bluuebunny/crossref_metadata_2025 huggingface dataset:
The Evaluation of Leukocytes in Response to the In Vitro Testing of Ventricular Assist Devices
Authors: Chan Chris H.H. , Hilton Andrew , Foster Graham , Hawkins Karl M. , Badiei Nafiseh , Thornton Catherine A.
Published: August 2013

Infection is a clinically relevant adverse event in patients with ventricular assist device (VAD) support. The risk of infection could be linked to a reduced immune response resulting from damage to leukocytes during VAD support. The purpose of this study was to develop an understanding of leukocyte responses during the in vitro testing of VADs by analyzing the changes to their morphology and biochemistry. The VentrAssist implantable rotary blood pump (IRBP) and RotaFlow centrifugal pump (CP) were tested in vitro under constant hemodynamic conditions. Automated hematology analysis of samples collected regularly over 25‐h tests was undertaken. A new flow cytometric assay was employed to measure biochemical alteration, necrosis (7‐AAD) and morphological alteration (CD45 expression) of the circulating leukocytes during the pumping process. The results of hematology analysis show the total leukocyte number and subset counts decreased over the period of in vitro tests dependent on different blood pumps. The percentage of leukocytes damaged during 6‐h tests was 40.8 ± 5.7% for the VentrAssist IRBP, 17.6 ± 5.4% for the RotaFlow CP, and 2.7 ± 1.8% for the static control (all n = 5). Flow cytometric monitoring of CD45 expression and forward/side scatter characteristics revealed leukocytes that were fragmented into smaller pieces (microparticles). Scanning electron microscopy and imaging flow cytometry were used to confirm this. Device developers could use these robust cellular assays to gain a better understanding of leukocyte‐specific VAD performance.
Retinal nerve fibre layer thickness measured by Spectralis spectral‐domain optical coherence tomography: The Beijing Eye Study
Authors: Zhao Liang , Wang Yaxing , Chen Chang X. , Xu Liang , Jonas Jost B.
Published: August 2013

Purpose

The aim of this study was to measure retinal nerve fibre layer thickness (RNFLT) and its associated factors in a population‐based setting.

Methods

The population‐based Beijing Eye Study 2011 included 3468 individuals. The study participants underwent spectral‐domain optical coherence tomography (Spectralis®; Spectralis OCT)–assisted measurement of the RNFLT. For this study, exclusion criteria were glaucoma, pseudoexfoliation, best‐corrected visual acuity of >0.5 logMAR, macular diseases, previous ocular surgery and known neurological diseases. The only inclusion criterion was an age of 50+ years.

Results

The inclusion criteria were fulfilled by 2548 participants. Mean RNFLT was 102 ± 11 μm. RNFLT was significantly (p < 0.001) thicker in the temporal inferior sector (153 ± 21 μm) than in the temporal superior sector (138 ± 21 μm), nasal inferior sector (118 ± 24 μm), nasal superior sector (106 ± 21 μm), temporal sector (76 ± 13 μm) and nasal sector (73 ± 15 μm). The mean intereye difference in RNFLT was 4.4 ± 6.0 μm. In multivariate analysis, thicker RNFLT was associated with younger age (p < 0.001), female gender (p < 0.001), urban region (p = 0.003), larger optic disc size (p < 0.001), larger neuroretinal rim area (p < 0.001), hyperopic refractive error (p < 0.001), larger beta zone of parapapillary atrophy (p = 0.008) and thicker subfoveal choroidal thickness (p = 0.02). RNFLT decreased by about 0.2 μm (0.2%) per year of life and by 1 μm (1%) per dioptre of myopia.

Conclusion

Mean RNFLT (measured by Spectralis® OCT; 102 ± 11 μm) was associated with younger age, female gender, urban region of habitation, larger optic disc, larger rim, hyperopic refractive error, larger parapapillary beta zone and thicker subfoveal choroidal thickness. Independent of age and refractive error, the RNFL was thickest temporal inferiorly and thinnest temporally and nasally.
A paired comparison of intracameral mydriatics in refractive lens exchange surgery
Authors: Lundqvist Oskar , Koskela Timo , Behndig Anders
Published: August 2013

Purpose

To compare the efficacy and intra‐operative safety of intracameral mydriatics to topical mydriatics in patients undergoing refractive lens exchange (RLE) surgery.

Methods

In a randomized intra‐individually comparing study performed at Koskelas Eye Clinic, Luleå, and Department of Clinical Sciences/Ophthalmology, Umeå University Hospital, Umeå, Sweden, 56 patients undergoing same‐day bilateral RLE were included. Pupils were randomly dilated with topical mydriatics in one eye and intracameral mydriatics in the fellow eye. Pupil sizes were recorded intra‐operatively throughout the procedures. Perceived pain/discomfort and glare were assessed immediately postoperatively using a visual analogue scale from 0 to 10.

Results

Topical mydriatics and intracameral mydriatics both give satisfactory pupil dilation in routine RLE. However, there was noticeable iris billowing in 17 eyes dilated with topical mydriatics but only one eye with intracameral mydriatics (p < 0.001). Pupils were initially slightly larger in the topical mydriatics group but contracted during surgery. There was no perceived difference with regards to glare, pain or discomfort between the treatments. The surgeon graded intracameral mydriatics eyes as easier to operate on.

Conclusion

Both topical mydriatics and intracameral mydriatics give satisfactory mydriasis for RLE, but pupil constriction and iris billowing are more pronounced with topical mydriatics.
CPAP‐induced mania in bipolar disorder: a case report
Authors: Aggarwal Richa , Baweja Raman , Saunders Erika FH , Singareddy Ravi
Published: August 2013

Objective

In this case report we present our clinical observations of two patients with bipolar disorder with comorbid obstructive sleep apnea (OSA) who were treated with continuous positive airway pressure (CPAP) for their sleep apnea.

Background

Bipolar disorder is a psychiatric disorder characterized by the presence of one or more episodes of mania and frequent episodes of depression. This disorder affects approximately 0.8% of the adult population, with estimates from community samples ranging between 0.4% and 1.6%. OSA syndrome is a severe sleep disorder with a prevalence of 2–4% in the general population, the risk of which is increased by obesity. The prevalence of OSA is expected to be high in bipolar disorder due to high comorbid obesity. It is expected that improvement in OSA in patients with bipolar disorder with CPAP will improve mood and other symptoms of bipolar disorder. However, there is a relative lack of data examining this aspect.

Results

In both cases of bipolar disorder, CPAP was started after a polysomnographic diagnosis of OSA and CPAP titration study indicating that most of the apneas/hypopneas were eliminated with a significant improvement in oxygen saturation. To our surprise, we noted that in both of these cases initiation of CPAP resulted in manic symptoms.

Conclusions

Clinicians need to monitor patients with bipolar disorder closely for worsening of manic symptoms when they are started on CPAP for underlying OSA.
Guideline on the prevention of secondary central nervous system lymphoma: British Committee for Standards in Haematology
Authors: McMillan Andrew , Ardeshna Kirit M. , Cwynarski Kate , Lyttelton Matthew , McKay Pam , Montoto Silvia
Published: August 2013

The guideline group was selected to be representative of UK‐based medical experts. Ovid MEDLINE, EMBASE and NCBI Pubmed were searched systematically for publications in English from 1980 to 2012 using the MeSH subheading ‘lymphoma, CNS’, ‘lymphoma, central nervous system’, ‘lymphoma, high grade’, ‘lymphoma, Burkitt's’, ‘lymphoma, lymphoblastic’ and ‘lymphoma, diffuse large B cell’ as keywords, as well as all subheadings. The writing group produced the draft guideline, which was subsequently revised by consensus by members of the Haemato‐oncology Task Force of the British Committee for Standards in Haematology (BCSH). The guideline was then reviewed by a sounding board of ~50 UK haematologists, the BCSH and the British Society for Haematology (BSH) Committee and comments incorporated where appropriate. The ‘GRADE’ system was used to quote levels and grades of evidence, details of which can be found in Appendix I. The objective of this guideline is to provide healthcare professionals with clear guidance on the optimal prevention of secondary central nervous system (CNS) lymphoma. The guidance may not be appropriate to patients of all lymphoma sub‐types and in all cases individual patient circumstances may dictate an alternative approach. Acronyms are defined at time of first use.
Patients with chronic lymphocytic leukaemia and clonal deletion of both 17p13.1 and 11q22.3 have a very poor prognosis
Authors: Greipp Patricia T. , Smoley Stephanie A. , Viswanatha David S. , Frederick Lori S. , Rabe Kari G. , Sharma Ruchi G. , Slager Susan L. , Van Dyke Daniel L. , Shanafelt Tait D. , Tschumper Renee C. , Zent Clive S.
Published: August 2013

Detection of a 17p13.1 deletion (loss of TP53) or 11q22.3 deletion (loss of ATM), by fluorescence in situ hybridization (FISH), in chronic lymphocytic leukaemia (CLL) patients is associated with a poorer prognosis. Because TP53 and ATM are integral to the TP53 pathway, we hypothesized that 17p13.1‐ (17p‐) and 11q22.3‐ (11q‐) occurring in the same cell (clonal 17p‐/11q‐) would confer a worse prognosis than either 17p‐ or 11q‐. We studied 2184 CLL patients with FISH (1995–2012) for the first occurrence of 17p‐, 11q‐, or clonal 17p‐/11q‐. Twenty (1%) patients had clonal 17p–/11q‐, 158 (7%) had 17p‐ (including 4 with 17p‐ and 11q‐ in separate clones), 247 (11%) had 11q‐, and 1759 (81%) had neither 17p‐ nor 11q‐. Eleven of 15 (73%) tested patients with clonal 17p‐/11q‐ had dysfunctional TP53 mutations. Overall survival for clonal 17p‐/11q‐ was significantly shorter (1·9 years) than 17p‐ (3·1 years, P = 0·04), 11q‐ (4·8 years, P ≤ 0·0001), or neither 17p‐ nor 11q‐ (9·3 years, P ≤ 0·0001). Clonal 17p‐/11q‐ thus conferred significantly worse prognosis, suggesting that loss of at least one copy of both TP53 and ATM causes more aggressive disease. Use of an ATM/TP53 combination FISH probe set could identify these very‐high risk patients.
Targeted resequencing for analysis of clonal composition of recurrent gene mutations in chronic lymphocytic leukaemia
Authors: Jethwa Alexander , Hüllein Jennifer , Stolz Tatjana , Blume Carolin , Sellner Leopold , Jauch Anna , Sill Martin , Kater Arnon P. , te Raa G. Doreen , Geisler Christian , van Oers Marinus , Dietrich Sascha , Dreger Peter , Ho Anthony D. , Paruzynski Anna , Schmidt Manfred , von Kalle Christof , Glimm Hanno , Zenz Thorsten
Published: August 2013

Recurrent gene mutations contribute to the pathogenesis of chronic lymphocytic leukaemia (CLL). We developed a next‐generation sequencing (NGS) platform to determine the genetic profile, intratumoural heterogeneity, and clonal structure of two independent CLL cohorts. TP53, SF3B1, and NOTCH1 were most frequently mutated (16·3%, 16·9%, 10·7%). We found evidence for subclonal mutations in 67·5% of CLL cases with mutations of cancer consensus genes. We observed selection of subclones and found initial evidence for convergent mutations in CLL. Our data suggest that assessment of (sub)clonal structure may need to be integrated into analysis of the mutational profile in CLL.
Mechanisms and ecological role of carbon transfer within coastal seascapes
Authors: Hyndes Glenn A. , Nagelkerken Ivan , McLeod Rebecca J. , Connolly Rod M. , Lavery Paul S. , Vanderklift Mathew A.
Published: August 2013

Worldwide, coastal systems provide some of the most productive habitats, which potentially influence a range of marine and terrestrial ecosystems through the transfer of nutrients and energy. Several reviews have examined aspects of connectivity within coastal seascapes, but the scope of those reviews has been limited to single systems or single vectors. We use the transfer of carbon to examine the processes of connectivity through multiple vectors in multiple ecosystems using four coastal seascapes as case studies. We discuss and compare the main vectors of carbon connecting different ecosystems, and then the natural and human‐induced factors that influence the magnitude of effect for those vectors on recipient systems. Vectors of carbon transfer can be grouped into two main categories: detrital particulate organic carbon (POC) and its associated dissolved organic and inorganic carbon (DOC/DIC) that are transported passively; and mobile consumers that transport carbon actively. High proportions of net primary production can be exported over meters to hundreds of kilometers from seagrass beds, algal reefs and mangroves as POC, with its export dependent on wind‐generated currents in the first two of these systems and tidal currents for the last. By contrast, saltmarshes export large quantities of DOC through tidal movement, while land run‐off plays a critical role in the transport of terrestrial POC and DOC into temperate fjords. Nekton actively transfers carbon across ecosystem boundaries through foraging movements, ontogenetic migrations, or ‘trophic relays’, into and out of seagrass beds, mangroves or saltmarshes. The magnitude of these vectors is influenced by: the hydrodynamics and geomorphology of the region; the characteristics of the carbon vector, such as their particle size and buoyancy; and for nekton, the extent and frequency of migrations between ecosystems. Through a risk‐assessment process, we have identified the most significant human disturbances that affect the integrity of connectivity among ecosystems. Loss of habitat, net primary production (NPP) and overfishing pose the greatest risks to carbon transfer in temperate saltmarsh and tropical estuaries, particularly through their effects on nekton abundance and movement. In comparison, habitat/NPP loss and climate change are likely to be the major risks to carbon transfer in temperate fjords and temperate open coasts through alteration in the amount of POC and/or DOC/DIC being transported. While we have highlighted the importance of these vectors in coastal seascapes, there is limited quantitative data on the effects of these vectors on recipient systems. It is only through quantifying those subsidies that we can effectively incorporate complex interactions into the management of the marine environment and its resources.
Surface Analysis of Titanium Biological Modification with Glow Discharge
Authors: Chang Yu‐Chi , Feng Sheng‐Wei , Huang Haw‐Ming , Teng Nai‐Chia , Lin Che‐Tong , Lin Hsi‐Kuei , Wang Peter‐D , Chang Wei‐Jen
Published: August 2013

Background

Glow discharge plasma (GDP) technology has been used to graft various proteins to the titanium surface, including albumin, type I collagen, but without fibronectin.

Purpose

The aim of this study was to evaluate and analyze the physical properties of fibronectin‐grafted titanium surfaces after GDP treatment.

Materials and Methods

Grade II titanium discs after cleaning and autoclaving were considered as original specimens, thus divided into four groups. The groups were different upon two treatments (GDP only and fibronectin grafting after GDP) and two storage temperature (4°C and 25°C). The implant surface morphology was characterized by scanning electron microscopy (SEM), roughness measurement, and wettability evaluation. The concentration relationship of fibronectin was by fluorescein isothiocyanate (FITC) labeling.

Results

SEM images showed that regular planar texture revealed on the surface of GDP‐treated group, and irregular‐folding protein was found on the fibronectin‐grafted discs. Fibronectin‐grafted groups had higher hydrophilicity and greater surface roughness than GDP‐treated specimens. The storage temperature did not make obvious difference on the surface topography, wettability, and roughness. The number of fibronectin dots on the titanium surface labeling by FITC had positive relationship with the concentration of fibronectin solution used.

Conclusions

Biologically modified titanium surface is more hydrophilic and rougher than GDP‐treated ones. GDP treatment combined with fibronectin grafting increased the surface hydrophilicity and surface roughness of titanium discs, which may attribute to the affinity of cell adhesion, migration, proliferation, and differentiation.
Water‐perfused manometry vs three‐dimensional high‐resolution manometry: a comparative study on a large patient population with anorectal disorders
Authors: Vitton V. , Ben Hadj Amor W. , Baumstarck K. , Grimaud J.‐C. , Bouvier M.
Published: August 2013

Aim

Our aim was to compare for the first time measurements obtained with water‐perfused catheter anorectal manometry and three‐dimensional (3D) high‐resolution manometry in patients with anorectal disorders.

Method

Consecutive patients referred to our centre for anorectal manometry (ARM) were recruited to undergo the two procedures successively. Conventional manometry was carried out using a water‐perfused catheter (WPAM) and high‐resolution manometry was achieved with a 3D probe (3DHRAM). For each procedure, parameters recorded included the following: anal canal length, resting pressure, squeeze pressure and rectal sensitivity.

Results

Two hundred and one patients were included in this study. The mean values for resting and squeeze pressures were correlated and found to be significantly higher when measured with 3DHRAM than with WPAM. However, the length of the anal canal was not significantly different when measured by the two techniques without correlation between the two mean values obtained. The presence of the rectoanal inhibitory reflex was systematically assessed by both WPAM and 3DHRAM and anismus was also systematically diagnosed by both WPAM and 3DHRAM.

Conclusion

The pressure values obtained with 3DHRAM are correlated with those measured with conventional manometry but are systematically higher. 3DHRAM has the advantage of providing a pressure recording over the entire length and circumference of the anal canal, allowing a more useful physiological assessment of anorectal function.
Identifying indicators of colorectal cancer care coordination: a Delphi study
Authors: Young J. M. , Masya L. M. , Solomon M. J. , Shepherd H. L.
Published: August 2013

Aim

Care coordination is an important aspect of the quality of cancer care but is difficult to evaluate due to the lack of valid and reliable measures. This study was conducted to identify a set of objective measures of colorectal cancer care coordination that could be included in a medical record audit tool.

Method

A two‐stage Delphi study was conducted to gain consensus among a national panel of experts about the validity of 41 potential indicators of colorectal cancer care coordination that had been identified during a literature review. The expert panel comprised 20 members from the National Health and Medical Research Colorectal Cancer Guidelines Working Party plus representatives from cancer nursing/coordination, general practice and cancer consumers.

Results

Consensus was reached on the validity of 15 of 41 potential indicators, including those that focused on practical aspects of communication (legibility, clarity, content and timeliness of hospital discharge letters, documentation of outcomes of multidisciplinary team meetings) and appropriateness (documentation of preoperative consultation with a stoma therapist, discussions and referrals for adjuvant therapy for appropriate patients, and treatment by an experienced colorectal surgeon). There was lack of consensus on the validity of indicators relating to access to and efficiency of services.

Conclusion

The study has identified a core set of measures considered to be valid indicators of colorectal cancer care coordination. A medical record audit based on these measures could be used to monitor adequacy of cancer care coordination and will complement subjective measures based on self‐reported experiences of patients and carers.
The SECCA procedure for faecal incontinence: a review
Authors: Frascio M. , Mandolfino F. , Imperatore M. , Stabilini C. , Fornaro R. , Gianetta E. , Wexner S. D.
Published: August 2013

Aim

The SECCA system is a treatment option for patients with faecal incontinence and was introduced into clinical practice in 2002. Clinical studies of radiofrequency energy to treat patients with faecal incontinence have been published. This article aimed to review all published series to assess the results of this treatment.

Method

Twelve studies were included. Outcomes analysed included quality of life, the Wexner incontinence score, anorectal manometry and endoanal ultrasound findings.

Results

A total of 220 patients from 10 studies were included. In the majority of clinical studies, the SECCA procedure has been shown to be an effective treatment of mild‐to‐moderate faecal incontinence.

Conclusion

When patient selection is appropriate, this treatment has demonstrated clinically significant improvements in symptoms, as demonstrated by statistically significant reductions in the Wexner incontinence and quality of life scores.
762. PATRINIA VILLOSA
Authors: O'Brien Seamus
Published: August 2013

The discovery and introduction of Patrinia villosa (Thunberg) Dufresne are described, and the species is illustrated with a coloured plate and a line drawing.
Of hissing snakes and angry voices: human infants are differentially responsive to evolutionary fear‐relevant sounds
Authors: Erlich Nicole , Lipp Ottmar V. , Slaughter Virginia
Published: August 2013

Adult humans demonstrate differential processing of stimuli that were recurrent threats to safety and survival throughout evolutionary history. Recent studies suggest that differential processing of evolutionarily ancient threats occurs in human infants, leading to the proposal of an inborn mechanism for rapid identification of, and response to, evolutionary fear‐relevant stimuli. The current study provides novel data in support of this proposal, showing for the first time that human infants differentially process evolutionary threats presented in the auditory modality. Sixty‐one 9‐month‐olds listened to evolutionary fear‐relevant, modern fear‐relevant, and pleasant sounds, while their heart rate, startle, and visual orienting behaviours were measured. Infants demonstrated significantly enhanced heart rate deceleration, larger eye‐blinks, and more visual orienting when listening to evolutionary fear‐relevant sounds compared to sounds from the other two categories. These results support the proposal that human infants possess evolved mechanisms for the differential processing of a range of ancient environmental threats.
Minimum income in a transition economy
Authors: Mangiavacchi Lucia , Verme Paolo
Published: August 2013

The AlbanianNdihma Ekonomikeis one of the first poverty reduction programmes launched in transitional economies. Its record has been judged positively during the recession period of the 1990s and negatively during the more recent growth phase. This article reconsiders the programme using a regression‐adjusted local linear matching estimator first suggested by Heckmanet al. (1997, 1998). We find the programme to have a weak targeting capacity and a non‐significant impact on different household outcomes.
Linking the spatio‐temporal distribution of an edaphic crane fly to its heterogeneous soil environment
Authors: PETERSEN MATTHEW J. , SETO MASANORI , PECK DANIEL
Published: August 2013

The persistence of a species within a habitat patch is determined by the degree to which the habitat meets the species' biotic and abiotic requirements. Local‐scale spatio‐temporal population dynamics should be structured by the heterogeneity of these factors within the habitat patch.

This study relates the abiotic (soil moisture) and biotic (plant community) factors defining a continuous turfgrass environment to the temporal population structure and spatial distribution of Tipula paludosa ontogenetic stages across 3 years of investigation.

Populations declined greatly from first instar to pupa across all sites. Survival was greatest in soils with higher water‐holding capacity. Intra‐patch insect spatial distributions were associated with soil moisture but not with plant community distributions.

A sink–source dynamic was evident. Low quality habitats could have high first instar populations, but these did not survive until pupation. Where high and low quality habitats intersected, there was a tendency for high quality habitats to be sparsely populated.

Tipula paludosa spatio‐temporal distributions are dynamic throughout the life cycle. This work suggests that population persistence within a habitat patch is determined by the quality of the habitat, largely defined by soil moisture, and the juxtaposition of high and low quality habitats within the patch.
On the Frontiers: The Implications of Social Entrepreneurship for International Entrepreneurship
Authors: Zahra Shaker A. , Newey Lance R. , Li Yong
Published: August 2013

We explore how social entrepreneurship (SE) research extends the field of international entrepreneurship (IE) to affect global sustainable well–being. Well–being is a multidimensional concept that includes financial, social, and environmental wealth creation. Much of IE research thus far has been based primarily on assumptions of economic opportunity recognition, evaluation, and exploitation. We use the SE perspectives of blended value and international governance to revise the definition, assumptions, and boundaries of IE at the firm and international policy levels. We propose a broader vision for the IE field based on an expanded set of assumptions beyond traditional economic thinking.
SnoworSand, Student Travel Solutions
Authors: Meyer Marc H. , McNett Jeanne
Published: August 2013

SnoworSand, Student Travel Solutions describes the development of a travel service targeting students abroad for cultural and recreational travel during their foreign sojourns. The case focuses on the decisions needed to transition the venture from a lifestyle hobby into a growing, scalable business.

Charlie Bishop, the founder, has created a niche business serving American college students in Europe, providing them with safe, educational, and fun excursions in Europe, Turkey, and North Africa. The venture has significant potential, but to achieve it, Charlie needs to make decisions about marketing strategy, personnel, and logistics, along with the critical issue of how best to finance growth.
Metamorphosis in river ecology: from reaches to macrosystems
Authors: Thorp James H.
Published: August 2013

A metamorphic shift in the focus of aquatic ecological research is needed to (i) better understand the functioning of river ecosystems at large spatiotemporal scales; (ii) respond to threats from climate change, species invasions and increased pressure for more river dams and interbasin water transfer; and (iii) meet critical needs for catchment‐level management.

Implementing changes in research and management necessitate new spatiotemporal and research domains and a partial shift from reach‐level studies to macrosystem ecology.

Macroecology, as defined here, and associated processes usually cannot be understood simply by scaling up information from smaller extent and finer grain samples because of problems of connectivity and spatial heterogeneity of crucial system components and entanglements from cross‐scale interactions producing threshold responses and other nonlinear dynamics.

An important driver of macrosystem research in terrestrial and aquatic ecosystems is the immediate and long‐term danger from global climate change, which will alter flow regimes, water temperatures and dissolved oxygen in riverine landscapes.

An initial step in implementing metamorphic change in river science is to integrate the newest macroecological perspectives with current large‐scale riverine concepts, especially ones emphasising the importance of tributary patterns and junctions (Network Dynamics Hypothesis) or the hydrogeomorphic patch nature of rivers at multiple scales (Riverine Ecosystem synthesis).

The hierarchical nature, system boundaries and research domains of riverine macrosystem ecology are examined, and twelve sample research questions are provided to help direct future research.

Current research impediments to riverine macroecology are discussed, and a partial solution based on the need for Long‐Term Ecological Research‐like sites (each with a central organisational hub and a diffuse, multi‐institutional network of data collection stations at strategic catchment points) is proposed.
Endovascular Treatment for Acute Ischemic Stroke in Octogenarians Compared with Younger Patients: A Meta-Analysis
Authors: Duffis E. Jesús , He Wenzhuan , Prestigiacomo Charles J. , Gandhi Chirag D.
Published: August 2013

Background

Little is known about the safety and efficacy of endovascular therapy for acute ischemic stroke in octogenarians.

Aim

We performed a systematic review and meta-analysis of published studies comparing outcomes of octogenarians and younger patients after endovascular treatment for acute ischemic stroke.

Methods

A computerized search of the medical literature from 1990 to 2012 was performed to identify comparative studies of endovascular treatment of ischemic stroke patients 80 years or older and younger patients. Data on clinical outcomes, mortality, symptomatic intracerebral hemorrhage, and recanalization were abstracted.

Results

Data from eight studies with 2729 patients were included in the final analysis. Good functional outcome defined as modified Rankin score 2 or less within 90 days was more common in younger patients compared with octogenarians [odds ratio 2·694; 95% confidence interval 1·941–3·740, P < 0·001). Symptomatic hemorrhage and death were significantly more come in patients 80 years or older (odds ratio 1·604; 95% confidence interval 1·013–2·540, P = 0·04 and odds ratio 3·695; 95% confidence interval 2·517–5·424, P < 0·001, respectively). Successful recanalization defined as Thrombolysis in Myocardial Infarction (TIMI) 2–3 was seen less frequently in older patients; however, this did not reach statistical significance (odds ratio 0·814; 95% confidence interval 0·522–1·269, P = 0·364).

Conclusion

Formal meta-analysis showed that octogenarians are less likely to achieve functional independence and have higher rates of mortality and intracerebral hemorrhage following endovascular treatment for ischemic stroke compared with younger patients. Decisions regarding endovascular treatment of elderly patients should be individualized until randomized controlled trials are available.
Stroke in Rural Coastal Ecuador: A Community-Based Survey
Authors: Del Brutto Oscar H. , Santamaría Milton , Zambrano Mauricio , Peñaherrera Ernesto , Pow-Chon-Long Freddy , Del Brutto Victor J. , Ochoa Elio , Valdiviezo Elsy , Santibáñez Rocío
Published: August 2013

Stroke will be South America's next epidemic. Therefore, information on stroke particularities in the region will help to overcome its impact burden. We evaluated prevalence, pattern of sub-types, and pathogenic mechanisms underlying stroke in Atahualpa, a village representative of rural coastal Ecuador. In a three-phase epidemiologic study, suspected cases were detected by a door-to-door survey (Phase I). Then, neurologists evaluated suspected cases and randomly selected negative persons (Phase II), and confirmed patients underwent complementary exams (Phase III). We found 20 stroke patients (mean age 70 years, 60% men) among 642 persons aged ⩽40 years. Stroke prevalence was 31·15%‰ that increased with age. Most patients had sub-cortical infarctions associated with leukoaraiosis or microbleeds. Hypertensive arteriolopathy was the most likely mechanism underlying strokes (55% patients). Intracranial arterial lesions were found in 47% cases. Extracranial atherosclerotic lesions or cardiac sources of emboli were not found in any case. Comparison of our findings with a previous survey performed in the same village showed an alarming increase in stroke prevalence (from 14·08%‰ in 2003 to 31·15%‰ in 2012, P = 0·03).
Ischemic Stroke in Patients with Cancer: Is it Different from Usual Strokes?
Authors: Lee Eun-Jae , Nah Hyun-Wook , Kwon Joo-Young , Kang Dong-Wha , Kwon Sun U. , Kim Jong S.
Published: August 2013

Background

It remains unclear whether the characteristics of ischemic stroke in patients with cancer (ISC) differ from usual ischemic strokes (non-ISC). Although a small number of studies have been conducted to characterize ISC, the status of cancer has rarely been considered seriously.

Aims

We aimed to investigate the features of ISC according to the status of cancer, and compare their characteristics with those of non-ISC.

Methods

We assessed and classified 204 ISC patients into two groups: 104 with active (ISC-active) and 100 with inactive (ISC-inactive) cancer. For each ISC patient, two age- and gender-matched ischemic stroke patients without history of cancer were selected as non-ISC control subjects. We compared the clinical/laboratory data, stroke mechanisms, and diffusion weighted imaging (DWI) lesion patterns between ISC-active and non-ISC patients, and between ISC-inactive and non-ISC patients.

Results

ISC-active patients demonstrated higher C-reactive protein (CRP) and D-dimer, more frequent cryptogenic stroke and patterns of multiple DWI lesions (in bilateral anterior or in anterior and posterior circulations), and less prevalent conventional risk factors than non-ISC patients, while ISC-inactive patients revealed no such marked differences. Among ISC-active patients, both elevated CRP and D-dimer levels were associated with cryptogenic mechanism and multiple lesion patterns. Furthermore, ISC-active patients with cryptogenic strokes tended to have multiple lesion patterns and metastasis.

Conclusions

ISC-active, but not ISC-inactive, is distinct in terms of risk factors, stroke mechanisms, and lesion patterns. Chronic inflammation and an activated coagulation system may contribute to the pathogenic mechanism of strokes, the extent of each depending on the activity and severity of cancer.
N-Terminal Pro-Brain Natriuretic Peptide Shows Diagnostic Accuracy for Detecting Atrial Fibrillation in Cryptogenic Stroke Patients
Authors: Fonseca Ana Catarina , Brito Dulce , e Melo Teresa Pinho , Geraldes Ruth , Canhão Patrícia , Caplan Louis R. , Ferro José M.
Published: August 2013

Background

Diagnosing paroxysmal atrial fibrillation in patients with stroke can be difficult. We aimed to determine if N-terminal pro-brain natriuretic peptide can help identify paroxysmal atrial fibrillation in cryptogenic stroke.

Methods and results

Among 264 ischemic stroke patients, serum levels of N-terminal pro-brain natriuretic peptide were measured within 72 h of stroke onset. In cryptogenic stroke patients, 24-h Holter monitoring was used to look for paroxysmal atrial fibrillation within the first week and also three-and six-months after admission. First, patients with a defined etiology were used to construct a receiver operating characteristic curve for the diagnosis of atrial fibrillation. From this curve, the sensitivity and specificity of preestablished cutoff points for the diagnosis of atrial fibrillation were calculated. A logistic regression was performed to assess the independent relationship of the logarithm of N-terminal pro-brain natriuretic peptide levels with atrial fibrillation. The cutoff points were then evaluated in patients with cryptogenic stroke.

Results

One hundred eighty-four patients had a specific stroke etiology. Fifty-five patients had atrial fibrillation. Using multivariate analysis, the logarithm of N-terminal pro-brain natriuretic peptide levels was independently associated with atrial fibrillation. The area under the receiver operating characteristic curve of N-terminal pro-brain natriuretic peptide for the diagnosis of atrial fibrillation was 0·91 (95% confidence interval 0·87–0·95). The cutoff point of 265·5 pg/ml had a sensitivity of 100% and specificity of 70·5% for the diagnosis of atrial fibrillation. The cutoff point of 912 pg/ml had a sensitivity of 81·8% and a specificity of 87·5%. Eighty patients had a cryptogenic stroke. In 17, paroxysmal atrial fibrillation was found during follow-up. In these patients, the area under the curve for the diagnosis of paroxysmal atrial fibrillation was 0·83. The cutoff point of 265·5 had a sensitivity of 88·2% and a specificity of 61·9%. The cutoff point of 912 pg/ml had a sensitivity of 47·1% and a specificity of 88·9%.

Conclusion

N-terminal pro-brain natriuretic peptide has good accuracy in predicting the presence of paroxysmal atrial fibrillation in patients with cryptogenic stroke and can help to identify these patients.
The Spot Sign and Tranexamic Acid on Preventing ICH Growth – AUStralasia Trial (STOP-AUST): Protocol of a Phase II Randomized, Placebo-Controlled, Double-Blind, Multicenter Trial
Authors: Meretoja Atte , Churilov Leonid , Campbell Bruce C. V. , Aviv Richard I. , Yassi Nawaf , Barras Christen , Mitchell Peter , Yan Bernard , Nandurkar Harshal , Bladin Christopher , Wijeratne Tissa , Spratt Neil J. , Jannes Jim , Sturm Jonathan , Rupasinghe Jayantha , Zavala Jorge , Lee Andrew , Kleinig Timothy , Markus Romesh , Delcourt Candice , Mahant Neil , Parsons Mark W. , Levi Christopher , Anderson Craig S. , Donnan Geoffrey A. , Davis Stephen M.
Published: August 2013

Rationale

No evidence-based acute therapies exist for intracerebral hemorrhage. Intracerebral hemorrhage growth is an important determinant of patient outcome. Tranexamic acid is known to reduce hemorrhage in other conditions.

Aim

The study aims to test the hypothesis that intracerebral hemorrhage patients selected with computed tomography angiography contrast extravasation ‘spot sign’ will have lower rates of hematoma growth when treated with intravenous tranexamic acid within 4·5-hours of stroke onset compared with placebo.

Design

The Spot sign and Tranexamic acid On Preventing ICH growth – AUStralasia Trial is a multicenter, prospective, 1:1 randomized, double-blind, placebo-controlled, investigator-initiated, academic Phase II trial. Intracerebral hemorrhage patients fulfilling clinical criteria (e.g. Glasgow Coma Scale >7, intracerebral hemorrhage volume <70 ml, no identified secondary cause of intracerebral hemorrhage, no thrombotic events within the previous 12 months, no planned surgery) and demonstrating contrast extravasation on computed tomography angiography will receive either intravenous tranexamic acid 1 g 10-min bolus followed by 1 g eight-hour infusion or placebo. A second computed tomography will be performed at 24 ± 3 hours to evaluate intracerebral hemorrhage growth and patients followed up for three-months.

Study outcomes

The primary outcome measure is presence of intracerebral hemorrhage growth by 24 ± 3 hours, defined as either >33% or >6 ml increase from baseline, and will be adjusted for baseline intracerebral hemorrhage volume. Secondary outcome measures include growth as a continuous measure, thromboembolic events, and the three-month modified Rankin Scale score.

Discussion

This is the first trial to evaluate the efficacy of tranexamic acid in intracerebral hemorrhage patients selected based on an imaging biomarker of high likelihood of hematoma growth. The trial is registered as NCT01702636.
Silencing ofP‐glycoproteinincreases mortality in temephos‐treatedAedes aegyptilarvae
Authors: Figueira‐Mansur J. , Ferreira‐Pereira A. , Mansur J. F. , Franco T. A. , Alvarenga E. S. L. , Sorgine M. H. F. , Neves B. C. , Melo A. C. A. , Leal W. S. , Masuda H. , Moreira M. F.
Published: August 2013

Re‐emergence of vector‐borne diseases such as dengue and yellow fever, which are both transmitted by theAedes aegyptimosquito, has been correlated with insecticide resistance.P‐glycoproteins (P‐gps) areATP‐dependent efflux pumps that are involved in the transport of substrates across membranes. Some of these proteins have been implicated in multidrug resistance (MDR). In this study, we identified a putativeP‐glycoprotein in theAe. aegyptidatabase based on its significantly high identity withAnopheles gambiae,Culex quinquefasciatus,Drosophila melanogasterand humanP‐gps. The basalATPaseactivity ofATP‐binding cassette transporters in larvae was significantly increased in the presence ofMDRmodulators (verapamil and quinidine). An eightfold increase inAe. aegypti P‐gp(AaegP‐gp) gene expression was detected in temephos‐treated larvae as determined by quantitativePCR. To analyse the potential role ofAaegP‐gp in insecticide efflux, a temephos larvicide assay was performed in the presence of verapamil. The results showed an increase of 24% in temephos toxicity, which is in agreement with the efflux reversing effect.RNAinterference (RNAi)‐mediated silencing of theAaegP‐gpgene caused a significant increase in temephos toxicity (57%). In conclusion, we have demonstrated for the first time in insects that insecticide‐inducedP‐gpexpression can be involved in the modulation of insecticide efflux.
Labour Market Behaviours of Back‐and‐Forth Migrants From Poland
Authors: Fihel Agnieszka , Grabowska‐Lusinska Izabela
Published: August 2013

After the fall of the Iron Curtain, Poland became the main sending country in Central Europe. Despite the lack of institutional barriers to settling in member states of the European Union since 2004, many Polish migrants continued to undertake temporary labour mobility including repetitive, back‐and‐forth moves. This article examines the relationship between migrants' back‐and‐forth international mobility and their activity in the labour market of the sending country. It describes changes in the labour market status of migrants engaging in repetitive migration, based on two surveys conducted in Poland in 2001 and 2007, complemented by qualitative follow‐ups. The results show that migrants deploy various economic strategies: reconcile employment in both countries; abandon jobs in Poland; or only remain economically active abroad. In many cases back‐and‐forth migration led to being unemployed in Poland, which constitutes an important challenge for labour market policy.

Policy Implications

Local Public Employment Services (PES) should be able to distinguish unemployed persons who undertake repetitive, back‐and‐forth migration. Local PES should include profiles of unemployed persons and questions about migration experience and its character: labour/non‐labour migration, short‐/long‐term, single/repetitive, etc.

For each unemployed person, the process of career guidance provided by the local PES should assess the possible impact of back‐and‐forth migration on the labour market situation in Poland.

The back‐and‐forth migration should be taken into account at the level of career guidance supplied by Career Centres at high schools and universities.
Intervention strategies to reduce the risk of zoonotic infection with avian influenza viruses: scientific basis, challenges and knowledge gaps
Authors: Sims Leslie D.
Published: August 2013

A range of measures has been recommended and used for the control and prevention of avian influenza. These measures are based on the assessment of local epidemiological situations, field observations and other scientific information. Other non‐technical factors are (or in some cases should be) taken into account when developing and recommending control measures. The precise effects under field conditions of most individual interventions applied to control and prevent avian influenza have not been established or subjected to critical review, often because a number of measures are applied simultaneously without controls. In most cases, the combination of measures used results in control or elimination of the virus although there are some countries where this has not been the case. In others, especially those with low poultry density, it is not clear whether the link between the adoption of a set of measures and the subsequent control of the disease is causative. This article discusses the various measures recommended, with particular emphasis on stamping out and vaccination, examines how these measures assist in preventing zoonotic infections with avian influenza viruses and explores gaps in knowledge regarding their effectiveness.
Brief literature review for the WHO global influenza research agenda – highly pathogenic avian influenza H5N1 risk in humans
Authors: Van Kerkhove Maria D.
Published: August 2013

Highly pathogenic avian influenza A H5N1 viruses remain a significant health threat to humans given the continued rare occurrence of human cases with a high case fatality rate. This brief literature review summarizes available evidence of risk factors for H5N1 infection in humans and updates a recent systematic review published in early 2011. Several epidemiologic studies have been published to evaluate the risk factors for H5N1 infection in humans, including contact with poultry and poultry products and non‐poultry‐related contact such as from H5N1‐contaminated water. While most H5N1 cases are attributed to exposure to sick poultry, it is unclear how many may be due to human‐to‐human transmission. The collective results of published literature suggest that transmission risk of H5N1 from poultry to humans may be highest among individuals who may have been in contact with the highest potential concentrations of virus shed by poultry. This suggests that there may be a threshold of virus concentration needed for effective transmission and that circulating H5N1 strains have not yet mutated to transmit readily from either poultry to human or from human to human. However, the mode of potential transmission can be quite varied throughout different countries and by study with exposures ranging from visiting a wet market, preparing infected poultry for consumption, to swimming or bathing in ponds frequented by poultry. Several important data gaps remain in the understanding of the epidemiology of H5N1 in humans and limit our ability to interpret the results of the available H5N1 seroepidemiologic studies.
Macroeconomic impact of pandemic influenza and associated policies in Thailand, South Africa and Uganda
Authors: Smith Richard D. , Keogh‐Brown Marcus R.
Published: August 2013

Background

Research has shown the value of conducting a macroeconomic analysis of the impact of influenza pandemics. However, previous modelling applications focus on high‐income countries, and there is a lack of evidence concerning the potential impact of an influenza pandemic on lower‐ and middle‐income countries.

Objectives

To estimate the macroeconomic impact of pandemic influenza in Thailand, South Africa and Uganda with particular reference to pandemic (H1N1) 2009.

Methods

A single‐country whole‐economy Computable General Equilibrium (CGE) model was set up for each of the three countries in question and used to estimate the economic impact of declines in labour attributable to morbidity, mortality and school closure.

Results

Overall GDP impacts were less than 1% of GDP for all countries and scenarios. Uganda's losses were proportionally larger than those of Thailand and South Africa. Labour‐intensive sectors suffer the largest losses.

Conclusion

The economic cost of unavoidable absence in the event of an influenza pandemic could be proportionally larger for low‐income countries. The cost of mild pandemics, such as pandemic (H1N1) 2009, appears to be small, but could increase for more severe pandemics and/or pandemics with greater behavioural change and avoidable absence.