bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of tissue diagnosis prior to neoadjuvant chemoradiotherapy for locally advanced rectal cancer
Authors: Daniel E. S. , Gibbs P. , Guerrieri M. , Faragher I.
Published: May 2014

Aim

Neoadjuvant chemoradiotherapy is the standard of care for locally advanced rectal cancer, with diagnostic work‐up routinely including a biopsy confirming invasive carcinoma. For the occasional patient where initial biopsies reveal only dysplasia, or even normal epithelium, repeat biopsy is currently advised, but this may delay therapy and repeat biopsy has potential adverse effects. The study aimed to determine, in the setting of clinical findings and imaging demonstrating locally advanced rectal cancer, whether the absence of a tissue diagnosis prior to commencing chemoradiation compromises patient outcome.

Method

A review was conducted of our database, including comprehensive treatment and outcome details, in which consecutive patients with colorectal cancer have been enrolled since 1997 at a single institution. All records for patients who received neoadjuvant chemoradiotherapy for locally advanced rectal cancer were reviewed to identify patients for whom treatment was initiated before a tissue diagnosis was obtained, and to assess any consequences of this.

Results

Of 254 patients who had received neoadjuvant treatment for rectal cancer, 16 (6.3%) were found to have had neoadjuvant therapy without a tissue diagnosis of invasive cancer. Compared with cases where a tissue diagnosis had been obtained, median age (59 vs 63 years, P = 0.497), sex (75% vs 71.3% male, P = 0.955) and tumour location (56.3% vs 73.5% < 8 cm, P = 0.230) were similar. Of these, 14 (87.5%) had adenocarcinoma identified on histopathology review of the surgical specimen. Three patients were considered to have had complete pathological responses with mucin lakes within the muscularis propria (n = 2) or lymph nodes (n = 1) or fibrosis (n = 3). One of these had no mucin evident and only fibrosis; thus final pathological proof of invasive cancer was present in 15 (93.5%) patients. There were no local recurrences, but three of the 16 (18.8%) cases developed distant recurrence.

Conclusion

For the small number of cases without a confirmatory tissue diagnosis before chemoradiation, no adverse consequences were identified. In particular the initial diagnosis was confirmed in 15 out of 16 cases following pathological examination of the operative specimen. We would suggest that, where clinical and radiological features support a diagnosis of locally advanced rectal cancer, proceeding directly to neoadjuvant chemoradiotherapy in the absence of a biopsy demonstrating invasive cancer may not be unreasonable, particularly where repeat biopsy would delay the commencement of treatment.
Local excision of T1 and T2 rectal cancer: proceed with caution
Authors: Elmessiry M. M. , Van Koughnett J. A. M. , Maya A. , DaSilva G. , Wexner S. D. , Bejarano P. , Berho M.
Published: May 2014

Aim

This study aimed to compare the clinical outcome between local excision (LE) and total mesorectal excision (TME) for early rectal cancer.

Method

After Institutional Review Board approval, charts of patients with T1 or T2 N0M0 rectal adenocarcinoma treated by curative LE or TME without preoperative radiotherapy from 2004 to 2012 were reviewed. Categorical and continuous variables were compared using chi‐square analysis and the ANOVA test. Kaplan–Meier analysis compared survival rates.

Results

The study included 153 patients: 79 underwent TME and 74 LE. Postoperative infection was more common after TME (P = 0.009). There was tumour involvement of the margins in 13.5% after LE compared with 0% after TME (P = 0.001). Of the patients treated initially by LE, 13.5% had additional surgery for unfavourable histological findings and 4.1% had residual tumour. Median follow up was 35 (17–96) months. No deaths were recorded in 56 patients with a pT1 lesion. There was no significant difference in local recurrence (P = 0.332) or 3‐year disease‐free survival (DFS; P = 0.232) between patients having LE or TME. The 68 patients with a T2 lesion had higher local recurrence (P = 0.025) and lower DFS following LE compared with TME (P = 0.044). There was no difference in overall survival (P = 0.351).

Conclusion

LE of early rectal cancer is associated with higher local recurrence and decreased DFS. These disadvantages are significant for T2 lesions.
CCR2 antagonism in patients with type 2 diabetes mellitus: a randomized, placebo‐controlled study
Authors: Di Prospero N. A. , Artis E. , Andrade‐Gordon P. , Johnson D. L. , Vaccaro N. , Xi L. , Rothenberg P.
Published: May 2014

Aims

Macrophage recruitment through C‐C motif chemokine receptor‐2 (CCR2) into adipose tissue is believed to play a role in the development of insulin resistance and type 2 diabetes mellitus (T2DM). The objective of this Phase 2 proof‐of‐concept study was to evaluate the safety, tolerability, pharmacokinetics and pharmacodynamics of JNJ‐41443532, an orally bioavailable CCR2 antagonist, in patients with T2DM.

Methods

This was a 4‐week, double‐blind, placebo‐controlled, randomized, multicenter study. A total of 89 patients were randomized to receive either 250‐ or 1000‐mg of JNJ‐41443532 twice daily, 30‐mg of pioglitazone once daily (reference arm), or placebo. The primary endpoint was change from baseline in 23‐h weighted mean glucose (WMG); secondary endpoints included change from baseline in fasting plasma glucose (FPG), insulin resistance (Homeostatic Model Assessment [HOMA‐IR]), insulin secretion (HOMA‐%B) and body weight.

Results

Absorption of JNJ‐41443532 into the systemic circulation occurred at a median tmax of 2 h, and the mean t½ was approximately 8 h for both doses; plasma systemic exposures increased slightly more than dose‐proportionally. After 4 weeks, reductions in 23‐h WMG and FPG were observed in all treatment groups compared with placebo and were significantly lower for 250‐mg JNJ‐41443532 and pioglitazone. HOMA‐IR was lower for all treatment groups, but significantly lower only for pioglitazone. Conversely, HOMA‐%B was increased for all groups, but significantly increased only for 250‐mg JNJ‐41443532. All groups, including placebo, had decreased body weight over time. There were no clinically significant findings during routine safety assessments and the incidence of treatment‐emergent adverse events was similar across all groups.

Conclusions

Administration of JNJ‐41443532 resulted in modest improvement in glycaemic parameters compared with placebo, and was generally well tolerated in patients with T2DM.
Incidence of Gremmeniella abietina in planted seedlings of Picea abies and Pinus sylvestris in northern Finland
Authors: Kaitera J. , Mäkitalo K. , Hantula J.
Published: May 2014

The ascomycete Gremmeniella abietina causes a disease (scleroderris canker) on conifers. The pathogen kills terminal shoots and branches of Pinus sylvestris and Picea abies, sporulates on host shoots and causes leader changes (i.e. dieback). Damage caused by G. abietina was investigated in young P. abies and P. sylvestris plantations in northern Finland. Side branches from seedlings of both species and the main stems of P. sylvestris were collected from three sites in two locations (Poksa 1 and 2, Kivalo) in northern Finland. The number of cankers and leader changes was counted in branches of each age (i.e. year) in a total of ca. 6300 shoots of P. abies and 1200 shoots of P. sylvestris. Cankers were common on both P. abies and P. sylvestris in Poksa 1 (2002–2008) and on P. abies in Poksa 2 (1998–2001). In Kivalo, cankers occurred only sporadically on P. sylvestris. Leader changes were most frequent in 1999–2009 in Poksa 1, in 2001–2009 in Poksa 2 and in 2003 in Kivalo. Cankers and other symptoms of infection were more obscure on P. abies than on P. sylvestris. According to both conidial morphology and molecular analysis, the strain of G. abietina infecting both P. abies and P. sylvestris was small‐tree type (STT). This is the first report of G. abietina, STT or B type, injuring P. abies in plantations.
First report of Laimaphelenchus heidelbergi (Nematoda: Aphelenchoididae) in Europe
Authors: Maleita C. , Costa S. R. , Abrantes I.
Published: May 2014

A survey of nematodes associated with branches of cork oak, Quercus suber, a species in decline since the second half of the 20th century, was conducted on two farms located in Alentejo, Portugal. Using specific morphological characters, some nematodes were identified as belonging to the genus Laimaphelenchus and one of the isolates being identified as L. heidelbergi. This research aimed to characterize the Portuguese L. heidelbergi isolate using morphobiometrical and molecular analyses and to analyze its phylogenetic relationship to other Laimaphelenchus spp. Morphometric and morphological characteristics of L. heidelbergi females and males were similar to the original description. For molecular analyses, the mitochondrial DNA region from the cytochrome oxidase subunit I and the D2/D3 expansion segments of the large subunit of rDNA were amplified and sequenced. In phylogenetic analyses, sequences of the Portuguese L. heidelbergi isolate clustered with sequences from the Australian isolate. Laimaphelenchus heidelbergi was originally described from wood of Pinus radiata growing in Australia and is here reported for the first time in Europe and Portugal. Cork oak is a new host record for L. heidelbergi.
Visual Matching in the Orientation of Desert Ants (Melophorus bagoti): The Effect of Changing Skyline Height
Authors: Julle‐Daniere Eglantine , Schultheiss Patrick , Wystrach Antoine , Schwarz Sebastian , Nooten Sabine S. , Bibost Anne‐Laurence , Cheng Ken
Published: May 2014

Ants are known to use the terrestrial visual panorama in navigation. Recent evidence has accumulated for the use of the currently perceived visual panorama to determine a direction to head in. The pattern of the height of the terrestrial surround, the skyline, is one key cue for the Central Australian red honey ant Melophorus bagoti in determining a direction of travel. But ants might also possess some mechanism to match the skyline heights encountered during training, which functions to steer away from regions whose skyline is too high and towards regions whose skyline is too low. We made an initial test of this hypothesis by training ants to visit a feeder centred between two experimentally constructed walls of black cloth. Trained ants were then tested for their initial homing direction with the walls retaining their heights as encountered in training (controls), with one of the walls lowered or raised in height, or with one wall lowered and the opposite wall raised. Wall‐height manipulations deflected the initial headings of ants towards the lower wall, with combined wall lowering and wall raising changing the initial headings by ~30° when compared with controls. The results suggest that the ants combined the dictates of the panorama in determining the best direction of travel (a heading towards the nest) with some attractor mechanism that functions to establish the skyline heights of training conditions (a heading towards the lower wall).
Can CAM treatments be evidence‐based?
Authors: Louhiala Pekka , Hemilä Harri
Published: May 2014

In this article, we first take a critical look at the definitions of evidence‐based medicine (EBM) and complementary and alternative medicine (CAM). We then explore the question of whether there can be evidence‐based forms of CAM. With the help of three examples, we show that EBM and CAM are not opposites, but rather concepts pointing at different dimensions. Each of the three examples is an evidence‐based treatment according to three to five randomised, double‐blind placebo controlled trials with consistent findings and narrow pooled confidence intervals. The most reasonable interpretation for the existence of evidence‐based CAM treatments seems to be that the opposite of CAM is ‘mainstream medicine’, and the demarcation line between CAM and mainstream medicine is not simply defined by the question of whether a treatment works or not. Some effective treatments may belong to the CAM domain for historical reasons and because of preconceptions within mainstream medicine. Therefore, some treatments that currently lie outside mainstream medicine can be evidence‐based.
The uneven geographies of the Olympic carceral: from exceptionalism to normalisation
Authors: Coaffee Jon
Published: May 2014

In recent years a vast academic literature has developed around the concept of ‘militarising’ or ‘securitising’ cities and in particular the policy responses to the occurrence of crime, fear of crime and the evaluation of cities as strategic sites for a spectrum of large‐scale increasingly destructive perturbations in everyday urban life, such as riots, protest and acts of terrorism. Increasingly policy interventions in response to such threats have embodied characteristics of the ‘carceral archipelago’ where incarceration techniques and strategies are punitively deployed within public places of the city and embedded within the design of urban space. Such attempts at creating increasingly hyper‐carceral spaces have often been supported by an array of legislation and regulation targeting the control of particular activities deemed unacceptable or inappropriate. This paper draws conceptually from the urban security literature noted above and emerging studies within the nascent sub‐discipline of carceral geography, and examines their convergence on the issue of Olympic security planning. This highlights the various spatial strategies and imprints that emerge from new conceptualisations and practices of securitisation, and how these might be seen to characterise an increasingly punitive state. Here Agamben's studies of exceptionality are deployed to highlight how ‘lockdown’ security often becomes the ‘normal’ option for Olympic cities, seen as being on the frontline in the war on terror, and how a range of uneven geographies emerge and are sustained in such locations before, during and after the event. Empirically the paper uses data from ethnographic research focusing on the experiences of security preparation for, and post‐event legacy of, the London 2012 Olympics. The paper also seeks to highlight how lessons from the military‐carceral security strategies deployed in London have been transferred to subsequent host cities of Sochi (2014) and Rio de Janeiro (2016).
Cosmopolitan beginnings? Transnational healthcare workers and the politics of carework in Singapore
Authors: Yeoh Brenda S A , Huang Shirlena
Published: May 2014

In recent times, the increasing scholarly interest in the contested place of the migrant in the cities of the North and South has drawn mainly on frameworks of integration, multiculturalism and cosmopolitanism. Much of the literature pays little heed to gender dynamics and accords little value in particular to the roles that female migrants play in actively shaping the urban contexts in which they live. We contend that by shifting attention to the more feminised spheres oriented towards the private sphere away from public display (including that of ‘carework’ which is increasingly performed by female migrant workers), we may be able to better glimpse cosmopolitanism at work. This is because the social relations of care provide more fertile ground for developing what Glick Schiller et al. (2011, Ethnic and Racial Studies 34 399–418) call ‘cosmopolitan sociability’. This is not to negate the findings of feminist analyses that suggest that carework, particularly in globalising cities restructured by neoliberal agendas, reproduces and extends forms of social inequalities. Indeed, even as the locus of carework shifts from local to foreign women from less developed countries, patriarchal norms and unequal gender relations are reinforced, and in fact intersect with other power geometries based on race, nationality and class. As illustration of the politics of carework, this paper discusses the place of migrant healthcare workers (primarily Chinese, Indian, Filipino and Burmese women) in institutionalised settings in the rapidly globalising city of Singapore. While their presence in the global city raises moral anxieties not only about the shift of carework from the family to outside the home, they also alert us to the possibilities and limits of a cosmopolitan approach to care transcending boundaries of race, culture, language and nationality.
Tailoring dialysis and resuming low‐protein diets may favor chronic dialysis discontinuation: Report on three cases
Authors: Piccoli Giorgina Barbara , Guzzo Gabriella , Vigotti Federica Neve , Capizzi Irene , Clari Roberta , Scognamiglio Stefania , Consiglio Valentina , Aroasio Emiliano , Gonella Silvana , Veltri Andrea , Avagnina Paolo
Published: May 2014

Renal function recovery (RFR), defined as the discontinuation of dialysis after 3 months of replacement therapy, is reported in about 1% of chronic dialysis patients. The role of personalized, intensive dialysis schedules and of resuming low‐protein diets has not been studied to date. This report describes three patients with RFR who were recently treated at a new dialysis unit set up to offer intensive hemodialysis. All three patients were females, aged 73, 75, and 78 years. Kidney disease included vascular‐cholesterol emboli, diabetic nephropathy and vascular and dysmetabolic disease. At time of RFR, the patients had been dialysis‐dependent from 3 months to 1 year. Dialysis was started with different schedules and was progressively discontinued with a “decremental” policy, progressively decreasing number and duration of the sessions. A moderately restricted low‐protein diet (proteins 0.6 g/kg/day) was started immediately after dialysis discontinuation. The most recent update showed that two patients are well off dialysis for 5 and 6 months; the diabetic patient died (sudden death) 3 months after dialysis discontinuation. Within the limits of small numbers, our case series may suggest a role for personalized dialysis treatments and for including low‐protein diets in the therapy, in enhancing long‐term RFR in elderly dialysis patients.
Speciation Study of Cr in a Geochemical Reference Material Sediment Series Using Sequential Extraction and XANES Spectroscopy
Authors: Ohta Atsuyuki
Published: May 2014

Speciation of Cr in geochemical reference materials was characterised by sequential extraction and X‐ray absorption near‐edge structure (XANES) spectroscopy to identify Cr(III) resulting from the reduction of pollutant Cr(VI). Sequential extraction suggested that the amount of Cr associated with an acetic acid soluble fraction was low; Cr associated with a reducible phase and an oxidisable phase was extracted at 5–10% of the total Cr concentration, and the residual phase was found to be the dominant Cr‐containing fraction. Cr speciation in soil artificially doped with Cr(VI) and sediment samples collected from highly populated and industrialised areas was different from that in naturally occurring materials. Substantial Cr was extracted as a reducible phase (15–30%) and an oxidisable phase (30–60%) for these samples. Through subsequent XANES spectroscopy analysis, the reducible phase was explained by Cr bound to Fe hydroxide, while the oxidisable phase was a mixture of Cr bound to humic substances and Cr hydroxides. That is, Cr(VI) present as a contaminant in sediments and soils was reduced to Cr(III), which then bound to Fe hydroxide and humic substances, precipitating as a hydroxide. Thus, a combination of sequential extraction and XANES spectroscopy allows for effective identification and quantification of the chemical forms of Cr in sediments and soils.
Pre‐Pleistocene origin of an endangered habitat: links between vernal pools and aquatic Oxalis in the Greater Cape Floristic Region of South Africa
Authors: Oberlander Kenneth C. , Roets Francois , Dreyer Léanne L.
Published: May 2014

Aim

Vernal pools constitute a minute and under‐studied habitat type scattered across the species‐rich Greater Cape Floristic Region (GCFR), and harbour a number of endemic species from a wide variety of phylogenetic backgrounds. The unique species complements, restricted habitat size and high levels of anthropogenic threat to these ecosystems merit more intensive research focus. In this study, we explore the history of vernal pool habitat through the lens of a major component of the vernal pool flora, Oxalis L.

Location

Greater Cape Floristic Region of South Africa.

Methods

We reconstructed phylogenies of southern African Oxalis using two plastid markers, including all vernal pool inhabitants, in a Bayesian Markov chain Monte Carlo context. We conducted Shimodaira–Hasegawa and Bayes factor tests of topology to assess the number of independent invasions of vernal pool habitat. We used ancestral state reconstruction across a range of probable trees to find the oldest nodes that could be convincingly reconstructed as vernal pool inhabitants. Divergence time estimation of these nodes used two different approaches to account for a lack of fossil data in the Oxalidaceae.

Results

Phylogenetic analyses of DNA sequence data show conclusively that Oxalis has invaded this habitat type multiple times. Ancestral state reconstruction and divergence time estimation suggest an extreme minimum age for this habitat type of 2.3 million years, with more credible estimates suggesting origins deep in the Pliocene or latest Miocene.

Main conclusions

These data suggest that, despite their insignificant total surface areas, vernal pools are a surprisingly ancient and persistent feature of the GCFR landscape.
Generational Differences in Values in Central and Eastern Europe: The Effects of Politico‐Economic Transition
Authors: Turkina Ekaterina , Surzhko‐Harned Lena
Published: May 2014

This article explores the effects of post‐communist transition and European enlargement on intergenerational politico‐economic values in three groups of countries: Central and Eastern European countries that became European Union members; countries with EU membership prospects; and those that have no membership prospects, at least in the foreseeable future. The analysis indicates considerable differences between these three groups of countries and shows that over time Europeanization served as an intra‐cohort mechanism of social change: it smoothed over intergenerational differences and led to a trend of convergence in values between new Eastern members of the EU and Western Europe. Europeanization also appears to have some harmonizing power on intergenerational differences in countries with EU membership prospects. At the same time, the rough post‐communist transition process and the lack of consolidation mechanisms created considerable intergenerational differences in European countries without EU membership prospects, as revealed by the dominance of cohort replacement mechanism in these countries.
Discriminating Drying Method of Tarhana Using Computer Vision
Authors: Kurtulmuş F. , Gürbüz O. , Değirmencioğlu N.
Published: May 2014

Tarhana is a traditionally fermented wheat flour product ofTurkey which has high nutritional value. A rapid and objective evaluation of tarhana quality by assessing the used drying method is important for producers and packaging companies. A computer vision method was developed to discriminate between drying methods of tarhana. Tarhana samples were prepared with three drying methods: sun dried, oven dried and microwave dried. An image acquisition station was constituted under artificial illumination. Different types of machine learning methods and feature selection methods were tested to find an effective system for the discrimination between drying methods of tarhana using visual texture features with different color components. Experimental results showed that the best accuracy rate (99.5%) was achieved with aK‐nearest‐neighbors classifier through the feature model based on stepwise discriminant analysis.

Practical Applications

The computer vision system proposed in this study can be used as an inspection tool for discrimination of drying method of tarhana by producers and packaging companies.
Dysregulation of multiple inflammatory molecules in lymph node and ileum of macaques during RT‐SHIV infection with or without antiretroviral therapy
Authors: Ambrose Zandrea , Kline Christopher , Polacino Patricia , Hu Shiu‐Lok
Published: May 2014

Background

Pathogenic infection with human immunodeficiency virus type 1 (HIV‐1) or simian immunodeficiency virus (SIV) is characterized by a loss of CD4+ T cells and chronic lymphocyte activation even during suppressive antiretroviral therapy (ART).

Methods

Using NanoString, expression of >100 molecules associated with inflammation or immune activation was evaluated in mesenteric lymph nodes and ileum of macaques infected with a pathogenic SIV/HIV virus, RT‐SHIV, during viremia or during suppressive ART and compared to uninfected controls.

Results

Of the 105 RNA species quantified in the tissues, expression of 33 genes was altered significantly in one or both tissues during viremia but returned to normal levels during ART. However, 29 additional genes were altered in expression levels in the tissues of both viremic and ART‐suppressed macaques.

Conclusions

Identification of the mechanisms of chronic inflammation in specific cells and in different tissues may help determine whether early ART initiation or novel therapies can prevent it.
The contribution of nurse consultants in England to the public health leadership agenda
Authors: Franks Helen
Published: May 2014

Aims and objectives

To examine the contribution of nurse consultants in relation to UK public health outcomes by contrasting the health and public health skills frameworks with a study of the role of nurse consultants.

Background

Nurse consultants are the most senior advanced nurse practitioners in the UK. They work clinically, lead, research, develop policy and disseminate knowledge.

Design

A synthesis of research and data from the UK professional skills frameworks with data from a mixed‐methods study of the role of nurse consultants.

Method

Data collected from nurse consultants and stakeholders in England (n = 10) were analysed to identify issues impacting on the skills, competencies and effectiveness of advanced nurses. This was contrasted with the skills and career frameworks for public health and advanced healthcare practice.

Results

Nurse consultants use their clinical expertise to lead practice, facilitate change and monitor effectiveness. Within healthcare organisations, they contribute servicewide to the implementation of public health policy, service delivery and policy development, mirroring expected competencies and improved health outcomes. Two barriers were identified. First, that there was little time or will for nurse consultants to undertake research, precluding them from demonstrating their value. Second, that a lack of interprofessional understanding and support of their roles meant that their worth was often not appreciated by decision‐makers.

Conclusions

Nurse consultants lead and influence public health on many levels and need support to develop needs‐led and evidence‐based local, national and international public health practice and policy development.

Relevance to clinical practice

This research contributes to the global discussion currently being held about the nomenclature of advanced nurse practitioner roles, their scope and influence. The challenge for nurses to contribute meaningfully to public health structures at an advanced level is a concern for all nations seeking the common goal of addressing public health needs within their populations and suggests that further development of our understanding of the potential contribution of advanced nurses is needed.
A quality improvement programme with a specialist nurse in a neurovascular clinic
Authors: McKee Jacqueline , Wade Carrie , McCarron Mark O
Published: May 2014

Aims and objectives

To measure the impact of a quality improvement programme with a stroke specialist nurse and increased capacity at neurovascular clinics.

Background

Transient ischaemic attack and minor stroke are medical emergencies prompting urgent assessment and treatment. Delays in specialist assessment and management are frequent and may increase stroke risk.

Design

Pre‐ and post evaluation of intervention.

Methods

All patients referred to a neurovascular clinic were recorded during two phases: 2006–2008 and 2010–2012. For the 2010–2012 period, a stroke specialist nurse contacted all patients with appointment details, provided driving advice and asked for an eyewitness to attend the clinic. Diagnosis, delay in specialist assessment, prevalence of transient ischaemic attack/minor stroke as confirmed at the clinic and compliance with UK driving regulations were measured and compared before and after this intervention.

Results

A total of 1327 patients were assessed in the two study phases. Referrals to the neurovascular service increased without a decrease in the prevalence of transient ischaemic attack/minor stroke. Delays from clinical event to assessment were decreased for referrals from 36·5–13 days, and adherence to the UK driving restrictions improved for confirmed transient ischaemic attack/minor stroke patients from 61–94%. Fewer patients failed to attend a neurovascular appointment arranged by the stroke specialist nurse than those who failed a general neurology appointment arranged by partial booking.

Conclusions

This quality improvement programme reduced delays for all referred patients, improved compliance with driving regulations and demonstrated efficient use of neurovascular clinic spaces. Increasing local capacity may unmask more transient ischaemic attack/minor stroke patients.

Relevance to clinical practice

A stroke nurse can help improve the efficiency of a neurovascular clinic and improve patient safety with driving advice.
Realizing nursing: a multimodal biopsychopharmacosocial approach to psychiatric nursing
Authors: Clark L. L. , Clarke T.
Published: May 2014

Accessible summary

This paper describes a person‐centred approach to psychiatric nursing assessment.

The biopsychopharmacosocial (BPPS) approach builds on previous models and best practice to promote person‐centred care planning.

The approach minimizes the risk of aspects of the person's condition being ignored or inappropriately attributed to a previously diagnosed medical or psychiatric condition (diagnostic overshadowing).

The BPPS approach structures and guides person‐centred nursing assessment, formulation and care planning, and will be most effective when supported by expert nurses and clinical academics.

The biological and psychosocial components of health, illness and treatment are well recognized. In addition, pharmacological interventions interact with both these components regarding health and illness; all components are potentially modifiable. A better understanding of these interactions on the course of illness, especially at the interface between illness and treatment, is needed to guide effective clinical and psychiatric nursing interventions. To this end, a multimodal biopsychopharmacosocial approach to assessment, formulation, care planning and implementation by psychiatric nurses is proposed. It is argued that a biopsychopharmacosocial approach, including a multimodal functional element, provides a person‐centred, responsive and responsible basis for a comprehensive approach to practice. The use of this approach will improve intervention outcomes and contribute to the ongoing development of psychiatric nursing practice. It is suggested that, in part, this will be achieved through innovative teaching methods delivered by ‘expert nurses’ and clinical academics.
Pacific Crossings: Oceania and the Circulation of Literature in the 19th Century
Authors: Macleod Jock , Ellison David
Published: May 2014

One consequence of increased European colonialism in the Pacific in the 19th century was a major growth in the circulation of literature, first from the colonial homelands and later from the colonies as well. This article introduces a cluster of three articles on the circulation of literature in the Pacific in the 19th century. It suggests that the elements that make up the ‘communications circuit’ for any publication change according to time, place and Imperial culture. Consequently, how we understand the circulation of literature in the Pacific depends on what aspect of the communication circuit we focus on, what time‐frame is at issue, and what part of the Pacific we are studying. The three articles that follow exemplify three different aspects of the communications circuit at three different moments in the 19th century Pacific. Acting as a cluster, they offer different but related perspectives on the circulation of literature in the Pacific in the 19th century.
Crossing ‘The Beach’: Samoa, Stevenson and ‘The Beach at Falesá’
Authors: Treagus Mandy
Published: May 2014

Across the islands of the Pacific during the 19th century, a resignification of the term ‘the beach’ occurred, as it took on a different and very specific meaning. It came to indicate a particular space of contact, where cultures and races mixed, and where trade, missionising and colonising occurred and new subjectivities developed. The figure of the ‘afakasi (mixed race Samoan) exemplifies many of the contradictions and possibilities of the beach, as ‘afakasi were both marginalised and yet often spectacularly successful in this environment. Stevenson lived in the vicinity of one of the more notable new Pacific beaches, Apia, and he and his extended family took a particular interest in the ‘afakasi members of their beach society. This interest provides a specific context for Stevenson's Pacific fiction, especially ‘The Beach at Falesá’, in which he acknowledges the potential emptiness of the late‐colonial project, yet never quite abandons its iteration of white colonial masculinity.
The New Zealand New Woman: Translating a British Cultural Figure to a Colonial Context
Authors: Hallum Kirby‐Jane
Published: May 2014

While New Woman scholarship has been a lively element of Victorian studies for the last 30 years, less attention has been given to the colonial space and the pressure it puts on the New Woman in the way in which her freedoms differed from that of her British counterpart. This essay for the Global Circulation Project begins to interrogate how the historical moment of the New Woman movement translates to a New Zealand context in the fiction of three turn‐of‐the‐century New Zealand writers: Julius Vogel (1835–1899), Louisa Alice Baker (1856–1926) and Edith Searle Grossmann (1863–1931). The state of criticism on each of these writers has tended to focus on their productive engagement with New Zealand cultural history rather their being situated within a New Woman literary tradition. Ranging from the late 1880s through to 1910, their writing shows a progression from a utopian vision of harmony between Britain and the colonies, to a refutation of the intellectual and cultural limitations of the colonial setting and, finally, to a rejection of Britain in favour of a distinctly New Zealand home. The three novels under analysis here are judged to be examples of New Zealand New Woman fiction and are recuperated within a wider framework of late 19th‐century New Woman writing.
Stem cells with decellularized liver scaffolds in liver regeneration and their potential clinical applications
Authors: Zhou Qian , Li Lanjuan , Li Jun
Published: May 2014

End‐stage hepatic failure is a potentially life‐threatening condition for which orthotopic liver transplantation (OLT) is the only effective treatment. However, a shortage of available donor organs for transplantation each year results in the death of many patients waiting for liver transplantation. Cell‐based therapies and hepatic tissue engineering have been considered as alternatives to liver transplantation. However, primary hepatocyte transplantation has rarely produced therapeutic effects because mature hepatocytes cannot be effectively expanded in vitro, and the availability of hepatocytes is often limited by shortages of donor organs. Decellularization is an attractive technique for scaffold preparation in stem cell‐based liver engineering, as the resulting material can potentially retain the liver architecture, native vessel network and specific extracellular matrix (ECM). Thus, the reconstruction of functional and practical liver tissue using decellularized scaffolds becomes possible. This review focuses on the current understanding of liver tissue engineering, whole‐organ liver decellularization techniques, cell sources for recellularization and potential clinical applications and challenges.
Divergent population structure and climate associations of a chromosomal inversion polymorphism across the Mimulus guttatus species complex
Authors: Oneal Elen , Lowry David B. , Wright Kevin M. , Zhu Zhirui , Willis John H.
Published: May 2014

Chromosomal rearrangement polymorphisms are common and increasingly found to be associated with adaptive ecological divergence and speciation. Rearrangements, such as inversions, reduce recombination in heterozygous individuals and thus can protect favourable allelic combinations at linked loci, facilitating their spread in the presence of gene flow. Recently, we identified a chromosomal inversion polymorphism that contributes to ecological adaptation and reproductive isolation between annual and perennial ecotypes of the yellow monkeyflower, Mimulus guttatus. Here we evaluate the population genetic structure of this inverted region in comparison with the collinear regions of the genome across the M. guttatus species complex. We tested whether annual and perennial M. guttatus exhibit different patterns of divergence for loci in the inverted and noninverted regions of the genome. We then evaluated whether there are contrasting climate associations with these genomic regions through redundancy analysis. We found that the inversion exhibits broadly different patterns of divergence among annual and perennial M. guttatus and is associated with environmental variation across population accessions. This study is the first widespread population genetic survey of the diversity of the M. guttatus species complex. Our findings contribute to a greater understanding of morphological, ecological, and genetic evolutionary divergence across this highly diverse group of closely related ecotypes and species. Finally, understanding species relationships among M. guttatus sp. has hitherto been stymied by accumulated evidence of substantial gene flow among populations as well as designated species. Nevertheless, our results shed light on these relationships and provide insight into adaptation in life history traits within the complex.
Rhodobacter capsulatus DprA is essential for RecA‐mediated gene transfer agent (RcGTA) recipient capability regulated by quorum‐sensing and the CtrA response regulator
Authors: Brimacombe Cedric A. , Ding Hao , Beatty J. Thomas
Published: May 2014

Gene transfer agents (GTAs) are genetic exchange elements that resemble small DNA bacteriophages that transfer random pieces of the producing cell's genome to recipient cells. The best‐studied GTA is that of Rhodobacter capsulatus, termed RcGTA. We discovered that the putative response regulator CtrA, which is essential for RcGTA production, is required for RcGTA‐mediated gene acquisition, and confirmed that a RecA homologue is required. It was also discovered that a DprA (DNA‐protecting protein A) homologue is essential for RcGTA‐mediated gene acquisition, and that dprA expression is induced by gtaI‐dependent quorum‐sensing and non‐phosphorylated CtrA. Modelling of the R. capsulatus DprA structure indicated the presence of a C‐terminal region that resembles a dsDNA‐binding protein domain. Purified His‐tagged R. capsulatus DprA protein bound to both single‐stranded (ss)DNA and double‐stranded (ds)DNA, but with a greater affinity for ssDNA. Additionally, DprA protected dsDNA from endonuclease digestion, and increased the rate of nucleation of Escherichia coli RecA onto ssDNA. Single‐cell expression analyses revealed that dprA is expressed in the majority of cells throughout a population. Overall, the results suggest that incorporation of RcGTA DNA into the recipient cell genome proceeds through a homologous recombination pathway resembling DNA recombination in natural transformation.
Mathematical modelling of arsenic transport, distribution and detoxification processes in yeast
Authors: Talemi Soheil Rastgou , Jacobson Therese , Garla Vijay , Navarrete Clara , Wagner Annemarie , Tamás Markus J. , Schaber Jörg
Published: May 2014

Arsenic has a dual role as causative and curative agent of human disease. Therefore, there is considerable interest in elucidating arsenic toxicity and detoxification mechanisms. By an ensemble modelling approach, we identified a best parsimonious mathematical model which recapitulates and predicts intracellular arsenic dynamics for different conditions and mutants, thereby providing novel insights into arsenic toxicity and detoxification mechanisms in yeast, which could partly be confirmed experimentally by dedicated experiments. Specifically, our analyses suggest that: (i) arsenic is mainly protein‐bound during short‐term (acute) exposure, whereas glutathione‐conjugated arsenic dominates during long‐term (chronic) exposure, (ii) arsenic is not stably retained, but can leave the vacuole via an export mechanism, and (iii) Fps1 is controlled by Hog1‐dependent and Hog1‐independent mechanisms during arsenite stress. Our results challenge glutathione depletion as a key mechanism for arsenic toxicity and instead suggest that (iv) increased glutathione biosynthesis protects the proteome against the damaging effects of arsenic and that (v) widespread protein inactivation contributes to the toxicity of this metalloid. Our work in yeast may prove useful to elucidate similar mechanisms in higher eukaryotes and have implications for the use of arsenic in medical therapy.
Relationship between Echocardiographic LV Mass and ECG Based Left Ventricular Voltages in an Adolescent Population: Related or Random?
Authors: CZOSEK RICHARD J. , CNOTA JAMES F. , KNILANS TIMOTHY K. , PRATT JESSE , GUERRIER KARINE , ANDERSON JEFFREY B.
Published: May 2014

Background

In attempts to detect diseases that may place adolescents at risk for sudden death, some have advocated for population‐based screening. Controversy exists over electrocardiography (ECG) screening due to the lack of specificity, cost, and detrimental effects of false positive or extraneous outcomes.

Objectives

Analyze the relationship between precordial lead voltage on ECG and left ventricle (LV) mass by echocardiogram in adolescent athletes.

Methods

Retrospective cohort analysis of a prospectively obtained population of self‐identified adolescent athletes during sports screening with ECG and echocardiogram. Correlation between ECG LV voltages (R wave in V6 [RV6] and S wave in lead V1 [SV1]) was compared to echocardiogram‐based measurements of left ventricular mass. Potential effects on ECG voltages by body anthropometrics, including weight, body mass index (BMI), and body surface area were analyzed, and ECG voltages indexed to BMI were compared to LV mass indices to analyze for improved correlation.

Results

A total of 659 adolescents enrolled in this study (64% male). The mean age was 15.4 years (14–18). The correlations between LV mass and RV6, SV1, and RV6 + SV1 were all less than 0.20. The false positive rate for abnormal voltages was relatively high (5.5%) but improved if abnormal voltages in both RV6 and SV1 were mandated simultaneously (0%). Indexing ECG voltages to BMI significantly improved correlation to LV mass, though false positive findings were increased (12.9%).

Conclusion

There is poor correlation between ECG precordial voltages and echocardiographic LV mass. This relationship is modified by BMI. This finding may contribute to the poor ECG screening characteristics.
Signaling to Partially Informed Investors in the Newsvendor Model
Authors: Schmidt William , Gaur Vishal , Lai Richard , Raman Ananth
Published: May 2014

We analyze a signaling game between the manager of a firm and an investor in the firm. The manager has private information about the firm's demand and cares about the short‐term stock price assigned by the investor. Previous research has shown that under continuous decision choices and the Intuitive Criterion refinement, the least‐cost separating equilibrium will result, in which a low‐quality firm chooses its optimal capacity and a high‐quality firm over‐invests in order to signal its quality to investors. We build on this research by showing the existence of pooling outcomes in which low‐quality firms over‐invest and high‐quality firms under‐invest so as to provide identical signals to investors. The pooling equilibrium is practically appealing because it yields a Pareto improvement compared to the least‐cost separating equilibrium. Distinguishing features of our analysis are that: (i) we allow the capacity decision to have either discrete or continuous support, and (ii) we allow beliefs to be refined based on either the Undefeated refinement or the Intuitive Criterion refinement. We find that the newsvendor model parameters impact the likelihood of a pooling outcome, and this impact changes in both sign and magnitude depending on which refinement is used.
Spatiotemporal variation in airborne sporangia of Phytophthora infestans: characterization and initiatives towards improving potato late blight risk estimation
Authors: Fall M. L. , Van der Heyden H. , Brodeur L. , Leclerc Y. , Moreau G. , Carisse O.
Published: May 2014

This study investigated the value of using real‐time monitoring of Phytophthora infestans airborne inoculum as a complement to decision support systems (DSS). The experiment was conducted during the 2010, 2011 and 2012 potato production seasons in two locations in New Brunswick, Canada. Airborne sporangia concentrations (ASC) of P. infestans were monitored using 16 rotating‐arm spore samplers placed 3 m above the ground. The first cases of late blight (2010 and 2011) were detected 6–7 days after the first ASC peak, and all samplers captured their first sporangia within the same week (at 3‐ and 9‐day periods). The cumulative ASC curve and the risk curves from two DSS (PLANT‐Plus and Pameseb Late Blight) had the same shape but different magnitudes. In both locations, the negative binomial distribution fitted the data better than the Poisson distribution, which is indicative of heterogeneity, and based on Taylor's power law, the heterogeneity increased with increasing ASC. Therefore, the present results suggest that spore‐sampling network devices may be a suitable approach for early detection of incoming inoculum and, when combined with DSS, represent a potential aid for targeting the optimal time to apply a disease‐control product. In this context, cumulative ASC can be a counterweight to the DSS risk estimate: a high risk combined with significant ASC will trigger fungicide spraying. Moreover, spore sampling can be used to assess the efficiency of management strategies by means of examining the area under the inoculum progress curve.