bluuebunny/crossref_metadata_2025 huggingface dataset:
Backscattered electron SEM imaging of cells and determination of the information depth
Authors: SEITER J. , MÜLLER E. , BLANK H. , GEHRKE H. , MARKO D. , GERTHSEN D.
Published: March 2014

Backscattered electron imaging of HT29 colon carcinoma cells in a scanning electron microscope was studied. Thin cell sections were placed on indium‐tin‐oxide‐coated glass slides, which is a promising substrate material for correlative light and electron microscopy. The ultrastructure of HT29 colon carcinoma cells was imaged without poststaining by exploiting the high chemical sensitivity of backscattered electrons. Optimum primary electron energies for backscattered electron imaging were determined which depend on the section thickness. Charging effects in the vicinity of the SiO2 nanoparticles contained in cell sections could be clarified by placing cell sections on different substrates. Moreover, a method is presented for information depth determination of backscattered electrons which is based on the imaging of subsurface nanoparticles embedded by the cells.
The effect of aromatherapy on haemodialysis patients' pruritus
Authors: Cürcani Mehtap , Tan Mehtap
Published: March 2014

Aims and objectives

To determine the effect of aromatherapy on pruritus observed in haemodialysis patients.

Background

Although the prevalence of pruritus in kidney failure has decreased in the recent years, pruritus is a difficult and serious problem which concerns the majority of haemodialysis patents and is hard to cure.

Design

A prospective, pretest–post‐test quasi‐experimental design was used.

Methods

The research is quasi‐experimental clinical trial conducted as pretest and post‐test with control groups between January 2011–April 2012, in haemodialysis units of hospitals in Erzurum. The collection of the data is achieved using a questionnaire to detect the patients' individual and pruritus score scale and to clarify certain laboratory parameters regarding the pruritus. Chi‐square analysis and t‐test are used for the analysis of data.

Results

The experimental group's mean post‐test pruritus scores (7·20 ± 3·14) were found to be lower than that of control group patients (10·00 ± 2·47), and a highly significant difference was found between the groups (p < 0·001). In the between‐groups comparisons of experimental and control group's laboratory parameters, the experimental group's post‐test blood urea nitrogen levels (118·26 ± 36·76) were found to be lower than that of control group patients (138·80 ± 48·69), and the between‐groups difference was found to be statistically significant (p < 0·05).

Conclusions

The results demonstrate that aromatherapy was found to decrease the pruritus problem of haemodialyses patients and led to positive changes in some laboratory parameters related to pruritus.

Relevance to clinical practice

One of the roles of health professionals is to advise individuals, who are living on this problem, using the nonpharmacological methods in checking the itching. By preventing or reducing uraemic pruritus, aromatherapy may also improve quality of life in this patient group.
“VY Mudimbe: from the ‘Nation’ to the ‘Global’ – ‘Who is the Master?' ”
Authors: Fraiture Pierre‐Philippe
Published: March 2014

This article examines Valentin Yves Mudimbe's work form the early 1970s, in the neo‐colonial era, to the present day, a period marked by the advent of “Empire”, as conceived by Michael Hardt and Toni Negri. The investigation appraises the way in which Mudimbe's epistemological excavation of African discourses and discourses about Africa serves wider ethical and political objectives resonating with critiques of anthropology as formulated by Benoît Verhaegen and Johannes Fabian in the 1960s and 1970s. Part I focuses on Zairian nationalism (“Zairianization”) and the ambition, on the part of the Mobutu regime, to develop an authentic national culture. This examination of the birth of a Zairian “community” is developed through a comparison between Mudimbe's little‐studied Autour de la “nation” (1972) and Kangafu Kutumbagana's Discours sur l'authenticité (1973) and is argued on the basis of a number of propositions formulated by Jean‐Luc Nancy in The Inoperative Community (1991). The second part of the article focuses on Mudimbe's On African Fault Lines (2013); it examines Mudimbe's attempts, in his analyses of contemporary works by Deepa Rajkumar and Geert Hofstede, to reflect on globalization and to assess the political and ethical relevance of critical tools developed in the neo‐colonial period to denounce the unequal basis of anthropology.
Do the Better Insured Cause More Damage? Testing for Asymmetric Information in Car Insurance
Authors: Zavadil Tibor
Published: March 2014

This article tests for the presence of asymmetric information in Dutch car insurance among senior drivers using several nonparametric tests based on conditional‐correlation approach. Since asymmetric information implies that more comprehensive coverage is associated with higher risk, we examine whether the better insured have a higher frequency of claims or cause more severe accidents. Using data on claim occurrences, incurred losses and written premiums, and controlling for the insureds’ experience rating, we do not find any evidence of asymmetric information in this market.
Calcium‐signaling components in rat insulinoma β‐cells (INS‐1) and pancreatic islets are differentially influenced by melatonin
Authors: Bazwinsky‐Wutschke Ivonne , Mühlbauer Eckhard , Albrecht Elke , Peschke Elmar
Published: March 2014

The pineal secretory product melatonin exerts its influence on the insulin secretion of pancreatic islets by different signaling pathways. The purpose of this study was to analyze the impact of melatonin on calcium‐signaling components under different conditions. In a transfected INS‐1 cell line overexpressing the human MT2 receptor (hMT2‐INS‐1), melatonin treatment induced even stronger depressive effects on calcium/calmodulin‐dependent kinase 2d and IV (Camk2d, CamkIV) transcripts during 3‐isobutyl‐1‐methylxanthine (IBMX) treatment than in normal INS‐1 cells, indicating a crucial influence of melatonin receptor density on transcript‐level regulation. In addition, melatonin induced a significant downregulation of calmodulin (Calm1) in IBMX‐treated hMT2‐INS‐1 cells. Long‐term administration of melatonin alone reduced CamkIV transcript levels in INS‐1 cells; however, transcript levels of Camk2d remained unchanged. The release of insulin was diminished under long‐term melatonin treatment. The impact of melatonin also involved reductions in CAMK2D protein during IBMX or forskolin treatments in INS‐1 cells, as measured by an enzyme‐linked immunosorbent assay, indicating a functional significance of transcriptional changes in pancreatic islets. Furthermore, analysis of melatonin receptor knockout mice showed that the transcript levels of Camk2d, CamkIV, and Calm1 were differentially influenced according to the melatonin receptor subtype deleted. In conclusion, this study provides evidence that melatonin has different impacts on the regulation of Calm1 and Camk. These calcium‐signaling components are known as participants in the calcium/calmodulin pathway, which plays an important functional role in the modulation of the β‐cell signaling pathways leading to insulin secretion.
Hepatic toll‐like receptor 4 expression is associated with portal inflammation and fibrosis in patients with NAFLD
Authors: Vespasiani‐Gentilucci Umberto , Carotti Simone , Perrone Giuseppe , Mazzarelli Chiara , Galati Giovanni , Onetti‐Muda Andrea , Picardi Antonio , Morini Sergio
Published: March 2014

Background & Aims

Notwithstanding evidences implicating the lipopolysaccharides (LPS)/toll‐like receptor‐4 (TLR4) axis in the pathogenesis of NAFLD, there are no studies aimed to characterize hepatic TLR4 expression in NAFLD patients. We aimed to analyse hepatic TLR4 expression and to verify its relationship with disease activity/evolution in NAFLD patients.

Methods

Liver tissue from 74 patients with NAFLD and 12 controls was analysed by immunohistochemistry (IHC) for TLR4, α–smooth muscle actin (α–SMA) and cytokeratin‐7. IHC for α–SMA was used to evaluate activation of fibrogenic cells (hepatic stellate cells and portal/septal myofibroblasts), that for cytokeratin‐7 to count hepatic progenitor cells and bile ducts/ductules, and that for CD68, in a subgroup of 27 patients, for detecting macrophages. Serum LPS‐binding protein (LBP), a sensitive marker of LPS activity, was determined in 36 patients and 32 controls.

Results

As confirmed by double‐labelling experiments, the highest level of TLR4 expression was observed in hepatic progenitor cells, biliary cells and portal/septal macrophages. TLR4‐positive hepatic progenitor cells and bile ducts/ductules correlated with portal/interface inflammation, activity of fibrogenic cells and fibrosis (P < 0.001). Also the score of TLR4 positivity of porto‐septal inflammatory infiltrate correlated with number of hepatic progenitor cells and bile ducts/ductules, activity of fibrogenic cells and fibrosis (P < 0.01). Serum LBP was increased in patients compared to controls (P < 0.001), and correlated with portal/interface inflammation, activity of portal/septal myofibroblasts and fibrosis (all P < 0.05).

Conclusions

TLR4 expression by regenerating and inflammatory cells at the porto‐septal and interface level, favoured by increased LPS activity, is associated with activation of fibrogenic cells and the degree of fibrosis.
Both bone marrow‐derived and non‐bone marrow‐derived cells contribute to AIM2 and NLRP3 inflammasome activation in a MyD88‐dependent manner in dietary steatohepatitis
Authors: Csak Timea , Pillai Arun , Ganz Michal , Lippai Dora , Petrasek Jan , Park Jin‐Kyu , Kodys Karen , Dolganiuc Angela , Kurt‐Jones Evelyn A. , Szabo Gyongyi
Published: March 2014

Background & Aims

Inflammation promotes the progression of non‐alcoholic steatohepatitis (NASH). Toll‐like receptor 4 (TLR4) and TLR9 activation through myeloid differentiation primary response gene 88 (MyD88) and production of mature interleukin‐1β (IL‐1β) via inflammasome activation contribute to steatohepatitis. Here, we investigated the inter‐relationship between TLR signalling and inflammasome activation in dietary steatohepatitis.

Methods

Wild type (WT), TLR4‐ and MyD88‐deficient (KO) mice received methionine‐choline‐deficient (MCD) or ‐supplemented (MCS) diets for 5 weeks and a subset was challenged with TLR9 ligand CpG‐DNA.

Results

TLR4, TLR9, AIM2 (absent in melanoma 2) and NLRP3 (NLR family pyrin domain containing 3) inflammasome mRNA, and mature IL‐1β protein levels were increased in MCD diet‐induced steatohepatitis compared to MCS controls. TLR9 stimulation resulted in greater up‐regulation of the DNA‐sensing AIM2 expression and IL‐1β production in livers of MCD compared to MCS diet‐fed mice. High mobility group box 1 (HMGB1), a TLR9‐activating danger molecule and phospho‐HMGB1 protein levels were also increased in livers of MCD diet‐fed mice. MyD88‐ but not TLR4‐deficiency prevented up‐regulation of AIM2, NLRP3 mRNA and IL‐1β protein production in dietary steatohepatitis. Selective MyD88 deficiency either in bone marrow (BM)‐derived or non‐BM‐derived cells attenuated hepatic up‐regulation of inflammasome mRNA, caspase‐1 activation and IL‐1β protein production, but only BM‐derived cell‐specific MyD88‐deficiency attenuated liver injury.

Conclusions

Our data demonstrate that both bone marrow‐derived and non‐BM‐derived cells contribute to inflammasome activation in a MyD88‐dependent manner in dietary steatohepatitis. We show that AIM2 inflammasome expression and activation are further augmented by TLR9 ligands in dietary steatohepatitis.
Nurses' lived experiences of intensive care unit bed spaces as a place of care: a phenomenological study
Authors: Olausson Sepideh , Ekebergh Margaretha , Österberg Sofia Almerud
Published: March 2014

Background

The environment of an intensive care unit (ICU) is, in general, stressful and has an impact on quality of care in terms of patient outcomes and safety. Little is known about nurses' experiences, however, from a phenomenological perspective with regard to the critical care settings as a place for the provision of care for the most critically ill patients and their families.

Aim

The aim of this study was to explore nurses' lived experiences of ICU bed spaces as a place of care for the critically ill.

Design and methods

A combination of qualitative lifeworld interviews and photos – photovoice methodology – was used when collecting data. Fourteen nurses from three different ICUs participated. Data were analysed using a phenomenological reflective lifeworld approach.

Findings

An outer spatial dimension and an inner existential dimension constitute ICU bed spaces. Caring here means being uncompromisingly on call and a commitment to promoting recovery and well‐being. The meanings of ICU bed spaces as a place of care comprise observing and being observed, a broken promise, cherishing life, ethical predicament and creating a caring atmosphere.

Conclusions and relevance to clinical practice

The architectural design of the ICU has a great impact on nurses' well‐being, work satisfaction and the provision of humanistic care. Nurses need to be involved in the process of planning and building new ICU settings. There is a need for further research to highlight the quality of physical environment and its impact on caring practice.
Corporate smart phones: professionals' conscious engagement in escalating work connectivity
Authors: Cavazotte Flávia , Heloisa Lemos Ana , Villadsen Kaspar
Published: March 2014

This article explores how the adoption of company sponsored smart phones inflicts upon the lives of professionals. Drawing upon qualitative interviews at a law firm in Brazil, the experiences of new smart phone users are reported upon in detail. Increased accessibility, accuracy and speed in exchanges gave the users a sense of autonomy and flexibility. However, the technology also helped to intensify the organisation's hold on employees outside of regular working hours, reaching into new settings, time slots and social contexts. Employees expressed concerns regarding demands from superiors that negatively affected their private spheres, yet many of them paradoxically requested more efficient smart phone connectivity. The article focuses on the justifications, the different narrative strategies, employed by professionals for their conscious engagement in escalating work connectivity. It is suggested that these justifications display users' attempt to ‘dis‐identify’ with the role and practice they perform.
Green shoots from the grass roots? The National Shop Stewards Network
Authors: McBride Jo , Stirling John
Published: March 2014

This paper presents an analysis of the significance of the Internet in rebuilding a shop stewards movement in a time of circumscribed trade union organisation and power. It takes the National Shop Stewards Network as the focus for empirical research and places the argument within the broader context of two historical periods of trade union activity. The study finds significant historical parallels in terms of the key questions of the relationship between a network and a movement and the virtual and real worlds. It suggests that the Internet is particularly significant in forging horizontal rather than vertical links between shop stewards and unions and also provides the potential for mutual support and solidarity. However, the empirical research suggests different levels of engagement with the network, which the paper categorises and it also illustrates how a political party can become engaged in the networking activity.
Equilibrium Unemployment Dynamics in a Panel of OECD Countries
Authors: Nymoen Ragnar , Sparrman Victoria
Published: March 2014

We focus on the equilibrium unemployment rate as a parameter implied by a dynamic aggregate model of wage and price setting. The equilibrium unemployment rate depends on institutional labour market institutions through mark‐up coefficients. Compared with existing studies, the resulting final equation for unemployment has a richer dynamic structure. The empirical investigation is conducted in a panel data framework and uses OECD data up to 2012. We propose to extend the standard estimation method with time dummies to control and capture the effects of common and national shocks by using impulse indicator saturation (WG‐IIS), which has not been previously used on panel data. WG‐IIS robustifies the estimators of the regression coefficients in the dynamic model, and it affects the estimated equilibrium unemployment rates. We find that wage co‐ordination stands out as the most important institutional variable in our data set, but there is also evidence pointing to the tax wedge and the degree of compensation in the unemployment insurance system as drivers of equilibrium unemployment.
Cardiac Resynchronization Therapy in Patients with Challenging Anatomy Due to Venous Anomalies or Adult Congenital Heart Disease
Authors: NIAZI IMRAN , DHALA ANWER , CHOUDHURI INDRAJIT , SRA JASBIR , AKHTAR MASOOD , TAJIK ABDUL JAMIL
Published: March 2014

Background

Cardiac resynchronization therapy (CRT) has proven salutary effects in patients with congestive heart failure, systolic dysfunction, and electromechanical dyssynchrony in the setting of ischemic, nonischemic, and congenital cardiomyopathy. While CRT device implants have become routine in the adult ischemic or nonischemic cardiomyopathy populations, patients with congenital heart disease offer special challenges due to unusual anatomic variations.

Methods

A comprehensive assessment of anatomic abnormalities is essential prior to implant. In addition, implant techniques and equipment must be tailored to the expected anatomy. A flexible approach is necessary—implant may require equipment and techniques adapted from vascular intervention.

Conclusion

This article describes our approach to CRT implant in patients with congenital heart disease, and is illustrated by reports of several cases.
GOVERNMENT FUNDING, EMPLOYMENT CONDITIONS, AND WORK ORGANIZATION IN NON‐PROFIT COMMUNITY SERVICES: A COMPARATIVE STUDY
Authors: CUNNINGHAM IAN , BAINES DONNA , CHARLESWORTH SARA
Published: March 2014

The article provides a comparative exploration of New Public Management (NPM) funding models on the non‐profit sectors in the UK and Australia, and the implications for services, employment conditions, and worker commitment. A degree of convergence exists around the principles of NPM in the two case studies, creating employment regimes of low pay, casualization, and work intensification. Enhanced vulnerability to pay cuts in the UK, and insecurity in Australia are explained by national differences in exposure to recession, industrial relations institutions, and competition, leading to diminishing worker commitment and raising important concerns for policy‐makers as benefits gained from outsourcing to non‐profits are eroded.
A multicenter, randomized, double‐blind placebo‐controlled, single dose trial of the safety and efficacy of intravenous ibuprofen for treatment of pain in pediatric patients undergoing tonsillectomy
Authors: Moss Jonathan R. , Watcha Mehernoor F. , Bendel Laima P. , McCarthy Denise L. , Witham Stacy L. , Glover Chris D.
Published: March 2014

Background

Tonsillectomy is one of the most common pediatric procedures in the United States. An optimal perioperative pain control regimen remains a challenge. Intravenous ibuprofen administered at induction of anesthesia may be a safe and efficacious option for postoperative tonsillectomy pain.

Objectives

To determine whether preoperative administration of intravenous ibuprofen (IV‐ibuprofen) can significantly decrease the number of doses of postoperative fentanyl when compared with placebo in pediatric tonsillectomy surgical patients.

Methods

This was a multicenter, randomized, double‐blind placebo‐controlled trial conducted at six hospitals in the United States. A total of 161 pediatric patients aged 6–17 years undergoing tonsillectomy were randomized to receive either a single preoperative dose of 10 mg·kg−1 IV‐ibuprofen or placebo (normal saline). Postoperative pain was managed with intravenous fentanyl (0.5 μg·kg−1) on an as needed basis when the visual analog scale (VAS) was >30 mm and deemed appropriate by recovery room nurse/physician. The primary endpoint was the number of doses and amount of postoperative fentanyl administered postoperatively for rescue analgesia.

Results

There was a significant reduction in the number of postoperative doses and the amount of fentanyl administered after surgery in the IV‐ibuprofen group compared with the placebo group (P = 0.021). There were no differences in the time to first analgesia request or the number of patients who required postoperative analgesia. There were no significant differences in the incidence of serious adverse events, surgical blood loss (P = 0.662), incidence of postoperative bleeding, or a need for surgical re‐exploration between the treatment groups.

Conclusion

Administration of IV‐ibuprofen, 10 mg·kg−1, significantly reduced fentanyl use in pediatric tonsillectomy patients.
Postoperative pain during the first week after adenoidectomy and guillotine adenotonsillectomy in children
Authors: Vons Kristy M.J. , Bijker Jilles B. , Verwijs Edwin W. , Majoor Maarten H.J.M. , de Graaff Jurgen C.
Published: March 2014

Background

Adenoidectomy (AD) and adenotonsillectomy (ATE) are frequently occurring and often painful interventions in children. In literature, it is very prevalent that postoperative pain in children following ATE is hard to control. The purpose of this study was to evaluate the prevalence and severity of postoperative pain in children undergoing AD and ATE in the ambulatory setting.

Methods

A prospective cohort study was performed including 167 children aged 0–12 years, undergoing AD using an adenotome and ATE using the guillotine technique in day care. Children undergoing AD received acetaminophen pre‐ and postoperatively. Children undergoing ATE received acetaminophen and diclofenac preoperatively, sufentanyl postoperative and a prescription of around‐the‐clock treatment with acetaminophen and diclofenac at home. Pain intensity and analgesic consumption were recorded in hospital using the Faces, Legs, Activity, Cry and Consolability‐scale (FLACC), as well as during a 1‐week follow‐up period at home using the Parents' Postoperative Pain Measure (PPPM) and Visual Analogue Scale (VAS) scores.

Results

All children left the recovery room with adequate pain scores and were discharged with a median VAS of two after ATE and one after AD. The PPPM and VAS scores were highest at the first measurement at home for AD patients (VAS = 2.0 and PPPM = 1.5) and ATE patients (VAS = 4.5 and PPPM = 9). On the second postoperative day, AD patients scored 0.0 points on both VAS and PPPM. ATE patients scored at that time 3.0 point on the VAS and 6.0 points using the PPPM. Despite high adherence to pain treatment, daytime activities normalized after an average of 2 and 7 days after AD and ATE, respectively.

Conclusion

Examination of the PPPM and VAS scores illustrated that children undergoing AD were comfortable with acetaminophen as a single analgesic, whereas children undergoing ATE experience significant pain for up to two postoperative days when treated with acetaminophen and diclofenac.
Dexmedetomidine and ketamine sedation for muscle biopsies in patients with Duchenne muscular dystrophy
Authors: Kako Hiromi , Corridore Marco , Kean John , Mendell Jerry R. , Flanigan Kevin M. , Tobias Joseph D.
Published: March 2014

Background

Duchenne muscular dystrophy (DMD) possesses many potential challenges for anesthetic care. Invasive and noninvasive procedures with corresponding sedation or general anesthesia are frequent and necessary for affected patients. There remains a need for a better agent or agents for procedural sedation in patients with comorbid diseases. This study prospectively evaluated a combination of ketamine with two different doses of dexmedetomidine for sedation during muscle biopsy in patients with DMD.

Methods

Dexmedetomidine 1.0 or 0.5 μg·kg−1 was administered as a loading dose over 3 min followed by a continuous infusion of 1.0 or 0.5 μg·kg·h−1. Ketamine (1 mg·kg−1) was administered along with the dexmedetomidine loading dose. As the procedure commenced, additional doses of ketamine (0.5 mg·kg−1) were administered as needed. Sedation scores, hemodynamic data, operative times, and recovery times were recorded.

Results

The study cohort included a total of 53 bicep, deltoid, or anterior tibialis muscle biopsies in 19 boys including 24 in the dexmedetomidine 1.0 μg·kg−1 group and 29 in the dexmedetomidine 0.5 μg·kg−1 group. Mean age and weight were 9.7 ± 1.4 years and 33.3 ± 7.7 kg in the dexmedetomidine 1.0 μg·kg−1 group and 8.8 ± 1.8 years and 30.2 ± 10.8 kg in the dexmedetomidine 0.5 μg·kg−1 group. No significant changes in blood pressure were noted. A decrease in heart rate (HR) occurred after the loading dose of dexmedetomidine in both groups. The HR was significantly lower in the dexmedetomidine 1.0 μg·kg−1 group compared with the dexmedetomidine 0.5 μg·kg−1 group. Total recovery time to discharge was significantly shorter in the dexmedetomidine 0.5 μg·kg−1 group than the dexmedetomidine 1.0 μg·kg−1 group (146 ± 65 vs 174 ± 58 min; P = 0.03), although the total ketamine dose was significantly greater in the dexmedetomidine 0.5 μg·kg−1 group (3.7 ± 1.0 vs 2.0 ± 0.5 mg·kg−1; P < 0.01). There were no episodes of apnea or hypoventilation; however, a jaw thrust was needed in one patient in the dexmedetomidine 1.0 μg·kg−1group.

Conclusion

The combination of dexmedetomidine and ketamine is safe and effective for moderately painful procedures with limited respiratory and cardiovascular effects in a high‐risk patient population. Dexmedetomidine 0.5 μg·kg−1 as a loading dose with ketamine followed by a continuous infusion of dexmedetomidine at 0.5 μg·kg−1·h−1 achieved an adequate sedation level with shorter total recovery times in the perioperative unit compared with a higher dose regimen of dexmedetomidine (1.0 μg·kg−1 loading dose followed by an infusion at 1.0 μg·kg−1·h−1).
Chest Pain in an Out‐of‐Hospital Emergency Setting: No Relationship Between Pain Severity and Diagnosis of Acute Myocardial Infarction
Authors: Galinski Michel , Saget Diane , Ruscev Mirko , Gonzalez Geraldine , Ameur Lydia , Lapostolle Frédéric , Adnet Frédéric
Published: March 2014

Background

Chest pain frequently prompts emergency medical services (EMS) call‐outs. Early management of acute coronary syndrome (ACS) cases is crucial, but there is still controversy over the relevance of pain severity as a diagnostic criterion.

Study objective

The aim of this study was to determine whether there is a relationship between the severity of chest pain at the time of out‐of‐hospital emergency care and diagnosis of acute myocardial infarction (AMI).

Methods

This was a subsidiary analysis of prehospital data collated prospectively by EMS in a large suburb. It concerned patients with chest pain taken to hospital by a mobile intensive care unit. Pain was rated on EMS arrival using a visual analog, numeric or verbal rating scale and classified on severe or not severe according to the pain score. A diagnosis of AMI was confirmed or ruled out on the basis of 2 plasma troponin measurements and/or coronary angiography results.

Results

Among the cohort of 2,279 patients included, 234 were suitable for analysis, of which 109 (47%) were diagnosed with AMI. The rate of severe pain on EMS arrival was not significantly different between AMI patients and no myocardial infarction patients (49% [95% CI 40 to 58] and 43% [34 to 52], respectively; P = 0.3; odds ratio 1.3 [0.8 – 2.3] after adjustment for age and gender).

Conclusion

In our out‐of‐hospital emergency setting, the severity of chest pain was not a useful diagnostic criterion for AMI.
Medical outcomes of adolescent live kidney donors
Authors: MacDonald David , Kukla Aleksandra K. , Ake Sarah , Berglund Danielle , Jackson Scott , Issa Naim , Spong Richard , Matas Arthur J. , Ibrahim Hassan N.
Published: March 2014

Living kidney donation from donors <18 yr of age is uncommon. The majority of donations from adolescents took place several decades ago providing a unique opportunity to study true long‐term consequences of donation. We compared survival, renal outcomes, and rates of hypertension and diabetes among 42 adolescent donors and matched older controls. Adolescent donors were matched with donors 18–30 yr on the following: gender, relation to the recipient, BMI at donation, eGFR at donation, and year of donation. After a mean follow‐up of 31.8 ± 8.0 yr, 94.9% of adolescent donors were alive vs. 93.8% of controls. There was no significant difference in having eGFR (MDRD) <60 mL/min/1.73 m2 (26.1% vs. 40.9%), hypertension (35.9% vs. 39.4%), diabetes (5.1% vs. 12.5%), or proteinuria (15.4% vs. 14.1%): adolescent donors vs. controls for all comparisons. These data suggest that adolescent donors are not at a higher risk of shortened survival, hypertension, diabetes, or proteinuria. Nevertheless, they probably should donate only when other options are exhausted as they have to live with a single kidney for decades and longer follow‐up is needed.
Using individual DSA titers to assess for accommodation after late humoral rejection
Authors: Filler Guido , Grimmer Joanne , Ball Edward , Sharma Ajay P. , Huang Shih‐Han Susan
Published: March 2014

Management of late humoral rejection remains challenging, and DSA may persist. A case report illustrates how individual DSA titers using solid‐phase‐based assays may help to assess for accommodation. A male cystinosis patient received a cadaveric renal transplant at the age of 12 yr with a daclizumab, tacrolimus, MMF, and steroids‐based immunosuppression. After three acute rejection episodes over the first eight months, interstitial fibrosis/tubular atrophy (IF/TA) was diagnosed on biopsy, while the immunosuppression was left unchanged with a high target exposure for both tacrolimus and MPA. One yr later, AMR type III (C4d and DSA positive) was treated with daily plasmapheresis, IVIG 100 mg/kg and pulse steroids 5 mg/kg. DSA (DR 53, DQ4, and DQ 2) were not responding until the plasma volume was increased to 2.5 plasma volumes. A second rise of creatinine confirmed worse humoral rejection; daily plasma exchange was resumed, and two doses of rituximab (375 mg/m2) were given. Subsequently, all DSA dropped, but only DR53 DSA remained unchanged, whereas the DQ antibodies rebounded to very strong titers. With a follow‐up of over 120 days after recovery of the CD19 count, off all additional treatment and on identical immunosuppression with tacrolimus and MMF and prednisone, the patient's creatinine remained stable between 45 and 50 um while DQ DSA remain strong to very strong. We conclude that the patient is in a state of accommodation. DSA titers should be monitored when managing late humoral rejection.
Policy by Doing: Formulation and Adoption of Policy through Government Leadership
Authors: Koski Chris , Lee Taedong
Published: March 2014

Do government choices, rather than legislative policies (i.e., mandatory regulations or incentives), influence the choices private actors make? In this article we develop a concept of “policy by doing,” which examines the power of government actions as hortatory tools to encourage other community members to act. “Policy by doing” can be an attempt to shape outcomes by providing symbolic leadership, reducing uncertainty, creating market, and telegraphing actions. Empirical analysis of privately held green buildings in 591U.S.cities from 2004 to 2010 suggests that when governments increase their own commitment to green building for their facilities; private actors will be more likely to build green. We find that the actions of local governments, rather than those of state or federal, exert the strongest substantive influence on private decision making. Our findings contribute to understanding how governments can augment existing policy regimes by modeling the behavior they hope to inspire in other actors.
Learning from Schools: School Choice, Political Learning, and Policy Feedback
Authors: Fleming David J.
Published: March 2014

This article investigates the policy feedback and political learning effects of school vouchers. Of particular interest is how market‐based policies affect the likelihood that program participants will connect their experiences with the policy to the government. I examine parent survey data from an evaluation of the Milwaukee school voucher program. I find that voucher parents are more likely than public school parents to perceive that the government has influenced their child's schooling and to believe that their experiences with their child's school have taught them about how government works. Further, voucher parents report that their experiences with the policy have made them more politically active. While majorities of voucher and public school parents support increased public school expenditures, there is some evidence that school vouchers may decrease support for public schools.
Cardiac output during exercise: A comparison of four methods
Authors: Siebenmann C. , Rasmussen P. , Sørensen H. , Zaar M. , Hvidtfeldt M. , Pichon A. , Secher N. H. , Lundby C.
Published: March 2014

Several techniques assessing cardiac output (Q) during exercise are available. The extent to which the measurements obtained from each respective technique compares to one another, however, is unclear. We quantified Q simultaneously using four methods: the Fick method with blood obtained from the right atrium (QFick‐M), Innocor (inert gas rebreathing; QInn), Physioflow (impedance cardiography; QPhys), and Nexfin (pulse contour analysis; QPulse) in 12 male subjects during incremental cycling exercise to exhaustion in normoxia and hypoxia (FiO2 = 12%). While all four methods reported a progressive increase in Q with exercise intensity, the slopes of the Q/oxygen uptake (VO2) relationship differed by up to 50% between methods in both normoxia [4.9 ± 0.3, 3.9 ± 0.2, 6.0 ± 0.4, 4.8 ± 0.2 L/min per L/min (mean ± SE) for QFick‐M, QInn, QPhys and QPulse, respectively; P = 0.001] and hypoxia (7.2 ± 0.7, 4.9 ± 0.5, 6.4 ± 0.8 and 5.1 ± 0.4 L/min per L/min; P = 0.04). In hypoxia, the increase in the Q/VO2 slope was not detected by Nexfin. In normoxia, Q increases by 5–6 L/min per L/min increase in VO2, which is within the 95% confidence interval of the Q/VO2 slopes determined by the modified Fick method, Physioflow, and Nexfin apparatus while Innocor provided a lower value, potentially reflecting recirculation of the test gas into the pulmonary circulation. Thus, determination of Q during exercise depends significantly on the applied method.
Impact of single and multiple sets of resistance exercise in type 1 diabetes
Authors: Turner D. , Luzio S. , Gray B. J. , Dunseath G. , Rees E. D. , Kilduff L. P. , Campbell M. D. , West D. J. , Bain S. C. , Bracken R. M.
Published: March 2014

To examine glycemic and glucoregulatory responses to resistance exercise (RE) sessions of different volume in type 1 diabetes (T1DM). Eight T1DM (seven males: one female; age: 38 ± 6 years, HbA1C: 8.7 ± 1.0%/71 ± 11 mmol/mol) attended the research facility fasted and on four separate occasions, having taken their usual basal insulin, but omitted morning rapid‐acting insulin. Participants completed a 1SET (14 min), 2SET (28 min), 3SET (42 min) RE session (eight exercises × 10 repetitions) at 67 ± 3% one‐repetition‐maximum followed by 60‐min recovery, or a resting trial (CON). Venous blood samples were taken before and after exercise. Data (mean ± SEM) were analyzed using repeated‐measures analysis of variance (P ≤ 0.05). RE did not induce hypoglycemia (BG < 4 mmol/L). During recovery, blood glucose (BG) concentrations remained above pre‐exercise after 1SET (15–60 min, P < 0.05) and 2SET (0–60 min, P < 0.05) but comparable (P > 0.05) with pre‐exercise after 3SET. BGIAUC(area‐under‐curve) (mmol/L/60 min) was greater after 1SET and 2SET vs CON (1SET 103.6 ± 36.9 and 2SET 128.7 ± 26.1 vs CON −24.3 ± 15.2, P < 0.05), but similar between 3SET and CON (3SET 40.7 ± 59.3, P > 0.05). Under all trials, plasma creatine kinase levels at 24 h post‐exercise were similar (P > 0.05) to pre‐exercise. RE does not induce acute hypoglycemia or damage muscle. BG progressively rose after one and two sets of RE. However, inclusion of a third set attenuated exercise‐induced hyperglycemia and returned BG to that of a non‐exercise trial.
Effects of real and sham whole‐body mechanical vibration on spinal excitability at rest and during muscle contraction
Authors: Hortobágyi T. , Rider P. , DeVita P.
Published: March 2014

We examined the effects of whole‐body mechanical vibration (WBV) on indices of motoneuronal excitability at rest and during muscle contraction in healthy humans. Real and sham WBV at 30 Hz had no effect on reflexes measured during muscle contraction. Real WBV at 30 and 50 Hz depressed the H‐reflex ∼45%. These depressions diminished across the five inter‐bout rest intervals. The depression converted to 27% and 7% facilitation over the 15‐min long recovery period following real WBV at 30 and 50 Hz, respectively. The depression, measured during the inter‐bout rest, correlated r = 0.48 (P = 0.007) with the subsequent facilitation, measured during the follow‐up. The depression produced by sham vs real WBV was significant but less (23%), recovered faster, and the facilitation was absent in the 15‐min long follow‐up period. WBV produced time‐varying depression followed by facilitation of the H‐reflex at rest. A lack of change in volitional wave suggests that WBV did not affect the efferent neural drive.
Pore volume is most highly correlated with the visual assessment of skin pores
Authors: Kim S. J. , Shin M. K. , Back J. H. , Koh J. S.
Published: March 2014

Background/Purpose

Many studies have been focused on evaluating assessment techniques for facial pores amid growing attention on skin care. Ubiquitous techniques used to assess the size of facial pores include visual assessment, cross‐section images of the skin surface, and profilometric analysis of silicone replica of the facial skin. In addition, there are indirect assessment methods, including observation of pores based on confocal laser scanning microscopy and the analysis of sebum secretion and skin elasticity. The aim of this study was to identify parameters useful in estimating pore of surface in normal skin.

Methods

The severity of pores on the cheek area by frontal optical images was divided on a 0–6 scale with ‘0’ being faint and small pore and ‘6’ being obvious and large pore.

After the photos of the frontal cheek of 32 women aged between 35 and 49 were taken, the size of their pores was measured on a 0–6 scale; and the correlation between visual grading of pore and various evaluations (pore volume by 3‐D image, pore area and number by Optical Image Analyzer) contributing to pore severity investigated using direct, objective, and noninvasive evaluations.

Results

The visual score revealed that the size of pores was graded on a 1–6 scale. Visual grading of pore was highly correlated with pore volume measured from 3‐D images and pore area measured from 2‐D optical images in the order (P < 0.01). Visual grading of pore was also slightly correlated with the number of pores in size of over 0.04 mm2 (P < 0.05).

Conclusion

High correlation between pore score and pore volume can be explained by 3‐D structural characteristics of pores. It is concluded that pore volume and area serve as useful parameters in estimating pore of skin surface.
Verb particles and OV/VO in the history of English
Authors: Elenbaas Marion , van Kemenade Ans
Published: March 2014

Verb particles (e.g.up,out,off,down,away) are a well‐known and well studied feature of English and of Germanic languages in general. Nevertheless, the functional and categorial status of English verb particles remains debated, and, especially in the diachronic literature onOV/VOword‐order change, this question is typically avoided entirely. This lack of precision about the nature of verb particles is surprising, given the central role attributed to verb particles as diagnostic elements for basic word order. We motivate an analysis of English verb particles as (optionally) projecting intransitive prepositions which function as secondary predicates. In relation to theOV/VOissue, we claim that, although there is a statistically strong cross‐Germanic correlation between the position of verb particles and verb complements, the position of verb particles is not a diagnostic forOV/VOorder. To support this claim, we will show that there is no one‐to‐one correspondence a) between Prt–V surface word order and an underlyingOVgrammar, or b) between V–Prt surface word order and an underlyingVOgrammar. Moreover, it will be shown thatOVorder withDP‐objects in early Middle English is highly discourse‐sensitive, suggesting thatOVorder withDP‐objects is not determined by phrase structure, but by discourse‐sensitive scrambling from aVObase.
West flemish verb‐based discourse markers and the articulation of the speech act layer
Authors: Haegeman Liliane
Published: March 2014

This paper focuses on the West Flemish discourse markers located at the edge of the clause. After a brief survey of the distribution of discourse markers in WF, the paper proposes a syntactic analysis of the discourse markers né and wè. Based on the distribution of these discourse markers, of vocatives and of dislocated DPs, an articulated speech act layer is elaborated which corroborates the proposals in Hill (). It is postulated that there is a syntactic relation between particles used as discourse markers and vocatives. The paper offers further support for the grammaticalization of pragmatic features at the interface between syntax and discourse and for the hypothesis that the relevant computation at the interface is of the same nature as that in Narrow Syntax.
The novel HLA‐B*35:240 allele identified by sequence‐based typing in an Italian family
Authors: Testi M. , Battarra M. , Troiano M. , Testa G. , Andreani M.
Published: March 2014

HLA‐B*35:240 shows one nucleotide change from B*35:01:01 at nt 160 from G to T.
HLA‐A*11:165, a variant of HLA‐A*11, discovered in a Taiwanese unrelated hematopoietic stem cell donor
Authors: Yang K. L. , Lee S. K. , Lin P. Y.
Published: March 2014

One nucleotide replacement in codon 145 (CGC>AGC) of the human leukocyte antigen HLA‐A*11:01:01 results in a novel allele, HLA‐A*11:165.
Identification of a novel HLA‐B*15 variant allele, HLA‐B*15:276, in an umbilical cord blood donor
Authors: Barbuti S. , Sciarrino R. , Mariotti M. , Curcio M. , Scatena F.
Published: March 2014

A newly identified allele, named HLA B*15:276, differs from B*15:01:01:01 by the single nucleotide substitution 511T‐C at codon 147 (Trp → Arg) in exon 3.
Characterization and Modeling of Micro Swimmers With Helical Tails and Cylindrical Heads Inside Circular Channels
Authors: Acemoglu Alperen , Zeynep Temel F. , Yesilyurt Serhat
Published: March 2014

Micro swimming robots offer many advantages in biomedical applications, such as delivering potent drugs to specific locations in targeted tissues and organs with limited side effects, conducting surgical operations with minimal damage to healthy tissues, treatment of clogged arteries, and collecting biological samples for diagnostic purposes. Reliable navigation techniques for micro swimmers need to be developed for navigation, positioning, and localization of robots inside the human body in future biomedical applications. In order to develop simple models to estimate trajectories of magnetically actuated micro swimmers blood vessels and other conduits, effects of the channel wall must be understood well. In this study, swimming of one-link robots with helical tails in stationary fluids inside channels is modeled with Stokes equations and solved numerically with the finite-element method. Lateral and angular velocities of the robot are obtained from force free swimming conditions. Effects of the amplitude and number of helical waves, and the relative size of the body of the swimmer and its radial position on angular and linear velocity vectors of the swimmer are presented.
Dynamics of a Linear Oscillator Coupled to a Bistable Light Attachment: Numerical Study
Authors: Romeo Francesco , Sigalov Grigori , Bergman Lawrence A. , Vakakis Alex F.
Published: March 2014

The conservative and dissipative dynamics of a 2DOF, system composed of a grounded linear oscillator coupled to a lightweight mass by means of both strongly nonlinear and linear negative stiffnesses is investigated. Numerical studies are presented aiming to assess the influence of this combined coupling on the transient dynamics. In particular, these studies are focused on passive nonlinear targeted energy transfer from the impulsively excited linear oscillator to the nonlinear bistable lightweight attachment. It is shown that the main feature of the proposed configuration is the ability of assuring broadband efficient energy transfer over a broad range of input energy. Due to the bistability of the attachment, such favorable behavior is triggered by different nonlinear dynamic mechanisms depending on the energy level. For high energy levels, strongly modulated oscillations occur, and the dynamics is governed by fundamental (1:1) and superharmonic (1:3) resonances; for low energy levels, chaotic cross-well oscillations of the nonlinear attachment as well as subharmonic resonances lead to strong energy exchanges between the two oscillators. The results reported in this work indicate that properly designed attachments of this type can be efficient absorbers and dissipators of impulsively induced vibration energy.
Mechanics Modeling of Multisegment Rod-Driven Continuum Robots
Authors: Rone William S. , Ben-Tzvi Pinhas
Published: March 2014

This paper presents a novel modeling approach for the mechanics of multisegment, rod-driven continuum robots. This modeling approach utilizes a high-fidelity lumped parameter model that captures the variation in curvature along the robot while simultaneously defined by a discrete set of variables and utilizes the principle of virtual power to formulate the statics and dynamics of the continuum robot as a set of algebraic equations for the static model and as a set of coupled ordinary differential equations (ODEs) in time for the dynamic model. The actuation loading on the robot by the actuation rods is formulated based on the calculation of contact forces that result in rod equilibrium. Numerical optimization calculates the magnitudes of these forces, and an iterative solver simultaneously estimates the robot's friction and contact forces. In addition, modeling considerations including variable elastic loading among segments and mutual segment loading due to rods terminating at different disks are presented. The resulting static and dynamic models have been compared to dynamic finite element analyses and experimental results to validate their accuracy.
Impact Mechanics of Elastic Structures With Point Contact
Authors: Szalai Róbert
Published: March 2014

This paper introduces a modeling framework that is suitable to resolve singularities of impact phenomena encountered in applications. The method involves an exact transformation that turns the continuum, often partial differential equation description of the contact problem into a delay differential equation. The new form of the physical model highlights the source of singularities and suggests a simple criterion for regularity. To contrast singular and regular behavior the impacting Euler–Bernoulli and Timoshenko beam models are compared.