bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of scintigraphy to evaluate gastric accommodation and emptying: Comparison with barostat
Authors: Tomita Toshihiko , Okugawa Takuya , Yamasaki Takahisa , Kondo Takashi , Toyoshima Fumihiko , Sakurai Jun , Oshima Tadayuki , Fukui Hirokazu , Daimon Takashi , Watari Jiro , Kashiwagi Toru , Matsumoto Takayuki , Miwa Hiroto
Published: September 2012

Background and Aim

Scintigraphy is a useful noninvasive technique for assessment of gastric motility, especially emptying, but there is little knowledge of use of the technique to assess gastric accommodation. Therefore, to clarify the usefulness of scintigraphy as a technique for assessing gastric accommodation, we compared scintigraphy with barostat, the gold standard modality.

Methods

Twenty healthy volunteers (14 men, six women; mean age, 28.5 ± 5.4 years) were enrolled in the study. The volunteers ingested a radiolabeled (99mTc) test meal and scintigraphic images were recorded. Radioactivity in the upper third and whole stomach was calculated to evaluate accommodation. In the barostat procedure, gastric accommodation was evaluated by measuring the maximum volume of the distended balloon. Thereafter, correlation between scintigraphic and barostat accommodation was investigated. Intra‐and inter‐observer variation of the scintigraphic test results were also assessed. Finally, the diagnostic performance of scintigraphy was evaluated by using sumatriptan as a positive control.

Results

Measurements of accommodation by scintigraphy and barostat correlated (r = 0.524, P < 0.05). Sumatriptan significantly increased scintigraphically measured gastric accommodation (with sumatriptan, 51.5 ± 16.4%; without sumatriptan, 38.4 ± 13.8%) (P < 0.01), and had significantly (P < 0.05) delayed 50% half emptying time at 60, 90, 120, and 150 min after the start of the experiment. The data from repeated scintigraphic tests were highly reproducible (r = 0.804) with significant differences not observed among the investigators (inter‐observer variation = 0.932, intra‐observer variation = 0.898).

Conclusion

Gastric scintigraphy is a useful technique for assessing gastric accommodation and emptying.
Celiac disease arthropathy and autoimmunity study
Authors: Iqbal Tariq , Zaidi Mukarram A , Wells George A , Karsh Jacob
Published: September 2012

Background and Aim

To evaluate presence of sero‐negative spondyloarthritis (SpA) in celiac disease (CD) patients, and whether compliance with a gluten free diet (GFD) improved arthritis manifestations in these patients.

Methods

We undertook a prospective, questionnaire based, cross‐sectional cohort study to evaluate the presence or absence of SpA simultaneously in both CD and non‐CD cohorts.

Results

356/590 (60.3%) patients with CD participated in this study. 99% had diagnosis confirmed by a diagnostic test (79% small bowel biopsy, 19.8% blood test, 3.9% stool test). Approximately 131 (37%) cases of arthritis were reported in CD patients. Of the 6/356 CD patients with seronegative spondyloarthritides, four had sacroiliitis, two ankylosing spondylitis, and one psoriatic arthritis, compared to one ankylosing spondylitis and five psoriatic arthritis in non‐CD. Osteoarthritis (89 vs 59, P = 0.93) was the most common diagnosis reported by respondents. More CD patients with diarrhea (94%) and anemia (81%) improved on GFD, compared to arthritis symptoms (30%). Autoimmune thyroiditis (10.6% vs 0.4%), insulin dependent diabetes mellitus (IDDM) (2.2% vs 1.7%), systemic Lupus erythematosus (SLE) (1.1% vs 0), and psoriasis (12.9% vs 5.5%) occurred more frequently in CD patients. The prevalence of Crohn's disease, ulcerative colitis, Sjogren's syndrome, primary biliary cirrhosis, and primary sclerosing cholangitis was around 1% each. Univariate Logistic regression analysis showed ≤ high school education (odds ratio [OR] 2.01, P < 0.003), age ≥ 60 years (OR 4.13, P < 0.001), and osteoporosis (OR 2.78, P < 0.001) to be significantly associated with report of arthritis in CD patients.

Conclusion

We did not find a high rate of SpA in CD patients. In contrast, increased rates of autoimmune thyroiditis, SLE, IDDM, and psoriasis were seen in CD.
Treatment monitoring and mortality risk adjustment in anaemic Jehovah's Witnesses
Authors: Beliaev Andrei M. , Marshall Roger J. , Smith Warren , Windsor John A.
Published: September 2012

Background

Management of anaemic Jehovah's Witness (JW) patients, who refuse blood transfusion on religious grounds, is challenging. In the published literature, there are few cohort studies that consider causes of mortality in isolation and are lacking in their predictive power. This does not allow clinicians to monitor treatment progress of severely anaemic JW patients and adjust their risk of mortality. The study aims to develop an anaemia‐related mortality risk prediction instrument.

Methods

This retrospective cohort study evaluated anaemia‐related mortality risk factors of JW patients. JW patients were identified from the records of four major public hospitals in the Auckland and Midlands regions of New Zealand (North Shore, Auckland City, Middlemore and Waikato hospitals) for the period 1998 to 2007 inclusive. The inclusion criteria were age ≥15 years and severe anaemia (haemoglobin concentration ≤80 g/L). Palliative care cancer patients were excluded.

Results

Anaemia‐related risk factors of mortality for JW patients were identified, weighted and used to construct a mortality risk predictive score (the Hamilton Anaemia Mortality Risk Score (Hamilton AMRS)). This permitted stratification of JW patients into mortality risk groups according to their Hamilton AMRS. It is shown that patients with Hamilton AMRS of 0 to 2 had 4% mortality, patients with Hamilton AMRS of 3 to 4 had 29% mortality, patients with Hamilton AMRS of 5 had 40% mortality and patients with Hamilton AMRS of ≥6 had 67% mortality.

Conclusion

The Hamilton AMRS allows treatment monitoring of anaemic JW patients and adjustment of their risk of mortality.
Thyroid cancer in Graves’ disease: is surgery the best treatment for Graves’ disease?
Authors: Tamatea Jade A. U. , Tu'akoi Kelson , Conaglen John V. , Elston Marianne S. , Meyer‐Rochow Goswin Y.
Published: September 2012

Background

Graves’ disease is a common cause of thyrotoxicosis. Treatment options include anti‐thyroid medications or definitive therapy: thyroidectomy or radioactive iodine (I131). Traditionally, I131 has been the preferred definitive treatment for Graves’ disease in New Zealand. Reports of concomitant thyroid cancer occurring in up to 17% of Graves’ patients suggest surgery, if performed with low morbidity, may be the preferred option. The aim of this study was to determine the rate of thyroid cancer and surgical outcomes in a New Zealand cohort of patients undergoing thyroidectomy for Graves’ disease.

Method

This study is a retrospective review of Waikato region patients undergoing thyroid surgery for Graves’ disease during the 10‐year period prior to 1 December 2011.

Results

A total of 833 patients underwent thyroid surgery. Of these, 117 were for Graves’ disease. Total thyroidectomy was performed in 82, near‐total in 33 and subtotal in 2 patients. Recurrent thyrotoxicosis developed in one subtotal patient requiring I131 therapy. There were two cases of permanent hypoparathyroidism and one of permanent recurrent laryngeal nerve palsy. Eight patients (6.8%) had thyroid cancer detected, none of whom had overt nodal disease. Five were papillary microcarcinomas (one of which was multifocal), two were papillary carcinomas (11 mm and 15 mm) and one was a minimally invasive follicular carcinoma.

Conclusion

Thyroid cancer was identified in approximately 7% of patients undergoing surgery for Graves’ disease. A low complication rate (<2%) of permanent hypoparathyroidism and nerve injury (<1%) supports surgery being a safe alternative to I131 especially for patients with young children, ophthalmopathy or compressive symptoms.
Technical competence in surgeons
Authors: Faurie Clare , Khadra Mohammed
Published: September 2012

In this paper, we review the literature to date on technical competence in surgeons; how it can be defined, taught to trainees and assessed. We also examine how we can predict which candidates for surgical training will most likely develop technical competence. While technical competency is just one aspect of what makes a good surgeon, we have recognized a need to review the literature in this area and to combine this with broader definitions of competency. Our review found that several methods are available to objectively measure, assess and predict technical competence and should be used in surgical training.
Arterial supply of the tendinous rotator cuff insertions: an anatomical study
Authors: Papakonstantinou Maritsa K. , Pan Wei‐Ren , le Roux Cara Michelle , Richardson Martin D.
Published: September 2012

Background

Confirming the presence of arteries crossing the osteotendinous junctions (OTJs) of the rotator cuff may explain why rates of avascular necrosis (AVN) of the humeral head vary between three‐ and four‐part proximal humeral fractures. It is hypothesized that the humeral head remains better vascularized in three‐part fractures because one tuberosity with its inserting rotator cuff tendons is still attached to the articular fragment and supplying it with blood.

Methods

Eighty rotator cuff tendons from 20 shoulder girdles of cadavers aged 68–94 years were studied. In six shoulder girdles, the anterior circumflex humeral artery and posterior circumflex humeral artery (PCHA) were injected with ink, and the extra‐ and intraosseous courses of the vasculature were dissected until the OTJs of the rotator cuff.

Results

The rotator cuff insertions received an arterial supply across their OTJs in 50% of cases (75% in supraspinatus, 67% in subscapularis, 33% in infraspinatus and 20% in teres minor). Supraspinatus and subscapularis insertions were vascularized by the arcuate artery, while the insertions of infraspinatus and teres minor were supplied by an unnamed terminal branch of the PCHA. This was named ‘posterolateral artery’.

Conclusion

The presence of arteries crossing the OTJs of the rotator cuff, as well as the differences in the frequency arteries crossed the OTJs of individual rotator cuff tendons, may help explain why there is a lower rate of AVN of the humeral head in thee‐part, compared with four‐part proximal humeral fractures.
Long‐range temporal correlations in the subthalamic nucleus of patients with Parkinson’s disease
Authors: Hohlefeld F. U. , Huebl J. , Huchzermeyer C. , Schneider G.‐H. , Schönecker T. , Kühn A. A. , Curio G. , Nikulin V. V.
Published: September 2012

Neuronal activity in the subthalamic nucleus (STN) of patients with Parkinson’s disease (PD) is characterised by excessive neuronal synchronization, particularly in the beta frequency range. However, less is known about the temporal dynamics of neuronal oscillations in PD. In this respect long‐range temporal correlations (LRTC) are of special interest as they quantify the neuronal dynamics on different timescales and have been shown to be relevant for optimal information processing in the brain. While the presence of LRTC has been demonstrated in cortical data, their existence in deep brain structures remains an open question. We investigated (i) whether LRTC are present in local field potentials (LFP) recorded bilaterally from the STN at wakeful rest in ten patients with PD after overnight withdrawal of levodopa (OFF) and (ii) whether LRTC can be modulated by levodopa treatment (ON). Detrended fluctuation analysis was utilised in order to quantify the temporal dynamics in the amplitude fluctuations of LFP oscillations. We demonstrated for the first time the presence of LRTC (extending up to 50 s) in the STN. Importantly, the ON state was characterised by significantly stronger LRTC than the OFF state, both in beta (13–35 Hz) and high‐frequency (> 200 Hz) oscillations. The existence of LRTC in subcortical structures such as STN provides further evidence for their ubiquitous nature in the brain. The weaker LRTC in the OFF state might indicate limited information processing in the dopamine‐depleted basal ganglia. The present results implicate LRTC as a potential biomarker of pathological neuronal processes in PD.
Common genetic variants associated with disease from genome‐wide association studies are mutually exclusive in prostate cancer and rheumatoid arthritis
Authors: Orozco Gisela , Goh Chee L. , Al Olama Ali Amin , Benlloch‐Garcia Sara , Govindasami Koveela , Guy Michelle , Muir Kenneth R. , Giles Graham G. , Severi Gianluca , Neal David E. , Hamdy Freddie C. , Donovan Jenny L. , Kote‐Jarai Zsofia , Easton Douglas F. , Eyre Steve , Eeles Rosalind A.
Published: September 2012

What's known on the subject? and What does the study add?

The link between inflammation and cancer has long been reported and inflammation is thought to play a role in the pathogenesis of many cancers, including prostate cancer (PrCa). Over the last 5 years, genome‐wide association studies (GWAS) have reported numerous susceptibility loci that predispose individuals to many different traits.

The present study aims to ascertain if there are common genetic risk profiles that might predispose individuals to both PrCa and the autoimmune inflammatory condition, rheumatoid arthritis. These results could have potential public heath impact in terms of screening and chemoprevention.

Objectives

To investigate if potential common pathways exist for the pathogenesis of autoimmune disease and prostate cancer (PrCa).

To ascertain if the single nucleotide polymorphisms (SNPs) reported by genome‐wide association studies (GWAS) as being associated with susceptibility to PrCa are also associated with susceptibility to the autoimmune disease rheumatoid arthritis (RA).

Materials and Methods

The original Wellcome Trust Case Control Consortium (WTCCC) UK RA GWAS study was expanded to include a total of 3221 cases and 5272 controls.

In all, 37 germline autosomal SNPs at genome‐wide significance associated with PrCa risk were identified from a UK/Australian PrCa GWAS.

Allele frequencies were compared for these 37 SNPs between RA cases and controls using a chi‐squared trend test and corrected for multiple testing (Bonferroni).

Results

In all, 33 SNPs were able to be analysed in the RA dataset. Proxies could not be located for the SNPs in 3q26, 5p15 and for two SNPs in 17q12.

After applying a Bonferroni correction for the number of SNPs tested, the SNP mapping to CCHCR1 (rs130067) retained statistically significant evidence for association (P = 6 × 10–4; odds ratio [OR] = 1.15, 95% CI: 1.06–1.24); this has also been associated with psoriasis.

However, further analyses showed that the association of this allele was due to confounding by RA‐associated HLA‐DRB1 alleles.

Conclusions

There is currently no evidence that SNPs associated with PrCa at genome‐wide significance are associated with the development of RA.

Studies like this are important in determining if common genetic risk profiles might predispose individuals to many diseases, which could have implications for public health in terms of screening and chemoprevention.
Narrow band imaging diagnosis of bladder cancer: systematic review and meta‐analysis
Authors: Zheng Changjian , Lv Yalan , Zhong Qiang , Wang Runhua , Jiang Qing
Published: September 2012

Study Type – Diagnosis (systematic review)

Level of Evidence 1

What's known on the subject? and What does the study add?

In recent years, more attention has focused on the role of narrow band imaging (NBI) in bladder cancer detection and NBI technology has spread rapidly. It is an important method for diagnosing new or recurrent bladder cancer. But its diagnostic accuracy is still uncertain.

This paper summarizes the diagnostic accuracy of NBI in bladder cancer and compares NBI with white light imaging. The results show that NBI cystoscopy significantly improves the detection accuracy in bladder cancer, compared with white light imaging. However, some limitations still exist. Multicentre randomized studies are recommended to determine whether the visual advantages of NBI can translate into real therapeutic benefit for individual patients.

OBJECTIVE

To assess the test performance and clinical effectiveness of narrow band imaging (NBI) cystoscopy compared with white light imaging (WLI) cystoscopy in people suspected of new or recurrent bladder cancer.

METHODS

Literature on NBI cystoscopy in the diagnosis of bladder cancer was searched in PubMed, EMBASE, Cochrane Library, MEDLINE and CNKI, with hand searching of relevant congress abstracts and journals.

The literature was selected according to inclusion and exclusion criteria. The Meta‐DiSc1.4 software was used to review management and analysis.

RESULTS

Eight studies including 1022 patients assessed test performance.

On a per‐person analysis, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of NBI and WLI were respectively 0.943 (95% CI 0.914−0.964) and 0.848 (95% CI 0.803−0.885), 0.847 (95% CI 0.812−0.878) and 0.870 (95% CI 0.831−0.903), 7.038 (95% CI 3.357−14.754) and 6.938 (95% CI 2.052−23.465), 0.054 (95% CI 0.012−0.237) and 0.181 (95% CI 0.091−0.361), and 185.32 (95% CI 45.714−751.26) and 42.931 (95% CI 8.088−227.88).

The area under the curve and Q* of NBI and WLI were respectively 0.9781 and 0.8944, and 0.9337 and 0.8253.

For the characterization of carcinoma in situ, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of NBI were 0.927 (95% CI 0.878−0.960), 0.768 (95% CI 0.730−0.802), 4.545 (95% CI 2.820−7.325), 0.125 (95% CI 0.051−0.304) and 48.884 (95% CI 15.642−152.77) on a per‐person analysis.

The area under the curve and Q* were 0.9391 and 0.8763.

CONCLUSION

NBI is an effective method for the identification of abnormal lesions including carcinoma in situ and can provide higher diagnostic precision of bladder cancer than WLI.
New Labour, ‘Sleaze’ and Television Drama
Authors: Fielding Steven
Published: September 2012

Research Highlights and Abstract

The article explores attitudes to New Labour in particular and politics in general through analysing their dramatization on TV. It indicates that such dramatizations are almost wholly negative, focusing on sleaze, spin and betrayal. The article explains the character of such dramas as being the result of the producers' desire to present politics in terms their audiences will accept. It suggests that, as a consequence, popular hostility to politics is reinforced by television drama and so indicates that culture has an independent part to play in this process.

Echoing Plato's banishment of artists, mainstream political scientists have excluded serious consideration of art from their discipline. Yet, there are grounds for believing that it can help address what Gerry Stoker suggests is one of social science's greatest failings: understanding ‘what politics means to citizens’. This study of New Labour's television dramatization suggests it can help political scientists better appreciate the dynamics underpinning the much-noted decline of popular trust in representative politics. It looks at the reasons for the narrowing of the public's picture of politics by focusing on the changing production context for television drama during the New Labour period, something that led it to emphasise ‘sleaze’. The article suggests such dramas consequently helped make more credible the public's pre-existing prejudices about what they supposed was the corrupt nature of Britain's political class.
The Multi-Level Governance of Wales: Layer Cake or Marble Cake?
Authors: Entwistle Tom , Downe James , Guarneros-Meza Valeria , Martin Steve
Published: September 2012

Research Highlights and Abstract

Provides a reading of the literatures on multi-level governance and federalism to develop a series of propositions about the nature of the relationship between different levels of government in the devolved United Kingdom. Drawing on a survey of local government officers in Wales, the article reports support for both layer cake and marble cake interpretations of multi-level governance. The article concludes with a discussion of the applicability of these models to our understanding of devolution in the United Kingdom.

Since the United Kingdom began its devolution programme in 1999 governments operating at four different territorial scales—embracing the EU, the UK, the national and the local—have played a part in the governance of Wales. Multi-level governance of this type can be likened to a layer cake, in which each government operates in its own distinct jurisdiction, or to a marble cake in which governments have overlapping and interlaced responsibilities. Drawing on a survey that asked senior officers in Welsh local government to rate the impact of different levels of government, this article finds support for both interpretations of multi-level governance. Although largely discredited as a description of American federalism, the layer cake simile may have a new lease of life in the analysis of Europe's devolved nations and regions.
Reforms and challenges in the era of inclusive education: the case of China
Authors: Deng Meng , Poon‐McBrayer Kim Fong
Published: September 2012

This article, written by Meng Deng of Beijing Normal University and Kim Fong Poon‐McBrayer of the Hong Kong Institute of Education, reviews and analyses the reform of special education in China, the challenges confronting Chinese special education provisions, and how the Chinese inclusive education model, namely ‘Learning in Regular Classrooms’, has been shaped by the pragmatic needs aligning with the nation's economic and social developments. In an effort to provide wider school access, the current inclusive education model has become the form of educational placement that serves the majority of students with disabilities in China. The authors conclude that reforms in the last two decades have resulted in dramatic changes and progress in many facets of special education service delivery, school structure, administrative monitoring mechanism, and instructional practices. However, the current Chinese special education service structure is still shaky, with inadequate resources, personnel preparation and support at the local level. Fundamental changes to the examination‐oriented mainstream education system are still needed, to enhance the quality of education for students with special needs.
Immoral Beliefs
Authors: Bashour Bana
Published: September 2012

In this paper, I argue that there exists a class of immoral beliefs. These beliefs are immoral not for the usual reasons, i.e. because of their tendency to cause harm, their immoral acquisition, or the fact that they involve unjustified moral judgments. Rather, the class of beliefs to which I wish to draw attention includes beliefs that do not even have any moral content, but whose non‐moral content is still morally significant. These beliefs are immoral because holding them constitutes an immoral condition of the belief‐holder. This usually involves a moral failure of the belief‐holder. We may object to such beliefs for all of the usual reasons, but I wish to draw attention to their objectionable content based on the kind of character they represent a person as having.1
The use of drama to teach social skills in a special school setting for students with autism
Authors: KEMPE ANDY , TISSOT CATHY
Published: September 2012

For children with autism, social challenges may be both part of the disability and a barrier to accessing education. This article reports on a project that used drama to address such challenges by drawing on the social skills of non‐autistic peers in a special school setting. The article demonstrates how drama's flexibility may be harnessed in order to help students support each other's development of creative and communicative skills. Focusing on two children in particular, specific examples are given to illustrate how they participated in group work, made imaginative contributions to verbal and physical representations and engaged with abstract ideas. The project's outcomes suggest that, given a concrete structure and an invitation to collaborate, drama can be a powerful learning medium for children with autistic spectrum disorder. The conclusion reflects on the diverse meaning of inclusive practice that can be achieved within specialist settings.
Interpretations of Integration in Early Accountable Care Organizations
Authors: KREINDLER SARA A. , LARSON BRIDGET K. , WU FRANCES M. , CARLUZZO KATHLEEN L. , GBEMUDU JOSETTE N. , STRUTHERS ASHLEY , VAN CITTERS ARICCA D. , SHORTELL STEPHEN M. , NELSON EUGENE C. , FISHER ELLIOTT S.
Published: September 2012

Context: It is widely hoped that accountable care organizations (ACOs) will improve health care quality and reduce costs by fostering integration among diverse provider groups. But how do implementers actually envision integration, and what will integration mean in terms of managing the many social identities that ACOs bring together?

Methods: Using the lens of the social identity approach, this qualitative study examined how four nascent ACOs engaged with the concept of integration. During multiday site visits, we conducted interviews (114 managers and physicians), observations, and document reviews.

Findings: In no case was the ACO interpreted as a new, overarching entity uniting disparate groups; rather, each site offered a unique interpretation that flowed from its existing strategies for social‐identity management: An independent practice association preserved members’ cherished value of autonomy by emphasizing coordination, not “integration”; a medical group promoted integration within its employed core, but not with affiliates; a hospital, engaging community physicians who mistrusted integrated systems, reimagined integration as an equal partnership; an integrated delivery system advanced its careful journey towards intergroup consensus by presenting the ACO as a cultural, not structural, change.

Conclusions: The ACO appears to be a model flexible enough to work in synchrony with whatever social strategies are most context appropriate, with the potential to promote alignment and functional integration without demanding common identification with a superordinate group. “Soft integration” may be a promising alternative to the vertically integrated model that, though widely assumed to be ideal, has remained unattainable for most organizations.
“If We Build It, Will It Stay?” A Case Study of the Sustainability of Whole‐System Change in London
Authors: GREENHALGH TRISHA , MACFARLANE FRASER , BARTON‐SWEENEY CATHERINE , WOODARD FRAN
Published: September 2012

Context: The long‐term sustainability of whole‐system change programs is rarely studied, and when it is, it is inevitably undertaken in a shifting context, thereby raising epistemological and methodological questions. This article describes a transferable methodology that was developed to guide the evaluation of a three‐year follow‐up of a large health care change program in London, which took place during a period of economic turbulence and rapid policy change.

Method: Using a mixed‐method organizational case study design, we studied three services (stroke, kidney, and sexual health) across primary and secondary care. Each had received £5 million (US$7.8 million) in modernization funding in 2004. In 2010/2011, we gathered data on the services and compared them with data from 2004 to 2008. The new data set contained quantitative statistics (access, process, and outcome metrics), qualitative interviews with staff and patients, documents, and field notes. Our data analysis was informed by two complementary models of sustainability: intervention‐focused (guided by the question, What, if anything, of the original program has been sustained?) and system‐dynamic (guided by the question, How and why did change unfold as it did in this complex system?).

Findings: Some but not all services introduced in the original transformation effort of 2004–2008 were still running; others had ceased or been altered substantially to accommodate contextual changes (e.g., in case mix, commissioning priorities, or national policies). Key cultural changes (e.g., quality improvement, patient centeredness) largely persisted, and innovative ideas and practices had spread elsewhere. To draw causal links between the original program and current activities and outcomes, it was necessary to weave a narrative thread with multiple intervening influences. In particular, against a background of continuous change in the local health system, the sustainability of the original vision and capacity for quality improvement was strongly influenced by (1) stakeholders’ conflicting and changing interpretations of the targeted health need; (2) changes in how the quality cycle was implemented and monitored; and (3) conflicts in stakeholders’ values and what each stood to gain or lose.

Conclusions: The sustainability of whole‐system change embodies a tension between the persistence of past practice and the adaptation to a changing context. Although the intervention‐focused question, What has persisted from the original program? (addressed via a conventional logic model), may be appropriate, evaluators should qualify their findings by also considering the system‐dynamic question, What has changed, and why? (addressed by producing a meaningful narrative).
The Concept of Harm and the Significance of Normality
Authors: Kahane Guy , Savulescu Julian
Published: September 2012

Many believe that severe intellectual impairment, blindness or dying young amount to serious harm and disadvantage. It is also increasingly denied that it matters, from a moral point of view, whether something is biologically normal to humans. We show that these two claims are in serious tension. It is hard explain how, if we do not ascribe some deep moral significance to human nature or biological normality, we could distinguish severe intellectual impairment or blindness from the vast list of seemingly innocent ways in which we fail to have as much wellbeing as we could, such not having super‐intelligence, or not living to 130. We consider a range of attempts to draw this intuitive normative distinction without appealing to normality. These, we argue, all fail. But this doesn't mean that we cannot draw this distinction or that we must, implausibly, conclude that biological normality does possess an inherent moral importance. We argue that, despite appearances, it is not biological normality but rather statistical normality that, although lacking any intrinsic moral significance, nevertheless makes an important moral difference in ways that explain and largely justify the intuitive distinction.
Trade‐offs between leaf hydraulic capacity and drought vulnerability: morpho‐anatomical bases, carbon costs and ecological consequences
Authors: Nardini Andrea , Pedà Giulia , Rocca Nicoletta La
Published: September 2012

Leaf hydraulic conductance (Kleaf) and vulnerability constrain plant productivity, but no clear trade‐off between these fundamental functional traits has emerged in previous studies.

We measured Kleaf on a leaf area (Kleaf_area) and mass basis (Kleaf_mass) in six woody angiosperms, and compared these values with species’ distribution and leaf tolerance to dehydration in terms of P50, that is, the leaf water potential inducing 50% loss of Kleaf. We also measured several morphological and anatomical traits associated with carbon investment in leaf construction and water transport efficiency.

Clear relationships emerged between Kleaf_mass, P50, and leaf mass per unit area (LMA), suggesting that increased tolerance to hydraulic dysfunction implies increased carbon costs for leaf construction and water use. Low P50 values were associated with narrower and denser vein conduits, increased thickness of conduit walls, and increased vein density. This, in turn, was associated with reduced leaf surface area.

Leaf P50 was closely associated with plants’ distribution over a narrow geographical range, suggesting that this parameter contributes to shaping vegetation features. Our data also highlight the carbon costs likely to be associated with increased leaf tolerance to hydraulic dysfunction, which confers on some species the ability to thrive under reduced water availability but decreases their competitiveness in high‐resource habitats.
Sensory and textural properties of chhana kheer made with three artificial sweeteners
Authors: Gautam Anuj , Jha Alok , Singh Rakhi
Published: September 2012

Chhana kheer, a dessert containing chhana and sugar, is very popular in the Indian subcontinent. A process for manufacturing chhana kheer based on milk fat, aspartame, acesulfame‐K and sucralose was optimised. Aspartame and acesulfame‐K at the level of 0.015% and sucralose at the level of 0.05% were found to be the most appropriate levels for chhana kheer replacing conventional product. The predicted score of the suggested formulation was 7.28 for sweetness, 8.06 for colour and appearance, 7.04 for texture, 7.79 for flavour, 6.69 for overall acceptability and 4820 g s for consistency respectively.
A longirostrine Temnodontosaurus (Ichthyosauria) with comments on Early Jurassic ichthyosaur niche partitioning and disparity
Authors: MARTIN JEREMY E. , FISCHER VALENTIN , VINCENT PEGGY , SUAN GUILLAUME
Published: September 2012

Abstract:  We describe an almost complete ichthyosaur skeleton from the middle Toarcian (Lower Jurassic) of the Beaujolais foothills near Lyon, France, and assign it to Temnodontosaurus azerguensis sp. nov. This new species exhibits cranial peculiarities such as a thin, elongated and possibly edentulous rostrum, as well as a reduced quadrate. These characters indicate dietary preferences that markedly differ from other species referred to Temnodontosaurus, a genus previously considered as the top predator of the Early Jurassic seas. Despite a conservative postcranial skeleton, we propose that Temnodontosaurus is one of the most ecologically disparate genera of ichthyosaurs, including apex predators and now a soft prey longirostrine hunter. Ammonites collected from the same stratigraphic level as the described specimen indicate that the new species is somewhat younger (bifrons ammonite zone) than the most known Toarcian ichthyosaurs and therefore slightly postdates the interval of severe environmental changes and marine invertebrate extinctions known as the Toarcian Oceanic Anoxic Event. The present study therefore raises the question of whether postcrisis recovery of vertebrate faunas, including the radiation of Temnodontosaurus into a new ecological niche, may have been a consequence of marine ecosystem reorganization across this event.
New stem elephant‐shrews (Mammalia, Macroscelidea) from the Eocene of Dur At‐Talah, Libya
Authors: TABUCE RODOLPHE , JAEGER JEAN‐JACQUES , MARIVAUX LAURENT , SALEM MUSTAPHA , BILAL AWAD ABOLHASSAN , BENAMMI MOULOUD , CHAIMANEE YAOWALAK , COSTER PAULINE , MARANDAT BERNARD , VALENTIN XAVIER , BRUNET MICHEL
Published: September 2012

Abstract:  Two new primitive macroscelideans, Eotmantsoius perseverans gen. et sp. nov. and Nementchatherium rathbuni sp. nov. from the late Middle or Late Eocene locality of Dur At‐Talah, Libya, are described. Eotmantsoius is known from a single tooth and is characterized by low crown height, isolated conules, and lack of a preprotocrista and prehypocrista. Based on these characters, it appears to be more plesiomorphic than Chambius (late Early Eocene, Chambi, Tunisia), which was, to date, universally accepted as the oldest and most basal macroscelidean. Eotmantsoius appears, however, somewhat derived in having an entostyle, a pericone, a shorter mesial cingulum and larger intercusp valleys. The phylogenetic position of Eotmantsoius is unclear. The second new species, N. rathbuni, allows a reassessment of Nementchatherium. We suggest that it is the most derived of the herodotiines in having long preprotocrista and prehypocrista, reduced M2/m2, a robust entostyle twinned with the hypocone on M1 and the posterior aspect of the root of the maxillary jugal process placed along the length of M2. Nementchatherium rathbuni appears more derived than N. senarhense, from the Eocene locality of Bir El Ater, Algeria, in having smaller m2‐3 with no paraconid, a smaller hypoconulid on m2 and a more reduced talonid on m3 (with smaller hypoconid and entoconid). Nementchatherium rathbuni also has, distal to the m3, a coronoid canal. This character has commonly been proposed as a synapomorphy for paenungulates (e.g. proboscideans, sirenians and hyracoids); we investigate the possibility that it unites macroscelideans and paenungulates, as the superordinal clade Afrotheria suggests. Comparisons reveal that a coronoid canal also occurs in several nonafrotherian orders (lagomorphs, xenarthrans, artiodactyls and perissodactyls), suggesting that is not an exclusive synapomorphy for paenungulates plus macroscelideans. Moreover, the homology of the character within paenungulates is doubtful.
Assessment of a Photogrammetric Approach for Urban DSM Extraction from Tri‐Stereoscopic Satellite Imagery
Authors: Tack Frederik , Goossens Rudi , Buyuksalih Gurcan
Published: September 2012

Built‐up environments are extremely complex for 3D surface modelling purposes. The main distortions that hamper 3D reconstruction from 2D imagery are image dissimilarities, concealed areas, shadows, height discontinuities and discrepancies between smooth terrain and man‐made features. A methodology is proposed to improve automatic photogrammetric extraction of an urban surface model from high resolution satellite imagery with the emphasis on strategies to reduce the effects of the cited distortions and to make image matching more robust. Instead of a “standard” stereoscopic approach, a digital surface model is derived from tri‐stereoscopic satellite imagery. This is based on an extensive multi‐image matching strategy that fully benefits from the geometric and radiometric information contained in the three images. The bundled triplet consists of an IKONOS along‐track pair and an additional near‐nadir IKONOS image. For the tri‐stereoscopic study a densely built‐up area, extending from the centre of Istanbul to the urban fringe, is selected. The accuracy of the model extracted from the IKONOS triplet, as well as the model extracted from only the along‐track stereopair, are assessed by comparison with 3D check points and 3D building vector data.
Use of Fully Biodegradable Panels to Reduce Derelict Pot Threats to Marine Fauna
Authors: Bilkovic D.M. , Havens K.J. , Stanhope D.M. , Angstadt K.T.
Published: September 2012

Fishing pots (i.e., traps) are designed to catch fish or crustaceans and are used globally. Lost pots are a concern for a variety of fisheries, and there are reports that 10–70% of deployed pots are lost annually. Derelict fishing pots can be a source of mortality for target and bycatch species for several years. Because continual removal of derelict gear can be impractical over large spatial extents, modifications are needed to disarm gear once it is lost. We tested a fully biodegradable panel with a cull or escape ring designed for placement on the sides of a crab pot that completely degrades into environmentally neutral constituents after approximately 1 year. This panel is relatively inexpensive, easy to install, and can be used in multiple fisheries. We used the blue crab (Callinectes sapidus) fishery as a test case because it is a large pot fishery and blue crab pots are similar to traps used in other pot fisheries. We had commercial fishers deploy pots with panels alongside standard pots in Chesapeake Bay (U.S.A.) to assess potential effects of our experimental pots on blue crab catch. We compared the number, biomass, and size of crabs captured between standard and experimental pots and evaluated differences in catch over a crabbing season (March–November) at five locations. There was no evidence that biodegradable panels adversely affected catch. In all locations and time periods, legal catches were comparable in abundance, biomass, and size between experimental and standard pots. Properly designed biodegradable panels appear to be a viable solution to mitigate adverse effects of derelict pots.

Uso de Paneles Completamente Biodegradables para Reducir las Amenazas de Vasijas Abandonadas para la Fauna Marina
Investors Do Respond to Poor Mutual Fund Performance: Evidence from Inflows and Outflows
Authors: Cashman George D. , Deli Daniel N. , Nardari Federico , Villupuram Sriram
Published: September 2012

We examine the relation between mutual fund performance and gross flows for a large sample of actively managed U.S. mutual funds. Unlike previous studies that have only examined periods of generally increasing net flows, our sample includes periods of both increasing and decreasing net flows. We find that outflows are related to performance, with investors withdrawing money from poor performers. We also find that outflows and inflows respond asymmetrically to performance, outflows increase more aggressively following poor performance, and inflows increase more aggressively following good performance. Additionally, we find a symmetric performance net flow relation.
Investigations on In Vitro and Degradation Properties of ZnO‐Added Phosphate‐Based Glasses and Glass Ceramics
Authors: Aravindan Samickannian , Rajkumar Gurusamy , Rajendran Venkatachalam , Rajendran Nallaiyan
Published: September 2012

A series of phosphate based glasses of composition 45P2O5–(40−x)CaO–15Na2O–xZnO (x = 0, 3, 6, 8 10, and 12 mol%) were prepared employing melt‐quenching techniques. Based on the thermal analysis data of glasses, the schedule of thermal treatments have been designed and employed to obtain their glass ceramic derivatives. The increase in thermal stability and decrease in crystallization tendency was observed from differential thermal analysis traces. The durability of phosphate glasses were improved as a result of the addition of ZnO content. The increasing ZnO content alters the phosphate glass structure and enhances the cross‐link formation between different network chains. A broad‐based characterization approach combining different techniques was used to investigate the in vitro properties of glasses and their glass‐ceramic equivalents against the addition of ZnO content into the glass composition. The in vitro results revealed the decreasing nature of apatite forming ability of phosphate glasses with increase in ZnO content before and after thermal treatments. Both the glass and glass‐ceramics containing ZnO content above 10 mol% exhibited poor in vitro performance mainly because of their dissolution nature. The weight loss analysis revealed that the decreasing solubility of glass and glass‐ceramics was observed as increasing of ZnO content.
Hf‐Doped Ni–Al2O3 Interfaces at Equilibrium
Authors: Meltzman Hila , Besmann Theodore M. , Kaplan Wayne D.
Published: September 2012

In this study, a series of solid‐state dewetting experiments of pure and Hf‐doped Ni films on sapphire and HfO2 substrates were conducted in order to measure the change in interfacial energy of the Ni–Al2O3 interface in the presence of Hf, and to study Hf interfacial segregation. It was found that Hf oxidizes under the conditions of the experiment (P(O2)=10−20 atm), Hf does not segregate to the Ni–Al2O3 interface, and that the interface energy of Ni–HfO2 is 2.7 ± 0.4 J/m2 vs 2.16 ± 0.2 J/m2 for the Ni–Al2O3 interface. This contradicts several theoretical studies that predict that Hf segregates to the interface to stabilize it thermodynamically. The solubility of Hf in bulk Ni was found to be significantly lower than the value reported in the equilibrium phase diagram.
Mechanism of Intrinsic Point Defects and Oxygen Diffusion in Yttrium Aluminum Garnet: First‐Principles Investigation
Authors: Li Zhen , Liu Bin , Wang Jiemin , Sun Luchao , Wang Jingyang , Zhou Yanchun
Published: September 2012

Formation of intrinsic point defect in yttrium aluminum garnet (YAG) is comprehensively investigated using first‐principles calculations. We showed that the defect formation energies of intrinsic point defects closely depend on the possible values of chemical potentials of Y, Al, and O. Both YAl16(a) anti‐site defect, oxygen vacancy VO, and interstitial Oi might be the preferred defect species when chemical potentials of Y, Al, and O vary in different areas. The O‐related defects are also important intrinsic point defects in YAG and deserve to be further examined. The oxygen self‐diffusion are investigated and we found that energy barrier of oxygen diffusion is enhanced and decreased by neighboring YAl16(a) and AlY anti‐site defects, respectively. The results are used to explain the mechanism of experimental observations that Al2O3 excess speeds up oxygen diffusion and that Y2O3 excess suppresses oxygen diffusion in YAG.
Utility of Emergency Cranial Computed Tomography in Patients Without Trauma
Authors: Narayanan Vignesh , Keniston Angela , Albert Richard K.
Published: September 2012

ACADEMIC EMERGENCY MEDICINE 2012; 19: 1055–1060 © 2012 by the Society for Academic Emergency Medicine

Objectives:  The objectives of this study were to determine, in patients admitted to the hospital from the emergency department (ED) without evidence of trauma, 1) the prevalence of clinically important abnormalities on cranial computed tomography (CCT) and 2) the frequency of emergent therapeutic interventions required because of these abnormalities.

Methods:  The authors retrospectively reviewed the records of all patients from 2007 between the ages of 18 and 89 years who had CCT as part of their ED evaluations prior to hospitalization. Patients with any indication of trauma were excluded, as were those who had a lumbar puncture (LP). Chief complaint, results of the ED neurologic examination, tomogram findings, and whether patients had emergent interventions were recorded. Patients presenting with altered mental status (AMS) were analyzed separately.

Results:  Of the 766 patients meeting inclusion criteria, 83 (11%) had focal neurologic findings, and 61 (8%) had clinically important abnormalities on computed tomography. Emergent interventions occurred in only 12 (1.6%), 11 (92%) of whom had focal neurologic findings. In the subgroup of 287 patients with AMS as their presenting problem, 14 (4.9%) had focal findings, six (2%) had clinically important abnormalities on tomography, and only two (0.7%) required emergent interventions, both of whom had focal findings. Patients presenting with AMS were less likely to have positive findings on tomography (odds ratio [OR] = 0.16, 95% confidence interval [CI] = 0.07 to 0.39). Patients presenting with motor weakness or speech abnormalities, or who were unresponsive, were more likely to have positive findings on tomography (OR = 4.7, 95% CI = 2.6 to 8.6; OR = 4.4, 95% CI = 1.5 to 2.7; and OR = 3.3, 95% CI = 1.6 to 7.1, respectively).

Conclusions:  Of patients without evidence of trauma who receive CCT in the ED, the prevalence of focal neurologic findings and clinically important abnormalities on tomography is low, the need for emergent intervention is very low, and the large majority of patients requiring emergent intervention have focal findings. The yield of CCT was lower for patients presenting with AMS, and higher for patients presenting with motor weakness or speech abnormalities, and for those who were unresponsive.