bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasibility and acceptability of a decision aid designed for people facing advanced or terminal illness: a pilot randomized trial
Authors: Matlock Dan D. , Keech Tarah A. E. , McKenzie Marlene B. , Bronsert Michael R. , Nowels Carolyn T. , Kutner Jean S.
Published: October 2011

Background  Patients nearing the end of their lives face an array of difficult decisions.

Objective  This study was designed to assess the feasibility and acceptability of a decision aid (DA) designed for patients facing advanced or terminal illness.

Design  We conducted a pilot randomized clinical trial of Health Dialog’s Looking Ahead: choices for medical care when you’re seriously ill DA (booklet and DVD) applied to patients on a hospital‐based palliative care (PC) service.

Setting  University of Colorado Hospital – December 2009 and May 2010.

Participants  All adult, English‐speaking patients or their decision makers were potentially eligible. Patients were not approached if they were in isolation, did not speak English or if any provider felt that they were not appropriate because of issues such as family conflict or actively dying.

Intervention  All participants received a standard PC consultation. Participants in the intervention arm also received a copy of the DA.

Measurements  Primary outcomes included decision conflict and knowledge. Participants in the intervention arm also completed an acceptability questionnaire and qualitative exit interviews.

Results  Of the 239 patients or decision makers, 51(21%) enrolled in the trial. The DA had no significant effect on decision conflict or knowledge. Exit interviews indicated it was acceptable and empowering, although they wished they had access to the DA earlier.

Conclusions  While the DA was acceptable, feasibility was limited by late‐life illness challenges. Future trials of this DA should be performed on patients earlier in their illness trajectory and should include additional outcome measures such as self‐efficacy and confidence.
Pancreatic neuroendocrine tumors in patients with tuberous sclerosis complex
Authors: Larson AM , Hedgire SS , Deshpande V , Stemmer‐Rachamimov AO , Harisinghani MG , Ferrone CR , Shah U , Thiele EA
Published: October 2011

Larson AM, Hedgire SS, Deshpande V, Stemmer‐Rachamimov AO, Harisinghani MG, Ferrone CR, Shah U, Thiele EA. Pancreatic neuroendocrine tumors in patients with tuberous sclerosis complex.

We explored pancreatic neuroendocrine tumors (PanNETs) associated with tuberous sclerosis complex (TSC) to determine their incidence in the TSC population; define their clinical, radiological, and pathological characteristics; and investigate their association with underlying genotypes. Retrospectively reviewed abdominal imaging of 219 patients with TSC, evaluating the incidence, size, and architecture of pancreatic lesions. Pathology records at Massachusetts General Hospital (MGH) were reviewed for all PanNET diagnoses in patients with TSC. Literature was reviewed for TSC‐related PanNET cases. Nine patients with TSC were found to have a pancreatic lesion(s) on abdominal imaging and six patients have been diagnosed with a PanNET by pathology at MGH. Twelve cases of TSC‐associated PanNETs have been reported in the literature. Of these 18 PanNET cases, one third were cystic, and the average age at resection was 26 years. Germline TSC2 mutations were found in all patients for whom genetic data were available (n = 3). We did not identify pancreatic angiomyolipomas in this series. Our results suggest that PanNETs are the most common pancreatic lesion in patients with TSC. Focal pancreatic mass lesions, solid or cystic, in patients with TSC should be considered possible PanNETs, and resection of the lesion may be clinically indicated.
The influence of laboratory‐induced MELD score differences on liver allocation: more reality than myth
Authors: Schouten J.N. , Francque S. , Van Vlierberghe H. , Colle I. , Nevens F. , Delwaide J. , Adler M. , Starkel P. , Ysebaert D. , Gadisseur A. , De Winter B. , Smits J.M. , Rahmel A. , Michielsen P.
Published: October 2011

Schouten JN, Francque S, Van Vlierberghe H, Colle I, Nevens F, Delwaide J, Adler M, Starkel P, Ysebaert D, Gadisseur A, De Winter B, Smits JM, Rahmel A, Michielsen P. The influence of laboratory‐induced MELD score differences on liver allocation: more reality than myth.  Clin Transplant 2012: 26: E62–E70. © 2011 John Wiley & Sons A/S.

Abstract:  Background:  Liver allocation in Eurotransplant (ET) is based on the MELD score. Interlaboratory MELD score differences in INR and creatinine determination have been reported. The clinical implication of this observation has not been demonstrated.

Methods:  MELD scores were calculated in 66 patients with liver cirrhosis using bilirubin, creatinine, and INR analyzed in six liver transplant centers. Based on allocation results of ET, patients transplanted from December 2006 to June 2007 were divided according to MELD score in four groups. For each group, the influence of the match MELD on the probability of receiving a transplant was studied (Cox proportional hazards model).

Results:  Laboratory‐dependent significant differences in MELD score were demonstrated. Cox proportional hazards model showed a significant association between MELD score and the probability of organ allocation. The unadjusted hazard ratio for receiving a liver transplant was significantly different between group 2 and group 4 (group 2: MELD 19–24; group 4: MELD > 30).

Conclusion:  Laboratory‐dependent significant differences in MELD score were observed between the six transplant centers. We demonstrated a significant association between the MELD score and the probability of organ allocation. The observed interlaboratory variation might yield a significant difference in organ allocation in patients with high MELD scores.
Simultaneous pancreas and kidney (SPK) retransplantation in prior SPK recipients
Authors: LaMattina John C. , Sollinger Hans W. , Becker Yolanda T. , Mezrich Joshua D. , Pirsch John D. , Odorico Jon S.
Published: October 2011

LaMattina JC, Sollinger HW, Becker YT, Mezrich JD, Pirsch JD, Odorico JS. Simultaneous pancreas and kidney (SPK) retransplantation in prior SPK recipients.  Clin Transplant 2011 DOI: 10.1111/j.1399‐0012.2011.01540.x.  © 2011 John Wiley & Sons A/S.

Abstract:  Introduction:  We have performed 113 renal and 28 isolated pancreas retransplants in our cohort of more than 1200 prior simultaneous pancreas and kidney (SPK) recipients. On the basis of these experiences, we began performing repeat SPK in prior SPK recipients (n = 9).

Methods:  This retrospective review summarizes our experience with repeat SPK transplantation in prior SPK recipients. Mean age at retransplant was 39 yr; mean interval to retransplant was 7.8 yr. Thirty‐three percent were pre‐dialysis. Eighty‐nine percent of patients underwent transplant nephrectomy (five during the repeat SPK and three prior to it), and 78% underwent transplant pancreatectomy (four during the repeat SPK and three prior to it). Enteric drainage was performed in all repeat SPKs.

Results:  Median length of stay was 11 d. Perioperative complications included the following: renal artery thrombosis (1), pancreatic portal venous thrombosis (1), enteric leak (1), and hematoma (2). Overall pancreatic allograft survival was 78% at one yr and 67% at two yr. Overall renal allograft survival was 89% at one yr and 78% at two yr. Patient survival at one and three yr was 100%.

Conclusions:  Survival of repeat SPK allografts is acceptable despite the increased technical and immunologic demands of retransplantation. Graftectomy prior to or at the time of retransplantation is often necessary.
Health‐related quality of life and employment among renal transplant recipients
Authors: Chisholm‐Burns Marie A. , Erickson Steven R. , Spivey Christina A. , Kaplan Bruce
Published: October 2011

Chisholm‐Burns MA, Erickson SR, Spivey CA, Kaplan B. Health‐related quality of life and employment among renal transplant recipients.  Clin Transplant 2011 DOI: 10.1111/j.1399‐0012.2011.01541.x.  © 2011 John Wiley & Sons A/S.

Abstract:  Objective:  To examine the relationship between health‐related quality of life (HQoL) and employment status in renal transplant recipients (RTRs).

Methods:  Eighty‐two RTRs met inclusion criteria: 21–65 yr of age; greater than one yr post‐transplant; and received calcineurin inhibitors. A cross‐sectional survey was conducted using a demographics questionnaire and the following HQoL instruments: SF‐12 Health Survey version 2 (Physical Component Summary [PCS‐12] and Mental Component Summary [MCS‐12]) and Kidney Transplant Questionnaire (KTQ). Two multivariate logistic regression analyses (SF‐12 model and KTQ model) were conducted to determine whether HQoL and demographic variables were independently associated with employment status.

Results:  Seventy‐five RTRs were included in the analysis. Compared with employed RTRs, a greater number of unemployed RTRs were non‐white, had lower education levels, and had deceased donor transplants (p < 0.05). Employed RTRs had significantly higher SF‐12 scores (p < 0.05). In the SF‐12 logistic regression model, PCS‐12 and education level were significant predictors of employment status (p < 0.05). In the KTQ model, the Fatigue subscale and education level were significant predictors of employment status (p < 0.05).

Conclusions:  Findings suggest higher PCS‐12, higher KTQ‐Fatigue, and education level are independently associated with employment status. Interventions targeted to improve HQoL, decrease fatigue, and increase education level are discussed.
HLA and MICA genes in patients with tuberculosis in Brazil
Authors: Souza C. F. , Noguti E. N. , Visentainer J. E. L. , Cardoso R. F. , Petzl‐Erler M. L. , Tsuneto L. T.
Published: October 2011

Major histocompatibility complex (MHC) genes have been investigated because of their crucial role in the defense against pathogens and their high degree of polymorphism. We performed a case–control study to assess a genetic association of MHC genes with susceptibility to tuberculosis (TB). The allelic lineages HLA‐A*02 and B*18 were significantly less frequent in TB patients (n = 112, 44.6% women) than in controls (n = 224, 51.5% women): 18.8% vs 26.5%; odds ratio (OR) = 0.64; P = 0.037 and 2.7% vs 6.9%; OR = 0.37; P = 0.041. The negative association with haplotype HLA‐B*18‐MICA*018 (2.3% patients vs 6.4% controls; OR = 0.34; P = 0.035) was significant as a consequence of strong linkage disequilibrium (D′ = 0.827 for patients and 0.923 for controls). These findings suggest a trend toward protection of the HLA‐A*02 and HLA‐B*18 alleles.
Peripheral T‐cell lymphoma arising from an intraglandular lymph node in the parotid gland: A case report and literature review
Authors: Yanagawa Naoki , Osakabe Mitsumasa , Furuse Hidekazu , Maeda Kunihiko , Tamura Gen
Published: October 2011

T/NK‐cell lymphoma of the salivary gland is rare. A 58‐year‐old man complained of a tumor mass in the left parotid gland region and he was diagnosed to have a left parotid tumor. The tumor was subsequently resected, revealing a diffuse growth pattern of medium to large sized atypical cells. The tumor was surrounded by fibrous connective tissue in the form of a capsule, and those were positive for CD3, CD4, CD5 and CD30, but negative for Bcl2, CD8, CD10, CD15, CD20, CD25, CD56, CD79a, CD246, EMA, granzyme B, TdT and TIA‐1. There was no molecular evidence of Epstein‐Barr virus (EBV) infection. It was diagnosed as peripheral T‐cell lymphoma (PTCL) arising from an intraglandular lymph node in the parotid gland. In conclusion, Only 17 cases of primary T/NK‐cell lymphoma of the salivary glands have been recorded until now, and the characteristics of these are not clear yet. Additional study is needed.
The Effects of Venture Capitalists on the Governance of Firms
Authors: Bonini Stefano , Alkan Senem , Salvi Antonio
Published: October 2011

Manuscript Type: Empirical

Research Question/Issue: What determines venture capitalists influence on the governance of firms? How do venture capitalists shape the governance of their investees? Are venture capitalists governance practices consistent across countries? These important questions are under‐investigated in the extant literature. In this study, we shed light on the effects of venture capital investors on a large set of governance decisions and we discover the existence of striking cross‐country differences.

Research Findings/Insights: We test our conjectures on a unique hand‐collected questionnaire‐based dataset of 164 companies in five countries and two regions (Europe and the US). Our empirical results show that there is a strong and positive relationship between VCs' funding and their influence on some factors like decisions on CEO hiring, executive compensation, board decisions and appointments. Employee incentives are also positively related to the proportion of VC funding. On the other hand, results show that the proportion of VC funding is only marginally significant in explaining VC influence on strategy direction and investment planning. Our analysis though, offers a remarkably different view after splitting data into European and American subsamples.

Theoretical/Academic Implications: Our results provide a novel view of the functioning of the Venture Capital industry and its degree of pervasiveness in the management of portfolio companies. Adopting a unique dataset, we add new evidence on detailed governance decisions, thus supporting the idea that the incremental contribution of a professional investor to a new venture is largely exceeding the capital infusion only. Finally, we show that governance decisions exhibit significant country effects. This evidence supports the view that a global theory of corporate governance cannot rely on a single interpretation framework such as agency theory, but needs to be integrated with predictions from alternative views such institutional theory.

Practitioner/Policy Implications: Corporate governance is the essential mechanism allowing proper management of financial and corporate resources by aligning incentives of employees and investors, thus enabling oversight and control on companies. Yet, corporate governance rules and mechanisms are costly and have different effectiveness across countries. Our results provide guidance to investors in selecting the appropriate set of governance provisions conditional on a set of investment‐specific factors.
Five‐year experience with incobotulinumtoxinA (Xeomin®): the first botulinum toxin drug free of complexing proteins
Authors: Dressler D.
Published: October 2011

In 2005, incobotulinumtoxinA (Xeomin®), a new botulinum toxin (BT) type A drug without complexing proteins (CPs), became available. This paper reviews the specific features of Xeomin® and the experience gathered with it during the last 5 years. Compared with conventional BT drugs, Xeomin®’s extended shelf live and its simplified temperature restrictions indicate that CPs are not necessary for BT drug stability. Its reduced molecular size does not translate into diffusion differences, and its potency labelling is identical to that of onabotulinumtoxinA (Botox®). With a reduced content of inactivated botulinum neurotoxin, Xeomin® should have reduced antigenicity. Lack of CP’s may further reduce antigenicity. Xeomin®’s therapeutic efficacy against cervical dystonia, blepharospasm and spasticity has been proven in large randomised, double‐blind and placebo‐controlled studies leading to registrations in many countries. Additional successful clinical use in axillary hyperhidrosis, hemifacial spasm, re‐innervation synkinesias and hypersalivation as well as in dystonia and spasticity in extended doses and throughout extended observation periods has been documented meanwhile. Lack of reported cases of antibody‐induced therapy failure (ABF), as to date, support the hypothesis of an improved antigenicity.
Social support in single parents' transition from welfare to work: Analysis of qualitative findings1
Authors: Cook Kay E.
Published: October 2011

Cook KE. Social support in single parents' transition from welfare to work: Analysis of qualitative findings

Since 1995, single parents have been required to participate in welfare‐to‐work activities. While quantitative meta‐analyses have consolidated the social and economic impacts of such transitions, no attempt has yet been made to synthesise the qualitative evidence. In this article, I offer an analysis of 16 qualitative articles that explore the role of social support in the lives of single mothers making the transition from welfare to work. By focusing on the functions and reciprocal nature of social support, this study examined how welfare‐to‐work programmes shift women's dependence from the state onto family and friends, many of whom are in similarly impoverished situations and/or are unable to provide adequate support. Furthermore, women are often required to reciprocate the support they receive, which creates additional barriers to a successful welfare‐to‐work transition.
Cute Masquerade and the Pimping of Japan
Authors: MILLER LAURA
Published: October 2011

This essay will consider gendered aspects of Cool Japan ideology as found in government‐sponsored texts and imagery, as well as in other international arenas. Although scholars have recently offered critiques of Cool Japan as a form of nationalistic nation branding, uses of an objectified femininity have rarely been included in these analyses. By displacing female innovations and creativity in cultural production to the margins, Cool Japan reifies and officially promotes male geek culture. We find general dematerialization of the producers of Cool Japan ideology, which in turn becomes characterized as creative, quirky, edgy, and benign, thus masking the way Cool Japan has been produced, critiqued, imagined and endorsed primarily by male elites in Japan and internationally. This discussion suggests that Cool Japan's otaku ethos does not include women and girls who fail to conform to a narrow model of cute femininity, thus maintaining and promoting structures of gender stratification. In addition, the global spread and government exploitation of uncomplicated cuteness (kawaii) often confounds a flat understanding of the aesthetic with a gendered perspective and its expressions in girl culture. Women and girls are contained in Cool Japan ideology, and are not usually represented as shaping, resisting, creating or critiquing Japanese popular culture.
The Pitfall Facing the Cool Japan Project: The Transnational Development of the Anime Industry under the Condition of Post‐Fordism*
Authors: MŌRI YOSHITAKA
Published: October 2011

This paper examines the way in which the anime industry has developed since the mid‐1960s, by looking at transnational production systems and the international division of labor. First, it tries to demonstrate that anime, though seen both as a cultural product originating from Japan and as an export within the recent Cool Japan project promoted by the Japanese government, has, from the beginning of its history, been a very hybridized product due to the transnational production system, in particular among Japan, Korea and China. Second, the paper also shows how this transnational production system has led to the lasting poor labor conditions suffered by Japanese animators, one of the prototypes for freeters in the 1990s. Third, by examining the anime promotion policy led by the Chinese government, I would like to discuss the possible future of anime production systems in the age of digital production in Asia.
Fabricating Japaneseness? The Identity Politics of Young Designers and Artists in Global Cities
Authors: FUJITA YUIKO
Published: October 2011

The present study explores the identity politics of young Japanese designers and artists working across national boundaries today. It addresses the following research questions: (i) Do young designers and artists aim to produce works with “universal” appeal or strategically make use of “Japaneseness”? (ii) Do they develop new transnational identities or regard themselves as “Japanese”? and (iii) Who do they think has the power to label their works as “Japanese” in the art worlds? For this purpose, I conducted in‐depth interviews with professional designers and artists who have migrated from Japan to London, New York, or Paris. The results show that most designers and artists who were interviewed indeed aim to produce works with “universal” appeal, while only a few respondents attempt to strategically express “Japaneseness” in their works. However, regardless of whether they make use of “Japaneseness” or not, all respondents regard themselves as “Japanese” without developing new transnational identities. Even so, they do not search for or hold onto Japaneseness; but rather the media, as well as a certain part of the art world, persistently attempt to emphasize “Japaneseness,” due to the structure of the art world, where whiteness continues to be the “norm.” While designers and artists are increasingly oriented toward creating works with new forms and values through the transnational production system, gatekeepers and legitimators of the art world continue to fabricate “the nation” and reinforce boundaries of national culture.
Social Integration in Post‐Multiculturalism: An Analysis of Social Integration Policy in Post‐war Britain
Authors: ADACHI SATOSHI
Published: October 2011

Social integration is one of the most urgent issues in Western countries, where cultural diversity has been recognized to make social unity danger. In the past, social integration used to be tackled by multiculturalism, which was an effort to recognize cultural diversity as a positive aspect of society. However, multiculturalism is losing the moral support of society because multiculturalism itself could not be a social glue among different people; rather it is thought to make society unstable. Thus, a new philosophy and policy is required to manage the issues of social integration in a globalized social environment. In order to create social integration, on one hand, people with different backgrounds need to share the same concept of society. On the other hand, people have to become accustomed to cultural diversity. However, this is not easily accomplished because both measures for social integration seem to be politically contradictory and incompatible. How, and by what reasons, could these two conditions of social integration be satisfied? To answer this question, this paper scrutinizes the changes in social integration policy in post‐war Britain. I divide social integration policy in Britain into three stages focusing on the relationship between social unity and cultural diversity: from after World War II to 1979; Thatcher's and Major's Conservative Governments; and Blair's new Labour Government. The social integration policy and philosophy of the new Labour Government in particular is important because it represents post‐multiculturalism discourse for social integration. The Labour Government tried to establish social integration by introducing an abstract common identity, which both the majority and minority groups could accept and which is compatible with various cultural or religious conventions and teaching, as it were, citizenship and Britishness, as a set of liberal values. Although the Labour Government's policy itself was controversial, it is giving us a reference point for the debate on social integration in a post‐multicultural era.
Upping the antedrug: is a novel anti‐inflammatory Toll‐like receptor 7 agonist also a bronchodilator?
Authors: Kaufman EH , Jacoby DB
Published: October 2011

In this issue of British Journal of Pharmacology, Biffen and colleagues present a novel Toll‐like receptor 7 (TLR7) antedrug to treat allergic disease that is rapidly metabolized in the lung to limit side effects due to systemic exposure. Asthma is characterized as an allergic disease of the lung, and TLR7 agonists are proposed to ameliorate allergic inflammation in the lung, a characteristic of prophylactic medications. We have previously shown that TLR7 agonists of multiple structural classes are acute bronchodilators, characteristic of rescue medication for asthma attacks. It will be interesting to determine whether the bronchodilating effect extends to the novel class of TLR7 agonists described here for a prophylactic and rescue therapy in one drug. Combined with the antedrug approach, this would further limit side effects improving on current combination therapies.

LINKED ARTICLE This article is a commentary on Biffen et al., pp. 573–586 of this issue. To view this paper visit http://dx.doi.org/10.1111/j.1476‐5381.2011.01790.x
The gastrointestinal peptide obestatin induces vascular relaxation via specific activation of endothelium‐dependent NO signalling
Authors: Agnew Andrew J , Robinson Emma , McVicar Carmel M , Harvey Adam P , Ali Imran HA , Lindsay Jennifer E , McDonald Denise M , Green Brian D , Grieve David J
Published: October 2011

BACKGROUND AND PURPOSE Obestatin is a recently discovered gastrointestinal peptide with established metabolic actions, which is linked to diabetes and may exert cardiovascular benefits. Here we aimed to investigate the specific effects of obestatin on vascular relaxation.

EXPERIMENTAL APPROACH Cumulative relaxation responses to obestatin peptides were assessed in rat isolated aorta and mesenteric artery (n≥ 8) in the presence and absence of selective inhibitors. Complementary studies were performed in cultured bovine aortic endothelial cells (BAEC).

KEY RESULTS Obestatin peptides elicited concentration‐dependent relaxation in both aorta and mesenteric artery. Responses to full‐length obestatin(1–23) were greater than those to obestatin(1–10) and obestatin(11–23). Obestatin(1–23)‐induced relaxation was attenuated by endothelial denudation, l‐NAME (NOS inhibitor), high extracellular K+, GDP‐β‐S (G‐protein inhibitor), MDL‐12,330A (adenylate cyclase inhibitor), wortmannin (PI3K inhibitor), KN‐93 (CaMKII inhibitor), ODQ (guanylate cyclase inhibitor) and iberiotoxin (BKCa blocker), suggesting that it is mediated by an endothelium‐dependent NO signalling cascade involving an adenylate cyclase‐linked GPCR, PI3K/PKB, Ca2+‐dependent eNOS activation, soluble guanylate cyclase and modulation of vascular smooth muscle K+. Supporting data from BAEC indicated that nitrite production, intracellular Ca2+ and PKB phosphorylation were increased after exposure to obestatin(1–23). Relaxations to obestatin(1–23) were unaltered by inhibitors of candidate endothelium‐derived hyperpolarizing factors (EDHFs) and combined SKCa/IKCa blockade, suggesting that EDHF‐mediated pathways were not involved.

CONCLUSIONS AND IMPLICATIONS Obestatin produces significant vascular relaxation via specific activation of endothelium‐dependent NO signalling. These actions may be important in normal regulation of vascular function and are clearly relevant to diabetes, a condition characterized by endothelial dysfunction and cardiovascular complications.
Effect of inorganic anions on the photocatalytic decolorisation of an azo dye in the aqueous phase by cadmium sulphide/polymer nanocomposite films under visible light irradiation
Authors: Jiang Ru , Guan Yujiang , Zhu Huayue , Fu Yongqian
Published: October 2011

Batch experiments were carried out to study the effects of various inorganic anions on the photocatalytic decolorisation of an azo dye (CI Methyl Orange 13025) in the aqueous phase in the presence of cadmium sulphide/polymer nanocomposite films under visible light irradiation. When anion concentrations were low (0.001 m), the inhibition effect on the photocatalytic decolorisation of CI Methyl Orange 13025 caused by these anions was ranked as . The presence of both and baffled the breakage of the benzene ring in the chemical structure of CI Methyl Orange 13025, while the presence of was of benefit to the degradation of the benzene ring. Adsorption experiments indicated that inorganic anions affected the decolorisation of CI Methyl Orange 13025 by competitive adsorption onto the surface of the photocatalyst. The photocatalytic decolorisation of CI Methyl Orange 13025 followed the pseudo‐first‐order kinetic reaction model well in all experimental cases.
Inotropic drugs and their uses in critical care
Authors: Parry Andrew
Published: October 2011

The aim of this article was to provide a resource for critical care nurses wishing to further their understanding of inotropic drugs used in critical care. The physiology of cardiac output and blood pressure is examined along with an explanation of adrenergic receptors acted on by inotropes. Some common indications for inotropic therapy are discussed, along with essential patient monitoring and dose calculations to ensure safe therapeutic ranges are observed. Some of the most commonly used positive inotropes used in critical care environments are individually explored, providing indications and some of the latest research relating to their uses. Frequently, observed side effects of individual inotropes are also offered, enabling the nurse to maintain patient safety when administering these potent drugs. Some major nursing and professional issues related to inotrope therapy and medicine administration are discussed, as well as some recommended practices in renewing infusions.
For Shame: Feminism, Breastfeeding Advocacy, and Maternal Guilt
Authors: Taylor Erin N. , Wallace Lora Ebert
Published: October 2011

In this paper, we provide a new framework for understanding infant‐feeding‐related maternal guilt and shame, placing these in the context of feminist theoretical and psychological accounts of the emotions of self‐assessment. Whereas breastfeeding advocacy has been critiqued for its perceived role in inducing maternal guilt, we argue that the emotion women often feel surrounding infant feeding may be better conceptualized as shame in its tendency to involve a negative self‐assessment—a failure to achieve an idealized notion of good motherhood. Further, we suggest, both formula‐feeding and breastfeeding mothers experience shame: the former report feeling that they fail to live up to ideals of womanhood and motherhood, and the latter transgress cultural expectations regarding feminine modesty. The problem, then, is the degree to which mothers are vulnerable to shame generally, regardless of infant feeding practices. As an emotion that is less adaptive and potentially more damaging than guilt, shame ought to be the focus of resistance for both feminists and breastfeeding advocates, who need to work in conjunction with women to oppose this shame by assisting them in constructing their own ideals of good motherhood that incorporate a sense of self‐concern.
Shortest Distances in a Modified Transportation Network
Authors: van Oudheusden Dirk L.
Published: October 2011

Taking as the starting point an undirected source network and a set of possible new links that can be used to extend the source network, a method is proposed to determine, by simple inspection of a matrix tableau, all shortest distances in any extended network, without using a shortest path algorithm. In consequence, this method may be a useful tool for analyzing and judging network extensions. In particular, computation time can be saved in many complex network optimization methods that use shortest path algorithms. The computer experiments show that the method is feasible even when an extended network may differ from the source network by several dozens of branches.
Adversarial Risk Analysis with Incomplete Information: A Level‐k Approach
Authors: Rothschild Casey , McLay Laura , Guikema Seth
Published: October 2011

This article proposes, develops, and illustrates the application of level‐k game theory to adversarial risk analysis. Level‐k reasoning, which assumes that players play strategically but have bounded rationality, is useful for operationalizing a Bayesian approach to adversarial risk analysis. It can be applied in a broad class of settings, including settings with asynchronous play and partial but incomplete revelation of early moves. Its computational and elicitation requirements are modest. We illustrate the approach with an application to a simple defend‐attack model in which the defender's countermeasures are revealed with a probability less than one to the attacker before he decides on how or whether to attack.
Prediction and Impact of Sea Level Rise on Properties and Infrastructure of Washington, DC
Authors: Ayyub Bilal M. , Braileanu Haralamb G. , Qureshi Naeem
Published: October 2011

The city of Washington, District of Columbia (DC) will face flooding, and eventual geographic changes, in both the short‐ and long‐term future because of sea level rise (SLR) brought on by climate change, including global warming. To fully assess the potential damage, a linear model was developed to predict SLR in Washington, DC, and its results compared to other nonlinear model results. Using geographic information systems (GIS) and graphical visualization, analytical models were created for the city and its underlying infrastructure. Values of SLR used in the assessments were 0.1 m for the year 2043 and 0.4 m for the year 2150 to model short‐term SLR; 1.0 m, 2.5 m, and 5.0 m were used for long‐term SLR. All necessary data layers were obtained from free data banks from the U.S. Geological Survey and Washington, DC government websites. Using GIS software, inventories of the possibly affected infrastructure were made at different SLR. Results of the analysis show that low SLR would lead to a minimal loss of city area. Damages to the local properties, however, are estimated at an assessment value of at least US$2 billion based on only the direct losses of properties listed in real estate databases, without accounting for infrastructure damages that include military installations, residential areas, governmental property, and cultural institutions. The projected value of lost property is in excess of US$24.6 billion at 5.0 m SLR.
The Modified Ablation Guided by Ibutilide Use in Chronic Atrial Fibrillation (MAGIC‐AF) Study: Clinical Background and Study Design
Authors: SINGH SHELDON M. , D'AVILA ANDRE , KIM YOUNG‐HOON , ARYANA ARASH , MANGRUM J. MICHAEL , MICHAUD GREGORY F. , DUKKIPATI SRINIVAS R. , CALLANS DAVID J. , BARRETT CONOR D. , BERAS‐JOVINE MAXIMO R. , REDDY VIVEK Y.
Published: October 2011

The MAGIC‐AF Study.

Background:
Beyond pulmonary vein isolation (PVI), adjuvant ablation at the sites of complex fractionated atrial electrograms (CFAE) has been shown to improve the long‐term success of catheter ablation of persistent atrial fibrillation (AF). However, this approach often requires extensive ablation due to the widespread distribution of CFAE within the left atrium. An optimal strategy would identify areas of CFAE which, when selectively targeted with ablation, result in AF termination with an acceptable long‐term freedom from AF. It is possible that the intraprocedural administration of an antiarrhythmic drug may help accomplish this.

Objective:
The Modified Ablation Guided by Ibutilide Use in Chronic AF (MAGIC‐AF) Study is an international multicenter prospective randomized double‐blinded clinical trial assessing the utility of the intraprocedural administration of 0.25 mg of intravenous ibutilide before performing CFAE ablation. The primary efficacy endpoint of this study will be the freedom from AF at 1 year after a single procedure off antiarrhythmic agents. Safety endpoints will include procedural and radiofrequency ablation time as well as overall procedural complication rate.

Methods:
Patients undergoing a first ever catheter ablation procedure for persistent AF will be included. Individuals with hypertrophic cardiomyopathy, complex congenital heart disease including atrial septal defects, and ejection fraction <35% will be excluded from the study. All patients will first undergo PVI. Those patients who remain in AF will then be randomized in a 1:1 fashion to receive either 0.25 mg intravenous ibutilide or saline placebo followed by a CFAE based ablation strategy. Two hundred randomized patients will be enrolled in this study—100 in each study arm.

Conclusion:
The MAGIC‐AF study will assess the utility of a combined pharmaco‐ablative strategy in patients with persistent AF undergoing a CFAE based ablation strategy.
Atrial Fibrillation in Patients with Wolff–Parkinson–White Syndrome:
Authors: DEREJKO PAWEŁ , SZUMOWSKI ŁUKASZ JAN , SANDERS PRASHANTHAN , KRUPA WOJCIECH , BODALSKI ROBERT , ORCZYKOWSKI MICHAŁ , URBANEK PIOTR , ZAKRZEWSKA JOANNA , LIM HAN S. , LAU DENNIS H. , KUŚNIERZ JACEK , WALCZAK FRANCISZEK
Published: October 2011

AF in WPW Syndrome. Aim: We aimed to characterize electrophysiological properties of pulmonary veins (PVs) in patients with Wolff–Parkinson–White (WPW) syndrome and atrial fibrillation (AF), and to compare them to those in patients with WPW without AF.

Methods and Results:
A total of 31 patients (mean age 40 ± 15 years, 23 males) with WPW were recruited: 16 patients with (AF group) and 15 without (controls) a history of AF. The basic electrophysiological (EPS) and echocardiographic data were not different between the 2 groups. Effective refractory periods (ERPs) of PVs were significantly shorter in the AF group compared to controls: left superior (LS) PV ERP 185±29 versus 230 ± 24 ms, P = 0.001; left inferior PV ERP 198 ± 25 versus 219 ± 26 ms, P = 0.04; right superior (RS) PV ERP 207 ± 25 versus 236 ± 19 ms, P = 0.001; right inferior PV ERP 208 ± 30 versus 240 ± 19 ms, P = 0.003. Maximal veno‐atrial conduction delay (i.e., the maximal prolongation of interval from stimulus delivered at PV ostia to proximal coronary sinus after extrastimulus compared to the basic drive cycle) was longer in the AF group when pacing from LSPV (69.3 ± 37.9 vs 32.6 ± 16.1 ms, P = 0.01) and RSPV (74.1 ± 25.9 vs 50.2 ± 26.5 ms, P = 0.04). During EPS, AF was induced more often in the AF group (n = 7) compared to controls (n = 1; P = 0.04). Follow‐up revealed that AF recurred in 3 patients in the AF group and none of the controls.

Conclusion:
Patients with WPW syndrome and AF have shorter ERPs of PVs and greater maximal veno‐atrial conduction delay compared to patients with WPW without AF. These findings suggest a potential role of PVs in the development of AF in patients with WPW.
(J Cardiovasc Electrophysiol, Vol. 23 p. 280‐286, March 2012.)
Heart Failure Decreases Nerve Activity in the Right Atrial Ganglionated Plexus
Authors: SHINOHARA TETSUJI , SHEN MARK J. , HAN SEONGWOOK , MARUYAMA MITSUNORI , PARK HYUNG‐WOOK , FISHBEIN MICHAEL C. , SHEN CHANGYU , CHEN PENG‐SHENG , LIN SHIEN‐FONG
Published: October 2011

Reduced Vagal Control in Heart Failure.

Objective: We tested the hypothesis that heart failure (HF) results in right atrial ganglionated plexus (RAGP) denervation that contributes to sinoatrial node dysfunction.

Background: HF is associated with sinoatrial node dysfunction. However, the detailed mechanisms remain unclear.

Methods: We recorded nerve activity (NA) from the RAGP, right stellate ganglion (SG), and right vagal nerve in 7 ambulatory dogs at baseline and after pacing‐induced HF. We also determined the effects of RAGP stimulation in isolated normal and HF canine RA.

Results: NAs in both the SG and vagal were significantly higher in HF than at baseline. The relationship between 1‐minute integrated NAs of vagal and RAGP showed either a positive linear correlation (Group 1, n = 4) or an L‐shaped correlation (Group 2, n = 3). In all dogs, a reduced heart rate was observed when vagal‐NA was associated with simultaneously increased RAGP‐NA. On the other hand, when vagal‐NA was not associated with increased RAGP‐NA, the heart rate was not reduced. The induction of HF significantly decreased RAGP‐NA in all dogs (P < 0.05). Stimulating the superior RAGP in isolated RA significantly reduced the sinus rate in normal but not the HF hearts. Immunohistochemical staining revealed lower densities of tyrosine hydroxylase‐ and choline acetyltransferase‐positive nerve tissues in HF RAGP than normal (P < 0.001 and P = 0.001, respectively).

Conclusions: The RAGP‐NA is essential for the vagal nerve to counterbalance the SG in sinus rate control. In HF, RAGP denervation and decreased RAGP‐NA contribute to the sinus node dysfunction.
The relationship between glutathione peroxidase and bioimpedance parameters in nondiabetic hemodialysis patients
Authors: Çelik Gülperi , Yöntem Mustafa , Cilo Mustafa , Bilge Murat , Mehmetoğlu İdris , Ünaldi Mustafa
Published: October 2011

There is growing evidence from experimental and clinical studies that oxidative stress is involved in the pathogenesis of malnutrition. This cross‐sectional study aimed to investigate the relationship between glutathione peroxidase (GPx) levels as a marker of antioxidant status and the nutritional status assessed by bioimpedance analysis (BIA). Ninety‐seven nondiabetic stable outpatient uremic adults undergoing chronic hemodialysis (HD) were recruited for this study. Impedance measurements were performed using a multifrequency bioelectrical impedance analyzer after dialysis. GPx levels correlated with intracellular water (ICW) (r = 0.341, P = 0.011), ICW/total body weight (r = 0.320, P = 0.017), lean body mass (r = 0.300, P = 0.026) and total body cell mass (r = 0.339, P = 0.011). When patients were divided into two groups according to mean GPx levels (83.9 U/gr hemoglobin), the patients with higher GPx (GPx > 83.9 U/gr hemoglobin) had higher albumin (P = 0.038), lean body mass (P = 0.026), ICW (P = 0.011), and total body cell mass (P = 0.011) compared with those with lower GPx (GPx ≤ 83.9 U/gr hemoglobin). Furthermore, in the patients with higher GPx, body fat; extracellular water/total body water; illness marker and body fat mass index were lower than other group. In conclusion, our results reveal correlation indicating a relationship between antioxidant status (as measured by GPx) and nutritional status as assessed by BIA in nondiabetic HD patients.
Fecundity and development of the ectoparasitic wasp Nasonia vitripennis are dependent on host quality
Authors: Rivers David B. , Denlinger David L.
Published: October 2011

The gregarious, ectoparasitoid Nasonia vitripennis (Walker) (Hymenoptera: Pteromalidae) was offered pupae representing seven fly species, but only members of two families (Sarcophagidae and Muscidae) were parasitized. Host acceptance as an oviposition site did not imply host suitability for parasitoid growth: N. vitripennis produced fewer progeny, a higher proportion of males, required a longer development time, and produced smaller adult wasps on Musca domestica L. (Diptera: Muscidae) than on the three sarcophagid species tested [Sarcophaga bullata Parker, S. crassipalpis Macquart, and Peckia abnormis (Enderlein) (Diptera: Sarcophagidae)]. The physiological and nutritional status of a preferred host, S. bullata, influenced oviposition behavior and development of N. vitripennis. Progeny allocation and sex ratio, which were regulated by the female parasitoid during oviposition, differed on living and dead nondiapausing hosts and on diapausing pupae. Differences in the host's nutritional condition was reflected in changes of the wasp's development time and adult body size. Envenomation was essential for successful development of the parasitoid on nondiapausing hosts, but venom injection by N. vitripennis did not increase the suitability of diapausing or dead pupae. The results suggest that wasp development is enhanced by changes induced in the host by parasitism.
Host‐age discrimination during host location by Cotesia glomerata, a larval parasitoid of Pieris brassicae
Authors: Mattiacci Letizia , Dicke Marcel
Published: October 2011

Some parasitoids are restricted with respect to the host stage that they attack and even to a certain age within a stage. In this paper we investigate whether the parasitoid Cotesia glomerata can discriminate between old and young caterpillar instars of its host, Pieris brassicae, before contacting these hosts, since contacts with older instars are very risky with a chance of being killed, due to the aggressive defensive behaviour of the caterpillars.

Flight chamber dual choice tests showed that volatile chemicals emitted by Brussels sprouts plants (Brassica oleracea var. gemmifera) after feeding damage by 1st and 5th larval instars are equally attractive to the wasps. Simulated herbivore damage by 2nd and 5th larval instars, obtained by treating mechanically damaged leaves with carterpillar regurgitant, was also equally attractive, even when the wasps were exposed to repeated experience on different larval instars to increase their discriminatory ability.

In contrast, single choice contact bioassays showed that the time spent searching on a leaf with feeding damage of 1st instar larvae was significantly longer than the time spent on 5th instar feeding damage or on mechanically damaged leaves. Both flight and contact bioassays did not show any effect of egg‐related infochemicals. The results demonstrate that C. glomerata can discriminate between young and old larval instars of P. brassicae, without contacting the caterpillars. This is not done through volatile herbivore‐induced synomones but through cues that are contacted after arrival at a caterpillar‐infested leaf.
Host plant constituents as oviposition stimulants for a generalist herbivore: European corn borer
Authors: Udayagiri Sujaya , Mason Charles E.
Published: October 2011

Oviposition response of the polyphagous European corn borer, Ostrinia nubilalis (Hübner) (Lepidoptera: Pyralidae), to chemical constituents in host plants was investigated in the laboratory using two‐choice bioassays. Foliar extracts of corn (Zea mays L.), pepper (Capsicum annuum L.) and potato (Solanum tuberosum L.) were prepared using the solvents pentane, acetone and methanol. In all three host plants, chemicals soluble in pentane stimulated oviposition. In potato, chemicals extractable in acetone also elicited a positive oviposition response. When presented with a choice between pentane extracts of corn and pepper, females preferred corn. No preferences were exhibited between pentane extracts of corn and potato or pepper and potato. Pentane extracts of corn husks, tassels, silk, and corn leaves from plants at early whorl and tassel (pre‐pollen shed) stages of development also stimulated oviposition. Similar extracts from plants at 2‐leaf and blister (when kernels resemble blisters) stages were not stimulatory. This indicates that plant phenology affects chemically mediated oviposition response in European corn borer. The potential use of plant chemicals for management of O. nubilalis in the field is suggested.
Merkel cell carcinoma with heterologous rhabdomyoblastic differentiation: the role of immunohistochemistry for Merkel cell polyomavirus large T‐antigen in confirmation
Authors: Adhikari Laura A. , McCalmont Timothy H. , Folpe Andrew L.
Published: October 2011

Merkel cell carcinoma (MCC) represents an uncommon and lethal form of cutaneous malignancy. Historically, the pathogenesis of MCC has been presumed to be linked to ultraviolet light overexposure, but recently, it has been documented that some examples harbor polyomavirus genome, the presence of which is presumed to be of pathogenetic importance. Extremely rare cases of MCC may show heterologous differentiation. We report an example of MCC with heterologous rhabdomyosarcomatous differentiation, the third such case to date, with emphasis on its distinction from fusion‐negative alveolar rhabdomyosarcoma. The role of immunohistochemistry for Merkel cell polyomavirus large T‐antigen in this differential diagnosis is emphasized.

Adhikari LA, McCalmont TH, Folpe AL. Merkel cell carcinoma with heterologous rhabdomyoblastic differentiation: the role of immunohistochemistry for Merkel cell polyomavirus large T‐antigen in confirmation.