bluuebunny/crossref_metadata_2025 huggingface dataset:
Enrollment in Medicare Advantage Plans in Miami-Dade County
Authors: Sinaiko Anna D. , Afendulis Christopher C. , Frank Richard G.
Published: July 2014

Evidence from behavioral economics reveals that decision making in health care settings can be affected by circumstances and choice architecture. This paper conducts an analysis of choice of private Medicare plans (Medicare Advantage [MA] plans) in Miami-Dade County. We provide a detailed description of the choice of MA plans available in Miami over much of the program’s history. Our analysis suggests that first becoming eligible for Medicare is the key transition point for MA and that there is a significant status quo bias in the MA market. Policy that regulates the MA market should anticipate, monitor, and account for this consumer behavior.
Impact of CPOE Usage on Medication Management Process Costs and Quality Outcomes
Authors: Spaulding Trent J. , Raghu T. S.
Published: July 2014

We assess the impact of computerized physician order entry (CPOE) systems usage on cost and process quality in the medication management process. Data are compiled from 1,014 U.S. acute-care hospitals that have already implemented CPOE. Data sources include the American Hospital Association, HIMSS Analytics, and the Centers for Medicare and Medicaid Services. We examine the association of CPOE usage with nursing and pharmacy salary costs, and evidence-based medication process compliance. Empirical findings controlling for endogeneity in usage show that benefits accrue even when 100 percent usage is not achieved. We demonstrate that the relationship of CPOE usage with cost and compliance is non-linear.
Union effectiveness: In search of the Holy Grail
Authors: Gall Gregor , Fiorito Jack
Published: July 2014

This article revisits the concept of union effectiveness and proposes a conceptual model to inform its study and application. Previous conceptual and empirical work is examined to identify key strengths and weaknesses, and to relate the union effectiveness concept to union renewal and other key concepts. This leads to the proposal of a Goal-System framework that builds and improves on prior research.
MapReduce-based web mining for prediction of web-user navigation
Authors: Li Meijing , Yu Xiuming , Ryu Keun Ho
Published: July 2014

Predicting web user behaviour is typically an application for finding frequent sequence patterns. With the rapid growth of the Internet, a large amount of information is stored in web logs. Traditional frequent-sequence-pattern-mining algorithms are hard pressed to analyse information from within big datasets. In this paper, we propose an efficient way to predict navigation patterns of web users by improving frequent-sequence-pattern-mining algorithms based on the programming model of MapReduce, which can handle huge datasets efficiently. During the experiments, we show that our proposed MapReduce-based algorithm is more efficient than traditional frequent-sequence-pattern-mining algorithms, and by comparing our proposed algorithms with current existed algorithms in web-usage mining, we also prove that using the MapReduce programming model saves time.
The Impact of Nasal Surgery on Sleep Quality: A Prospective Outcomes Study
Authors: Stapleton Amanda L. , Chang Yue‐Fang , Soose Ryan J. , Gillman Grant S.
Published: July 2014

Objective

(1) Evaluate the impact of nasal airway surgery on sleep quality using validated outcome measurements, (2) compare the utility of Epworth Sleepiness Scale (ESS) versus Pittsburgh Sleep Quality Index (PSQI) as a reflection of sleep quality, and (3) identify perioperative variables that might correlate with a beneficial effect of nasal surgery on sleep quality.

Study Design

Prospective outcome study of patients with symptomatic nasal obstruction undergoing nasal airway surgery.

Setting

Academic medical center.

Methods

Patients completed the Nasal Obstruction Symptom Evaluation (NOSE) scale, ESS, PSQI, and Ease‐of‐Breathing and Sleep Quality Likert scales preoperatively and 3 months postoperatively. A nonparametric analysis compared pre‐ and postoperative values, and associations were examined using Spearman correlations.

Results

Sixty‐one patients completed the study. Mean NOSE scores decreased significantly from 68.2 preoperatively to 17.5 three months after surgery. Mean ESS scores and PSQI scores improved (P <. 0001) over that same interval (7.5 to 5.3 and 7.8 to 4.6, respectively). There was a correlation seen between the degree of change in both NOSE scores and Ease‐of‐Breathing scores and the change in sleep quality measured using the PSQI or Sleep Quality Likert scores. The PSQI correlated better with Sleep Quality Likert scores than the ESS. Overall, 86.9% of subjects reported subjective improvement in sleep quality postoperatively.

Conclusion

In patients undergoing nasal airway surgery there may be a secondary improvement in subjective sleep quality. The degree of change in sleep quality correlates with the severity of nasal obstruction preoperatively and the degree of improvement in obstruction with surgery.
Perfusionist techniques of reducing acute kidney injury following cardiopulmonary bypass: an evidence-based review
Authors: Long DM , Jenkins E , Griffith K
Published: July 2014

Cardiac surgery utilizing cardiopulmonary bypass has come a long way since its introduction nearly 60 years ago. In the early days, end-organ damage was linked to contact of the blood with the extracorporeal circuit. One potential cardiac surgery complication known to result in significant morbidity and mortality is acute kidney injury (AKI). Causes of AKI are multifaceted, but most of them are associated with techniques that perfusionists employ during extracorporeal circuit management. These can cause patients to either go on dialysis or renal replacement therapy. Patients with AKI have longer lengths of stay and consume significant resources beyond those with normal kidney function. Few current evidence-based markers determine if the kidneys are adequately protected during surgery. Most relevant literature does not address perfusion-specific techniques that reduce the incidence of AKI. This paper reviews the pathophysiology of the kidney and focuses on perfusion techniques that may reduce the incidence of AKI.
The Work Profiler: A digital instrument for selection and diagnosis of the unemployed
Authors: Wijnhoven Martijn A , Havinga Harriët
Published: July 2014

The Work Profiler is an instrument that indicates a job seeker’s probability of work resumption within a year. In addition, it offers a quick diagnosis of the job seeker’s obstacles for return to work. The Work Profiler was developed through a three-stage research process (a literature review, a cross-sectional study and a longitudinal study) in order to identify the best predictive factors for work resumption. While a large part of the research was done regionally in the Province of North Holland, the Dutch Institute for Employee Benefit Schemes (UWV) has decided to use it nationwide. At present this profiling instrument is already being used in almost a third of all unemployment offices in the Netherlands.
Radiologic and clinicopathologic findings of peripheral primitive neuroectodermal tumors
Authors: Ba Lei , Tan Hongna , Xiao Huijuan , Guan Yansheng , Gao Jianbo , Gao Xianzheng
Published: July 2014

Background

Primitive neuroectodermal tumors (PNETs) constitute a rare type of malignant neuroectodermal tumors that have chromosomal translocations identical to Ewing’s sarcoma (ES), and the characteristics of this disease remain unclear.

Purpose

To describe the clinical, radiological, and pathological features of peripheral PNETs (pPNETs) to enhance their recognition.

Material and Methods

The clinical, imaging, and pathologic findings of 35 patients with pPNETs were retrospectively reviewed, all being confirmed by biopsy or surgical pathology. All 35 patients had preoperative computed tomography (CT) examinations; 10 patients had preoperative magnetic resonance imaging (MRI) studies.

Results

Of 35 pPNET patients, 54.3% had a primary tumor in soft tissue, the others in bone. On plain CT images, 33 lesions demonstrated heterogeneous hypodense masses with multiple lamellar lower density, and with osteolytic destruction if the tumor originated in bone. Calcification was only found in five lesions arising in soft tissue. All lesions enhanced heterogeneously with varying areas of cystic changes, and all lesions in bone and 52.6% of lesions in soft tissue showed ill-defined margins after contrast administration. On MRI, these tumors appeared in conjunction with osteolytic bone destruction and irregular soft tissue masses iso- to hypointense to skeletal muscle on T1-weighted images and showed heterogeneously high intensity on T2-weighted images. All lesions enhanced heterogeneously with cystic changes. Homer–Wright rosettes were observed in 15 lesions, and 97.1% lesions were positive for CD99 in histopathological results.

Conclusion

pPNETs can involve any part of the body, and a large, ill-defined, aggressive soft tissue mass and heterogeneous enhancement with or without osteolytic bone destruction on CT or MR images could suggest the diagnosis.
The impact of analyst-investor disagreement on the cross-section of implied cost of capital
Authors: Makrominas Michalis
Published: July 2014

Implied cost of capital estimates are typically calculated using analysts’ forecasts as proxies for the market’s earnings expectations. We examine the case where deviations between investors’ expectations and analysts’ beliefs, as manifested by analysts’ recommendations, cause predictable variation in implied cost of capital. We find that stocks recommended by analysts as Buy or Strong Buy have, ceteris paribus, higher implied cost of capital than stocks recommended as Underperform or Sell, and that the effect is more clearly pronounced in stocks that have been downgraded. We attribute the effect to differential expectations between analysts and investors regarding future profitability, rather than differential expectations regarding systematic risk. We demonstrate that adjusting analysts’ earnings forecasts in line with the market’s earnings expectations largely eliminates the observed variation, indicating that such corrective mechanisms could and should be incorporated in the estimation of implied cost of capital.
Accuracy of a Computer-Based Diagnostic Program for Ambulatory Patients With Knee Pain
Authors: Bisson Leslie J. , Komm Jorden T. , Bernas Geoffrey A. , Fineberg Marc S. , Marzo John M. , Rauh Michael A. , Smolinski Robert J. , Wind William M.
Published: July 2014

Background:

Looking up information regarding a medical condition is the third most popular activity online, and there are a variety of web-based symptom-checking programs available to the patient. However, the authors are not aware of any that have been scientifically evaluated as an accurate measure for the cause of one’s knee pain.

Purpose/Hypothesis:

The purpose of this study was to design and evaluate an Internet-based program that generates a differential diagnosis based on a history of knee pain entered by the patient. The hypothesis was that the program would accurately generate a differential diagnosis for patients presenting with knee pain.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

A web-based program was created to collect knee pain history and generate a differential diagnosis for ambulatory patients with knee pain. The program selected from 26 common knee diagnoses. A total of 527 consecutive patients aged ≥18 years, who presented with a knee complaint to 7 different board-certified orthopaedic surgeons during a 3-month period, were asked to complete the questionnaire in the program. Upon completion, patients were examined by a board-certified orthopaedic surgeon. Both the patient and physician were blinded to the differential diagnosis generated by the program. A third party was responsible for comparing the diagnosis(es) generated by the program with that determined by the physician. The level of matching between diagnoses determined the accuracy of the program.

Results:

A total of 272 male and 255 female patients, with an average age of 47 years (range, 18-84 years), participated in the study. The median number of diagnoses generated by the program was 4.8 (range, 1-10), with this list containing the physician’s diagnosis(es) 89% of the time. The specificity was 27%.

Conclusion:

Despite a low specificity, the results of this study show the program to be an accurate method for generating a differential diagnosis for knee pain.
Effect of residual stress of friction stir welding on the fatigue life of AA 2024-T351 joint
Authors: Zhang Zhengwei , Zhang Zhao , Zhang Hongwu
Published: July 2014

A sequentially coupled thermo-mechanical finite element model is used to simulate the friction stir welding process. Fracture mechanical models for the middle tension specimen and the eccentrically loaded single-edge crack tension specimen are established. Utilizing the residual stress intensity factor obtained by the fracture mechanical models, the crack-closure model and superposition method are adopted to predict the fatigue crack growth rates of the two specimens. The results indicate that the effect of the residual stress on the fatigue crack growth rate becomes obvious as the stress ratio decreases. Considering the residual stress, the fatigue life of the welded plate exhibits a dramatic decrease for the middle tension specimen, but a remarkable increase for the eccentrically loaded single-edge crack tension specimen. The fatigue life of the middle tension specimen is almost insensitive to the rotational speed, but that of the eccentrically loaded single-edge crack tension specimen increases with the increase in the rotational speed.
Multi-criteria decision making approach for selecting the best friction distribution in superplastic forming of a vehicle component
Authors: Shojaeefard Mohammad Hasan , Khalkhali Abolfazl , Miandoabchi Elyar
Published: July 2014

In the superplastic forming process, the die–sheet interface friction distribution affects the required forming time and thickness uniformity of the formed part. This study undertakes the numerical investigation of applying variable interfacial friction distribution in superplastic forming of AA5083 aluminum alloy into a vehicle closure component using the commercial software, ABAQUS/Implicit. The die surface is divided into seven regions and a set of finite element simulations of the hot gas-pressure forming process are performed with focus on the effects of applying different friction coefficients at those regions on the forming time and thinning factor. For selecting the trade-off optimum friction distribution, forming time and thinning factor are calculated for each friction condition to form an evaluation matrix. Finally, TOPSIS as a multi-criteria decision making method is employed to select the best compromise friction distribution.
Integrated flight/thrust vectoring control for jet-powered unmanned aerial vehicles with ACHEON propulsion
Authors: Cen Zhaohui , Smith Tim , Stewart Paul , Stewart Jill
Published: July 2014

As a new alternative to tilting rotors or turbojet vector mechanical oriented nozzles, ACHEON (Aerial Coanda High Efficiency Orienting-jet Nozzle) has enormous advantages because it is free of moving elements and highly effective for vertical/short-take-off and landing (V/STOL) aircraft. In this article, an integrated flight/thrust vectoring (TV) control scheme for a jet-powered unmanned aerial vehicle (UAV) with an ACHEON nozzle is proposed to assess its suitability in jet aircraft flight applications. First, a simplified TV population model is built based on CFD simulation data and parameter identification. Second, this TV propulsion model is embedded as a jet actuator for a benchmark fixed-wing ‘Aerosonde’ UAV, and then a four ‘cascaded-loop’ controller, based on nonlinear dynamic inversion (NDI), is designed to individually control the angular rates (in the body frame), attitude angles (in the wind frame), track angles (in the navigation frame), and position (in the earth-centred frame) . Unlike previous research on fixed-wing UAV flight controls or TV controls, our proposed four-cascaded NDI control law can not only coordinate surface control and TV control as well as an optimization controller, but can also implement an absolute self-position control for the autopilot flight control. Finally, flight simulations in a high-fidelity aerodynamic environment are performed to demonstrate the effectiveness and superiority of our proposed control scheme.
Fast terminal sliding mode control based on extended state observer for swing nozzle of anti-aircraft missile
Authors: Sun Lianghua , Wang Weihong , Yi Ran , Zhang Wulong
Published: July 2014

This paper concerns with achieving fast and accurate control in swing nozzle of anti-aircraft missile with nonlinear system. Firstly, swing nozzle servo institutions and their load torque has been modeled; secondly, a fast terminal sliding mode control based on extended state observer has been proposed to reduce the influence of large disturbance and system uncertainty; finally, the controller designed has been studied and the stability of the control algorithm has been proved. The computer simulation results show that on the condition of large disturbance and system uncertainty, the fast terminal sliding mode control with extended state observer has high control accuracy and fast performance for swing nozzle servo system, and can effectively reduce the chattering. The results are in agreement with experimental data, which verifies the validity of the algorithm.
Comparison of bone mass and quality determinants in adolescents and young adults with juvenile systemic lupus erythematosus (JSLE) and juvenile idiopathic arthritis (JIA)
Authors: Stagi S , Cavalli L , Bertini F , Signorini C , Matucci Cerinic M , de Martino M , Brandi M L , Falcini F
Published: July 2014

Background

Few prospective data have been published on the comparison of bone density and quality in homogeneous groups of patients with juvenile systemic lupus erythematosus (JSLE) and juvenile idiopathic arthritis (JIA).

Objective and hypothesis

The objective of this study is to perform a longitudinal evaluation of the prevalence and the characteristics of bone mass and quality and to evaluate the differences on the bone parameters, using DXA, pQCT and QUS.

Population and/or methods

Forty-three JSLE patients (35 females, 8 males, median age 18.8, range 14.0–34.1 years) have been studied with DXA, pQCT and QUS scans and compared with 138 JIA patients (112 females, 26 males, median age 18.9, range 13.4–33.2 years), and 79 controls (59 females, 20 males; median age 19.3, range 13.5–36.5 years). Of these, 39 patients (32 females and 7 males, median age 20.3, range 16.6–36.8 years) with JSLE were followed longitudinally and compared with 131 patients (108 females, 23 males median age 20.7, range 15.8–37.1 years) with JIA and 63 controls (48 females, 15 males; median age 21.9, range 15.5–38.3 years).

Results

JSLE patients have a higher bone cortical density (CrtBMD) than controls and JIA patients ( p < 0.005). However, JSLE and JIA patients have a significantly reduced bone trabecular density (TrbBMD) compared to controls ( p < 0.0001), with no differences between JSLE and JIA. In addition, JIA patients show a significantly reduced muscle area (MuscleCSA) compared to JSLE and controls ( p < 0.001). Conversely, fat area (FatCSA) is significantly increased both in JIA and JSLE patients when compared to controls ( p < 0.001), with no differences between the JSLE and JIA groups. Analogous results are observed in the polar resistance to stress (SSIp). On longitudinal evaluation, contrary to CrtBMD, the difference between BMAD SDS, TrbBMD, MuscleCSA and FatCSA remains unchanged; in JSLE patients, SSIp is stable in comparison to JIA and controls without any difference between the two groups.

Conclusions

The evaluation of bone density and structure parameters in JSLE patients highlights significant differences compared with JIA patients and controls. These data might indicate a different pathogenesis of bone damage in the two entities, and suggest a different diagnostic and therapeutic approach to improve the peak bone mass.
China–Africa Relations: An Analysis of Forum on China–Africa Cooperation (FOCAC) Documents Using Shinn and Eisenman’s Optimist–Pessimist Dual Framework
Authors: Fernando Sithara
Published: July 2014

Using Shinn and Eisenman’s Optimist–Pessimist dual framework this article has analysed contemporary China–Africa relations through documents produced by the Forum on China–Africa Cooperation. This analysis both substantiates and problematises the Optimist and Pessimist perspectives that make up the framework. It identifies zero-sum thinking as a weakness common to key postulates of both the perspectives. In the Optimist perspective, China provides Africa with a political counterweight to the West. In the Pessimist perspective, the strengthening of China–Africa relations constitutes an unwelcome challenge to the West in Africa. In both cases, the gain of one party results in a loss for the other. In the first case, Africa’s gain results in a loss to the West and, in the second case, it is China’s gain as against a loss to the West. In order to rectify this weakness, it calls for greater non-zero-sum thinking in the West in response to the growing China–Africa relationship aimed at realising joint gains for all parties.
The experience of psychiatry training in rural NSW
Authors: Nash Louise , Hickie Catherine , Clark Scott , Karageorge Aspasia , Kelly Patrick J , Earle Maree
Published: July 2014

Objective:

To examine the experience of psychiatry training in rural New South Wales.

Method:

All rural trainees in New South Wales and key psychiatrists involved in their training were invited to complete a survey in May–July 2013.

Results:

Responses were received from 26 out of 44 rurally placed psychiatry trainees (57% response rate) and 37 out of 55 psychiatrists involved in training in a rural area (67% response rate). Positive and negative aspects of rural training were reported. In general, trainees reported positive experiences regarding supervision, consultant input and their Site Coordinator of training. Their experience of other aspects of training and education in rural areas was often negative with 52% of trainees feeling at a disadvantage due to fewer registrar peers and 60% feeling educationally isolated. Difficulty progressing through training, workforce shortages, difficulty accessing formal aspects of training and limited options for advanced training were reported. Metropolitan trainees on rotation to rural terms receive accommodation, travel and an increase in wage from the rural Local Health District. Rural trainees on rotation to the city for their mandatory subspecialty training receive no such support.

Conclusions:

There are many challenges for rural trainees. Support from the Royal Australian and New Zealand College of Psychiatrists and state and federal governments to enhance the rural training experience is vital.
Evaluation of a closed-system cytotoxic transfer device in a pharmaceutical isolator
Authors: Vyas N , Turner A , Clark JM , Sewell GJ
Published: July 2014

Purpose

The occupational risk associated with handling of cytotoxic anticancer drugs is well documented and, in many countries, pharmaceutical isolators are used to contain cytotoxic residues during preparation of cytotoxic infusions. Isolators are difficult to clean leading to concerns that cytotoxic contamination from the work area could be transferred to surfaces of products leaving the isolator. This study investigated the surface contamination arising from the preparation of five anticancer drug infusions (Epirubicin, Fluorouracil, Cisplatin, Oxaliplatin and Carboplatin) in a pharmaceutical isolator and compared use of a conventional syringe and needle technique with a closed-system drug transfer device (CSDTD).

Methods

Wipe samples were taken over 1 week from pre-defined areas in the isolator, gloves, preparation mats, and also from the surfaces of prepared cytotoxic infusion bags and pre-filled syringes to obtain baseline surface contamination data. Following operator familiarisation, the CSDTD was then introduced and sampling repeated for a further week ( intervention period). The samples obtained were analysed using validated HPLC-UV, HPLC-FL and ICP-MS techniques, as appropriate.

Results

All surfaces sampled during baseline, including external surfaces of infusions and syringes, were contaminated with each marker drug. During the intervention phase, isolator surfaces were free from detectable contamination and the contamination measured on gloves, preparation mats and surface of infusions was markedly reduced. The frequency of contamination on syringe and infusion surfaces was also lower.

Conclusion

Surface contamination from cytotoxic infusion preparation in a pharmaceutical isolator was significant and could transmit cytotoxic residues to patient and public areas via infusion surfaces. The frequency and amount of contamination were reduced by the CSDTD.
Attending to Communication and Patterns of Interaction
Authors: Molewyk Doornbos Mary , Zandee Gail Landheer , DeGroot Joleen
Published: July 2014

BACKGROUND: The United States is ethnically diverse. This diversity presents challenges to nurses, who, without empirical evidence to design culturally congruent interventions, may contribute to mental health care disparities. OBJECTIVE: Using Leininger’s theory of culture care diversity and universality, this study documented communication and interaction patterns of ethnically diverse, urban, impoverished, and underserved women. DESIGN: Using a community-based participatory research framework, 61 Black, Hispanic, and White women participated in focus groups around their experiences with anxiety/depression. Researchers recorded verbal communication, nonverbal behavior, and patterns of interaction. RESULTS: The women’s communication and interaction patterns gave evidence of three themes that were evident across all focus groups and five subthemes that emerged along ethnic lines. CONCLUSIONS: The results suggest cultural universalities and cultural uniquenesses relative to the communication and interaction patterns of urban, ethnically diverse, impoverished, and underserved women that may assist in the design of culturally sensitive mental health care.
Cultural Variations in Shame’s Responses
Authors: Sheikh Sana
Published: July 2014

The diverse literature on shame has led to disparate and often contradictory conclusions regarding the emotion’s nature and consequences. The article proposes a motivational theory of shame that accounts for these discrepant findings. The first part of the article uses the concept of active avoidance to outline a dynamic motivational perspective in which shame is based initially in behavioral inhibition that then incorporates subsequent behavioral activation. The motivational shift is guided by shame’s relational phenomenology and the normative beliefs associated with shame. In the second part, the motivational perspective is used to account for variations in shame’s consequences. Externalizing and restorative tendencies of shame are culturally variable and due to differences in behavioral activation associated with the emotion. However, withdrawal tendencies occur across cultural contexts because of shame’s basis in inhibition. Issues in conducting cross-cultural studies on emotion and suggestions for future research are discussed.
Management of endemic Microsporum canis dermatophytosis in an open admission shelter: a field study
Authors: Newbury Sandra , Moriello Karen , Coyner Kimberly , Trimmer Ann , Kunder Darcie
Published: July 2014

Endemic Microsporum canis dermatophytosis was identified in a large, open admission, private, no-kill shelter that admitted >1200 cats per year. Fungal culture (FC) screening revealed that 166/210 (79%) and 38/99 (38%) cats in the non-public and public area were culture positive, respectively. However, pending screening FC results, the 99 cats in the public area were treated with once-weekly lime sulfur rinses and monitored with once-weekly FC. Cats in the non-public area were not treated. When FC results were available, cats were separated into low-risk (n = 61) and high-risk (n = 38) groups based upon the presence or absence of skin lesions. Low-risk cats continued to receive once-weekly topical lime sulfur and rapidly achieved culture-negative status. High-risk cats were divided into two groups based upon the number of colony-forming units/plate (low or high). All 38 cats were treated with twice-weekly lime sulfur and oral terbinafine and within 6–7 weeks only 5/38 cats were still FC-positive. These cats were moved to a separate room. Dermatophytosis was eradicated within 5 months; eradication was prolonged owing to reintroduction of disease into the remaining room of cats under treatment from three kittens returning from foster care. Continued admissions and adoptions were possible by the institution of intake procedures that specifically included careful Wood’s lamp examination to identify high-risk cats and use of a ‘clean break strategy’.
Patellar ligament rupture in the cat: repair methods and patient outcomes in seven cases
Authors: Das Smita , Thorne Rebecca , Langley-Hobbs Sorrel J , Perry Karen L , Burton Neil J , Mosley John R
Published: July 2014

The medical records of cats receiving surgical treatment for unilateral patellar ligament rupture between 1999 and 2012 at 12 referral centres in the UK and Ireland were reviewed. Seven cases were identified: six were caused by trauma and one was iatrogenic, occurring as a complication following surgical stabilisation of a tibial fracture. All cases were treated by sutured anastomosis of the ruptured ligament, with six of the repairs protected by a circumpatellar and/or transpatellar loop of suture. The stifle was immobilised by transarticular external skeletal fixation in three cases. No cases required revision surgery. No complications were reported. Final evaluation, performed at a median time of 31 days, determined five patients to have returned to acceptable or good limb function; two cases were lost to follow-up. The data suggest that, in cats, the current surgical techniques extrapolated from their canine counterparts for repair of a completely or partially ruptured patellar ligament are successfully used and result in acceptable limb function.
Venous thromboembolism in hospitalized patients: An updated analysis of missed opportunities for thromboprophylaxis at a university-affiliated tertiary care center
Authors: Ma Kim A , Cohen Eva , Kahn Susan R
Published: July 2014

Thromboprophylaxis remains often underused in hospitalized patients. In 2001, a cohort study done at our institution, a tertiary care center in Montreal, Canada, showed that 67.7% of VTE cases necessitating thromboprophylaxis were potentially preventable with adequate use of American College of Chest Physicians (ACCP) guidelines. Following implementation of an institution-wide policy in 2005, we assessed the changes in the rate of potentially preventable VTE. We conducted a retrospective cohort study including all hospitalized patients with objectively diagnosed VTE in 2010 at our institution. Each case was classified as preventable (thromboprophylaxis indicated but inadequately administered), non-preventable (thromboprophylaxis indicated and correctly administered), spontaneous (thromboprophylaxis not indicated), and ineligible (contraindication to thromboprophylaxis). The results were compared to those obtained in 2001. Of the 230 cases of VTE, 55 cases were classified as potentially preventable (23.9%), 85 were non-preventable (37.0%), 74 were spontaneous (32.2%) and 16 (7.0%) were ineligible. Of the 140 cases requiring thromboprophylaxis, 39.3% were potentially preventable. The potentially preventable cases were mostly due to omission of thromboprophylaxis (50.9%), occurred during general medical admissions (74.5%), and the most common VTE risk factor was cancer (47.2%). In conclusion, we demonstrate a lower frequency of potentially preventable cases in 2010 compared to 2001 (39.3% vs 67.7%, respectively), partially due to physician education and adoption of an institution-wide policy. However, patients with medical indications for thromboprophylaxis, particularly those with cancer, are more prone to having preventable VTE, indicating an area for potential improvement.
Profile and predictors of service needs for families of children with autism spectrum disorders
Authors: Hodgetts Sandra , Zwaigenbaum Lonnie , Nicholas David
Published: July 2014

Purpose:

Increasing demand for autism services is straining service systems. Tailoring services to best meet families’ needs could improve their quality of life and decrease burden on the system. We explored overall, best, and worst met service needs, and predictors of those needs, for families of children with autism spectrum disorders.

Methods:

Parents of 143 children with autism spectrum disorders (2–18 years) completed a survey including demographic and descriptive information, the Family Needs Survey–Revised, and an open-ended question about service needs. Descriptive statistics characterize the sample and determine the degree to which items were identified and met as needs. Predictors of total and unmet needs were modeled with regression or generalized linear model. Qualitative responses were thematically analyzed.

Results:

The most frequently identified overall and unmet service needs were information on services, family support, and respite care. The funding and quality of professional support available were viewed positively. Decreased child’s age and income and being an older mother predicted more total needs. Having an older child or mother, lower income, and disruptive behaviors predicted more total unmet needs, yet only disruptive behaviors predicted proportional unmet need. Child’s language or intellectual abilities did not predict needs.

Conclusion:

Findings can help professionals, funders, and policy-makers tailor services to best meet families’ needs.
Intersectoral action for health: The experience of a Danish municipality
Authors: Larsen Maja , Rantala Riikka , Koudenburg Okje Anna , Gulis Gabriel
Published: July 2014

Background:The aim was to build up evidence on intersectoral action for health at local government level by identifying both challenges and facilitating factors in collaboration between sectors when developing and implementing an intersectoral health policy in Varde, Denmark. Methods: The study was carried out in 2011 using the case-study method. Approximately 500 pages of documents from the period 2007−2011 were analysed, and semi-structured interviews were carried out with nine key informants. Results: The following challenges were identified: the policy was perceived as an additional task by employees outside the health sector; initially no direct funding was allocated to intersectoral projects; the level of ambition was not balanced between sectors; there was a lack of ownership of the policy; baseline measures were lacking and the policy had no clear objectives. Facilitating factors were considered to be: significant political support; public involvement; use of local media; establishment of a ‘Fund for Health’; establishment of ‘Health Networks’ within sectors; and collaboration with a research group. Conclusions: Important practical lessons can be drawn from this experience for other cities planning to introduce similar formal intersectoral health policies. In order to increase the chance of successful intersectoral action in further development and implementation of the intersectoral health policy in Varde in the future, the challenges and facilitating factors identified in this study should be considered. More evidence is required on the long-term health impacts of such policies.
Solitary fibrous tumor of the post-styloid parapharyngeal space
Authors: Lee Ji Eun , Hong Hyun Sook , Chang Kee-Hyun , Kim Hee Kyung , Park Jisang
Published: July 2014

Solitary fibrous tumor (SFT) is a well-known tumor composed of spindle cells found most commonly in the pleura. Recently, accounts of their rare occurrence at other sites, including the head and neck area, have been reported. The parapharyngeal space is a rare location even for head and neck SFTs, and thus, could be confused with a variety of other tumors that can originate in this area. Here, we report a case of SFT originating from the post-styloid parapharyngeal space and discuss the possible differential diagnosis on radiographic findings.
Acid sphingomyelinase is activated in sickle cell erythrocytes and contributes to inflammatory microparticle generation in SCD
Authors: Awojoodu Anthony O. , Keegan Philip M. , Lane Alicia R. , Zhang Yuying , Lynch Kevin R. , Platt Manu O. , Botchwey Edward A.
Published: July 2014

Key Points

Alterations in RBC membranes contribute to dysregulated sphingolipid metabolism in sickle cell disease (SCD). Increased RBC-derived MP production enhances monocyte adhesion and activation in SCD.
CXCR7-dependent angiogenic mononuclear cell trafficking regulates tumor progression in multiple myeloma
Authors: Azab Abdel Kareem , Sahin Ilyas , Azab Feda , Moschetta Michele , Mishima Yuji , Burwick Nicholas , Zimmermann Johann , Romagnoli Barbara , Patel Kalpana , Chevalier Eric , Roccaro Aldo M. , Ghobrial Irene M.
Published: July 2014

Key Points

AMCs home to tumor sites in MM. CXCR7 inhibition delayed tumor progression in MM through specific regulation of AMC trafficking but not through a direct tumor effect.
BMP type II receptors have redundant roles in the regulation of hepatic hepcidin gene expression and iron metabolism
Authors: Mayeur Claire , Leyton Patricio A. , Kolodziej Starsha A. , Yu Binglan , Bloch Kenneth D.
Published: July 2014

Key Points

Presence of either ActR2a or BMPR2 in hepatocytes is sufficient to maintain hepatic hepcidin gene expression and iron metabolism. Deficiency of both BMP type II receptors in hepatocytes induces iron overload.
Controlled nanodot fabrication by rippling polycarbonate surface using an AFM diamond tip
Authors: Yan Yongda , Sun Yang , Li Jiran , Hu Zhenjiang , Zhao Xuesen
Published: July 2014

The single scratching test of polymer polycarbonate (PC) sample surface using an atomic force microscope (AFM) diamond tip for fabricating ripple patterns has been studied with the focus on the evaluation of the effect of the tip scratching angle on the pattern formation. The experimental results indicated that the different oriented ripples can be easily machined by controlling the scratching angles of the AFM. And, the effects of the normal load and the feed on the ripples formation and their periods were also studied. Based on the ripple pattern formation, we firstly proposed a two-step scratching method to fabricate controllable and oriented complex three-dimensional (3D) nanodot arrays. These typical ripple formations can be described via a stick-slip and crack formation process.
IL-10 Mediated by Herpes Simplex Virus Vector Reduces Neuropathic Pain Induced by HIV gp120 Combined with ddC in Rats
Authors: Zheng Wenwen , Huang Wan , Liu Shue , Levitt Roy C , Candiotti Keith A , Lubarsky David A , Hao Shuanglin
Published: July 2014

Background:

HIV-associated sensory neuropathy affects over 50% of HIV patients and is a common peripheral nerve complication of HIV infection and highly active antiretroviral therapy (HAART). Evidence shows that painful HIV sensory neuropathy is influenced by neuroinflammatory events that include the proinflammatory molecules, MAP Kinase, tumor necrosis factor-α (TNFα), stromal cell-derived factor 1-α (SDF1α), and C-X-C chemokine receptor type 4 (CXCR4). However, the exact mechanisms of painful HIV sensory neuropathy are not known, which hinders our ability to develop effective treatments. In this study, we investigated whether inhibition of proinflammatory factors reduces the HIV-associated neuropathic pain state.

Results:

Neuropathic pain was induced by peripheral HIV coat protein gp120 combined with 2′,3′-dideoxycytidine (ddC, one of the nucleoside reverse transcriptase inhibitors (NRTIs)). Mechanical threshold was tested using von Frey filament fibers. Non-replicating herpes simplex virus (HSV) vectors expressing interleukin 10 (IL10) were inoculated into the hindpaws of rats. The expression of TNFα, SDF1α, and CXCR4 in the lumbar spinal cord and L4/5 dorsal root ganglia (DRG) was examined using western blots. IL-10 expression mediated by the HSV vectors resulted in a significant elevation of mechanical threshold. The anti-allodynic effect of IL-10 expression mediated by the HSV vectors lasted more than 3 weeks. The area under the effect-time curves (AUC) in mechanical threshold in rats inoculated with the HSV vectors expressing IL-10, was increased compared with the control vectors, indicating antinociceptive effect of the IL-10 vectors. The HSV vectors expressing IL-10 also concomitantly reversed the upregulation of p-p38, TNFα, SDF1α, and CXCR4 induced by gp120 in the lumbar spinal dorsal horn and/or the DRG at 2 and/or 4 weeks.

Conclusion:

The blocking of the signaling of these proinflammatory molecules is able to reduce HIV-related neuropathic pain, which provide a novel mechanism-based approach to treating HIV-associated neuropathic pain using gene therapy.
Cardiac arrest patients have an impaired immune response, which is not influenced by induced hypothermia
Authors: Beurskens Charlotte J , Horn Janneke , de Boer Anita M Tuip , Schultz Marcus J , van Leeuwen Ester MM , Vroom Margreeth B , Juffermans Nicole P
Published: July 2014

Introduction

Induced hypothermia is increasingly applied as a therapeutic intervention in ICUs. One of the underlying mechanisms of the beneficial effects of hypothermia is proposed to be reduction of the inflammatory response. However, a fear of reducing the inflammatory response is an increased infection risk. Therefore, we studied the effect of induced hypothermia on immune response after cardiac arrest.

Methods

A prospective observational cohort study in a mixed surgical-medical ICU. Patients admitted at the ICU after surviving cardiac arrest were included and during 24 hours body temperature was strictly regulated at 33°C or 36°C. Blood was drawn at three time points: after reaching target temperature, at the end of the target temperature protocol and after rewarming to 37°C. Plasma cytokine levels and response of blood leucocytes to stimulation with toll-like receptor (TLR) ligands lipopolysaccharide (LPS) from Gram-negative bacteria and lipoteicoic acid (LTA) from Gram-positive bacteria were measured. Also, monocyte HLA-DR expression was determined.

Results

In total, 20 patients were enrolled in the study. Compared to healthy controls, cardiac arrest patients kept at 36°C (n = 9) had increased plasma cytokines levels, which was not apparent in patients kept at 33°C (n = 11). Immune response to TLR ligands in patients after cardiac arrest was generally reduced and associated with lower HLA-DR expression. Patients kept at 33°C had preserved ability of immune cells to respond to LPS and LTA compared to patients kept at 36°C. These differences disappeared over time. HLA-DR expression did not differ between 33°C and 36°C.

Conclusions

Patients after cardiac arrest have a modest systemic inflammatory response compared to healthy controls, associated with lower HLA-DR expression and attenuated immune response to Gram-negative and Gram-positive antigens, the latter indicative of an impaired immune response to bacteria. Patients with a body temperature of 33°C did not differ from patients with a body temperature of 36°C, suggesting induced hypothermia does not affect immune response in patients with cardiac arrest.

Trial registration

ClinicalTrials.gov NCT01020916, registered 25 November 2009
Mammographic features associated with interval breast cancers in screening programs
Authors: Boyd Norman F , Huszti Ella , Melnichouk Olga , Martin Lisa J , Hislop Greg , Chiarelli Anna , Yaffe Martin J , Minkin Salomon
Published: July 2014

Introduction

Percent mammographic density (PMD) is associated with an increased risk of interval breast cancer in screening programs, as are younger age, pre-menopausal status, lower body mass index and hormone therapy. These factors are also associated with variations in PMD. We have examined whether these variables influence the relative frequency of interval and screen-detected breast cancer, independently or through their associations with PMD. We also examined the association of tumor size with PMD and dense and non-dense areas in screen-detected and interval breast cancers.

Methods

We used data from three case-control studies nested in screened populations. Interval breast cancer was defined as invasive breast cancer detected within 12 months of a negative mammogram. We used a computer-assisted method of measuring the dense and total areas of breast tissue in the first (baseline) mammogram taken at entry to screening programs and calculated the non-dense area and PMD. We compared these mammographic features, and other risk factors at baseline, in women with screen-detected (n?=?718) and interval breast cancer (n?=?125).

Results

In multi-variable analysis, the baseline characteristics of younger age, greater dense area and smaller non-dense mammographic area were significantly associated with interval breast cancer compared to screen-detected breast cancer. Compared to screen-detected breast cancers, interval cancers had a larger maximum tumor diameter within each mammographic measure.

Conclusions

Age and the dense and non-dense areas in the baseline mammogram were independently associated with interval breast cancers in screening programs. These results suggest that decreased detection of cancers caused by the area of dense tissue, and more rapid growth associated with a smaller non-dense area, may both contribute to risk of interval breast cancer. Tailoring screening to individual mammographic characteristics at baseline may reduce the number of interval cancers.
A simple metric of promoter architecture robustly predicts expression breadth of human genes suggesting that most transcription factors are positive regulators
Authors: Hurst Laurence D , Sachenkova Oxana , Daub Carsten , Forrest Alistair RR ,   the FANTOM consortium, Huminiecki Lukasz
Published: July 2014

Background

Conventional wisdom holds that, owing to the dominance of features such as chromatin level control, the expression of a gene cannot be readily predicted from knowledge of promoter architecture. This is reflected, for example, in a weak or absent correlation between promoter divergence and expression divergence between paralogs. However, an inability to predict may reflect an inability to accurately measure or employment of the wrong parameters. Here we address this issue through integration of two exceptional resources: ENCODE data on transcription factor binding and the FANTOM5 high-resolution expression atlas.

Results

Consistent with the notion that in eukaryotes most transcription factors are activating, the number of transcription factors binding a promoter is a strong predictor of expression breadth. In addition, evolutionarily young duplicates have fewer transcription factor binders and narrower expression. Nonetheless, we find several binders and cooperative sets that are disproportionately associated with broad expression, indicating that models more complex than simple correlations should hold more predictive power. Indeed, a machine learning approach improves fit to the data compared with a simple correlation. Machine learning could at best moderately predict tissue of expression of tissue specific genes.

Conclusions

We find robust evidence that some expression parameters and paralog expression divergence are strongly predictable with knowledge of transcription factor binding repertoire. While some cooperative complexes can be identified, consistent with the notion that most eukaryotic transcription factors are activating, a simple predictor, the number of binding transcription factors found on a promoter, is a robust predictor of expression breadth.