bluuebunny/crossref_metadata_2025 huggingface dataset:
Monitoring Nutrition Therapy in the Critically Ill Patient With Obesity
Authors: Dickerson Roland N. , Drover John W.
Published: August 2011

Obesity compounds the metabolic response to critical illness and augments the consequences of overfeeding. Effective monitoring is essential for the prevention of, or to avoid, worsening of preexistent morbidities associated with obesity during the implementation of specialized nutrition support. This monitoring should guide the clinician toward the selection of appropriate therapeutic options to reduce complications from significant hyperglycemia, dyslipidemia, hypercapnia, fluid overload, and worsening of hepatic steatosis. Conventional nutrition outcome markers should be employed, with their limitations understood, when used for the critically ill obese patient.
Gut Microbiota, Intestinal Permeability, Obesity‐Induced Inflammation, and Liver Injury
Authors: Frazier Thomas H. , DiBaise John K. , McClain Craig J.
Published: August 2011

Obesity and its metabolic complications are major health problems in the United States and worldwide, and increasing evidence implicates the microbiota in these important health issues. Indeed, it appears that the microbiota function much like a metabolic “organ,” influencing nutrient acquisition, energy homeostasis, and, ultimately, the control of body weight. Moreover, alterations in gut microbiota, increased intestinal permeability, and metabolic endotoxemia likely play a role in the development of a chronic low‐grade inflammatory state in the host that contributes to the development of obesity and associated chronic metabolic diseases such as nonalcoholic fatty liver disease. Supporting these concepts are the observations that increased gut permeability, low‐grade endotoxemia, and fatty liver are observed in animal models of obesity caused by either high‐fat or high‐fructose feeding. Consistent with these observations, germ‐free mice are protected from obesity and many forms of liver injury. Last, many agents that affect gut flora/permeability, such as probiotics/prebiotics, also appear to affect obesity and certain forms of liver injury in animal model systems. Here the authors review the role of the gut microbiota and metabolic endotoxemia‐induced inflammation in the development of obesity and liver injury, with special reference to the intensive care unit setting.
Current Strategies of Critical Care Assessment and Therapy of the Obese Patient (Hypocaloric Feeding)
Authors: Kushner Robert F. , Drover John W.
Published: August 2011

Two of the most challenging issues in the clinical management of the obese patient are assessing energy requirements and whether hypocaloric (permissive) underfeeding should be employed. Multiple predictive equations have been used in the literature to estimate resting metabolic rate, although no consensus has emerged regarding which prediction equation is most accurate and precise in the obese population. Hypocaloric, or permissive underfeeding, specifically refers to the intentional administration of calories that are less than predicted energy expenditure. Thus far, very few studies performed have been performed to assess the efficacy of hypocaloric feeding in the obese hospitalized patient. It is concluded that the optimal caloric intake of obese patients in the intensive care unit remains unclear given the limitation of the existing data.
Vitamin D Status Affects Strength Gains in Older Adults Supplemented With a Combination of β‐Hydroxy‐β‐Methylbutyrate, Arginine, and Lysine
Authors: Fuller John C. , Baier Shawn , Flakoll Paul , Nissen Steven L. , Abumrad Naji N. , Rathmacher John A.
Published: August 2011

Background: Older adults supplemented for 1 year with β‐hydroxy‐β‐methylbutyrate, arginine, and lysine (HMB/ARG/LYS) were previously shown to have significant gains in fat‐free mass (FFM) but not muscular strength. Objective: Recently, increasing levels of serum vitamin D have been associated with an increase in muscle function, particularly in the elderly. To determine if vitamin D status may have limited strength gain in participants supplemented with HMB/ARG/LYS, the authors performed post hoc analysis of strength based on the participants' vitamin D status. Methods: Elderly (age 76.0 ± 1.6 years) adults were recruited for a double‐blinded, controlled study and were randomly assigned to either an isonitrogenous control (n = 37) or HMB/ARG/LYS (n = 40) for the yearlong study. Participants were further segregated based on their vitamin D status of either <30 or ≥30 ng 25OH‐vitD3/mL serum, and an analysis was performed on the 4 cohorts. Results: Regardless of vitamin D status, HMB/ARG/LYS resulted in significantly increased FFM (P < .02), but only in those with vitamin D status ≥30 ng 25OH‐vitD3/mL was there a significant increase in strength with HMB/ARG/LYS (P < .01). Control‐supplemented participants, regardless of vitamin D status, and the HMB/ARG/LYS‐supplemented participants with vitamin D status <30 ng 25OH‐vitD3 failed to show improvements in strength. Conclusions: The nutrient cocktail of HMB/ARG/LYS alone was effective in increasing muscle mass regardless of vitamin D status, but accompanying strength increases were observed only when participants also had adequate vitamin D status indicating a synergistic effect between the HMB/ARG/LYS and vitamin D.
Changing family routines at kindergarten entry predict biomarkers of parental stress
Authors: DeCaro Jason A. , Worthman Carol M.
Published: August 2011

This study tested associations among parenting stress prior to a child’s kindergarten entry, the sustainability of family routines, and biomarkers of stress among parents following the kindergarten transition. Parents (N = 51) with higher prekindergarten scores on the Parenting Stress Index Short Form reported lower Family Routines Inventory scores following school entry relative to their baseline. Declining family routines, in turn, were associated following kindergarten entry with greater 5-day mean and variance in evening cortisol, and higher C-reactive protein, an inflammatory mediator. However, only the cortisol findings remained significant controlling for baseline physiology. These findings support a family systems, social-ecological approach to life course development, wherein even mild challenges posed by children’s normative transitions may reveal differences in parents’ biobehavioral functioning.
Minding the music: Neuroscience, video recording, and the pianist
Authors: Schlosser Milton
Published: August 2011

Research in music education asserts that video review by performers facilitates self-directed learning and transforms performing. Yet, certain videos may be traumatic for musicians to view; those who perceive themselves as failing or experience performance-related failures are prone to feelings of distress and sadness that can negatively affect their music-making and well-being. In this study, the reactions of nine Canadian undergraduate pianists to reviewing themselves regularly on video are examined. The study was designed in two parts: first of all, to track the effects of watching self-referent videos of piano lessons and other performances; second, to highlight student responses to a Recital Review Protocol (RRP). The RRP was designed with instructors and students in mind, incorporating neuroscience strategies to reverse blood flow patterns in areas of the brain responsible for negative mood induction. The results from the first part of the study point to how regular video analysis is able to shift initial negative perceptions and transform practicing and performing. The findings from the second part indicate that more attention needs to be paid to students by instructors immediately after performances.
Appropriate Use of Recovery Groups in Nonclinical Toxicity Studies: Value in a Science-Driven Case-by-Case Approach
Authors: Pandher K. , Leach M. W. , Burns-Naas L. A.
Published: August 2011

A recovery phase—a nondosing period that follows the main dosing phase of a study—is sometimes included in nonclinical toxicity studies, and it is designed to understand whether toxicities observed at the end of the dosing phase are partially or completely reversible. For biopharmaceuticals with long half-lives, the inclusion of recovery arms can be helpful in understanding effects of prolonged exposure and assessing antidrug antibodies. This commentary discusses when to include recovery groups in nonclinical toxicity studies, the number of recovery groups to include in a given study, the number of animals to include in each recovery group, and the duration of the recovery phase. In general, the inclusion of recovery arms should follow a case-by-case approach that values rational scientific design and reflects the development needs and regulatory requirements applicable to individual nonclinical programs to ensure appropriate guidance for human studies while minimizing laboratory animal use.
Sex, Politics, and Social Change in the Eighteenth and the Nineteenth Centuries
Authors: Guzzi-Heeb Sandro
Published: August 2011

The eighteenth-century “sexual revolution” cannot simply be explained as a consequence of economic or institutional factors—industrialization, agricultural revolution, secularization, or legal hindrances to marriages. The example of western Valais (Switzerland) shows that we have to deal with a complex configuration of factors. The micro-historical approach reveals that in the eighteenth- and nineteenth-century sexuality—and above all illicit sexuality—was a highly subversive force that was considerably linked to political innovation and probably more generally to historical change. Nonmarital sexuality was clearly tied to political dissent ant to innovative ways of behavior, both among the social elites and the common people. This behavior patterns influenced crucial evolutions in the social, cultural and economic history of the region.
Flammability and Thermal Characteristics of Alkaline Aqueous Solution Treated Groundnut Shell–HDPE Composites
Authors: Ishidi E.Y. , Adamu I.K. , Kolawale E.G. , Sunmonu K.O. , Yakubu M.K.
Published: August 2011

The influence of alkaline aqueous solution treatment of groundnut shell–high density polyethylene composites consist of magnesium hydroxide as flame-retardant additives was investigated. FTT daul cone calorimetry and Perkin-Elmer Diamond differential scanning calorimetry (DSC) were used to characterize flammability and thermal properties of the fabricated composites. Quanta 200ESEM was used to investigate the effect of alkaline aqueous solution treatment on the microstructure of the composites. The result obtained revealed that the alkaline treatment of the shell enhanced filler–matrix compatibility. The cone calorimetry result revealed that Mg(OH)2 has good fire retardancy characteristics on the fabricated composites as properties such as heat release rate, effective heat of combustion, mass loss rate, total smoke produced, and specific extinction area were enhanced. DSC results suggested that the additives had little impact on the melting temperature of the composite.
Mechanical properties of nano/micro multilayered thermoplastic composites based on PP matrix
Authors: Aurilia M. , Sorrentino L. , Berardini F. , Sawalha S. , Iannace S.
Published: August 2011

We have shown in an earlier work that the addition of both organomodified layered silicates and micrometric calcium carbonate (CaCO3) into a polypropylene (PP) matrix resulted in improved mechanical properties due to synergistic effect of the fillers. In this study, we analyzed the feasibility of producing continuous glass fibers composites with micro/nanoreinforced matrix. In particular, either highly filled matrices with micrometric CaCO3 (22, 40, and 50 wt %) or micro/nanoreinforced matrix were used to prepare composites in order to investigate the effect of fillers on both mechanical and thermomechanical properties. The best mechanical performances were obtained when nano- and microsized particles were combined to reinforce the thermoplastic matrices employed in the film stacking manufacturing method. In such systems, the micro/nanocomposites have improved the flexural properties of the continuous fiber laminate, producing an increase of both flexural modulus (60%) and flexural strength (130%). Moreover, storage modulus of glass fibers composite prepared with micro/nanoreinforced matrix was higher than modulus of the composites manufactured with either neat PP matrix or microreinforced matrix in −40/150°C temperature range.
Thermal impact and the fiber orientation effect of structures reinforced by composites FRP, the new prestressed laminates model
Authors: Kerboua Bachir , Addabedia El Abbes , Tounsi Abdelwahad , Sereir Zouaoui
Published: August 2011

This article presents an improved theoretical solution with the new prestressed – fibre-reinforced polymer (FRP) – model. The prestressing technique employed in this article was developed and refined by the prestressed force model coupled with the externally applied load and the fiber orientation effect. The new theoretical improved solution for the shear lag is developed. Comparisons are made with beams externally reinforced with a plate unstressed for different theory and the beams reinforced with a prestressed plate FRP. This research gives a numerical precision in comparison with the other studies that neglect the effect of prestressed plate model coupled with the thermal loads and fiber orientation impact. The physical and geometric properties of materials are taken into account and that may play an important role in reducing the interfacial stresses magnitude.
Career Choice Intentions of Adolescents With a Family Business Background
Authors: Schröder Elke , Schmitt-Rodermund Eva , Arnaud Nicolas
Published: August 2011

This study investigates the determinants of career choice intentions of adolescents with family business background from both adolescents’ and parents’ views. Comparing three groups of adolescents (“intentional successors,” “intentional founders,” and “intentional employees”) from 106 German family firms through multinomial regression analyses, the authors found personality traits (i.e., Openness and Agreeableness), gender, adolescent identification with the family business, perceived parental job rewards, and parental succession preference and preparation to significantly differentiate adolescents’ career choice intentions. Findings add to previous succession research by empirically demonstrating the impact of individual and socialization influences on offspring’s succession intentions as early as in adolescence.
Knowledge, Attitudes, Beliefs, and Perception of the North Indian Population Toward Adoption of Contraceptive Practices
Authors: Bajwa Sukhwinder Kaur , Bajwa Sukhminder Jit Singh , Ghai Gagandeep Kaur , Singh Kamaljit , Singh Nirankar
Published: August 2011

Background and context. Uncontrolled and exponentially increasing population is one of the biggest obstacles in the socioeconomic progress and prosperity of a nation. Aims and objectives. The present study was undertaken to evaluate contraceptive practices among eligible couples living in the rural areas of Punjab and their perception, knowledge, attitude, and behavior toward various family planning methods. Materials and methods. A cross-sectional descriptive study was done by the interview method to evaluate the various individual determinants toward contraceptive practices among 1123 married women and their husbands aged between 15 and 49 years. Eligible couples (5477) from in and around the hospital were registered at the rural health center of our institute. Statistical analysis was carried out using nonparametric tests such as percentand χ2 test. Results. Contraceptive prevalence was found to be 78.1% and the most commonly used method was surgical sterilization (42.3%). Among the spacing methods, condoms, oral contraceptive pills, and intrauterine contraceptive devices (Cu-T) were used by 36.4%, 7.4%, and 5.5% of the couples, respectively while traditional methods were preferred by 8.3% of the women. Weakness, menstrual dis infertility, weight gain, etc were few of the side effects that were perceived by women as the main hurdle in the use of contraceptives. Irrespective of the method of contraception used, 33.3% of the women reported unwanted pregnancy, most commonly among the users of condoms (79.1%). Sixpercent of the women were not satisfied with the gender composition of their family and desired a male child. Conclusions. Increased use of modern contraceptives requires community-wide and multifaceted interventions that aim at countering negative perceptions about modern methods.
Uncovering the Experiences and Needs of Patients With Chronic Hepatitis B Infection at Diagnosis
Authors: Ng Chirk Jenn , Low Wah Yun , Wong Li Ping , Sudin Mohd Ridwan , Mohamed Rosmawati
Published: August 2011

Patients with hepatitis B face uncertainty at diagnosis. Information and support they receive at the early stage of the disease determine their adherence to follow up and treatment. This study aimed to explore the experiences and needs of patients with hepatitis B at diagnosis. A qualitative methodology was used. Nine focus groups (n = 44) were conducted to explore patients’ feelings and reaction to the diagnosis, encounters with health care professionals, and their needs. The transcribed data were analyzed using a thematic approach. Most patients were not prepared for the diagnosis and many felt anxious and distressed. This was attributed to poor patients’ knowledge, doctor’s emphasis on disease complications, and associated stigma. Information about the disease was lacking and patients wanted to know more about the mode of transmission, natural progression of the disease, complications, and treatment options. There was a feeling of “passivity” among patients because there was often no active treatment available at diagnosis. This resulted in patients defaulting surveillance visits and missing the opportunity to start antiviral treatment. Therefore, there is an urgent need to provide sufficient information and education about hepatitis B to newly diagnosed patients, break “bad news” to patients with sensitivity, address their emotional needs, and emphasize on the rationale and importance of surveillance and treatment. This may entail public awareness campaign, implementation of pretest and posttest counseling, and educating doctors on how to communicate the diagnosis and management to patients accurately and sensitively.
Women’s Knowledge of Human Papillomavirus (HPV) and Their Attitudes Toward HPV Vaccine
Authors: Feng Suwen , Xu Xinfen , Jin Ying , Yao Xueying
Published: August 2011

To explore women’s knowledge of human papillomavirus (HPV) and attitudes toward the HPV vaccine in Zhejiang, China, women attending the checkup clinics were invited to participate. A questionnaire-guided interview was conducted with a representative sample of 1490 women, and 1432 effective questionnaires were obtained. The authors found 39.1% of women in urban areas and 27.1 % in rural areas had heard of HPV, whereas 23.7% and 15.1%, respectively, had heard of the HPV vaccine. The mean score of HPV knowledge was 3.75 in urban areas and 3.18 in rural areas, with a significant difference ( P = .016). Of the sample who had heard of the HPV vaccine, the supportive mean score was 2.59 and 2.11, with a significant difference ( P = .003). Women with more HPV knowledge were more likely to support the HPV vaccination ( r = 0.50 and r = 0.61). The authors conclude that inadequate knowledge and misconceptions about HPV are common. Attitudes toward HPV vaccine are unsatisfactory. Education campaigns targeting different populations are needed prior to the introduction of an HPV vaccine.
Political activism, racial identity and the commercial endorsement of athletes
Authors: Cunningham George B , Regan Michael R
Published: August 2011

With a focus on African American male athletes as product endorsers, the purpose of this study was to examine the influence of activism type and level of racial identity on perceptions of trustworthiness and athlete-product fit. Participants ( N = 73 White undergraduate students) participated in a 2 (activism type: anti-obesity, anti-war) × 2 (level of racial identity: low, high) experimental study. Results indicate that perceptions of trustworthiness were highest when the athlete was engaged in non-controversial activism and had a strong racial identity. These perceptions were significantly associated with endorser-product (i.e. New Balance shoes) fit, even beyond the effects of activism type, level of racial identity, and athlete attractiveness. Results are discussed in terms of theoretical and practical implications.
Voices of Elders
Authors: Hutchinson Shirley , Hersch Gayle , Davidson Harriett A. , Chu Adeline Yee-Mei , Mastel-Smith Beth
Published: August 2011

Purpose: The aim of this study was to investigate person and environment factors of elders that facilitate adaptation to relocation to long-term care skilled nursing facilities. Results represent findings from Phase 1 of three phases of a 2-year study to develop and test a cultural heritage intervention to improve adaptation to nursing home relocation. Design: Qualitative interviews were conducted with 23 newly admitted Caucasians and African Americans residing in skilled nursing facilities. Findings/Results: Themes that emerged include (a) spirituality, death and dying, and philosophy of life; (b) life experiences with change; (c) cultural heritage; (d) health; (e) ethnicity; (f) social support, family and friends; (g) long-term care facility (LTCF) relationships; (h) LTCF system maintenance; and (i) LTCF support of personal growth. Comparison of African Americans and Caucasians showed more similarities than differences between the groups. Discussion: Implications for research, clinical practice, and cultural heritage interventions for LTCF adaptation are discussed.
The Use of Internet Cancer Support Groups by Asian Americans and White Americans Living With Cancer
Authors: Im Eun-Ok , Lee Bokim , Chee Wonshik
Published: August 2011

Purpose: To explore the use of Internet cancer support groups (UICSG) by Asians and Whites living with cancer and determine the factors influencing their UICSG. Design and Method: A cross-sectional Internet study among 30 Asians and 30 Whites. The instruments included (a) questions on sociodemographic and cultural factors, and disease status, (b) the Support Care Needs Survey-34 Short Form, (c) the 2003 Health Information National Trends Survey subscale on Internet usage, and (d) the UICSG Questionnaire. The data were analyzed using the Wilcoxon rank-sum test and nonparametric multiple regression analyses. Results: There was a significant ethnic difference in the UICSG, but there were no ethnic differences in general Internet use or needs for help. Across the ethnic groups, the significant factors influencing the UICSG included “self-reported ethnic identity,” “born in the United States,” and “general Internet use.” Conclusion: Nurses should consider the cultural factors that influence the UICSG.
Mechanics of Pressure-Adaptive Honeycomb
Authors: Vos Roelof , Barrett Ron , Romkes Albert
Published: August 2011

Pressure-adaptive honeycomb is a new type of adaptive structure that can exhibit great strains by relying on a pressure differential to alter the structural stiffness. The structure consists of a grid of honeycomb cells that extend a significant length perpendicular to the plain of the hexagons. Each cell possesses a pouch that can be pressurized and alter the stiffness of the structure. An analytical model is presented that predicts the stress—strain behavior in principal directions of this pressure-adaptive honeycomb. The predictions of the analytical model are shown to correlate well to experimental tests on a 130-cell aluminum honeycomb specimen that is loaded up to compressive strains of 12.5%. Based on this model, an equivalent material stiffness is defined for the honeycomb cell walls that can be employed in a FEA. An FE approximation of a 145-cell honeycomb beam based on this equivalent material stiffness is shown to correlate well to experimental results of a three-point bend test of such a specimen. The model of equivalent material stiffness greatly reduces the complexity of the FE approximation by eliminating the need to define a pouch or an internal pressure field. Therefore, the prediction method could be used in a design tool for pressure-adaptive honeycomb structures.
Damage Identification After Impact in Sandwich Composites Through Embedded Fiber Bragg Sensors
Authors: Hackney D. , Peters K.
Published: August 2011

Based on the full-spectral response of fiber Bragg grating sensors, embedded at the facesheet-core interface, we identify the progression of failure modes in foam core sandwich composites during multiple, low-velocity impacts. By considering the characteristic shape of the reflected spectrum from the FBG sensor in the post-impact, residual strain state, it is shown that we can classify the extent of damage into one of three states. Unlike the previous FBG peak wavelength measurements; this identification does not require the full strain history to identify the current state of damage in the composite. The disparate material properties between the facesheet and core materials, which create significant challenges for conventional non-destructive evaluation methods, enhance the damage detection through large deformations in the core at the impact location with sharp strain gradients.
Experimental Test Results for a Fiber Bragg Grating-based Flow Sensor
Authors: Pannekeet Robbert , Rodriguez-Erdmenger Rodrigo , Ruggiero Eric J. , Simpson Alexander , Wolfe Christopher
Published: August 2011

A fiber optic-based mass flow sensor has been developed that uses fiber Bragg gratings to deduce flow velocity. Flow velocity, local temperature, pressure measurements (which all can be extracted using fiber Bragg gratings), and geometric information can be combined to determine mass flow.

A range of concepts have each been investigated and compared using the same “design of experiment” for each sensor. The most promising concept has been further developed into a prototype. The working prototype successfully demonstrated a thermally insensitive sensor design that has the capability to track flow velocities. The sensor design is incorporated directly with a structural beam element to magnify the strain effect while simultaneously compensating for thermally induced wavelength shifts in the sensor response. Further testing has been performed using three flexible beams at different angular positions, demonstrating that flow angles can be measured using a similar approach to that used for three-hole pneumatic probes. As a final test, the sensor has been tested in a shock tube, demonstrating superior performance to steady pneumatic measurements, which rely on tubing to reach the measurement location.
Spiritually Competent Practice With Individuals and Families Dealing With Medical Conditions
Authors: Sperry Len
Published: August 2011

Counselors and psychotherapists are increasingly expected to provide services that are spiritually competent. Those counseling individuals and families where medical concerns are a focus would do well to consider the implications of spiritual competence in their work. The article defines spiritual competence, describes spiritual competencies, and provides a clinical illustration.
The Shortened Raven Standard Progressive Matrices
Authors: Van der Elst Wim , Ouwehand Carolijn , van Rijn Peter , Lee Nikki , Van Boxtel Martin , Jolles Jelle
Published: August 2011

The purpose of the present study was to evaluate the psychometric properties of a shortened version of the Raven Standard Progressive Matrices (SPM) under an item response theory framework (the one- and two-parameter logistic models). The shortened Raven SPM was administered to N = 453 cognitively healthy adults aged between 24 and 83 years. The IQ point estimates that were obtained under the one- and two-parameter logistic models were very similar ( r = .97), but the two-parameter logistic-based test version had a higher measurement precision. The results showed that older age and being female were associated with a lower Raven SPM test performance. A user-friendly computer program was provided to facilitate the scoring and norming of the shortened Raven SPM under the different frameworks.
Bone health management in prostate cancer patients receiving androgen deprivation therapy
Authors: Dhanapal Vishnuprabha , Reeves David J
Published: August 2011

Purpose. Patients receiving androgen deprivation therapy undergo a rapid decline in bone mineral density during the first 6 to 12 months of initiating therapy. The World Health Organization has developed and implemented the Fracture Risk Assessment Tool (FRAX) to predict the ten year risk of a major fracture & hip fracture. Additionally, the National Comprehensive Cancer Network and the National Osteoporosis Foundation have developed osteoporosis guidelines. This study aims to characterize the fracture risk (based on the FRAX tool) and the current management of bone health based on national guidelines compliance.

Methods. A retrospective chart review of patients receiving a LHRH agonist at our institution was conducted. Data collection commenced upon Institutional Review Board approval and included demographics, past medical history, medication regimen, history of androgen deprivation therapy, bone health and its management. The ten year fracture risk calculated with the collected information using the FRAX tool.

Results. A total of 174 subjects included with a mean age of 65.5 years, 71.8% had stage II prostate cancer, 97.7% received the LHRH agonist leuprolide for a mean of 13.8 ± 18.1 months. In addition to ADT, 57% of patients had ≥ 2 risk factors for developing osteoporosis. The risk of sustaining a major facture increased from 4% to 5.6% after the initiation of ADT (P = <0.001). The risk for sustaining a hip fracture rose from 1.3% to 2.2% (P = <0.001). National guideline compliance was found to be 9%, 5% and 3% respectively for obtaining Dual Energy X-ray Absorptiometry (DEXA) scans, calcium supplementation, and vitamin D supplementation.

Conclusion. In addition to predisposing risk factors for osteoporosis, ADT significantly increases the fracture risk in the prostate cancer population. There is room for improvement in the management of bone health as some intervention could have been made in over 90% of patients evaluated.
Dexamethasone premedication for prophylaxis of taxane toxicities: Can the doses be reduced when paclitaxel or docetaxel are given weekly?
Authors: Schwartz Joanna R
Published: August 2011

Purpose: To evaluate the clinical literature supporting reduced doses of dexamethasone to prevent taxane hypersensitivity reactions (HSRs), and edema/skin toxicities in respect to docetaxel, when taxanes are given weekly, as opposed to every 3 weeks.

Data sources: Clinical literature of human-controlled clinical trials, accessed through MEDLINE and meeting abstract databases (from 1990 to 2010).

Data extraction: The retrieved literature was reviewed to include all human clinical trials that recorded adverse effect information with weekly taxanes utilizing reduced-dose or tapering dexamethasone schemas, either prospectively or retrospectively.

Data synthesis: Prophylaxis for paclitaxel-related HSRs generally includes one or more 20 mg doses of dexamethasone, with histamine-1 and -2 receptor antagonists prior to infusion of paclitaxel. Prophylaxis for docetaxel-related HSRs generally includes dexamethasone beginning 1 day before docetaxel, and continuing twice daily for a total of 3 days. These schedules were designed for taxanes given every 3 weeks, but may lead to steroid-related adverse effects when given weekly with weekly taxane administration. Treatment strategies designed to reduce corticosteroid exposure in patients receiving weekly taxanes have been investigated.

Conclusions: Several predication strategies utilizing reduced doses of dexamethasone with weekly taxanes appear to be feasible and safe, and can be considered for patients experiencing, or at high risk for steroid-induced side effects. However, the optimal schedule is not yet determined; larger prospective clinical trials are needed.
Ipilimumab-induced thrombocytopenia in a patient with metastatic melanoma
Authors: Ahmad S , Lewis M , Corrie P , Iddawela M
Published: August 2011

A 57-year-old man with metastatic melanoma developed grade 4 thrombocytopenia during treatment with ipilimumab (anti-CTLA-4 antibody). Bone marrow examination confirmed increased megakaryocytes, which supported a diagnosis of drug-induced, immune-mediated thrombocytopenia and he received 1 mg/kg prednisolone and 1 g/kg intravenous immunoglobulin. There was a delayed response to treatment, with the first evidence of rise in platelet count seen after 9 days. This was followed by a complete and sustained resolution of thrombocytopenia. Hematological toxicity has rarely been associated with ipilimumab and to our knowledge this is the first report of isolated grade 4 thrombocytopenia. This case demonstrates the importance of monitoring full blood count in all patients receiving ipilimumab.
The Reliability and Validity of the English and Spanish Strengths and Weaknesses of ADHD and Normal Behavior Rating Scales in a Preschool Sample
Authors: Lakes Kimberley D. , Swanson James M. , Riggs Matt
Published: August 2011

Objective:

To evaluate the reliability and validity of the English and Spanish versions of the Strengths and Weaknesses of ADHD-symptom and Normal-behavior (SWAN) rating scale.

Method:

Parents of preschoolers completed both a SWAN and the well-established Strengths and Difficulties Questionnaire (SDQ) on two separate occasions over a span of 3 months; instruments were in the primary language of the family (English or Spanish).

Results:

Psychometric properties for the English and Spanish versions of the SWAN were adequate, with high internal consistency and moderate test–retest reliability. Skewness and kurtosis statistics for the SWAN were within the range expected for a normally distributed population. The SWAN also demonstrated adequate convergent and discriminant validity in correlations with the various subscales of the SDQ.

Conclusion:

Psychometric properties of both the English and Spanish versions of the SWAN indicate that it is a reliable and valid instrument for measuring child attention and hyperactivity. The stability of ratings over time in this preschool sample was moderate, which may reflect the relative instability of these characteristics in preschool children.
Parliamentary salaries as a party resource
Authors: Bolleyer Nicole , Gauja Anika
Published: August 2011

Research on contemporary party organization emphasizes the growing power of the party in public office (PPO). The relationship between the external party organization and the PPO, however, is rarely analysed directly. We argue that the capacity of the extra-parliamentary party to regularly extract a fixed share from their MPs' salaries – the collection of ‘party taxes' or ‘tithes' – can give us insights into the level and the nature of control the external organization exercises over MPs within and across organizational levels. Beyond providing new insights into an under-researched, but generally widespread, source of party funding across 25 parties in five Westminster democracies, the study shows the following: while party family shapes a party’s basic capacity to establish an intra-organizational rule that obliges MPs to regularly contribute parts of their salary, ideology drives the salary share a party can expect MPs to pay. The federal–unitary divide affects whether the national or the regional organizations are the main recipients of these contributions.
Conceptualizing resistance
Authors: Armstrong Natalie , Murphy Elizabeth
Published: August 2011

The 1990s saw a proliferation of sociological work applying Foucault’s ideas on governmentality to health promotion and public health. This work characterized public health discourses as regimes of power and knowledge employed in the regulation and surveillance of individuals and populations. This article is concerned with the question of how and to what extent those who are subject to such regimes are able to resist them. We seek to identify the various forms in which resistance to such regimes of power have been manifest in empirical studies of health and illness. Our aims are threefold. The first is to alert empirical researchers who wish to examine resistance in the context of health and health care to the subtle and nuanced ways in which such resistance can be manifested both within and outside encounters with health professionals. This is achieved through tracing both the evolution of Foucault’s own concepts around resistance and the way in which these ideas have been mobilized in empirical studies. The second, and related, aim is to demonstrate the complex forms which such resistance takes, problematizing the simplistic assumptions that adherence to health promotion advice necessarily implies the collapse of agency, and that resistance necessarily involves the rejection of advice and interventions. The third is to highlight the potentially problematic normative qualities that may be assigned to resistance.
Haemorrhage control in pelvic trauma
Authors: Clamp Jonathan A , Moran Christopher G
Published: August 2011

A pelvic fracture usually indicates high energy transfer from a significant mechanism and a high likelihood of associated injuries. Mortality from pelvic trauma is usually due to massive haemorrhage mandating expedient resuscitation of the patient and immediate control of exsanguinating haemorrhage. Damage control resuscitation incorporates permissive hypotensive resuscitation and early replacement of clotting factors with early aggressive surgical control of bleeding. A commercially available pelvic binder provides circumferential compression and rapidly closes the pelvis, leading to fracture splintage and reduction in pelvic volume, both of which reduce haemorrhage. It is critical to distinguish ongoing bleeding due to a pelvic ring injury from intra-peritoneal haemorrhage. The identification of intra-peritoneal bleeding in a haemodynamically unstable patient mandates laparotomy. On-going haemorrhage from the pelvis requires diagnostic pelvic angiography, followed by selective embolisation if a source of bleeding is identified. If angiography is not available pelvic packing can be life-saving.
Bikinis and Bandages: An Itinerary for Cosmetic Surgery Tourism
Authors: Bell David , Holliday Ruth , Jones Meredith , Probyn Elspeth , Taylor Jacqueline Sanchez
Published: August 2011

This paper explores the ways in which cosmetic surgery tourism can be thought of specifically as a tourist experience. We argue that whilst essentially involving travel for the purpose of undertaking painful surgery, cosmetic surgery tourism has a particular resonance with the holiday, most usually constructed as relaxing and restorative. This resonance is connected to the importance in contemporary society of not simply possessing the cultural capital associated with travel knowledge and conspicuous leisure, but of being able to mark that upon and express it through the body. The paper also explores the elements of tourism that seem important to a successful cosmetic surgery tourism experience. These include a sense of place, constituted through cultural and physical proximity or distance, and discursive and physical construction of a destination’s particular characteristics – most usually in terms of the idea of ‘retreat’, care and the ‘friendliness’ of its people. This is connected to the willingness of a range of staff, from surgeons and nurses to interpreters and tour guides, to engage in successful emotional and aesthetic labour; some of these forms of labour are outlined here. The material we draw upon has tended to centre on white, middle-class Western tourists travelling to destinations outside the wealthiest nations for their surgeries. We end with a call for more wide-ranging studies and wonder whether the ‘tourism-ness’ of cosmetic surgery tourism remains central to tourists whose only motivation for travel is finding surgeries at minimal cost.
Combination of Activated Protein C and Topical Negative Pressure Rapidly Regenerates Granulation Tissue Over Exposed Bone to Heal Recalcitrant Orthopedic Wounds
Authors: Wijewardena Aruna , Vandervord Elle , Lajevardi Sepehr Seyed , Vandervord John , Jackson Christopher John
Published: August 2011

Chronic wounds arising from orthopedic surgery present a major clinical challenge. Osteomyelitis may develop from polymicrobial infection, which can be unresponsive to treatment and lead to amputation. Topical negative pressure (TNP) is an effective treatment in wound management and is now used worldwide. Activated protein C (APC) is an anticoagulant with cytoprotective and healing properties. The aim of this study was to determine whether combined treatment of TNP and APC was tolerated and was efficacious for treatment of difficult-to-treat wounds. Four patients who presented to Royal North Shore Hospital with wounds that were not responsive to conventional therapy were studied. All cases showed a marked reduction in wound size and depth within 1 week of starting treatment and progressively improved over time. There was a remarkable increase in the volume of granulation tissue. After treatment, wounds either completely closed or provided sufficient granulation tissue to allow split-thickness skin grafting. The treatment was well tolerated, and the patients were able to be managed on out-patient basis. Long-term follow-up suggested that this treatment prevented osteomyelitis. This innovative treatment is very promising and may significantly increase quality of care for patients with recalcitrant orthopedic wounds. A randomized, placebo-controlled double blind trial is required to further determine the efficacy of APC plus TNP.
Gate leakage reduction through the use of a gate-to-source/drain non-overlapped metal–oxide–semiconductor field-effect transistor structure
Authors: Rana A K , Chand N , Kapoor V
Published: August 2011

In this paper, a novel, nanoscale, metal–oxide–semiconductor field-effect transistor (MOSFET) with gate-to-source/drain non-overlapped and high- k spacer structure has been demonstrated to reduce gate leakage current for the first time. The gate leakage behaviour of the novel MOSFET structure has been investigated with the help of a compact analytical model and Sentaurus simulation. The fringing gate electric field through the dielectric spacer induces an inversion layer in the non-overlap region to act as an extended source/drain region. It is found that the optimal gate-to-source/drain non-overlapped and high- k spacer structure reduces the gate leakage current to a great extent compared with an overlapped structure. Further, the proposed structure has an improved off-current, sub-threshold slope, and drain-induced barrier-lowering characteristic. It is concluded that this structure solves the problem of high leakage current without introducing the extra series resistance.
Choosing a consumption strategy for a population of units based on reliability
Authors: Lu L , Anderson-Cook C M , Wilson A G
Published: August 2011

Managers and decision makers are often faced with difficult decisions balancing multiple competing objectives when selecting between several strategies for how to use the units in their inventory or stockpile. This paper considers how to define different metrics which appropriately summarize the objectives of a good strategy, how to consider what impact unanticipated changes in the future might have, and how to combine several criteria into a decision when no global winner is likely. This process is discussed in the context of maximizing the reliability of a population of single-use non-repairable units, such as missiles or batteries, which are being consumed (used and removed from the population) as they age over time.
The rate, risk factors and cost of surgical site infections in primary breast surgery
Authors: Tanner J. , Khan D. , Ball J. , Aplin C. , Pickard J. , Bankart J.
Published: August 2011

Although breast surgery involving clean wounds is expected to be associated with a low risk of surgi-cal site infection (SSI) and minimal associated costs, estimates of infection could be affected by intensity of case finding and choice of follow-up methods. A broad range of post-discharge follow-up methods is more likely to estimate true SSI rates and costs. This prospective systematic study used 30 day surveillance with active data collection methods to identify the rate and cost of surgical site infection in patients having primary breast surgery. Ten per cent of patients (16/159) had a surgical site infection. The additional average cost of treating each infected patient was £1443. Hierarchical sequential regression identified high body mass index, operations lasting more than two hours and smoking as significant independent risk factors.
A hospital cleaning study using microfibre and a novel copper biocide. I. Microbiological studies
Authors: Hall Tony J. , Jeanes Annette , Coen Pietro G. , Odunaike Anthony , Hickok Stephen S. , Gant Vanya A.
Published: August 2011

We compared the performance of Vermop ultramicrofibre cloths/mops (UMF) with water (UMF + water) or impregnated with a novel copper-based biocide (UMF + CuWB50; 300 mg/L) with standard cleaning using cotton mops/cloths with Hospec detergent. Six sites were sampled with contact plates to enumerate total viable (bacterial) counts (TVCs) and with the 3M Clean-Trace ATP assay to assess cleaning efficacy. Statistical analysis revealed that one hour post-cleaning TVC levels were lower when using UMF + CuWB50 (75% reduction) compared with standard cleaning or UMF + water (45% and 35% reductions, respectively). There was a small overall residual effect when cleaning with UMF + CuWB50 (11.7% reduction in TVCs, p = 0.209). ATP levels were reduced more with UMF + CuWB50 than with standard cleaning or UMF + water. UMF( ± CuWB50) cleaning was more effective than standard cleaning (~78% vs. 61% reduction of ATP levels, respectively). This hospital implementation study demonstrates overall superior cleaning performance of UMF, which is enhanced with CuWB50, compared with standard cleaning.
A UK district general hospital cleaning study: a comparison of the performance of ultramicrofibre technology with or without addition of a novel copper-based biocide with standard hypochlorite-based cleaning
Authors: Hall Tony J , Jeanes Annette , McKain Leslie W , Jepson Michael J , Coen Pietro G , Hickok Stephen S , Gant Vanya A
Published: August 2011

We compared the performance of an ultramicrofibre (UMF)-based system with or without a novel copper-based biocide (CuWB50) with standard cleaning using Actichlor Plus in four hospital wards in a crossover study design, and analysed our results using univariate and multivariate statistics. We measured total viable counts (TVCs) and ATP levels in 10 near-patient sites three times weekly, one hour before and after cleaning. Standard cleaning reduced TVCs further than UMF cleaning with water, but UMF cleaning with CuWB50 produced equivalent TVC reduction. Furthermore we identified a ‘residual effect’ with UMF + CuWB50, conferring TVC suppression for up to a week after application. ATP results did not correlate with TVCs. We conclude that UMF-based cleaning with CuWB50 results in TVC reductions equivalent to hypochlorite-based standard cleaning, with the added advantages of a residual effect that keeps TVCs lower between cleaning rounds.