bluuebunny/crossref_metadata_2025 huggingface dataset:
Enteric Dysganglionosis Resembling Intestinal Neuronal Dysplasia in a Foal With Bacterial Colitis
Authors: Giri D. K. , Quist E. M. , Ambrus A. , Gold J. , Porter B. F. , Bratton G. R. , Storts R. W.
Published: May 2010

A 5-day-old quarter horse colt with a history of hypothermia, agonal breathing, and diarrhea was euthanized. At necropsy, numerous slightly raised, discrete, closely approximated submucosal nodules were observed in the colon and small intestine. Histologically, these nodules were composed of expanded submucosal mesenchyme that contained numerous neurons either individually or in ganglia. Thirty-two percent of these ganglia included 8 or more neurons, in contrast to 6% in an age-matched foal. Some nodules had necrosuppurative inflammation with vasculitis, thrombosis, and bacterial colonization. A few heterotopic neurons were randomly distributed in the mucosa and the muscularis mucosa. Histologic changes were most consistent with intestinal neuronal dysplasia, a disease of the submucosal plexus described in humans.
Transverse Solidarity: Water, Power, and Resistance
Authors: Ravi Raman K.
Published: May 2010

Conceived as Transverse Solidarity, the Cola Quit Plachimada struggle in a rural hamlet in the Indian state of Kerala reveals how the socio-economic sustainability of communities is of as much importance as environmental, cultural, and political justification for a social movement and its success. The implicit theoretical notion is further enriched and elucidated by the ethnographic narration of a plurality of contested issues and struggles at multiple sites of power. The study addresses how a water-based subaltern movement gradually grew into transverse solidarity within the space between civil society and the state/governing institutions, politicizing them and consequently making allies of them, and how the discursive and material practices of structure-authorities and macro-power relations were contested.

JEL codes: Q25, Q28, N55, O1, O25, O28, Q53, Z1
Social Justice and Dispositions for Adult Education
Authors: Holst John D.
Published: May 2010

The article identifies dispositions from a thematic investigation of the pedagogical practice of Ernesto Che Guevara and various social movements in the United States. The article outlines and places these dispositions within the context of debates over social justice and dispositions for education program accreditation in the United States that often directly impact adult education graduate programs. These dispositions are then demonstrated in historical and contemporary adult education practice. The article argues that these dispositions have increasing relevance given the growing polarization of wealth and poverty and environmental destruction facing humanity.
A Contemporary Review of Feminist Aesthetic Practices in Selective Adult Education Journals and Conference Proceedings
Authors: Clover Darlene E.
Published: May 2010

This feminist content analysis of selective adult education journals and conference proceedings draws on feminist aesthetic theory to develop a deeper understanding of women adult education scholars’ work with/in the arts. Four major categories identified were community cultural development, aesthetic civic engagement and knowledge mobilization, arts-based research, and art education. Within these were multidimensional and at times contesting themes of cultural justice, identity and agency, elitism and postmodernism in museums, artistic quality and collective process, personal and social transformation, and pleasure and subversion. Women’s diverse cultural practices contribute not only to liberatory or emancipatory struggles in feminist adult education but also to discourses of feminist aesthetic theory that all but ignore the educational potential of the arts.
Critical Race Theory and Adult Education
Authors: Closson Rosemary B.
Published: May 2010

Critical race theory (CRT) was developed to examine the persistence of racism. This literature review attempts to understand CRT as it has been applied in related fields such as higher education and possible reasons for its limited application in adult education theorizing about race and racism. This analysis of CRT is framed against a backdrop of the evolution of an adult education discourse on race and racism over several decades and distinguishes CRT from other racial theories that have been used in the field. CRT tenets are discussed using examples that demonstrate how CRT reveals areas of racism left untouched by other forms of theorizing. The author provides a critique of CRT, caveats for those adult educators who might choose to use it, and examples of areas within the field of adult education that might benefit from a CRT lens.
Counter-Learning Under Oppression
Authors: Kucukaydin Ilhan
Published: May 2010

This qualitative study utilized the method of narrative analysis to explore the counter-learning process of an oppressed Kurdish woman from Turkey. Critical constructivism was utilized to analyze counter-learning; Frankfurt School—based Marcusian critical theory was used to analyze the sociopolitical context and its impact on the oppressed. Key issues for adult education theory and practice are highlighted.
More Important Than Guns: Chinese Adult Education After the Long March
Authors: Boshier Roger , Yan Huang
Published: May 2010

Without adult education, there would have been no Communist government in China. Once the Long March arrived in Yan’an, Mao and Communist leaders used adult education in informal and nonformal settings to build momentum for revolution. This article analyzes the theory and practice of adult education during the Yan’an “golden years” (1936—1939) of Chinese communism. Data were derived from interviews in Yan’an and close analysis of writings by foreign visitors to the Red base. Because of 1950s McCarthyism in the United States and tyrannical behavior in post-1949 China, Chinese Communists rarely appear in orthodox adult education history in the west. But after 30 years of “reform and opening,” this is a good time to recall Yan’an adult education and remarkable foreigners who studied and contributed to it. Although Chinese are now obsessed with modernization and money, looking into a rearview mirror might help illuminate adult education on the Red road ahead.
Anticoagulation in the Management of Non-ST-Segment Elevation Acute Coronary Syndrome
Authors: Dobesh Paul P. , Trujillo Toby C.
Published: May 2010

There are currently over 1 million patients admitted to hospitals in the United States with the diagnosis of non-ST-segment elevation acute coronary syndrome (NSTE ACS). Due to the significant morbidity and mortality associated with NSTE ACS, appropriate use of the numerous medications employed is critical in ensuring optimal outcomes. Because atherosclerotic plaque rupture and thrombus formation are the central pathophysiologic process in patients with NSTE ACS, it is important to utilize effective and safe combinations of antiplatelet and anticoagulant drug therapy. There are a number of different anticoagulant agents available for use in patients with NSTE ACS, but it is essential to have an in-depth knowledge of the setting in which these agents have been investigated, what current consensus guidelines recommend, as well as an appreciation for the treatment approach and philosophy of the institution for management of patients with NSTE ACS. In this review manuscript, the reader will find an evaluation of the current guidelines concerning the use of anticoagulant therapy in patients with NSTE ACS, as well as a detailed examination of the literature with critical analysis on issues that should be considered when deciding on the appropriate implementation of anticoagulant therapy in protocols for NSTE ACS patients.
Flame Retardant Epoxy Resins containing Aromatic Poly(phosphonamides)
Authors: Gordon K.L. , Thompson C.M. , Lyon R.E.
Published: May 2010

As part of a program to develop more survivable aircraft, flame-retardant epoxy resins were investigated for their potential as fire-resistant exterior composite structures for future subsonic commercial and general aviation aircraft. Four different poly(phosphonamide)s were prepared by low temperature NMR condensation and characterized by Fourier transform infrared spectroscopy, 1H-NMR spectroscopy, 31P-NMR, differential scanning calorimetry, viscometry and gel-permeation chromatography. The poly(phosphonamides) were used as toughening agents (with 4,4'-diaminodiphenyl sulfone) to partially cure a commercially available unmodified liquid epoxy resin. The resulting cured epoxy formulations were evaluated for water uptake, flame retardance and fracture toughness. The formulations show good flame retardation with phosphorus content as low as 1.6% by weight, but exhibited high moisture uptake compared to the baseline epoxy. The fracture toughness of the cured formulations showed no detrimental effect due to phosphorus content (∼ 1.5% P). The heat of combustion of the pyrolysis gases, hc = 23.5 ± 1.3 kJ g—1 for the poly(phosphonamide) formulations were essentially the same as the N, N, N', N'-tetraglycidylether of -4,4'-methylene dianiline/4,4'-diaminodiphenyl sulfone epoxy formulation, hc = 24 kJ g—1.
Consistency of Symptom Clusters in Advanced Cancer
Authors: Kirkova Jordanka , Aktas Aynur , Walsh Declan , Rybicki Lisa , Davis Mellar P.
Published: May 2010

Background: The reproducibility of symptom clusters (SCs) in different populations would support the validity of the cluster concept. Ideal approaches to cluster identification are unknown. The presence of a sentinel (most prevalent) symptom may reduce the number of symptoms in a comprehensive symptom assessment tool. The primary purpose was to assess consistency of SCs between 2 independent data sets. A secondary aim was to evaluate whether use of a sentinel symptom might abbreviate assessment but retain acceptable accuracy. Methods: An agglomerative hierarchical cluster analysis in 922 patients with advanced cancer identified 7 SCs. We conducted the same analysis on an additional 181 cancer patients to assess cluster consistency. The most prevalent symptom within each cluster was defined as the ‘‘sentinel’’ symptom. Positive predictive value (PPV) and negative predictive value (NPV) were calculated to assess ability of the sentinel symptom to predict other symptoms in the cluster. Results: Similar clusters were identified in both data sets, which included nausea/vomiting, neuropsychologic, and aerodigestive clusters. When the sentinel symptom was present, >50% nonsentinel symptoms in a cluster were present; when absent, <50% nonsentinel symptoms were identified. However, the range for PPV and NPV of the sentinel symptom to identify other symptoms in the cluster was 19% to 72% and 41% to 95%, respectively. Conclusions: Consistent SCs were found in 2 separate data sets with the same assessment tool and statistical analysis. These findings support the statistical and clinical validity of the cluster concept through consistency between different populations. The nausea/vomiting, neuropsychologic, and aerodigestive clusters may be reliable for use in assessment. The presence or absence of a sentinel symptom in each cluster did not predict the presence or absence of other symptoms in the cluster. Sentinel symptoms are inadequate to assess symptom burden.
Building Student Competency to Develop Power and Influence Through Social Capital
Authors: Van Buren Harry J. , Hood Jacqueline N.
Published: May 2010

The course discussed in this article uses an integrative approach in presenting the concept of social capital and power to Executive MBA students at a large public university in the southwestern United States, where a majority of the students are members of non-dominant racial, gender and ethnicity groups. The article describes the theoretical constructs of social capital, power, and influence; notes how ascribed characteristics such as race and gender affect social capital and power; discusses how the application of these constructs can be understood in the context of organizations; and presents examples of student writings used to assess learning outcomes.
A Case of Difficulty Predicting Neurological Deficit During Thoracoabdominal Aortic Surgery
Authors: Leff Jonathan D. , Sudheera K.S. , Shore-Lesserson Linda
Published: May 2010

Perioperative spinal cord injury associated with thoracoabdominal aorta (TAAA) surgery is a devastating complication. With variable results, the intraoperative use of neurophysiologic monitoring has been employed for the diagnosis and prevention of spinal cord ischemia. We present a case report of a patient undergoing TAAA surgery with the use of evoked potential monitoring. Intraoperatively, both sensory and motor evoked potentials were utilized and consequently the patient experienced changes in monitoring consistent with a new neurologic deficit. However, postoperatively these changes in evoked potentials never manifested in neurologic injury. We examine the utility of neurophysiologic monitoring as it pertains to TAAA surgery.
The Importance of Oral Health for Cardiothoracic and Vascular Patients
Authors: Yasny Jeffrey
Published: May 2010

Prior to cardiothoracic or vascular surgery, a patient's oral health is not usually a high priority for the surgical team. Yet, oral neglect often mirrors systemic disease and the need for proper dental care is often unmet. In the perioperative period, the presence of untreated decayed teeth and periodontal disease can result in a potent odontogenic infection with significant consequences. Patients can unknowingly present for such operations with undetected oral infections that can magnify the likelihood of an adverse outcome, increase costs, morbidity, and possibly mortality. Considering scheduling constraints and the urgency of the procedure, a pre-operative dental screening is suggested for patients who undergo elective cardiothoracic or vascular surgery, to ensure that any oral infection is diagnosed and definitively treated. Implementing such an effective and preventive approach can improve surgical outcome and overall patient health.
Highlights of Anesthetic Considerations for Intraoperative Neuromonitoring
Authors: Deiner Stacie
Published: May 2010

Though relatively new, intraoperative neurophysiological monitoring (IONM) has become standard of care for many neurosurgical procedures. The use of IONM has substantially decreased the rate of paralysis after deformity surgery, and has been validated in cervical spine surgery, and thoracic and lumbar laminectomy ((1) (2), (3). The main modalities are: somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), and electromyography (EMGs). Each test examines a functionally separate area of the spinal cord, which test is chosen depends on the location of the surgery and the patient’s preexisting injuries and deficits (6). Inhaled anesthetics decrease the waveform amplitude and increase latency, intravenous anesthetics have the same effect but to a lesser degree. Best anesthetic regimen for surgery involving intraoperative monitoring is controversial. Both inhaled and intravenous agents depress signal attainment, however for equal MAC concentrations inhaled agents cause more depression(11).

While studies have shown that halogenated agents and nitrous oxide do in fact depress MEP signals more than total intravenous anesthesia, less is known on the relationship between IONM and patient characteristics. Lo’s study documenting MEP attainment with 0.5 MAC was done in an otherwise healthy scoliosis population (12), and no study to date has analyzed signal attainment in correlation with patient characteristics and anesthetic technique. While it is clear that anesthetic technique is extremely important, certain patient characteristics appear to be more common in difficult to monitor patients. The identification of these characteristics would suggest to the anesthesiologist the need for a more stringent technique (TIVA) and avert surgical delay or cancellation due to inability to obtain baseline or worse- loss of intraoperative waveform and need for a Stagnara wake-up test. Our group at Mt. Sinai has retrospectively studied patient characteristics, anesthetic technique and attainment of neuromonitoring signals. Hypertension and diabetes are independent predictors of monitoring failure, and these are preferentially sensitive to inhalational agents. Age and weight are also predictors, but less significant.

In summary, neurophysiologic monitoring has evolved to be a consistent part of many procedures. The anesthesiologist should strive to understand the rationale behind monitoring and the basis of its utility. IONM has many implications for anesthetic technique and need for control of the physiologic milieu. With this knowledge the anesthesiologist can work together with the neuromonitoring team and surgeon to ensure patient safety during and after surgery.
Anesthesia Considerations for the Patient With Acute Ischemic Stroke
Authors: Shaikh Shaheen
Published: May 2010

Stroke is the leading cause of long-term disability in the United States. Hence immediate diagnosis must be made by CT or MRI and therapy instituted rapidly. Anesthesiologists must be aware of the concept of “penumbra” and maintain collateral flow. Blood pressure management is crucial. American Stroke Council recommends blood pressure reduction if systolic >220 mm Hg and diastolic >120 mm Hg. However if thrombolytic therapy is being used, blood pressure must be reduced to systolic <180 mmHg and diastolic < 105 mm Hg. Cerebral autoregulation may be dysfunctional in ischemic brain. Anesthesia management requires control of the airway to prevent aspiration, maintain adequate oxygenation and ventilation, and management of raised intra cranial pressure. Complications of intra-arterial thrombolysis include intracerebral hemorrhage. Frequent neurological exams are warranted. Extensive cerebral swelling may require hemi craniectomy. “Time is Brain” hence urgent thrombolysis is the key to a good outcome.
Heparin-Induced Thrombocytopenia
Authors: Szokol Joseph W.
Published: May 2010

Heparin-induced thrombocytopenia (HIT) is an antibody-mediated reaction caused by exposure to heparin that can lead to devastating thrombotic complications. HIT usually occurs 5 to 10 days after exposure to heparin but can happen more rapidly to patients who are reexposed to heparin within 100 days. The hallmark of this disorder is a sudden drop in platelet count of greater than 50%. Once HIT is suspected the heparin must be immediately discontinued and an anticoagulant (direct thrombin inhibitor or heparinoid) started. For patients presenting for cardiac surgery and cardiopulmonary bypass that have a history of HIT and positive antibodies a direct thrombin inhibitor such as lepirudin, argatroban or bivalirudin must be used in lieu of heparin.
Risk Stratification in Cardiac Surgery
Authors: Ranucci Marco
Published: May 2010

Risk stratification in cardiac surgery is based on different models. The great majority of these models derives from a logistic regression equation, and the resulting risk score attributes a specific value to a number of risk factors. However, the number, definition, and type of risk factors included in each risk score greatly varies. Some of the existing risk models include up to 15-20 risk factors. However, it has been demonstrated that for elective patients a simple risk model based on just three factors (age, creatinine, and ejection fraction) has the same level of accuracy and a much better calibration that more complex models. The main deficiency of all the risk models is that they cannot take into consideration the presence of extreme risk conditions which have a very low prevalence, but which are accompanied by a very high operative mortality rate.
Use of Paravertebral Blockade to Facilitate Early Extubation after Minimally Invasive Cardiac Surgery
Authors: Lynch James J. , Mauermann William J. , Pulido Juan N. , Rehfeldt Kent H. , Torres Norman E.
Published: May 2010

We retrospectively reviewed the first 14 patients who received preoperative paravertebral blockade prior to minimally invasive cardiac surgical procedures. The use of paravertebral blockade along with an anesthetic technique designed to facilitate rapid recovery allowed early extubation in the operating room or intensive care unit in all but one patient. Extubated patients leaving the operating room were comfortable. No postoperative respiratory complications occurred.
Postoperative Recovery Advantages in Patients Undergoing Thyroid and Parathyroid Surgery Under Regional Anesthesia
Authors: Suri K.B. , Hunter C.W. , Davidov T. , Anderson M.B. , Dombrovskiy V. , Trooskin S.Z.
Published: May 2010

Thyroid or parathyroid surgery may be performed using general anesthesia or regional anesthesia. Ninety-five (95) patients underwent thyroid or parathyroid surgery using general anesthesia (n=64) or bilateral superficial cervical plexus block with sedation (n=31) and completed a postoperative questionnaire regarding the perioperative experience. Patients undergoing parathyroid surgery under regional anesthesia (n=24) were more likely to experience better energy levels (p=0.012) and earlier return to work (p=0.045) postoperatively. Overall, 96% of patients undergoing either type of surgery with either type of anesthetic reported satisfaction with the anesthetic.
Challenging Cases in Pediatric Anesthesia
Authors: Chietero Michael
Published: May 2010

Administering anesthesia to pediatric patients can always be challenging, especially for the nonpediatric anesthesiologist. Certain types of pathology and non—operating room settings can make these cases even more of a challenge, even for the most skilled pediatric anesthesiologist. This article will outline a few of these special situations, and attempt to give the practitioner an approach to the management of these patients.
Transcatheter Repair of Perivalvular Regurgitation
Authors: Love Barry A. , Fischer Gregory W. , Mittnacht Alexander , Kalman Jill , Adams David H.
Published: May 2010

Hemodynamically significant perivalvular regurgitation affects about 1.5% of all prosthetic valve implants. Reoperation carries increased risk—especially in the setting of concomitant comorbidities of left ventricular dysfunction, prior coronary artery bypass grafts, renal dysfunction, and advanced age. Transcatheter closure of the perivalvular regurgitant channel using a variety of occluders has been available for several years; however, recent improvements in technology and technique have made this therapy more effective and available to a wider group of patients. This article describes the recent advances and the state of the art of this therapy.
Invitation to Mapping: How GIS Can Facilitate New Discoveries in Urban and Planning History
Authors: Hillier Amy
Published: May 2010

Urban and planning historians frequently focus on inherently spatial topics such as migration, segregation, gentrification, and suburbanization and rely on historical maps as primary sources, but they rarely use geographic information systems (GIS) as a research method for analyzing spatial patterns. This article considers the reasons that GIS is not used more, including longstanding ambivalence about quantitative methods and limited training opportunities. It then outlines ways in which GIS can uniquely inform historical research—by emphasizing underlying spatial processes, making spatial patterns visible, and transforming mapping into a process—in ways that can refine and challenge existing urban historical narratives. Finally, recommendations for overcoming existing barriers to historical GIS are presented.
Martin Meyerson and Jaqueline Tyrwhitt and the Global Exchange of Planning Ideas
Authors: Shoshkes Ellen
Published: May 2010

This article examines one facet of Martin Meyerson’s internationalism, by tracing the work he did with the English town planner, educator, and editor Jaqueline Tyrwhitt. Their professional association began in 1948, when Meyerson was the editor of the journal TASK. They became collaborators while both were on the faculty of Harvard University’s Graduate School of Design (GSD). They remained colleagues as participants in the ten annual international conferences—the Delos Symposia—hosted by Constantinos Doxiadis, beginning in1963. Consideration of their association spanning four decades illuminates the increasingly international dimension of Meyerson’s work, which parallels the internationalization of urban planning and design as a discipline, within an increasingly internationalized university.
Mobile phones: emerging threat for infection control
Authors: Srikanth Padma , Rajaram Ezhilarasan , Sudharsanam Suchithra , Lakshmanan Anandhi , Mariappan Umamageswari Sivamurugan Sangappan , Jagannathan Kalyani
Published: May 2010

This study was conducted to determine whether mobile phones of healthcare workers (HCWs) and T corporate users harbour micro-organisms. Swabs collected from mobile phones were inoculated in solid and liquid media, and incubated aerobically. Growth was identified as per standard microbiological procedures. Antibiotic susceptibility was determined for Staphylococcus aureus. A questionnaire was used for data collection on awareness of mobile phone use. Of 51 HCWs and 36 corporate mobile phones sampled, only 5 (6%) showed no growth. Pathogens isolated from HCW samples included S. aureus [meticillin-sensitive S. aureus (4), meticillin-resistant S. aureus (2)], Escherichia coli (1), Klebsiella pneumoniae (1) and Pseudomonas aeruginosa (1). Coagulase-negative Staphylococci (43) were also isolated. Among corporate isolates, 29% were pathogenic. Polymicrobial growth was detected in 71% of HCW and 78% of corporate mobile phones. Only 12% of HCWs used disinfectants to wipe their mobile phones. Mobile phones serve as a ready surface for colonisation of nosocomial agents indicating the importance of hand hygiene to prevent cross-transmission.
Survey of healthcare-associated infection rates in a nursing home resident population
Authors: Roberts C. , Roberts J. , Roberts RJ
Published: May 2010

In this study we assessed the incidence and types of healthcare-associated infection (HCAI) in a nursing home resident population. The influences of home size, resident category, gender and age were also examined. Fifteen homes were recruited and infection rates recorded from 1 October 2006 to 2 December 2006. A rate of 6.04 infections/1000 bed days was recorded for the complete study. Infection rates for the four main categories of infection (number of infections/ 1000 bed days) were respiratory (2.52), urinary (1.87), skin and soft tissue (1.57) and gastrointestinal (0.41). Infection rates for small, medium and large homes were 4.64 (range 1.95—6.51), 5.9 (range 0.49—10.76) and 7.79 (range 5.79—9.39), respectively; however, statistical significance was not achieved ( p = 0.335). Results indicate that respiratory infection rates are higher in larger homes (4.08) than in small (1.88) or medium size homes (2.22). Urinary infection rates were similar in small (1.89), medium (1.88) and large (1.82) homes and skin and soft tissue infections were lower in small homes (0.87) but similar in medium (1.69) and large (1.90) homes. We found a statistically significant relationship between the type of infection acquired and both resident category ( p = 0.017) and gender ( p = 0.005); the relationship between type of infection and age did not reach statistical significance ( p = 0.346).
Review: Combination therapy in high-risk stage II or stage III colon cancer: current practice and future prospects
Authors: Assed Bastos Diogo , Coelho Ribeiro Suilane , de Freitas Daniela , Hoff Paulo M.
Published: May 2010

Colon cancer represents the second leading cause of cancer-related deaths. For patients who have undergone curative surgery, adjuvant therapy can reduce the risk of recurrence and death from relapsed or metastatic disease. Postoperative chemotherapy with a 5-fluorouracil-based regimen combined with oxaliplatin is the current standard of care for stage III patients. However, there is still controversy in stage II disease about the real impact of adjuvant monotherapy or combined therapy on survival. Better identification of a subgroup of patients with a higher risk of recurrence can select patients who might benefit from adjuvant therapy. For the elderly population, there is a well-established role for postoperative therapy, although the most appropriate regimen remains to be defined. Targeted agents for combined adjuvant therapy in stage II and III colon cancer is a promising area, but to date, there is no evidence supporting its use in this setting. Results from large prospective trials with targeted therapy have been disappointing and new drugs and strategies are needed to define the role of these types of agents in the adjuvant scenario of colon cancer.
The emerging role of epidermal growth factor receptor (EGFR) inhibitors in first-line treatment for patients with advanced non-small cell lung cancer positive for EGFR mutations
Authors: Okamoto Isamu , Mitsudomi Tetsuya , Nakagawa Kazuhiko , Fukuoka Masahiro
Published: May 2010

Gefitinib and erlotinib, small-molecule tyrosine kinase inhibitors (TKIs) of the epidermal growth factor receptor (EGFR), were the first molecularly targeted agents to become clinically available for the treatment of non-small cell lung cancer (NSCLC). During the course of their clinical development, it has become clear that the substantial clinical benefit associated with EGFR-TKIs is limited to patients harboring activating mutations of EGFR. Accumulating clinical outcomes in patients with EGFR mutation-positive NSCLC treated with EGFR-TKIs support the notion that this group of individuals constitutes a clinically distinct population. These findings have prompted investigations of the potential role of first-line treatment with EGFR-TKIs in molecularly selected patients, with platinum-based doublet chemotherapy currently being the standard of care for most individuals with advanced NSCLC. This review summarizes the results of recent clinical trials of EGFR-TKIs in selected patients and highlights the efficacy of these drugs in first-line treatment as a form of personalized medicine aimed at improving therapy for advanced NSCLC.
What Defines an Intensive Care Unit?
Authors: Marik Paul E.
Published: May 2010

An ICU is a geographically distinct area of a hospital where critically ill and injured patients undergo continuous monitoring and support of failing organ systems. Although a number of ICU organizational models exist, the optimal model requires the frequent presence of intensivists at the patient’s bedside supported by a multidisciplinary team of health care professionals. This article explores the history of critical care medicine and the evolution of different staffing models.
An Evidence-Based Approach for Integrating Bedside Ultrasound Into Routine Practice in the Assessment of Undifferentiated Shock
Authors: Elmer Jonathan , Noble Vicki E.
Published: May 2010

Undifferentiated hypotension remains a central diagnostic and therapeutic challenge in emergency and critical care medicine. Increasingly, bedside ultrasound conducted by intensivists and emergency medicine providers is assuming a central role in diagnosis and resuscitation of hypotension. This review discusses sample algorithms for the bedside ultrasonographic assessment of undifferentiated shock and outlines an evidence-based framework for the intensivist seeking to incorporate bedside ultrasound into daily clinical practice. The literature regarding specific applications including cardiac, thoracic, pulmonary, and vascular assessment is briefly reviewed, as is the evidence pertaining to effective implementation, training, credentialing, and ongoing quality assurance.
Atypical Thyroid Storm Caused by Metamorphosis of Thyroid Autoimmunity
Authors: Milanesi Anna , Kelekar Gauri , Yu Run
Published: May 2010

Objective: To describe a rare case of thyroid storm with atypical presentation resulting from conversion of Hashimoto’s thyroiditis with hypothyroidism to Graves’ disease. Methods: The authors present a case report, including the detailed clinical, laboratory, and radiographic data. They also review other significant reports available in the literature. Results: A 61-year-old woman with a history of long-standing hypothyroidism and more recently of erratic behavior, hallucination, and polysubstance abuse presented to the hospital with altered mental status. In the following 3 days, she developed lethargy, tachycardia, respiratory failure, and severe lactic acidosis. She was afebrile. Clinical features, thyroid function tests, thyroid antibody panel, and thyroid ultrasound were indicative of Graves’ disease developed on a preexisting Hashimoto’s thyroiditis. Clinical conditions rapidly improved after initiation of treatment for thyroid storm. Conclusion: This is the first reported case of thyroid storm resulting from conversion of hypothyroidism due to Hashimoto’s thyroiditis to Graves’ hyperthyroidism. Moreover, the case suggested that an atypical presentation of thyroid storm without fever could be a negative prognostic sign because of the possible association with severe lactic acidosis.
Significant Reduction of Ventilator-Associated Pneumonia Rates Associated With the Introduction of a Prevention Protocol and Maintained for 10 Years
Authors: Korah J. M. , Rumbak Mark J. , Cancio M. R. , Solomon D. A.
Published: May 2010

Objective: To determine if the institution of a ventilator-associated pneumonia (VAP) prevention protocol was associated with VAP decrease in mechanically ventilated patients at a long-term acute care (LTAC) hospital over time. Introduction: VAP is the most common serious nosocomial infectious disease in mechanically ventilated patients. It has a high mortality and morbidity and significantly increases the cost of care. Design: A prospective preintervention and postintervention observational study comparing the number of episodes of VAP per 1000 patient ventilator-days in the 16 months preceding and 120 months (10 years) after the introduction of a VAP prevention protocol. Setting: A 73-bed, university-affiliated LTAC hospital. Methods: The implementation of a VAP prevention protocol included the following: (1) head of bed raised at 30°; (2) twice-weekly whole-body chlorhexidine-based bath with mupirocin 2% ointment applied to nares; (3) adequate hand washing; (4) adequate nutrition; (5) early tracheotomy by Day 7 if patients had endotracheal tubes; (6) monitor staff compliance; (7) infection control–run campaign involving posters, handouts, small group education events, positive reinforcement of good infection control practices, and focus on hand washing and universal precautions. Results: The initial VAP rate of 6.1 fell to 1.98/1000 ventilator-days within 5 months ( P < .001), and this was maintained. Relative risk was 0.32 ( P = .001) (68% relative risk reduction). Conclusion: The institution of a VAP prevention protocol showed a significant reduction in VAP episodes after the first 5 months of implementation. This rate was sustained for 10 years.
Isolation and characterization of endosteal niche cell populations that regulate hematopoietic stem cells
Authors: Nakamura Yuka , Arai Fumio , Iwasaki Hiroko , Hosokawa Kentaro , Kobayashi Isao , Gomei Yumiko , Matsumoto Yoshiko , Yoshihara Hiroki , Suda Toshio
Published: May 2010

The endosteal niche is critical for the maintenance of hematopoietic stem cells (HSCs). However, it consists of a heterogeneous population in terms of differentiation stage and function. In this study, we characterized endosteal cell populations and examined their ability to maintain HSCs. Bone marrow endosteal cells were subdivided into immature mesenchymal cell-enriched ALCAM−Sca-1+ cells, osteoblast-enriched ALCAM+Sca-1−, and ALCAM–Sca-1− cells. We found that all 3 fractions maintained long-term reconstitution (LTR) activity of HSCs in an in vitro culture. In particular, ALCAM+Sca-1− cells significantly enhanced the LTR activity of HSCs by the up-regulation of homing- and cell adhesion–related genes in HSCs. Microarray analysis showed that ALCAM−Sca-1+ fraction highly expressed cytokine-related genes, whereas the ALCAM+Sca-1− fraction expressed multiple cell adhesion molecules, such as cadherins, at a greater level than the other fractions, indicating that the interaction between HSCs and osteoblasts via cell adhesion molecules enhanced the LTR activity of HSCs. Furthermore, we found an osteoblastic markerlow/− subpopulation in ALCAM+Sca-1− fraction that expressed cytokines, such as Angpt1 and Thpo, and stem cell marker genes. Altogether, these data suggest that multiple subsets of osteoblasts and mesenchymal progenitor cells constitute the endosteal niche and regulate HSCs in adult bone marrow.
Complement inhibition decreases the procoagulant response and confers organ protection in a baboon model of Escherichia coli sepsis
Authors: Silasi-Mansat Robert , Zhu Hua , Popescu Narcis I. , Peer Glenn , Sfyroera Georgia , Magotti Paola , Ivanciu Lacramioara , Lupu Cristina , Mollnes Tom E. , Taylor Fletcher B. , Kinasewitz Gary , Lambris John D. , Lupu Florea
Published: May 2010

Severe sepsis leads to massive activation of coagulation and complement cascades that could contribute to multiple organ failure and death. To investigate the role of the complement and its crosstalk with the hemostatic system in the pathophysiology and therapeutics of sepsis, we have used a potent inhibitor (compstatin) administered early or late after Escherichia coli challenge in a baboon model of sepsis-induced multiple organ failure. Compstatin infusion inhibited sepsis-induced blood and tissue biomarkers of complement activation, reduced leucopenia and thrombocytopenia, and lowered the accumulation of macrophages and platelets in organs. Compstatin decreased the coagulopathic response by down-regulating tissue factor and PAI-1, diminished global blood coagulation markers (fibrinogen, fibrin-degradation products, APTT), and preserved the endothelial anticoagulant properties. Compstatin treatment also improved cardiac function and the biochemical markers of kidney and liver damage. Histologic analysis of vital organs collected from animals euthanized after 24 hours showed decreased microvascular thrombosis, improved vascular barrier function, and less leukocyte infiltration and cell death, all consistent with attenuated organ injury. We conclude that complement-coagulation interplay contributes to the progression of severe sepsis and blocking the harmful effects of complement activation products, especially during the organ failure stage of severe sepsis is a potentially important therapeutic strategy.
Are antibody deficiency disorders associated with a narrower range of cancers than other forms of immunodeficiency?
Authors: Vajdic Claire M. , Mao Limin , van Leeuwen Marina T. , Kirkpatrick Philippa , Grulich Andrew E. , Riminton Sean
Published: May 2010

Analysis of cancer risk in primary immune deficiency (PID) offers insight into the relationship between immune function and cancer. Data on Australian patients (n = 1132) notified voluntarily to the Australasian Society of Clinical Immunology and Allergy PID Registry (1990-2008) were linked with national death and cancer registries. Person-years of follow-up commenced from up to 15 years before registration on the PID Registry or January 1982, the inception of national cancer registration. Site-specific, 5-year age-, sex-, calendar year–, and state-standardized incidence ratios (SIRs) with 95% confidence intervals (95% CIs) were calculated for all cancers except nonmelanocytic skin cancer. During an average of 16 person-years follow-up, a 1.6-fold excess relative risk of cancer was observed (n = 58; SIR 1.60, 95% CI 1.22-2.07) for all PID combined. Relative risk was increased for non-Hodgkin lymphoma (n = 16; SIR 8.82, 95% CI 5.04-14.30), leukemia (n = 4; SIR 5.36, 95% CI 1.46-13.73), and stomach cancer (n = 3; SIR 6.10, 95% CI 1.26-17.84). Excess cancer risk was observed for predominantly antibody deficiencies and other well-defined immunodeficiency syndromes. Results suggest that predominantly antibody deficiencies may be associated with a narrower range of solid cancers than immunodeficiency characterized by predominantly T-cell deficiency, such as iatrogenic and HIV-related immunodeficiency, although this requires confirmation in larger cohorts.
New components of the Dictyostelium PKA pathway revealed by Bayesian analysis of expression data
Authors: Parikh Anup , Huang Eryong , Dinh Christopher , Zupan Blaz , Kuspa Adam , Subramanian Devika , Shaulsky Gad
Published: May 2010

Background

Identifying candidate genes in genetic networks is important for understanding regulation and biological function. Large gene expression datasets contain relevant information about genetic networks, but mining the data is not a trivial task. Algorithms that infer Bayesian networks from expression data are powerful tools for learning complex genetic networks, since they can incorporate prior knowledge and uncover higher-order dependencies among genes. However, these algorithms are computationally demanding, so novel techniques that allow targeted exploration for discovering new members of known pathways are essential.

Results

Here we describe a Bayesian network approach that addresses a specific network within a large dataset to discover new components. Our algorithm draws individual genes from a large gene-expression repository, and ranks them as potential members of a known pathway. We apply this method to discover new components of the cAMP-dependent protein kinase (PKA) pathway, a central regulator of Dictyostelium discoideum development. The PKA network is well studied in D. discoideum but the transcriptional networks that regulate PKA activity and the transcriptional outcomes of PKA function are largely unknown. Most of the genes highly ranked by our method encode either known components of the PKA pathway or are good candidates. We tested 5 uncharacterized highly ranked genes by creating mutant strains and identified a candidate cAMP-response element-binding protein, yet undiscovered in D. discoideum, and a histidine kinase, a candidate upstream regulator of PKA activity.

Conclusions

The single-gene expansion method is useful in identifying new components of known pathways. The method takes advantage of the Bayesian framework to incorporate prior biological knowledge and discovers higher-order dependencies among genes while greatly reducing the computational resources required to process high-throughput datasets.
In-silico prediction of blood-secretory human proteins using a ranking algorithm
Authors: Liu Qi , Cui Juan , Yang Qiang , Xu Ying
Published: May 2010

Background

Computational identification of blood-secretory proteins, especially proteins with differentially expressed genes in diseased tissues, can provide highly useful information in linking transcriptomic data to proteomic studies for targeted disease biomarker discovery in serum.

Results

A new algorithm for prediction of blood-secretory proteins is presented using an information-retrieval technique, called manifold ranking. On a dataset containing 305 known blood-secretory human proteins and a large number of other proteins that are either not blood-secretory or unknown, the new method performs better than the previous published method, measured in terms of the area under the recall-precision curve (AUC). A key advantage of the presented method is that it does not explicitly require a negative training set, which could often be noisy or difficult to derive for most biological problems, hence making our method more applicable than classification-based data mining methods in general biological studies.

Conclusion

We believe that our program will prove to be very useful to biomedical researchers who are interested in finding serum markers, especially when they have candidate proteins derived through transcriptomic or proteomic analyses of diseased tissues. A computer program is developed for prediction of blood-secretory proteins based on manifold ranking, which is accessible at our website http://csbl.bmb.uga.edu/publications/materials/qiliu/blood_secretory_protein.html.
High quality protein sequence alignment by combining structural profile prediction and profile alignment using SABERTOOTH
Authors: Teichert Florian , Minning Jonas , Bastolla Ugo , Porto Markus
Published: May 2010

Background

Protein alignments are an essential tool for many bioinformatics analyses. While sequence alignments are accurate for proteins of high sequence similarity, they become unreliable as they approach the so-called 'twilight zone' where sequence similarity gets indistinguishable from random. For such distant pairs, structure alignment is of much better quality. Nevertheless, sequence alignment is the only choice in the majority of cases where structural data is not available. This situation demands development of methods that extend the applicability of accurate sequence alignment to distantly related proteins.

Results

We develop a sequence alignment method that combines the prediction of a structural profile based on the protein's sequence with the alignment of that profile using our recently published alignment tool SABERTOOTH. In particular, we predict the contact vector of protein structures using an artificial neural network based on position-specific scoring matrices generated by PSI-BLAST and align these predicted contact vectors. The resulting sequence alignments are assessed using two different tests: First, we assess the alignment quality by measuring the derived structural similarity for cases in which structures are available. In a second test, we quantify the ability of the significance score of the alignments to recognize structural and evolutionary relationships. As a benchmark we use a representative set of the SCOP (structural classification of proteins) database, with similarities ranging from closely related proteins at SCOP family level, to very distantly related proteins at SCOP fold level. Comparing these results with some prominent sequence alignment tools, we find that SABERTOOTH produces sequence alignments of better quality than those of Clustal W, T-Coffee, MUSCLE, and PSI-BLAST. HHpred, one of the most sophisticated and computationally expensive tools available, outperforms our alignment algorithm at family and superfamily levels, while the use of SABERTOOTH is advantageous for alignments at fold level. Our alignment scheme will profit from future improvements of structural profiles prediction.

Conclusions

We present the automatic sequence alignment tool SABERTOOTH that computes pairwise sequence alignments of very high quality. SABERTOOTH is especially advantageous when applied to alignments of remotely related proteins. The source code is available at http://www.fkp.tu-darmstadt.de/sabertooth_project/, free for academic users upon request.
Phylogenetic nomenclature and evolution of mannose-binding lectin (MBL2) haplotypes
Authors: Boldt Angelica BW , Messias-Reason Iara J , Meyer Diogo , Schrago Carlos G , Lang Florian , Lell Bertrand , Dietz Klaus , Kremsner Peter G , Petzl-Erler Maria Luiza , Kun Jürgen FJ
Published: May 2010

Background

Polymorphisms of the mannose-binding lectin gene (MBL2) affect the concentration and functional efficiency of the protein. We recently used haplotype-specific sequencing to identify 23MBL2haplotypes, associated with enhanced susceptibility to several diseases.

Results

In this work, we applied the same method in 288 and 470 chromosomes from Gabonese and European adults, respectively, and found three new haplotypes in the last group. We propose a phylogenetic nomenclature to standardizeMBL2studies and found two major phylogenetic branches due to six strongly linked polymorphisms associated with high MBL production. They presented high Fst values and were imbedded in regions with high nucleotide diversity and significant Tajima's D values. Compared to others using small sample sizes and unphased genotypic data, we found differences in haplotyping, frequency estimation, Fu and Li's D* and Fst results.

Conclusion

Using extensive testing for selective neutrality, we confirmed that stochastic evolutionary factors have had a major role in shaping this polymorphic gene worldwide.