bluuebunny/crossref_metadata_2025 huggingface dataset:
Do some trusts deliver a consistently better experience for patients? An analysis of patient experience across acute care surveys in English NHS trusts
Authors: Raleigh Veena S , Frosini Francesca , Sizmur Steve , Graham Chris
Published: March 2012

Introduction

Data were used from inpatient, outpatient and accident and emergency surveys in acute trusts in England to examine consistency in patient-reported experience across services, and factors associated with systematic variations in performance.

Methods

Standardised mean scores for six domains of patient experience were constructed for each survey for 145 non-specialist acute trusts. Hierarchical cluster analysis was used to investigate whether and how trust performance clusters. Multilevel regression analysis was used to determine trust characteristics associated with performance.

Results

Cluster analysis identified three groups: trusts that performed consistently above (30 trusts) or below (six trusts) average, and those with mixed performance. All the poor performing trusts were in London, none were foundation trusts or teaching hospitals, and they had the highest mean deprivation score and the lowest proportion of white inpatients and response rates. Foundation and teaching status, and the proportion of white inpatients, were positively associated with performance; deprivation and response rates showed less consistent positive associations. No regional effects were apparent after adjusting for independent variables.

Conclusion

The results have significant implications for quality improvement in the NHS. The finding that some NHS providers consistently perform better than others suggests that there are system-wide determinants of patient experience and the potential for learning from innovators. However, there is room for improvement overall. Given the large samples of these surveys, the messages could also have relevance for healthcare systems elsewhere.
Identifying patients with advanced illness for needs assessment and care planning: SPICT in practice
Authors: Boyd Kirsty , Highet Gill , Crawford Debbie , Duthie Fiona , Murray Scott
Published: March 2012

Background

Systematic identification of patients with advanced illnesses is central to UK end-of-life policies. Recognising a limited prognosis fosters decision-making about future care but probabilistic predictions such as the ‘surprise question’ tend to be overoptimistic. Even in cancer, complex mathematical models are only 60% accurate and open to confounders. The 2009 Supportive and Palliative Indicators Tool (SPICT) used clinical indicators derived from a review of prognostic tools to identify patients likely to have advanced illness and unmet supportive and palliative care needs for assessment.

Aims

To pilot the SPICT tool in the renal, liver, cardiac and respiratory wards of a large teaching hospital and assess its utility in an acute hospital setting.

Methods

Each ward team developed a customised checklist containing the SPICT clinical indicators. All unplanned admissions to each ward over 2 months were screened and followed up for 3 months to record re-admissions; hospital bed days; time, cause and place of death. The Charleson index of co-morbidities was calculated for comparison.

Findings

The indicators were evaluated and refined by successive teams. Multi-morbidity predicted a limited prognosis, re-admission risk and complex needs but should take account of disease severity. Most, but not all those who died, had a poor performance status (PS). Patients may spend more time bed-bound when hospitalised so usual status at home is important as an acute deterioration might be reversible. Repeated hospital admissions are well documented but increased community care needs are not always apparent initially.

Conclusions

The SPICT performs as well as the Charleson index in identifying patients with a limited prognosis and complex needs. The revised version contains fewer, clearly identifiable indicators that provide a rationale for reviewing care goals with patients and planning care; such as hospital admission, poorly controlled symptoms, increasing dependency and robust descriptors for common illnesses.
Rapid discharge at end of life-shared experience from an acute trust
Authors: Montgomery Emma , Whitfield Andrea
Published: March 2012

Background

As part of the drive to reduce patients dying in hospital a rapid discharge at end of life task and finish group with multi-agency participation was established in 2010 in a large district general hospital in North West England. The aim of the group was to set up seamless pathways of care for patients at end of life who choose not to die in hospital.

Method

The group met monthly and identified barriers to discharge. These included lack of identification of end of life and consequent lack of discussion with patients and their relatives, limited use of Liverpool Care Pathway, difficulty in accessing equipment and care provision, limited communication with primary care, delays in obtaining medication and transport. These were compounded by delays in obtaining continuing care funding. Solutions to these barriers will be described.

Results

From April 2010 to March 2011, 92 patients were discharged from hospital to their own home or to a nursing home depending on their preference. Seventy-four (deemed to have a prognosis of less than 4 weeks) were discharged within 24 h. The remaining 18 were felt to have a prognosis of hours to days and were discharged within 4 h. All received continuing care funding and were supported to die in their preferred place of care. Feedback from patients and relatives has been positive.

Conclusion

The authors have demonstrated that it is possible to meet patients and relatives wishes for preferred place of care at end of life through the use of our rapid discharge pathway. The first year highlighted the need to ensure that all patients are discharged with appropriate supplies of as-required medication for symptom control to prevent crises at home. We have recently launched a printed version of the Pathway with documentation to support multi-agency working and will be auditing its use.
A national survey of the management of implantable cardioverter defibrillators in specialist palliative care settings
Authors: Beattie James , Butler Jane , MacCallum Annie , Fuller Alice , Johnson Miriam
Published: March 2012

Background

Implantable cardioverter defibrillators (ICDs), used alone, or sometimes combined with pacemaker-based cardiac resynchronisation therapy, are increasingly inserted to treat those with heart failure (HF) at risk of lethal arrhythmias. Device activity may discomfort dying patients and induce dilemmas for recipients, families and professional carers at the end of life.

Methods

Over a 4 week period between February and March 2011, we undertook a web based retrospective survey of ICD management over the preceding 12 months by specialist palliative care (SPC) services across England, Wales and Northern Ireland.

Results

Of 95 respondents, 65% were hospice based, 13% were from SPC units in acute trusts, and 22% were from SPC teams working in a variety of care settings without SPC beds. Of the clinical cohort cared for by these SPC professionals, 5.5% were said to have HF either as a primary or secondary diagnosis. 93% of these services accepted patients with ICDs and 55% had treated such individuals over the relevant period. Half used explicit device-related admission documentation but only 26% had a site specific or regional deactivation policy in place. 42 patients were estimated to have required defibrillator deactivation and in >75% of cases, this required the patient to attend an external device clinic or be visited by a member of the cardiology team or industry representative. Importantly, 44% of SPC teams had no access to a magnet for emergency ICD deactivation and only 32% provided staff training in this intervention.

Conclusion

The results of this national survey demonstrate inconsistency in ICD management by SPC teams, with gaps in service which may adversely affect end of life care. SPC units need to develop robust policies to document and manage ICDs prospectively, with staff education and ready access to the necessary expertise and equipment.
Development and evaluation of a decision support tool for ambulance workers
Authors: Munday Daniel , Gakhal Sandeep , Cole Robert , Bronner Rosanna , Clerici Joanne , Cooke Matthew W
Published: March 2012

Aims

Recently completed research demonstrated that ambulance crews had received little training in managing terminally ill patients and showed marked variation in what they consider to be a valid DNAR or what they would accept as an advance care plan indicating that a patient would not want to be admitted to hospital. This research informed the development of an end of life care online education package. However, as it might be difficult for crews to call to mind such learning in an emergency situation, we also developed and are currently evaluating a decision support tool to assist ambulance crews in managing terminally ill patients.

Methods

End of life vignettes were presented to 21 ambulance clinicians in order to inform the development of the tool. A multidisciplinary expert group subsequently designed the tool. Suggestions for modification were made by two focus groups of ambulance clinicians. 60 ambulance clinicians have been trained to use the tool and currently involved in a survey to evaluate the effectiveness of the tool in practice.

Results

Data from the vignettes provided further confirmation of the lack of consistency among ambulance crews in their approach to decision making at the end of life, despite working in the same ambulance trust with standard policies and procedures. There was strong evidence that their decision-making is particularly risk averse leading to the likelihood that terminally ill patients would be admitted to hospital or have cardiopulmonary resuscitation following a cardiac arrest. Participants in the focus and education groups reported that the tool appeared to be helpful and appropriate. The tool is being currently tested and results from this evaluation will be available for presentation.

Conclusion

Lack of consistency in how ambulance crews deal with end of life situations highlights the importance of a decision support tool. Sponsor: NHS West Midlands.
Management of oesophageal coins in children
Authors: Nafousi O , Pertwee Richard , Roland Damian , Acheson Jonathan
Published: March 2012

Objective

Is a watch and wait approach safe in asymptomatic patients presenting to the emergency department with a confirmed oesophageal coin on x-ray?

Methods

A retrospective case note review for children <16 years attending with a confirmed oesophageal coin on x-ray over a 7-year period (1 January 2004 to 31 December 2010).

Results

89% (33/37) of coins in asymptomatic patients, who were conservatively managed, had passed spontaneously on repeat chest x-ray up to 18 h later. No patient who was discharged with a middle or lower oesophageal coin required a GA and no child who was treated conservatively developed any complications.

Conclusion

In the UK asymptomatic children, with no history of tracheal or oesophageal disease and a confirmed oesophageal coin on x-ray should undergo a period of observation up to 18 h. This can be safely undertaken at home, followed by a repeat x-ray in the emergency department.
IDENTIFICATION OF TEMPERATURE-DEPENDENT PARAMETERS IN LASER-INTERSTITIAL THERMO THERAPY
Authors: TSE OLIVER , PINNAU RENÉ , SIEDOW NORBERT
Published: March 2012

Laser-induced thermotherapy (LITT) is an established minimally invasive percutaneous technique of tumor ablation. Nevertheless, there is a need to predict the effect of laser applications and optimize irradiation planning in LITT. Optical attributes (attenuation, absorption, scattering) change due to thermal denaturation. The work presents the possibility to identify these temperature-dependent parameters from given temperature measurements via an optimal control problem. The solvability of the optimal control problem is analyzed and results of successful implementations are shown.
LONG-TERM DYNAMICS OF THE COUPLED SUSPENSION BRIDGE SYSTEM
Authors: BOCHICCHIO IVANA , GIORGI CLAUDIO , VUK ELENA
Published: March 2012

In this paper we study the long-term dynamics of a nonlinear suspension bridge system. The road bed and the main cable are modeled as a nonlinear beam and a vibrating string, respectively, and their coupling is carried out by one-sided springs. First, we scrutinize the set of stationary solutions, which turns out to be nontrivial when the axial load exceeds some critical value. Then, we prove the existence of a bounded global attractor of optimal regularity and we give its characterization in terms of the steady states of the problem.
MEAN FIELD GAMES EQUATIONS WITH QUADRATIC HAMILTONIAN: A SPECIFIC APPROACH
Authors: GUÉANT OLIVIER
Published: March 2012

Mean field games models describing the limit of a large class of stochastic differential games, as the number of players goes to +∞, have been introduced by J.-M. Lasry and P.-L. Lions in Refs. 10–12. We use a change of variables to transform the mean field games (MFG) equations into a system of simpler coupled partial differential equations, in the case of a quadratic Hamiltonian. This system is then used to exhibit a monotonic scheme to build solutions of the MFG equations. Effective numerical methods based on this constructive scheme are presented and numerical experiments are carried out.
UNIQUENESS IN A CAUCHY PROBLEM FOR REACTION–DIFFUSION SYSTEM AND INVERSE SOURCE PROBLEMS IN WATER POLLUTION
Authors: BEN BELGACEM FAKER
Published: March 2012

The purpose is a uniqueness result for an ill-posed multi-dimensional parabolic system arising in pollution modeling of surface waters like lakes, estuaries or bays. Exploring organic pollution effects mostly needs the recovery of two tracers, the biochemical oxygen demand (BOD) and the dissolved oxygen (DO) densities when only measurements on the dissolved oxygen concentration are available. The particularity of the reaction–diffusion system resides then in the nature of the boundary conditions. Missing boundary data on BOD is compensated by over-determined boundary conditions on DO which induces a strong coupling in the system. We check first the ill-posedness of the problem. Then, a uniqueness theorem is stated. The saddle point theory and tools from the semi-group analysis turn out to be at the basis of the proof. The results established here may serve for the data completion and the identifiability of pointwise pollution sources in multi-dimensional water bodies.
"华侨为革命之母"：
Authors: 黄坚立
Published: March 2012

在近百年追述孙中山、南洋与辛亥革命这三方关系的过程中 ，“华侨为革命之母” 已成为了最典型的名言之一。 本文通过孙中山和其他人的著作与演讲来追探此赞誉不明的来历。 我们也将分析其为人们运用与叙述的高低潮，这让我们发觉它在1930年代经常被人引用，但在1940年代却暗淡下来。 1950年代到1980年代时，它成为了台湾冷战时期的工具。 在中华人民共和国1978年改革开放后，它又呈现为中国学界研究课题的焦点之一。 本文的最后一个部分，探讨了南洋大众文化是怎样通过纪念馆的文物陈列、戏剧的表演和电影的制作把这赞誉性别化。 古往今来，此赞誉在不同的历史背景下经历过无穷的变数与叙述，但它一直持续地作为海外华侨、华人与他们祖国联系中的关键脐带
Comparison of Chemical Vapor Sensing Properties between Graphene and Carbon Nanotubes
Authors: Park Hyung Goo , Hwang Sukju , Lim Juhwan , Kim Duck-Hwan , Song In Sang , Kim Jae Hun , Woo Deok Ha , Lee Seok , Jun Seong Chan
Published: March 2012

We demonstrated the chemical-vapor sensing properties of graphene and carbon nanotubes (CNTs) by comparing their performances based on the two-dimensional exposure ratio. In order to implement the gas sensing, two kinds of sensors were properly prepared via the highly oriented pyrolytic graphite (HOPG) and CNT-dispersing methods, which cover different sensing area each other. Although the area of graphene is three times smaller than that of CNTs, the excellent sensing performance of graphene in the various concentration of the target gas is shown in terms of the sensitivity, the reactivity, and response time. We concluded this experimental result by focusing on the surface to volume ratio.
Dielectrophoretic Assembly of Semiconducting Carbon Nanotubes Separated and Enriched by Spin Column Chromatography and Its Application to Gas Sensing
Authors: Nakano Michihiko , Fujioka Masahiro , Mai Kaori , Watanabe Hideaki , Martin Yul , Suehiro Junya
Published: March 2012

The present authors have previously demonstrated the electrokinetic fabrication of a single-walled carbon nanotube (SWCNT) gas sensor by employing dielectrophoresis. Because this method employs mass-produced SWCNTs, it can realize cheaper and more flexible SWCNT gas sensor fabrication than that based on the on-site synthesis of SWCNTs. In this study, a new protocol was proposed and tested for the separation and enrichment of semiconducting SWCNTs, aiming to improve the SWCNT gas sensor sensitivity. The protocol employed a spin column filled with size-exclusion dextran-based gel beads as well as two surfactants (sodium dodecyl sulfate and sodium deoxycholate), which had different affinities to metallic and semiconducting SWCNTs. The separation and enrichment of the semiconducting SWCNTs were confirmed by measuring their optical and electrical properties. The CNT gas sensor fabricated using enriched semiconducting SWCNTs was highly sensitive to nitrogen dioxide (NO2) gas, – more sensitive by 10 times than that fabricated using the pristine SWCNT mixture.
3-D illustration of network orientations of interstitial cells of Cajal subgroups in human colon as revealed by deep-tissue imaging with optical clearing
Authors: Liu Yuan-An , Chung Yuan-Chiang , Pan Shien-Tung , Hou Yung-Chi , Peng Shih-Jung , Pasricha Pankaj J. , Tang Shiue-Cheng
Published: March 2012

Morphological changes of interstitial cells of Cajal (ICC) have been proposed to characterize motility disorders. However, a global view of the network orientations of ICC subgroups has not been established to illustrate their three-dimensional (3-D) architectures in the human colon. In this research, we integrate c-kit immunostaining, 3-D microscopy with optical clearing, and image rendering to present the location-dependent network orientations with high definition. Full-depth colonic tissues were obtained from colectomies performed for nonobstructing carcinoma. Specimens of colon wall were prepared away from the tumor site. C-kit and nuclear fluorescent staining were used to identify the ICC processes and cell body. Optical clearing was used to generate transparent colon specimens, which led to panoramic visualization of the fluorescence-labeled ICC networks at the myenteric plexus (ICC-MY), longitudinal (ICC-LM) and circular (ICC-CM) muscles, and submucosal boundary (ICC-SM) up to 300 μm in depth via confocal microscopy with subcellular level resolution. We observed four distinct network patterns: 1) periganglionic ICC-MY that connect with ICC-LM and ICC-CM, 2) plexuses of ICC-LM within the longitudinal muscle and extending toward the serosa, 3) repetitive and organized ICC-CM layers running parallel to the circular muscle axis and extending toward the submucosa, and 4) a condensed ICC-SM layer lining the submucosal border. Among the four patterns, the orderly aligned ICC-CM layers provide an appropriate target for quantitation. Our results demonstrate the location-dependent network orientations of ICC subgroups and suggest a practical approach for in-depth imaging and quantitative analysis of ICC in the human colon specimen.
Influence of age and sex on the pressor response following a spontaneous burst of muscle sympathetic nerve activity
Authors: Vianna Lauro C. , Hart Emma C. , Fairfax Seth T. , Charkoudian Nisha , Joyner Michael J. , Fadel Paul J.
Published: March 2012

The sympathetic nervous system is critical for the beat-to-beat regulation of arterial blood pressure (BP). Although studies have examined age- and sex-related effects on BP control, findings are inconsistent and limited data are available in postmenopausal women. In addition, the majority of studies have focused on time-averaged responses without consideration for potential beat-to-beat alterations. Thus we examined whether the ability of muscle sympathetic nerve activity (MSNA) to modulate BP on a beat-to-beat basis is affected by age or sex. BP and MSNA were measured during supine rest in 40 young (20 men) and 40 older (20 men) healthy subjects. Beat-to-beat fluctuations in mean arterial pressure (MAP) were characterized for 15 cardiac cycles after each MSNA burst using signal averaging. The rise in MAP following an MSNA burst was similar between young men and women (+2.64 ± 0.3 vs. +2.57 ± 0.3 mmHg, respectively). However, the magnitude of the increase in MAP after an MSNA burst was reduced in older compared with young subjects ( P < 0.05). Moreover, the attenuation of the pressor response was greater in older women (+1.20 ± 0.1 mmHg) compared with older men (+1.72 ± 0.2 mmHg; P < 0.05). Interestingly, in all groups, MAP consistently decreased after cardiac cycles without MSNA bursts (nonbursts) with the magnitude of fall greatest in older men. In summary, healthy aging is associated with an attenuated beat-to-beat increase in BP after a spontaneous MSNA burst, and this attenuation is more pronounced in postmenopausal women. Furthermore, our nonburst findings highlight the importance of sympathetic vasoconstrictor activity to maintain beat-to-beat BP, particularly in older men.
A Phase I Dose–Escalation Study of Regorafenib (BAY 73–4506), an Inhibitor of Oncogenic, Angiogenic, and Stromal Kinases, in Patients with Advanced Solid Tumors
Authors: Mross Klaus , Frost Annette , Steinbild Simone , Hedbom Susanne , Büchert Martin , Fasol Ulrike , Unger Clemens , Krätzschmar Jörn , Heinig Roland , Boix Oliver , Christensen Olaf
Published: March 2012

Purpose: Regorafenib is a novel oral multikinase inhibitor of angiogenic (VEGFR1-3, TIE2), stromal (PDGFR-β, FGFR), and oncogenic kinases (KIT, RET, and RAF). This first-in-man, phase I dose–escalation study assessed the safety, pharmacokinetic, pharmacodynamic, and efficacy profiles of regorafenib in patients with advanced solid tumors.

Patients and Methods: Patients aged 18 years or older with advanced solid tumors refractory to standard treatment were recruited. Regorafenib was administered orally for 21 days on/seven days off in repeating cycles, until discontinuation due to toxicity or tumor progression. Adverse events (AE) were assessed using National Cancer Institute Common Terminology Criteria for Adverse Events v3.0. Pharmacokinetic profiles were measured after a single dose and on day 21. Pharmacodynamic and efficacy evaluations included tumor perfusion assessment using dynamic contrast-enhanced MRI, plasma cytokines, and tumor response using RECIST (v1.0).

Results: Fifty-three patients were enrolled into eight cohorts at dose levels from 10 to 220 mg daily. The recommended dose for future studies was determined to be 160 mg daily, with a treatment schedule of 21 days on/seven days off in repeating 28-day cycles. The most common drug-related grade 3 or 4 AEs were dermatologic AEs (hand–foot skin reaction, rash), hypertension, and diarrhea. Pharmacokinetic analysis revealed a similar exposure at steady state for the parent compound and two pharmacologically active metabolites. Tumor perfusion and plasma cytokine analysis showed biologic activity of regorafenib. Three of 47 evaluable patients achieved a partial response (renal cell carcinoma, colorectal carcinoma, and osteosarcoma).

Conclusion: Regorafenib showed an acceptable safety profile and preliminary evidence of antitumor activity in patients with solid tumors. Clin Cancer Res; 18(9); 2658–67. ©2012 AACR.
Implications of Different CA 15-3 Levels according to Breast Cancer Subtype at Initial Diagnosis of Recurrent or Metastatic Breast Cancer
Authors: Park Silvia , Ahn Hee Kyung , Park Lee Chun , Hwang Deok Won , Ji Jun Ho , Maeng Chi Hoon , Cho Su-Hee , Lee Ji Yean , Park Kyung Tae , Ahn Jin Seok , Park Yeon Hee , Im Young-Hyuck
Published: March 2012

Background: CA 15-3 is derived from proteolytic shedding of the extracellular domain of mucin 1 (MUC1) glycoprotein. Luminal subtype breast cancer shows a higher expression in MUC1 genes, and a positive relationship between MUC1 expression and estrogen receptor (ER) expression has been reported. In this study, we attempted to determine the difference of CA 15-3 level according to the subtype of breast cancer. Methods: From January 2000 to December 2009, a total of 707 patients who were diagnosed with metastatic or recurrent breast cancer at Samsung Medical Center were included in this study. Among these, 536 patients with available clinical data including pretreatment CA 15-3 and immunohistochemistry for ER, progesterone receptor (PgR) and hormone receptor 2 (HER2) were analyzed in this study. Patients were classified into 3 groups according to their receptor status: ER-positive (ER+) and/or PgR+ irrespective of HER2 (HR+), ER–/PgR–/HER2+ (HER2-enriched) and ER–/PgR–/HER2– (triple negative, TN). Results: The supranormal values of CA 15-3 were frequently observed in HR+ breast cancer compared to other types (45.6% for HR+, 24.4% for HER2-enriched and 28.8% for TN; p < 0.001). The increase of marker levels differed significantly among the 3 groups (24 U/ml for HR+, 13 U/ml for HER2-enriched and 18 U/ml for TN; p < 0.001). Conclusions: The increase of both marker levels and the frequency of supranormal values of CA 15-3 were more frequently observed in HR+ breast cancer, which is positively associated with MUC1 expression. These results could potentially serve as a basis for expanding the clinical implications of CA 15-3 in the field of clinical trials for novel targeted therapies in breast cancer.
Extravascular Migration of a Guide Wire with Perforation of the Heart Eight Months after Percutaneous Coronary Intervention: Consequence of a Conservative Approach
Authors: De Praetere H. , Di Bari N. , Gutermann H. , Van Kerrebroeck C. , Dens J. , Dion R.
Published: March 2012

Impingement of a guide wire is not unusual during complex percutaneous coronary intervention procedures. It is mostly retrieved by endovascular procedures. If not possible, conservative therapy is frequently the next option, leaving the guide wire in place. This case describes the consequence of such an approach 9 months after initial percutaneous coronary intervention. The guide wire migrated through the abdominal cavity and finally perforated the heart. We therefore defend a more aggressive approach if a guide wire is locked in or lost. Surgical retrieval seems to be the best choice. Fixation of the guide wire with a stent is an acceptable alternative in high-risk patients.
CNS Medications as Predictors of Precipitous Cognitive Decline in the Cognitively Disabled Aged: A Longitudinal Population-Based Study
Authors: Puustinen Juha , Nurminen Janne , Vahlberg Tero , Lyles Alan , Isoaho Raimo , Räihä Ismo , Kivelä Sirkka-Liisa
Published: March 2012

Background/Aims: Psychotropics and antiepileptics (AE) are medications commonly used among the aged with cognitive decline or dementia, although they may precipitate further cognitive decline. Our aim was to analyze the relationships between the use of (i) psychotropics (i.e. benzodiazepines or related drugs, BZD, antipsychotics, AP, or antidepressants, AD), opioids (Op), anticholinergics (ACh) or AEs or the concomitant use of two of these drugs, and (ii) the risk of precipitous cognitive decline in an older (≧65 years) cognitively disabled population. Methods: A longitudinal population-based study of general aged community-dwelling patients was executed in two phases (1990–1991 and 1998–1999) in Lieto, Finland. Fifty-two individuals cognitively disabled (MMSE score 0–23) at the 1990–1991 baseline form this study’s sample. Cognitive abilities were assessed in each phase with the Mini-Mental State Examination (MMSE) and medication utilization data were collected in both phases. The mean follow-up time was 7.6 years. Multivariate models were used to analyze the change in MMSE total score between medication users and non-users. Results: BZD or any psychotropic use was associated with greater cognitive decline in elders aged ≧75 years compared to non-users (change in MMSE sum score: –8.6 ± 7.0 vs. –3.3 ± 5.6 and –5.9 ± 7.0 vs. –2.7 ± 6.4, respectively). A greater decline was also associated specifically with the concomitant use of BZD and AP (–16 vs. –1.4 ± 7.8); as were BZD and any drug with CNS effects (–9.6 ± 9.9 vs. –1.3 ± 7.2) compared to non-users. The concomitant use of BZD and AD (–10.7 ± 4.7 vs. –3.2 ± 5.6) or ACh (–15.0 ± 8.5 vs. –3.3 ± 5.6) or any drug with CNS effects (–13.3 ± 6.5 vs. –3.3 ± 5.6) was associated with cognitive decline in patients ≧75 years compared to non-users of any drug with CNS effects. Conclusion: The use of a BZD or any psychotropic medication may be an independent risk factor for cognitive decline in the cognitively disabled aged, and patients co-prescribed psychotropic medications had greater cognitive decline. Studies with larger sample sizes and studies on possible pathophysiologic mechanisms are needed.
Analyses from a Centre of Short- and Long-Term Growth in Turner’s Syndrome on Standard Growth Hormone Doses Confirm Growth Prediction Algorithms and Show Normal IGF-I Levels
Authors: Ranke Michael B. , Schweizer Roland , Martin David D. , Ehehalt Stefan , Schwarze Carl-Philipp , Serra Felice , Binder Gerhard
Published: March 2012

Aims and Methods: Prediction algorithms suggest factors determining short- and long-term growth response to growth hormone (GH) in Turner’s syndrome (TS). A total of 133 patients (group A; 53% with karyotype 45,X) completed 1 year of treatment and 77 patients (group B) reached adult height (AH) after >4 years on GH treatment. The patients were analysed for factors determining the outcomes, and in addition, the validity of published algorithms was tested. Results: In group A [values are given as medians (10th–90th percentiles)], starting age was 9.4 (4.8–14) years, height was –3.2 (–4.4 to –1.9) SDS (Prader references), and GH dose was 38 (23–48) µg/kg/day. Observed height velocity was 7.7 (5.2–9.8) cm/years and was equal to the predicted height velocity. In group B, projected adult height (PAH) was 147.4 (139.5–154.8) cm. Total gain in height over PAH of 6.1 (2.0–12.6) cm was negatively correlated with height at start, but positively correlated with GH duration, first year Δheight SDS, or index of responsiveness. Observed AH was 153.5 (146.6–160.1) cm and predicted AH was 155.0 (147.4–161.0) cm, which is statistically not different. On GH <5% IGF-I levels were >2 SDS. Conclusions: The published prediction algorithms were found to be valid. If normal AH is to be reached at the lowest costs and risks, probably only TS children with a good growth potential and a high responsiveness to GH can be treated successfully with GH doses of <50 µg/kg/day.
Dementia Diagnosis Differs in Men and Women and Depends on Age and Dementia Severity: Data from SveDem, the Swedish Dementia Quality Registry
Authors: Religa Dorota , Spångberg Kalle , Wimo Anders , Edlund Ann-Katrin , Winblad Bengt , Eriksdotter-Jönhagen Maria
Published: March 2012

Aims: We examine the dementia assessment with focus on age and gender differences. Methods: Data from the national quality database, Swedish Dementia Registry (SveDem), including 6,937 dementia patients diagnosed during 2007–2009 at memory clinics were used. We have studied the use of investigations for dementia diagnostics such as cognitive tests, blood and cerebrospinal fluid analyses, electroencephalography, radiological examinations and assessments of functions. Severity of cognitive impairment was assessed with the Mini Mental State Examination (MMSE). Results: There was a significant decrease in the number of total tests used in the elderly group (>75 years) when compared with the middle-aged group (65–75 years) and younger patients (<65 years). The oldest group was examined with 4 of 11 possible tests, the middle-aged group had 5/11 tests performed and the youngest age group 6/11 tests. There was also a significant gender difference in the diagnostic workup, however, mostly attributable to age. The number of tests positively correlated with the level of cognition assessed by the MMSE. Conclusion: We show here for the first time the impact of age, gender and MMSE score on the dementia diagnostic workup in a large memory clinic patient population in one country.
BAFF Receptor Deficiency Reduces the Development of Atherosclerosis in Mice—Brief Report
Authors: Sage Andrew P. , Tsiantoulas Dimitrios , Baker Lauren , Harrison James , Masters Leanne , Murphy Deirdre , Loinard Celine , Binder Christoph J. , Mallat Ziad
Published: March 2012

Objective—

The goal of this study was to assess the role of B-cell activating factor (BAFF) receptor in ­B-­cell regulation of atherosclerosis.

Methods and Results—

Male LDL ­receptor-­deficient mice (
Ldlr
−/−
) were lethally irradiated and reconstituted with either wild type or BAFF receptor (BAFF-R)–deficient bone marrow. After 4 weeks of recovery, mice were put on a ­high-­fat diet for 6 or 8 weeks. ­BAFF-­R deficiency in bone marrow cells led to a marked reduction of conventional mature B2 cells but did not affect the B1a cell subtype. This was associated with a significant reduction of dendritic cell activation and ­T-­cell proliferation along with a reduction of IgG antibodies against ­malondialdehyde-­modified low-density lipoprotein. In contrast, serum IgM type antibodies were preserved. Interestingly, ­BAFF-­R deficiency was associated with a significant reduction in atherosclerotic lesion development and reduced numbers of plaque T cells. Selective ­BAFF-­R deficiency on B cells led to a similar reduction in lesion size and ­T-­cell infiltration but in contrast did not affect dendritic cell activation.

Conclusion—

BAFF-­R deficiency in mice selectively alters mature B2 ­cell-­dependent cellular and humoral immune responses and limits the development of atherosclerosis.
Correlation Between Signal-Averaged ECG and the Histologic Evaluation of the Myocardial Substrate in Right Ventricular Outflow Tract Arrhythmias
Authors: Santangeli Pasquale , Pieroni Maurizio , Russo Antonio Dello , Casella Michela , Pelargonio Gemma , Biase Luigi Di , Macchione Andrea , Burkhardt J. David , Bellocci Fulvio , Santarelli Pietro , Tondo Claudio , Natale Andrea
Published: March 2012

Background—

The differential diagnosis between idiopathic and cardiomyopathy-related right ventricular outflow tract (RVOT) ventricular arrhythmias (VAs) is crucial. Signal-averaged ECG (SAECG) abnormalities are frequent in cardiomyopathy-related RVOT-VAs, although their pathophysiologic basis and diagnostic value in this setting are undefined. We tested the association between SAECG and the myocardial substrate underlying RVOT-VAs.

Methods and Results—

Twenty-four consecutive patients (median age, 50 years [42–59]; 12 men) with RVOT-VAs (10 with frequent [>1000/24 hours] premature ventricular contractions, 14 with ventricular tachycardias) underwent SAECG with 40-Hz filtering and electroanatomic mapping (EAM) with EAM-guided biopsy for characterization of the RVOT-VAs substrate. A filtered averaged QRS (fQRS) was obtained and analyzed for fQRS duration, low amplitude signal duration <40 mV (LAS40), and root-mean-square voltage in the last 40 ms of the QRS (RMS40). Standard definition of EAM scar was used. EAM-guided biopsy diagnosed ARVC in 11 (46%), myocarditis in 8 (33%), and idiopathic RVOT-VAs in 5 (21%) patients. Patients with cardiomyopathy-related RVOT-VAs had ≥1 EAM scar (median, 2 [1–2]; all with RVOT scar). EAM of patients with idiopathic RVOT-VAs was normal. Patients with cardiomyopathy-related RVOT-VAs had significantly longer fQRS (106 ms [92–132] versus 83 ms [82–84],
P
=0.01) and LAS40 (39 ms [36–51] versus 19 ms [18–21],
P
=0.02), and lower RMS40 (18 µV [9–26] versus 33 µV [32–33],
P
=0.04). A significant linear correlation was found between the extension (cm2) of the RVOT scar and all 3 SAECG parameters (rs=0.76,
P
<0.001 for the fQRSd; rs=0.73,
P
<0.001 for the LAS40; and rs=−0.72,
P
<0.001 for the RMS40). Using the established 2 of 3 criteria (ie, late potentials), SAECG diagnosed cardiomyopathy-related RVOT-VAs with high positive (100%) but low negative (38%) predictive values and missed 7 of 9 (78%) patients with RVOT scar <8 cm
2
.

Conclusions—

In patients with RVOT-VAs, abnormal SAECG parameters reflect the presence of extensive cardiomyopathic involvement of the RVOT. However, a negative SAECG does not reliably rule out cardiomyopathy-related RVOT-VAs in the presence of a small RVOT scar.
Apolipoprotein-E Controls Adenosine Triphosphate-Binding Cassette Transporters ABCB1 and ABCC1 on Cerebral Microvessels After Methamphetamine Intoxication
Authors: ElAli Ayman , Urrutia Andrés , Rubio-Araiz Ana , Hernandez-Jimenez Macarena , Colado Maria I. , Doeppner Thorsten R. , Hermann Dirk M.
Published: March 2012

Background and Purpose—

Methamphetamine is a powerful addictive, which has been associated with ischemic stroke and brain hemorrhage in humans. Whether and how methamphetamine influences the expression of tight junctions and adenosine triphosphate-binding cassette transporters, which have previously been shown to be regulated by apolipoprotein-E (ApoE) under conditions of brain ischemia, was unknown.

Methods—

C57BL/6J mice received intraperitoneal injections of methamphetamine (3 times 4 mg/kg separated by 3 hours) either alone or in combination with the ApoE receptor-2 inhibitor receptor-associated protein (40 μg/kg) or the inducible nitric oxide synthase inhibitor 1400W (5 mg/kg). Animals were euthanized 3 or 24 hours after methamphetamine exposure. Tissue responses were evaluated with Western blots, immunoprecipitation, and immunohistochemistry using total brain and cerebral microvessel extracts.

Results—

Methamphetamine induced a transient activation of stress kinases c-Jun N-terminal kinase 1/2 and p38 in the brain parenchyma and increased intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 expression on cerebral microvessels without inducing loss of tight junction proteins and without inducing IgG extravasation. Methamphetamine transiently increased the expression of the luminal adenosine triphosphate-binding cassette transporter ABCB1 on cerebral microvessels and reduced the expression of the abluminal transporter ABCC1. Elevated expression of ApoE was noted in the brain parenchyma by methamphetamine, activating ApoE receptor-2 on brain capillaries, deactivating c-Jun N-terminal kinase 1/2 and c-Jun, and regulating ABCB1 and ABCC1 expression. Indeed, ApoE receptor-2 and inducible nitric oxide synthase inhibition prevented the ABCB1 and ABCC1 expression changes.

Conclusions—

Acute exposure to methamphetamine at doses comparable to those consumed in drug addiction does not induce tight junction breakdown but differentially regulates adenosine triphosphate-binding cassette transporters through the ApoE/ApoE receptor-2/c-Jun N-terminal kinase 1/2 pathway.
Semantic Role Labeling of Implicit Arguments for Nominal Predicates
Authors: Gerber Matthew , Chai Joyce
Published: March 2012

Nominal predicates often carry implicit arguments. Recent work on semantic role labeling has focused on identifying arguments within the local context of a predicate; implicit arguments, however, have not been systematically examined. To address this limitation, we have manually annotated a corpus of implicit arguments for ten predicates from NomBank. Through analysis of this corpus, we find that implicit arguments add 71% to the argument structures that are present in NomBank. Using the corpus, we train a discriminative model that is able to identify implicit arguments with an F1 score of 50%, significantly outperforming an informed baseline model. This article describes our investigation, explores a wide variety of features important for the task, and discusses future directions for work on implicit argument identification.
Probabilistic Risk Assessment of the Rice Cropping Schedule for Central Hokkaido, Japan
Authors: Nemoto Manabu , Hamasaki Takahiro , Sameshima Ryoji , Kumagai Etsushi , Ohno Hiroyuki , Wakiyama Yasuyuki , Maruyama Atsushi , Goto Shinkichi , Ozawa Kiyoshi
Published: March 2012

A framework for the probabilistic risk assessment of the rice (Oryza sativa L.) cropping schedule (PRARCS) is presented. The method accounts for interannual meteorological variation, as opposed to the traditional cultivation schedule planning method, which is based on the seasonal change in long-term average air temperature. PRARCS uses an arbitrary developmental index model to estimate the timing of the heading stage, which is required to assess the risks of cold or heat damage and productivity. All results of risk assessment and productivity are linked to transplanting date as the most important cultivation practice for irrigated rice paddies. The results of assessments using PRARCS at Iwamizawa, central Hokkaido, Japan, indicated that for the current climate the optimal transplanting period is the end of May, and this corresponds to the actual transplanting dates used and the increasing risks and decreasing productivity with earlier or later transplanting. Assessment using projected climatic data for the period 2031–50 showed that Akitakomachi and Hitomebore, present-day cultivars in the Tohoku region, could achieve satisfactory productivity in central Hokkaido. For the term 2081–2100, assessment using an extreme warming projection (4.7°C higher than at present) indicated that the probability of heat damage (white-based rice and heat sterility) is once every 2 yr for some transplanting dates and that cold risks (transplanting damage, cold injury, and immature ripening) are reduced. It was also found that the cultivar Koshihikari, at present suited to more southern regions, could be cultivated in central Hokkaido in 2081–2100 if transplanting is conducted in early May.
‘I am tomorrow’: Violence against Indian students in Australia and political denial
Authors: Mason Gail
Published: March 2012

India has experienced significant economic growth since the 1990s. Young middle-class Indian nationals have embraced international tertiary and vocational education as a part of this trend. Many of these students have come to Australia to study. In 2009, claims that Indian students in Australia were being targeted for racial violence received worldwide media attention. This article presents the results of a qualitative study of public documents surrounding the ‘violence against Indian students’ issue over a 12-month period. It contends that there is sufficient evidence to conclude that some of the victimisation had a racial or anti-Indian element to it. Drawing upon literature on racism, it reveals a discourse of denial that runs through the responses of Australia’s political leaders to this claim. In the current global environment, however, exposure of Australia’s denial by the Indian media may operate as a form of counter-discourse from an emerging superpower whose citizens refuse to tolerate the failure of western nations to take responsibility for the injustice of racial violence.
Dangerous seas: Moral panic and the Somali pirate
Authors: Collins Victoria E
Published: March 2012

Piracy in the coastal waters of Somalia has received significant attention from the news media and international political community, both of which have been major actors in defining the issue of piracy in and around the waters of Somalia. Drawing on the thematic frames of Cohen (1972) and Goode and Ben-Yehuda (1994) , this work provides an analysis of the media and political depictions and international responses to Somali piracy, to evaluate if the phenomenon is reflective of normal societal concern or constitutes a case of ‘moral panic’. The results indicate that the media presentation and the international political community’s discourse on piracy in the Somali coastal waters have led to increased levels of fear and panic and over-reaction, resulting in an excess of militarized response to piracy. This then has negated attention being paid to the underlying causes of Somali piracy; the extant structural conditions in Somalia that have continued to facilitate increased instances of piracy. The findings suggest that a moral panic failed to materialize with the general public, rather, the reaction of the international political community, the international shipping industry, and the media’s actions correspond with the theoretical perspective of agenda-setting.
Are written instructions enough? Efficacy of male condom packaging leaflets among college students
Authors: Lindemann Dana F , Harbke Colin R
Published: March 2012

Objective:

To evaluate whether or not written condom use instructions successfully inform correct condom use skills.

Design:

Between-subjects, two-group design.

Setting:

Public university located in rural Midwestern region of the United States.

Method:

Participants were randomly assigned to either a control condition (read physical exercise instructions) or a treatment condition (read condom use instructions). Participants answered self-report questions related to condom use and performed a condom demonstration task.

Participants:

Participants were 106 male and 87 female college students, primarily in their freshmen (52%) or sophomore (22%) year.

Results:

On average, participants who read the condom instructions did not perform significantly better on the demonstration task. When the specific condom application and removal steps were considered, however, those who read the condom instructions had four times greater odds of successfully pinching the reservoir tip during condom application.

Conclusions:

These data suggest that the benefits of written instructions are limited and do not fully inform correct condom use.
Towards an Ecosociology
Authors: Stevens Paul
Published: March 2012

This article offers insights from ecopsychology – which aims to place human behaviour back in the context of the natural world – to further the development of an ecosociology that meets Catton and Dunlap’s (1978) call for a paradigmatic shift in the way sociology views the role of nature in human society. A more ecocentric viewpoint, reincorporating direct experience, including the environment as part of being embodied, and extending the social to the more-than-human world, could offer new views on the nature of the social, what it is to be human, and wider issues of environmental sustainability. This would be a move towards a revitalized ecosociology that could help humanity come to terms with its unique, but not pre-eminent role in the global system.
Emotional Reflexivity: Feeling, Emotion and Imagination in Reflexive Dialogues
Authors: Burkitt Ian
Published: March 2012

Theories of reflexivity have primarily been concerned with the way agents monitor their own actions using knowledge (Giddens) or deliberate on the social context to make choices through the internal conversation (Archer), yet none have placed emotion at the centre of reflexivity. While emotion is considered in theories of reflexivity it is generally held at bay, being seen as a possible barrier to clear reflexive thought. Here, I challenge this position and, drawing on the work of C.H. Cooley, argue that feeling and emotion are central to reflexive processes, colouring the perception of self, others and social world, thus influencing our responses in social interaction as well as the way we reflexively monitor action and deliberate on the choices we face. Emotional reflexivity is therefore not simply about the way emotions are reflexively monitored or ordered, but about how emotion informs reflexivity itself.
The Ambivalent Insider/Outsider Status of Academic ‘Homecomers’: Observations on Identity and Field Research in the Nigerian Delta
Authors: Oriola Temitope , Haggerty Kevin D
Published: March 2012

This research note draws attention to the play of a researcher’s identity during a summer’s worth of research conducted in the Niger Delta region of Nigeria. Focus is particularly directed at the position of ‘academic homecomers’, and the various ways in which different forms of their identity and ‘insiderness’ can structure research.