bluuebunny/crossref_metadata_2025 huggingface dataset:
Environmental Upgrading of Developing Country Firms in Global Value Chains
Authors: Achabou Mohamed Akli , Dekhili Sihem , Hamdoun Mohamed
Published: December 2015

While the strategic management literature on corporate social responsibility (CSR) is abundant, it tends to consider the context of developed countries, with a focus on certain specific issues such as the strategic behaviour of firms with regard to sustainable development and the economic benefits of CSR practices. The present study examines the influence of western organizations on responsible corporate behaviour in developing countries, an issue that has been somewhat neglected in the existing academic literature. In particular, it explores the environmental upgrading of developing country firms in global value chains.

This research, conducted with the analytic hierarchy process (AHP) method, involves 24 Tunisian olive oil companies. The findings indicate that exporting companies have indeed benefited from environmental upgrading, but, because of the cooperation strategy adopted by leading western firms (imposition of standards) and the absence of financial and technical assistance, the extent of environmental upgrading remains limited. Copyright © 2015 John Wiley & Sons, Ltd and ERP Environment
A retrospective analysis of treatment‐related hospitalization costs of pediatric, adolescent, and young adult acute lymphoblastic leukemia
Authors: Kaul Sapna , Korgenski Ernest Kent , Ying Jian , Ng Christi F. , Smits‐Seemann Rochelle R. , Nelson Richard E. , Andrews Seth , Raetz Elizabeth , Fluchel Mark , Lemons Richard , Kirchhoff Anne C.
Published: December 2015

This retrospective study examined the longitudinal hospital outcomes (costs adjusted for inflation, hospital days, and admissions) associated with the treatment of pediatric, adolescent, and young adult acute lymphoblastic leukemia (ALL). Patients between one and 26 years of age with newly diagnosed ALL, who were treated at Primary Children's Hospital (PCH) in Salt Lake City, Utah were included. Treatment and hospitalization data were retrieved from system‐wide cancer registry and enterprise data warehouse. PCH is a member of the Children's Oncology Group (COG) and patients were treated on, or according to, active COG protocols. Treatment‐related hospital costs of ALL were examined by computing the average annual growth rates (AAGR). Longitudinal regressions identified patient characteristics associated with costs. A total of 505 patients (46.9% female) were included. The majority of patients had B‐cell lineage ALL, 6.7% had T‐ALL, and the median age at diagnosis was 4 years. Per‐patient, first‐year ALL hospitalization costs at PCH rose from $24,197 in 1998 to $37,924 in 2012. The AAGRs were 6.1, 13.0, and 7.6% for total, pharmacy, and room and care costs, respectively. Average days (AAGR = 5.2%) and admissions (AAGR = 3.8%) also demonstrated an increasing trend. High‐risk patients had 47% higher costs per 6‐month period in the first 5 years from diagnosis than standard‐risk patients (P < 0.001). Similarly, relapsed ALL and stem cell transplantations were associated with significantly higher costs than nonrelapsed and no transplantations, respectively (P < 0.001). Increasing treatment‐related costs of ALL demonstrate an area for further investigation. Value‐based interventions such as identifying low‐risk fever and neutropenia patients and managing them in outpatient settings should be evaluated for reducing the hospital burden of ALL.
Postremission sequential monitoring of minimal residual disease by WT1 Q‐PCR and multiparametric flow cytometry assessment predicts relapse and may help to address risk‐adapted therapy in acute myeloid leukemia patients
Authors: Malagola Michele , Skert Cristina , Borlenghi Erika , Chiarini Marco , Cattaneo Chiara , Morello Enrico , Cancelli Valeria , Cattina Federica , Cerqui Elisa , Pagani Chiara , Passi Angela , Ribolla Rossella , Bernardi Simona , Giustini Viviana , Lamorgese Cinzia , Ruggeri Giuseppina , Imberti Luisa , Caimi Luigi , Russo Domenico , Rossi Giuseppe
Published: December 2015

Risk stratification in acute myeloid leukemia (AML) patients using prognostic parameters at diagnosis is effective, but may be significantly improved by the use of on treatment parameters which better define the actual sensitivity to therapy in the single patient. Minimal residual disease (MRD) monitoring has been demonstrated crucial for the identification of AML patients at high risk of relapse, but the best method and timing of MRD detection are still discussed. Thus, we retrospectively analyzed 104 newly diagnosed AML patients, consecutively treated and monitored by quantitative polymerase chain reactions (Q‐PCR) on WT1 and by multiparametric flow cytometry (MFC) on leukemia‐associated immunophenotypes (LAIPs) at baseline, after induction, after 1st consolidation and after 1st intensification. By multivariate analysis, the factors independently associated with adverse relapse‐free survival (RFS) were: bone marrow (BM)‐WT1 ≥ 121/104 ABL copies (P = 0.02) and LAIP ≥ 0.2% (P = 0.0001) (after 1st consolidation) (RFS at the median follow up of 12.5 months: 51% vs. 82% [P < 0.0001] and 57% vs. 81%, respectively [P = 0.0003]) and PB‐WT1 ≥ 16/104 ABL copies (P = 0.0001) (after 1st intensification) (RFS 43% vs. 95% [P < 0.0001]) Our data confirm the benefits of sequential MRD monitoring with both Q‐PCR and MFC. If confirmed by further prospective trials, they may significantly improve the possibility of a risk‐adapted, postinduction therapy of AML.
Two decades of external peer review of cancer care in general hospitals; the Dutch experience
Authors: Kilsdonk Melvin J. , Siesling Sabine , Otter Rene , van Harten Wim H.
Published: December 2015

External peer review was introduced in general hospitals in the Netherlands in 1994 to assess and improve the multidisciplinary team approach in cancer care. This paper aims to explore the value, perceived impact, and (future) role of external peer review in cancer care. Semistructured interviews were held with clinicians, oncology nurses, and managers from fifteen general hospitals that participated in three rounds of peer review over a period of 16 years. Interviewees reflected on the goals and expectations, experiences, perceived impact, and future role of external peer review. Transcriptions of the interviews were coded to discover recurrent themes. Improving clinical care and organization were the main motives for participation. Positive impact was perceived on multiple aspects of care such as shared responsibilities, internal prioritization of cancer care, improved communication, and a clear structure and position of cancer care within general hospitals. Establishing a direct relationship between the external peer review and organizational or clinical impact proved to be difficult. Criticism was raised on the content of the program being too theoretical and organization‐focussed after three rounds. According to most stakeholders, external peer review can improve multidisciplinary team work in cancer care; however, the acceptance is threatened by a perceived disbalance between effort and visible clinical impact. Leaner and more clinically focused programs are needed to keep repeated peer reviews challenging and worthwhile.
Chemical Genetic Approaches for the Investigation of Neutral Lipid Metabolism
Authors: Doler Carina , Schweiger Martina , Zimmermann Robert , Breinbauer Rolf
Published: December 2015

The coordinated processes of lipid synthesis, degradation, and transport are mediated by enzymes, cofactors, and transport proteins. Accordingly, lipid‐metabolizing enzymes represent logical targets for the treatment of dyslipidemia, a major risk factor for type 2 diabetes, atherosclerosis, and other disorders. Small‐molecule tool compounds, modulating the functions of such proteins, can substantially facilitate the characterization of target proteins. Such molecules complement genetic studies, and allow time‐ and dose‐dependent control of protein activity in biological systems. This can improve our understanding of physiological processes, give insights into the druggability of target proteins, and might finally result in the development of therapeutic compounds. In this review we summarize the current state of available inhibitors targeting key proteins in neutral lipid metabolism, with a focus on metabolic lipases, acyltransferases, and fatty‐acid‐binding proteins.
Autoxidation/Aldol Tandem Reaction of 2‐Oxindoles with Ketones: A Green Approach for the Synthesis of 3‐Hydroxy‐2‐Oxindoles
Authors: Zhang Qing‐Bao , Jia Wen‐Liang , Ban Yong‐Liang , Zheng Yong , Liu Qiang , Wu Li‐Zhu
Published: December 2015

In the presence of tetrabutylammonium fluoride and molecular sieves (MS) 4 Å in DMF, an efficient autoxidation reaction of 2‐oxindoles with ketones under air at room temperature has been developed. This approach may provide a green, practical, and metal‐free protocol for a wide range of biologically important 3‐hydroxy‐3‐(2‐oxo‐alkyl)‐2‐oxindoles.
New RuII Complex for Dual Activity: Photoinduced Ligand Release and 1O2 Production
Authors: Loftus Lauren M. , White Jessica K. , Albani Bryan A. , Kohler Lars , Kodanko Jeremy J. , Thummel Randolph P. , Dunbar Kim R. , Turro Claudia
Published: December 2015

The new complex [Ru(pydppn)(biq)(py)]2+ (1) undergoes both py photodissociation in CH3CN with Φ500=0.0070(4) and 1O2 production with ΦΔ=0.75(7) in CH3OH from a long‐lived 3ππ* state centered on the pydppn ligand (pydppn=3‐(pyrid‐2‐yl)benzo[i]dipyrido[3,2‐a:2′,3′‐c]phenazine; biq = 2,2′‐biquinoline; py=pyridine). This represents an order of magnitude decrease in the Φ500 compared to the previously reported model compound [Ru(tpy)(biq)(py)]2+ (3) (tpy=2,2′:6′,2′′‐terpyridine) that undergoes only ligand exchange. The effect on the quantum yields by the addition of a second deactivation pathway through the low‐lying 3ππ* state necessary for dual reactivity was investigated using ultrafast and nanosecond transient absorption spectroscopy, revealing a significantly shorter 3MLCT lifetime in 1 relative to that of the model complex 3. Due to the structural similarities between the two compounds, the lower values of Φ500 and ΦΔ compared to that of [Ru(pydppn)(bpy)(py)]2+ (2) (bpy=2,2′‐bipyridine) are attributed to a competitive excited state population between the 3LF states involved in ligand dissociation and the long‐lived 3ππ* state in 1. Complex 1 represents a model compound for dual activity that may be applied to photochemotherapy.
Evolutionary origin of Tbr2‐expressing precursor cells and the subventricular zone in the developing cortex
Authors: Martínez‐Cerdeño Verónica , Cunningham Christopher L. , Camacho Jasmin , Keiter Janet A. , Ariza Jeanelle , Lovern Matthew , Noctor Stephen C.
Published: December 2015

The subventricular zone (SVZ) is greatly expanded in primates with gyrencephalic cortices and is thought to be absent from vertebrates with three‐layered, lissencephalic cortices, such as the turtle. Recent work in rodents has shown that Tbr2‐expressing neural precursor cells in the SVZ produce excitatory neurons for each cortical layer in the neocortex. Many excitatory neurons are generated through a two‐step process in which Pax6‐expressing radial glial cells divide in the VZ to produce Tbr2‐expressing intermediate progenitor cells, which divide in the SVZ to produce cortical neurons. We investigated the evolutionary origin of SVZ neural precursor cells in the prenatal cerebral cortex by testing for the presence and distribution of Tbr2‐expressing cells in the prenatal cortex of reptilian and avian species. We found that mitotic Tbr2+ cells are present in the prenatal cortex of lizard, turtle, chicken, and dove. Furthermore, Tbr2+ cells are organized into a distinct SVZ in the dorsal ventricular ridge (DVR) of turtle forebrain and in the cortices of chicken and dove. Our results are consistent with the concept that Tbr2+ neural precursor cells were present in the common ancestor of mammals and reptiles. Our data also suggest that the organizing principle guiding the assembly of Tbr2+ cells into an anatomically distinct SVZ, both developmentally and evolutionarily, may be shared across vertebrates. Finally, our results indicate that Tbr2 expression can be used to test for the presence of a distinct SVZ and to define the boundaries of the SVZ in developing cortices. J. Comp. Neurol. 524:433–447, 2016. © 2015 Wiley Periodicals, Inc.
A Phosphine Oxide Functional Group Based [2]Rotaxane That Operates as a Multistable Molecular Shuttle
Authors: Cheng Ming , Liu Li , Cao Yihan , Jiang Juli , Wang Leyong
Published: December 2015

A switchable [2]rotaxane based on a pyridinediamide crown ether macrocycle and a thread bearing phosphine oxide, urea, and dibenzylammonium functional groups was successfully developed and characterized by 1H NMR and 2D NMR spectroscopy, mass spectrometry, and single‐crystal analysis. The three recognition sites in the [2]rotaxane were sorted from strong to weak, according to their bonding abilities, so that the macrocycle could move along the thread from one side to the other in a directional way, operating as a multistable molecular shuttle.
Sustainability Innovation at the Base of the Pyramid through Multi‐Sited Rapid Ethnography
Authors: Halme Minna , Kourula Arno , Lindeman Sara , Kallio Galina , Lima‐Toivanen Maria , Korsunova Angelina
Published: December 2015

The past decade has seen a proliferation of suggestions for market‐based solutions to global poverty. While research emphasises that sustainability innovation aimed at poverty alleviation must be grounded in user needs, few studies demonstrate how to study the poor for purposes of early phase innovation in business enterprises, especially in multiple locations comparatively. This study suggests that the necessary understanding of low‐income users and their practices can be gained throughmulti‐sited rapid ethnography. We exemplify how the process moves from an understanding of the needs of the poor towards innovation and offer a general framework for evaluating the success of these types of projects. The paper describes the challenges and solutions found in a multi‐sited rapid ethnography research in urban base of the pyramid (BOP) contexts in Brazil, India, Russia, and Tanzania. It suggests businesses can learn about the poor with the help of this method and conduct sustainability innovation on the basis of the needs of the poor, rather than start with existing products. Copyright © 2015 John Wiley & Sons, Ltd and ERP Environment.
European Climate Change Perceptions: Public support for mitigation and adaptation policies
Authors: Hagen Bjoern , Middel Ariane , Pijawka David
Published: December 2015

This paper presents results from a large multi‐country study focusing on public perceptions of climate change and relevant mitigation and adaptation policies in Spain, Netherlands, UK and Germany. The purpose of this paper is two‐fold: first, to understand the nature of public perceptions of global climate change in different countries; and secondly, to gauge the public's support of climate change measures in terms of mitigation and adaptation policies. Our analysis shows high levels of public indecisiveness regarding the danger climate change poses, which source of climate change information to trust and whether to support any mitigation or adaptation strategies. The high levels of uncertainty present an opportunity to increase policy support and foster behavioural changes in the future through well‐designed communication programmes. Therefore, this study has identified several aspects that need to be considered in future communication programmes. Copyright © 2015 John Wiley & Sons, Ltd and ERP Environment
External‐beam radiotherapy for differentiated thyroid cancer locoregional control: A statement of the American Head and Neck Society
Authors: Kiess Ana P. , Agrawal Nishant , Brierley James D. , Duvvuri Umamaheswar , Ferris Robert L. , Genden Eric , Wong Richard J. , Tuttle R. Michael , Lee Nancy Y. , Randolph Gregory W.
Published: December 2015

The use of external‐beam radiotherapy (EBRT) in differentiated thyroid cancer (DTC) is debated because of a lack of prospective clinical data, but recent retrospective studies have reported benefits in selected patients. The Endocrine Surgery Committee of the American Head and Neck Society provides 4 recommendations regarding EBRT for locoregional control in DTC, based on review of literature and expert opinion of the authors. (1) EBRT is recommended for patients with gross residual or unresectable locoregional disease, except for patients <45 years old with limited gross disease that is radioactive iodine (RAI)‐avid. (2) EBRT should not be routinely used as adjuvant therapy after complete resection of gross disease. (3) After complete resection, EBRT may be considered in select patients >45 years old with high likelihood of microscopic residual disease and low likelihood of responding to RAI. (4) Cervical lymph node involvement alone should not be an indication for adjuvant EBRT. © 2015 Wiley Periodicals, Inc. Head Neck 38: 493–498, 2016
A long‐term study of stable isotopes as tracers of processes governing water flow and quality in a lowland river basin: the upper Thames, UK
Authors: Darling W. George , Bowes Michael J.
Published: December 2015

A long‐term study of O, H and C stable isotopes has been undertaken on river waters across the 7000‐km2 upper Thames lowland river basin in the southern UK. During the period, flow conditions ranged from drought to flood. A 10‐year monthly record (2003–2012) of the main River Thames showed a maximum variation of 3‰ (δ18O) and 20‰ (δ2H), although interannual average values varied little around a mean of –6.5‰ (δ18O) and –44‰ (δ2H). A δ2H/δ18O slope of 5.3 suggested a degree of evaporative enrichment, consistent with derivation from local rainfall with a weighted mean of –7.2‰ (δ18O) and –48‰ (δ2H) for the period. A tendency towards isotopic depletion of the river with increasing flow rate was noted, but at very high flows (>100 m3/s), a reversion to the mean was interpreted as the displacement of bank storage by rising groundwater levels (corroborated by measurements of specific electrical conductivity). A shorter quarterly study (October 2011–April 2013) of isotope variations in 15 tributaries with varying geology revealed different responses to evaporation, with a well‐correlated inverse relationship between Δ18O and baseflow index for most of the rivers. A comparison with aquifer waters in the basin showed that even at low flow, rivers rarely consist solely of isotopically unmodified groundwater.

Long‐term monitoring (2003–2007) of carbon stable isotopes in dissolved inorganic carbon (DIC) in the Thames revealed a complex interplay between respiration, photosynthesis and evasion, but with a mean interannual δ13C‐DIC value of –14.8 ± 0.5‰, exchange with atmospheric carbon could be ruled out. Quarterly monitoring of the tributaries (October 2011–April 2013) indicated that in addition to the aforementioned factors, river flow variations and catchment characteristics were likely to affect δ13C‐DIC. Comparison with basin groundwaters of different alkalinity and δ13C‐DIC values showed that the origin of river baseflow is usually obscured.

The findings show that long‐term monitoring of environmental tracers can help to improve the understanding of how lowland river catchments function. Copyright © NERC 2015. Hydrological Processes © 2015 John Wiley & Sons, Ltd.
EARLY CHILDHOOD MENTAL HEALTH CONSULTATION: AN EVALUATION OF EFFECTIVENESS IN A RURAL COMMUNITY
Authors: Vuyk M. Alexandra , Sprague‐Jones Jessica , Reed Christie
Published: December 2015

Little research has been done to evaluate the effectiveness of early childhood mental health consultation (ECMHC) in rural, applied settings. In this mixed‐methods study, we evaluated an approach to ECMHC used in rural Southwest Kansas with individualized services for childcare providers. Twenty‐nine home‐based and center‐based childcare providers completed measures on provider growth, perceptions of child outcomes, and satisfaction with sessions. In total, 162 data points were collected and analyzed using multilevel growth models. In addition, 16 providers participated in qualitative interviews. Both home‐based and center‐based providers reported very high satisfaction with consultation sessions which increased with time, although home‐based providers showed significantly higher satisfaction than did center‐based providers. Provider growth, encompassing personal well‐being, scheduling and transitions, connections with parents, and positive discipline strategies increased significantly over time. Child outcomes, encompassing prosocial behavior, resilience, and overall well‐being also improved significantly in providers’ perception. ECMHC as conducted in Southwest Kansas appears to have a positive effect on childcare providers and the children in their care.
Biological activity of selenium: Revisited
Authors: Wrobel Jagoda K. , Power Ronan , Toborek Michal
Published: December 2015

Selenium (Se) is an essential micronutrient that exerts multiple and complex effects on human health. Se is essential for human well‐being largely due to its potent antioxidant, anti‐inflammatory, and antiviral properties. The physiological functions of Se are carried out by selenoproteins, in which Se is specifically incorporated as the amino acid, selenocysteine. Importantly, both beneficial and toxic effects of Se have been reported suggesting that the mode of action of Se is strictly chemical form and concentration dependent. Additionally, there is a relatively narrow window between Se deficiency and toxicity and growing evidence suggests that Se health effects depend greatly on the baseline level of this micronutrient. Thus, Se supplementation is not an easy task and requires an individualized approach. It is essential that we continue to explore and better characterize Se containing compounds and mechanisms of action, which could be crucial for disease prevention and treatment. © 2015 IUBMB Life, 68(2):97–105, 2016
Ultrasound diagnosis of caesarean scar defects
Authors: Fonda Jane
Published: December 2015

Caesarean section (CS) scar defects are seen in up to 19% of women post lower segment caesarean section. Ultrasound and in particular transvaginal ultrasound, with or without saline, is the imaging modality of choice to delineate such defects. There are limited data available however which enable clinicians to quantify the risk of potential sequelae in women with a demonstrable CS scar defect.
Ultrasound (in)accuracy: it's in the formulae not in the technique – assessment of accuracy of abdominal circumference measurement in term pregnancies
Authors: Nesbitt‐Hawes Erin M , Tetstall Emma , Gee Kiera , Welsh Alec W
Published: December 2015

Introduction: Fetal abdominal circumference (AC) is utilised in calculations for the estimation of fetal weight (EFW) and has been proposed as a method of monitoring diabetic pregnancies. We evaluated true ultrasound accuracy by comparing fetal AC biometry with neonatal anthropometry and compared this with standard ultrasound estimations of fetal weight.

Methods: A prospective observational study was performed at a tertiary referral centre. Women who were having their confinement of a term, singleton gestation either by induction of labour or elective caesarean section from 2009–2011 were approached to participate. An ultrasound was performed within 24 hours of delivery measuring the biometric parameters of AC, head circumference (HC), biparietal diameter and femur length. Following delivery the AC, HC and birthweight were measured on the neonate.

Results: Fifty‐two patients were enrolled in the study with data collected from 50. Mean AC measurement was 35.1 ± 2.1 cm and birth weight was 3596 ± 517 g. A Bland‐Altman plot was used to compare the two AC measurements with the 95% limits of agreement ranging from −2.33–4.69 cm around a mean difference of 1.2 cm. Mean percentage error was 5.0% and 6.2% for the AC and HC measurements respectively, in comparison with percentage errors of 7.0–13.8% for estimation of fetal weight (EFW) from 27 formulae.

Conclusions: Sonographic AC measurement is accurate in term pregnancies, with a percentage error less than HC or EFW. Perceptions of ultrasound inaccuracy may relate to the application of formulae rather than the ultrasound technique itself. Fetal surveillance using serial AC measurement has been proposed, in particular monitoring of diabetic pregnancies and in such a group AC may be easier and faster to obtain and more meaningful than EFW.
Three patients with signs of acute flail mitral leaflet seen on emergency department echo: a critical constellation within the focused cardiac exam
Authors: Bomann J Scott , Stephenson George , Wallace Craig , Mao Pras , Moore Chris
Published: December 2015

Acute flail mitral leaflet is a time‐sensitive, reversible cause of cardiogenic shock. Transthoracic echocardiography (echo) is increasingly becoming a vital tool for non‐cardiologist physicians who treat patients with undifferentiated chest pain and dyspnoea. The sonographic abnormalities seen in acute flail mitral leaflet are within the boundaries of a focused echo. Individually, these findings are non‐specific. As a constellation, however, they are highly suggestive of this disease process. We present a case series of three patients with acute flail mitral leaflet seen on emergency department echo along with a discussion of the findings and the disease itself.
The association between discharge before noon and length of stay in medical and surgical patients
Authors: Rajkomar Alvin , Valencia Victoria , Novelero Maria , Mourad Michelle , Auerbach Andrew
Published: December 2015

BACKGROUND

Discharging patients before noon is a key approach to improving bed utilization. Few data exist to describe whether patients are discharged earlier or their stay is extended to allow for an early discharge the next day.

OBJECTIVE

To determine if a discharge before noon (DCBN) is associated with length of stay (LOS).

DESIGN/SETTINGS/PATIENTS

Retrospective analysis of data from adult medical and surgical discharges from a single academic center from July 2012 through April 2015. We used a multivariable generalized linear model to evaluate the association between DCBN and LOS.

RESULTS

Of 38,365 hospitalizations, 6484 (16.9%) were discharged before noon, and the median LOS was 3.7 days. After adjustment, DCBN was associated with a longer LOS (adjusted odds ratio [OR]: 1.043, 95% confidence interval [CI]: 1.003‐1.086). The association between longer LOS and DCBN was more pronounced in patients admitted emergently (n = 14,192, 37%) (adjusted OR: 1.14, 95% CI: 1.033‐1.249).

CONCLUSIONS

Although we cannot discern whether discharges were delayed to achieve discharge before noon, earlier discharge was associated with a longer LOS, particularly among emergent admissions. Journal of Hospital Medicine 2015;11:859–861. © 2015 Society of Hospital Medicine
Gray and white matter alterations in early HIV‐infected patients: Combined voxel‐based morphometry and tract‐based spatial statistics
Authors: Wang Bo , Liu Zhenyu , Liu Jiaojiao , Tang Zhenchao , Li Hongjun , Tian Jie
Published: December 2015

Purpose

To investigate both the gray matter (GM) and whiter matter (WM) alterations in a homogeneous cohort of early HIV‐infected patients by combining voxel‐based morphometry (VBM) and tract‐based spatial statistics (TBSS).

Materials and Methods

Twenty‐six HIV and 26 control subjects enrolled in this study with 3D T1 and diffusion‐tensor imaging acquired on a 3.0T Siemens scanner. Group differences in regional GM were assessed using VBM analysis, while differences in fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and relative anisotropy (RD) of WM were evaluated using TBSS analysis. After that, interactions between GM changes and white matter alterations were investigated by using a correlation analysis.

Results

The HIV‐infected patients displayed decreased GM volume, mainly located in the bilateral frontal cortices, bilateral anterior cingulate cortex, and left supplementary motor area (P < 0.05, false discovery rate‐corrected). Meanwhile, the patient group showed decreased FA in the genu of capsule callosum, body of capsule callosum, and bilateral anterior corona radiate (P < 0.05, family wise error [FEW]‐corrected). Areas of increased MD, RD, and AD in HIV patients were more extensive and observed in most skeleton locations (P < 0.05, FEW‐corrected). The interaction analysis in the patient group revealed that there were no significant correlations between GM changes and WM alterations (P > 0.05).

Conclusion

Our results indicate that structural brain alterations occurred early in HIV‐infected patients. The current study may shed further light on the potential brain effects of HIV. J. Magn. Reson. Imaging 2016;43:1474–1483.
Polypharmacy: a risk factor to consider in valproate‐induced hyperammonaemic encephalopathy
Authors: Kowalski Melanie , Tong Erica Y. , Yip Gary S. , Dooley Michael J.
Published: December 2015

Background

Valproate is commonly prescribed as part of combination therapy in antiepileptic or mood stabilising regimens. Although generally well tolerated, valproate has potential to cause serious adverse effects, one of which is valproate‐induced hyperammonaemic encephalopathy (VHE). The risk of developing VHE is rare; however, this can increase when valproate is used in conjunction with other medications.

Aim

This report aims to highlight the importance of early diagnosis of VHE and emphasise the potential deleterious effects of polypharmacy and certain hazardous drug combinations.

Clinical details

A 58‐year‐old woman with a 1‐week history of increasing lethargy, confusion and drowsiness presented to the emergency department. Blood tests showed a raised ammonia level and liver function test (LFT) derangement. She had been on a long‐term antiepileptic regimen which included sodium valproate. The only recent change to her medications was the introduction of atorvastatin. A diagnosis of VHE was made and valproate was discontinued. Atorvastatin was also stopped on account of its likely role in LFT derangement.

Outcomes

After discontinuation of both agents attributed to her presentation, serum ammonia and LFTs returned to within normal range. The patient also gradually resumed her usual level of alertness and functional state.

Conclusion

This report describes a case of VHE and emphasises the detrimental role of polypharmacy associated with this presentation. This illustrates the potentially complex pharmacy issues that must be considered in the management of a patient on chronic valproate therapy.
Atypical presentation of metoclopramide‐induced galactorrhea
Authors: Menon Parvathy , Thunga Girish , Nambiar Srikanth , Khera Kanav
Published: December 2015

Background

Metoclopramide is commonly used for the management of nausea and vomiting, but is associated with a range of adverse effects, including galactorrhea.

Aim

To present a case of an atypical presentation of metoclopramide‐induced galactorrhea.

Clinical details

A previously asymptomatic 30‐year‐old woman was treated with metoclopramide for management of gastrointestinal symptoms. Five days after the initiation of treatment she developed pain in both breasts and whitish discharge from nipples of both breasts, which was subsequently identified as milk. Her last menstrual period was 4 days before admission to hospital, and had lasted only for a day. Four years prior to admission, she had undergone a tubectomy. Transvaginal ultrasound was used to rule out pregnancy. Thyroid, liver and kidney function were normal, and the serum concentration of prolactin at this time was 1.8 ng/mL (reference range 3.3–26 ng/mL), slightly below the normal level. Metoclopramide was discontinued and galactorrhea, mastalgia and fever subsided.

Outcomes

Metoclopramide was discontinued and galactorrhea, mastalgia and fever subsided.

Conclusion

Although previous reports have described metoclopramide‐induced galactorrhea in association with hyperprolactinaemia, this case appears to represent a probable atypical presentation of an adverse drug reaction.
Narrative review: status of key performance indicators in contemporary hospital pharmacy practice
Authors: Lloyd Georgia F. , Bajorek Beata , Barclay Peter , Goh Sue
Published: December 2015

Aim

The aim of this review was to explore the status of key performance indicators (KPIs) in Australian hospital pharmacy practice.

Data sources

For this narrative review, databases (MEDLINE, PubMed and EBSCO) were searched for relevant publications within the period from April 1980 to April 2014 using the following search terms: hospital pharmacy, key performance indicators, performance measures, clinical indicators and benchmarking. The inclusion criteria were as follows: full text papers (papers only available as abstracts were discarded) and English language. Reference lists of selected papers were also searched to identify additional literature.

Results

While there are established competencies, standards and quality use of medicines (QUM) indicators for hospital pharmacy in Australia, there are no standardised KPIs relating to the performance and practice of hospital pharmacy. International research has demonstrated that KPIs are valuable tools for measuring pharmacy performance; the need for KPIs is highlighted in research from the UK, USA, Canada, New Zealand and Australia. Particular challenges associated with KPI implementation include: the need for relevance to all stakeholders; difficulties in measuring pharmacists’ activities due to the inherent nature of their work; lack of resources for data collection; limited understanding of KPIs; and negative attitudes toward KPIs by some pharmacists.

Conclusion

Before nationally standardised KPIs are introduced into Australian hospital pharmacy practice, attention must be paid to developing relevant measures through careful consultation with all relevant stakeholders, including pharmacists themselves. KPIs should provide relevant results, be easy to measure and highlight the value of hospital pharmacy services in a resource‐friendly manner.
Chronic obstructive pulmonary disease exacerbations, ‘Sugar Sugar’, what are we monitoring?
Authors: M. del Campo Michaela , W. Roberts Greg , Cooter Anna
Published: December 2015

Background

High‐dose prednisolone is the mainstay of treatment for chronic obstructive pulmonary disease (COPD) exacerbation and commonly causes hyperglycaemia that requires management. Routine blood glucose level (BGL) tests four times a day should be performed to monitor for hyperglycaemia in this group.

Objective

To investigate the impact of pharmacist intervention to improve BGL monitoring and recording for COPD inpatients treated with high‐dose prednisolone.

Design

A pre‐ and post‐intervention design was used. Pre‐intervention data were collected retrospectively and post‐intervention data prospectively. The main endpoints were the proportion of patients with BGLs monitored at least three times a day (which was considered to be the minimum clinical requirement) and evaluation of the time period BGL monitoring occurred. Secondary assessments were to explore hyperglycaemia management and the use of HbA1c as a tool for detecting unknown diabetics.

Results

A greater proportion of post‐intervention patients achieved the minimum required monitoring on Day 1 compared to the pre‐intervention group (29 vs 7%, p = 0.043). An improvement in monitoring occurred on Day 2 (42 vs 17%, p = 0.048). The post‐intervention group had a higher mean number of BGL tests during all time periods of the day with a threefold increase between 1400 and 2400 hours (2.4 ± 1.9 vs 0.8 ± 1.2, p = 0.00).

Conclusion

Pharmacist intervention can significantly improve BGL monitoring, including targeting of the time period crucial for detecting steroid‐induced hyperglycaemia.
Cysteamine eye drops in the treatment of cystinosis – an Australian perspective
Authors: Radojkovic Branko
Published: December 2015

Cystinosis is a rare but very serious genetic disorder. Advancements in medical science, in the past few decades, have transformed this previously terminal condition into a manageable disease. Ophthalmic sequelae of cystinosis are caused by accumulation of cystine crystals in ocular tissues and are very troublesome for most cystinosis patients. Accumulation of crystals in the cornea causes debilitating photophobia and pain that does not respond to systemic cysteamine therapy. If left untreated, this can lead to structural damage (corneal ulcers, scarring and band keratopathy) and eventually result in corneal blindness requiring corneal transplant. Topical ophthalmic application of cysteamine can alleviate the symptoms and, if instituted early, may prevent the damage. There is no commercially manufactured ophthalmic cysteamine product available in Australia and patients who receive treatment are usually supplied with extemporaneously prepared cysteamine eye drops or ointment. Stability issues, various factors influencing product effectiveness and patient adherence are only few of the problems that make formulation and compounding of cysteamine ophthalmic products a complex task.
Medication costs in an emergency department
Authors: Harding Andrew M. , Welton Caillan G. , Yeoh Michael J.
Published: December 2015

Objective

To determine the average medication costs associated per emergency department (ED) presentation. To determine the top 10 medications by cost to the ED.

Methods

Retrospective analysis of all pharmacy‐related medication costs and ED patient presentations from 1 January 2013 to 31 December 2013. Medication expenditure data were collected from the pharmacy software Merlin Hospital Drug Management System. Patient presentation data were collected from the hospital ED information system (MedTrak).

Results

The average medication cost per patient per episode of care was AU$7.49. The top 10 medications by cost to the ED were alteplase, diphtheria and tetanus vaccine, Hartmann's intravenous fluid, sodium chloride 0.9% 10 mL ampoules, enbucrilate, digoxin immune Fab, acetylcysteine injection, icatibant injection, ondansetron wafers and metaraminol injection.

Conclusion

The total cost of medication per patient presentation in the ED is small and represents limited opportunities for cost savings through changes to prescribing practices.
Hypoglycaemia in elderly patients with type 2 diabetes mellitus: a review of risk factors, consequences and prevention
Authors: Jafari Badieh , Britton Mary E.
Published: December 2015

The prevalence of diabetes in the elderly is high. Hypoglycaemia is a treatment‐related complication of diabetes. Owing to age‐related changes, decreased perception of hypoglycaemic symptoms, comorbidities and polypharmacy, elderly diabetic persons are at a greater risk of developing hypoglycaemia. Other risk factors include longer duration of diabetes, history of previous hypoglycaemic episodes, intensive glycaemic control, poor nutrition or missed meals and recent hospitalisation. Insulin and sulphonylureas are the medication classes most frequently associated with hypoglycaemia. Other antidiabetic medications typically cause hypoglycaemia only when used in combination with sulphonylureas or insulin. Hypoglycaemia in older people is associated with loss of independence, increased morbidity and mortality. Prevention of hypoglycaemia requires recognition of the risk, identification of precipitating factors, patient and caregiver education, appropriate prescribing and ongoing health professional support.
Five‐descriptor model to predict the chromatographic sequence of natural compounds
Authors: Hou Shuying , Wang Jinhua , Li Zhangming , Wang Yang , Wang Ying , Yang Songling , Xu Jia , Zhu Wenliang
Published: December 2015

Despite the recent introduction of mass detection techniques, ultraviolet detection is still widely applied in the field of the chromatographic analysis of natural medicines. Here, a neural network cascade model consisting of nine small artificial neural network units was innovatively developed to predict the chromatographic sequence of natural compounds by integrating five molecular descriptors as the input. A total of 117 compounds of known structure were collected for model building. The order of appearance of each compound was determined in gradient chromatography. Strong linear correlation was found between the predicted and actual chromatographic position orders (Spearman's rho = 0.883, p < 0.0001). Application of the model to the external validation set of nine natural compounds was shown to dramatically increase the prediction accuracy of the real chromatographic order of multiple compounds. A case study shows that chromatographic sequence prediction based on a neural network cascade facilitated compound identification in the chromatographic fingerprint of Radix Salvia miltiorrhiza. For natural medicines of known compound composition, our method provides a feasible means for identifying the constituents of interest when only ultraviolet detection is available.
The generation of amplified spontaneous emission in high‐power CPA laser systems
Authors: Keppler Sebastian , Sävert Alexander , Körner Jörg , Hornung Marco , Liebetrau Hartmut , Hein Joachim , Kaluza Malte Christoph
Published: December 2015

An analytical model is presented describing the temporal intensity contrast determined by amplified spontaneous emission in high‐intensity laser systems which are based on the principle of chirped pulse amplification. The model describes both the generation and the amplification of the amplified spontaneous emission for each type of laser amplifier. This model is applied to different solid state laser materials which can support the amplification of pulse durations . The results are compared to intensity and fluence thresholds, e.g. determined by damage thresholds of a certain target material to be used in high‐intensity applications. This allows determining if additional means for contrast improvement, e.g. plasma mirrors, are required for a certain type of laser system and application. Using this model, the requirements for an optimized high‐contrast front‐end design are derived regarding the necessary contrast improvement and the amplified “clean” output energy for a desired focussed peak intensity. Finally, the model is compared to measurements at three different high‐intensity laser systems based on Ti:Sapphire and Yb:glass. These measurements show an excellent agreement with the model.

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Effective thermal conductivity of inhomogeneous medium containing gas‐filled inclusions
Authors: Markov Mikhail , Levin Valery , Mousatov Aleksandr , Kazatchenko Elena
Published: December 2015

Determination of effective physical parameters of gas‐filled porous media is of practical interest to a wide spectrum of applications from construction industry to petrophysics. The classical equations of thermal conductivity are not applicable for sufficiently small pores, the characteristic size of which is comparable with the mean free path of gas molecules. In this case, for description of the gas behavior, it is necessary to use the methods of physical kinetics and rarefied gas dynamics. In this work, we have considered so‐called slip flow regime, 0 <  Kn < 1, where Kn =λ/R is the Knudsen number, λ is the mean free path, and R is the characteristic pore size. In this regime, we can use the classical equations of mechanics of continuum media with modified boundary conditions that take into account the temperature and energy flux jumps on the pore boundaries. We have solved the so‐called one‐particle problem of thermal polarization of gas‐filled inclusion. The obtained solution was then used in some self‐consistent homogenization methods to calculate the effective conductivity coefficient. Our calculations have shown that the effective conductivity depends substantially on the pore size (the Knudsen number). The obtained results demonstrate the feasibility of pore sizes determination by using measurements of effective thermal conductivity. Copyright © 2015 John Wiley & Sons, Ltd.
Antidiffusive Lagrangian‐remap schemes for models of polydisperse sedimentation
Authors: Bürger Raimund , Chalons Christophe , Villada Luis M.
Published: December 2015

One‐dimensional models of gravity‐driven sedimentation of polydisperse suspensions with particles that belong to N size classes give rise to systems of N strongly coupled, nonlinear first‐order conservation laws for the local solids volume fractions. As the eigenvalues and eigenvectors of the flux Jacobian have no closed algebraic form, characteristic‐wise numerical schemes for these models become involved. Alternative simple schemes for this model directly utilize the velocity functions and are based on splitting the system of conservation laws into two different first‐order quasi‐linear systems, which are solved successively for each time iteration, namely, the Lagrangian and remap steps (so‐called Lagrangian‐remap [LR] schemes). This approach was advanced in (Bürger, Chalons, and Villada, SIAM J Sci Comput 35 (2013), B1341–B1368) for a multiclass Lighthill–Whitham‐Richards traffic model with nonnegative velocities. By incorporating recent antidiffusive techniques for transport equations a new version of these Lagrangian‐antidiffusive remap (L‐AR) schemes for the polydisperse sedimentation model is constructed. These L‐AR schemes are supported by a partial analysis for N = 1. They are total variation diminishing under a suitable CFL condition and therefore converge to a weak solution. Numerical examples illustrate that these schemes, including a more accurate version based on MUSCL extrapolation, are competitive in accuracy and efficiency with several existing schemes. © 2015 Wiley Periodicals, Inc. Numer Methods Partial Differential Eq 32: 1109–1136, 2016
Cardiometabolic disease risk in metabolically healthy and unhealthy obesity: Stability of metabolic health status in adults
Authors: Guo Fangjian , Garvey W. Timothy
Published: December 2015

Objective

To assess the stability of metabolic status and body mass index (BMI) status and their relative contribution to risk of diabetes, cardiovascular events, and mortality.

Methods

A total of 14,685 participants from the Atherosclerosis Risk in Communities Study and 4,990 from the Coronary Artery Risk Development in Young Adults Study were included. People with healthy obesity (HO) are defined as those meeting all three indices of blood pressure, blood glucose, and blood lipids. People with unhealthy obesity crossed the risk threshold for all three criteria.

Results

In both healthy and unhealthy subgroups, risks for coronary heart disease (CHD), stroke, and mortality were comparable among BMI status during a mean 18.7‐year follow‐up. When compared with HO, hazard ratios were increased for diabetes (5.56, 95% confidence interval [CI] 4.12‐7.48), CHD (5.60, 95% CI 3.14‐9.98), stroke (4.84, 95% CI 2.13‐10.97), and mortality (2.6, 95% CI 1.88‐3.61) in people with unhealthy obesity. BMI only moderately increased the risks for diabetes among healthy subjects. In the Coronary Artery Risk Development in Young Adults Study over 20 years, 17.5% of lean subjects and 67.3% of overweight subjects at baseline developed obesity during follow‐up. Despite rising BMI, metabolic status remained relatively stable.

Conclusions

Metabolic status is relatively stable despite rising BMI. HO had lower risks for diabetes, CHD, stroke, and mortality than unhealthy subjects but increased diabetes risks than healthy lean people. Cardiometabolic risk factors confer much higher risk than obesity per se.