bluuebunny/crossref_metadata_2025 huggingface dataset:
Objective Measures of Right Ventricular Function during Exercise: Results of a Pilot Study
Authors: Anjak Ahmad , López‐Candales Angel , Lopez Francisco R. , Harris David , Elwing Jean
Published: October 2013

Background

A growing body of evidence seems to suggest that reduction in right ventricular (RV) systolic function is not only associated with both development of symptoms associated with pulmonary arterial hypertension (PAH) but also increased morbidity and adverse clinical outcomes. Recent data suggest that supine bicycle stress echocardiography (sBEE) is feasible and provides realistic resistance and compliance estimations.

Methods

The study design was a retrospective analysis of sBEE obtained for clinical indications of dyspnea on exertion or unexplained exercise intolerance. A total of 30 sBEE studies were included. The first 10 sBEE studies served as a calibration cohort not only to establish objective measures of RV performance but also to determine feasibility and reproducibility. The following 20 sBEE served as a validation cohort.

Results

Our results demonstrate that tricuspid annular plane systolic excursion and tricuspid annular systolic velocity, even when measured by an untrained reader, are reliable and accurate measures of the RV response to exercise during a sBEE protocol. Furthermore, measurements of RV myocardial performance (Tei index) or peak RV strain during exercise not only are time consuming but also simply unreliable and should not be utilized to evaluate RV function during sBEE.

Conclusion

The results of our pilot study suggest that sBEE might be promising for detecting RV abnormalities during exercise. A larger prospective study is now needed to determine if TAPSE and tricuspid annular systolic velocity recorded during sBEE might be useful in assessing patients presenting with dyspnea during exercise or suspected of having PAH.
A Different Kind of Christmas Tree: Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery (ARCAPA)
Authors: Afolabi‐Brown Olayinka , Witzke Christian , Moldovan Raul , Pressman Gregg
Published: October 2013

Anomalous right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly that has an incidence of 0.002%. We report a case of a previously healthy female who presented to our hospital with pneumonia and was incidentally discovered to have ARCAPA. This was initially diagnosed on echocardiography by the unusual echocardiographic finding of multiple color flow Doppler signals around the right ventricular free wall and apex which were subsequently confirmed by angiography to be due to extensive collateral circulation between the left and right coronary arteries. This represents an unusual echocardiographic manifestation of this very rare condition.
Right Ventricular Ejection Efficiency: A New Echocardiographic Measure of Mechanical Performance in Chronic Pulmonary Hypertension
Authors: López‐Candales Angel , Lopez Francisco R. , Trivedi Setu , Elwing Jean
Published: October 2013

Background

The severity of pulmonary vascular resistance (PVR) is known to be a critical determinant of right ventricular (RV) systolic function; this relationship remains poorly characterized. We therefore, designed a study to examine the relationship that exists between echocardiographically measured PVR and maximal tricuspid annular plane systolic excursion (TAPSE) to gain some insight regarding RV ejection efficiency (RVEe) in patients with chronic pulmonary hypertension (cPH).

Methods

Standard echocardiographic measures of RV size and systolic performance were recorded from 95 patients (age 54 ± 15 years and pulmonary artery systolic pressures [PASP] that range from 20 to 125 mmHg). For this study, RVEe was defined as TAPSE/Echocardiographic PVR.

Results

A strong negative correlation (R2 = −0.51, P < 0.001) was seen between TAPSE and PASP; however, a power curve trend line fit the relationship between RVEe and PASP (R2 = 0.77; P < 0.01). In a multiple regression analysis, abnormal pulmonary pressures were better identified when RVEe (P < 0.0001) was used.

Conclusions

Based on these results, it appears that measurement of RVEe might be extremely useful for the assessment of RV mechanics and plasticity. The power curve relationship clearly demonstrates that minimal changes in PASP (up to 50 mmHg) result in dramatic reductions in RVEe. A steady decline in RVEe, though at a lower rate, continues to occur with increasing PASP. Additional studies are required using RVEe into a functional RV imaging algorithm and determine if RVEe correlates with development of symptoms, response to therapy and overall clinical outcomes.
Framing Classroom Discussion of Same‐Sex Marriage
Authors: Hand Michael
Published: October 2013

Assuming that the issue of same‐sex marriage should be discussed in schools, how should the discussion be framed? Michael Hand first distinguishes this question from the related but distinct question of whether discussion on this topic should be steered. He then examines three possible frames for discussion of same‐sex marriage: the perfectionist frame, the antiperfectionist frame, and the practical accommodation frame. He defends the perfectionist frame over the two alternatives: the purpose of state involvement in marriage is to promote valuable forms of intimate relationship, so the case for enabling same‐sex couples to marry turns on the ethical claim that same‐sex and opposite‐sex intimate relationships are similarly valuable. Interrogation of this ethical claim must be central to classroom discussion of same‐sex marriage.
The Democratic Imperative to Address Sexual Equality Rights in Schools
Authors: Gereluk Dianne
Published: October 2013

Issues of sexual orientation elicit ethical debates in schools and society. In jurisdictions where a legal right has not yet been established, one argument commonly rests on whether schools ought to address issues of same‐sex relationships and marriage on the basis of civil equality, or whether such controversial issues ought to remain in the private sphere. Drawing upon an antiperfectionist liberal framework, Dianne Gereluk argues that schools have an obligation to educate students in two important ways. First, students must develop an awareness and understanding of the range of acceptable and permissible ways of life that may lead to human flourishing. Second, students must understand the requisite protections and recognition afforded to individuals in a pluralist society.
Reason, Liberalism, and Democratic Education: A Deweyan Approach to Teaching About Homosexuality
Authors: Petrovic John E.
Published: October 2013

Teaching about homosexuality, especially in a positive light, has long been held to be a controversial issue. There is, however, a view of the capacity for reason that finds that those who deem homosexuality to be controversial will ultimately contradict themselves, becoming unreasonable. By this standard of reason, homosexuality should be treated as non controversial in schools. In this essay, John Petrovic argues that this epistemic position is problematic. Instead, he defends a Deweyan epistemology that casts reason as, in part, a set of socially acquired habits of mind. People who have been socialized into heterosexist habits of mind must be exposed to counterhegemonic discourses. One such discourse can be found in the public values of liberal democracy through which the practice of reason must be pursued. Petrovic discusses the practical guidance provided by assuming a view of normative reason versus habituated reason in terms of both pedagogy and curriculum.
The origin of projections from the posterior cingulate and retrosplenial cortices to the anterior, medial dorsal and laterodorsal thalamic nuclei of macaque monkeys
Authors: Aggleton John P. , Saunders Richard C. , Wright Nicholas F. , Vann Seralynne D.
Published: October 2013

Interactions between the posterior cingulate cortex (areas 23 and 31) and the retrosplenial cortex (areas 29 and 30) with the anterior, laterodorsal and dorsal medial thalamic nuclei are thought to support various aspects of cognition, including memory and spatial processing. To detail these interactions better, the present study used retrograde tracers to reveal the origins of the corticothalamic projections in two closely related monkey species (Macaca mulatta, Macaca fascicularis). The medial dorsal thalamic nucleus received only light cortical inputs, which predominantly arose from area 23. Efferents to the anterior medial thalamic nucleus also arose principally from area 23, but these projections proved more numerous than those to the medial dorsal nucleus and also involved additional inputs from areas 29 and 30. The anterior ventral and laterodorsal thalamic nuclei had similar sources of inputs from the posterior cingulate and retrosplenial cortices. For both nuclei, the densest projections arose from areas 29 and 30, with numbers of thalamic inputs often decreasing when going dorsal from area 23a to 23c and to area 31. In all cases, the corticothalamic projections almost always arose from the deepest cortical layer. The different profiles of inputs to the anterior medial and anterior ventral thalamic nuclei reinforce other anatomical and electrophysiological findings suggesting that these adjacent thalamic nuclei serve different, but complementary, functions supporting memory. While the lack of retrosplenial connections singled out the medial dorsal nucleus, the very similar connection patterns shown by the anterior ventral and laterodorsal nuclei point to common roles in cognition.
Integrating the ‘genomic mosaic’ view of species into studies of biotic interactions: a comment on Bernhardsson et al. ()
Authors: Lexer Christian , Caseys Celine , Stritt Christoph , Whitham Thomas G.
Published: October 2013

The co‐occurrence of geographical structure in herbivore communities, metabolomes and defence genes in forest trees has been analysed in the context of ‘geographical mosaics’ of coevolution. A deeper understanding of these important issues will require full integration of a ‘genomic mosaic’ view of species into community ecology.
Regional thalamic neuropathology in patients with hippocampal sclerosis and epilepsy: A postmortem study
Authors: Sinjab Barah , Martinian Lillian , Sisodiya Sanjay M. , Thom Maria
Published: October 2013

Purpose

Clinical, experimental, and neuroimaging data all indicate that the thalamus is involved in the network of changes associated with temporal lobe epilepsy (TLE), particularly in association with hippocampal sclerosis (HS), with potential roles in seizure initiation and propagation. Pathologic changes in the thalamus may be a result of an initial insult, ongoing seizures, or retrograde degeneration through reciprocal connections between thalamic and limbic regions. Our aim was to carry out a neuropathologic analysis of the thalamus in a postmortem (PM) epilepsy series, to assess the distribution, severity, and nature of pathologic changes and its association with HS.

Methods

Twenty‐four epilepsy PM cases (age range 25–87 years) and eight controls (age range 38–85 years) were studied. HS was classified as unilateral (UHS, 11 cases), bilateral (BHS, 4 cases) or absent (No‐HS, 9 cases). Samples from the left and right sides of the thalamus were stained with cresyl violet (CV), and for glial firbillary acidic protein (GFAP) and synaptophysin. Using image analysis, neuronal densities (NDs) or field fraction staining values (GFAP, synaptophysin) were measured in four thalamic nuclei: anteroventral nucleus (AV), lateral dorsal nucleus (LD), mediodorsal nucleus (MD), and ventrolateral nucleus (VL). The results were compared within and between cases.

Key Findings

The severity, nature, and distribution of thalamic pathology varied between cases. A pattern that emerged was a preferential involvement of the MD in UHS cases with a reduction in mean ND ipsilateral to the side of HS (p = 0.05). In UHS cases, greater field fraction values for GFAP and lower values for synaptophysin and ND were seen in the majority of cases in the MD ipsilateral to the side of sclerosis compared to other thalamic nuclei. In addition, differences in the mean ND between classical HS, atypical HS, and No‐HS cases were noted in the ipsilateral MD (p < 0.05), with lower values observed in HS.

Significance

Our study demonstrates that stereotypical pathologic changes, as seen in HS, are not clearly defined in the thalamus. This may be partly explained by the heterogeneity of our PM study group. With quantitation, there is some evidence for preferential involvement of the MD, suggesting a potential role in TLE, which requires further investigation.
Malformation in index pregnancy in women with epilepsy is not followed by recurrence in subsequent pregnancy
Authors: Begum Shehanaaz , Sarma Sankara P. , Thomas Sanjeev V.
Published: October 2013

Use of antiepileptic drugs (AEDs) in pregnant women with epilepsy (WWE) is associated with an increased risk of major congenital malformations (MCM). Previous studies have suggested that WWE who had a malformation in their index pregnancy were at an increased risk of recurrence in future pregnancies. We aimed to assess the risk of recurrence of MCM in 1,616 WWE from Kerala Registry of Epilepsy and Pregnancy. The pregnancy outcome of women (n = 246) with two prospective pregnancies in the registry were analyzed. They had partial seizures with or without generalization (57.3%) or generalized seizures (42.7%). Polytherapy was used in 26.4% (index pregnancy) and 23.6% (follow‐up pregnancy). The mean dosage of AED for valproate was 498 mg/day and carbamazepine was 555 mg/day. The malformation rate in the index pregnancy was 8.5% (21/246) and in the follow‐up pregnancy was 8.9% (22/246) with only one recurrence. There was no increased risk of MCM in follow‐up pregnancy for those who had MCM in the index pregnancy (p = 0.70; OR 0.49; 95% CI 0.06–3.80). The use of any specific drug, continuation of the same drug or a change in drug therapy between two pregnancies did not alter the recurrence risk.
What predicts the use by brook trout (Salvelinus fontinalis) of terrestrial invertebrate subsidies in headwater streams?
Authors: Wilson Matthew K. , Lowe Winsor H. , Nislow Keith H.
Published: October 2013

Spatial subsidies are important resources for organisms in receiving habitats, particularly when production in those habitats is low. Terrestrial invertebrates provide a critical subsidy for trout, including eastern brook trout (Salvelinus fontinalis), but we have limited understanding of what causes input and use of these subsidies to vary among streams.

We predicted that forest successional stage would be an especially important driver of variation in terrestrial invertebrate subsidies to brook trout in headwater streams due to differences in terrestrial invertebrate biomass in early and late successional habitats. Specifically, we expected biomass of aerial invertebrates, those capable of dispersal to the stream, to be greater in early successional habitat than late successional habitat due to the nutrient‐rich, herbaceous vegetation typical of early successional habitat.

We measured aerial terrestrial invertebrate biomass in early and late successional habitats, input to streams and use by resident brook trout in 12 first‐ and second‐order catchments in northern New Hampshire, U.S.A. The study catchments represented a range of early successional habitat coverage (0–51.5%). We also measured a suite of reach‐scale variables that might influence terrestrial invertebrate input and use by brook trout, including riparian forest conditions and benthic invertebrate biomass.

Within study catchments, aerial terrestrial invertebrate biomass and abundance were significantly higher in early successional habitats than late successional habitats. However, terrestrial invertebrate input to streams and use by brook trout were unrelated to per cent early successional habitat in the catchment, and to other catchment and riparian forest characteristics. These results indicate that the management for upland early successional habitat has little effect on terrestrial invertebrate subsidies to headwater streams and fish.

Surprisingly, benthic invertebrate biomass was the one significant predictor of per cent terrestrial invertebrates in brook trout diets. Use of terrestrial invertebrate subsidies declined with increasing benthic invertebrate biomass, suggesting that productivity in the aquatic environment influences the degree to which brook trout use terrestrial subsidies. Although subsidy inputs are controlled by the donor system, this study shows that use of these subsidies by consumers can be determined by conditions in the recipient habitat.
How social media transform migrant networks and facilitate migration
Authors: DEKKER RIANNE , ENGBERSEN GODFRIED
Published: October 2013

We argue that social media are not only new communication channels in migration networks, but also that they actively transform the nature of these networks and thereby facilitate migration. Despite some limitations, which stem from the ‘digital divide’ and the lower trustworthiness of virtual ties, qualitative data reveal four relevant ways in which social media facilitate international migration. First, they enhance the possibilities of maintaining strong ties with family and friends. Second, they address weak ties that are relevant to organizing the process of migration and integration. Third, they establish a new infrastructure consisting of latent ties. Fourth, they offer a rich source of insider knowledge on migration that is discrete and unofficial. This makes potential migrants ‘streetwise’ when undertaking migration. Based on these empirical findings we conclude that social media are transforming migration networks and thereby lowering the threshold for migration.
Navigating return: the gendered geographies of skilled return migration to Ghana
Authors: WONG MADELEINE
Published: October 2013

In this article, I extend the literature on return migration by exploring the gendered mechanisms of return for highly skilled Ghanaian migrants. Drawing on interviews with Ghanaian women and men who returned in their prime productive years, I examine their decision‐making, the strategies they implement and the challenges they negotiate in the process. While the decision to return was straightforward, the actual processes circumscribing it contained tensions and compromises that involved renegotiations of gender identities, roles and norms, which themselves intersected with class differences. The empirical analyses emphasize how skilled migrants capitalize on their class status, social networks and transnational activities as means not only to return but also, for some, to mitigate the impacts of separation for themselves and their families as they seek to accomplish specific goals.
Accuracy of endodontic working length determination using cone beam computed tomography
Authors: Connert T. , Hülber‐J M. , Godt A. , Löst C. , ElAyouti A.
Published: October 2013

Aim

To evaluate the accuracy of endodontic working length (WL) measurements by cone beam computed tomography (CBCT).

Methodology

Forty‐two extracted human teeth were placed into three full jaw models. Preoperatively, CBCT scans of the models were performed (voxel size: 0.2 mm). Endodontic access cavities were prepared, and the coronal third of 70 root canals were pre‐flared. The real WL was measured by inserting a K‐file into the root canal until the tip was visible at the foramen, a silicon stopper was adjusted to the corresponding cusp tip, and the length was measured using a micrometer. CBCT WL was simply measured by tracing a line between the apical foramen and the corresponding cusp tip. When the foramen and cusp tip were not visible in one plane, the measurement was taken in two planes. To quantify measurement error, real and CBCT WLs were repeated four times by two experienced operators. Paired analysis for each variable was performed, and the mean of absolute differences and the corresponding 99% confidence intervals were calculated. The t‐test was used for comparison.

Results

The coefficient of repeatability, reproducibility and interoperator agreement were <0.5 mm. CBCT measurements were accurate; the mean of absolute differences between CBCT and real WL was 0.41 mm (99% CI 0.31–0.52 mm).

Conclusion

Using a simplified method, CBCT images of 0.2 mm voxel size can be used to accurately determine endodontic WL.
CutaneousT‐cell lymphoma in patients with chronic lymphocytic leukemia: clinical characteristics, temporal relationships, and survival data in a series of 14 patients atMayoClinic
Authors: Chang Michael B. , Weaver Amy L. , Brewer Jerry D.
Published: October 2013

Background

We examined the course of cutaneous T‐cell lymphoma (CTCL), which has been associated with chronic lymphocytic leukemia (CLL) in patients withCLL.

Materials and methods

A search was conducted of the master diagnosis index at our institution to identify patients with bothCLLandCTCLfrom 1980 to 2010. A retrospective chart review was then conducted.

Results

Of the 14 patients withCTCLandCLL, eight had mycosis fungoides (MF; two with patch stage, two with plaque stage, two with tumor stage, and two with erythrodermic stage), four had Sézary syndrome, one had natural killer cell lymphoma involving the skin, and one had peripheral T‐cell lymphoma involving the skin. Eight had concurrent diagnoses, five received aCLLdiagnosis first, and one received aCTCLdiagnosis first. Ten patients were deceased at the time of data abstraction due to unknown causes (n = 4), lymphoma (n = 2), pneumonia (n = 2),MF(n = 1), or respiratory failure (n = 1). Of the nine patients with concurrent or priorCTCL, seven were deceased, with a median time to death of 10.2 months (range, 6–89 months). Of the five patients withCLLprior toCTCL, three were deceased at 18, 27, and 47 months, respectively, after theCTCLdiagnosis. The median survival for the two groups was 12 and 47 months, respectively.

Conclusions

Patients withCTCLconcurrent with or prior toCLLhave a worse overall survival than patients withCLLin whomCTCLlater develops. Larger studies are needed.
Skin cancer prevention in annual performance of total skin examination, photoprotection counseling, and patient instruction of self‐skin examination
Authors: Yiannias James A. , Laman Susan D. , Stevens Ryan , Rkein Ali M. , Nelson Evan , Noble Brie N.
Published: October 2013

Background

Prevention of skin cancer includes early diagnosis and photoprotection, such as by physician‐performed total skin examination (TSE) and patient‐performed self‐skin examination (SSE). Hypothesizing that 90% of our patients receive an annual TSE, photoprotection counseling, and SSE instruction, we assessed the extent to which this was documented in patients' records. We also sought to identify differences in documentation of TSE, photoprotection counseling, and instruction on SSE with or without use of a dictation template prompting documentation.

Materials and methods

Retrospective review of a random sample of 400 patients in an outpatient dermatology practice of a tertiary care academic medical center for any dermatology appointment between May 1 and July 31, 2007. Exclusion criteria included refusal to undergo TSE, lack of access to skin (e.g. wheelchair‐bound or in cast), or inappropriate visit type (e.g. for acne, psoriasis, or lupus).

Results

Of 400 randomly selected patients, 313 met inclusion criteria. The dictation template was used in 133; of these, 89% (119/133) had documentation in their clinical note of a TSE (exclusive of the buttocks or groin area), and 98% (130/133) had documentation of instruction on sun protection and SSE. Without use of the dictation template, these percentages dropped to 78% (140/180) and 20% (36/180), respectively. Physicians using a dictation template were more likely to document having conducted a TSE and instructed patients on photoprotection and SSE.

Conclusions

A dictation template aids documentation of annual TSE and patient education efforts on photoprotection and SSE.
Prevalence of vitiligo among type 2 diabetic patients in an Iranian population
Authors: Afkhami‐Ardekani Mohammad , Ghadiri‐Anari Akram , Ebrahimzadeh‐Ardakani Mohammad , Zaji Neda
Published: October 2013

Background

Vitiligo is one of many diseases that can be found with diabetes mellitus. Diabetic patients have a high incidence of vitiligo compared to the general population. This study assesses prevalence of vitiligo in type 2 diabetic patients in Iran.

Methods

One thousand one hundred type 2 diabetic patients and 1100 healthy adults were recruited in this cross‐sectional study. Patients were evaluated for vitiligo by a dermatologist both clinically and by Wood's lamp. Data were analyzed using SPSS. P value ≤0.05 was considered statistically significant.

Results

There was a significant difference between groups with respect to presence of vitiligo; 4.9% of diabetic patients had vitiligo versus 1.8% of control group (P = 0.001). In the female group with diabetes, 5.8% had vitiligo, and in male diabetic patients, 3.9% had vitiligo (P = 0.057). In the control group, 1.8% of females and 1.8% of males had vitiligo that was equal.

Conclusion

Vitiligo and diabetes may have a causal relationship. Vitiligo may coexist with type 2 diabetes. Therefore it is reasonable to investigate each patient periodically.
Rare atypical presentations in Type 2 lepra reaction: a case series
Authors: Vijendran Pragasam , Verma Rajesh , Vasudevan Biju , Mitra Debdeep , Badad Ambresh , Neema Shekhar
Published: October 2013

Objectives

Type 2 lepra reaction is a Th2‐mediated type III hypersensitivity reaction in leprosy, with a characteristic cutaneous manifestation in the form of erythema nodosum leprosum (ENL). We describe unusual presentations of Type 2 lepra reaction in five patients.

Methods

Patient data and dermatological findings were analyzed in three men and two women diagnosed with Hansen's disease.

Results

Findings included multiple tender, polycyclic, necrotic lesions distributed over the face in one patient, and painful, fluid‐filled lesions on both arms and lower limbs in another. The third patient showed erythematous, tender nodules, bullae, and necrotic ulcers over the back and upper and lower limbs. The fourth showed erythematous tender nodules over the face, neck, back, and extremities, predominantly in sun‐exposed areas. The fifth revealed multiple erythematous, severely tender nodules and urticarial plaques mimicking those of Sweet's syndrome. Diagnosis of borderline or lepromatous leprosy with atypical Type 2 reaction were made in all cases.

Conclusions

Type 2 lepra reactions are antigen antibody‐mediated immune complex reactions that present with constitutional symptoms and ENL characterized by tender, erythematous, evanescent nodules mainly on the face, arms, and legs. Over 50% of lepromatous leprosy patients and 25% of borderline lepromatous leprosy patients experienced type 2 lepra reactions prior to the advent of multi‐drug therapy. Thalidomide is the drug of choice for severe atypical lepra reactions because of its anti‐tumor necrosis factor‐α action. Awareness of these atypical variants and prompt diagnosis and treatment are essential to prevent mortality and morbidity in potentially treatable patients.
Functional bowel symptoms and diet
Authors: Gibson P. R. , Barrett J. S. , Muir J. G.
Published: October 2013

It is well recognised that ingestion of food is a trigger for functional bowel symptoms, particularly those associated with irritable bowel syndrome (IBS). Patients often use manipulation of diet as a means of controlling symptoms. Despite description of multiple dietary methods, few have scientific backing or quality evidence of efficacy. One approach is to define how specific food components influence the pathophysiology of IBS and then rationally design dietary approaches. For example, short‐chain poorly absorbed carbohydrates (fermentable oligo‐, di‐ and mono‐saccharides and polyols (FODMAP)) cause luminal distension, which is a major stimulus for the development of symptoms in patients with visceral hypersensitivity. By determining food content of FODMAP, a diet in which foods low in FODMAP are favoured over those high in FODMAP can be designed. Observational, comparative and randomised controlled treatment and rechallenge studies have shown that such an approach is efficacious in the majority of patients with IBS. The low FODMAP diet is now the primary dietary therapy for such patients. Similar approaches can be applied to other food components, including proteins (such as gluten), fats and natural bioactive food chemicals. Such approaches have suggestions of efficacy, but the evidence base remains underdeveloped. An additional and important consideration for any dietary therapy is its nutritional adequacy and potential adverse health effects. Dietary manipulation is now a key management strategy in patients with functional bowel symptoms. Future well‐designed interventional studies will lead to refinement of dietary approaches taken and to a better understanding of their long‐term safety.
Are doctors the structural weakness in the e‐health building?
Authors: Hannan T. J. , Celia C.
Published: October 2013

Progressive evaluations by the Organization for Economic Co‐operation and Development (OECD) demonstrate that health care is now or becoming unaffordable. This means nations must change the way they manage health care. The costly nature of health care in most nations, as a percentage of Gross Domestic Product (GDP) seems independent of the national funding models. Increasing evidence is demonstrating that the lack of involvement by clinicians (doctors, nurses, pharmacists, ancillary care and patients) in e‐health projects is a major factor for the costly failures of many of these projects.

The essential change in focus required to improve healthcare delivery using e‐health technologies has to be on clinical care. To achieve this change clinicians must be involved at all stages of e‐health implementations.

From a clinicians perspective medicine is not a business. Our business is clinical medicine and e‐health must be focussed on clinical decision making. This paper views the roles of physicians in e‐health structural reforms.
Pricing strategies with reference effects in competitive industries
Authors: Coulter Brian , Krishnamoorthy Srini
Published: October 2013

This paper examines the effect of reference prices on companies operating within competitive industries. We confirm that even with competition, firms optimally price high in the short term to generate a high reference price and then decrease this price over time. Competitors' prices converge toward each other over time, emphasizing the short‐term nature of reference prices. We then show that pricing optimally to take advantage of reference prices generates a positive externality for other firms in an industry, such that competitors may generate higher profit. The longer the focus of a given firm, the more profit the firm generates, but less relative to its competitors. This arises because the externalities created through pricing high to increase reference prices outweigh the benefits of the higher reference prices themselves. If pricing managers are compensated relative to their competition, this suggests that short‐termism may be implicitly encouraged to the detriment of profit.
Better Government
Authors: O'DONNELL GUS
Published: October 2013

The decline in future trend economic growth coupled with the ever increasing demands of an ageing population mean the public sector will need to deliver better for less. This will require a smarter bureaucracy using the latest behavioural advances and using wellbeing as a measure of success. Spending will need to be directed more to prevention rather than cure. Radical tax and benefit reform is needed to make work pay and offset the rise in inequality.

Decision making could be improved by attracting more diverse, experienced people into politics by, for example, more use of open primaries, a level playing field for independent candidates and better training. Ministers could be set proper objectives and have constructive appraisals.

A proposed Office of Taxpayer Responsibility could screen policies to avoid the worst ones, backed by no evidence, from being introduced as it is very hard to abolish bad policies.
Enhanced 2.0 μm Emission and Lowered Upconversion Emission in Fluorogermanate Glass‐Ceramic Containing LaF3:Ho3+/Yb3+ by Codoping Ce3+ Ions
Authors: Zhang Jia‐Peng , Zhang Wei‐Juan , Yuan Jian , Qian Qi , Zhang Qin‐Yuan
Published: October 2013

Intense 2.0 μm emission of Ho3+ has been achieved through Yb3+ sensitization in fluorogermanate glass‐ceramic (GC) containing LaF3 pumped with 980 nm laser diode (LD). The observation of concurrent emissions at 538, 650, and 1192 nm points to the additional deexcitation routes based on infrared‐to‐visible upconversion processes and Ho3+:5I6 → 5I8 radiative transition. Comparative investigations of photoluminescent spectra and decay curves have indicated the effective role of Ce3+ ions in enhancing the 2.0 μm fluorescence along with suppressing the occurrence of these concurrent emissions. This would offer a promising approach to develop compact and efficient 2.0‐μm laser systems.
Engineering academic performance with selective retrieval: the benefits of implied ability
Authors: Fuller Eric W. , McIntyre Rusty B. , Oberleitner David E.
Published: October 2013

Research on retrieval fluency suggests that, under different recall constraints, recalling past failures might be as effective as past successes for engineering task performance. In the current study, students recalling three instances of academic success correctly answered more items on a knowledge task than those recalling nine instances. Other students, asked to recall nine instances of failure, answered more items correctly than those recalling three failures and more than those recalling nine successes. This pattern was partially mediated by the assessments of one's ability as compared with other students. The results are interpreted as extending previous research in retrieval fluency by suggesting that the ease of retrieving task‐related instances informs individuals about their comparative ability that, in turn, influences performance.
What does it mean to be an ally?: The perception of allies from the perspective of people of color
Authors: Brown Kendrick T. , Ostrove Joan M.
Published: October 2013

Allies are frequently studied from the viewpoint of dominant group members. Three studies took a different perspective by investigating how people of color perceive both White allies and allies of color. Study 1 used content analysis of qualitative data from 80 people of color to describe eight major themes of ally perception. With samples of 182 and 195 people of color, Studies 2 and 3 employed exploratory and confirmatory factor analysis to identify two subscales, informed action and affirmation, based on the themes. Both independent and paired samples t tests showed that people of color rating a White ally versus an ally of color perceived significantly less willingness to engage racial issues. Findings are discussed in relation to existing allies research.
Seeing is believing: communication modality, anger, and support for action on behalf of out‐groups
Authors: Glasford Demis E.
Published: October 2013

Relatively few studies have investigated the impact of communication modality (e.g., video vs. print) on political action intentions, as well as what motivates external observers to act when both the victim and perpetrator of injustice are out‐group members. The present research experimentally investigated the influence of communication modality of an injustice (text vs. video), where all parties were out‐group members, on observers' sympathy, anger, social cohesion to victims, and political action intentions. Participants reported greater intentions to politically act in the video condition, relative to print, which was explained by increased anger in the video condition. In addition, both sympathy and anger were positively related to social cohesion to the out‐group, but only anger was associated with political action intentions.
On the motivation of quid pro quo sexual harassment in men: relation to masculine gender role stress
Authors: Mellon Robert C.
Published: October 2013

Male office workers reported levels of distress elicited by personal violations of a range of masculine gender role expectations, as well as their proclivities to coerce sexual favors from “attractive” subordinate women via bribery or extortion. Sexual harassment proclivity levels were directly correlated with levels of distress related to four dimensions of masculine gender role violations, including acts of subordination to women, public expression of emotional behavior, inadequate heterosexual prowess, and inferiority in athletic and intellectual domains. These findings accord with an interpretation that men's quid pro quo sexual harassment may be motivated by the social punishment of their own failures to conform to masculine gender role expectations, including, but importantly, not limited to the expectation that men should punish women's violations of feminine gender role norms.
Assessing the impact of genomic selection against hip dysplasia in theLabradorRetriever dog
Authors: Sánchez‐Molano E. , Woolliams J.A. , Blott S.C. , Wiener P.
Published: October 2013

Many purebred dogs exhibit a higher prevalence of inherited diseases compared with non‐purebred dogs. One of the most popular breeds in theUKis the Labrador Retriever, which has a high prevalence of hip dysplasia resulting in high costs for surgical operations and impaired animal welfare. Considering the many complications of highly managed populations, mainly due to breeder's conventions and the resulting population structure, is of great importance for the proper development of a strategy against the disease. In this study, we have compared the utilities and performances of both genomic and phenotypic selection against hip dysplasia in a simulated population with the characteristics of theBritishVeterinaryAssociation andKennelClub (BVA/KC) hip dysplasia scheme. The results confirm the potential benefits of genomic selection by showing a moderate increase of 1.15‐fold (assuming a realistic accuracy ofr2 = 0.5) in response to selection due to the higher accuracy (between 0.96‐ and 1.32‐fold, considering 0.35 ≤ r2 ≤ 0.7) and more than a threefold increase when all the offspring in each litter are tested (between 3.25‐ and 4.55‐fold, again considering 0.35 ≤ r2 ≤ 0.7).
Chronic disease influences over 40 major life‐changing decisions (MLCDs): a qualitative study in dermatology and general medicine
Authors: Bhatti Z.U. , Finlay A.Y. , Bolton C.E. , George L. , Halcox J.P. , Jones S.M. , Ketchell R.I. , Moore R.H. , Salek M.S.
Published: October 2013

Background

Chronic disease not only impairs patients' psycho‐social well‐being but also influences major life‐changing decisions (MLCDs). There is little information about the types of MLCDs affected and the long‐term consequences.

Objectives

The aims were to identify the MLCDs influenced by chronic disease, to define ‘MLCD’ and to suggest support strategies for patients taking MLCDs.

Methods

Adult dermatology patients explained how their chronic disease had influenced MLCDs in individual interviews. Adult patients from other medical specialities gave similar information by postal survey. NVivo8 software was used for qualitative analysis of data. Themes were categorized through a coding–recoding iterative process.

Results

There were 308 evaluable responses (male 55.2%; mean age = 51.8 years, mean disease duration = 19 years) from the 365 (55.7%) responses to the 655 patient invitations. These were used to generate themes to conceptualize ‘MLCDs’. The most frequently reported MLCDs in the dermatology interviews concerned career choice (66%), job (58%), choice of clothing (54%), relationships (52%), education (44%), stopping swimming (34%), moving abroad (32%), not socializing (34%), wearing make‐up (22%) and having children (22%). In the postal survey early retirement (40.6%), impact on job (29.4%), having children (24.8%), career choice (22.4%) and relationships (15.5%) were most commonly reported. The number of MLCDs reported by individuals was inversely related to age. Forty‐one affected MLCD themes were grouped into 18 MLCD categories. A definition of MLCD was developed and strategies suggested to support patients.

Conclusions

Chronic diseases influence a wide range of MLCDs. MLCDs are a novel domain in disease burden assessment. Clinicians' knowledge about this is important in patient management.
Investment Incentives and Electricity Spot Market Competition
Authors: Grimm Veronika , Zoettl Gregor
Published: October 2013

In this paper we analyze investment decisions of strategic firms that anticipate competition on many consecutive spot markets with fluctuating (and possibly uncertain) demand. We study how the degree of spot market competition affects investment incentives and welfare and provide an application of the model to electricity market data. We show that more competitive spot market prices strictly decrease investment incentives of strategic firms. The effect can be severe enough to even offset the beneficial impact of more competitive spot markets on social welfare. Our results obtain with and without free entry. The analysis demonstrates that investment incentives necessarily have to be taken into account for a serious assessment of electricity spot market design.
Causal knowledge in evidence‐based medicine. In reply to Kerry et al.'s causation and evidence‐based practice: an ontological review
Authors: Strand Anders , Parkkinen Veli‐Pekka
Published: October 2013

In Causation and evidence‐based practice: an ontological review, Kerry et al. argue that evidence‐based practice (EBP) should revise its understanding of causation, and take on board a dispositionalist ontology. We point out that the challenges from complexity discussed by Kerry et al., are not properly addressed by their proposed ontology. Rather, the difference making views of causation Kerry et al. criticize, spell out the relevant aspects of causation, and have a range of advantages compared to dispositionalist accounts. We explore some of these here, with a special focus on the role of causal assumptions in inferences from scientific evidence to clinical decisions. A philosophical account should help us explicate the assumptions that go into causal inference in EBM. In doing so, it enables an understanding of the various ways in which these assumptions might fail, and of how they can be justified.
Identification of Differentially Expressed Water‐insoluble Proteins in the Encystment Process of Colpoda cucullus by Two‐dimensional Electrophoresis and LC‐MS/MS Analysis
Authors: Sogame Yoichiro , Kojima Katsuhiko , Takeshita Toshikazu , Kinoshita Eiji , Matsuoka Tatsuomi
Published: October 2013

In the encystment process of the ciliate protist Colpoda cucullus, we observed that the cell total protein abundance was reduced at 12 h–1 d after the onset of encystment induction subsequent to the reduction in mRNA abundance. We analyzed the alteration of the expression levels of water‐insoluble proteins by two‐dimensional polyacrylamide gel electrophoresis using polyoxyethylene (20) sorbitan monooleate (Tween‐80), and we identified proteins whose expression levels were altered in the encystment process by a liquid chromatography tandem mass spectrometry analysis. The expression level of a 60‐kDa protein (p60; heat shock protein 60) was temporarily enhanced and that of a 55‐kDa protein (p55; actin) and a 49‐kDa protein (p49; actin) was enhanced in the Colpoda encystment process. In mature cysts, the expression level of p55 and p49 tended to be reduced, whereas the expression level of a 50‐kDa protein (p50d; α‐tubulin), a 25‐kDa protein (p25; α‐tubulin) and a 52‐kDa protein (p52c; β‐tubulin) was enhanced.
Climate Change and Structural Vulnerability of a Metropolitan Energy System
Authors: Gößling‐Reisemann Stefan , Wachsmuth Jakob , Stührmann Sönke , von Gleich Arnim
Published: October 2013

In this article, we present methodology and results of a vulnerability assessment of the energy system of the metropolitan region Bremen‐Oldenburg in Northwest Germany.

This work is part of the regional climate adaptation project “nordwest2050” aiming at innovative solutions toward a climate‐proof and resilient region. Methodologically, we extended the established vulnerability assessment based on climate change impacts by a structural analysis, highlighting general weaknesses of the metropolitan energy system. Our findings indicate that the structural vulnerabilities of the energy system around Bremen‐Oldenburg pose a greater threat to maintaining the system's services than climate change itself. Climate‐change–based vulnerabilities, however, aggravate many of the structural vulnerabilities and therefore demand attention in their own right. The structural vulnerabilities mainly originate from political and regulatory uncertainties, turbulent market conditions, conflicts along the supply chains, and the current dynamics in the energy sector induced by increased climate mitigation efforts. One of our main conclusions is thus that the metropolitan energy system's capabilities to handle turbulence, perturbations, and surprises must be improved. This will also help in reducing the climate‐change vulnerabilities, because such a system is better equipped when facing currently hard‐to‐predict changes in climate parameters. The results of the assessment described here will be used as the starting point to find options for innovations toward a climate‐proof and resilient energy system for the region in the course of the remaining project.
SCA14 mutation V138E leads to partly unfolded PKCγ associated with an exposed C‐terminus, altered kinetics, phosphorylation and enhanced insolubilization
Authors: Jezierska Justyna , Goedhart Joachim , Kampinga Harm H. , Reits Eric A. , Verbeek Dineke S.
Published: October 2013

The protein kinase C γ (PKCγ) undergoes multistep activation and participates in various cellular processes in Purkinje cells. Perturbations in its phosphorylation state, conformation or localization can disrupt kinase signalling, such as in spinocerebellar ataxia type 14 (SCA14) that is caused by missense mutations in PRKCG encoding for PKCγ. We previously showed that SCA14 mutations enhance PKCγ membrane translocation upon stimulation owing to an altered protein conformation. As the faster translocation did not result in an increased function, we examined how SCA14 mutations induce this altered conformation of PKCγ and what the consequences of this conformational change are on PKCγ life cycle. Here, we show that SCA14‐related PKCγ‐V138E exhibits an exposed C‐terminus as shown by fluorescence resonance energy transfer‐fluorescence lifetime imaging microscopy in living cells, indicative of its partial unfolding. This conformational change was associated with faster phorbol 12‐myristate 13‐acetate‐induced translocation and accumulation of fully phosphorylated PKCγ in the insoluble fraction, which could be rescued by coexpressing PDK1 kinase that normally triggers PKCγ autophosphorylation. We propose that the SCA14 mutation V138E causes unfolding of the C1B domain and exposure of the C‐terminus of the PKCγ‐V138E molecule, resulting in a decrease of functional kinase in the soluble fraction.

image

Here, we show that the mutation V138E of the protein kinase C γ (PKCγ) C1B domain (PKCγ‐V138E), which is implicated in spinocerebellar ataxia type 14, exhibits a partially unfolded C‐terminus. This leads to unusually fast phorbol 12‐myristate 13‐acetate‐induced membrane translocation and accumulation of phosphorylated PKCγ‐V138E in the insoluble fraction, causing loss of the functional kinase. In contrast to general chaperones, coexpression of PKCγ's ‘natural chaperone’, PDK1 kinase, could rescue the PKCγ‐V138E phenotype.