013

L’auteur propose d’étudier l’imposition de l’ensemble de règles contenues dans l’International Traffic in Arms Regulations (ITAR) et leur effet discriminatoire en matière d’emploi aux États-Unis puis au Canada. D’abord, il tentera d’expliquer en quoi consiste l’ITAR. Ensuite, il cherchera à déterminer si ses mesures sont réellement conformes aux lois antidiscrimination en emploi du côté américain ainsi qu’à celles qui sont applicables au Québec. Enfin, les récentes modifications à l’ITAR sous l’administration d’Obama retiendront aussi l’attention. Concrètement, la politique américaine poussait les compagnies canadiennes à exclure un employé-stagiaire né dans un des 25 pays proscrits (pays ennemis des États-Unis, pays communistes ou encore sous embargo) ou en détenant la citoyenneté. Washington souhaitait ainsi protéger certaines données techniques qui auraient pu se retrouver entre les mains d’employés présumés « peu scrupuleux », uniquement de par leurs origines. Depuis plus d’une décennie, les compagnies canadiennes dans les domaines de la défense et de l’aérospatiale, qui recevaient des contrats du gouvernement américain, étaient devant un dilemme de taille. Elles étaient obligées de respecter les critères de l’ITAR sous peine de sanctions et la perte de contrats.
Le droit international et la réglementation des agences de notation de crédit : vers une réglementation universelle ?
Authors: Maheu Claudia
Published: August 2013

À la suite de l’effondrement du système financier international en 2008, la communauté internationale a accusé les agences de notation de crédit d’avoir été la pierre angulaire du gouffre financier, particulièrement en ce qui a trait à la dérive des produits adossés à des actifs. L’article qui suit offre une mise en perspective de la structure réglementaire internationale en place avant et après les évènements financiers. L’auteure fera ressortir le manque flagrant d’encadrement des agences de notation de crédit avant 2008 et les difficultés à réaliser pour l’avenir un cadre réglementaire international qui soit efficient et harmonisé.
Frequency of Serious Outcomes in Patients With Hypertension as a Chief Complaint in the Emergency Department
Authors: Frei Steven P. , Burmeister David B. , Coil Jesse F.
Published: August 2013

Context: Hypertension is a common incidental finding in the emergency department (ED). However, the authors noticed a segment of patients who present to the ED specifically because their blood pressure is found to be elevated outside of the hospital. Emergency medicine physicians are often unsure of the level of intervention that is required for these patients.

Objective: To determine if these patients have serious outcomes (ie, final diagnosis of myocardial infarction, angina, coronary syndrome, congestive heart failure, pulmonary edema, hypertensive encephalopathy, malignant hypertension, stroke, transient ischemic attack, subarachnoid hemorrhage, loss of vision, kidney failure, or aortic dissection) within 7 days of the initial ED visit.

Methods: The authors retrospectively reviewed ED medical records from 2008 with a chief complaint of high blood pressure or hypertension in the physician or nursing notes. Age, sex, blood pressure, history of hypertension, associated symptoms, tests, medications, admission or discharge information, final diagnoses, and return visits within 7 days were recorded.

Results: Of the 316 medical records that were reviewed, 149 met the study criteria and were included in analysis. Patient age range was 19 to 94 years (mean, 59.8 years; median, 61 years). Sixty patients (40%) were men and 89 (60%) were women. Of the 149 patients, 121 (81%) had a previous diagnosis of hypertension and 28 (19%) did not. Five patients (3%) had a normal initial blood pressure in the ED. Sixteen patients (11%) did not undergo diagnostic tests, and 77 patients (52%) received medication in the ED. Twenty-six patients (17%) were admitted to the hospital, and 123 (83%) were discharged or eloped. Four patients (2.7%; 95% confidence interval, 0.7-6.7) had a serious outcome noted within 7 days of initial presentation to the ED.

Conclusion: Among patients presenting to the ED with a chief complaint of hypertension or high blood pressure and no serious associated complaint, the risk of serious outcome within 7 days is low.
Leg Length Discrepancy and Osteoarthritic Knee Pain in the Elderly: An Observational Study
Authors: Noll Donald R.
Published: August 2013

Context: Osteoarthritic knee pain is very common, as are leg length discrepancies (LLDs). The relationship between LLDs and osteoarthritic knee pain is not well understood.

Objective: To confirm a clinical impression that osteoarthritic knee pain is more common in the short (ie, superior-presenting) leg, as measured by supine physical examination of 3 bony landmarks: the medial malleoli, the anterior superior iliac spines, and the iliac crests. The secondary objective was to measure the relative positions of the 3 bony landmarks to better understand functional contributions to LLD.

Methods: A prospective single-occasion observational design was used. Patients who reported osteoarthritic knee pain during an office visit were recruited, and data were collected on 3 bony landmarks and which knee was usually most painful.

Results: Of the 32 participants who were recruited, 28 were women and 4 were men. Of the 17 participants who reported having right knee pain, 10 had a short right leg and 7 had a short left leg. Of the 15 participants who reported having left knee pain, 13 had a short left leg, 1 had a short right leg, and 1 had equal leg lengths. Knee pain was most severe in the short leg for 23 of 32 participants (71.9%). The most common pattern was for both iliac crests to be equal and the short leg to be concordant with a superior anterior superior iliac spine, which occurred in 23 of 32 participants (71.9%). In the present study population, the magnitude of LLD ranged from 0 to 2.1 cm.

Conclusion: Osteoarthritic knee pain was more common in the apparent short leg. More sophisticated studies, including investigations into the role of pelvic torsion in knee pain, as well as investigations for interoperator reliability and validity, are needed to build on the findings reported in this observational study.
Mucormycosis in a Patient With AIDS Receiving Systemic Steroids
Authors: Pan Andrew Shiau , Srinath Latha
Published: August 2013

Mucormycosis is an opportunistic fungal infection with a high mortality rate. Although mucormycosis is relatively rare, recent studies suggest that the incidence is on the rise as a result of increased use of chemotherapy and steroids. The authors present an unusual case of invasive mucormycosis in a hospitalized patient with AIDS who was receiving short-term, high-dose steroids and who had associated steroid-induced diabetes. The patient was otherwise healthy, with no underlying risk factors such as neutropenia or intravenous drug use. The patient developed acute onset of proptosis, vision loss, and invasiveMucorin the left maxillary sinus that extended along the optic nerve intracranially. Despite aggressive treatment, the patient died. Physicians should be aware of steroid-induced diabetes as a risk factor for invasive fungal infections such as mucormycosis.
Movements of walruses (Odobenus rosmarus) between Central West Greenland and Southeast Baffin Island, 2005-2008
Authors: Dietz Rune , Born Erik W , Stewart Robert EA , Heide-Jørgensen Mads Peter , Stern Harry , Rigét Frank , Toudal Leif , Lanthier Clement , Jensen Mikkel Villum , Teilmann Jonas
Published: August 2013

Between 2005 and 2008, 31 walruses were tagged with Argos satellite transmitters at their wintering grounds at Store Hellefiske Banke, Central West Greenland (N=23), and at their summering grounds off the coast of Southeast Baffin Island, Canada (N=8). Two male walruses moved along the Greenland coast from Store Hellefiske Banke north to Disko Banke, where contact was lost. Two other males went further north, up to the Upernavik area. Contact was lost with one of these tags, but the other animal travelled southward again and went towards SE Baffin Island. Eight of the tagged walruses moved between West Greenland and Baffin Island, demonstrating a connection between walruses at these sites. Walruses left the Store Hellefiske Banke during the period 7 April to 17 May and on average used 7 days to swim the 400 km across Davis Strait. The migration routes were quite similar; they travelled over the shallowest areas at the narrowest part of the strait. The timing of the spring dispersal and migration towards Canada was closely linked to the extent and timing of the retreat of the pack ice edge. One flipper tagged male that was marked off South Baffin Island was recovered in a hunt on Store Hellefiske Banke, documenting that the reverse migration also occurs. Off West Greenland satellite tagged walruses spent a lot of time around the Store Hellefiske Banke (55.0o-56.5o W), using this shallow area as feeding grounds irrespective of the ice cover in this area. Partial sexual segregation was observed. Despite a tendency in West Greenland for males to occur farther offshore, farther from the ice edge and at greater depths, only their preference for denser ice cover (64% ice cover) differed significantly (P=0.019) from the habitat preferences of females (52% ice cover). Coast dispersal was more condensed and the segregation between males and females was more pronounced during autumn along the Southeast Baffin Island. Females remained farther north (P<0.001) and farther east (P=0.006), and males were more often located offshore in areas with greater water depths (P=0.024). Males had also had larger home range than females during both seasons.
Abundance of walruses in Eastern Baffin Bay and Davis Strait
Authors: Heide-Jørgensen Mads Peter , Laidre Kristin , Fossette Sabrina , Rasmussen Marianne H , Nielsen Nynne Hjort , Hansen Rikke G
Published: August 2013

Walruses (Odobenus rosmarus) are exploited for subsistence purposes in West Greenland. However, current information about the abundance of walruses subject to harvest in eastern Baffin Bay subject to harvest has been unavailable despite being critical for maintaining sustainable catch levels. Three visual aerial surveys were conducted in 2006 (21 March to 19 April 2006), 2008 (3 to 12 April) and 2012 (24 March to 14 April) to estimate the number of walruses on the wintering grounds in eastern Baffin Bay and Davis Strait. Data on the fraction of walruses that were submerged below a 2m detection threshold during the surveys were obtained from 24 walruses instrumented with satellite-linked-time-depth-recorders in northern Baffin Bay in May-June 2010-2012. An availability correction factor was estimated at 36.5% (cv=0.08) after filtering of data for an observed drift of the pressure transducer of more than 2.5 m. The surveys resulted in walrus abundance estimates that were corrected for walruses submerged below a detection threshold and for walruses that were missed by the observers. The estimates of abundance were 1,105 (cv=0.31, 95% CI 610-2,002) in 2006, 1,137 (0.48, 468-2,758) in 2008 and 1,408 (0.22, 922-2,150) in 2012.
Microsatellite assessment of walrus (Odobenus rosmarus rosmarus) stocks in Canada
Authors: Shafer Aaron BA , Davis Corey S , Coltman David W , Stewart Robert EA
Published: August 2013

Walruses in Canada are currently subdivided into seven stocks based on summering areas; Western Jones Sound (WJS), Baffin Bay (BB), Penny Strait-Lancaster Sound (PS-LS), North Foxe Basin (N-FB), Central Foxe Basin (C-FB), Hudson Bay Davis Strait (HB-DS) and Southern and Eastern Hudson Bay (SE-HB). In this study, walrus were sampled from six of the seven stocks (SE-HB samples were not available) and genotyped at 10 microsatellite loci. All stocks were genetically diverse (average heterozygosity of 0.58) with no evidence of inbreeding (average FIS of 0.03). We detected significant genetic differentiation among the stocks and a pattern of genetic spatial autocorrelation that suggests a moderate effect of geographic distance on gene flow among stocks. Bayesian clustering suggested the six recognized stocks were elements of two larger genetic clusters - a northern Arctic population (containing BB, WJS, and PS-LS stocks) and a central Arctic population (containing C-FB, N-FB, and HB-DS stocks). These populations are moderately differentiated (FST = 0.07), but based on evidence of contemporary movement from assignment tests, are not completely isolated. There was support for maintaining the WJS stock and a combined BB+PS-LS stock, although the latter conclusion is based on a small sample size. Similarly, there was some evidence suggesting separation of the Foxe Basin stocks from the HB-DS but not the N-FB from the C-FB stock. However, given that there are morphological and chemical differences between N-FB and C-FB stocks, there is currently insufficient evidence to support a revision of the current stock designations.
Clinical Outcomes of Pediatric Patients With Acute Abdominal Pain and Incidental Findings of Free Intraperitoneal Fluid on Diagnostic Imaging
Authors: Matz Samantha , Connell Mary , Sinha Madhumita , Goettl Christopher S. , Patel Palak C. , Drachman David
Published: August 2013

Objectives

The presence of free intraperitoneal fluid on diagnostic imaging (sonography or computed tomography [CT]) may indicate an acute inflammatory process in children with abdominal pain in a nontraumatic setting. Although clinical outcomes of pediatric trauma patients with free fluid on diagnostic examinations without evidence of solid‐organ injury have been studied, similar studies in the absence of trauma are rare. Our objective was to study clinical outcomes of children with acute abdominal pain of nontraumatic etiology and free intraperitoneal fluid on diagnostic imaging (abdominal/pelvic sonography, CT, or both).

Methods

We conducted a retrospective review of medical records of children aged 0 to 18 years presenting to a pediatric emergency department with acute abdominal pain (nontraumatic) between April 2008 and March 2009. Patients with intraperitoneal free fluid on imaging were divided into 2 groups: group I, imaging suggestive of an intra‐abdominal surgical condition such as appendicitis; and group II, no evidence of an acute surgical condition on imaging, including patients with equivocal studies. Computed tomograms and sonograms were reviewed by a board‐certified radiologist, and the free fluid volume was quantitated.

Results

Of 1613 patients who underwent diagnostic imaging, 407 were eligible for the study; 134 (33%) had free fluid detected on diagnostic imaging. In patients with both sonography and CT, there was a significant correlation in the free fluid volume (r = 0.79; P < .0005). A significantly greater number of male patients with free fluid had a surgical condition identified on imaging (57.4% versus 25%; P < .001). Children with free fluid and an associated condition on imaging were more likely to have surgery (94.4% versus 6.3%; P < .001).

Conclusions

We found clinical outcomes (surgical versus nonsurgical) to be most correlated with a surgical diagnosis on diagnostic imaging and not with the amount of fluid present.
Fusion Imaging–Guided Percutaneous Biopsy of Focal Hepatic Lesions With Poor Conspicuity on Conventional Sonography
Authors: Park Hyun Jeong , Lee Min Woo , Lee Mi Hee , Hwang Jiyoung , Kang Tae Wook , Lim Sanghyeok , Rhim Hyunchul , Lim Hyo K.
Published: August 2013

Objectives

The purpose of this study was to evaluate the effectiveness of real‐time fusion imaging (sonography combined with computed tomography or magnetic resonance imaging) for percutaneous sonographically guided biopsy of focal hepatic lesions with poor sonographic conspicuity.

Methods

This study was conducted as a retrospective analysis of a prospective database and was approved by the Institutional Review Board. Patients who had target lesions with poor conspicuity on B‐mode sonography for percutaneous biopsy were enrolled in the study. Lesion conspicuity was assessed by conventional B‐mode sonography first and then by fusion imaging later in the same session. We compared lesion conspicuity and detection rates between B‐mode sonography and fusion imaging and evaluated how many cases of initially invisible lesions on B‐mode sonography became visible on fusion imaging. The technical success rate was evaluated on the basis of the final diagnoses, which were established by pathologic examination of the biopsy specimens as well as follow‐up clinical and radiologic examinations.

Results

A total of 22 patients were enrolled in the study. On fusion imaging, lesion conspicuity was increased in 63.6% of focal hepatic lesions (14 of 22). Moreover, 66.7% of lesions (6 of 9) that were invisible on B‐mode sonography became visible on fusion imaging. The true‐positive detection rate was significantly different between B‐mode sonography and fusion imaging (9 of 22 versus 19 of 22; P = .0044). Percutaneous biopsy was performed for all lesions, including 3 target lesions that were invisible even on fusion imaging. The technical success rate was 95.5% (21 of 22).

Conclusions

Fusion imaging is effective for percutaneous biopsy of focal hepatic lesions with poor sonographic conspicuity.
Routine Sonographic Measurement of the Near‐Field Lateral Ventricle During Second‐Trimester Morphologic Scans
Authors: VanHaltren Keith , Bethune Michael , Curcio Frank , Lombardo Paul , Schneider-Kolsky Michal E.
Published: August 2013

Objectives

The purpose of this study was to determine whether measurement of the near‐field lateral ventricular diameter can be reliably obtained within a practical time frame during second‐trimester obstetric scans by angling the fetal head approximately 30° away from the horizontal image axis such that the posterior aspect of the fetal head lies closer to the transducer.

Methods

Fifty consecutive singleton pregnancies presenting for a routine‐second trimester scan were recruited for this study. The far‐field lateral ventricular diameter was measured, followed by the near‐field lateral ventricular diameter using the proposed technique. The measurements were repeated by a second operator who was blinded to the first measurement. Both operators recorded the measurements taken and scored the level of visibility of the near‐field lateral ventricle. The difference between the two operators' measurements was compared by a κ analysis.

Results

The near‐field lateral ventricle was visualized in 49 of 50 cases (98%). There was no statistically significant difference in the measurement of the near‐field lateral ventricular diameter by the two operators (P = .34). There was, however, a statistically significant difference in the time it took each operator to obtain the near‐field measurement after the far‐field measurement (P = .01).

Conclusions

Manipulating the transducer to position the falx of the fetal head approximately 30° away from the horizontal image axis allows the near‐field lateral ventricle to be routinely visualized and measured with a high degree of interoperator agreement and within a practical time frame once the operator is experienced in performing the technique.
Efficiency of First‐Trimester Uterine Artery Doppler, A‐Disintegrin and Metalloprotease 12, Pregnancy‐Associated Plasma Protein A, and Maternal Characteristics in the Prediction of Preeclampsia
Authors: Goetzinger Katherine R. , Zhong Yan , Cahill Alison G. , Odibo Linda , Macones George A. , Odibo Anthony O.
Published: August 2013

Objectives

The purpose of this study was to estimate the efficiency of first‐trimester uterine artery Doppler, A‐disintegrin and metalloprotease 12 (ADAM12), pregnancy‐associated plasma protein A (PAPP‐A), and maternal characteristics in the prediction of preeclampsia.

Methods

We conducted a prospective cohort study of patients presenting for first‐trimester aneuploidy screening between 11 and 14 weeks' gestation. Maternal serum ADAM12 and PAPP‐A levels were measured by an immunoassay, and mean uterine artery Doppler pulsatility indices were calculated. Outcomes of interest included preeclampsia, early preeclampsia (defined as requiring delivery at <34 weeks' gestation), and gestational hypertension. Logistic regression analysis was used to model the prediction of preeclampsia using ADAM12 multiples of the median (MoM), PAPP‐A MoM, and uterine artery Doppler pulsatility index MoM, either individually or in combination. The sensitivity, specificity, and area under the receiver operating characteristic curves were used to compare the screening efficiency of the models using nonparametric U statistics.

Results

Among 578 patients with complete outcome data, there were 54 cases of preeclampsia (9.3%) and 13 cases of early preeclampsia (2.2%). Median ADAM12 levels were significantly lower in patients who developed preeclampsia compared to those who did not (0.81 versus 1.01 MoM; P = .04). For a fixed false‐positive rate of 10%, ADAM12, PAPP‐A, and uterine artery Doppler parameters in combination with maternal characteristics identified 50%, 48%, and 52% of patients who developed preeclampsia, respectively. Combining these first‐trimester parameters did not improve the predictive efficiency of the models.

Conclusions

First‐trimester ADAM12, PAPP‐A, and uterine artery Doppler characteristics are not sufficiently predictive of preeclampsia. Combinations of these parameters do not further improve their screening efficiency.
Formative Assessment Based on an Audit and Feedback Improves Nuchal Translucency Ultrasound Image Quality
Authors: Chalouhi Gihad E. , Salomon Laurent J. , Fontanges Marianne , Althuser Marc , Haddad Georges , Scemama Olivier , Chabot Jean-Michel , Duyme Michel , Fries Nicolas
Published: August 2013

Objectives

The purpose of this work was to study the impact of an audit and feedback on the quality of routine first‐trimester nuchal transparency ultrasound images.

Methods

Eighty‐eight sonographers were each sent 2 different series of 30 consecutive nuchal translucency images at a mean interval of 3 months to a dedicated, protected server for remote double‐blind independent analysis based on the new Collège Français d'Echographie Foetale/Centre National de la Recherche Scientifique image‐scoring method (https://www.cfef.org/evaluation/ISMCFEFCNRS.pdf). The sonographers were classified as low (score below the median) or high (score above the median) scorers for each series. Before their second evaluation, 73 of the 88 sonographers received a feedback report on their first series of images, whereas the other 15 participants received no feedback. The baseline characteristics of the participants who did and did not receive feedback were comparable.

Results

Participants who received feedback increased their average score significantly, from a mean ± SD of 11.1 ± 1.3 to 13.4 ± 1.4 among low scorers (P < .00001) and from 15.1 ± 1.2 to 16.0 ± 1.4 among high scorers (P < .001), whereas no significant change was seen among participants who received no feedback (low scorers, 10.9 ± 1.5 to 12.1 ± 2.0; P = .11; high scorers, 14.7 ± 1.3 to 14.6 ± 1.3; P = .99). The proportion of satisfactory images increased by 48% among low scorers who received feedback.

Conclusions

Formative assessment based on a moderately intensive audit and feedback is feasible and effective for improving the quality of routine first‐trimester nuchal transparency ultrasound images.
Efficacy of the Genetic Sonogram in a Stepwise Sequential Protocol for Down Syndrome Screening
Authors: Shamshirsaz Alireza A. , Ravangard Samadh F. , Turner Garry , Borgida Adam , Janicki Mary Beth , Campbell Winston A. , Zelop Carolyn , Shamshirsaz Amirhoushang A. , Spiel Melissa , Prabulos Anne Marie , Feldman Deborah , Rodis John , Ingardia Charles J. , Gurram Padmalatha , Fuller Kisti , Fang Yu M. , Benn Peter , Egan James F. X.
Published: August 2013

Objectives

The purpose of this study was to evaluate the efficacy of the genetic sonogram in Down syndrome screening for women who have received the stepwise sequential test.

Methods

This retrospective cohort study included women with singleton pregnancies who underwent stepwise sequential (first‐trimester combined and second‐trimester serum) screening and then had a genetic sonogram between March 2005 and January 2010. Stepwise sequential Down syndrome risks were multiplied by either a positive or negative likelihood ratio based on the second‐trimester sonographic findings to determine the final Down syndrome risk. A final Down syndrome risk of 1:270 or higher was considered screen positive.

Results

A total of 6286 women fulfilled our criteria, including 17 with Down syndrome–affected fetuses. After stepwise sequential testing, the Down syndrome detection rate was 88.2% (15 of 17), and after the genetic sonogram, there was a non‐significant reduction in detection to 82.4% (14 of 17; P > .05). For the 6269 unaffected pregnancies, the genetic sonogram converted 58 screen‐negative results (1%) to positive and 183 screen‐positive results (3.1%) to negative. The net effect was a change in the false‐positive rate from 6.2% (390 of 6269) after stepwise sequential screening to 4.2% (266 of 6269) after the genetic sonogram.

Conclusions

The genetic sonogram should be applied cautiously for women who have received prior prenatal screening tests. Women with screen‐positive results need to be counseled that a negative sonographic result can be falsely reassuring. Conversely, for women with screen‐negative results who have a risk close to the cutoff, a sonographic examination could assist in the decision of whether to accept or reject amniocentesis.
Reference Values for the Right and Left Fetal Choroid Plexus at 11 to 13 Weeks
Authors: Abu-Rustum Reem S. , Ziade M. Fouad , Abu-Rustum Sameer E.
Published: August 2013

Objectives

The purpose of this study was to establish reference values for the length, area, and circumference of the right and left fetal choroid plexus at 11 to 13 weeks with respect to the fetal biparietal diameter and to compare the right to the left side.

Methods

We conducted a prospective study on 114 fetuses at 11 to 13 weeks undergoing first‐trimester screening for aneuploidy and structural fetal abnormalities. After the establishment of the fetal situs, the plane of the “butterfly” was obtained on all fetuses, from which the length, area, and circumference of both the right and left choroid plexus were obtained and the right and left sides compared. Using a pairedttest, analysis of variance, scatterplots, and linear and logarithmic fittings, reference ranges and charts for the length, area, and circumference of the choroid plexus were then formulated according to their relationship to the fetal biparietal diameter.P< .05 was considered statistically significant.

Results

Reference values for the length, area, and circumference of the fetal choroid plexus, with respect to the fetal biparietal diameter, were established. There was a statistically significant difference between the right and left sides for all parameters, with all measurements statistically greater on the left side (P< .0001).

Conclusions

Reference values for the length, area, and circumference of the fetal choroid plexus at 11 to 13 weeks are presented. These may prove to be of clinical importance in the early screening for central nervous system abnormalities. In addition, the statistically significant difference between the right and left sides may be an early sign of “developmental” laterality.
Medial or Lateral Location of the Whirlpool Sign in Adnexal Torsion
Authors: Navve Daniella , Hershkovitz Reli , Zetounie Eti , Klein Zvi , Tepper Ronnie
Published: August 2013

Objectives

The whirlpool sign is used as a sonographic marker for adnexal torsion. The aims of this study were to describe the location of the whirlpool sign (lateral or medial to the ovary) and to evaluate the clinical importance of the location.

Methods

: Thirty patients with a confirmed surgical diagnosis of torsion and a positive whirlpool sign on sonography before surgery were included. We examined the sonographic clips of these patients. Classic signs of adnexal torsion were determined: ovarian edema, the presence of a mass, pelvic free fluid, and ovarian ischemia on Doppler imaging. The whirlpool sign was detected on grayscale and color Doppler sonography by moving the transducer to and fro along the axis of suspected torsion.

Results

Sixteen of 30 patients had right‐sided torsion. Of these, 7 had a lateral whirlpool sign. All 7 of these patients had an ovarian or paraovarian mass. Nine of these 16 patients had a medial whirlpool sign. Of these, 7 had an ovarian or paraovarian mass, and 2 had no mass. Of the 14 patients with left‐sided torsion, all had a medial whirlpool sign. Nine of 14 these patients had an ovarian or paraovarian mass, and 5 had no mass. The mean volume of the masses among cases with the lateral whirlpool sign was significantly greater compared to those with the medial whirlpool sign (304 versus 108 cm3; P = .035). In 25 of 30 cases, the torsed components included the ovary.

Conclusions

The lateral whirlpool sign is associated with enlarged masses in comparison to the medial whirlpool sign. This finding indicates the need to search meticulously for the lateral whirlpool sign in cases with enlarged masses to decide whether to operate on these patients emergently.
Sonographic Visualization of the First Branch of the Lateral Plantar Nerve (Baxter Nerve)
Authors: Presley James C. , Maida Eugene , Pawlina Wojciech , Murthy Naveen , Ryssman Daniel B. , Smith Jay
Published: August 2013

Objectives

The primary purpose of this investigation was to document the ability of high‐resolution sonography to accurately identify the first branch of the lateral plantar nerve (FBLPN) using sonographically guided perineural injections in an unembalmed cadaveric model.

Methods

single experienced operator completed sonographically guided perineural FBLPN injections in 12 unembalmed cadaveric specimens (6 right and 6 left) obtained from 10 donors (5 male and 5 female) aged 47 to 95 years (mean, 71 years) with an average body mass index of 24.2 kg/m2 (range, 17.2–31.6 kg/m2). All injections were completed using 22‐gauge, 38‐mm stainless steel needles to deliver 1 mL of 50% diluted colored latex adjacent to the FBLPN in the abductor hallucis‐quadratus plantae (AH‐QP) interval. Six injections were completed using a cart‐based ultrasound (US) machine and a 17–5‐MHz transducer, and 6 were completed using a portable US machine and a 12–3‐MHz transducer. Nerve conspicuity was graded on a 4‐point scale (1, poor; 4, excellent). After a minimum of 24 hours, study coinvestigators dissected each specimen to assess injectate placement.

Results

All 12 injections accurately placed latex onto the FBLPN within the AH‐QP interval, with 11 of 12 (91%) resulting in complete nerve coverage. Proximal latex overflow to the lateral plantar nerve occurred in 82% of cases (10 of 12). The average distance between the plantar fascia and injected latex was 1.2 cm (range, 1.0–1.75 cm). No vascular injury was seen in any specimen. The average nerve conspicuities were 3.7 (range, 3–4) using the cart‐based US machine and 1.8 (range, 1–4) using the portable US machine.

Conclusions

Sonographic visualization of the FBLPN in the AH‐QP interval is feasible and should be considered for diagnostic and therapeutic purposes in patients presenting with chronic or atypical heel pain syndromes. Further clinical experience should refine the role of FBLPN sonography and explore the utility of sonographically guided diagnostic and therapeutic FBLPN perineural injections.
Power M‐Mode Transcranial Doppler Examination of the Ophthalmic Artery in Pregnancy
Authors: Chen Qian , Haeri Sina , Van Veen Teelkien , Ruano Rodrigo , Golabbakhsh Hossein , Belfort Michael A.
Published: August 2013

Our aim was to describe the standard operating procedure for transcranial Doppler investigation of the ophthalmic artery in pregnancy, determine the interobserver and intraobserver variability using power M‐mode technology, and review the existing literature. Accordingly, 27 healthy pregnant or immediately postpartum women were enrolled and underwent transcranial Doppler investigation of the ophthalmic artery using power M‐mode technology. Good interobserver and intraobserver variability was observed for both, especially with respect to the clinically important indices. Transcranial Doppler power M‐mode examination of the ophthalmic artery is easy and reproducible and holds a great deal of potential for investigation in pregnancy.
The pathophysiological relationship and clinical significance of left atrial function and left ventricular diastolic dysfunction in β‐thalassemia major
Authors: Kostopoulou Anna G. , Tsiapras Dimitrios P. , Chaidaroglou Antigoni S. , De giannis Dimitrios E. , Farmakis Dimitrios , Kremastinos Dimitrios Th.
Published: August 2013

Iron deposition in combination with inflammatory and immunogenetic factors is involved in the pathophysiology of cardiac dysfunction in β‐thalassemia major. We investigated the mechanical and endocrine function of the left atrium and ventricle to identify early signs of dysfunction. We studied 90 patients (mean age: 29 ± 11 years) with β‐thalassemia and normal left ventricular function and 90 age and sex‐matched healthy controls. Patients and controls underwent a thorough cardiac echocardiographic study and measurements of the b‐type (NT‐proBNP) and atrial natriuretic peptides (proANP). Patients underwent 24‐hr Holter recordings for arrhythmia monitoring. In the patient group, atria were affected early during the course of the disease, prior to diastolic and systolic left ventricular dysfunction. The E/E′ratio (E Doppler mitral fast inflow to the corresponding tissue Doppler E) continually increased with age (P < 0.05) and reached levels indicating left ventricular diastolic dysfunction (E/E′ > 15) in the third decade whereas indexes of active and passive atrial function decreased gradually throughout life. In controls, the E/E′ ratio continually increased with age but with later (fifth decade) appearance of diastolic dysfunction and a compensatory increase in atrial active function. Both natriuretic peptides were significantly increased in patients compared to controls (558 ± 141 and 2,580 ± 1,830 fmol/mL for NT‐proBNP and proANP versus 332 ± 106 and 1,331 ± 1,134 fmol/mL, respectively). Atrial fibrillation was found in a subgroup of 23 (26%) patients, older in age with mild diastolic function and enlarged, depressed atria. In conclusion, atrial mechanical depression seems to be a very early sign of cardiac damage. It may become echocardiographically evident even before diastolic and systolic dysfunction and is associated to supraventricular arrhythmias. Am. J. Hematol. 89:13–18, 2014. © 2013 Wiley Periodicals, Inc.
Efficacy and safety of IV ferumoxytol for adults with iron deficiency anemia previously unresponsive to or unable to tolerate oral iron
Authors: Vadhan‐Raj Saroj , Strauss William , Ford David , Bernard Kristine , Boccia Ralph , Li Joe , Allen Lee F.
Published: August 2013

Although oral iron is the initial treatment approach for iron deficiency anemia (IDA), some patients fail to respond to or cannot tolerate oral iron. This double‐blind safety and efficacy study of the intravenous (IV) iron, ferumoxytol, randomized patients with a history of unsatisfactory oral iron therapy, or in whom oral iron could not be used, to ferumoxytol (n = 609) or placebo (n = 203). The proportion of patients achieving the primary endpoint (hemoglobin increase ≥2.0 g/dL at Week 5) was 81.1% with ferumoxytol versus 5.5% with placebo (P < 0.0001). The mean increase in hemoglobin from Baseline to Week 5, a secondary endpoint (also the alternative preplanned primary efficacy endpoint for other health authorities), was 2.7 versus 0.1 g/dL (P < 0.0001). Achievement of a hemoglobin ≥12 g/dL, time to a hemoglobin increase ≥2.0 g/dL, and improvement in the Functional Assessment of Chronic Illness Therapy Fatigue score also significantly favored ferumoxytol over placebo at Week 5 (P < 0.0001). Ferumoxytol treatment‐emergent adverse events were mainly mild to moderate. Ferumoxytol was effective and well tolerated in patients with IDA of any underlying cause in whom oral iron was ineffective or could not be used. This trial was registered at www.clinicaltrials.gov as #NCT01114139. Am. J. Hematol. 89:7–12, 2014. © 2013 Wiley Periodicals, Inc.
A comparison of septal stapler to suture closure in septoplasty: a prospective, randomized trial evaluating the effect on operative time
Authors: Sowerby Leigh J. , Wright Erin D.
Published: August 2013

Background

Septoplasty requires coaptation of the mucosal flaps at the conclusion of the procedure; classically this is done with nasal packing. Quilting sutures provide a welcome alternative to packing, but can be time‐consuming to place. A septal stapler has recently been developed that provides a rapid alternative to quilting sutures but the timesaving has not been quantified.

Methods

This study was a prospective, randomized trial comparing a septal stapler to quilting suture for coaptation of mucosal flaps in septoplasty. After meeting inclusion criteria, patients underwent septoplasty and inferior turbinoplasty. The total operative time, surgical segment times, including time for closure was recorded. Preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores were recorded. A sample size of 16 was determined to detect a difference of 5 minutes in closure time.

Results

A total of 16 patients were enrolled in the study. The mean time for closure with septal stapler was 35 ± 22 seconds vs 7 minutes ± 1 minute 10 seconds for suture closure (p < 0.0001). The mean total operative time using the septal stapler was 28 minutes ± 6 minutes whereas 43 minutes ± 13 minutes was required for suture (p = 0.014). No difference in postoperative complications or mucosal healing was seen; preoperative and postoperative improvement in NOSE scores was comparable.

Conclusion

Coaptation of the mucosal flaps in septoplasty with a septal stapler affords a timesaving in the operating room with no difference in operative outcome.
Epidermal growth factor receptor, p16, cyclin D1, and p53 staining patterns for inverted papilloma
Authors: Lin Giant C. , Scheel Adam , Akkina Sarah , Chinn Steven , Graham Martin , Komarck Christine , Walline Heather , McHugh Jonathan B. , Prince Mark E. , Carey Thomas E , Zacharek Mark A.
Published: August 2013

Background

The aim of this study was better characterize the staining patterns of inverted papilloma (IP) with and without carcinoma by performing immunohistochemistry for p16, epidermal growth factor receptor (EGFR), p53, and cyclin D1 antibodies in a large patient cohort.

Methods

A total of 162 IP specimens were collected from 147 patients treated at the University of Michigan between 1996 and 2011. Twenty‐two specimens contained carcinoma. Tumor was extracted for construction of 2 tissue microarrays and stained for p16, EGFR, p53, and cyclin D1. Tumor staining intensity and percentage staining were scored.

Results

Benign disease was positive for p16 in 64%, EGFR in 50%, p53 in 30%, and cyclin D1 in 76%. IP with carcinomatous degeneration was positive for p16 in 14%, EGFR in 71%, p53 in 62%, and cyclin D1 in 76%. The differences in staining positivity between benign and malignant disease reached significance for p16 and p53 only. Mean percentage staining by tumor surface area for IP and IP with carcinoma was 12% vs 7% for p16 (no statistical significance [NS]), 20% vs 34% for EGFR (NS), 4% vs 24% for p53 (p < 0.001), and 17% vs 21% for cyclin D1 (NS).

Conclusion

Important characteristic staining pattern for IP with and without carcinoma are highlighted in this study. Unlike recent trends in human papilloma virus (HPV)‐related head and neck malignancies, low expression of p16 is a marker for malignancy in this series. Positive staining for p53 correlates with the development of carcinoma in IP.