bluuebunny/crossref_metadata_2025 huggingface dataset:
A clinical study of a microfilled composite resin for labial veneers
Authors: WELBURY R. R.
Published: March 2010

Summary. Two‐hundred and eighty‐nine composite resin‐full labial veneers were placed after labial enamel reduction in children and adolescents and reviewed after periods of up to 3 years. The median (±S.E.) survival time was 35.6 ± 0.8 months with 42 (14%) of the veneers considered to have failed. There was a small incidence of marginal staining, no deterioration in gingival health, and patient satisfaction was high.

Résumé. Une totale de 289 facettes veneers vestibulaires en résine posées, après réduction de l'émail vestibulaire chez des enfants et des adolescents, ont été étudiés pendant 3 années. Le temps moyen de maintien en bouche a été de 35,6 mois et 42 facettes (14%) ont été considérées comme des échecs. La coloration marginale était faible; il n'y a pas eu de détérioration parodontale et les patients étaient très satisfaits.

Zussamenfassung. Zwei‐hundert neun und achtzig labiale Komposit‐Schalen welche, nach einer Schmelzreduktion bei Kinder und Jugendlichen eingegliedert wurden hat man während 3 Jahren untersucht. Die mittlere Haftdauer war 35,6 Monate (S.E. 0,8 Monate). Zwei und vierzig Schalen (14%) wurden als Misserfolg angesehen. Es zeigt sich ein kleiner Anteil von marginaler Verfärbungen. Gingivale Gesundheit und Patientenzufriedenheit wurden als gut befunden.

Resumen. Un total de 289 frentes en veneer con resina composite fueron colocadas despues de reducir el esmalte vestibular en niños y adolescentes y fueron examinados por períodos de hasta tres años. El tiempo medio de duración de los frentes de composite fue de 35.6 meses (Error Standard 0.8 meses) con 42 (14%) de los veneers considerados como fracasos. Hubo una pequeña incidencia de tinción marginal, ho hubo deterioro de la salud gingival y la satisfacción por parte del paciente fue muy alta.
Inversion, rotation and ectopic eruption of a mandibular second premolar
Authors: BURNS SARAH J.
Published: March 2010

Summary. This case illustrates complete inversion, rotation and ectopic extra‐oral eruption of a mandibular right second premolar and the congenital absence of the contralateral tooth. As far as can be ascertained, the simultaneous expression of these four abnormalities in one patient has not been reported before.

Résumé. Ce cas illustre l'inversion complète, la rotation, l'éruption en position ectopique d'une seconde prémolaire mandibulaire droite et l'absence congénitale de la dent contra‐latérale. Pour autant que nous le sachions, l'expression simultanée de ces quatre anomaies chez le même patient n'a jamais été rapportée jusqu'à maintenant.

Zusammenfassung. Dieser Fall wird die Inversion, Rotation und der ektopische Durchbruch eines zweiten Prämolars im Unterkiefer beschreiben sowie die congenitale Nichtanlage des kontralateralen Zahnes. Soweit bekannt wurden das simultane Auftreten von diesen vier Abnormalitäten an einem Patienten bis anhin nicht beschrieben.

Resumen. Este caso ilustra la inversión completa, rotación, y erupción ectópica del segundo premolar mandibular derecho y la ausencia congénita del diente contralateral. Por lo que se puede determinar, la expresión simultanea de estas cuatro anormalidades en un solo paciente no ha sido reportado.
Dental caries and dental anomalies in children treated by chemotherapy for malignant disease: a study in the north of England
Authors: NUNN J. H. , WELBURY R. R. , GORDON P. H. , KERNAHAN J. , CRAFT A. W.
Published: March 2010

Summary: Fifty‐two children in remission from childhood cancer and 41 siblings underwent a full clinical and radiographic dental examination. All the children had received chemotherapy. The leukaemic patients had received radiotherapy also, but not involving the jaws. There was no significant difference in dental caries experience between the treated children and the siblings, but significantly more dental anomalies were detected radiographically in the treated group.

Résumé. Nous avons examine 52 enfants en remission de cancer infantile, et 41 de leurs freres et soeurs, par examen dentaire clinique et radiologique complets. Tous ces enfants avaient étè sous Chimiotherapie les lencemiques sous radiotherapie mais non aux machoises, Nous n'avons trouve aucune difference significative de caries dentaires entre les enfants traites et non traites (freres et soeurs), mais plus d'anomalies dentaires radiographiques dans le groupe traite (statistiquement) significatif).

Zusammefassung. 52 Krebskranke Kinder in der Remissionsphase und 41 weitere Kinder wurden klinisch und röntgologisch zahnärztlich untersucht. Alle Kinder erhielten Chemotherapie. Die Leukemie Patienten wurden auch bestrahlt aber nicht die Kiefer. In Bezug der Kariesanfälligkeit wurde kein Unterschied festgestellt zwischen der behandelten und der nicht behandelten Gruppe, aber eine signifikante grössere Anzahl von Zahna‐nomalien wurden röntgologisch bei der behandelten Gruppen gefunden.

Resumen. Un total de 52 niños en remisión de cancer y 41 hermanos(as) recibieron un examen clínico y radiográfico completo. Todos los niños habían recibido quimioterapia. Los pacientes leucémicos tambien recibieron radioterapia, pero no en los maxilares. No hubo diferencia significativa en la experiencia de caries dental entre los niños tratados y los hermanos(as), pero significativamente, más anomalías dentales feuron radigráficamente detectadas en el grupo tratado.
Evaluation of students' performance in obtaining local anaesthesia in children
Authors: KAUFMAN E. , HOLAN G. , GOODMAN‐TOPPER E. , EIDELMAN E.
Published: March 2010

Summary: This study was designed to determine the success of various local anaesthesia techniques as assessed by the presence or absence of pain during restorative procedures performed by senior undergraduate dental students in a paedodontic clinic. Data gathered from the treatment of 151 patients by 43 students recorded the frequency of pain complaints during procedures for which local anaesthesia had been employed. It was found that 73% of the administrations were successful. The proportion of children who complained of pain during the operative procedure was significantly higher in those with a previous history of a painful dental experience.

Résumé. Le but de cette etude est de déterminer l'efficacite de diverses techniques d'anesthesie locale en fonction de la presence ou absence de douleur pendant des procédès de raparation effectués par des etudiants dentaires de terminale dans une consultation d'orthodontie pediatrique. Nous presentons les resultats du traitement de 141 patients par 43 etudiants, sous anesthesie locale. 73% des administrations furent efficaces. Le pour‐centage d'enfants se plaignant de douleur fut plus éleve de manière significative chez ceux ayant une experience antécédante de douleur dentaire.

Zusammenfassung. Die Aufgabe dieser Arbeit ist die Beurteilung von verschiedenen Techniken der Lokalanästhesie sur Schmerzkontrolle bei konservierenden Eingriffen bei Kindern. Diese Techniken wurden angewendet von 43 undergraduate Studenten in einer kinderzahnmedizinischen Klinik an 151 Kinder. 73% der Anwendungen waren erfolgreich. Bei Kindern welche bei früheren zahnärztlichen Eingriffen Schmerzen erdulden mussten, klagten auch bei dieser Studie vermehrt über Schmerzen.

Resumen. Este estudio determinó el éxito obtenido por varias técnicas de anestesia local al evaluar la presencia o ausencia de dolor durante procedimientos restaurativos realizados por estudiantes del último año de odontología en una clínica odontopediátrica. La información obtenida durante el tratamiento de 151 pacientes por 43 estudiantes consistió de la frecuencia de quejas por dolor durante los procedimientos en los que se utilizó anestesia local. Se encontró que el 73% de las administraciones anestésicas fueron exitosas. La proporción de niños que se quejo de dolor durante procedimientos de operatoria fue significativamente mayor en los casos con una previa experiencia dental dolorosa.
Correspondence
Authors: Bedi Raman
Published: March 2010

The Editor invites readers to comment on articles published in the Journal, or on any aspect of paediatric dentistry
Transforming care strategies and nursing‐sensitive patient outcomes
Authors: Chaboyer Wendy , Johnson Joanne , Hardy Linda , Gehrke Tanya , Panuwatwanich Kriengsak
Published: March 2010

chaboyer w., johnson j., hardy l., gehrke t. & panuwatwanich k. (2010)
 Transforming care strategies and nursing‐sensitive patient outcomes. Journal of Advanced Nursing 66(5), 1111–1119.

Title.  Transforming care strategies and nursing‐sensitive patient outcomes.

Aim.  This paper is a report of the effects of implementing 13 Transforming Care At the Bedside improvement strategies on medication errors, patient falls and pressure ulcers.

Background.  A number of international reports and research studies have led to a focus on safety and quality in health care. Transforming Care At the Bedside involves nursing managers and front‐line staff together contributing to practice improvement.

Method.  An observational, time series study in two medical units in one Australian hospital was conducted. Statistical process control analysis was used to identify changes in the outcomes. Routinely collected, anonymous clinical incident reports were used to calculate the proportion of reported clinical incidents that were reported to result in patient harm in the 15 months prior to and 18 months after Transforming Care At the Bedside strategies were implemented, between February, 2005 and December, 2007.

Results.  The proportion of reported medication errors, falls and pressure ulcers that resulted in harm as reported in clinical incident reports were reduced from 46·3% to 17·1%, 97·0% to 51·0% and 91·3% to 46·6% respectively, representing an absolute reduction by about one half. Consistent, sustained improvement in the first two was demonstrated, but analysis showed wide variation in the third – pressure ulcers – which meant that the differences in this outcome may have occurred by chance.

Conclusion.  A rapid change management cycle such as Transforming Care At the Bedside can be a useful process when implementing numerous clinical changes in short succession.
The relationship between organizational justice and workplace aggression
Authors: St‐Pierre Isabelle , Holmes Dave
Published: March 2010

st‐pierre i. & holmes d. (2010) The relationship between organizational justice and workplace aggression. Journal of Advanced Nursing 66(5), 1169–1182.

Title.  The relationship between organizational justice and workplace aggression.

Aim.  This paper is a discussion of the links between organizational justice and workplace aggression.

Background.  Managers have been identified as key players in implementing and maintaining an organizational culture of trust and justice. Employees who perceive themselves to be victims of injustice may rebel, using various means to ‘punish’ the source of the injustice.

Data sources.  Literature review of publications in English and French from the early 1960 to 2009, including books, was conducted. Bibliographic databases searched for journal articles were Cumulative Index to Nursing and Allied Health Literature, Current Content, EMBASE, Medline, PsycINFO and Web of Science.

Discussion.  The work environment and roles of nursing managers have changed considerably in the last 20 years, resulting in challenging working conditions for nursing managers. These can have an impact on their ability to create a trusting and fair culture, and can mean that they themselves be considered victims of organizational injustice.

Implications for nursing.  The failure of many re‐engineering projects has been linked to a lack of consideration of the impact of perception of justice when implementing change. In addition, perception of organizational justice has the potential to influence many organizational outcomes, such as perception of respect and trust. As justice is a founding principle of biomedical ethics, principles of justice, equity and fairness must be upheld in practice in accordance with the requirements of professional codes of ethics.

Conclusion.  The concept of justice is linked to the founding principles of biomedical ethics, and these must be upheld in order to practise in accordance with professional codes of ethics and conduct.
Wing pointedness associated with migratory distance in common‐garden and comparative studies of stonechats (Saxicola torquata)
Authors: BALDWIN M. W. , WINKLER H. , ORGAN C. L. , HELM B.
Published: March 2010

Migration promotes utilization of seasonal resources, and the distance flown is associated with specific morphologies, yet these relationships can be confounded by environmental factors and phylogeny. Understanding adaptations associated with migration is important: although migration patterns change rapidly, it is unclear whether migratory traits track behavioural shifts. We studied morphometrics of four stonechat populations representing a migratory gradient and raised under common‐garden conditions. With multivariate analyses, we identified wing traits that differed clearly from general size trends, and used phylogenetic comparative methods to test the prediction that these traits correlated with migratory distance in captive and wild populations. Pointedness differed among populations, changed independently from overall body size, and was correlated with migration distance. Migration in stonechats may lead to deviations from allometric size changes, suggesting that birds may adapt morphologically to selection pressures created by their own behaviour in response to changing environmental conditions.
Allergic transfusion reactions from blood components donated by IgA‐deficient donors with and without anti‐IgA: a comparative retrospective study
Authors: Robitaille N. , Delage G. , Long A. , Thibault L. , Robillard P.
Published: March 2010

Background and Objectives  IgA deficiency is common (1/500) and up to 40% of affected individuals will develop anti‐IgA. A few studies suggested that passive transfusion of anti‐IgA was not associated with an increased risk of allergic reactions. This study was designed to assess the safety of transfusing blood components containing anti‐IgA.

Materials and Methods  IgA‐deficient blood donors with and without anti‐IgA were identified from Héma‐Québec’s (HQ) computerized database. IgA deficiency was confirmed by an ELISA method and the presence of anti‐IgA by a passive hemagglutination assay. Blood donations from IgA‐deficient donors issued to hospitals between March 1999 and December 2004 were retrieved. Medical charts of recipients were reviewed for the occurrence of a suspected transfusion reaction. Presence and nature of transfusion reactions were assessed blindly by an adjudicating committee.

Results  A total of 323 IgA‐deficient blood products were issued by HQ to 55 hospitals. Of these, 48 agreed to participate [315 blood products (97·5%)]. A total of 272 products were transfused: 174 contained anti‐IgA, and 98 did not. Only two minor allergic reactions occurred in each group. Incidence of allergic reactions was 1·15% in the anti‐IgA group and 2·04% in the group without anti‐IgA (P = 0·91). There was no anaphylactic reaction in either group.

Conclusions  This study indicates that the proportion of allergic reactions does not appear to be greater in recipients of blood components containing anti‐IgA compared to recipients of non‐anti‐IgA‐containing components. Allowing donations from IgA‐deficient donors with anti‐IgA may therefore be contemplated.
Phase I/II safety study of transfusion of prion‐filtered red cell concentrates in transfusion‐dependent patients
Authors: Cahill M. R. , Murphy T. , Khan M. , Fagan J. , Murphy W. G.
Published: March 2010

Background and Objectives  Variant Creutzfeldt‐Jakob (vCJD) is a fatal transfusion transmissible prion infection. No test for vCJD in the donor population is currently available. Therefore, prion removal by filtration of red cell concentrate (RCC) is an attractive option for prevention.

Materials and Methods  Twenty patients were recruited with ethical permission, to receive clinically necessary transfusion containing one unit of pfRCC. Follow‐up at 24 hours, 6 weeks and 6 months was undertaken. A second pfRCC was administered to 6 patients with similar follow up. pfRCC were prepared using the CE marked P‐Capt device by the IBTS.

Results  In 20 transfused patients undergoing one exposure to a prion filtered unit, no attributable adverse events were noted. A subset of these (n = 6) underwent re‐exposure to a further filtered unit without incident.

Conclusions  This phase 1/11 clinical study provides encouraging data on safety of prion filtration which can be used to plan more extensive studies on the use of filtered blood in adults and children.
Enemy Recognition of Reed Warblers (Acrocephalus scirpaceus): Threats and Reproductive Value Act Independently in Nest Defence Modulation
Authors: Campobello Daniela , Sealy Spencer G.
Published: March 2010

Organisms should respond more aggressively towards species perceived as a danger to their offspring, but intensity of defence may be gauged by the value of current offspring weighed against the value of future reproductive opportunities. We tested whether defensive responses of nesting reed warblers (Acrocephalus scirpaceus) are the result of an interaction effect between the type of stimulus confronted and the value of the warbler’s nesting attempt. We quantified the ability of reed warblers to discriminate among brood parasites, nestling predators and non‐threatening species at different stages of the breeding cycle. We also determined whether variables that influence the value of offspring, such as time of season, size and age of clutch or brood, and time of day and number of visits to the nest, explain variation in the intensity of defence recorded during the egg and nestling stages. Responses to the three stimuli differed significantly, as reed warblers consistently directed their mobbing calls and attacks towards parasites, whereas they were less conspicuous when confronted with models of predators. Reed warblers modulated their responses towards each stimulus in accordance with the threat each posed at a specific nesting stage, whereas they were not affected by other variables relative to their reproductive potential. The churr call, however, was uttered independently of the stimulus, as it was triggered by the mere presence of nestlings in the nest.
Overhead is superior to underneath light‐emitting diode phototherapy in the treatment of neonatal jaundice: A comparative study
Authors: Tayman Cuneyt , Tatlı Mustafa Mansur , Aydemir Salih , Karadag Ahmet
Published: March 2010

Aim:  To compare the efficacy of overhead and underneath light‐emitting diode (LED) devices in the treatment of neonatal jaundice.

Methods:  We compared two LED phototherapy devices: the neoBLUE device, which provides overhead illumination, and the neoBLUE cozy device, which provides illumination from underneath the infant. The models we used had similar LED sources and provided similar light intensities (30 µW/cm2/nm). Infants with hyperbilirubinemia were assigned to one of two groups according to the phototherapy device used (group 1, overhead illumination, 181 infants; group 2, underneath illumination, 61 infants). Recorded variables included birthweight, gender, family history, aetiology of jaundice, total duration of phototherapy and total serum bilirubin (TSB) concentration at the initiation of phototherapy, at 12‐hour intervals and just before the cessation of phototherapy. The rates of decrease in TSB concentration were calculated.

Results:  There were significant differences in the mean duration of phototherapy and in the rate of decrease in TSB concentration between the two groups. The mean duration of phototherapy in group 2 was higher than in group 1 (P= 0.037). The rate of decrease in TSB in group 1 was higher than in group 2 (P= 0.01).

Conclusion:  These results suggest that when phototherapy is used in the treatment of neonatal jaundice, the direction from which the light is applied should be considered in addition to light source intensity.
Securing endotracheal tubes: Does NeoBar availability improve tube position?
Authors: Brinsmead Tammy Lee , Davies Mark William
Published: March 2010

Objective:  To assess if neonatal endotracheal tube (ETT) position improved with introduction of the NeoBar.

Methods:  This retrospective study compared two cohorts of intubated neonates and their x‐rays. During the first 2‐month study period, ETTs were secured with tape only – the ‘Tape‐only’ period; during the second study period, they were secured with a NeoBar (or tape if the NeoBar was unsuitable) – the ‘NeoBar’ period. ETT tip position was assessed subjectively as very high, high, OK, low, or very low; and objectively by vertebral body position and the ETT‐tip‐to‐T1 distance.

Results:  During the Tape‐only period, 59 babies had 275 x‐rays with an ETT visible. During the NeoBar period, 67 babies had 331 x‐rays with an ETT visible. There were 160 (58.2%) and 193 (58.3%) assessed as OK during the Tape‐only and NeoBar periods, respectively (Fisher's Exact Test, P= 1.0). There were more very high tubes during the NeoBar period, and more low and very low tubes during the Tape‐only period (Chi‐squared test, P= 0.011). A similar trend was observed with the distribution of the ETT‐tip‐to‐T1 distance (difference not statistically significant, Mann–Whitney test, P= 0.079).

Conclusion:  During both time periods, less than two‐thirds of ETTs were located in an acceptable position. For ETTs in unacceptable positions, there were more tubes in the higher positions during the NeoBar period, and more tubes in the lower positions during the Tape‐only period. Further investigation is necessary to clarify if the differences in ETT position on x‐ray correlate with relevant clinical outcomes.
Bilious vomiting in the newborn: 6 years data from a Level III Centre
Authors: Malhotra Atul , Lakkundi Anil , Carse Elizabeth
Published: March 2010

Background:  Bilious vomiting in the newborn is an urgent condition that frequently requires neonatal and paediatric surgical involvement. Investigations involve abdominal X‐ray and contrast imaging in most cases. We aimed to describe the prevalence of surgical intervention in this cohort and assess the reliability of contrast imaging in accurate prediction of underlying condition.

Methods:  A retrospective audit of data from December 2001 to October 2007 was undertaken. Data on newborns admitted to a level III unit with bilious vomiting was extracted. Infants with bilious aspirates but no vomiting were excluded.

Results:  Sixty‐one infants were admitted to the unit during the period with bilious vomiting. Most of them were out born (83.6%). Mean (and standard deviation) gestation was 38.3 weeks (±3.2); weight was 3173.5 grams (±717.6); day of admission was 3.68 days (1–28); and length of stay in the unit was 9.96 days (1–48). There were 52 (85.2%) abnormal X‐rays and 21 (34.4%) abnormal contrast studies. Sixteen (26.6%) babies had laparotomies of which 6 were malrotations with volvulus, 2 small bowel obstructions, 2 meconium ileus, 2 Hirschsprung's disease, 2 other findings, while 2 were normal. Positive predictive value (number of accurate predictions of surgical findings) for barium contrast studies was 85.7% in this series.

Conclusion:  Bile stained vomiting is a surgical emergency and prompt investigation is the key in the management. Contrast studies still form the backbone of such investigations.
PANCREATIC PSEUDOCYSTS IN POST‐GASTRECTOMY PATIENTS TREATED VIA THE DUODENAL MINOR PAPILLA WITH AN OBLIQUE‐VIEWING ENDOSCOPE
Authors: Matsuhashi Toru , Kikuyama Masataka , Sasada Yuzo , Ota Yuji , Nakahodo Jun
Published: March 2010

Endoscopic retrograde cholangiopancreatography (ERCP) in patients after Billroth II or Roux‐en‐Y reconstruction is challenging because of difficulties in insertion of the endoscope into the afferent loop, which is a great distance away from the papilla of Vater, and cannulation into the desired duct from a reverse position. To facilitate ERCP, various endoscopes have been selected according to operator preference. Previously, we reported that an oblique‐viewing endoscope (XK‐200; Olympus, Tokyo, Japan) can contribute to successful performance of ERCP and associated procedures in Billroth II gastrectomy patients. We report here our experience with two post‐gastrectomy patients with chronic pancreatitis who were treated with an oblique‐viewing endoscope from the minor papilla.
RISKY ENDOSCOPIC ULTRASONOGRAPHY‐GUIDED FINE‐NEEDLE ASPIRATION FOR ASYMPTOMATIC RETROPERITONEAL TUMORS
Authors: Kubota Kensuke , Kato Shingo , Mawatari Hironori , Iida Hiroshi , Akiyama Tomoyuki , Fujita Koji , Yoneda Masato , Takahashi Hirokazu , Inamori Masahiko , Abe Yasunobu , Kirikoshi Hiroyuki , Kobayashi Noritoshi , Saito Satoru , Nakajima Atsushi
Published: March 2010

Paraganglioma, a sporadically occurring rare tumor should be included in the differential diagnosis of retroperitoneal tumors, such as malignant lymphomas, gastrointestinal stromal tumors, sarcoma and carcinoma of unknown primary site. A 58‐year‐old Japanese woman presented with a large retroperitoneal tumor detected by ultrasonography (US). She had no medical history of hypertension. Computed tomography showed a mass, 7 cm in diameter, located between the pancreas and the inferior vena cava. It was unclear whether the mass originated from the duodenum or the mesentery. Endoscopic ultrasonography (EUS) demonstrated a large solid paraduodenal mass. Doppler US revealed sparse vascularity in the tumor. With the differential diagnosis of retroperitoneal tumor, we carried out EUS‐FNA. At the time of the third needle puncture, transient severe hypertension was noted, with a blood pressure measurement of 269/130 mmHg. Data obtained from urine and blood examinations after EUS‐fine‐needle aspiration indicated a diagnosis of paraganglioma.
THERAPEUTIC OUTCOMES OF ENDOSCOPIC SUBMUCOSAL DISSECTION OF UNDIFFERENTIATED‐TYPE INTRAMUCOSAL GASTRIC CANCER WITHOUT ULCERATION AND PREOPERATIVELY DIAGNOSED AS 20 MILLIMETRES OR LESS IN DIAMETER
Authors: Yamamoto Yorimasa , Fujisaki Junko , Hirasawa Toshiaki , Ishiyama Akiyoshi , Yoshimoto Kazuhito , Ueki Nobue , Chino Akiko , Tsuchida Tomohiro , Hoshino Etsuo , Hiki Naoki , Fukunaga Tetsu , Sano Takeshi , Yamaguchi Toshiharu , Takahashi Hiroshi , Miyata Satoshi , Yamamoto Noriko , Kato Yo , Igarashi Masahiro
Published: March 2010

Aim:  The aim of the present study was to examine therapeutic outcomes of endoscopic submucosal dissection (ESD) of undifferentiated‐type intramucosal gastric cancer and the problems of diagnosis.

Methods:  We reviewed 58 patients with preoperatively diagnosed undifferentiated‐type intramucosal early gastric cancer (EGC) without ulceration with a diameter of 20 mm or smaller (expanded‐indication lesion) who underwent ESD at the Cancer Institute Hospital between September 2003 and August 2008.

Results:  The overall rates of one‐piece resection and complete resection were 98% and 90% respectively, and the median operation time was 70 min. Bleeding was seen in 8.6% and perforation in 3.4%. The curative resection rate was low at 79%. Factors responsible for non‐curative resection were most commonly submucosal invasions. If limited to pathologically diagnosed expanded‐indication lesions, the curative resection rate was 98%. The difference in tumor size between a macroscopic diameter and a histological diameter was within ±5 mm in 96% of expanded‐indication lesions, with none of these cases having a histological diameter that exceeded the macroscopic diameter by more than 5 mm.

Conclusion:  ESD was technically feasible for expanded‐indication lesions of undifferentiated‐type EGC. We achieved a high rate of curative resection by the markings at sites 5 mm beyond the preoperatively determined lesion area. Factors responsible for non‐curative resection were most commonly submucosal invasions. We should diagnose the depth of such lesions more carefully.
TRACTION MID‐ESOPHAGEAL DIVERTICULUM ASSOCIATED WITH POTT'S SPINAL CARIES
Authors: Ikeda Yoshifumi
Published: March 2010

A 71‐year‐old man was admitted to Teikyo University Hospital with paraplegia, subileus, back pain and high fever. He gave a history of having received treatment for spinal caries 20 years previously. Chest computed tomography and esophageal endoscopy demonstrated evidence of spinal caries and traction mid‐esophageal diverticulum associated with kyphosis of the spine. The present report describes the extremely rare case of diverticula associated with kyphosis of the spine caused by spinal caries (Pott's spinal caries).
Missed lesions in synchronous multiple gastric cancer
Authors: Ha Tae Kyung , An Ji Yeong , Youn Ho Geun , Choi Min Gew , Noh Jae Hyung , Sohn Tae Sung , Kim Sung
Published: March 2010

Background:  The aims of this study were to define differences between synchronous multiple gastric cancer (MGC) and solitary gastric cancer (SGC) and to evaluate the characteristics of missed lesions in MGC so as to improve the detection rate of missed lesions during perioperative procedure.

Methods:  The authors retrospectively analysed data on 9157 gastric cancer patients who underwent gastrectomy for gastric cancer in a single hospital. The characteristics of 8893 SGC and 264 MGC patients were evaluated. The characteristics of missed lesions in MGC were compared with those of diagnosed lesions found in preoperative endoscopy.

Results:  Of the 9157 gastric patients, 264 patients with MGC showed a total of 565 cancer lesions, 70 of which were missed at endoscopy. The patients with MGC demonstrated different characteristics compared with those with SGC in terms of sex, age, type of operation, depth of tumour, lymph node metastasis, tumour size, tumour location and curability (P < 0.05). The characteristics of the missed lesions (n= 70) were a small size (P < 0.05), a middle one‐third location (P < 0.001) and a flat type by macroscopic examination (P < 0.05) as compared with detected lesions (n= 495). No survival difference was detected between patients with and without missed lesions over a mean follow‐up of 36.0 ± 22.7 month.

Conclusions:  Preoperative gastroscopy should be performed meticulously in the entire stomach, especially in older men, in order to identify the presence and locations of cancer lesions that might otherwise be missed.
Therapeutic embolization in the treatment of recurrent haemarthrosis following knee arthroplasty
Authors: Tat‐Sing Law Michael , McClure David N.
Published: March 2010

Recurrent spontaneous haemarthrosis after knee arthroplasty occurs in less than 1% of cases, commonly thought to be the result of impingement of hypertrophic vascular synovium or fat pads, and exacerbated by anti‐coagulation or anti‐platelet therapy. Traditional treatment comprises an initial period of rest followed by open or arthroscopic washout, and by synovectomy if bleeding recurs or fails to settle. We present three cases of recurrent haemarthrosis following knee arthroplasty, which were successfully treated by angiography and feeding vessel coil embolization. An injury to one of the genicular arteries was identified as the cause of bleeding in all three cases; one manifest as a traumatic arteriovenous fistula. Bleeding ceased in all cases without recurrence (follow‐up period 6 months – 5 years, median of 2 years). Endovascular treatment offers a minimally invasive treatment option in selected cases of recurrent post‐operative haemarthrosis.
Distribution and ultrastructural features of the serotonin innervation in rat and squirrel monkey subthalamic nucleus
Authors: Parent Martin , Wallman Marie‐Josée , Descarries Laurent
Published: March 2010

The main purpose of this light and electron microscopic immunocytochemical study was to characterize and compare the serotonin (5‐HT) innervation of the subthalamic nucleus (STN) in rats and squirrel monkeys (Saimiri sciureus) following labeling with an antibody against the 5‐HT transporter (SERT). Unbiased counts of SERT+ axon varicosities revealed an average density of 5‐HT innervation higher in monkeys (1.52 × 106 varicosities/mm3) than rats (1.17 × 106), particularly in the anterior half of the nucleus (1.70 × 106). As measured by electron microscopy, SERT+ axon varicosity profiles in the STN of both species were smaller than unlabeled profiles. The number of SERT+ profiles displaying a synaptic junction indicated that, in both rat and monkey STN, approximately half of 5‐HT axon varicosities were asynaptic. In monkeys, all synaptic junctions made by SERT+ varicosities were asymmetrical, as opposed to only 77% in rats. Despite the higher density of 5‐HT innervation in the anterior half of monkey STN, the ultrastructural features of its SERT+ varicosities, including synaptic incidence, did not significantly differ from those in its posterior half. These findings suggest that, throughout the rat and monkey STN, 5‐HT afferents may exert their influence via both synaptic delivery and diffusion of 5‐HT, and that an ambient level of 5‐HT maintained in STN by these two modes of transmission might also modulate neuronal activity and influence motor behavior. A better understanding of the factors governing the complex interplay between these signaling processes would greatly improve our knowledge of the physiopathology of the STN.
Proposal for the management of the unexpected difficult pediatric airway
Authors: WEISS MARKUS , ENGELHARDT THOMAS
Published: March 2010

The incidence of unanticipated difficult or failed airway in otherwise healthy children is rare, and routine airway management in pediatric patients is easy in experienced hands. However, difficulties with airway management in healthy children are not infrequent in nonpediatric anesthetists and are a main reason for pediatric anesthesia‐related morbidity and mortality. Clear concepts and strategies are, therefore, required to maintain oxygenation and ventilation in children. Several complicated algorithms for the management of the unanticipated difficult adult and pediatric airway have been proposed, but a simple structured algorithm for the pediatric patient with unanticipated difficult airway is missing. This paper proposes a simple step‐wise algorithm for the unexpected difficult pediatric airway based on an adult Difficult Airway Society (DAS) protocol, discusses the role of recently introduced airway devices, and suggests a content of a pediatric airway trolley. It is intended as an easy to memorize and a practical guide for the anesthetist only occasionally involved in pediatric anesthesia care as well as a call to stimulate discussion about the management of the unanticipated difficult pediatric airway.
Designing a Highly Immersive Interactive Environment: The Virtual Mine
Authors: Soares L. P. , Pires F. , Varela R. , Bastos R. , Carvalho N. , Gaspar F. , Dias M. S.
Published: March 2010

To achieve a full‐scale simulation of a pyrite mine, a highly immersive environment becomes necessary and this research has led to a complex system enabling users to walk through a virtual mine in real time, presenting all the behaviours present in such environment. Some of the problems encountered are the tunnels behaviours, including highly contrasted images due to the presence of the head light, narrow paths, elevators, sound reverberation and tunnels texture shades. The use of immersive virtual reality enables the generation of high‐quality simulations, because it is possible to control several feedback mechanisms such as the degree of luminance of produced imagery and spatial sound. In this research, a projection infrastructure and tracking system were specified and developed, aiming at producing the best results for this kind of simulation. To achieve our purposes, distributed algorithms were developed to run in a cluster solution that drives a four‐sided CAVE‐like environment. The complete production pipeline is presented, ranging from the developed authoring techniques, enabling fast production of new content for the simulation, to the tracking techniques produced for the improvement of the interaction.
The left periphery of Japanese exclamatives*
Authors: Yamato Naoyuki
Published: March 2010

Abstract. In this paper, I intend to shed light on the fact that Japanese exclamatives, unlike their English counterparts, may not be embedded under factive verbs but instead may be embedded under a set of assertive predicates such assayandthink(first observed inOno 2006). I argue that this contrast is attributed to the interrogative and declarative syntax that English and Japanese exclamatives have, respectively. In order to account for the selection of predicates that may embed Japanese exclamatives, I further argue for a cartographic approach based onRizzi’s (1997)andHaegeman’s (2006)left periphery structures and followingOno (2006), namely that Japanese exclamatives always contain MoodP, which allows only a subset of assertive matrix predicates to embed exclamatives given its position above TopicP and FocusP in the hierarchy. Another observation made in the paper is that the subject DP in Japanese exclamatives is obligatorily either aboutness topicalized or exhaustive listing focalized.
On the syntax of verb‐initial exclamatives*
Authors: Brandner Ellen
Published: March 2010

Abstract. This article discusses exclamative utterances that have the form of Y/N questions with no wh‐phrase present but only the finite verb in initial position. It will be shown that they cannot be captured by a purely pragmatic ‘reinterpretation’ of Y/N questions. This result implies that verb‐initial structures are syntactically ambiguous. An alternative to the traditional view on clause types as features/operators in the C‐domain, triggering V–C movement, will be suggested. V–C movement marks syntactically all those structures that correspond to non‐assertive speech acts. The structures are disambiguated by non‐syntactic means like intonation and/or lexical triggers.
Does Firm Size Affect Self‐selection and Learning‐by‐Exporting?
Authors: Máñez‐Castillejo Juan A. , Rochina‐Barrachina María E. , Sanchis‐Llopis Juan A.
Published: March 2010

The trade literature has long discussed the existence of some benefits attributed to exporting, among others, the improvement of firm productivity. This paper examines whether firm size plays a role in this supposedly favourable relationship between exporting and total factor productivity (TFP). To examine this, we investigate, separately for large and small firms, whether firms starting to export perform better ex ante (self‐selection) than non‐exporting firms and, conditional on this fact, if they are also more productive ex post (learning‐by‐exporting). With this purpose, we use both stochastic dominance and matching techniques. The dataset is a representative sample of Spanish manufacturing firms drawn from the Encuesta sobre Estrategias Empresariales for 1990–2002. Our results shed light on the importance of considering differences in firm size when analysing both self‐selection into exporting and post‐entry productivity changes. They confirm the existence of a binding process of self‐selection into exporting among small firms, but not among large firms. Post‐entry productivity growth, although with different time patterns, is significant both for small and large firms.
From Innovation to Exporting or Vice Versa?
Authors: Damijan Jože P. , Kostevc Črt , Polanec Sašo
Published: March 2010

Firm productivity and export decisions are closely related to innovation activity. Innovation may play a more important role in the decision to start exporting, and successful exporting may drive process innovation. This suggests that the causality between innovation and exporting may run in both directions. Using detailed microdata from innovation surveys, industrial production surveys, and trade information for Slovenian firms in 1996–2002, we investigate the bidirectional causal relationship between firm innovation and export activity. We find no evidence for the hypothesis that either product or process innovations increase the probability of becoming a first‐time exporter, but we do find evidence in both the innovation survey and the industrial production survey that exporting leads to productivity improvements. These, however, are likely to be related to process rather than product innovations, and are observed only in a sample of medium and large first‐time exporters. This finding makes a case in favour of the learning‐by‐exporting hypothesis by demonstrating that these learning effects from exporting occur through the mechanism of process innovation enhancing firm technical efficiency.
Offshoring and Firm Performance: Evidence from French Manufacturing Industry
Authors: Jabbour Liza
Published: March 2010

This paper examines the implications of offshoring by French manufacturing firms on their productivity and profitability. Offshoring is considered as endogenous and its impact is estimated onex postmeasures of firm performance. The dataset used allows the distinction between two forms of offshoring: vertical foreign direct investment (FDI) and international outsourcing. It also gives us the possibility of distinguishing between offshoring to developed and developing countries. The results show, first, that offshoring has a stronger effect on profitability and, second, that the implications on performance are significant only in the case of international outsourcing to developing countries.
ARE LIBERALS AND EVANGELICALS SINGING FROM THE SAME SONG SHEET?
Authors: SMITH DEAN
Published: March 2010

Characterising Liberal and Evangelical theology as positions on a continuum or spectrum is common within Protestant circles. I argue that Liberals and Evangelicals do not share a common conceptual framework but embody competing and incommensurable conceptual schemes. Liberal theology then is not a distortion of true Biblical Christianity, as is often supposed, but rather is an entirely different approach to doing theology, indeed, to seeing the world. What I hope to achieve by way of this paper is to provide a context within which to better understand both Liberal and Evangelical claims, and to offer an explanation as to why the debates between the two schools are seemingly intractable. Further, I hope to encourage Liberals and Evangelicals to pursue the difficult task of understanding each other's position so that genuine dialogue can take place.
‘It’s all changed:’ carers’ experiences of caring for adults who have Down’s syndrome and dementia
Authors: McLaughlin Katrina , Jones Dr Aled
Published: March 2010

Accessible summary

 People who care for someone with Down’s syndrome and dementia were asked about what it was like being a carer. Four of the carers were brothers or sisters of the person who had dementia, and two were paid carers not family members.

 All carers say that they want more information about some of the health and social problems that come with having dementia.

 Carers said that they want to know more information and meet other carers and other people who have dementia.

A qualitative interview study was undertaken to determine the information and support needs of carers of adults who have Down’s syndrome and dementia. The data were analysed thematically. Carers’ information and support needs were seen to change at pre‐diagnosis, diagnosis and post‐diagnosis. Helping carers to manage the changing nature of the adult with dementia is seen to be an essential part of the health professional’s role.
The application of failure mode diagrams for exploring the roles of fluid pressure and stress states in controlling styles of fracture‐controlled permeability enhancement in faults and shear zones
Authors: COX S. F.
Published: March 2010

Geofluids (2010) 10, 217–233

Permeability enhancement associated with deformation processes in faults and shear zones plays a key role in facilitating fluid redistribution between fluid reservoirs in the crust. Especially in high fluid flux hydrothermal systems, fracture‐controlled permeability can be relatively short‐lived, unless it is repeatedly regenerated by ongoing deformation. Failure mode diagrams in pore fluid factor and differential stress space, here termed λ–σ failure mode diagrams, provide a powerful tool for analysing how fluid pressure and stress states drive failure, associated permeability enhancement and vein styles during deformation in faults and shear zones. During fault‐valve behaviour in the seismogenic regime, relative rates of recovery of pore fluid factor, differential stress and fault cohesive strength between rupture events impact on styles of veining and associated, fracture‐controlled permeability enhancement in faults and shear zones. Examples of vein‐rich fault zones are used to illustrate how constraints can be placed, not just on fluid pressure and stress states at failure, but also on the fluid pressurization and loading paths associated with failure and transitory permeability enhancement in faults and shear zones. This provides insights about when, during the fault‐valve cycle, various types of veins can form. The use of failure mode diagrams also provides insights about the relative roles of optimally oriented faults and misoriented faults as hydraulically conductive structures. The analysis highlights the dynamics of competition between fluid pressures and loading rates in driving failure and repeated permeability regeneration in fracture‐controlled, hydrothermal systems.
Loneliness in adolescence: gene × environment interactions involving the serotonin transporter gene
Authors: Van Roekel Eeske , Scholte Ron H.J. , Verhagen Maaike , Goossens Luc , Engels Rutger C.M.E.
Published: March 2010

Background:  Loneliness is assumed to peak in early adolescence and to decrease throughout middle and late adolescence, but longitudinal confirmation of this tendency is lacking. Behavioral genetic studies with twin designs have found a significant genetic component for loneliness in children and adults, but no molecular genetic studies have been conducted to reveal the functional polymorphisms involved.

Methods:  Associations among the serotonin transporter gene (5‐HTTLPR), sex, parental support, and loneliness were examined in a longitudinal study spanning five annual waves (N = 306).

Results:  Using latent growth curve modeling (LGCM), loneliness was found to be highest in early adolescence and slowly declined throughout adolescence. The 5‐HTTLPR genotype was related to the development of loneliness, in that short allele carriers remained stable in loneliness over time, whereas adolescents with the long‐long genotype decreased in loneliness. Interactions were found between maternal support and 5‐HTTLPR genotype, showing that adolescents who perceived little support from their mothers and carried a short allele were at increased risk for developing loneliness.

Conclusions:  Our study is the first to chart adolescent loneliness longitudinally and to examine the genetic underpinnings of loneliness. Our results contribute to a further understanding of the environmental and genetic basis of loneliness. Replication of our results is needed in both population‐based and clinical samples.