bluuebunny/crossref_metadata_2025 huggingface dataset:
Acoustic emission monitoring of interlaminar delamination onset in carbon fibre composites
Authors: Silversides Ian , Maslouhi Ahmed , LaPlante Gabriel
Published: January 2013

This article presents the development of an experimental methodology based on acoustic emission wave detection for determining delamination onset and propagation in carbon fibre composite materials under quasi-static and fatigue loading. Delamination was investigated in quasi-static interlaminar fracture testing over a wide range of mixed-mode ratios ( GII/ GT = 0, 0.3, 0.5 and 1) for unidirectional and woven samples. An acoustic emission wave detection method was developed to detect delamination onset, and the corresponding fracture toughness was computed. Interlaminar fracture toughness was also calculated by beam theory and from finite element analysis with the virtual crack closure technique. The mechanical testing results, acoustic emission monitoring and numerical model’s interlaminar fracture toughness were used to define delamination initiation criteria by drawing two-dimensional envelopes corresponding to GC = f( GII/ GT). The acoustic emission wave detection method showed damage accumulation before observable crack propagation, and its failure envelope corresponded to lower fracture energies than the standard test and modelling methods. Mode I fatigue testing with acoustic emission monitoring was performed on the woven samples for different energy release rate ratios ( GIMAX/ GIC = 0.3–0.8). A first series of samples were tested to construct an onset delamination fatigue curve Δ G = f( N). A second series of samples were used to study the cumulative acoustic emission energy distribution during delamination growth. An unsupervised pattern recognition methodology is presented for crack opening and closing testing, in order to discriminate between fatigue signal noise and acoustic emission signals emitted from crack initiation and crack growth. Correlations were observed between the acoustic emission energy distribution, the load range, the delamination length and the crack growth rate.
Entry Strategies in Business Process Offshoring
Authors: Luo Yadong , Jayaraman Vaidyanathan
Published: January 2013

Business process offshoring (BPO) has emerged as an important strategy and a prevalent landscape in global service operations management. As one of the first attempts to analyze this challenging issue in an emerging market, this study examines how firms develop a set of global expansion strategies, including where (location), when (timing), and what (diversification), that are unique to BPO service operations. Our analysis of 424 BPO service operations centers in India demonstrates that BPO units with greater knowledge specialization tend to operate in more developed cities and that information connectivity, government support, and human resources competitiveness are critical locational determinants. Although BPO investment is less path dependent than traditional foreign direct investment, behavioral variables, such as assertiveness and pre-BPO experience in the host locations, are important factors behind the timing decision. Finally, BPO units involving lower knowledge specialization or higher process measurability are more diversified in terms of the number of business processes outsourced.
Strategic Leadership
Authors: Carter Suzanne M. , Greer Charles R.
Published: January 2013

Strategic leaders are being challenged by stakeholder demands that organizations meet triple bottom line performance measures. Nonetheless, there is a paucity of empirical research on how strategic leaders’ values and leadership styles are related to such measures. We describe values and established and evolving leadership styles and review the results of empirical studies investigating their relationship with organizational performance. Gaps in our knowledge of such relationships are identified and suggestions for future research are provided. A continuum of leadership styles, from transactional through responsible, is developed using the dimensions of stakeholder salience and economic, social, and environmental performance outcomes.
Image-Guided Techniques Improve the Short-Term Outcome of Autologous Osteochondral Cartilage Repair Surgeries
Authors: Kunz Manuela , Devlin Steven M. , Hurtig Mark B. , Waldman Stephen D. , Rudan John F. , Bardana Davide D. , Stewart A. James
Published: January 2013

Objective:

Autologous osteochondral cartilage repair is a valuable reconstruction option for cartilage defects, but the accuracy to harvest and deliver osteochondral grafts remains problematic. We investigated whether image-guided methods (optically guided and template guided) can improve the outcome of these procedures.

Design:

Fifteen sheep were operated to create traumatic chondral injuries in each knee. After 4 months, the chondral defect in one knee was repaired using (a) conventional approach, (b) optically guided method, or (c) template-guided method. For both image-guided groups, harvest and delivery sites were preoperatively planned using custom-made software. During optically guided surgery, instrument position and orientation were tracked and superimposed onto the surgical plan. For the template-guided group, plastic templates were manufactured to allow an exact fit between template and the joint anatomy. Cylindrical holes within the template guided surgical tools according to the plan. Three months postsurgery, both knees were harvested and computed tomography scans were used to compare the reconstructed versus the native pre-injury joint surfaces. For each repaired defect, macroscopic (International Cartilage Repair Society [ICRS]) and histological repair (ICRS II) scores were assessed.

Results:

Three months after repair surgery, both image-guided surgical approaches resulted in significantly better histology scores compared with the conventional approach (improvement by 55%, P < 0.02). Interestingly, there were no significant differences found in cartilage surface reconstruction and macroscopic scores between the image-guided and the conventional surgeries.
On Subregional Analysis of Cartilage Loss from Knee MRI
Authors: Jørgensen Dan R. , Lillholm Martin , Genant Harry K. , Dam Erik B.
Published: January 2013

Objective:

Understanding how knee cartilage is affected by osteoarthritis (OA) is critical in the development of sensitive biomarkers that may be used as surrogate endpoints in clinical trials. The objective of this study was to analyze longitudinal changes in cartilage thickness using detailed change maps and to examine if current methods for subregional analysis are able to capture the underlying cartilage changes.

Materials and Methods:

MRI images of 267 knees from 135 participants were acquired at baseline and 21-month follow-up and processed using a fully automatic framework for cartilage segmentation and quantification. The framework provides an anatomical coordinate system that allows for direct comparison across cartilage thickness maps. The reproducibility of this method was evaluated on 37 scan–rescan image pairs.

Results:

In OA knees, an annualized thickness loss of 3.7% was observed in the medial femoral cartilage plate (MF) whereas subregional measurements varied between −9.0% (loss) and 1.6%. The largest changes were observed in the posterior part of the MF. In the medial tibial cartilage plate (MT), a thickness increase of 0.4% was observed whereas subregional measurements varied between −0.8% (loss) and 1.6%. In addition, notable differences in the patterns of cartilage change were observed between genders.

Conclusions:

This study indicated that the spatial changes, although highly heterogeneous, showed distinct patterns of cartilage thinning and cartilage thickening in both the MF and the MT. These patterns were not accurately reflected when thickness changes were averaged over large, predefined subregions as defined in current methods for subregional analysis.
Reflections on Communication and Sport
Authors: Wanta Wayne
Published: January 2013

In this essay, Wayne Wanta reflects on sports reporting and journalists in the context of the traditions of mass communication research and theory. The first section focuses on the importance of communication and sport and the challenges in getting respect for sports journalism. The second section focuses on influences on and the development of a research agenda on sports reporting. The focus section of the paper considers theoretical development and the challenges of finding an appropriate theoretical framework for the study of sports reporting and journalists. Here, research centered on cultivation theory, the hostile media effect, gender comparisons in coverage, the social construction of reality, agenda-setting and framing, and news gathering routines is considered. The article closes with a look ahead for communication and sport research.
Reflections on Communication and Sport
Authors: Jackson Steven
Published: January 2013

This essay highlights the unique and intimately interrelated nature of the relationship between communication and advertising by providing a selective overview of communication about and through sport within the context of promotional culture. While advertising and marketing of sport leagues, teams, celebrity athletes, and commodities are important, this treatment focuses on how the advertising industry has come to dominate contemporary social life, and why “sport” is such an important channel of communication within promotional culture. The article (a) outlines the emergence, nature, and social significance of advertising; (b) offers a framework for analysis based on the circuit of commodification and communication model that emphasizes the context and complex interrelationships between particular moments in commodification processes; (c) discusses a current research example examining sport, globalization, and corporate nationalism; and (d) considers directions for future research.
A highly conserved sequence associated with the HIV gp41 loop region is an immunomodulator of antigen-specific T cells in mice
Authors: Ashkenazi Avraham , Faingold Omri , Kaushansky Nathali , Ben-Nun Avraham , Shai Yechiel
Published: January 2013

Key Points

A motif associated with the gp41 loop region of HIV interacts with the T-cell receptor complex and inactivates antigen-specific T cells.
SRAdb: query and use public next-generation sequencing data from within R
Authors: Zhu Yuelin , Stephens Robert M , Meltzer Paul S , Davis Sean R
Published: January 2013

Background

The Sequence Read Archive (SRA) is the largest public repository of sequencing data from the next generation of sequencing platforms including Illumina (Genome Analyzer, HiSeq, MiSeq, .etc), Roche 454 GS System, Applied Biosystems SOLiD System, Helicos Heliscope, PacBio RS, and others.

Results

SRAdb is an attempt to make queries of the metadata associated with SRA submission, study, sample, experiment and run more robust and precise, and make access to sequencing data in the SRA easier. We have parsed all the SRA metadata into a SQLite database that is routinely updated and can be easily distributed. The SRAdb R/Bioconductor package then utilizes this SQLite database for querying and accessing metadata. Full text search functionality makes querying metadata very flexible and powerful. Fastq files associated with query results can be downloaded easily for local analysis. The package also includes an interface from R to a popular genome browser, the Integrated Genomics Viewer.

Conclusions

SRAdb Bioconductor package provides a convenient and integrated framework to query and access SRA metadata quickly and powerfully from within R.
Endoscopic large-balloon dilation alone versus endoscopic sphincterotomy plus large-balloon dilation for the treatment of large bile duct stones
Authors: Hwang Jae Chul , Kim Jin Hong , Lim Sun Gyo , Kim Soon Sun , Shin Sung Jae , Lee Kee Myung , Yoo Byung Moo
Published: January 2013

Background

Endoscopic sphincterotomy (EST) combined with large-balloon dilation (LBD) has been proposed as an alternative to manage large bile duct stones. However, recent reports indicate that LBD without EST may be safe and effective in this setting.

Methods

One hundred thirty-one patients with large common bile duct (CBD) stones 12 mm in size or larger underwent LBD alone (n = 62) or EST plus LBD (n = 69) for lithotripsy. The therapeutic outcome and complications were reviewed and compared.

Results

There were no differences between the two groups with regard to age, size and number of stones, or bile duct diameter. The LBD alone group (mean age, 70.4 years) and the EST plus LBD group (mean age, 68.2 years) had similar outcomes in terms of overall successful stone removal (96.8% vs. 95.7%, P = 0.738) and complete stone removal without the need for mechanical lithotripsy (80.6% vs. 73.9%, P = 0.360). Complications in the LBD alone and EST plus LBD groups were as follows: pancreatitis (6.5% vs. 4.3%, P = 0.593), impaction of basket and stone (0% vs. 1.4%, P = 0.341), and perforation (0% vs. 1.4%, P = 0.341).

Conclusions

LBD alone may be a simple, safe, and effective alternative to EST plus LBD in relatively aged patients with large CBD stones, and it can simplify the procedure compared with EST plus LBD.
Pseudo (Platelet-type) von Willebrand disease in pregnancy: a case report
Authors: Grover Neetu , Boama Vincent , Chou Munazzah Rifat
Published: January 2013

Background

Pseudo (platelet-type)-von Willebrand disease is a rare autosomal dominant bleeding disorder caused by an abnormal function of the glycoprotein lb protein; the receptor for von Willebrand factor. This leads to an increased removal of VWF multimers from the circulation as well as platelets and this results in a bleeding diathesis. Worldwide, less than 50 patients are reported with platelet type von Willebrand disease (PT-VWD).

Case presentation

We describe the management of platelet type von Willebrand disease in pregnancy of a 26 year old Caucasian primigravida. The initial diagnosis was made earlier following a significant haemorrhage post tonsillectomy several years prior to pregnancy. The patient was managed under a multidisciplinary team which included obstetricians, haematologists, anaesthetists and neonatologists. Care plans were made for the ante- natal, intra-partum and post-partum periods in partnership with the patient. The patient’s platelet count levels dropped significantly during the antenatal period. This necessitated the active exclusion of other causes of thrombocytopenia in pregnancy. A vaginal delivery was desired and plans were made for induction of labour at 38 weeks of gestation with platelet cover in view of the progressive fall of the platelet count. The patient however went into spontaneous labour on the day of induction. She was transfused two units of platelets before delivery. She had an unassisted vaginal delivery of a healthy baby. The successful antenatal counselling has encouraged the diagnosis of the same condition in her mother and sister. We found this to be a particularly interesting case as well as challenging to manage due to its rarity. Psuedo von Willebrand disease in pregnancy can be confused with a number of other differential diagnoses, such as gestational thrombocutopenia, idiopathatic thrombocytopenia, thrombotic thrombocytopenic purpura and pre-eclampsia; all need consideration during investigations even in a case such as this where the diagnosis of platelet type von Willebrand disease was known before pregnancy.

Conclusion

Management of pseudo von Willebrand disease in pregnancy involves the co-operation of multidisciplinary teams, regular monitoring of platelet levels and factor VIII and replacement as appropriate. This case report highlights this rare condition and the need to exclude all the other differential diagnoses of thrombocytopenia in pregnant women with thrombocytopenia.
Axillary web syndrome following secondary breast-conserving surgery: a case report
Authors: Wei Panmei , Zhu Liling , Chen Kai , Jia Weijuan , Hu Yue , Su Fengxi
Published: January 2013

Background

Axillary web syndrome is a cause of significant morbidity in the early postoperative period after axillary surgery.

Case presentation

A patient developed axillary web syndrome after secondary breast surgery and recovered in 3 weeks through physical therapy and using Aescuven Forte.

Discussion

The pathogenesis of axillary web syndrome is not clear. It is reported that axillary surgery is the main cause. The presented case indicates that tissue injury might be an important cause of axillary web syndrome. Though axillary web syndrome is self-limiting, special physical therapy and Aescuven Forte can shorten the natural duration.

Conclusion

Secondary breast surgery could cause axillary web syndrome. Physical therapy and Aescuven Forte could shorten the duration of the self-limited morbidity.
Paper-like graphene-Ag composite films with enhanced mechanical and electrical properties
Authors: Gao Rungang , Hu Nantao , Yang Zhi , Zhu Qirong , Chai Jing , Su Yanjie , Zhang Liying , Zhang Yafei
Published: January 2013

In this paper, we have reported that paper-like graphene-Ag composite films could be prepared by a facile and novel chemical reduction method at a large scale. Using ascorbic acid as a reducing agent, graphene oxide films dipped in Ag+ aqueous solutions can be easily reduced along with the decoration of different sizes of Ag particles distributed uniformly. The results reveal that the obtained films exhibit improved mechanical properties with the enhancement of tensile strength and Young's modulus by as high as 82% and 136%, respectively. The electrical properties of graphene-Ag composite films were studied as well, with the sheet resistance of which reaching lower than approximately 600 Ω/□. The graphene-Ag composite films can be expected to find interesting applications in the area of nanoelectronics, sensors, transparent electrodes, supercapacitors, and nanocomposites.
Recent advances in the diagnosis and treatment of bladder cancer
Authors: Cheung Grace , Sahai Arun , Billia Michele , Dasgupta Prokar , Khan Muhammad S
Published: January 2013

Bladder cancer is the commonest malignancy of the urinary tract. In this review, we look at the latest developments in the diagnosis and management of this condition. Cystoscopy and urine cytology are the most important tools in the diagnosis and follow-up of bladder cancer. Various alternatives have been investigated, either to reduce the frequency of cystoscopy, or improve its sensitivity for detection of tumors. These include urine-based markers and point-of-care tests. Narrow-band imaging and photodynamic diagnosis/blue-light cystoscopy have shown promise in improving detection and reducing recurrence of bladder tumors, by improving the completion of bladder resection when compared with standard resection in white light. The majority of patients with a new diagnosis of bladder cancer have non-muscle-invasive bladder cancer, which requires adjuvant intravesical chemotherapy and/or immunotherapy. Recent developments in post-resection intravesical regimens are discussed. For patients with muscle-invasive bladder cancer, both laparoscopic radical cystectomy and robot-assisted radical cystectomy have been shown to reduce peri-operative morbidity, while being oncologically equivalent to open radical cystectomy in the medium term. Bladder-preserving strategies entail resection and chemoradiation, and in selected patients give equivalent results to surgery. The development, advantages, and disadvantages of these newer approaches are also discussed.
Detection and comparison of microRNA expression in the serum of Doberman Pinschers with dilated cardiomyopathy and healthy controls
Authors: Steudemann Carola , Bauersachs Stefan , Weber Karin , Wess Gerhard
Published: January 2013

Background

Dilated cardiomyopathy (DCM) is the most common heart disease in Doberman Pinschers. MicroRNAs (miRNAs) are short non-coding RNAs playing important roles in gene regulation. Different miRNA expression patterns have been described for DCM in humans and might represent potential diagnostic markers. There are no studies investigating miRNA expression profiles in canine DCM. The aims of this study were to screen the miRNA expression profile of canine serum using miRNA microarray and to compare expression patterns of a group of Doberman Pinschers with DCM and healthy controls.

Results

Eight Doberman Pinschers were examined by echocardiography and 24-hour-ECG and classified as healthy (n = 4) or suffering from DCM (n = 4). Total RNA was extracted from serum and hybridized on a custom-designed 8x60k miRNA microarray (Agilent) containing probes for 1368 individual miRNAs. Although total RNA concentrations were very low in serum samples, 404 different miRNAs were detectable with sufficient signal intensity on miRNA microarray. 22 miRNAs were differentially expressed in the two groups (p < 0.05 and fold change (FC) > 1.5), but did not reach statistical significance after multiple testing correction (false discovery rate adjusted p > 0.05). Five miRNAs were selected for further analysis using quantitative Real-Time RT-PCR (qPCR) assays. No significant differences were found using specific miRNA qPCR assays (p > 0.05).

Conclusions

Numerous miRNAs can be detected in canine serum. Between healthy and DCM dogs, miRNA expression changes could be detected, but the results did not reach statistical significance most probably due to the small group size. miRNAs are potential new circulating biomarkers in veterinary medicine and should be investigated in larger patient groups and additional canine diseases.
Experiences with a simple laparoscopic gastric tube construction
Authors: Wang Bing-Yen , Tsao Lien Cheng , Cheng Ching-Yuan , Lin Ching-Hsiung , Shih Chih-Shiun , Liu Chia-Chuan
Published: January 2013

Background

Minimally invasive esophagectomy (MIE) is a complex operation, and the detailed optimal surgical procedure has not been well described. Our aim was to evaluate use of a simple method of laparoscopic gastric tube construction as minimally invasive surgery for patients with esophageal cancer.

Methods

We performed a retrospective review of 26 consecutive patients who underwent MIE for esophageal cancer in the Koo Foundation Sun Yat-Sen Cancer Center between September 2009 and August 2011. Perioperative data and postoperative complications were statistically analyzed.

Results

The patient group consisted of 22 men and 4 women. MIE was performed successfully in all patients. The mean operative time was 430.4 ± 60.6 minutes, and the mean estimated operative blood loss was 135.0 ± 97.8 mL. There were no cases of conversion to open surgery during the procedure. The postoperative complication rate was 53.8%, and there was no surgical mortality.

Conclusions

We recommend this novel method of total laparoscopic staplized formation of gastric tube to facilitate gastric pull-up.
MicroRNA-16 affects key functions of human endothelial progenitor cells
Authors: Goretti Emeline , Rolland-Turner Magali , Léonard Frédérique , Zhang Lu , Wagner Daniel R , Devaux Yvan
Published: January 2013

Antagonism of miR-16 stimulates cell cycle progression and differentiation of early endothelial progenitor cells.

The capacity of EPCs to repair injured tissues is limited. The role of miRNAs in EPCs is largely unknown. We tested whether miRNAs may be useful to enhance the regenerative capacity of EPCs. Early EPCs were isolated from human PBMCs, and late EPCs were amplified from enriched human peripheral CD34+ cells. Expression profiles of miRNAs and mRNAs were obtained by microarrays. Among the miRNAs differentially expressed between early and late EPCs, five members of the miR-16 family (miR-15a/-15b/-16/-103/-107) were overexpressed in early EPCs. Web-accessible databases predicted 375 gene targets for these five miRNAs. Among these, two regulators of cell cycle progression (CCND1 and CCNE1) and one associated gene (CDK6) were less expressed in early EPCs. Administration of anti-miR-16 in early EPCs enhanced the expression of these three genes, and administration of pre-miR-16 in late EPCs decreased their expression. In early EPCs, antagonism of miR-16 allowed for cell-cycle re-entry, stimulated differentiation, enhanced IL-8 secretion, and promoted the formation of capillary-like structures by HUVECs. In conclusion, miR-16 regulates key biological pathways in EPCs. This may have important implications to enhance the capacity of EPCs to repair injured tissues.
Breaking the Codex: Brendan Fernandes’s Recent Work
Authors: Bourland W. Ian
Published: January 2013

This article examines two recent projects by the Brooklyn-based artist Brendan Fernandes at the Guggenheim Museum and Art in General. It argues that Fernandes’s practice is important because it shows the language-power relations by which cultural identification is produced, and it takes those relations as his work’s central problem.
Renal Cell Carcinoma Metastases to the Pancreas: Value of Arterial Phase Imaging at MDCT
Authors: Corwin Michael T , Lamba Ramit , Wilson Machelle , Mcgahan John P
Published: January 2013

Background

The pancreas is an increasingly recognized site of renal cell carcinoma metastases. It is important to determine the optimal MDCT protocol to best detect RCC metastases to the pancreas.

Purpose

To compare the rate of detection of renal cell carcinoma metastases to the pancreas between arterial and portal venous phase MDCT.

Material and Methods

A retrospective review of CTs of the abdomen yielded six patients with metastatic RCC to the pancreas. Five of six patients had pathologically proven clear cell RCC. Two blinded reviewers independently reported the number of pancreatic lesions seen in arterial and venous phases. Each lesion was graded as definite or possible. The number of lesions was determined by consensus review of both phases. Attenuation values were obtained for metastatic lesions and adjacent normal pancreas in both phases.

Results

There were a total of 24 metastatic lesions to the pancreas. Reviewer 1 identified 20/24 (83.3%) lesions on the arterial phase images and 13/24 (54.2%) lesions on the venous phase. Seventeen of 20 (85.0%) arterial lesions were deemed definite and 9/13 (69.2%) venous lesions were definite. Reviewer 2 identified 19/24 (79.2%) lesions on the arterial phase and 14/24 (58.3%) on the venous phase. Seventeen of 19 (89.5%) arterial lesions were definite and 7/14 (50%) venous lesions were definite. Mean attenuation differential between lesion and pancreas was 114 HU and 39 HU for arterial and venous phases, respectively (P < 0.0001).

Conclusion

Detection of RCC metastases to the pancreas at MDCT is improved using arterial phase imaging compared to portal venous phase imaging.
Converting Continuous Insulin Infusion to Subcutaneous Insulin Glargine After Cardiac Surgery Using Percentage-Based Versus Weight-Based Dosing: A Pilot Trial
Authors: Silinskie Kevin M , Kirshner Ronald , Hite Mindee S
Published: January 2013

BACKGROUND

Most studies report using percentage of total daily insulin (TDI) for converting therapy from continuous insulin infusion to subcutaneous insulin in cardiac surgery patients. Few studies have evaluated the efficacy of using body weight to calculate the basal insulin dose.

OBJECTIVE

To compare the efficacy and safety of dosing insulin glargine by weight versus percentage of TDI in cardiac surgery patients transitioning from continuous insulin infusion to subcutaneous insulin.

METHODS

We conducted a prospective, randomized, open-label, pilot study. Study patients who had a preoperative weight less than 100 kg and were receiving at least 6 hours of a continuous insulin infusion were randomized to receive either 50% of their TDI requirement or 0.5 units/kg of glargine as a one-time dose 2 hours before stopping the continuous insulin infusion. All patients were administered subcutaneous corrective insulin. Blood glucose monitoring occurred before each meal, at bedtime, and with morning laboratory tests for 24 hours after administration of the glargine dose.

RESULTS

A total of 200 blood glucose measurements were performed in each group. The percentage of blood glucose measurements in target range (80–140 mg/dL) was similar between the weight-based group and the percentage-based group (66% vs 64%, p = 0.75). Median blood glucose after transition was 120 mg/dL (interquartile range [IQR] 99–147) in the weight-based group compared to 127 mg/dL (IQR 107–149; p = 0.03) in the percentage-based group. The median glargine dose was higher in the weight-based group (41 units; IQR 36–44) than in the weight-based group (24 units; IQR 14–30, p < 0.001). The rate of hypoglycemia (blood glucose <60 mg/dL) was 2.5% in each group.

CONCLUSIONS

In this small cohort, dosing insulin glargine by weight proved to be safe, but larger scale studies are needed before adopting weight-based dosing in this patient population.
Outcomes of Health Care–Associated Pneumonia Empirically Treated with Guideline-Concordant Regimens Versus Community-Acquired Pneumonia Guideline–Concordant Regimens for Patients Admitted to Acute Care Wards from Home
Authors: Chen Jenny I , Slater Leonard N , Kurdgelashvili George , Husain Khawaja O , Gentry Chris A
Published: January 2013

BACKGROUND

The introduction of the health care–associated pneumonia (HCAP) categorization expanded recommendations for broad-spectrum empiric antibiotics to pneumonia patients presenting from the community with recent health care–system exposure. However, the efficacy of such regimens in improving clinical outcomes in these patients has not been well established.

OBJECTIVE

To compare the clinical outcomes of HCAP patients treated initially with HCAP guideline–concordant antibiotic regimens to those treated initially with community-acquired pneumonia (CAP) guideline-concordant antibiotic regimens.

METHODS

This retrospective study included HCAP patients presenting from home and admitted to general medical wards. HCAP regimen patients were treated empirically with at least 1 antipseudomonal agent. All other patients were assigned to the CAP regimen group. The primary end point was clinical cure at 30 days postdischarge. Subgroup analysis was performed in patients hospitalized 1–30 days and 31–90 days before the HCAP admission.

RESULTS

Of 228 HCAP admissions, 122 patients received CAP regimens and 106 received HCAP regimens. The 2 groups were similar at baseline, including Pneumonia Severity Index scores. Attributable clinical cure occurred in 75.4% of CAP regimen patients and 69.8% of HCAP regimen patients (p = 0.34). Overall clinical cure occurred in 59.8% of CAP regimen patients and 54.7% of HCAP regimen patients (p = 0.44). The CAP regimen group used fewer days of intravenous antibiotics (4.39 vs 7.75, p < 0.0001) and had shorter lengths of stay (6.36 vs 8.58 days, p < 0.0001). For patients hospitalized 31–90 days earlier, clinical cure was higher in the CAP regimen group (attributable, 82.9% vs 60.0%, p = 0.0090; overall, 67.1% vs 47.5%, p = 0.044).

CONCLUSIONS

Compared to CAP guideline–concordant regimens, treatment of HCAP with HCAP guideline–concordant regimens did not increase clinical cure rates and was associated with lower clinical cure rates in patients hospitalized 31–90 days prior to the HCAP admission. This study suggests that broad-spectrum empiric antibiotics may not be necessary in all HCAP patient groups.
Effect of Concurrent Prescription Antiarthralgia Pharmacotherapy on Persistence to Aromatase Inhibitors in Treatment-Naïve Postmenopausal Females
Authors: Hashem Mohamed G , Kevin Cleary , Fishman Doris , Nichols Linda , Khalid Mona
Published: January 2013

BACKGROUND

Aromatase inhibitors function by suppressing estrogen biosynthesis in peripheral tissues. The resulting estrogen deprivation is considered the underlying cause for aromatase inhibitor–induced arthralgia, which affects patients' quality of life and may affect their persistence to aromatase inhibitor therapy. The effect of concurrent treatment with aromatase inhibitors and prescription antiarthralgia pharmacotherapy on improving persistence to aromatase inhibitor therapy is unknown.

OBJECTIVE

To evaluate the effect of concurrent prescription antiarthralgia pharmacotherapy on persistence to aromatase inhibitor therapy in treatment-naïve postmenopausal women.

METHODS

This retrospective cohort pharmacy claims study examined the drug utilization pattern between July 2008 and October 2009 of postmenopausal females, naïve to aromatase inhibitor therapy, with 18 months of continuous prescription benefit eligibility. Patients were divided into 2 groups: group A (control) included patients who did not have a claim for a prescription antiarthralgia medication in a 1-year follow-up period, while group B (active) included patients with prescription antiarthralgia medications started within the 1-year follow-up period after starting treatment with an aromatase inhibitor. Persistence to aromatase inhibitor therapy was compared between the 2 groups.

RESULTS

The study population comprised 29,967 patients: 24,804 (82.8%) in group A, and 5163 (17.2%) in group B. Aromatase inhibitor discontinuation rates within the first year of therapy were not statistically significantly different between groups: 40.9% in group A (10,145/24,804) and 34.5% in group B (1781/5163) (HR 1.127; 95% CI 0.900–1.411; p = 0.297). Persistence for the 2 groups did not differ statistically significantly for any of the 3 aromatase inhibitors measured separately.

CONCLUSIONS

Postmenopausal females treatment-naïve to aromatase inhibitor therapy who also received treatment with a prescription antiarthralgia medication did not have significantly higher persistence with aromatase inhibitor therapy. Further research should focus on other possible causes of poor persistence in patients using aromatase inhibitor therapy.
Antidepressant-Selective Gynecomastia
Authors: Kaufman Kenneth R , Podolsky Dina , Greenman Danielle , Madraswala Rehman
Published: January 2013

OBJECTIVE

To describe what we believe is the first reported case of synergistic gynecomastia during treatment of depressive and anxiety disorders when sertraline was added to a stable medication regimen including duloxetine, rosuvastatin, and amlodipine.

CASE SUMMARY

A 67-year-old male with major depression, dysthymia, obsessive-compulsive disorder, social anxiety, hypertension, diabetes, and hyperlipidemia presented with new-onset gynecomastia and breast tenderness. Mammography revealed bilateral gynecomastia (fibroglandular tissue posterior to the nipples bilaterally) without suspicious mass, calcification, or other abnormalities. These new symptoms developed after sertraline was added to his stable medication regimen (duloxetine, alprazolam, rosuvastatin, metoprolol, amlodipine, hydrochlorothiazide/triamterene, metformin, and sitagliptin). These symptoms were dose-dependent, with gynecomastia and breast tenderness more severe as sertraline was titrated from 25 mg/day to 50 mg/day and then to 75 mg/day. When sertraline was discontinued, gynecomastia and breast tenderness rapidly resolved.

DISCUSSION

Mammoplasia and gynecomastia are associated with altered dopamine neurotransmission and/or perturbations in sexual hormones. These adverse effects may be medication induced. Selective serotonin reuptake inhibitors (sertraline), serotonin-norepinephrine reuptake inhibitors (duloxetine), rosuvastatin, and amlodipine have been reported to cause these adverse effects. This case was unique, since the patient had been on both sertraline and duloxetine previously as independent psychotropics without the development of gynecomastia. In the context of an additive drug adverse effect, the probability of sertraline as the precipitant drug was determined by both the Naranjo probability scale and the Horn drug interaction probability scale as probable.

CONCLUSIONS

Gynecomastia is associated with antidepressants and other medications but is rarely addressed. Gynecomastia may be antidepressant selective or may be the result of additive adverse effects. Clinicians are advised to question patients regarding this potential adverse effect. Further education of clinicians is indicated.
Evolution, Current Structure, and Role of a Primary Care Clinical Pharmacy Service in an Integrated Managed Care Organization
Authors: Heilmann Rachel MF , Campbell Stephanie M , Kroner Beverly A , Proksel Jenel R , Billups Sarah J , Witt Daniel M , Helling Dennis K
Published: January 2013

The impact of the declining number of primary care physicians is exacerbated by a growing elderly population in need of chronic disease management. Primary care clinical pharmacy specialists, with their unique knowledge and skill set, are well suited to address this gap. At Kaiser Permanente of Colorado (KPCO), primary care clinical pharmacy specialists have a long history of integration with medical practices and are located in close proximity to physicians, nurses, and other members of the health care team. Since 1992, Primary Care Clinical Pharmacy Services (PCCPS) has expanded from 4 to 30 full-time equivalents (FTEs) to provide services in all KPCO medical office buildings. With this growth in size, PCCPS has evolved to play a vital role in working with primary care medical teams to ensure that drug therapy is effective, safe, and affordable. In addition, PCCPS specialists provide ambulatory teaching sites for pharmacy students and pharmacy residents. There is approximately 1 specialist FTE for every 13,000 adult KPCO members and every 9 clinical FTEs of internal medicine and family medicine physicians. All clinical pharmacy specialists in the pharmacy department are required to have a PharmD degree, to complete postgraduate year 2 residencies, and, as a condition of employment, to become board certified in an applicable specialty. The evolution, current structure, and role of PCCPS at KPCO, including factors facilitating successful integration within the medical team, are highlighted. Patient and nonpatient care responsibilities are described.
Tiotropium for Adults with Inadequately Controlled Persistent Asthma
Authors: Adams Katie S , Lowe Denise K
Published: January 2013

OBJECTIVE

To review the literature evaluating the efficacy and steroid-sparing effect of tiotropium for inadequately controlled persistent asthma in adults.

DATA SOURCES

Information was obtained through a search of MEDLINE/PubMed (1966-October 2012), using the terms asthma and tiotropium. A further review of reference citations was performed to identify other relevant articles.

STUDY SELECTION AND DATA EXTRACTION

English-language case reports and clinical trials were reviewed. Publications evaluating the efficacy and steroid-sparing effect of tiotropium in adults with inadequately controlled persistent asthma were included in the review. One case report and 5 clinical trials met our criteria.

DATA SYNTHESIS

The ultimate goal for asthma management is to maintain disease control by preventing acute exacerbations while avoiding adverse medication effects. Inhaled corticosteroids (ICS) are part of all preferred maintenance regimens for persistent asthma. Unfortunately, persistent asthma remains inadequately controlled in some patients and concerns about serious adverse effects with long-term high-dose ICS treatment exist. Interest in the use of tiotropium to control asthma symptoms and reduce steroid requirements in inadequately controlled persistent asthma is emerging. Results of several trials indicate that tiotropium improves pulmonary function markers and reduces corticosteroid requirements. Moreover, the largest and longest published trial not only showed improvements in pulmonary function tests but also a reduction in corticosteroid use and an increase in the time to first exacerbation.

CONCLUSIONS

Although tiotropium use in treatment of persistent asthma appears to be promising, more robust clinical trials are needed to assess whether improved pulmonary function tests as well as a decrease in asthma exacerbations and corticosteroid requirements translate into improvements in quality of life. Additionally, the optimal patient population, long-term efficacy, and safety of tiotropium when delivered by various methods need to be determined before it can be recommended over current alternative asthma therapies.
Developmental Localization of Nephrin in Zebrafish and Medaka Pronephric Glomerulus
Authors: Ichimura Koichiro , Fukuyo Yayoi , Nakamura Tomomi , Powell Rebecca , Sakai Tatsuo , Janknecht Ralf , Obara Tomoko
Published: January 2013

Slit diaphragm (SD) is a highly specialized intercellular junction between podocyte foot processes and plays a crucial role in the formation of the filtration barrier. In this study, we examined the developmental localization of Nephrin, an essential component of SD, in the pronephric glomerulus of zebrafish and medaka. In the mature glomerulus of both fish, Nephrin is localized along the glomerular basement membrane as seen in mammals, indicating that Nephrin is localized at the SD. Interestingly, Nephrin was detected already in immature podocytes before the SD and foot processes started to form in both fish. Nephrin was localized along the cell surface of immature podocytes but as different localization patterns. In zebrafish, Nephrin signal bordered the lateral membrane of podocytes, which were columnar in shape, as in rat immature podocytes. However, in medaka immature podocytes, Nephrin was localized in a punctate pattern among podocyte cell bodies. These findings suggest that Nephrin needs to be integrated to the membrane before the formation of the SD and then moves to the proper site to form the SD. Furthermore, a podocyte-specific marker, such as Nephrin, should be a useful tool for the future analysis of pronephric glomerular development in fish mutants and morphants.
Illness appraisals and health-related quality of life in adolescents and young adults with allergies and asthma
Authors: Hullmann Stephanie E. , Eddington Angelica R. , Molzon Elizabeth S. , Mullins Larry L.
Published: January 2013

The current study sought to: 1) assess differences in levels of physical and mental health-related quality of life (HRQOL), illness uncertainty, and intrusiveness in adolescents and young adults (AYAs) with allergies and asthma, as well as 2) examine the effect of illness appraisals on HRQOL. Participants were undergraduate students with self-reported allergies (n=74) and asthma (n=74) who completed the Mishel Uncertainty in Illness Scale (MUIS), the Illness Intrusiveness Scale (IIS), and the SF-36 Health Survey Questionnaire. Paired t-tests indicated that AYAs with allergies reported higher levels of illness uncertainty and poorer mental HRQOL than AYAs with asthma; the groups did not differ on reported levels of illness intrusiveness or physical HRQOL. Hierarchical regressions were conducted to examine the relationship between illness appraisals and HRQOL. Results revealed that poorer mental HRQOL was associated with higher illness uncertainty in AYAs with allergies and higher illness intrusiveness in AYAs with asthma. Poorer physical HRQOL was associated with higher illness uncertainty in AYAs with asthma and higher illness intrusiveness in AYAs with allergies and asthma. The current examination suggests that illness appraisals may be differentially related to HRQOL in AYAs with allergies compared to those with asthma.
Healthcare utilization and barriers for youth post-detention
Authors: Golzari Mana , Kuo Anda
Published: January 2013

Aim: Adolescents in the juvenile justice system are particularly susceptible to high rates of co-occurring health-risk behaviors, while at the same time lacking access to the healthcare system.

Methods: A verbal questionnaire was administered from December 2009 to June 2010 to youth between the ages of 13–17 years old, who had previously been detained in an urban juvenile detention facility in California.

Results: A total of 50 participants were enrolled in the study (40% female, 60% male, 16 years mean age, 80% Black, 18% Latino, 2% White). The mean time post-detention was 15 months, and the mean time in detention was 4 months. Our study provides evidence that adolescents exiting juvenile detention in the United States are interested in gaining access to healthcare providers but perceive lack of insurance and transportation as barriers to care. These barriers need to be addressed in order to facilitate access to healthcare services for this underserved and at-risk population of youth.
Translation of children’s cycling into steps: the share of cycling in 10-year-olds’ physical activity
Authors: Raustorp Anders , Boldemann Cecilia , Mårtensson Fredrika , Sternudd Catarina , Johansson Maria
Published: January 2013

Background:Active travel has a potential to increase children’s physical activity (PA). Pedometers offer a valid option to measure PA, but do not capture cycling activity. Children’s self-reported cycling distances can be analyzed by the Geografic Information System (GIS).

Aim:To combine pedometry and GIS mapping to identify the relative amount of cycling in children’s PA.

Study group:Of all children in 4th grade (n=187) in Staffanstorp Sweden, 144 had valid pedometer data. Fifty-six children were non-cyclists while 88 children (32 boys, 47 girls, 9 gender unknown) reported at least one cycle journey.

Methods:Cycle trips were entered into GIS and calculated to total cycling distance. Average length of the single distances cycled per day was 676 m (SD=534 m). A previously reported cycling speed (13.5 km/h) was used to calculate time spent cycling. Consequently distance=676 m, speed=13.5 km/h=13,500 m/3600 s=3.75 m/s and time=676m/3.75m/s=180.26 s=3 min. Expenditure of 4 and 5 metabolic equivalents (METs) has in children been reported equivalent to 122 and 127 steps/min, respectively. We estimated 4.7 METs (13.5 km/h) as 126 steps for every min of cycling (127–122=5×0.7=125.5).

Results:The daily mean cycle distance was 676 m, on average 379 additional steps/day for cycling children (min. 21, max. 1385, SD=299) with no gender difference. Additional “steps” obtained by cycling corresponded to on average 3% of their PA.

Conclusion:The relative contribution of cycling in 10-year-old children’s PA level is quite small and stable between children across different levels of activity levels, regardless of gender.
Outcome of isolated fetal renal pyelectasis diagnosed during midtrimester screening ultrasound and cut-off value to predict a persistent or progressive pyelectasis in utero
Authors: Kim Moon-Kyung , Kim Min-Ji , An Jung-Joo , Cha Hyun-Hwa , Choi Suk-Joo , Oh Soo-Young , Roh Cheong-Rae , Kim Jong-Hwa
Published: January 2013

Aim: To define a better cut-off value of the renal pelvis anteroposterior diameter (RPAPD) to predict persistent or progressive pyelectasis during pregnancy.

Methods: We retrospectively reviewed 8873 women whose fetal RPAPD was measured. Midtrimester pyelectasis was defined as a RPAPD of ≥4 mm. Persistent/progressive pyelectasis was defined as a RPAPD of ≥10 mm before delivery. A RPAPD cut-off value to predict a persistent/progressive pyelectasis was determined by receiver operating characteristic curve analysis.

Results: Among 249 isolated cases of pyelectasis, persistent/progressive pyelectasis was found in 6.9% before delivery. The midtrimester RPAPD cut-off value that best predicted persistent/progressive pyelectasis before delivery was ≥6 mm with sensitivity, specificity, positive and negative predictive values of 64.3%, 88.7%, 30.0%, and 97.1%, respectively.

Conclusions: Although most cases of midtrimester fetal pyelectasis regress to normal during pregnancy, those with a RPAPD of ≥6 mm in the midtrimester are at higher risk for persistent or progressive pyelectasis.