bluuebunny/crossref_metadata_2025 huggingface dataset:
(Dis)-Trust in transitioning ventilator-dependent children from hospital to homecare
Authors: Manhas Kiran Pohar , Mitchell Ian
Published: December 2014

Background:

Scholarly work is needed to develop the conceptual and theoretical understanding of trust to nursing practice. The transition from hospital care to complex pediatric homecare involves nurses in myriad roles, including management and care provision. Complex pediatric homecare transforms children, families, professionals, and communities, but its exact implications are unclear.

Research objectives:

To conduct an ethical inquiry into the role and responsibilities of nurses in the qualitative experience of adults involved in the hospital-to-home transition of young, ventilator-dependent children.

Research design:

We followed methods described by Franco Carnevale. We used a sociologically grounded theoretical orientation—trust—to re-interpret qualitative data for an ethical inquiry into a specific facet of that data.

Participants and study context:

The participants included 26 adults, including 14 nurses, involved in the hospital-to-home transition in a Canadian province. Participants represented family, hospital, home, and government.

Ethical considerations:

The Conjoint Health Research Ethics Board at the University of Calgary approved this study.

Findings:

First, the concept and practice of trust was salient to the experience of transition. For example, responsibilities’ allocation between hospital-based professionals to mothers, home-based nurses, and non-professionals necessitated reliance and vulnerability. Second, the consequences of distrust connected to recognized challenges. For example, tensions along rural–urban, medical-family, and professional–personal divide each revealed suspicion and uncertainty that led to isolation and anxiety for all involved. Third, recommendations to improve the experience and mitigate the challenges of transition can be grounded in trust promotion. For example, transition-specific education programs and codes of ethics would promote openness, recognize mutual vulnerability, and advance trust in transition.

Conclusions:

The challenges to transition evidenced distrust, while trust represents a powerful tool to counter these challenges and their implications. A climate of trust could bridge divides between mothers and professionals; rural and urban professionals; and professionals with differing relationships with the family.
Stepping Through the Looking Glass
Authors: Stringer Christina , Simmons Glenn
Published: December 2014

Qualitative researchers may encounter unforeseen risks when undertaking fieldwork; however, such risks are not widely addressed in the management and international business literatures. Furthermore, risks to participants and their families, and translators, is also an important phenomenon seldom explored in the literature. In this article, we reflect on our investigations of slavery in the foreign charter vessel sector of New Zealand’s fishing industry. Third parties threatened and intimidated many of those involved in our research, for example, through direct confrontation and surveillance. We contend that methodological awareness around risks and coping strategies needs further development, particularly in the management and international business literatures. Knowledge of potential risks and coping strategies can help mitigate consequences and, by doing so, enhance research designs.
Corporate Responsibility and Employee Relations
Authors: Griffin Jennifer J. , Bryant Andrew , Koerber Charles P.
Published: December 2014

Research has traditionally portrayed voluntary corporate responsibility (CR) actions toward employees as episodic, discretionary activities that individual firms take in response to marginalized, fringe “gadflies.” In this study, which examines numerous external pressures from a firm’s institutional and task environment, our findings suggest more than simple episodic responses that vary from firm to firm, but rather a conformity of action with respect to a firm’s voluntary activities toward its employees. In the absence of explicit mandates, firms are voluntarily strengthening employee relations, especially if they are increasing employee-relations concerns. Overall, external pressures significantly affect the CR activities that firms direct toward employees.
Regional Volumetric Differences Based on Structural MRI in Children With Two Subtypes of ADHD and Controls
Authors: Semrud-Clikeman Margaret , Fine Jodene Goldenring , Bledsoe Jesse , Zhu David C.
Published: December 2014

Objective: The purpose of this study was to compare groups of children with two subtypes of ADHD and controls on selected regions using volumetric magnetic resonance imaging (MRI) measures. Children with ADHD were expected to have smaller volumes of the anterior cingulate cortex (ACC) and caudate. Parent behavioral rating measures of hyperactivity were predicted to relate to the volume of the caudate and attention with the ACC. Method: There were a total of 74 children in the final sample (27 controls, 25 ADHD:Combined type [ADHD:C], 22 ADHD:Inattentive type [ADHD:I]). Results: Findings indicated that the ADHD:C group had bilaterally smaller volumes of the caudate and ACC compared with the other two groups. In addition, parent ratings of attention and hyperactivity significantly predicted the right volume of the ACC, whereas hyperactivity ratings predicted the volume of the right caudate. Analysis of the ADHD groups without the control confirmed these findings. Conclusion: These findings indicate that different structures are related to the ADHD subtypes and suggest that they may be different phenotypes.
Japanese Bobtail: vertebral morphology and genetic characterization of an established cat breed
Authors: Pollard Rachel E , Koehne Amanda L , Peterson Carlyn B , Lyons Leslie A
Published: December 2014

Several cat breeds are defined by morphological variation of the tail. The Japanese Bobtail is a breed that has been accepted for registration only within the past 50 years; however, the congenital kinked tail variants defining this breed were documented in the Far East centuries ago and the cats are considered ‘good luck’ in several Asian cultures. The recent discovery of the mutation for the tailless Manx phenotype has demonstrated that the Japanese Bobtail does not have a causative mutation in the same gene ( T-Box). Here, a simple segregation analysis of cats bred from a pedigreed Japanese Bobtail demonstrated a simple autosomal dominant mode of inheritance with variable expression of the tail length and kink placement. Unexpectedly, radiological examinations of the entire vertebral column of kink-tailed cats indicated variation from the normal vertebral feline formula (C7, T13, L7, S3, Cd20–24), including cats with mostly one reduction of thoracic vertebrae (C7, T12, L7, S3), and an average of 15.8 caudal vertebrae. A few cats had variation in the number of cervical vertebrae. Several transitional vertebrae and anomalous ribs were noted. One cat had a bifid vertebra in the tail. Most cats had hemivertebrae that were usually included in the tail kink, one of which was demonstrated by gross pathology and histopathology. The abnormal vertebral formula or the placement of the kink in the tail did not coincide with morbidity or mortality.
Bone marrow angiotensin AT2 receptor deficiency aggravates atherosclerosis development by eliminating macrophage liver X receptor-mediated anti-atherogenic actions
Authors: Kato Taku , Kawahito Hiroyuki , Kishida Sou , Irie Daisuke , Wakana Noriyuki , Kikai Masakazu , Takata Hiroki , Ogata Takehiro , Ueyama Tomomi , Matoba Satoaki , Yamada Hiroyuki
Published: December 2014

Background:

Bone marrow (BM) Angiotensin II (Ang II) type 1 (AT1) receptor plays a crucial role in atherosclerosis development; however, the effect of BM Ang II type 2 (AT2) receptor on atherogenesis remains undefined.

Methods and results:

We generated BM chimera apoE-deficient ( apoE−/−) mice whose BM cells were repopulated with AT2-deficient ( Agtr2−/−) or wild-type ( Agtr2+/+) cells. After 2 months of a high-cholesterol diet, the atherosclerotic lesion area was significantly increased in the apoE−/−/BM-Agtr2−/− mice compared with the apoE−/−/BM-Agtr2+/+ mice (51%, P < 0.05), accompanied by an augmented accumulation of lesion macrophages. Although phenotypic polarization in BM-derived macrophages and lipopolysaccharide-induced expression of proinflammatory cytokines in thioglycollate-induced peritoneal macrophages (TGPMs) were not affected by AT2-deficiency, mRNA and protein expression levels of macrophage liver X receptor β (LXRβ) were significantly decreased in Agtr2−/− TGPMs compared with Agtr2+/+ TGPMs. Anti-inflammatory effects of LXR agonist (GW3965) were markedly inhibited in Agtr2−/− TGPMs. Furthermore, the expression levels of ATP-binding cassette transporter ABCA1 and CCR7 were much lower in Agtr2−/− TGPMs than Agtr2+/+ TGPMs, accompanied by a significantly reduced cholesterol efflux.

Conclusions:

Our findings demonstrate that BM-AT2 deficiency aggravates atherosclerosis, at least in part, by eliminating the anti-atherogenic properties of macrophages elicited by LXRβ activation.
Bovine Carotid Artery (Artegraft) as a Hemodialysis Access Conduit in Patients Who Are Poor Candidates for Native Arteriovenous Fistulae
Authors: Harlander-Locke Michael , Jimenez Juan Carlos , Lawrence Peter F. , Gelabert Hugh A. , Derubertis Brian G. , Rigberg David A. , Farley Steven M.
Published: December 2014

Our experience with bovine carotid artery graft (BCAG) for hemodialysis access (Artegraft, North Brunswick, New Jersey) is presented. A review of all patients who underwent placement of BCAG for hemodialysis access at our institution was performed. Between January 2012 and June 2013, 17 BCAGs were placed in 17 patients. Indications included skin compromise, recurrent expanded polytetrafluoroethylene (ePTFE) and catheter infections, immunosuppression, groin placement, and surgeon's choice. Actuarial primary, primary-assisted, and secondary patency rates at 18 months were 73.3%, 67%, and 89%, respectively. One immunosuppressed patient developed a vancomycin-resistant enterococcus graft infection and required removal 2 months following the initial procedure. We conclude that BCAG can be used as an alternative to ePTFE for angioaccess in patients with no available superficial vein in high-risk patients with low morbidity and good functional patency. Our 1-year patency rates were superior to ePTFE as reported in the contemporary peer-reviewed literature.
Clopidogrel and 1-Year Freedom From Amputation After Endovascular Lower Extremity Revascularization in the Medicare Population
Authors: Janzen Mark L. , Dombrovskiy Viktor Y. , Galiñanes Edgar Luis , Vogel Todd R.
Published: December 2014

Objective:

To evaluate freedom from amputation in patients identified utilizing clopidogrel following their lower extremity endovascular revascularization (LER).

Methods:

Patients, 65 years of age and older, undergoing LER were identified from Medicare Provider Analysis and Review and Carrier files utilizing International Classification of Diseases diagnosis and Current Procedural Terminology codes. Postprocedural use of clopidogrel was identified using the National Drug Code directory. Outcomes were evaluated.

Results:

A total of 14 353 patients were identified: 5697 (39.7%) with claudication, 1467 (10.2%) with rest pain, and 7189 (50.1%) with ulceration/tissue loss. In all, 5416 (37.7%) patients were identified using clopidogrel after LER. Overall, patients initiated on clopidogrel had lower amputation rates at 30 days (10.34% vs 14.09%; P < .0001), 90 days (14.05% vs 18.71%; P < .0001), and 1 year (19.68% vs 24.06%; P < .0001).

Conclusion:

Utilization of clopidogrel after LER was associated with lower rates of amputation, yet only 38% of the Medicare population was identified as using clopidogrel. Patients with ulceration and tissue loss benefited the most with significantly greater freedom from amputation and overall survival.
Diagnosis and management of primary autoimmune neutropenia in children: insights for clinicians
Authors: Farruggia Piero , Dufour Carlo
Published: December 2014

Autoimmune neutropenia of infancy (AIN), also called primary autoimmune neutropenia, is a disease in which antibodies recognize membrane antigens of neutrophils, mostly located on immunoglobulin G (IgG) Fc receptor type 3b (FcγIIIb receptor), causing their peripheral destruction. It is the most frequent type of neutropenia in children under 3–4 years of age and in most cases shows a benign, self-limited course. The diagnosis is based on evidence of indirect antineutrophil antibodies, whose detection frequently remains difficult. In this review we have analyzed the literature regarding AIN and present our personal experience in diagnosis and management.
Tai Chi as an Alternative and Complimentary Therapy for Anxiety
Authors: Sharma Manoj , Haider Taj
Published: December 2014

Anxiety has become a global public health problem. Tai chi offers one possible way of reducing anxiety. The purpose of this study was to examine studies from 1989 to March 2014 to assess whether tai chi can be an efficacious approach for managing anxiety. A systematic search of Medline, CINAHL, and Alt HealthWatch databases was conducted for quantitative articles involving applications of tai chi for anxiety. A total of 17 articles met the inclusion criteria. Of these, 8 were from the United States, 2 from Australia, 2 from Japan, 2 from Taiwan, and 1 each from Canada, Spain, and China. Statistically significant results of anxiety reduction were reported in 12 of the studies reviewed. Despite the limitations of not all studies using randomized controlled designs, having smaller sample sizes, having different outcomes, having nonstandardized tai chi interventions, and having varying lengths, tai chi appears to be a promising modality for anxiety management.
The Phenomenon of the Third Year
Authors: Long Jody , Allen David
Published: December 2014

This article describes the phenomenon of the outpatient year experiences of the PGY(Post Graduate Year)-3 year psychiatry residents using participant interviews, focus groups, and research observation at a university health science center. A qualitative research approach was used to identify and understand psychiatric residents’ experiences of their third year. The research question was, “What are the important and valuable experiences of psychiatry residents and what meaning do they ascribe to these experiences in their acquisition of psychiatric skills?” Four themes emerged from the study: Specialty Choice Was a Momentous Decision, Observation and Reflection Should Be Modeled Prior to Practice, The Value of the Third Year Was the Shift to Psychotherapy Training, and The Importance of Overcoming Hurdles to Acquire Their Psychiatric Skills This research study revealed that psychiatry residents saw the third year of their psychiatry education as foundational in building their career.
Is Emerging Adults’ Attachment Preference for the Romantic Partner Transferred From Their Attachment Preferences for Their Mother, Father, and Friends?
Authors: Umemura Tomo , Lacinová Lenka , Macek Petr
Published: December 2014

This study examined whether emerging adults’ attachment preference for their romantic partner is complementary to their attachment preferences for their mother, father, and friends using a cross-sectional research design. Participants were 1,021 emerging adults recruited in the Czech Republic (mean age = 21.46, SD = 1.55) who filled out questionnaires. The attachment preference for the romantic partner correlated inversely with the attachment preference for friends but not with the preference for the mother or for the father. Our regression analyses revealed that emerging adults who were currently in a romantic relationship and had a longer romantic relationship were more likely to prefer their partner and less likely to prefer their friends. However, those emerging adults were not necessarily less likely to prefer their parents. For females, the length of romantic relationship was positively linked to their preferences for their mother. Hence, the results of this study accord with the claim that emerging adults’ attachment preferences are shifted to the romantic partner only from friends and not from the parents.
Microstructure and corrosion behaviour of FeCoNiCuSnx high entropy alloys
Authors: Zheng Z. Y. , Li X. C. , Zhang C. , Li J. C.
Published: December 2014

The FeCoNiCuSnx alloys with different Sn contents are prepared, the microstructure and the corrosion behaviour of the alloys are investigated. When Sn content is lower than 0.09, FeCoNiCuSnx alloys consist of a single FCC phase. While Sn content of the alloy is 0.09, a small quantity of BCC structure is present. The FeCoNiCuSnx alloys have a wider passive region in the NaOH solution. FeCoNiCuSnx alloys exhibit a better corrosion resistance in NaCl solution than 304 stainless steel, the corrosion resistance of FeCoNiCuSn0.04 alloy is best among all the alloys. The corrosion resistance of FeCoNiCuSnx alloys in NaOH solution is lower than that of 304 stainless steel, the corrosion resistance of FeCoNiCuSn0.03 alloy is best among all FeCoNiCuSnx alloys.
Quantification of deformation induced α’-martensite in Fe–19Cr–3Mn–4Ni–0.15C–0.15N austenitic steel by in situ magnetic measurements
Authors: Hauser M. , Wendler M. , Ghosh Chowdhury S. , Weiß A. , Mola J.
Published: December 2014

An in situ magnetic device was employed to quantify the deformation induced martensite in a Fe–19Cr–3Mn–4Ni–0.15C–0.15N (wt-) steel during tensile testing in the temperature range of −40 to 22°C. The new device consists of an electromagnetic field which serves to magnetise the martensite phase as it forms during tensile loading and a second coil to detect the effective electrical potential difference induced by the magnetisation of tensile specimens. To implement the in situ measurement system, a correlation was necessary between the induced electrical potential difference and the deformation induced martensite fractions during uniaxial static tensile tests. The correlation procedure was found to require only the quantification of deformation induced martensite content in a tensile specimen strained until fracture using an ex situ magnetic saturation unit.
Nutrition habits in 24-hour mountain bike racers
Authors: Chlíbková Daniela , Knechtle Beat , Rosemann Thomas , Tomášková Ivana , Chadim Vlastimil , Shortall Marcus
Published: December 2014

We investigated seventy-four ultra-mountain bikers (MTBers) competing in the solo category in the first descriptive field study to detail nutrition habits and the most common food before during and after the 24 hour race using questionnaires. During the race, bananas (86.5%), energy bars (50.0%), apples (43.2%) and cheese (43.2%) were the most commonly consumed food, followed by bread (44.6%), rice (33.8%) and bananas (33.8%) after the race. Average fluid intake was 0.5 ± 0.2 l/h. The main beverage was isotonic sports drink (82.4%) during and pure water (66.2%) after the race. The most preferred four supplements in the four weeks before, the day before, during and after the race were vitamin C (35.1%), magnesium (44.6%), magnesium (43.2%) and branched-chain amino acids (24.3%), respectively. Total frequency of food intake (30.6 ± 10.5 times/24 hrs) was associated with fluid intake (r = 0.43,P = 0.04) and both were highest at the beginning of the race and lower during the night hours and the last race segment in a subgroup of twenty-three ultra-MTBers. Supplement intake frequency (6.8 ± 8.4 times/24 hrs) was highest during the night hours and lower at the beginning and end of the race. Elevated food and fluid intake among participants tracked across all race segments (P < 0.001). In conclusion, the nutrition strategy employed by ultra-MTBers was similar to those demonstrated in previous studies of ultra-cyclists with some exceptions among selected individuals.
Borderline pulmonary arterial pressure in systemic sclerosis patients: a post-hoc analysis of the DETECT study
Authors: Visovatti Scott H , Distler Oliver , Coghlan J Gerry , Denton Christopher P , Grünig Ekkehard , Bonderman Diana , Müller-Ladner Ulf , Pope Janet E , Vonk Madelon C , Seibold James R , Torres-Martin Juan-Vicente , Doelberg Martin , Chadha-Boreham Harbajan , Rosenberg Daniel M , McLaughlin Vallerie V , Khanna Dinesh
Published: December 2014

Introduction

Patients with mean pulmonary artery pressures (mPAP) of 21 to 24 mm Hg have a so-called borderline elevation of mPAP (BoPAP)—a condition thought to represent early-stage pulmonary arterial vasculopathy. Based on the DETECT study, this post-hoc analysis examined patient characteristics of systemic sclerosis (SSc) patients with normal mPAP, BoPAP and elevated mPAP, fulfilling pulmonary arterial hypertension (PAH) criteria.

Methods

Adult patients with a duration of SSc more than 3 years, a diffusing capacity of the lung for carbon monoxide less than 60% predicted, and no previous diagnosis of any form of pulmonary hypertension (PH) underwent screening tests followed by right heart catheterization. Subjects were divided into three groups: normal mPAP, BoPAP, and PAH. Exploratory comparative and binary logistic regression analyses were performed for the BoPAP versus normal mPAP and PAH versus BoPAP groups.

Results

Of 244 patients evaluated, 148 (60%) had normal mPAP, 36 (15%) had BoPAP, and 60 (25%) had definite PAH. Univariable logistic regression (ULR) showed the mean tricuspid regurgitation velocity in patients with BoPAP to be intermediate between normal mPAP and PAH. In the ULR analyses BoPAP versus normal mPAP and PAH versus BoPAP, the statistically significant predictors were, amongst others: demographic, clinical, pulmonary function, echocardiographic and hemodynamic variables.

Conclusions

In this exploratory post-hoc analysis of the DETECT study population patients with BoPAP could be distinguished from patients with normal mPAP and PAH, and it appears that BoPAP may be an intermediate stage on the continuum between normal PA pressures and PAH.
Quadriceps arthrogenic muscle inhibition: the effects of experimental knee joint effusion on motor cortex excitability
Authors: Rice David Andrew , McNair Peter John , Lewis Gwyn Nancy , Dalbeth Nicola
Published: December 2014

Introduction

Marked weakness of the quadriceps muscles is typically observed following injury, surgery or pathology affecting the knee joint. This is partly due to ongoing neural inhibition that prevents the central nervous system from fully activating the quadriceps, a process known as arthrogenic muscle inhibition (AMI). This study aimed to further investigate the mechanisms underlying AMI by exploring the effects of experimental knee joint effusion on quadriceps corticomotor and intracortical excitability.

Methods

Seventeen healthy volunteers participated in this study. Transcranial magnetic stimulation was used to measure quadriceps motor evoked potential area, short-interval intracortical inhibition, intracortical facilitation and cortical silent period duration before and after experimental knee joint effusion. Joint effusion was induced by the intraarticular infusion of dextrose saline into the knee.

Results

There was a significant increase in quadriceps motor evoked potential area following joint infusion, both at rest (P = 0.01) and during voluntary muscle contraction (P = 0.02). Cortical silent period duration was significantly reduced following joint infusion (P = 0.02). There were no changes in short interval intracortical inhibition or intracortical facilitation over time (all P > 0.05).

Conclusions

The results of this study provide no evidence for a supraspinal contribution to quadriceps AMI. Paradoxically, but consistent with previous observations in patients with chronic knee joint pathology, quadriceps corticomotor excitability increased after experimental knee joint effusion. The increase in quadriceps corticomotor excitability may be at least partly mediated by a decrease in gamma-aminobutyric acid (GABA)-ergic inhibition within the motor cortex.
Multicenter Phase II Trial of Temsirolimus and Bevacizumab in Pancreatic Neuroendocrine Tumors
Authors: Hobday Timothy J. , Qin Rui , Reidy-Lagunes Diane , Moore Malcolm J. , Strosberg Jonathan , Kaubisch Andreas , Shah Manisha , Kindler Hedy Lee , Lenz Heinz-Josef , Chen Helen , Erlichman Charles
Published: December 2014

Purpose

There are few effective therapies for pancreatic neuroendocrine tumors (PNETs). Recent placebo-controlled phase III trials of the mammalian target of rapamycin (mTOR) inhibitor everolimus and the vascular endothelial growth factor (VEGF)/platelet-derived growth factor receptor inhibitor sunitinib have noted improved progression-free survival (PFS). Preclinical studies have suggested enhanced antitumor effects with combined mTOR and VEGF pathway–targeted therapy. We conducted a clinical trial to evaluate combination therapy against these targets in PNETs.

Patients and Methods

We conducted a two-stage single-arm phase II trial of the mTOR inhibitor temsirolimus 25 mg intravenously (IV) once per week and the VEGF-A monoclonal antibody bevacizumab 10 mg/kg IV once every 2 weeks in patients with well or moderately differentiated PNETs and progressive disease by RECIST within 7 months of study entry. Coprimary end points were tumor response rate and 6-month PFS.

Results

A total of 58 patients were enrolled, and 56 patients were eligible for response assessment. Confirmed response rate (RR) was 41% (23 of 56 patients). PFS at 6 months was 79% (44 of 56). Median PFS was 13.2 months (95% CI, 11.2 to 16.6). Median overall survival was 34 months (95% CI, 27.1 to not reached). For evaluable patients, the most common grade 3 to 4 adverse events attributed to therapy were hypertension (21%), fatigue (16%), lymphopenia (14%), and hyperglycemia (14%).

Conclusion

The combination of temsirolimus and bevacizumab had substantial activity and reasonable tolerability in a multicenter phase II trial, with RR of 41%, well in excess of single targeted agents in patients with progressive PNETs. Six-month PFS was a notable 79% in a population of patients with disease progression by RECIST criteria within 7 months of study entry. On the basis of this trial, continued evaluation of combination mTOR and VEGF pathway inhibitors is warranted.
Institutional Clinical Trial Accrual Volume and Survival of Patients With Head and Neck Cancer
Authors: Wuthrick Evan J. , Zhang Qiang , Machtay Mitchell , Rosenthal David I. , Nguyen-Tan Phuc Felix , Fortin André , Silverman Craig L. , Raben Adam , Kim Harold E. , Horwitz Eric M. , Read Nancy E. , Harris Jonathan , Wu Qian , Le Quynh-Thu , Gillison Maura L.
Published: December 2014

Purpose

National Comprehensive Cancer Network guidelines recommend patients with head and neck cancer (HNC) receive treatment at centers with expertise, but whether provider experience affects survival is unknown.

Patients and Methods

The effect of institutional experience on overall survival (OS) in patients with stage III or IV HNC was investigated within a randomized trial of the Radiation Therapy Oncology Group (RTOG 0129), which compared cisplatin concurrent with standard versus accelerated fractionation radiotherapy. As a surrogate for experience, institutions were classified as historically low- (HLACs) or high-accruing centers (HHACs) based on accrual to 21 RTOG HNC trials (1997 to 2002). The effect of accrual volume on OS was estimated by Cox proportional hazards models.

Results

Median RTOG accrual (1997 to 2002) at HLACs was four versus 65 patients at HHACs. Analysis included 471 patients in RTOG 0129 (2002 to 2005) with known human papillomavirus and smoking status. Patients at HLACs versus HHACs had better performance status (0: 62% v 52%; P = .04) and lower T stage (T4: 26.5% v 35.3%; P = .002) but were otherwise similar. Radiotherapy protocol deviations were higher at HLACs versus HHACs (18% v 6%; P < .001). When compared with HHACs, patients at HLACs had worse OS (5 years: 51.0% v 69.1%; P = .002). Treatment at HLACs was associated with increased death risk of 91% (hazard ratio [HR], 1.91; 95% CI, 1.37 to 2.65) after adjustment for prognostic factors and 72% (HR, 1.72; 95% CI, 1.23 to 2.40) after radiotherapy compliance adjustment.

Conclusion

OS is worse for patients with HNC treated at HLACs versus HHACs to cooperative group trials after accounting for radiotherapy protocol deviations. Institutional experience substantially influences survival in locally advanced HNC.
Pre- and Postdiagnosis Physical Activity, Television Viewing, and Mortality Among Patients With Colorectal Cancer in the National Institutes of Health–AARP Diet and Health Study
Authors: Arem Hannah , Pfeiffer Ruth M. , Engels Eric A. , Alfano Catherine M. , Hollenbeck Albert , Park Yikyung , Matthews Charles E.
Published: December 2014

Purpose

Physical inactivity has been associated with higher mortality risk among survivors of colorectal cancer (CRC), but the independent effects of pre- versus postdiagnosis activity are unclear, and the association between watching television (TV) and mortality in survivors of CRC is previously undefined.

Methods

We analyzed the associations between prediagnosis (n = 3,797) and postdiagnosis (n = 1,759) leisure time physical activity (LTPA) and TV watching and overall and disease-specific mortality among patients with CRC. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% CIs, adjusting for known mortality risk factors.

Results

Comparing survivors of CRC reporting more than 7 hours per week (h/wk) of prediagnosis LTPA with those reporting no LTPA, we found a 20% lower risk of all-cause mortality (HR, 0.80; 95% CI, 0.68 to 0.95; P for trend = .021). Postdiagnosis LTPA of ≥ 7 h/wk, compared with none, was associated with a 31% lower all-cause mortality risk (HR, 0.69; 95% CI, 0.49 to 0.98; P for trend = .006), independent of prediagnosis activity. Compared with 0 to 2 TV hours per day (h/d) before diagnosis, those reporting ≥ 5 h/d of TV before diagnosis had a 22% increased all-cause mortality risk (HR, 1.22; 95% CI, 1.06 to 1.41; P trend = .002), and more postdiagnosis TV watching was associated with a nonsignificant 25% increase in all-cause mortality risk (HR, 1.25; 95% CI, 0.93 to 1.67; P for trend = .126).

Conclusion

LTPA was inversely associated with all-cause mortality, whereas more TV watching was associated with increased mortality risk. For both LTPA and TV watching, postdiagnosis measures independently explained the association with mortality. Clinicians should promote both minimizing TV time and increasing physical activity for longevity among survivors of CRC, regardless of previous behaviors.
DYRK1A BAC Transgenic Mouse: A New Model of Thyroid Dysgenesis in Down Syndrome
Authors: Kariyawasam Dulanjalee , Rachdi Latif , Carré Aurore , Martin Mercè , Houlier Marine , Janel Nathalie , Delabar Jean-Maurice , Scharfmann Raphaël , Polak Michel
Published: December 2014

The most common thyroid abnormality among Down syndrome (DS) children corresponds to a mildly elevated TSH, with T4 decreased or in the normal range and thyroid hypoplasia, from the neonatal period onward, which aggravate their mental impairment. Transgenic Dyrk1A mice, obtained by bacterial artificial chromosome engineering (mBACTgDyrk1A), have 3 copies of the Dyrk1A gene. The objective is to determine whether this transgenic Dyrk1A (Dyrk1A+/++) mouse is an adequate murine model for the study of thyroid dysgenesis in DS. Embryonic thyroid development from embryonic day 13.5 (E13.5) to E17.5 was analyzed in wild-type (WT) and Dyrk1A+/++ mice by immunofluorescence with anti-Nkx2–1, anti-thyroglobulin, and anti-T4 antibodies, markers of early thyroid development, hormonogenesis, and final differentiation, respectively. The expression of transcription factors Nkx2–1, Pax8, and Foxe1 involved in thyroidogenesis were studied by quantitative RT-PCR at the same embryonic stages. We then compared the adult phenotype at 8 to 12 weeks in Dyrk1A+/++ and WT mice for T4 and TSH levels, thyroidal weight, and histological analysis. Regarding thyroidal development, at E15.5, Dyrk1A+/++ thyroid lobes are double the size of WT thyroids (P = .01), but the thyroglobulin stained surface in Dyrk1A+/++ thyroids is less than a third as large at E17.5 (P = .04) and their differentiated follicular surface half the size (P = .004). We also observed a significant increase in Nkx2–1, Foxe1, and Pax8 RNA levels in E13.5 and E17.5 Dyrk1A+/++ embryonic thyroids. Dyrk1A+/++ young adult mice have significantly lower plasma T4 (2.4 ng/mL versus WT, 3.7 ng/mL; P = 0.019) and nonsignificantly higher plasma TSH (114 mUI/L versus WT, 73mUI/L; P = .09). In addition, their thyroids are significantly heavier (P = .04) and exhibit large disorganized regions. Dyrk1A overexpression directly leads to thyroidal embryogenetic, functional and morphological impairment. The young adult thyroid phenotype is probably a result of embryogenetic impairment. The Dyrk1A+/++ mouse can be considered a suitable study model for thyroid dysgenesis in DS.
Primary and Metastatic Parathyroid Malignancies: A Rare or Underdiagnosed Condition?
Authors: Shifrin Alexander , LiVolsi Virginia , Shifrin-Douglas Svetlana , Zheng Min , Erler Brian , Matulewicz Theodore , Davis John
Published: December 2014

Objective:

Parathyroid gland malignancies are considered rare. The most common of these tumor types is primary parathyroid carcinoma. Metastatic spread from other cancers may also occur with up to 10% of cancers from other sites showing parathyroid involvement at autopsy. Tumor-to-tumor metastases (metastatic spread to parathyroid neoplasm) from remote cancers to the parathyroid gland have been described.

Methods:

We did a PubMed literature review and analysis of our own experience of 392 consecutive parathyroidectomies.

Results:

Primary and secondary parathyroid malignancies can be grouped into three categories: primary parathyroid carcinoma (PPCa), spread of carcinoma into parathyroid glands by contiguous extension from the thyroid gland or other head and neck cancer, and metastatic disease to the parathyroid gland from distant cancers. Studies of tumor-to-tumor spread indicate a predilection of spread to endocrine tumors possibly because of the rich blood supply that is present in endocrine tumors. Two of our 392 parathyroidectomies (0.5%) had cancer: one metastatic (thymic neuroendocrine tumor) and another PPCa.

Conclusion:

Metastatic disease to the parathyroid gland is poorly documented. When performing surgery for primary thyroid cancer, the search for parathyroid gland metastases is often overlooked because of the desire to preserve parathyroid function. Metastatic disease from other cancers to a benign parathyroid gland or to a parathyroid adenoma probably suggests a grave prognosis because it likely indicates widespread metastatic disease; however, isolated metastases to the parathyroid may occur. Although these lesions may be uncommon they may not be as rare as once thought.
Sclerostin Levels and Changes in Bone Metabolism After Bariatric Surgery
Authors: Muschitz Christian , Kocijan Roland , Marterer Christina , Nia Arastoo Rahbar , Muschitz Gabriela Katharina , Resch Heinrich , Pietschmann Peter
Published: December 2014

Context:

The role of sclerostin as a key regulator of bone formation remains unknown after Roux-en-Y gastric bypass (RYGB) or laparoscopic sleeve gastrectomy (SG).

Objectives:

The study objectives were evaluation of sclerostin and Dickkopf-1 (DKK-1) serum levels after surgery and correlations with bone turnover markers (P1NP, CTX), parathyroid hormone (iPTH) and areal bone mineral density (BMD), changes at total body, lumbar spine and total hip.

Design and Setting:

This was a prospective observational single-center two-arm study in premenopausal women with acute adipositas over 24 months.

Participants:

Participants were 52 premenopausal women (40 ± 8 years, BMI 43.4) after RYGB and 38 premenopausal women (41 ± 7 years, BMI 45.7) after SG.

Main Outcome Measures:

Prior to surgery and 1, 3, 6, 9, 12, 18, and 24 months after surgery sclerostin, DKK-1, CTX, P1NP levels and BMD were measured.

Results:

Sclerostin, CTX and (to a lesser extent) P1NP increased after surgery and remained elevated during the entire study period (P < 0.001). DKK-1 declined during months 3–9 (P < 0.005) and then remained unchanged, serum phosphate continuously increased (P < 0.001), iPTH remained within the upper normal limit. Sclerostin increases were significantly positively correlated with CTX and P1NP increases and negatively correlated with BMD loss. BMD independently declined regardless of RYGB and SG. Elevations of sclerostin, CTX, P1NP, and phosphate, but not DKK-1 and iPTH, were significant discriminating factors for BMD loss (AUC 0.920).

Conclusion:

Rapid and sustained increases of sclerostin, CTX, and to a lesser extent, P1NP cause an increase in bone metabolism and result in BMD loss at all skeletal sites.
The Risk of Incident Type 2 Diabetes in a Korean Metabolically Healthy Obese Population: The Role of Systemic Inflammation
Authors: Jung Chang Hee , Lee Min Jung , Kang Yu Mi , Jang Jung Eun , Leem Jaechan , Hwang Jenie Yoonoo , Kim Eun Hee , Park Joong-Yeol , Kim Hong-Kyu , Lee Woo Je
Published: December 2014

Objective:

This study sought to investigate whether the metabolically healthy obese (MHO) phenotype is associated with an increased risk of incident type 2 diabetes in a Korean population and, if so, whether systemic inflammation affects this risk in MHO individuals.

Design and Methods:

The study population comprised 36 135 Koreans without type 2 diabetes. Participants were stratified by body mass index (cutoff value, 25.0 kg/m2) and metabolic health state (assessed using Adult Treatment Panel-III criteria). High-sensitive C-reactive protein (hsCRP) was used as a surrogate marker of systemic inflammation. Subjects were classified into low (ie, hsCRP < 0.5 mg/L) and high (ie, hsCRP ≥ 0.5 mg/L) systemic inflammation groups.

Results:

During a median followup of 36.5 months (range, 4.8–81.7 mo), 635 of the 36 135 individuals (1.8%) developed type 2 diabetes. The MHO group had a significantly higher risk of incident type 2 diabetes (multivariate-adjusted hazard ratio [HR], 1.57; 95% confidence interval [CI], 1.16–2.11) than the metabolically healthy nonobese (MHNO) group. However, the risk of the MHO group varied according to the degree of systemic inflammation. Compared with the MHNO/low systemic inflammation group, the risk of type 2 diabetes in the MHO/low systemic inflammation group was not significantly elevated (multivariate-adjusted HR, 1.61; 95% CI, 0.77–3.34). However, the MHO/high systemic inflammation group had an elevated risk of incident type 2 diabetes (multivariate-adjusted HR, 3.73; 95% CI 2.36–5.88).

Conclusions:

MHO subjects show a substantially higher risk of incident type 2 diabetes than MHNO subjects. The level of systemic inflammation partially explains this increased risk.
Request for help
Authors: Morgan Janette
Published: December 2014

I am currently studying for a diploma in Health and Social Welfare. This is to be my qualification for Preregistration Training for Midwifery when the course becomes available in Mid Glamorgan.
Book reviews
Authors: McAuley A , Bick Debra
Published: December 2014

I consider this video to have a lot of potential as a future teaching aid to both student midwives and medical students. It explains and illustrates in a clear, concise, logical, easy-to-follow sequence, the technique of perineal repair in three well defined stages, i.e. vaginal wall, muscle wall, perineal skin.
Letters
Authors: Rosser Jilly , Kirkham Marvis
Published: December 2014

I refer to the editorial on Informed Choice leaflets in the March issue of British Journal of Midwifery.
Book reviews
Authors: Jaiyesimi RAK , Pacanowski Lynne
Published: December 2014

The book set out to provide information on studies from the National Perinatal Epidemiology Unit (NPEU). It is commendable that there is a considerable input by research midwives in the activities of the unit, and it buttresses the important role midwives play in scientific research.
Book reviews
Authors: den Akker Olga van , Hancock Barbara
Published: December 2014

In this report the BMA publicises its recommendations, and provides guidance to those involved in non exploitative surrogacy. The report focuses in depth on the changing social, psychological, medical and legal climate of surrogacy in the UK today.
Bottle or breast?
Authors: Dennison Julie
Published: December 2014

In her article ‘Breast is best’ (May, 1996), Kate Jackson talks of a need to provide unbiased and comprehensive information, and for women to have choice and control.
Book reviews
Authors: Lindsay Julie , Bharj Kuldip , White Valerie M
Published: December 2014

As the author talks us through the beginnings of this work, which began as a series of articles, readers involved in health care provision and health care education may feel a touch of deja vu. The book discusses experiences which will feel familiar to many of us.
Book reviews
Authors: Merriman Jane , Murphy-Black Tricia
Published: December 2014

With the family and childcare now frequently a hot topic for political debate, it is heartening to find in Teresa Wilson's book such a levelheaded and practical guide for working mothers.
Chronic obstructive pulmonary disease in patients with HIV: an emerging problem
Authors: Scourfield Andrew T , Doffman Sarah R , Miller Robert F
Published: December 2014

People with well-controlled HIV now have normal life expectancies and physicians managing these patients are increasingly encountering co-existing chronic obstructive pulmonary disease. This article reviews similarities with this disease in the general population and highlights key differences including significant drug–drug interactions.
Is a preoperative group and save necessary for enhanced recovery joint replacement patients?
Authors: Metcalfe Christopher W , Jayatilaka Malwattage LT , Cope Marcus R
Published: December 2014

Aim:

To consider the financial benefit to the authors' trust of omitting a preoperative group and save in enhanced recovery arthroplasty patients, and to estimate the scope for national savings. Patient safety was considered to determine acceptability for routine practice.

Methods:

A total of 121 patients receiving a total knee replacement or total hip replacement on the authors' enhanced recovery protocol were selected. Pre- and postoperative haemoglobin levels were obtained. The transfusion team were contacted when the postoperative haemoglobin level was ≤8 g/dl to determine whether blood products had been issued. Costs for group and save were obtained from the pathology department.

Results:

Mean postoperative reduction in haemoglobin level was 2.6 g/dl (P≤0.001) and 2.1 g/dl (P≤0.001) for total hip replacement and total knee replacement respectively. No patients were transfused. One group and save costs £12.00, and omission of this test in these patients would have saved £1452.00. Potentially, £1 605 408 could have been saved in the 133 784 patients undergoing NHS arthroplasty in 2012. Group and save omission would not affect management of intraoperative haemorrhage where O negative blood would be available. If a transfusion is required postoperatively it would take 100 minutes to issue crossmatched blood – a time delay unlikely to compromise patient safety.

Conclusions:

These results suggest that a preoperative group and save could be omitted in arthroplasty patients on this enhanced recovery programme to prevent needless expenditure, but more long-term follow up is required to ensure patients are not put at risk.
Establishing the “Gross Domestic Product of Welfare”: A Major Revision of GDP for a Better Accounting System
Authors: Enfu Cheng  , Lichun Cao
Published: December 2014

Gross Domestic Product (GDP) has long been the most widely used measure of the national economy. The pursuit of economic growth exacts too high a toll in every country. Therefore,
it is theoretically and practically significant to propose and establish a new index to measure the growth of national welfare—the “Gross Domestic Product of
Welfare” (GDPW).
Mao Zedong and the Independent and Comprehensive Industrial System and the Modernization of New China
Authors: Zhikai Dong  , Translated by Yuhua Gao
Published: December 2014

In 1949, when the new republic was founded, China was a poor and weak agricultural country. Thanks to Mao Zedong and his comrades who were, at the very beginning of the new republic, all clear of the goal of building an independent and self-sufficient economic system so as to gain the core competitive competence in the world, China has become an initially industrialized and modernized country. Such an industrial and national economic system is the outcome of the efforts of Mao and the communist party and the government led by him. The successes and failures of those efforts clearly reflect features of this particular time.
Economic Democracy through Collective Capital Formation: The Cases of Germany and Sweden, and Strategies for the Future
Authors: Stefan Sjöberg  , Nyegosh Dube
Published: December 2014

The global economic crisis, whose effects are ongoing, was the result of an undemocratic, anti-social system of production, investment, and finance. Therefore, it is an opportune
time to revisit the question of economic democracy. This question has emerged in various periods and places as a salient issue within the labour movement and the Left. In Europe,
two paths to economic democracy have been considered: the co-determination line and the more radical property line challenging private ownership of capital. While the former has
been dominant in social democracy, in the 1970s, the latter became the main focus of debates in Germany and especially Sweden in the social democratic parties and trade unions. In
both cases, system-transforming proposals for collective capital formation, aiming beyond the Fordist accumulation regime, played a key role. This article examines these
experiences, paying particular attention to the issue of hegemony in a changing mode of production, and then explores several newer strategies of collective capital formation:
trade union pension funds, societal funds, and hybrid citizen—worker ownership. Based on the lessons of the German and Swedish debates, it concludes that labour and Left
forces need to form a transnational hegemonic bloc to overcome the resistance of international capital and advance an economic democracy agenda, with the structural reformism of
collective capital formation occupying a central place on this agenda.
Reforming Police Powers of Stop And Search: Voluntary Action
Authors: Parpworth Neil
Published: December 2014

The police use of statutory stop and search powers is an ongoing cause for concern. Research evidence dating back a number of years suggests that the misuse of such powers is commonplace. It has long been recognised that the important relationship between the police and the communities which they serve can be severely damaged where innocent people are routinely stopped and searched for no good reason. The Home Secretary has recently announced in Parliament a package of reforms aimed at reducing the overall use of stop and search powers, ensuring that stops and searches are more intelligence-led, and improving the ratio between the number of encounters and arrests made. Significantly, the proposed reforms are largely voluntary in nature. Their content is therefore particularly important, as is their potential take-up by police forces. There are sound reasons for believing that they may be a prelude to legislative reform in this area of policing.