bluuebunny/crossref_metadata_2025 huggingface dataset:
Transfusion reaction reporting in the era of hemovigilance: where form meets function
Authors: Dunbar Nancy M. , Walsh Shannon J. , Maynard Kimberly J. , Szczepiorkowski Zbigniew M.
Published: July 2011

BACKGROUND: Transfusion services rely on transfusion reaction reporting to provide patient care and protect the blood supply. By voluntary participation in the Hemovigilance Module of the Biovigilance Component of the National Healthcare Safety Network, health care facilities have an opportunity to share institutional transfusion reaction data nationally. An optimally designed reporting form is a critical part of reaction reporting.

STUDY DESIGN AND METHODS: All reports of transfusion reactions from 2006 to 2009 were analyzed to evaluate the frequency of reported signs and symptoms and the ability of our reporting form to capture this information. A total of 400 reactions with 879 reported signs and symptoms were reviewed. We then redesigned our reporting form to facilitate participation in hemovigilance reporting and capture with the check‐box option at least 90% of historically reported signs and symptoms and all those reported in at least 2% of reactions.

RESULTS: Our original reporting form failed to capture 10 of 32 (31%) signs and symptoms present on the hemovigilance reporting tool. Although our original reporting form contained 27 check‐box options, these captured only 657 (74.8%) of reported signs and symptoms. Our redesigned form captures all hemovigilance signs and symptoms. Based on our retrospective review, the new form would also capture up to 95% of previously reported signs and symptoms using the check‐box option.

CONCLUSION: We believe that this study presents an evidence‐based approach to the improvement of the transfusion reaction reporting form, which may be attractive for hospitals considering participation in the hemovigilance program.
Storage of aliquots of apheresis platelets for neonatal use in syringes with and without agitation
Authors: Diab Yaser , Wong Edward , Criss Valli R. , Moroff Gary , Wagner Stephen J. , Luban Naomi L.C.
Published: July 2011

BACKGROUND: To facilitate volume control in neonates, platelets (PLTs) are aliquoted and stored for short periods in non–gas‐permeable syringes before infusion. Although agitation of PLTs during storage in gas‐permeable bags is performed to maintain their quality, the effect of syringe agitation during storage is unknown.

STUDY DESIGN AND METHODS: Double apheresis PLTs (n = 6) were collected and split, providing two identical products. On Days 2 and 4 of storage, aliquots from one bag of each pair were transferred to two syringes and stored for 6 hours on flatbed agitator or were left at 20 to 24°C without agitation. A series of in vitro tests was performed on Days 0, 2 (Hours 0 and 6), and 4 (Hours 0 and 6). Control samples were obtained from the second matched bag that was stored on the agitator. Data were analyzed by one‐way analysis of variance with differences considered significant if the p value was less than 0.05.

RESULTS: Comparable results for several PLT variables were obtained with or without agitation of the syringes. On Day 4 Hour 6, pH values were 7.18 ± 0.12 (agitated syringes) and 7.19 ± 0.1 (nonagitated syringes), and extent of shape change and hypotonic shock response measurements were not significantly different between agitated syringes and nonagitated syringes (23.7 ± 6.4 and 74.3 ± 9.8% vs. 23.3 ± 5.4 and 76.0 ± 7.6%), respectively.

CONCLUSION: Based on in vitro testing, apheresis PLT aliquots can be stored in syringes for at least 6 hours without agitation before transfusions.
The effect of blood transfusion on pulmonary permeability in cardiac surgery patients: a prospective multicenter cohort study
Authors: Vlaar Alexander P.J. , Cornet Alexander D. , Hofstra Jorrit J. , Porcelijn Leendert , Beishuizen Albertus , Kulik Willem , Vroom Margreeth B. , Schultz Marcus J. , Groeneveld A.B. Johan , Juffermans Nicole P.
Published: July 2011

BACKGROUND: There is an association between blood transfusion and pulmonary complications in cardiac surgery. Mediators of increased pulmonary vascular leakage after transfusion are unknown. We hypothesized that factors may include antibodies or bioactive lipids, which have been implicated in transfusion‐related acute lung injury.

STUDY DESIGN AND METHODS: We performed a prospective cohort study in two university hospital intensive care units in the Netherlands. Pulmonary vascular permeability was measured in cardiac surgery patients after receiving no, restrictive (one or two transfusions), or multiple (five or more transfusions) transfusions (n = 20 per group). The pulmonary leak index (PLI), using 67Ga‐labeled transferrin, was determined within 3 hours postoperatively. Blood products were screened for bioactive lipid accumulation and the presence of antibodies.

RESULTS: The PLI was elevated in all groups after cardiac surgery. Transfused patients had a higher PLI compared to nontransfused patients (33 × 10−3 ±  20 × 10−3 vs. 23 × 10−3 ± 11 × 10−3/min, p < 0.01). The amount of red blood cell (RBC) products, but not of fresh‐frozen plasma or platelets, was associated with an increase in PLI (β, 1.6 [0.2‐3.0]). Concerning causative factors in the blood product, neither the level of bioactive lipids nor the presence of antibodies was associated with an increase in PLI. Patient factors such as surgery risk and time on cardiopulmonary bypass did not influence the risk of pulmonary leakage after blood transfusion.

CONCLUSIONS: Transfusion in cardiothoracic surgery patients is associated with an increase in pulmonary capillary permeability, an effect that was dose dependent for RBC products. The level of bioactive lipids or the presence of HLA or HNA antibodies in the transfused products were not associated with increased pulmonary capillary permeability.
DIII Type 7 is likely the original serologically defined DIIIb
Authors: Lomas‐Francis Christine , Halter Hipsky Christine , Velliquette Randall W. , Reid Marion E.
Published: July 2011

BACKGROUND: Due to their homology, close proximity, and opposite orientation, RHD and RHCE can exchange nucleotides giving rise to variant alleles. Some of these variants encode the so‐called partial phenotypes. The DIII partial D category has been subdivided into DIIIa, DIIIb, DIIIc, DIII Type 4, DIII Type 6, and DIII Type 7. During DNA‐based screening tests, we identified a second example of DIII Type 7 in a Dce donor from South Africa. Our study describes hemagglutination tests on this sample and raises a question regarding the molecular basis of the originally defined DIIIb category.

STUDY DESIGN AND METHODS: Hemagglutination and DNA testing were performed by standard techniques.

RESULTS: Red blood cells from this DIII Type 7 donor typed D+C−E−c+e+G−, DAK+ and did not react with anti‐D made by people with the DIII phenotype. The allele is RHD*DIII 150C, 178C, 201A, 203A, 307C, 410T, 455C, 602G, 667G.

CONCLUSIONS: Based on the serotype and ethnicity (black African), it is likely that DIII Type 7 is the originally defined DIIIb category.
Red blood cell alloimmunization in transfusion‐dependent Egyptian patients with thalassemia in a limited donor exposure program
Authors: El Danasoury Azza S. , Eissa Doaa G. , Abdo Reham M. , Elalfy Mohsen S.
Published: July 2011

BACKGROUND: Thalassemia is considered the most common hemoglobinopathy in Egypt and is one of its major health problems. Lifelong red blood cell (RBC) transfusion remains the main treatment for severe forms; however, RBC alloimmunization results as a complication of regular transfusions due to repeated exposure to foreign antigens. The objective was to compare the frequency of alloantibodies in a group of patients in a limited donor exposure program (LDEP) with those receiving RBCs from multiple donors in Egyptian transfusion‐dependent patients with thalassemia.

STUDY DESIGN AND METHODS: A total of 235 regularly transfused patients with thalassemia were studied, 36 of which were on LDEP. All patients were investigated for the presence of RBC autoantibodies and alloantibodies, followed by antibody identification for positive patients.

RESULTS: Forty‐six (19.5%) patients developed RBC alloantibodies. The most common clinically significant alloantibodies were directed against antigens in the Kell and Rh systems. Development of alloantibodies was associated with older age, higher transfusion frequency, and splenectomy. A trend toward lower alloimmunization was elicited in the LDEP group, where 8.3% (3/36) patients were alloimmunized compared to 21.6% (43/199) in the non‐LDEP one (p = 0.057).

CONCLUSIONS: Examination of donor RBCs for presence of Kell and Rh(E) antigens before transfusion can help decrease RBC alloimmunization. Further larger studies are required to assess the frequency of alloantibody production in patients on LDEP.
Donation return time at fixed and mobile donation sites
Authors: Carey Patricia M. , High Patrick M. , Schlumpf Karen S. , Johnson Bryce R. , Mast Alan E. , Rios Jorge A. , Simon Toby L. , Wilkinson Susan L. ,   for the NHLBI Retrovirus Epidemiology Donor Study‐II (REDS‐II)
Published: July 2011

BACKGROUND: This study investigated the effect of blood donation environment, fixed or mobile with differing sponsor types, on donation return time.

STUDY DESIGN AND METHODS: Data from 2006 through 2009 at six US blood centers participating in the Retrovirus Epidemiology Donor Study‐II (REDS‐II) were used for analysis. Descriptive statistics stratified by whole blood (WB), plateletpheresis (PP), and double red blood cell (R2) donations were obtained for fixed and mobile locations, including median number of donations and median interdonation interval. A survival analysis estimated median return time at fixed and mobile sites, while controlling for censored return times, demographics, blood center, and mandatory recovery times.

RESULTS: Two‐thirds (67.9%) of WB donations were made at mobile sites, 97.4% of PP donations were made at fixed sites, and R2 donations were equally distributed between fixed and mobile locations. For donations at fixed sites only or alternating between fixed and mobile sites, the highest median numbers of donations were nine and eight, respectively, and the shortest model‐adjusted median return times (controlling for mandatory eligibility times of 56 and 112 days) were 36 and 30 days for WB and R2 donations, respectively. For PP donations, the shortest model‐adjusted median return time was 23 days at a fixed location and the longest was 693 days at community locations.

CONCLUSION: WB, PP, and R2 donors with the shortest time between donations were associated with fixed locations and those alternating between fixed and mobile locations, even after controlling for differing mandatory recovery times for the different blood donation procedures.
Fluoroscopic Left Ventricular Lead Position and the Long‐Term Clinical Outcome of Cardiac Resynchronization Therapy
Authors: FOLEY PAUL W.X. , CHALIL SHAJIL , RATIB KARIM , SMITH RUSSELL , PRINZEN FRITS , AURICCHIO ANGELO , LEYVA FRANCISCO
Published: July 2011

Background:
 To determine the effects of left ventricular (LV) lead tip position on the long‐term outcome of cardiac resynchronization therapy (CRT).

Setting:
 Cardiac device therapy center.

Patients:
 Five hundred and fifty‐six patients (age 70.4 ± 10.7 years [mean ± standard deviation]).

Interventions:
 CRT‐pacing or CRT‐defibrillation device implantation.

Main outcome measures:
 Cardiovascular mortality and events over a maximum follow‐up period of 9.1 years.

Results:
 Hazard ratios (HRs [95% 785]797) for cardiovascular mortality, adjusted for age, gender, QRS duration, heart failure etiology, New York Heart Association class, and presence of diabetes and atrial fibrillation, were derived for LV lead tip positions in terms of veins, circumferential, and longitudinal positions with respect to the LV chamber. For vein position, these were 1.07 (0.74–1.56) for anterolateral vein position and 1.24 (0.79–1.95) for the middle cardiac vein, compared with a posterolateral vein. For circumferential lead tip position, HRs were 1.56 (0.73–3.34) for anterolateral and 1.57 (0.76–3.25) for lateral, compared with posterior positions. For longitudinal lead tip positions, HRs were 1.02 (0.72–1.46) for basal and 1.21 (0.68–2.17) for apical, compared with mid‐ventricular positions. The risk of meeting the composite endpoints of cardiovascular death or hospitalizations for heart failure and death from any cause or hospitalizations for major adverse cardiovascular events was similar among the various LV lead tip positions.

Conclusions:
 The position of the LV lead over the LV free wall, assessed by fluoroscopy, has no influence over the long‐term outcome of CRT. (PACE 2011; 34:1–13)
Treatment of Cardiovascular Implantable Electronic Device Infection with Daptomycin
Authors: JEBRAN AHMAD F. , POPOV ARON F. , ZENKER DIETER , BIRETA CHRISTIAN , RAJARUTHNAM DIRENDRA , FRIEDRICH MARTIN , SCHOENDUBE FRIEDRICH A.
Published: July 2011

We describe a case of 83‐year‐old man who was admitted to our department for treatment of recurrent device‐pocket infections. Our report shows that in a case of high‐risk patient with a complicated cardiac implantable electric devices infection involving multidrug‐resistent gram‐positive pathogen, the application of daptomycin in combination with staged surgical therapy can be efficient and safe. PACE 2012; 35:e105–e107)
An ICD Lead with Failure of Outer Insulation Goes Undetected by Regular Measurements
Authors: CHAN CHI‐WO , CHIANG CHUNG‐SEUNG
Published: July 2011

We report a patient with ischemic cardiomyopathy status post implantable cardioverter‐defibrillator (ICD) implantation in June 2009. Outer insulation failure of her Riata ST ventricular ICD lead goes undetected by routine interrogation and provocative tests as recommended from its manufacturer.1 Another domain of assessment, fluoroscopy, to facilitate early detection of structural abnormality in this family of ICD lead is discussed. (PACE 2012; 35:e261–e262)
Une méthode illustrée pour la sectorisation morphodynamique de la rivière Neigette (Québec)
Authors: Demers Sylvio , Buffin‐Bélanger Thomas
Published: July 2011

L’hydrogéomorphologie fluviale est peu reconnue dans les politiques de gestion et d’aménagement du territoire québécois. Une meilleure reconnaissance permettrait pourtant une gestion plus éclairée des cours d’eau par une intégration de leur dimension dynamique. Cette étude teste l’applicabilité d’une méthode de sectorisation de cours d’eau en unités morphodynamiques homogènes. Cette compartimentation résulte d’une division longitudinale sur la base des changements des valeurs de puissance spécifique, de composition sédimentaire des berges, du confinement dans la vallée et de géométrie planimétrique. La caractérisation est appliquée à un corridor de la rivière Neigette comportant une diversité de formes et de processus fréquemment retrouvés dans les rivières du Québec. Les résultats suggèrent la présence de trois unités morphodynamiques: divagant à chenaux multiples, méandres dynamiques et méandres stables. La méthode présente une forte capacitéà discriminer ces environnements morphodynamiques ainsi que leurs limites respectives. La puissance spécifique présente à elle seule une forte capacité de discrimination. L’efficacité de la démarche, l’aisance de son application et sa flexibilité font de cette approche un solide outil à intégrer dans le processus de gestion des environnements fluviaux.
Influence of Externally Imposed and Internally Generated Electrical Fields on Grain Growth, Diffusional Creep, Sintering and Related Phenomena in Ceramics
Authors: Raj Rishi , Cologna Marco , Francis John S. C.
Published: July 2011

Microwaves and spark plasma sintering (SPS) enhance sinterability. Simple electrical fields, applied by means of a pair of electrodes to bare specimens, have been shown to accelerate the rate of superplastic deformation, reduce the time and temperature for sintering, and to retard the rate of grain growth. By inference, the influence of electrical and electromagnetic fields on grain boundary energetics and kinetics is unmistakable. Often, in ceramics, grain boundaries are themselves endowed with space charge that can couple with externally applied fields. The frequency dependence of this coupling ranging from zero frequency to microwave frequencies is discussed. The classical approach for modeling grain growth, creep, and sintering, considers chemical diffusion (self‐diffusion) under a thermodynamic driving force, underpinned by a physical mechanism that visualizes the flow of mass transport in a way that reproduces the phenomenological observations. In all instances, the final analytical result can be separated into a product of three functions: one of the grain size, the second related to the thermodynamic driving force, and the third to the kinetics of mass transport. The influence of an electrical field on each of these functions is addressed.The fundamental mechanisms of these electrical interactions are discussed in the following ways: (i) dielectric loss and Joule heating in the crystal and at the grain boundary, (ii) the coupling between mechanical stress and the electrochemical potential of charged species, (iii) the interaction between applied electrical fields and the intrinsic fields that exist within the space charge layers, (iv) and the possibility of nucleating defect avalanches under electrical fields. We limit ourselves to ceramics that have at least some degree of ionic character. In these experiments the electrical fields range from several volts to several hundred volts per centimeter, and the power dissipation from Joule heating is of the order of several watts per cubic centimeter of the specimen. Metals, where very high current densities are obtained at relatively low applied electric fields, leading to phenomenon such as electromigration, are not considered.
Tape Casting Thin, Continuous, Homogenous, and Flexible Tapes of ZrB2
Authors: Natividad Sylvia L. , Marotto Victoria R. , Walker Luke S. , Pham David , Pinc William , Corral Erica L.
Published: July 2011

Using an organic solvent‐based formulation, flexible and homogeneous ZrB2 tapes were cast for potential use as advanced aerospace exploration vehicles. Dispersant concentrations were optimized for attrition‐milled ZrB2 powder using gravitational sedimentation and viscosity measurements. Tape cast slurry formulations with varying amounts of binder (6–8 vol%), plasticizer (7–11 vol%), and solids loading (20–23 vol%) were used to optimize the casting slurry. An optimal slurry formulation was determined based on cast tape uniform particle distribution and flexibility without cracking. Thermal gravimetric analysis of the optimized tape was used to create a binder burnout schedule that did not alter the tape structure or particle distribution. Our organic solvent‐based tape casting approach results in minimum oxygen contamination after colloidal processing and robust cast tapes with a thickness of 280 μm and green density of ~41% theoretic density after binder burnout.
High Concentration Substitutional N‐Doped TiO2 Film: Preparation, Characterization, and Photocatalytic Property
Authors: Jiang Xudong , Wang Yongqian , Pan Chunxu
Published: July 2011

This article introduces a novel and valid process for preparing a high concentration substitutional N‐doped TiO2 photocatalytic film, i.e. firstly the titanium substrate was plasma nitrided and then the N‐doped TiO2 was synthesized on the surface of nitrided titanium by using micro‐arc oxidation. Compared with the traditional thermal annealing, the present process provides a possibility to increase the nitrogen doping concentration up to 3.21 at.% and x to 0.11 in TiO2–xNx, which exhibits a significant red‐shift in the band‐gap transition, narrow band gap to 2.6 eV, higher photo‐generated charge carrier density and improved photocatalytic property.
Anomalous Increase in the Resistivity of n‐Doped BaTiO3‐Based Ceramics with Pressure Observed at Room Temperature
Authors: Al‐Allak Haider M.
Published: July 2011

In this article, the observation of a large anomalous increase in room temperature resistivity with pressure following the pressure‐induced ferroelectric‐paraelectric phase transition in n‐doped BaTiO3‐based ceramics is reported. It is well known that the thermally induced phase transition in these ceramics is accompanied by an anomalous rise in resistivity, an effect referred to as the positive temperature coefficient of resistance. This phenomenon is considered as a grain boundary effect which depends on the behavior of the spontaneous polarization and the relative permittivity of the material with temperature. As the pressure dependence of the relative permittivity and spontaneous polarization in pure BaTiO3 crystals resemble their corresponding behavior with temperature, it was tempting to speculate that the pressure‐induced phase transition in n‐doped BaTiO3‐based ceramics may also be accompanied by a similar rise in resistivity. Preliminary investigations confirming such a prediction were carried out. This behavior may be, appropriately, referred to as the positive pressure coefficient of resistance. A model based on the grain boundary effects has also been proposed to explain the results. This large increase of resistivity with applied pressure may be used for pressure sensing applications.
Immediate Fixed Implant Rehabilitation of the Atrophic Edentulous Maxilla after Bilateral Sinus Floor Augmentation: A 12‐Month Pilot Study
Authors: Pieri Francesco , Aldini Nicolò Nicoli , Fini Milena , Marchetti Claudio , Corinaldesi Giuseppe
Published: July 2011

Purposes: The aims of this study were to evaluate a surgical/prosthetic protocol for the immediate rehabilitation of the augmented edentulous maxilla, and to compare the outcomes of implants placed in grafted (test group) versus native (control group) sites in the same patients.

Materials and Methods: Twenty patients were included in the study. Each patient was treated with a bilateral sinus augmentation procedure using a 50:50 composite graft of autogenous mandibular bone and bovine hydroxyapatite. Four to 5 months later, 155 implants (90 test and 65 control) were placed and restored with screw‐retained fixed definitive prostheses supported by titanium frameworks within 1 week. All patients were followed for 1 year. Implant stability quotient (ISQ) measurements and radiographic evaluation of the marginal bone resorption (MBR) were performed.

Results: Two test implants failed in two patients, giving a cumulative 1‐year success rate of 98.7%; the prostheses success rate was 100%. Insertion torque and ISQ values for test implants were significantly lower than those for control implants (unpaired t‐test, p < .0001). The mean MBR around control and test implants at the 1‐year evaluation were similar (0.47 ± 0.25 mm and 0.43 ± 0.21 mm, respectively).

Conclusions: The combination of implants placed in sinus‐grafted and native sites can be immediately loaded with a fixed full‐arch prosthesis and yield short‐term successful outcomes.
Acute Inflammatory Response to Laser‐Induced Micro‐ and Nano‐Sized Titanium Surface Features
Authors: Palmquist Anders , Johansson Anna , Suska Felicia , Brånemark Rickard , Thomsen Peter
Published: July 2011

Background: The inflammatory process induced by implant surfaces is an important component of the tissue response, where limited knowledge is available regarding the role of surface topography. With laser ablation, a combined micro‐ and nanoscale surfacemodification could be created, which have been shown to enhance bone growth and biomechanical stability in vivo.

Purpose: The aim of this article was to evaluate the early in vivo inflammatory response to laser‐modified titanium disks, with machined titanium disks and sham operation sites serving as controls.

Materials and Methods: Circular disks were installed in a subcutaneous rat model for 24 and 72 hours, where the cell number, cell types, and cytokine levels were evaluated.

Results: The results revealed that significantly fewer inflammatory cells (mononuclear and polymorphonuclear) were attracted to the sites with the laser‐modified implants compared with the machined titanium implants. Similar concentrations of pro‐inflammatory cytokines (TNF‐a and MCP‐1), together with slightly higher cell viability, were observed around the laser‐modified surface compared with the machined surface.

Conclusions: The results in the present study suggest that the combination of surface micro and nano features of the laser‐treated surface contributes to the downregulation of early inflammatory events.
A Hydrophilic Dental Implant Surface Exhibit Thrombogenic Properties In Vitro
Authors: Hong Jaan , Kurt Seta , Thor Andreas
Published: July 2011

Background: Surface modifications of dental implants have gained attention during several years and the thrombotic response from blood components with these materials has become more important during recent years.

Purpose: The aims of this study were to evaluate the thrombogenic response of whole blood, in contact with clinically used dental surfaces, Sandblasted Large grit Acid etched titanium (SLA) and Sandblasted Large grit Acid etched, and chemically modified titanium with hydrophilic properties (SLActive).

Methods: An in vitro slide chamber model, furnished with heparin, was used in which whole blood came in contact with slides of the test surfaces. After incubation (60‐minute rotation at 22 rpm in a 37°C water bath), blood was mixed with ethylenediaminetetraacetic acid (EDTA) or citrate, further centrifuged at +4°C. Finally, plasma was collected pending analysis.

Results: Whole blood in contact with surfaces resulted in significantly higher binding of platelets to the hydrophilic surface, accompanied by a significant increase of contact activation of the coagulation cascade. In addition, the platelet activation showed a similar pattern with a significant elevated release of β‐TG from platelet granule.

Conclusions: The conclusion that can be drawn from the results in our study is that the hydrophilic modification seems to augment the thrombogenic properties of titanium with implications for healing into bone of, that is titanium dental implants.
An Interdisciplinary Treatment Approach Combining Orthodontic Forced Eruption with Immediate Implant Placement to Achieve a Satisfactory Treatment Outcome: A Case Report
Authors: Chou Yu‐Hsiang , Du Je‐Kang , Chou Szu‐Ting , Hu Kai‐Fang , Tsai Chi‐Cheng , Ho Kun‐Yen , Wu Yi‐Min , Ho Ya‐Ping
Published: July 2011

Background: Periodontal disease often results in severely bony defects around the teeth and leads to eventual extraction. Remaining bone morphology often compromises ideally restoration‐driven positions and deteriorates the success rates for dental implants.

Purpose: The present investigation illustrates the clinical outcome of immediately installing an implant following orthodontic forced eruption and atraumatic extraction.

Material and Methods: The subject of this study is a 40‐year‐old Asian female with a right mandibular first molar that had a deep probing depth on the mesial side and mobility. Via the aid of radiographic examination, the tooth that had an angular bony defect and apical lesion was diagnosed as having deep caries and chronic periodontitis with a poor prognosis. After consultation with the patient, we developed a treatment plan incorporating a forced eruption with immediate implantation, intended to augment the alveolar bone volume and increase the width of keratinized gingivae, in a nonsurgical manner.

Results: Following 12 months of orthodontic treatment, the tooth was successfully moved occlusally in conjunction with an 8 mm vertical interdental bone augmentation. Because of sufficient volume of bone and satisfactory gingival dimensions, the implant showed adequate initial stability in the correct position to facilitate physiological and aesthetic prerequisites. After 6 months of ossteointegration, a customized impression coping was utilized to transfer the established emergence profile to a definitive cast for the fabrication of a customized abutment. The final prosthesis was made using a customized metal abutment and ceramometal crown.

Conclusion: In the face of difficult clinical challenges, meticulous inspection and a comprehensive treatment plan were crucial. Interdisciplinary treatment through the careful integration of multiple specialists suggests the possibility of optimal results with high predictability.
Comparison between Conventional and Piezoelectric Surgical Tools for Maxillary Sinus Floor Elevation. A Randomized Controlled Clinical Trial
Authors: Rickert Daniela , Vissink Arjan , Slater James J.R. Huddleston , Meijer Henny J.A. , Raghoebar Gerry M.
Published: July 2011

Aim: The aim of this study was to assess the performance of conventional rotative instruments and a piezoelectric device for maxillary sinus floor elevation surgery, and to assess whether application of a resorbable membrane reduces resorption of an augmented site in a randomized clinical trial.

Materials and Methods: Thirty‐six consecutive patients (59.2 ± 10.7 years, range 38–76 years) needing bilateral sinus floor elevation surgery agreed to participate in this study. In a parallel split mouth design randomized clinical trial, in which the allocation of the surgical technique to be used on the determined sites was randomly assigned, one site was always treated with conventional rotative instruments (control group) and the other site with piezosurgery (test group). In addition, in a random order, the grafted sites were covered with a collagen membrane or no membrane. After a healing period of 3–4 months implants were placed.

Results: Comparison of clinical features of the test and control sites revealed no differences with regard to wound healing and complications (perforations of the sinus membrane) during or postsurgery (p = .458, p = 1.0, respectively). A clinically insignificant, but statistically shorter operation time was observed when using conventional rotative instruments (11.1 ± 2.4 minutes) than using piezosurgery (15.1 ± 2.9 minutes; p < .001). In both groups, application of a resorbable membrane did not result in less horizontal bone resorption (membrane: 1.43 mm, no membrane: 1.06 mm; p = .062); All 193 implants could be placed with primary stability. One year after functional loading, survival rate was 100%.

Conclusion: It can be concluded that, for maxillary sinus floor elevation surgery, a piezoelectric device shows no advantages over rotative instruments as well as that placement of a barrier membrane did not reduce resorption of the augmented site.
Seven‐Year Follow‐Up Results of TiUnite Implants Supporting Mandibular Overdentures: Early versus Delayed Loading
Authors: Turkyilmaz Ilser , Tozum Tolga F. , Fuhrmann Dana M. , Tumer Celal
Published: July 2011

Background and Purpose: Implant‐supported mandibular overdentures have recently become a popular treatment alternative for edentulous patients desiring increased retention of complete dentures. The goal of this study was to evaluate and present treatment outcomes of mandibular overdentures retained by two unsplinted, early‐loaded implants and compare these results with those for delayed‐loaded implants.

Material and Methods: Twenty‐six edentulous patients had two interforaminal implants placed with a one‐stage protocol. The patients were each treated with a mandibular overdenture supported by ball abutments. In the test group, the overdenture was loaded 1 week after surgery and in the control group, the overdenture was loaded 3 months after surgery. Standardized clinical and radiographic parameters were recorded at surgery, and after 3, 6, 12, and 18 months, and 2, 3, 4, 5, and 7 years.

Results: Because two patients did not make the 7‐year recall, only 24 patients (48 implants) were evaluated in this study. No implants were lost, and 1.31 ± 0.2 mm marginal bone resorption was noted for all implants after 7 years. Implant stability measurements, clinical peri‐implant parameters and marginal bone levels exhibited no statistically significant differences between the two groups over 7 years.

Conclusion: The results of this clinical trial show that there is no significant difference in the clinical and radiographic outcomes of patients treated with mandibular overdentures supported by TiUnite implants that are either early or delayed loaded.
Efficiency and Thermal Changes during Implantoplasty in Relation to Bur Type
Authors: Sharon Eldad , Shapira Lior , Wilensky Asaf , Abu‐hatoum Rami , Smidt Ami
Published: July 2011

Background: Implantoplasty is one of the options in treating peri‐implantitis. The efficacy of the dental bur used can reduce the time needed for the procedure and, as a consequence, minimize the risk of overheating that can negatively affect the remaining bone surrounding the implant.

Purpose: The aim of this study was to evaluate the efficacy of three dental burs in removing implant substance (titanium) and to determine the amount of heat generated by each bur.

Materials and Methods: Four burs with different surface properties (diamond, diamond – Premium Line, carbide, and smooth bur – control [Strauss Co., Raanana, Israel]) were attached to a high‐speed handpiece and applied to a titanium implant for a total of 60 seconds after cooling by water spray. Variations in temperature were recorded every 5 seconds, and the amount of implant substance removed (reduction in weight of the implant) was evaluated.

Results: The diamond Premium Line bur removed 59.24 mg; carbide, 29.39 mg; diamond, 11.35 mg; and smooth bur (control) 0.19 mg, statistically significant. Only minimum thermal changes (∼1.5°C) were recorded for all four burs.

Conclusions: There are considerable differences in efficiency of different burs working on titanium. Selecting the proper bur can reduce working time. Under proper cooling conditions, implantoplasty does not generate excess temperature increases that can damage soft tissue or bone surrounding the treated implant.
A Retrospective Analysis of Early and Immediately Loaded Osseotite Implants in Cross‐Arch Rehabilitations in Edentulous Maxillas and Mandibles Up to 7 Years
Authors: Browaeys Hilde , Defrancq Joel , Dierens Melissa C.A. , Miremadi Resa , Vandeweghe Stefan , Van de Velde Tommie , De Bruyn Hugo
Published: July 2011

Background: Immediate loading of full‐arch restorations yields good results in selected cases, but long‐term follow‐up and the outcome in compromised bone are scarcely evaluated.

Purpose: To evaluate immediately loaded Osseotite implants (Biomet 3i, Palm Beach, FL, USA) installed in healed or grafted bone, with regard to implant survival and peri‐implant bone loss up to 7 years in function.

Materials and Methods: Information was retrospectively retrieved from 83 patients' records with 749 Osseotite implants supporting immediately loaded semipermanent full‐arch acrylic restorations. Five hundred sixty‐eight (75.8%) implants were placed in healed bone and 181 (24.2%) in augmented bone, regenerated with sinus lifting and/or onlay/inlay grafts with/without biomaterials and membranes. Implant survival and success based on radiological peri‐implant bone loss were registered. Wilcoxon rank sum tests evaluated peri‐implant bone loss in compromised versus healed bone or between jaws or time intervals with p < .05 as statistically significant.

Results: Sixteen of 749 implants failed (2.1%), 11/343 in maxilla (3.2%) and 5/406 (1.2%) in mandible. After 7 years, the cumulative failure rate was 9%. Mean peri‐implant bone loss increased to 1.2 mm (SD 1.0) during the first 2 years but remained unchanged thereafter. Around implants in grafted bone, on average, 0.3 mm more bone loss was found.

Conclusion: The Osseotite implants offer a predictable long‐term outcome in terms of implant survival and stable peri‐implant bone under immediate loading even in grafted bone. However, the high incidence of technical repair because of fractures of the semipermanent provisionals requires attention because it may be negative from a cost‐benefit perspective. Implants in grafted bone show a tendency to a more pronounced initial bone remodeling without clinical consequence in the long term.
On the occupation of X-ray-selected galaxy groups by radio active galactic nuclei since z = 1.3
Authors: Smolčić V. , Finoguenov A. , Zamorani G. , Schinnerer E. , Tanaka M. , Giodini S. , Scoville N.
Published: July 2011

Previous clustering analysis of low-power radio active galactic nuclei (AGNs) has indicated that they preferentially live in massive groups. The X-ray surveys of the Cosmic Evolution Survey (COSMOS) field have achieved a sensitivity at which these groups are directly detected out to z = 1.3. Making use of the surveys Chandra, XMM–Newton and VLA-COSMOS, we identify radio AGN members [1023.6≲ L1.4 GHz/(W Hz−1) ≲ 1025] of galaxy groups (1013.2≲ M200/M⊙≲ 1014.4; 0.1 < z < 1.3) and study (i) the radio-AGN–X-ray group occupation statistics as a function of group mass; and (ii) the distribution of radio AGNs within the groups. We find that radio AGNs are preferentially associated with galaxies close to the centre (<0.2r200). Compared to our control sample of group members matched in stellar mass and colour to the radio-AGN host galaxies, we find a significant enhancement of radio-AGN activity associated with 1013.6≲ M200/M⊙≲ 1014 haloes. We present the first direct measurement of the halo occupation distribution (HOD) for radio AGNs, based on the total mass function of galaxy groups hosting radio AGNs. Our results suggest a possible deviation from the usually assumed power-law HOD model. We also find an overall increase in the fraction of radio AGNs in galaxy groups (<1r200), relative to that in all environments.
Downsides and DCF: Valuing Biased Cash Flow Forecasts
Authors: Ruback Richard S.
Published: July 2011

The discounted cash flow valuation method relies on expected cash flows. But because they often ignore low‐probability downside events, the forecasts of expected cash flows that are provided by corporate managers and analysts are often excessively optimistic, or upwardly biased. As a result, such forecasts need to be adjusted when used in valuations.

Whereas academics generally prefer adjustments of the cash flow forecasts, practitioners typically account for such downsides by increasing t he discount rate above the market‐based cost of capital. This article suggests that the appropriate adjustment to the DCF formula should depend on the nature of the omitted downside.

The author shows that when the down side is assumed to be “temporary”— say, a large, weather‐related loss—the appropriate adjustment to the DCF formula is to reduce the forecasts by the expected downside and set the discount rate equal to the market‐based cost of capital. But when the omitted downside scenario is expected to be “permanent”—in the sense that the event reduces all subsequent future cash flows—the appropriate adjustment is to reduce the cash flows and increase the discount rate to reflect the probability that such a downside occurs.

By endorsing both of these prescriptions, the author effectively acknowledges that there is a reasonable conceptual basis for both the academic approach of adjusting the forecasted cash flows and the practitioner approach of inflating the discount rate. The appropriate approach depends on the characterization of the omitted downside as either temporary or permanent.
How the U.S. Army Analyzes and Copes with Uncertainty and Risk
Authors: Jones Hugh
Published: July 2011

In this edited transcript of a presentation at the CARE/CEASA conference, a U.S. army officer who teaches economics and finance at West Point discusses the Army's approach to managing uncertainty and risk while reflecting on his own two tours of duty in Iraq.

The U.S. military makes a clear distinction between risk and uncertainty. Whereas “risks” are threats to a mission or operation that can be identified, and at least to some degree controlled or mitigated, “uncertainty” applies to unknown or ambiguous hazards that resist any application of probability theory or quantitative methods. The risk mitigation process begins with assessments of the probability and severity of a given risk followed by the development of controls designed to limit that risk. Once the controls are implemented, the process becomes a continuous feedback loop in which the controls are evaluated and, if ineffective, either adjusted or eliminated.

The Army has two main ways that it tries to mitigate uncertainty: the “information‐focused” solution and the “action‐focused” solution. The information‐focused solution aims to reduce uncertainty by getting better information, and processing and disseminating it more quickly than the enemy. It also aims to avoid the illusion of precision that can come from too detailed predictions and instead plans for a worst‐case scenario as well as a most‐likely scenario. The action‐focused solution acknowledges that, no matter how good your information, some uncertainty is unavoidable, and the aim of this part of the program is to develop, train, and maintain units that can fight and win in the face of uncertainty. Much of this capability is attributed to training and a mission command framework in which intensive strategic planning (involving “the who, what, when, where and why of an undertaking”) and communication of the plan to field commanders and subordinate leaders is combined with heavy emphasis on the exercise of initiative by those field commanders and leaders.
Accounting for Sovereign Risk When Investing in Emerging Markets
Authors: Anshuman V. Ravi , Martin John , Titman Sheridan
Published: July 2011

In theory, political risk is project‐specific and should be accounted for in the estimation of the expected investment cash flows. But in practice, the political risk associated with this type of investment is typically accounted for implicitly by adjusting the investment's required rate of return or the discount rate. As the authors discuss in the article, this approach disguises the specific assumptions being made about the risk of expropriation and so makes it difficult to assess this risk properly.

While defending some aspects of current practice, the authors argue that corporate executives should consider some changes. For example, although a project analysis that is shared with the host government could incorporate a risk adjustment to the discount rate, the authors suggest that more explicit analysis of the anticipated risk of expropriation should be incorporated into the analysis of expected project cash flows. This analysis could involve making specific assumptions about the “term structure” of expropriation risk over the life of the investment.

Finally, the authors note that the political risk of making investments in emerging economies can be managed to some extent. Investments can be structured in ways that reduce political risk by structuring project cash flows in ways that better align the incentives of the project sponsor and the government of the host country.
How Corporate Diversity and Size Influence Spinoffs and Other Breakups
Authors: Milano Gregory V. , Treadwell Steven C. , Hopson Frank
Published: July 2011

In recent months, the list of large diversified companies that have decided they would be worth more as several smaller, focused companies has grown sharply. In many of these cases, it has been outside pressure from activist investors that has motivated these actions by management—and with some pretty favorable results.

But what is driving these strategic actions and what is most important in determining whether breakups create value? To answer this fundamental questions, it is critical to decide whether large, diversified companies have a value recognition problem or a value creation problem. In this article, the authors present and try to integrate the findings of two separate but related research studies on business diversity and size with the aim of identifying their implications for corporate strategy and helping company executives create more value for their investors.

The specific reasons for underperformance by large diverse companies vary greatly, but there are a number of potential problems discussed in this article, including organizational “distance,” capital allocation, human capital allocation, cross subsidies, and ineffective governance. Instead of waiting for activist investors to demand a breakup, executives of large diverse companies should be proactive in addressing the potential weaknesses of their organizations. Private equity firms understand how to make diversification work and many of today's executives could learn some valuable lessons from these firms. Large diverse businesses should embrace “Internal Capitalism,” a corporate culture and set of practices that emphasizes the importance of strategic decision‐making that is linked through continuous performance assessment to the corporate goals of boosting efficiency and sustainable growth.
The Three‐Factor Model: A Practitioner's Guide
Authors: Estrada Javier
Published: July 2011

The three‐factor model (3FM) has slowly but steadily become a popular alternative to the CAPM for measuring risk from the perspective of both corporate finance and portfolio management. The evidence clearly shows a negative relationship between market capitalization and returns, and a positive relationship between the book‐to‐market ratio and returns. Under the assumption that size and value are risk factors, the 3FM incorporates a market risk premium, a size premium, and a value premium into a model that aims to assess risk in a more comprehensive way, and ultimately to provide a more reliable estimation of required return. The required return produced by the 3FM has corporate finance applications (such as cost of capital estimation, project evaluation, and firm valuation) as well as portfolio management applications (such as performance evaluation). This article discusses the foundations and intuition behind the 3FM, as well as its application to the estimation of the cost of equity and excess returns.
Valuing Companies with Cash‐Flow@Risk
Authors: Bancel Franck , Tierny Jacques
Published: July 2011

The classic DCF approach to capital budgeting—the one that MBA students in the world's top business schools have been taught for the last 30 years—begins with the assumption that the corporate investment decision is “independent of” the financing decision. That is, the value of a given investment opportunity should not be affected by how a company is financed, whether mainly with debt or with equity. A corollary of this capital structure “irrelevance” proposition says that a company's investment decision should also not be influenced by its risk management policy—by whether a company hedges its various price exposures or chooses to leave them unhedged.

In this article, the authors—one of whom is the CFO of the French high‐tech firm Gemalto—propose a practical alternative to DCF that is based on a concept they call “cash‐flow@risk.” Implementation of the concept involves dividing expected future cash flow into two components: a low‐risk part, or “certainty equivalent,” and a high‐risk part. The two cash flow streams are discounted at different rates (corresponding to debt and equity) when estimating their value.

The concept of cash‐flow@risk derives directly from, and is fully consistent with, the concept of economic capital that was developed by Robert Merton and Andre Perold in the early 1990s and that has become the basis of Value at Risk (or VaR) capital allocation systems now used at most financial institutions. But because the approach in this article focuses on the volatility of operating cash flows instead of asset values, the authors argue that an internal capital allocation system based on cash‐flow@risk is likely to be much more suitable than VaR for industrial companies.