bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating Joint Effects of Induction–Salvage Treatment Regimes on Overall Survival in Acute Leukaemia
Authors: Wahed Abdus S. , Thall Peter F.
Published: September 2013

Typical oncology practice often includes not only an initial front-line treatment but also subsequent treatments given if the initial treatment fails. The physician chooses a treatment at each stage based on the patient's baseline covariates and history of previous treatments and outcomes. Such sequentially adaptive medical decision-making processes are known as dynamic treatment regimes, treatment policies or multistage adaptive treatment strategies. Conventional analyses in terms of front-line treatments that ignore subsequent treatments may be misleading, because they actually are an evaluation of more than front-line treatment effects on outcome. We are motivated by data from a randomized trial of four combination chemotherapies given as front-line treatments to patients with acute leukaemia. Most patients in the trial also received a second-line treatment, which was chosen adaptively and subjectively rather than by randomization, either because the initial treatment was ineffective or the patient's cancer later recurred. We evaluate effects on overall survival time of the 16 two-stage strategies that actually were used. Our methods include a likelihood-based regression approach in which the transition times of all possible multistage outcome paths are modelled, and estimating equations with inverse probability of treatment weighting to correct for bias. Although the two approaches give different numerical estimates of mean survival time, they lead to the same substantive conclusions when comparing the two-stage regimes.
A Multistate Modelling Approach for Pancreatic Cancer Development in Genetically High-Risk Families
Authors: Kolamunnage-Dona Ruwanthi , Vitone L. , Greenhalf W. , Henderson R. , Williamson P. R.
Published: September 2013

The paper describes a complex multistate modelling approach for the analysis of association between the onset of diabetes and the diagnosis of pancreatic cancer among families with hereditary pancreatitis. The model allows for competing risks, correlated survival times and time-dependent covariates, so taking several interrelated factors into account: the consequences of pancreatic resection, genetic similarities between family members and the possibility that the onset of diabetes is the first symptom of an undiagnosed pancreatic cancer. The model is applied to data on diabetes and cancer outcomes for 593 pancreatitis patients, taken from the world's largest registry of patients with heredity pancreatitis.
Robust Estimation of Economic Indicators from Survey Samples Based on Pareto Tail Modelling
Authors: Alfons Andreas , Templ Matthias , Filzmoser Peter
Published: September 2013

Motivated by a practical application, the paper investigates robust estimation of economic indicators from survey samples based on a semiparametric Pareto tail model. Economic performance is typically measured by a set of indicators, which are often estimated from survey data—the motivating example being the European indicators on social exclusion and poverty computed from the well-known European Union statistics on income and living conditions survey. Since economic data typically contain variables with heavily tailed distributions and additional extreme outliers, the idea is to use robust Pareto tail modelling to detect the extreme outliers and to reduce their influence on the indicators. In the survey context, however, sample weights need to be considered when modelling the tail with a Pareto distribution such that the true distribution on the population level is accurately reflected. Therefore, the main methodological contribution is to adapt commonly used robust estimators for the parameters of the Pareto distribution to take sample weights into account. The resulting approach for robust estimation of indicators is then evaluated by means of a simulation study and applied in the context of estimating the Gini coefficient from the survey data.
How to Find an Appropriate Clustering for Mixed-Type Variables with Application to Socio-Economic Stratification
Authors: Hennig Christian , Liao Tim F.
Published: September 2013

Data with mixed-type (metric–ordinal–nominal) variables are typical for social stratification, i.e. partitioning a population into social classes. Approaches to cluster such data are compared, namely a latent class mixture model assuming local independence and dissimilarity-based methods such as k-medoids. The design of an appropriate dissimilarity measure and the estimation of the number of clusters are discussed as well, comparing the Bayesian information criterion with dissimilarity-based criteria. The comparison is based on a philosophy of cluster analysis that connects the problem of a choice of a suitable clustering method closely to the application by considering direct interpretations of the implications of the methodology. The application of this philosophy to economic data from the 2007 US Survey of Consumer Finances demonstrates techniques and decisions required to obtain an interpretable clustering. The clustering is shown to be significantly more structured than a suitable null model. One result is that the data-based strata are not as strongly connected to occupation categories as is often assumed in the literature.
What If We Voted on the Weights of a Multidimensional Well‐Being Index? An Illustration with Flemish Data*
Authors: Decancq Koen , Van Ootegem Luc , Verhofstadt Elsy
Published: September 2013

There is a widespread consensus that well‐being is a multidimensional notion. To quantify multidimensional well‐being, information on the relative weights of the different dimensions is essential. There is, however, considerable disagreement in the literature on the most appropriate weighting scheme to use. Making use of a recent data set for Flanders, we calculate and compare various common weighting schemes, which are uniformly applied to all individuals. We find that a policymaker would identify different groups of individuals as being worst off depending on the scheme that is chosen. In order to compare and evaluate the weighting schemes, we simulate the support each scheme would get in a voting procedure. Weighting schemes that obtain higher support reflect better the priorities of the respondents and suffer less from the problem of paternalism that is inherent to any common weighting scheme.
Gender, Time Use, and Children's and Adolescents' Well‐Being: Implications for Public Policies*
Authors: Gálvez‐Muñoz Lina , Domínguez‐Serrano Mónica , Rodríguez‐Modroño Paula , Matus‐López Mauricio
Published: September 2013

This paper has two main goals. The first is to analyse and measure gender differences in children's and adolescents' well‐being by using a capability approach. The second aim is to identify the parameters that can help design policies to improve children's and adolescents' well‐being. The econometric model used is a multiple indicator multiple causes (MIMIC) model, belonging to the class of structural equation models. The estimation is done on a sample of 10‐ to 17‐year‐old girls and boys and uses micro‐data from the Spanish Time Use Survey (2002–03). Results show that parents' working time, both paid and unpaid, is a determinant of children's well‐being. Gender differences are also especially significant, consequently posing important policy implications.
Hygienic and Sanitary Conditions in the Hospital Foodservice: Relationship between Good Practices and Microbiological Quality
Authors: Gonçalves Juliana Macedo , Rodrigues Kelly Lameiro , Demoliner Fernanda , Rossales Roseméri , Almeida Ângela Teresinha Santiago , Buchweitz Márcia Rúbia Duarte
Published: September 2013

This study evaluated the hygienic and sanitary conditions of hospital kitchens, assessing good practices through a checklist and comparing the results to microbiological analyses. The good practices that were implemented in the hospital foodservices were evaluated through a checklist based on the current Brazilian legislation. Microbiological analyses of the air, water, utensils, surfaces and food handlers' hands were conducted. The air and water quality were adequate according to the checklist; however, the microbiological analyses of the water detected the presence of coliform bacteria in almost all tested samples. The air quality was also unsatisfactory based on the counts of aerobic mesophilic bacteria, mold and yeast. Even though the checklist assigned a “regular” in the hygienic classification, the utensils and surfaces had satisfactory hygienic results based on the aerobic mesophilic bacteria, mold and yeast counts. The hands of the food handlers tested positive for staphylococcus coagulase, suggesting flaws in their personal hygienic techniques, although the checklist indicated that these professionals were trained on a regular basis. The analysis of good practices in hospital meal preparation through checklists was not sufficiently sensitive for identifying microbiological risks.

Practical Applications

The importance of this study is in control of sanitary hygienic meals produced in hospitals. Because of the importance of proper meals in the recovery of patients, the objective of this study was to assess the hygiene and sanitation in hospital kitchens, relating the analysis of good practices through a checklist with microbiological analyses.
Information needs among patients with chronic obstructive pulmonary disease at their first hospital admission: priorities and correlates
Authors: Guo Su‐Er , Huang Chiung‐Yu , Hsu Hsin‐Tien
Published: September 2013

Aims and objectives

To better understand chronic obstructive pulmonary disease patients' informational needs and associated factors using the Predisposing, Reinforcing and Enabling Causes in Educational Diagnosis and Evaluation model.

Background

Despite the increase in the incidence of chronic obstructive pulmonary disease, little research has been carried out on the information needs from a patient perspective.

Design

A cross‐sectional, correlational design was used.

Methods

A convenience sample of 107 subjects was recruited from four Taiwanese hospitals. Multiple regression analyses were conducted to identify the total informational needs and related factors.

Results

Major findings were that (1) patients' top informational need was daily care, and (2) variables associated with the total information needs were younger age, greater health internal locus of control, less dyspnoea severity and greater social support.

Conclusions

Patients' perceived chronic obstructive pulmonary disease informational needs are not congruent with the information received from healthcare professionals.

Relevance to clinical practice

Healthcare professionals need to be sensitive to the fact that treatment‐related information was not the top priority of patients with chronic obstructive pulmonary disease. Healthcare professionals also need to target the special subpopulation of chronic obstructive pulmonary disease patients with greater total informational need to maximise educational impact.
Analysis of factors affecting the life quality of the patients with late stomach cancer
Authors: Ma Yan‐Mei , Ba Cai‐Feng , Wang Yu‐Bin
Published: September 2013

Aims and objectives

To provide a theoretical basis for the clinical care of patients with late stomach cancer, we investigated the life quality and analysed its related factor in the patients with late stomach cancer.

Background

Due to the lack of effective screening methods, stomach cancer usually has been in the advanced stage when patients are diagnosed. However, the treatment for late stomach cancer is a tough problem in today's medicine. Chemotherapy or radiotherapy brings patients physiological and psychological distress and heavy financial burden, affecting patients' therapeutic effects, prognosis and life quality.

Design

The patients with late stomach cancer were included, and then, questionnaires about the life quality were completed.

Methods

Questionnaires including European Organisation for Research on Treatment of Cancer Quality of Life Questionnaire‐Core 30, Social Support Rating Scale, Medical Coping Modes Questionnaire and Self‐rating Anxiety Scale were completed by 173 patients with late stomach cancer who received treatment in our hospital between May 2010 and May 2011. Correlation analyses were performed.

Results

The overall score of the life quality of the patients with late stomach cancer was only 29·54 ± 12·21. The social support, medical coping modes, anxiety and patients' clinical data (except radiotherapy) markedly affected the overall life quality of the patients with late stomach cancer (p < 0·05).

Conclusion

The life quality of the patients with late stomach cancer is poor and is associated with many factors.

Relevance to clinical practice

This study provides a theoretical basis for better nursing the patients with late stomach cancer and improving their life quality.
Single or repeated gonadotropin‐releasing hormone agonist treatment avoids hysterectomy in premenopausal women with large symptomatic fibroids with no effects on sexual function
Authors: Perrone Anna Myriam , Pozzati Federica , Di Marcoberardino Barbara , Rossi Martina , Procaccini Martina , Pellegrini Alice , Santini Donatella , De Iaco Pierandrea
Published: September 2013

Aim

The aim of our study was to explore the effects on symptoms and female sexual function of the medical management with gonadotropin‐releasing hormone agonist (GnRHa) in women of more than 45 years old compared to surgical management.

Methods

Women with symptomatic uterine fibroids were enrolled to participate to the present open‐label study. We offered two different treatment options: medical with GnRHa for 6 months (group A) or hysterectomy (group B). The patients were reviewed in follow‐up for 24 months. The impact of medical or surgical therapy on sexual life was evaluated.

Results

No significant differences were found in population characteristics between the two groups. GnRHa treatment was efficient in reducing symptoms in 88% of patients but 22% of patients needed adjunctive cycles of medical therapy. After 24 months, 16% of the patients did not complete the study. The failure percentage of the medical treatment was 12%. No severe side‐effects were recorded, and eight patients had reached menopause. No significant differences were observed in the Female Sexual Function Index score in each domain between the medical and surgical groups, with total scores of 18.94 ± 10.16 and 22.00 ± 8.86, respectively (mean ± standard deviation), and the prevalence of dysfunction was 12% and 22%, respectively, similar to the general population of the same age.

Conclusion

We found that medical therapy with GnRHa is a satisfactory alternative to surgery for fibroids in women of more than 45 years old.
Humoral hypercalcemia caused by uterine corpus carcinosarcoma consisting of squamous cell carcinoma in its epithelial component
Authors: Takamatsu Shiro , Matsumura Noriomi , Baba Tsukasa , Mandai Masaki , Mikami Yoshiki , Konishi Ikuo
Published: September 2013

Humoral hypercalcemia of malignancy (HHM) is a paraneoplastic syndrome primarily caused by a tumor‐producing parathyroid hormone‐related protein (PTH‐rP). We describe the first reported case of a uterine carcinosarcoma causing HHM. A 70‐year‐old patient was transferred to our hospital for a uterine tumor accompanied by impaired consciousness. The laboratory tests indicated anemia, malnutrition, elevated serum calcium and elevated PTH‐rP. Emergency surgery, including abdominal hysterectomy and bilateral salpingo‐oophorectomy, was performed due to uncontrollable uterine bleeding. The pathological diagnosis was carcinosarcoma consisting of pure squamous cell carcinoma in its epithelial component. Postoperatively, chemotherapy with paclitaxel and carboplatin was performed. The patient had recurrent tumors at the para‐aortic lymph nodes 11 months after the initial surgery and underwent a pelvic and para‐aortic lymphadenectomy, which removed all of the recurrent tumors.
Enterobius vermicularis: Can it be a possible pathogen in Bartholin gland abscess formation?
Authors: Dönmez Melahat Emine , Özlü Tülay , Yılmaz Fahri , Ayaz Erol
Published: September 2013

The most frequent disorders of the Bartholin glands are cysts or abscesses. Bartholin gland abscesses occur generally as a result of polymicrobial infections or agents that cause sexually transmitted diseases. But as far as we know, no parasite has been previously reported among the infectious agents that are detected from the abscesses of the Bartholin gland. Here, we report a 45‐year‐old woman, in the Bartholin abscess aspirate of whom Enterobius vermicularis eggs were detected in between the inflammatory infiltrate by cytological examination.
Pelvic magnetic resonance imaging in the ewe: A model for experimental gynecologic research
Authors: Gauthier Tristan , Marquet Pierre , Kanoun Dorra , Maubon Antoine , Piver Pascal , Couquet Claude , Aubard Yves
Published: September 2013

Aim

Our goal was to demonstrate the feasibility of pelvic magnetic resonance imaging (MRI) in the ewe.

Material and Methods

Two ewes underwent a pelvic 3 Tesla MRI scan, under light anesthesia, with T2‐weighted fast spin‐echo images and T1‐weighted spoiled gradient‐echo images. Multiplan T1 weighted images were also obtained after the intravenous injection of a contrast product. One ewe was anestrous and the other one had undergone ovarian stimulation.

Results

No incident occurred during the examination. Both the uterus (with two horns) and the ovaries were identified. The intensity of the endometrial, myometrial and ovarian signals was similar to that encountered in women. The uterus and ovaries could be enhanced in both cases. Pelvic vasculature was also studied. In the case of hormonal stimulation, the endometrium was thicker, follicular growth was identified and enhancement seemed greater.

Conclusion

MRI in the ewe is feasible and could be helpful in experimental gynecologic research, especially in uterus transplantation.
Two nursing mothers treated with zonisamide: Should breast‐feeding be avoided?
Authors: Ando Hitoshi , Matsubara Shigeki , Oi Asako , Usui Rie , Suzuki Mitsuaki , Fujimura Akio
Published: September 2013

Zonisamide, an antiepileptic drug, is excreted into breast milk, but information regarding the safety of breast‐feeding while using this drug is limited. We present the cases of two nursing mothers, taking 300 and 100 mg/day zonisamide. At 5 days after delivery, the milk concentrations and relative infant doses of the drug were 18.0 and 5.1 μg/mL, and 44 and 36%, respectively. In the first case, the mother fed colostrum and continued partial breast‐feeding thus reducing the relative infant dose to 8%. The neonatal serum concentration of zonisamide declined to below the limit of detection at day 34 after birth. In the second case, the mother breast‐fed partially until 2 weeks postpartum. No adverse effect was observed in the infants. These findings suggest that mothers taking zonisamide should not breast‐feed exclusively, but may not have to avoid partial breast‐feeding, with significant caution regarding adverse effects in infants.
Unusual ectopic pregnancies: A retrospective analysis of 65 cases
Authors: Shan Nan , Dong Dan , Deng Weiguo , Fu Yan
Published: September 2013

Aim

The aim of this study was to retrospectively investigate unusual ectopic pregnancies (EP) and compare them with fallopian ones.

Material and Methods

A total of 1000 cases of ectopic pregnancies were analyzed, including 65 unusual cases. We discussed distribution, incidence, risk factors, examinations, treatments and prognoses.

Results

Ovarian pregnancy was associated with placement of intrauterine device and pelvic inflammatory diseases. Extratubal EP have a high rate of misdiagnosis and presented more serious manifestations. Some unusual EP could be diagnosed by ultrasonography. Ovarian pregnancy was usually manifested as positive culdocentesis. Most of the unusual EP underwent surgery, except some early cervical and corneal pregnancies.

Conclusion

Although extratubal pregnancies are difficult to diagnose, some histories and auxiliary examinations could make diagnosis easier for clinical physicians. Surgery is still the most effective approach for treatment of unusual EP, while conservative treatment of mifepristone combined with methotrexate or curettage could be used for early diagnosis and treatment of cervical pregnancy.
Passion Isn't Always a Good Thing: Examining Entrepreneurs' Network Centrality and Financial Performance with a Dualistic Model of Passion
Authors: Ho Violet T. , Pollack Jeffrey M.
Published: September 2013

We propose a conceptual model that links entrepreneurs' passion, network centrality, and financial performance, and test this model with small business managers in formal business networking groups. Drawing on the dualistic model of passion, we explore the relationships that harmonious and obsessive passion have with financial performance, mediated by network centrality. Results indicate that harmoniously passionate entrepreneurs had higher out‐degree centrality in their networking group (i.e., they were more inclined to seek out members to discuss work issues), which increased the income they received from peer referrals and, ultimately, business income. Obsessively passionate entrepreneurs had lower in‐degree centrality (i.e., they were less likely to be approached by peers), and in turn received less income from referrals and less business income. These findings highlight that entrepreneurial passion does not always result in positive financial outcomes – the type of passion makes a difference. Implications for research and practice are discussed.
Playing on Two Chessboards: Reputation Effects between Corporate Social Responsibility (CSR) and Corporate Political Activity (CPA)
Authors: den Hond Frank , Rehbein Kathleen A. , de Bakker Frank G. A. , Lankveld Hilde Kooijmans‐van
Published: September 2013

It has recently been argued that corporate social responsibility (CSR) is ‘political’. It has been neglected however, that firms also operate politically in a traditional sense, in seeking to secure favourable political conditions for their businesses. We argue that there are potential synergies between CSR and corporate political activity (CPA) that are often overlooked by firms and that recognition of these synergies will stimulate firms to align their CSR and CPA. We develop a conceptual model that specifies how various configurations of a firm's CSR and CPA – alignment, misalignment, and non‐alignment – affect the firm's reputation beyond the separate reputation effects of CSR and CPA. This model has important implications for understanding how and why firms should pay attention to their CPA and CSR configurations, and thereby contributes to the broader issue of why firms should make sure that they are consistent in terms of responding to stakeholder concerns.
The Financial Effects of Uniform and Mixed Corporate Social Performance
Authors: Oikonomou Ioannis , Brooks Chris , Pavelin Stephen
Published: September 2013

Firms typically present a mixed picture of corporate social performance (CSP), with positive and negative indicators exhibited by the same firm. Thus, stakeholders' judgments of corporate social responsibility (CSR) typically evaluate positives in the context of negatives, and vice versa. Building on social judgment theory, we present two alternative accounts of how stakeholders respond to such complexity, which provide differing implications for the financial effects of CSP: reciprocal dampening and rewarding uniformity. Echoing notable findings on strategic consistency, our US panel study finds that firms that exhibit uniformly positive or uniformly negative indicators in particular dimensions of CSP outperform firms that exhibit a mixed picture of positives and negatives, which supports the notion that stakeholders' judgments of CSR reward uniformity.
Evidence for the role of vacuolar soluble pyrophosphatase and inorganic polyphosphate in Trypanosoma cruzi persistence
Authors: Galizzi Melina , Bustamante Juan M. , Fang Jianmin , Miranda Kildare , Soares Medeiros Lia C. , Tarleton Rick L. , Docampo Roberto
Published: September 2013

Trypanosoma cruzi infection leads to development of a chronic disease but the mechanisms that the parasite utilizes to establish a persistent infection despite activation of a potent immune response by the host are currently unknown. Unusual characteristics of T. cruzi are that it possesses cellular levels of pyrophosphate (PPi) at least 10 times higher than those of ATP and molar levels of inorganic polyphosphate (polyP) within acidocalcisomes. We characterized an inorganic soluble EF‐hand containing pyrophosphatase from T. cruzi (TcVSP) that, depending on the pH and cofactors, can hydrolyse either pyrophosphate (PPi) or polyphosphate (polyP). The enzyme is localized to both acidocalcisomes and cytosol. Overexpression of TcVSP (TcVSP‐OE) resulted in a significant decrease in cytosolic PPi, and short and long‐chain polyP levels. Additionally, the TcVSP‐OE parasites showed a significant growth defect in fibroblasts, less responsiveness to hyperosmotic stress, and reduced persistence in tissues of mice, suggesting that PPi and polyP are essential for the parasite to resist the stressful conditions in the host and to maintain a persistent infection.
Morphometry of the hippocampal microvasculature in post‐stroke and age‐related dementias
Authors: Burke M. J. C. , Nelson L. , Slade J. Y. , Oakley A. E. , Khundakar A. A. , Kalaria R. N.
Published: September 2013

Background

Optimal vascular function is vital for prevention of dementia. We hypothesized that elderly post‐stroke survivors who preserve cognitive function show unperturbed cerebral microvasculature compared with those who develop dementia.

Methods

Using stereological spherical probe software, we compared the length density (Lv, cumulative vessel length per unit tissue volume) of hippocampal microvessels in post mortem brain tissue from post‐stroke survivors, Alzheimer's disease (AD), vascular dementia (VaD) and normal ageing control subjects. We also assessed microvessel diameters in the same subjects. Microvessels were identified by markers of endothelial cells (glucose transporter 1; GLUT1), basement membrane (collagen IV; COL4) and smooth muscle cell α‐actin (SMA).

Results

We found increased Lv of both GLUT1 and COL4 immunostained microvessels (P < 0.05) in the hippocampal CA1 region of post‐stroke demented (PSD) and AD cases compared with post‐stroke nondemented (PSND), control and VaD subjects. However, no changes were apparent in the CA2 region. We also noted significant increase in Lv in the entorhinal cortex of AD compared with PSND and PSD subjects. The mean diameter of microvessels was decreased in PSD, compared with PSND, as well as in AD and VaD compared with controls. Cumulative frequency analysis showed PSND subjects to have significantly greater proportion of microvessels with diameters, ranging from 7 to 12 μm.

Conclusions

An increase in microvascular Lv in AD and PSD suggests either an increase in angiogenesis or the formation of newer microvessel loops in response to cerebral hypoperfusion. The decreased vessel diameters found in AD and VaD suggests increased vasoconstriction in dementia.
Outcomes of combination therapy for chronic antibody‐mediated rejection in renal transplantation
Authors: Kim Myung‐Gyu , Kim Yoon Jung , Kwon Hyuk Yong , Park Hayne Cho , Koo Tai Yeon , Jeong Jong Cheol , Jeon Hee Jung , Han Miyeun , Ahn Curie , Yang Jaeseok
Published: September 2013

Aim

Chronic antibody‐mediated rejection (CAMR) in renal transplant patients has poor allograft outcomes. However, treatment strategy has not been established yet. Herein, we present short‐term outcomes of combination therapy for CAMR.

Methods

We identified nine patients with CAMR or suspicious CAMR who were treated with antihumoral therapy from 2010 to 2011 and analyzed their medical records retrospectively.

Results

Five patients had CAMR, and four patients had suspicious CAMR. Severe transplant glomerulopathy (TG) was observed in seven patients. The estimated glomerular filtration rate (eGFR) was decreased in all patients before treatment. We used three different treatment regimens: (i) high‐dose intravenous immunoglobulin (IVIG) and rituximab; (ii) high‐dose IVIG, rituximab, and bortezomib; and (iii) plasmapheresis with low‐dose IVIG, rituximab and bortezomib. After treatment with one of these three regimens, graft function improved or stabilized in six patients, whereas three patients showed further deterioration of eGFR. The third regimen suppressed deterioration of renal function in all patients. Most patients showed no progression of proteinuria. Infectious complications due to Pneumocystis jirovecii pneumonia and herpes zoster occurred in two patients.

Conclusion

Combination therapy for CAMR might be effective, even in patients with relatively late‐stage CAMR.
Evaluating theories of drought‐induced vegetation mortality using a multimodel–experiment framework
Authors: McDowell Nate G. , Fisher Rosie A. , Xu Chonggang , Domec J. C. , Hölttä Teemu , Mackay D. Scott , Sperry John S. , Boutz Amanda , Dickman Lee , Gehres Nathan , Limousin Jean Marc , Macalady Alison , Martínez‐Vilalta Jordi , Mencuccini Maurizio , Plaut Jennifer A. , Ogée Jérôme , Pangle Robert E. , Rasse Daniel P. , Ryan Michael G. , Sevanto Sanna , Waring Richard H. , Williams A. Park , Yepez Enrico A. , Pockman William T.
Published: September 2013

Model–data comparisons of plant physiological processes provide an understanding of mechanisms underlying vegetation responses to climate. We simulated the physiology of a piñon pine–juniper woodland (Pinus edulis–Juniperus monosperma) that experienced mortality during a 5 yr precipitation‐reduction experiment, allowing a framework with which to examine our knowledge of drought‐induced tree mortality. We used six models designed for scales ranging from individual plants to a global level, all containing state‐of‐the‐art representations of the internal hydraulic and carbohydrate dynamics of woody plants. Despite the large range of model structures, tuning, and parameterization employed, all simulations predicted hydraulic failure and carbon starvation processes co‐occurring in dying trees of both species, with the time spent with severe hydraulic failure and carbon starvation, rather than absolute thresholds per se, being a better predictor of impending mortality. Model and empirical data suggest that limited carbon and water exchanges at stomatal, phloem, and below‐ground interfaces were associated with mortality of both species. The model–data comparison suggests that the introduction of a mechanistic process into physiology‐based models provides equal or improved predictive power over traditional process‐model or empirical thresholds. Both biophysical and empirical modeling approaches are useful in understanding processes, particularly when the models fail, because they reveal mechanisms that are likely to underlie mortality. We suggest that for some ecosystems, integration of mechanistic pathogen models into current vegetation models, and evaluation against observations, could result in a breakthrough capability to simulate vegetation dynamics.

Contents

Summary
305

I.
Background
305

II.
Model–experiment approach
306

III.
Simulations of hydraulic failure and carbon starvation
310

IV.
On thresholds vs duration of stress as drivers of mortality
311

V.
Interdependence of hydraulic failure and carbon starvation
314

VI.
Next‐generation, traditional, and empirical models
316

VII.
A path forward
317

VIII.
Conclusions
318

Acknowledgements
318

References
318
Philosophic reflections on the meaning of touch in nurse–patient interactions
Authors: Green Catherine
Published: September 2013

In this paper I examine the meaning of physical touch as it occurs in the nurse–patient interaction. There are two aspects of the nurse–patient relationship that are found in most nurse–patient interactions which together have profound implications for nurses as practitioners and as individual human persons. The first is the clinical intimacy of the nurse–patient relationship where nurses touch, rub, smooth, clean, dress and otherwise physically interact with patients. The other is the existential crisis, the possibility of loss, suffering and death that lurks at the horizon of most, if not all, healthcare encounters. Edmund Husserl, Merleau‐Ponty and more recently Robert Sokolowski argue that tactile sensations and resultant perceptions are fundamental to all sensory perception. Further, they argue that tactile sensation is fundamental for the ongoing constitution of ‘my’ self as a person and for the development and exercise of human intersubjectivity. If tactile interaction is crucial to the development of our very selves as persons and a significant aspect of our interaction with patients includes direct or observed tactile sensations and if further these sensations occur around the context of existential crises for our patients, then nurse's very selves as persons are being challenged by these interactions. Here, then I examine the philosophical argument for the role of tactile sensations in our human development and briefly look at contemporary neurophysiologic research that supports this philosophical account. I then suggest ways such physical intimacy can lead to a strengthening or weakening of the person of the nurse and the nursing interaction and end with some thoughts about ways to support nurses in these activities.
Nursing opinion leadership: a preliminary model derived from philosophic theories of rational belief
Authors: Anderson Christine A. , Whall Ann L.
Published: September 2013

Opinion leaders are informal leaders who have the ability to influence others' decisions about adopting new products, practices or ideas. In the healthcare setting, the importance of translating new research evidence into practice has led to interest in understanding how opinion leaders could be used to speed this process. Despite continued interest, gaps in understanding opinion leadership remain. Agent‐based models are computer models that have proven to be useful for representing dynamic and contextual phenomena such as opinion leadership. The purpose of this paper is to describe the work conducted in preparation for the development of an agent‐based model of nursing opinion leadership. The aim of this phase of the model development project was to clarify basic assumptions about opinions, the individual attributes of opinion leaders and characteristics of the context in which they are effective. The process used to clarify these assumptions was the construction of a preliminary nursing opinion leader model, derived from philosophical theories about belief formation.
Understanding ‘caring’ through biopolitics: the case of nurses under the Nazi regime
Authors: Foth Thomas
Published: September 2013

These days, discussions of what might be the ‘essence’ or the ‘core’ of nursing and nursing practice sooner or later end in a discussion about the concept of care. Most of the ‘newer’ nursing theories use this concept as a theoretical core concept. Even though these theoretical approaches use the concept of care with very different philosophical foundations and theoretical consistency, they concur in defining care as the essence of nursing and thereby glorify goodness as the decisive characteristic of nursing. These theoretical approaches neglect the fact that nursing is above all a profession with a societal task and is characterized by an asymmetrical power relation between nurses and their patients. Based on the results of a research project that analysed the role nurses played in the killing of psychiatric patients in Germany during the Nazi regime, I demonstrate that an approach based on the concept of care is not able to explain how nurses were able to commit crimes of such atrocity. These crimes were bound to an emotional investment that sustained the production of ‘life unworthy of living’. In the case of nurses under the Nazi regime, certainly a kind of sadism was at issue that can only be explained if we recognize that the social bond is characterized by a certain tension; ‘goodness’ that caring theories assign to the social bond always coexists with the capacity for destruction. Using the Foucauldian theoretical framework of biopower and biopolitics enables one to analyse violence and power as integral parts of nurses' practice. Seen from this perspective, the killing of patients was part of a biopolitical programme and not a relapse into barbarism. The concept of care obscures the political agenda of nursing and does not provide a critical and political framework to analysing nursing practice.
Domestic abuse as a transgressive practice: understanding nurses' responses through the lens of abjection
Authors: Bradbury‐Jones Caroline , Taylor Julie
Published: September 2013

Domestic abuse is a worldwide public health issue with long‐term health and social consequences. Nurses play a key role in recognizing and responding to domestic abuse. Yet there is considerable evidence that their responses are often inappropriate and unhelpful, such as trivializing or ignoring the abuse. Empirical studies have identified several reasons why nurses' responses are sometimes wanting. These include organizational constraints, e.g. lack of time and privacy; and interpersonal factors such as fear of offending women and lack of confidence. We propose, however, that these factors present only a partial explanation. Drawing on the work of Julia Kristeva, we suggest that alternative understandings may be derived through applying the concept of abjection. Abjection is a psychological defence against any threat (the abject) to the clean and proper self that results in rejection of the abject. Using examples from our own domestic abuse research, we contend that exposure of nurses to the horror of domestic abuse evokes a state of abjection. Domestic abuse (the abject) transgresses established social boundaries of clean and proper. Thus when exposed to patients' and clients' experiences of it, some nurses subconsciously reject domestic abuse as a possibility (abjection). They do this to protect themselves from the horror of the act, but in so doing, render themselves unable to formulate appropriate responses. Rather than understanding the practice of some nurses as wilfully neglectful or ignorant, we argue that through a state of abjection, they are powerless to act. This does not refute existing evidence about nurses' responses to domestic abuse. Rather, as a relatively unknown concept in nursing, abjection provides an additional explanatory layer that accounts for why some nurses respond the way they do. Crucially, it elucidates the need for nurses to be supported emotionally when faced with the transgressive practice of abuse.
Psoralen–narrowband UVB phototherapy for the treatment of vitiligo in comparison to narrowband UVB alone
Authors: Bansal Shivani , Sahoo Bijaylaxmi , Garg Vijay
Published: September 2013

Background

The potential of psoralen–narrowband ultraviolet B (NBUVB) photochemotherapy has been investigated in vitiligo. The present study aims to evaluate the efficacy of psoralen–NBUVB (P‐NBUVB) vs. NBUVB in vitiligo.

Methods

In a randomized study, 45 Indian patients (age above 13 years) with vitiligo involving more than 5% body surface area were randomly allocated to receive either NBUVB or P‐NBUVB treatment. Both groups received NBUVB exposure thrice weekly, with a total of 60 sessions. The extent of repigmentation achieved was calculated on the basis of Vitiligo Area Severity Index (VASI) scoring.

Results

Forty patients were available for analysis at the end of the study. The extent of repigmentation in the P‐NBUVB group was statistically significantly greater in face and neck (P = 0.006, t‐test) and hands (P = 0.007, t‐test) in comparison with the NBUVB group (t‐test). Percentage reduction in VASI scores was statistically significantly greater in the P‐NBUVB group (29.2% vs. 21.7%, P = 0.043, t‐test). The response to P‐NBUVB therapy started earlier than the response to NBUVB. After excluding sunlight as a confounding factor, treatment response was also significantly better in the P‐NBUVB group (P = 0.005).

Conclusion

Addition of psoralen increased the extent of repigmentation due to NBUVB therapy in vitiligo. Further studies are required to determine the long‐term efficacy and safety of P‐NBUVB.
A Model-Based Framework for Air Quality Indices and Population Risk Evaluation, with an Application to the Analysis of Scottish Air Quality Data
Authors: Finazzi Francesco , Scott E. Marian , Fassò Alessandro
Published: September 2013

The paper is devoted to the development of a statistical framework for air quality assessment at the country level and for the evaluation of the ambient population exposure and risk with respect to airborne pollutants. The framework is based on a multivariate space–time model and on aggregated indices defined at different levels of aggregation in space and time. The indices are evaluated, uncertainty included, by considering both the model outputs and the information on the population spatial distribution. The framework is applied to the analysis of air quality data for Scotland for 2009 referring to European and Scottish air quality legislation.
Locally Adaptive Spatial Smoothing Using Conditional Auto-Regressive Models
Authors: Lee Duncan , Mitchell Richard
Published: September 2013

Conditional auto-regressive models are commonly used to capture spatial cor relation in areal unit data, as part of a hierarchical Bayesian model. The spatial correlation structure that is induced by these models is determined by geographical adjacency, but this is too simplistic for some real data sets, which can visually exhibit subregions of strong correlation as well as locations at which the response exhibits a step change. An example of this, and the motivation for the paper, is the spatial pattern in respiratory disease risk in the 271 intermed iate geographies in the Greater Glasgow and Clyde Health Board in 2005. The methodology proposed is an extension to the class of conditional auto-regressive priors, which allow them to capture such localized spatial correlation and to identify step changes. The approach takes the form of an iterative algorithm, which sequentially updates the spatial correlation structure that is assumed by the model in addition to estimating the remaining parameters. The efficacy of the approach is assessed by simulation, before being applied to the motivating Greater Glasgow application.
A Penalized Likelihood Approach to Estimate Within-Household Contact Networks from Egocentric Data
Authors: Potter Gail E. , Hens Niel
Published: September 2013

Acute infectious diseases are transmitted over networks of social contacts. Epidemic models are used to predict the spread of emergent pathogens and to compare intervention strategies. Many of these models assume equal probability of contact within mixing groups (homes, schools, etc.), but little work has inferred the actual contact network, which may influence epidemic estimates. We develop a penalized likelihood method to infer contact networks within households, which are a key area for disease transmission. Using egocentric surveys of contact behaviour in Belgium, we estimate within-household contact networks for six different age compositions. Our estimates show dependence in contact behaviour and vary substantively by age composition, with fewer contacts in older households. Our results are relevant for epidemic models that are used to make policy recommendations.
The Item Count Method for Sensitive Survey Questions: Modelling Criminal Behaviour
Authors: Kuha Jouni , Jackson Jonathan
Published: September 2013

The item count method is a way of asking sensitive survey questions which protects the anonymity of the respondents by randomization before the interview. It can be used to estimate the probability of sensitive behaviour and to model how it depends on explanatory variables. We analyse item count survey data on the illegal behaviour of buying stolen goods. The analysis of an item count question is best formulated as an instance of modelling incomplete categorical data. We propose an efficient implementation of the estimation which also provides explicit variance estimates for the parameters. We then suggest specifications for the model for the control items, which is an auxiliary but unavoidable part of the analysis of item count data. These considerations and the results of our analysis of criminal behaviour highlight the fact that careful design of the questions is crucial for the success of the item count method.
Semiparametric Bayesian Models for Clustering and Classification in the Presence of Unbalanced In-Hospital Survival
Authors: Guglielmi Alessandra , Ieva Francesca , Paganoni Anna M. , Ruggeri Fabrizio , Soriano Jacopo
Published: September 2013

Bayesian semiparametric logit models are fitted to grouped data related to in-hospital survival outcome of patients hospitalized with an ST-segment elevation myocardial infarction diagnosis. Dependent Dirichlet process priors are considered for modelling the random-effects distribution of the grouping factor (hospital of admission), to provide a cluster analysis of the hospitals. The clustering structure is highlighted through the optimal random partition that minimizes the posterior expected value of a suitable loss function. There are two main goals of the work: to provide model-based clustering and ranking of the providers according to the similarity of their effect on patients' outcomes, and to make reliable predictions on the survival outcome at the patient's level, even when the survival rate itself is strongly unbalanced. The study is within a project, named the ‘Strategic program of Regione Lombardia’, and is aimed at supporting decisions in healthcare policies.
Estimating Disease Onset Distribution Functions in Mutation Carriers with Censored Mixture Data
Authors: Ma Yanyuan , Wang Yuanjia
Published: September 2013

We consider non-parametric estimation of disease onset distribution functions in multiple populations by using censored data with unknown population identifiers. The problem is motivated from studies aiming at estimating the age-specific disease risk distribution in deleterious mutation carriers for genetic counselling and design of therapeutic intervention trials to modify disease progression (i.e. to slow down the development of symptoms and to delay the onset of disease). In some of these studies, the distribution of disease risk in participants assumes a mixture form. Although the population identifiers are missing, study design and scientific knowledge allow calculation of the probability of a subject belonging to each population. We propose a general family of weighted least squares estimators and show that existing consistent non-parametric methods belong to this family. We identify a computationally effortless estimator in the family, study its asymptotic properties and show its significant gain in efficiency compared with the existing estimators in the literature. The application to a large genetic epidemiological study of Huntington's disease reveals information on the age-at-onset distribution of Huntington's disease which sheds light on some clinical hypotheses.
A Factor Mixture Model for Multivariate Survival Data: An Application to the Analysis of Lifetime Mental Disorders
Authors: Almansa Josué , Vermunt Jeroen K. , Forero Carlos G. , Alonso Jordi
Published: September 2013

The assessment of the lifetime prevalence of mental disorders under comorbidity conditions is an important area in mental health research. Because information on lifetime disorders is usually gathered retrospectively within cross-sectional studies, the information is necessarily right censored and this should be taken into account when setting up models for the estimation of lifetime prevalences. We propose a factor analytic discrete time survival model combining mixture item response theory and discrete time hazard functions to describe disorder associations while accounting for censoring. This model is used for describing the lifetime prevalence and comorbidity of eight depression and anxiety disorders from the European Study of the Epidemiology of Mental Disorders.