bluuebunny/crossref_metadata_2025 huggingface dataset:
Eruptive dermal clear cell desmo‐plastic mesenchymal tumors with perivascular myoid differentiation in a young boy. A clinical, histopathologic, immunohistochemical and electron microscopy study of 17 lesions
Authors: Tomasini Carlo , Metze Dieter , Osella‐Abate Simona , Novelli Mauro , Kutzner Heinz
Published: October 2013

Clear cell tumors of the skin are observed in a wide variety of benign and malignant conditions with different histogenesis, sharing the presence of cells with abundant clear cytoplasm. Herein, we report the clinicopathologic features of a healthy young patient affected by asymptomatic, eruptive and disseminated, benign clear cell dermal tumors since early infancy. Neither family history nor genetic testing and counseling provided further useful information. The lesions were mostly confined to the face and lower left extremity with pink teleangiectatic papules and small nodules. Over a 4‐year period, a total of 16 different cutaneous lesions were biopsied and histopathologic and immunohistochemical studies carried out; an additional lesion was also removed for electron microscopy examination. Histopathology evidenced multiple perivascular growths of spindle to oval and round cells intermingled with clear/granular cells throughout the dermis, with prominent desmoplasia and numerous capillary‐like vessels with focal hemangiopericytoma‐like features. Immunohistochemical neoplastic cells were uniformly positive for h‐caldesmon and focally smooth muscle α‐actin and CD13 indicating myoid differentiation whereas the consistent diffuse cytoplasmic staining for lysosome antigen, such as CD68PG‐M1 and NKI/C3 along with the ultrastructural findings supported the view of a lysosome‐mediated apoptotic process. The differential diagnosis with other clear cell cutaneous neoplasms is discussed.
Perineural inflammation in morphea (localized scleroderma): systematic characterization of a poorly recognized but potentially useful histopathological feature
Authors: Dhaliwal Catharine A. , MacKenzie Andrew I. , Biswas Asok
Published: October 2013

The association between morphea and perineural inflammation has been reported sporadically but never studied systematically. To assess the prevalence and nature of perineural inflammation in various clinicopathologic stages of morphea and a cohort of other inflammatory dermatoses, 80 morphea and 36 control skin biopsies were studied using hematoxylin/eosin and S100 stains. Perineural inflammation was semiquantitatively analyzed (scored), which along with the pattern (concentric vs. marginal) and cellular composition was compared in the two groups. Perineural inflammation was identified in 84% and 61% of morphea and control cases, respectively. Examination of only routinely stained sections could still detect this feature in 58% of morphea and 33% of control biopsies. Mean perineural inflammation score in morphea (0.65) was significantly higher than in the control group (0.23) (p < 0.0001) and the inflammation tended to show a concentric pattern with plasma cell neurotropism. Intraneural inflammation was limited to four morphea cases. Although perineural inflammation is common in morphea, it is not unusual to find this feature in other inflammatory conditions. Nevertheless, perineural inflammation can serve as an important diagnostic adjunct in difficult cases of morphea if one considers its greater intensity, predominantly concentric pattern and the tendency to show plasma cell neurotropism.
Bird functional diversity enhances insectivory at forest edges: a transcontinental experiment
Authors: Barbaro Luc , Giffard Brice , Charbonnier Yohan , van Halder Inge , Brockerhoff Eckehard G.
Published: October 2013

Aim

The role of bird–insect interactions in shaping bird distribution patterns at the landscape scale has been seldom investigated. In mosaic landscapes, bird functional diversity is considered to be an important driver of avian insectivory, but depends on forest fragmentation and edge effects from adjacent, non‐forest habitats. In a transcontinental experiment, we investigated edge and landscape effects on bird functional diversity and insectivory in mosaic landscapes of mixed forests and open habitats.

Location

New Zealand and France.

Methods

We paired edge and interior plots in native forest fragments in New Zealand and native plantation forests in France. We sampled bird communities using point‐counts and linear transects respectively and simultaneously quantified avian insectivory as the rate of bird attacks on plasticine models mimicking tree‐feeding Lepidoptera larvae. The same seven life traits and attributes were compiled for French and New Zealand birds, including biogeographic origin, body mass, mobility, foraging method, adult diet, nest location and clutch size. Bird functional diversity was quantified on this multitrait basis by four indices: functional richness, evenness, divergence and dispersion. We used mixed models to test for the effects of forest edges, study area, surrounding landscape diversity and native forest cover on bird functional diversity and insectivory.

Results

We found higher bird functional richness at forest edges than interiors in New Zealand and lower functional richness at edges in France. However, bird functional evenness and divergence were significantly higher at forest edges in the two countries. Functional evenness and dispersion both increased with landscape diversity and evenness increased with native forest cover. Moreover, bird insectivory increased at forest edges with functional evenness, irrespective of the study area.

Main conclusions

We suggest that intermediate levels of forest fragmentation and edge effects increase avian insectivory in mosaic landscapes, through enhanced functional evenness and trait complementation within predatory bird assemblages.
Multiscale impacts of forest degradation through browsing by hyperabundant moose (Alces alces) on songbird assemblages
Authors: Rae Lauren F. , Whitaker Darroch M. , Warkentin Ian G.
Published: October 2013

Aim

Songbirds are sensitive to changes in forest structure and composition at various spatial scales, particularly during the breeding season. Habitat degradation associated with herbivore browsing may contribute to declines in songbird populations. Here, we evaluate songbird responses to herbivore‐induced habitat change at multiple spatial scales.

Location

In Gros Morne National Park (GMNP), Newfoundland, Canada, browsing by hyperabundant moose (Alces alces) has changed forest structure by reducing understorey cover and converting regenerating stands to open areas dominated by grasses and shrubs.

Methods

We conducted point count surveys to measure bird occurrence throughoutGMNPduring the 2010 breeding season. Using vegetation information from ground plots and remote sensing, we characterized habitat at three scales: local, neighbourhood and landscape. Following a two‐step procedure to model species occurrence with habitat, the most important habitat factors within each scale were retained for cross‐scale modelling.

Results

Cross‐scale models revealed patterns in the association of songbird habitat assemblages with moose‐altered habitats. Early successional species such as mourning warbler (Geothlypis philadelphia) were positively associated with moose‐browsed habitat at the landscape scale. Forest interior specialist (e.g. black‐throated green warbler,Setophaga virens)and generalist species (e.g. boreal chickadee,Poecile hudsonicus) were negatively associated with moose‐browsed habitat at the neighbourhood scale. Local songbird species richness was independent of moose‐browsed habitat at any scale.

Main conclusions

The influence of intense browsing on forest songbirds varies by species but has the potential to extend beyond the area of immediate impact. Continued intense browsing and resulting forest alteration could cause declines in forest specialists and generalists, but may increase populations of early successional species. To maintain bird assemblages characteristic of the region, we recommend management actions that lower moose density in areas with hyperabundant populations such asGMNPto maintain forest structure and regeneration comparable to that present prior to the introduction of moose.
Endoscopic approaches for pancreatobiliary diseases in patients with altered gastrointestinal anatomy
Authors: Shimatani Masaaki , Takaoka Makoto , Matsushita Mitsunobu , Okazaki Kazuichi
Published: October 2013

Endoscopic treatment for pancreatobiliary diseases is less invasive than surgery and percutaneous transhepatic biliary drainage is highly beneficial to patients. The endoscopic approach is indicated for an increasing number of patients, including those who have undergone previous gastrointestinal surgery, although these patients face two major challenges. First, the endoscopic approach to the afferent loop, blind end, and the site of choledochojejunostomy is difficult with the use of a conventional endoscope because of the distance from the gastrojejunal anastomosis site, unusual anatomical features of the intestine such as its winding shape, and postoperative adhesion. Second, it is difficult to reach Vater's papilla or the site of choledochojejunostomy andto cannulate selectively into the pancreatic and/or biliary duct. The balloon‐assisted endoscope (BAE), a recently developed technology, can be useful for carrying out endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy. ERCP using the BAE is highly effective and safe in patients with altered gastrointestinal anatomy, especially in patients with Roux‐en‐Y reconstruction.
Infants' goal anticipation during failed and successful reaching actions
Authors: Brandone Amanda C. , Horwitz Suzanne R. , Aslin Richard N. , Wellman Henry M.
Published: October 2013

The ability to interpret and predict the actions of others is crucial to social interaction and to social, cognitive, and linguistic development. The current study provided a strong test of this predictive ability by assessing (1) whether infants are capable of prospectively processing actions that fail to achieve their intended outcome, and (2) how infants respond to events in which their initial predictions are not confirmed. Using eye tracking, 8‐month‐olds, 10‐month‐olds, and adults watched an actor repeatedly reach over a barrier to either successfully or unsuccessfully retrieve a ball. Ten‐month‐olds and adults produced anticipatory looks to the ball, even when the action was unsuccessful and the actor never achieved his goal. Moreover, they revised their initial predictions in response to accumulating evidence of the actor's failure. Eight‐month‐olds showed anticipatory looking only after seeing the actor successfully grasp and retrieve the ball. Results support a flexible, prospective social information processing ability that emerges during the first year of life.
Properties of gene knockdown system by vector‐based siRNAin zebrafish
Authors: Shinya Minori , Kobayashi Kayo , Masuda Aki , Tokumoto Mika , Ozaki Yuichi , Saito Kenji , Kawasaki Toshihiro , Sado Yukiko , Sakai Noriyoshi
Published: October 2013

RNA interference (RNAi) has emerged as a powerful tool to silence specific genes. Vector‐based RNAi systems have been developed to downregulate targeted genes in a spatially and temporally regulated fashion bothin vitroandin vivo. The zebrafish (Danio rerio) is a model animal that has been examined based on a wide variety of biological techniques, including embryonic manipulations, forward and reverse genetics, and molecular biology. However, a heritable and tissue‐specific knockdown of gene expression has not yet been developed in zebrafish. We examined two types of vector, which produce small interfering RNA (siRNA), the direct effector in RNAi system; microRNA (miRNA) process mimicking vectors with a promoter for RNA polymerase II and short hairpin RNA (shRNA) expressing vector through a promoter for RNA polymerase III. Though gene‐silencing phenotypes were not observed in the miRNA process mimicking vectors, the transgenic embryos of the second vector (Tg(zU6‐shGFP)), shRNA expressing vector forenhanced green fluorescence protein, revealed knockdown of the targeted gene. Interestingly, only the embryos from Tg(zU6‐shGFP) female but not from the male fish showed the downregulation. Comparison of the quantity of siRNA produced by each vector indicates that the vectors tested here induced siRNA, but at low levels barely sufficient to silence the targeted gene.
What constitutes cerebral palsy in the twenty‐first century?
Authors: Smithers‐Sheedy Hayley , Badawi Nadia , Blair Eve , Cans Christine , Himmelmann Kate , Krägeloh‐Mann Ingeborg , McIntyre Sarah , Slee Jennie , Uldall Peter , Watson Linda , Wilson Meredith
Published: October 2013

Aim

Determining inclusion/exclusion criteria for cerebral palsy (CP) surveillance is challenging. The aims of this paper were to (1) define inclusion/exclusion criteria that have been adopted uniformly by surveillance programmes and identify where consensus is still elusive, and (2) provide an updated list of the consensus concerning CP inclusion/exclusion when a syndrome/disorder is diagnosed.

Method

Data were drawn from an international survey of CP registers, the New South Wales CP Register (1993–2003), the Western Australian CP Register (1975–2008), and the Surveillance of CP in Europe (SCPE; 1976–1998). An expert panel used a consensus building technique, which utilized the SCPE ‘decision tree’ and the original ‘What constitutes cerebral palsy?’ paper as frameworks.

Results

CP surveillance programmes agree on key clinical criteria pertaining to the type, severity, and origin of motor disorder in CP. Further work is warranted to reach agreement for (1) minimum age of survival and maximum age of postneonatal brain injury, and (2) metabolic disorders with highly variable clinical courses/responses to treatment. One hundred and ninety‐seven syndromes/disorders were reviewed and advice on their inclusion/exclusion is provided.

Interpretation

What constitutes CP will continue to evolve as diagnostics improve. Surveillance programmes throughout the world are committed to addressing their differences regarding inclusion/exclusion criteria for the umbrella term CP.
Prevalence of cerebral palsy, co‐occurring autism spectrum disorders, and motor functioning –Autism andDevelopmentalDisabilitiesMonitoringNetwork,USA, 2008
Authors: Christensen Deborah , Van Naarden Braun Kim , Doernberg Nancy S , Maenner Matthew J , Arneson Carrie L , Durkin Maureen S , Benedict Ruth E , Kirby Russell S , Wingate Martha S , Fitzgerald Robert , Yeargin‐Allsopp Marshalyn
Published: October 2013

Aim

The aim of this study was to report the prevalence and characteristics of children with cerebral palsy (CP).

Method

Children withCP(n=451) were ascertained by the Autism and Developmental Disabilities Monitoring (ADDM) Network, a population‐based, record‐review surveillance system monitoringCPin four areas of theUSA. Prevalence was calculated as the number of children withCPamong all 8‐year‐old children residing in these areas in 2008. Motor function was categorized byGrossMotorFunctionClassificationSystem level and walking ability. Co‐occurring autism spectrum disorders (ASD) and epilepsy were ascertained usingADDMNetwork surveillance methodology.

Results

The period prevalence ofCPfor 2008 was 3.1 per 1000 8‐year‐old children (95% confidence interval 2.8–3.4). Approximately 58% of children walked independently. Co‐occurringASDfrequency was 6.9% and was higher (18.4%) among children with non‐spasticCP, particularly hypotonicCP. Co‐occurring epilepsy frequency was 41% overall, did not differ byASDstatus orCPsubtype, and was highest (67%) among children with limited or no walking ability.

Interpretation

The prevalence ofCPin childhood fromUSsurveillance data has remained relatively constant, in the range of 3.1 to 3.6 per 1000, since 1996. The higher frequency ofASDin non‐spastic than in spastic subtypes ofCPcalls for closer examination.
The intriguing relationship between cerebral palsy and autism
Authors: Zwaigenbaum Lonnie
Published: October 2013

This commentary is on the original article by Christensen et al. on pages 59–65 of this issue.
The genetic landscape of autism spectrum disorders
Authors: Rosti Rasim O , Sadek Abdelrahim A , Vaux Keith K , Gleeson Joseph G
Published: October 2013

Autism spectrum disorders (ASDs) are a group of heterogeneous neurodevelopmental disorders that show impaired communication and socialization, restricted interests, and stereotypical behavioral patterns. Recent advances in molecular medicine and high throughput screenings, such as array comparative genomic hybridization (CGH) and exome and whole genome sequencing, have revealed both novel insights and new questions about the nature of this spectrum of disorders. What has emerged is a better understanding about the genetic architecture of various genetic subtypes of ASD and correlations of genetic mutations with specific autism subtypes. Based on this new information, we outline a strategy for advancing diagnosis, prognosis, and counseling for patients and families.
Monitoring the prevalence of severe intellectual disability in children across Europe: feasibility of a common database
Authors: van Bakel Marit , Einarsson Ingolfur , Arnaud Catherine , Craig Sarah , Michelsen Susan I , Pildava Santa , Uldall Peter , Cans Christine
Published: October 2013

Aim

Our aim was to study the feasibility of creating a framework for monitoring and undertaking collaborative research on intellectual disability at the European level, based on existing databases of children with such disability.

Method

The characteristics of five existing European intellectual disability databases from four countries (Iceland, Latvia, Ireland, and two in France), were discussed on the basis of ideal criteria set by a working group on childhood intellectual disability as part of the Surveillance of Cerebral Palsy in Europe Network (SCPE‐NET). Mean prevalence values for severe intellectual disability for the birth years 1990 till 2002 were compared across databases.

Results

Methods of case recruitment and diagnosis differed across databases, but classification of intellectual disability and completeness were similar. Severe intellectual disability (IQ<50) prevalence estimates were significantly (p<0.001) different across databases (south‐east France: 3.3 out of 1000; south‐west France: 3.0 out of 1000; Latvia: 3.9 out of 1000; Ireland: 5.0 out of 1000; and Iceland 5.1 out of 1000).

Interpretation

In spite of differences in diagnosis and case inclusion across databases, the construction of a common database for severe intellectual disability was deemed feasible through harmonization of certain criteria, such as age, and through restriction to those with severe intellectual disability.
Risk of cerebral palsy in term‐born singletons according to growth status at birth
Authors: Dahlseng Magnus Odin , Andersen Guro L , Irgens Lorentz M , Skranes Jon , Vik Torstein
Published: October 2013

Aims

An excess risk of cerebral palsy (CP) has been reported in children of both low and high birthweight. However, the risk associated with deviations from the mean of other anthropometric measurements has been less well studied. The aim of our study therefore was to determine the association between size measurements at birth and incidence of CP in singletons born at term.

Method

Standard deviation z‐scores for weight, length, head circumference, and ponderal index at birth of term‐born singletons born between 1996 and 2006 were calculated using data from the Medical Birth Registry of Norway. The measurements of 398 children with CP recorded in the Cerebral Palsy Registry of Norway were compared with those of 490 022 typically developing infants.

Results

Children with low birthweight (p<0.001; <10th centile) as well as low and high z‐scores for length (p<0.001 and p<0.001) and head circumference (p<0.001 and p<0.003; <90th centile) had an excess risk of CP, in particular of spastic bilateral CP. Spastic unilateral CP was associated only with low z‐scores, whereas children with the greatest body length and largest head circumference, but with low ponderal index, had an excess risk of spastic quadriplegic and dyskinetic CP.

Interpretation

Our results are consistent with the notion that most subtypes of CP are due to antenatal factors leading to poor intrauterine growth, whereas CP in children who were large at birth is more likely to be due to intrapartum factors.
Stroke in infancy: a convergence of causes
Authors: Deveber Gabrielle
Published: October 2013

This commentary is on the original article by Lingappa et al. on pages 78–84 of this issue
Reduced incidence of lower‐extremity amputations in a Danish diabetes population from 2000 to 2011
Authors: Jørgensen M. E. , Almdal T. P. , Færch K.
Published: October 2013

Aims

Diabetic foot disease and amputations severely reduce quality of life and have major economic consequences. The aim of this study was to estimate time trends in the incidence of lower‐extremity amputations in Danish people with diabetes.

Methods

We studied major and minor lower‐extremity amputations from 2000 to 2011 among 11 332 people with diabetes from the Steno Diabetes Center. Amputations were identified by linkage of the electronic medical system with the National Patient Registry. Sex‐specific incidence rates of amputations by age, diabetes duration, calendar time and diabetes type were modelled by Poisson regression.

Results

From 2000 to 2011, 384 incident lower‐extremity amputations (205 major, 179 minor) occurred during 100 495 years of patient follow‐up. From 2000 to 2011, the incidence of all lower‐extremity amputations decreased by 87.5% among men and 47.4% among women with Type 1 diabetes and by 83.3% among men and 79.1% among women with Type 2 diabetes (P < 0.001). In particular, there was a decline in major lower‐extremity amputations. In 2011, the incidence rates of major lower‐extremity amputations were 0.25 (95% CI 0.07–0.82) among men and 0.21 (95% CI 0.06–0.71) among women per 1000 patient‐years at age 50 years and 0.56 (95% CI 0.18–1.89) among men and 0.41 (95% CI 0.16–1.09) among women per 1000 patient‐years at age 70 years. No significant change in incidence of minor amputations was observed.

Conclusion

The incidence of major lower‐extremity amputations reduced significantly from 2000 to 2011 in Danish people with diabetes followed at a diabetes specialist centre.
Corneal nerve fibre damage precedes diabetic retinopathy in patients with Type 2 diabetes mellitus
Authors: Bitirgen G. , Ozkagnici A. , Malik R. A. , Kerimoglu H.
Published: October 2013

Aims

To quantify the morphological alterations in corneal nerve fibres and cells in patients with Type 2 diabetes mellitus in relation to the severity of diabetic retinopathy.

Methods

One hundred and thirty‐two eyes of 132 patients with Type 2 diabetes and 32 eyes of 32 healthy control subjects were evaluated with in vivo corneal confocal microscopy. Patients with diabetes were classified into three groups: patients without diabetic retinopathy, patients with non‐proliferative diabetic retinopathy and patients with proliferative diabetic retinopathy. Anterior and posterior stromal keratocyte, endothelial cell and basal epithelial cell densities and sub‐basal nerve fibre structure were evaluated.

Results

Significant reductions in basal epithelial cell, anterior stromal keratocyte and endothelial cell densities were observed only in patients with diabetic retinopathy. However, nerve fibre density, nerve branch density and nerve fibre length were reduced in patients without diabetic retinopathy and worsened progressively with increasing severity of retinopathy.

Conclusions

Corneal cell pathology occurs in patients with diabetic retinopathy, but corneal nerve fibre damage seems to precede the development of diabetic retinopathy.
Will the next generation of basal insulins offer clinical advantages?
Authors: Garber A. J.
Published: October 2013

The 21st century has seen the arrival of several insulin analogue products and the refinement of insulin regimens, with widespread advocacy of continuous titration algorithms and earlier initiation of supplementary insulin therapy (predominantly using basal insulins) in type 2 diabetes. Nevertheless, many insulin‐treated diabetes patients remain in poor glycaemic control. This might reflect insufficient titration effort or lax adherence, but these issues could in some cases result from concerns about hypoglycaemia. Certainly there is scope for improving the pharmacokinetic/pharmacodynamic (PK/PD) profile of basal insulin, and three new products offer this prospect. Insulin degludec, now in clinical use, and PEGylated insulin lispro, in development, have greatly extended action profiles that result from two very different, but unique, mechanisms. With once‐daily dosing, these insulins produce stable PK/PD profiles at steady state, associated with a low incidence of hypoglycaemia. The feasibility of varied daily dose timing has also been confirmed with insulin degludec. High strength formulations of insulin glargine and insulin degludec offer the prospect of a reduced injection number/volume in high dose users, and in the case of glargine, the PK/PD profile might also be favourably modified. This review considers critically the clinical evidence and expectations we should have for these new basal insulins.
Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance
Authors: Florez H. , Temprosa M. G. , Orchard T. J. , Mather K. J. , Marcovina S. M. , Barrett‐Connor E. , Horton E. , Saudek C. , Pi‐Sunyer X. F. , Ratner R. E. , Goldberg R. B. ,   for the Diabetes Prevention Program Research Group
Published: October 2013

Aims

To determine the association of metabolic syndrome (MetS) and its components with diabetes risk in participants with impaired glucose tolerance (IGT), and whether intervention‐related changes inMetSlead to differences in diabetes incidence.

Methods

We used the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) revisedMetSdefinition at baseline and intervention‐related changes of its components to predict incident diabetes using Cox models in 3234 Diabetes Prevention Program (DPP) participants withIGTover an average follow‐up of 3.2 years.

Results

In an intention‐to‐treat analysis, the demographic‐adjusted hazard ratios (95% confidence interval) for diabetes in those withMetS(vs. noMetS) at baseline were 1.7 (1.3–2.3), 1.7 (1.2–2.3) and 2.0 (1.3–3.0) for placebo, metformin and lifestyle groups, respectively. Higher levels of fasting plasma glucose and triglycerides at baseline were independently associated with increased risk of diabetes. Greater waist circumference (WC) was associated with higher risk in placebo and lifestyle groups, but not in the metformin group. In a multivariate model, favourable changes inWC(placebo and lifestyle) and high‐density lipoprotein cholesterol (placebo and metformin) contributed to reduced diabetes risk.

Conclusions

MetSand some of its components are associated with increased diabetes incidence in persons withIGTin a manner that differed according toDPPintervention. After hyperglycaemia, the most predictive factors for diabetes were baseline hypertriglyceridaemia and both baseline and lifestyle‐associated changes inWC. Targeting these cardiometabolic risk factors may help to assess the benefits of interventions that reduce diabetes incidence.
Creating New Paths? Offshore Wind, Policy Activism, and Peripheral Region Development
Authors: Dawley Stuart
Published: October 2013

This article extends economic geography research on path creation by developing a conceptual framework that moves beyond existing firm‐centric accounts and connects to a wider array of actors and multiscalar institutional contexts that mediate the emergence and development of growth paths. As part of a broader understanding of social and institutional agency, the approach specifically redresses the apparent neglect of the multiple roles of the state and public policy interventions in research on path creation. The framework is used to interpret more than 30 years of path‐creation activities that have placed the peripheral region of North East England at the forefront of the United Kingdom's burgeoning offshore wind sector. The empirical findings reveal how a variety of path‐creation mechanisms have served to shape, and be shaped by, successive causal episodes of complex and geographically situated social agency. Emerging from an episode of entrepreneurial activity, the path's creation was subsequently catalyzed by a decade of strategic and contextual regional policy intervention before a radical restructuring of economic development governance in the United Kingdom created a policy vacuum for the path's development. The analysis of the policy‐on, policy‐off episodes illustrates the potential agency of evolutionary inspired policy interventions in supporting mechanisms of path creation and reveals a varied set of implications for the cohesion and embeddedness of the path's development.
Predictive value of atrial high‐rate episodes for arterial stiffness and endothelial dysfunction in dual‐chamber pacemaker patients
Authors: Krishnamoorthy Suresh , Khoo Chee W. , Lim Hoong S. , Lip Gregory Y. H.
Published: October 2013

Background

Various pacing studies have demonstrated an association between right ventricular pacing (RVp) and atrial fibrillation (AF), even after preserving atrioventricular (AV) synchrony. We aimed to assess the interaction between arterial stiffness, endothelial function and atrial high‐rate episodes (AHRE) in patients with dual‐chamber pacemakers.

Methods

We studied 101 patients with dual‐chamber pacemakers incorporated with sophisticated AF detection and therapy algorithms. Macrovascular endothelial dysfunction (ED) was measured by the relative change in aortic augmentation index (AIx), using carotid artery applanation tonometry in response to inhaled salbutamol and sublingual glyceryl trinitrate. Microvascular ED was measured by cutaneous laser Doppler flowmetry (LDF) in response to acetylcholine (Ach, endothelium dependent) and sodium nitroprusside (SNP, endothelium independent). Arterial stiffness was measured using carotid‐femoral pulse wave velocity (PWVcf). ‘Reservoir pressure’ (Pr, MATLAB) describes the aortic ‘cushioning’ properties.

Results

Mean age of the cohort was 72·1 ± 10·8 years; men (n = 69) 68·3%. Of 101 dual‐chamber pacemaker patients, 23·8% (n = 24) had AHRE detected on the baseline pacemaker interrogation. PP, PWVcf and Pr were significantly higher in patients with AHRE compared with those without AHRE. The change in AIx with salbutamol (∆% AIx Sal) and acetylcholine‐induced changes in LDF (Δ%LDF Ach) were lower in patients with AHRE compared with those without AHRE. In patients with AHRE, significant correlations were observed between%Vp and Δ%LDF Ach (P = 0·03) as well as between PP and Δ%LDF Ach (P = 0·05). On multivariate analysis, PP, Pr, PWVcf and ∆% AIx Sal remained as independent predictors of AHRE.

Conclusion

In patients with dual‐chamber pacemakers, both higher arterial stiffness and greater endothelial dysfunction independently predicted AHRE, irrespective of the degree (or mode) of pacing. Arterial stiffness and endothelial dysfunction may potentially contribute to the perpetuation of atrial arrhythmias beyond the adverse effects of ventricular pacing alone.
Mean platelet volume predicts outcome in patients with asymptomatic carotid artery disease
Authors: Mayer Florian J. , Hoke Matthias , Schillinger Martin , Minar Erich , Arbesú Itziar , Koppensteiner Renate , Mannhalter Christine
Published: October 2013

Background and Objective

Platelets play a pivotal role in atherothrombosis and are potentially involved in the pathogenesis of atherosclerosis. We investigated whether mean platelet volume (MPV) predicts clinical outcome and progression of atherosclerosis in patients with asymptomatic carotid artery disease.

Methods

We studied 1006 of 1268 prospectively collected consecutive patients with asymptomatic carotid atherosclerosis who were evaluated by duplex sonography. Patients were followed up clinically for the occurrence of a major adverse cardiovascular event (MACE), a composite of myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, stroke and death.

Results

During a median follow‐up of 3·1 years (interquartile range, 2·5–3·5), a total of 316 (31·5%) MACEs were recorded. Increased levels of MPV were significantly associated with increased risk of the occurrence of MACEs (adjusted hazard ratio [HR] for an increase in one standard deviation [SD] of MPV 1·22, confidence interval [CI] 1·05–1·35, P < 0·01). Patients with MPV levels above 11·8 femtolitre (= fifth quintile) had a significantly higher event rate (41·3% vs. 29·3%, P < 0·001) with an adjusted HR for MACEs of 1·65 (95% CI 1·26–2·16, P < 0·001) compared with patients with MPV levels in the first to fourth quintile. No significant association was found between baseline MPV levels with either baseline degree or progression during a 6‐month follow‐up of carotid stenosis.

Conclusion

Mean platelet volume was independently and significantly associated with adverse cardiovascular outcome in patients with asymptomatic carotid atherosclerosis.
Seniority and Incumbency in Legislatures
Authors: Muthoo Abhinay , Shepsle Kenneth A.
Published: October 2013

In this article, we elaborate on a strategic view of institutional features. Our focus is on seniority, though we note that this general approach may also be deployed to understand other aspects of institutional arrangements. We have taken the initial game‐theoretic model of seniority of McKelvey and Riezman (), simplified it in order to characterize its fundamental implications, generalized these results in several ways, and extended the model by deriving additional implications. The broad messages of our article, articulated by McKelvey and Riezman as well, are two. First, the endogenous choice of institutional features like seniority by self‐governing groups is strategic. While the fine‐grained ways of doing things in an institutional context surely serve internal functional objectives, these are not the only objectives. Agents making choices on how to govern themselves have private motivations – in the case of elected politicians they often revolve around re‐election. This leads to our second broad message. The institutions through which self‐governing groups conduct their business do not exist in a vacuum. They are embedded in a broader context. Those offering functional explanations for various institutional features overlook this. Particular institutional arrangements have effects outside the governance institution itself. These effects, in principle, could be accidental by‐products. Our strategic approach, however, argues that they may well be the primary reasons for a practice being instituted.
Radicular maturity level of primary teeth and its association with trauma sequelae
Authors: Qassem Aya , Goettems Marília , Torriani Dione D. , Pappen Fernanda G.
Published: October 2013

Aim

This study aimed to investigate the influence of the radicular maturity level of primary teeth on the sequelae of traumatic dental injury (TDI).

Materials and methods

A longitudinal retrospective study that collected data from dental records and radiographs of patients with TDI in one or both maxillary primary central incisors was conducted. Sequelae such as crown discoloration, pulp canal obliteration (PCO) and inflammatory root resorption (IRR) were evaluated during a 12‐ to 18‐month follow‐up period after the trauma.

Results

Of the 132 patients included in the study, 103 (78%) had luxations and 29 (22%) had dental fractures. At the initial postinjury examination, 12 teeth (9.1%) were found to have immature roots, 107 (81.1%) had closed apexes and 13 (9.8%) had visible root resorption. Inflammatory root resorption occurred mostly in traumatized teeth that presented with physiological root resorption at the moment of trauma (P = 0.004). The frequency of PCO was higher in teeth with a closed apex at the moment of the injury (P = 0.026). There was also an association between the type of injury and the occurrence of crown discoloration (P = 0.008) as well as between the type of injury and the development of PCO (P = 0.001).

Conclusions

The occurrence of TDI sequelae can be determined by the type of injury as well as by the radicular maturity level of the primary teeth at the moment of injury.
A retrospective study of pediatric traumatic dental injuries in Xi'an, China
Authors: Zhang Yu , Zhu Yuan , Su Wenqiang , Zhou Zhifei , Jin Yan , Wang Xiaojing
Published: October 2013

Background/Aim

Pediatric traumatic dental injury is an important public health problem because of its high prevalence, severe physical or psychological impacts, and high prevention and treatment costs. This study aimed to determine the distributive features of pediatric traumatic dental injury in a university dental hospital in Xi'an, China.

Materials and methods

Children (aged 1 to 15 years) visiting the hospital from February 2011 to May 2012 as a result of dental trauma were investigated. Trauma‐related information was recorded and analyzed.

Results

Most of the traumas occurred in children aged 7 to 12 years and affected the maxillary incisors. Of all the children involved, 17.2% had overjet. Concussion, enamel–dentin–pulp fracture, avulsion, and lateral luxation occurred more in the primary dentition (20.9%, 16.5%, 14.3%, and 13.2%, respectively). However, most traumas to the permanent dentition were enamel–dentin–pulp fractures and enamel–dentin fractures (33.7% and 29.1%, respectively). Most traumas were luxations (n = 156) in the 1‐ to 6‐year‐old group, while fractures were more common in the 7‐ to 12‐ and >13‐year‐old groups (n = 549, 84; P < 0.001). In total, 357 urban children had access to immediate medical care, whereas only 12 rural children were able to access a clinic within 24 h after injury (P < 0.001).

Conclusion

Based on the information presented in this survey, the government should focus on medical development in rural settings and should attempt to balance the distribution of medical resources between urban and rural areas. Educational and preventive programs should also be promoted to enhance the guardians' awareness regarding pediatric traumatic dental injuries.
Dispersal of butterflies in a New Guinea rainforest: using mark–recapture methods in a large, homogeneous habitat
Authors: VLASANEK PETR , SAM LEGI , NOVOTNY VOJTECH
Published: October 2013

In an intensive mark‐release‐recapture study of all butterfly species in a tropical rainforest understory, 5903 individuals from 90 butterfly species (from the estimated total of 104 ± 9 species present in understory habitat) were marked, and 1308 recaptured at least once.

The study proved that mark‐recapture methods are feasible in tropical rainforests, but also showed its limitations, as after 232 person‐days of sampling we could only characterise dispersal for one‐third of the species present.

The mean dispersal distance was 184 ± 46.1 m per species, while for six of the 14 species studied >1% of individuals were estimated to disperse 1 km or more. These parameters are, however, strongly dependent on the size and spatial configuration of the study plots, particularly in large homogeneous habitats. A new method proposed here to correct this bias revised the mean distance between two captures from 135 ± 33.6 to 325 ± 87.0 m per species.

These results, in combination with data from large permanent rainforest plots, suggest that most woody plant species in tropical forests are sufficiently abundant to serve as host plant species even to monophagous Lepidoptera species.
Spatial variation in the magnitude and functional form of density‐dependent processes on the large skipper butterfly Ochlodes sylvanus
Authors: DOOLEY CLAIRE A. , BONSALL MICHAEL B. , BRERETON TOM , OLIVER TOM
Published: October 2013

Understanding the underlying ecological processes that govern population dynamics is essential for identifying the risk of extinction faced by a population. Ecological processes are driven by a number of different density‐dependent and density‐independent factors. Influential factors may vary between species and are often classified for large areas of a species' geographical range.

Here we test the hypothesis that these factors vary on a relatively small spatial scale across a species' range. The population dynamics of the large skipper butterfly Ochlodes sylvanus is investigated for each 100 km2 region within its British range.

Different forms of density dependence, including Allee effects, and different density‐independent factors are found to influence population change significantly in different regions. The possible underlying mechanisms responsible for each are discussed.

In addition to this qualitative spatial variation in influencing factors, the relative contribution of density dependence and density‐independent factors to temporal dynamics within each region is quantified. As the range of O. sylvanus is crossed from north‐west to east, there appears to be a switch from density independence being more influential to density dependence having a greater impact on population change.
Morphology and life history of the Great Slave Lake ciscoes (Salmoniformes: Coregonidae)
Authors: Muir Andrew M. , Vecsei Paul , Power Michael , Krueger Charles C. , Reist James D.
Published: October 2013

The taxonomy of the North American ciscoes (Salmoniformes: Coregonidae) remains unresolved. We provide the first comprehensive description of the Great Slave Lake ciscoes. Our analysis supports the hypothesis that the Great Slave Lake cisco complex includes at least two nominate species (Coregonus artedi and Coregonus sardinella) and an adfluvial C. artedi morph that is distinct from its lacustrine conspecific in terms of life history, morphology, age, growth and mortality. Coregonus sardinella has previously been identified from Great Slave Lake, but we provide the first comprehensive description of this species in the lake and confirm a significant range extension for the species. The lacustrine C. artedi differs little from descriptions throughout its range. In addition to these three ciscoes, linear phenotypic traits, gillraker number and morphology, and growth data support the possible occurrence of two other, less‐distinct morphs, the big‐eye cisco and a shortjaw‐like morph Coregonus zenithicus. Although the big‐eye morph was not identified by body shape and linear phenotypic measures, it was visually identified on the basis of differences in traditional phenotypic proportions, such as orbital length, paired fin lengths, head and gillraker morphology expressed as thousands of standard length and showed different age and growth structure compared with the other lacustrine cisco morphs. Coregonus zenithicus was distinguished visually and by a statistical model of linear phenotypic traits as well as by gillraker number and morphology. Identifying, characterising and managing locally adapted cisco morphs that reflect important ecological and bioenergetic linkages are critical to conserving the ecological integrity of northern ecosystems.
Third‐wave strategies for emotion regulation in early psychosis: a pilot study
Authors: Khoury Bassam , Lecomte Tania , Comtois Ginette , Nicole Luc
Published: October 2013

Aim

Emerging evidence supports the priority of integrating emotion regulation strategies in cognitive behaviour therapy for early psychosis, which is a period of intense distress. Therefore, we developed a new treatment for emotional regulation combining third‐wave strategies, namely compassion, acceptance, and mindfulness (CAM) for individuals with early psychosis. The purpose of this study was to examine the acceptability, feasibility and potential clinical utility of CAM.

Method

A non‐randomized, non‐controlled prospective follow‐up study was conducted. Outpatients from the First Psychotic Episode Clinic in Montreal were offered CAM, which consisted of 8‐week 60–75 min weekly group sessions. Measures of adherence to medication, symptoms, emotional regulation, distress, insight, social functioning and mindfulness were administered at baseline, post‐treatment and at 3‐month follow up. A short feedback interview was also conducted after the treatment.

Results

Of the 17 individuals who started CAM, 12 (70.6%) completed the therapy. Average class attendance was 77%. Post‐treatment feedback indicated that participants found the intervention acceptable and helpful. Quantitative results suggest the intervention was feasible and associated with a large increase in emotional self‐regulation, a decrease in psychological symptoms, especially anxiety, depression, and somatic concerns, and improvements in self‐care.

Conclusion

Overall results support the acceptability, feasibility and potential clinical utility of the new developed treatment. A significant increase in emotional self‐regulation and a decrease in affective symptoms were found. No significant changes were observed on measures of mindfulness, insight, distress and social functioning. Controlled research is warranted to validate the effectiveness of the new treatment.
Assessment of left ventricular and atrial diastolic function using two‐dimensional (2D) strain imaging in patients with β‐thalassemia major
Authors: Karamanou Alexandra G. , Hamodraka Eftihia S. , Vrakas Spyridon C. , Paraskevaidis Ioannis , Lekakis Ioannis , Kremastinos Dimitrios Th.
Published: October 2013

Background

β‐thalassemia major is a unique disease characterized by early severe diastolic dysfunction, due to iron myocardial deposition alone, while left ventricular systolic dysfunction and failure seem to be multifactorial in aitiology.

Objectives

The purpose of this study was to investigate left ventricular diastolic dysfunction using a new echo index as speckle tracking in comparison with the conventional methods.

Material and methods

Eighty‐eight consecutive patients (38 male, 50 female) aged 36 ± 8.2 yr with β‐thalassemia major and preserved LV ejection fraction (LVEF>55%) were studied. Patients were divided into two groups according to the E mitral/E mitral annulus ratio (E/E′): group A patients with E/E′ ratio ≤8 and group B patients with E/E′ >8. Cutoff value of eight was used to separate patients with normal and abnormal diastolic function. All subjects were studied thoroughly by tissue Doppler echocardiography as also by 2D left ventricular and atrial strain imaging 2–4 d following blood transfusion. Blood samples were also taken for plasma BNP measurements at the same time.

Results

Left atrial volumes(LAV max, LAV min) as also left atrial index were significantly higher in patients with diastolic dysfunction compared with patients without diastolic dysfunction(LAV max: 57.6 ± 19.4 vs. 71.3 ± 22.9, P < 0.01,LAV min: 20.2 ± 11.4 vs. 33.9 ± 18, P < 0.01, LAVI: 37.66 ± 12.18 vs. 47.13 ± 14.77, P < 0.01). Radial 2D strain (RS) and peak atrial 2D strain (AS) were significantly reduced in patients with suspected diastolic dysfunction compared with patients without diastolic dysfunction (RS: 43.48 ± 13.92 vs. 35.58 ± 11.32, P < 0.05; AS: 36.36 ± 8.45 vs. 29.85 ± 9.25, P < 0.01). Using ROC analysis, peak atrial 2D strain at a cutoff of 41.1 cm/s was highly accurate (AUC: 0.66, P < 0.05 in ruling out diastolic dysfunction (E/E′<8) with a sensitivity of 90% and a specificity of 81%.

Conclusions

B‐thalassemic major patients with preserved left ventricular systolic function had impaired left atrial function at the longitudinal axis and left ventricular function at the radial axis. The new echo markers have better prognostic value than the traditional echo indexes in detecting latent diastolic dysfunction in β‐thalassemia major, earlier than E/E′ ratio.