bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementing a systems-oriented morbidity and mortality conference in remote rural Nepal for quality improvement: Table 1
Authors: Schwarz Dan , Schwarz Ryan , Gauchan Bikash , Andrews Jason , Sharma Ranju , Karelas Gregory , Rajbhandari Ruma , Acharya Bibhav , Mate Kedar , Bista Amir , Bista Megha Giri , Sox Colin , Smith-Rohrberg Maru Duncan
Published: September 2011

Problem

In hospitals in rural, resource-limited settings, there is an acute need for simple, practical strategies to improve healthcare quality.

Setting

A district hospital in remote western Nepal.

Key measures for improvement

To provide a mechanism for systems-level reflection so that staff can identify targets for quality improvement in healthcare delivery.

Strategies for change

To develop a morbidity and mortality conference (M&M) quality improvement initiative that aims to facilitate structured analysis of patient care and identify barriers to providing quality care, which can subsequently be improved.

Design

The authors designed an M&M involving clinical and non-clinical staff in conducting root-cause analyses of healthcare delivery at their hospital. Weekly conferences focus on seven domains of causal analysis: operations, supply chain, equipment, personnel, outreach, societal, and structural. Each conference focuses on assessing the care provided, and identifying ways in which services can be improved in the future.

Effects of change

Staff reception of the M&Ms was positive. In these M&Ms, staff identified problem areas in healthcare delivery and steps for improvement. Subsequently, changes were made in hospital workflow, supply procurement, and on-site training.

Lessons learnt

While widely practiced throughout the world, M&Ms typically do not involve both clinical and non-clinical staff members and do not take a systems-level approach. The authors' experience suggests that the adapted M&M conference is a simple, feasible tool for quality improvement in resource-limited settings. Senior managerial commitment is crucial to ensure successful implementation of M&Ms, given the challenging logistics of implementing these programmes in resource-limited health facilities.
Acupuncture: a treatment for breakthrough pain in cancer?
Authors: Paley Carole A , Johnson Mark I , Bennett Michael I
Published: September 2011

Context

Patients with chronic cancer pain frequently suffer severe exacerbations of pain intensity which are difficult to control adequately via pharmaceutical management. Management of these episodes of breakthrough pain (BTP) presents a challenge both to the physician and the patient, and supplemental ‘rescue’ doses of opioids required to control BTP can produce intolerable side-effects and often do not act rapidly enough to provide adequate analgesia. There is very little evidence to support the use of acupuncture for BTP in cancer and few studies have considered the rapidity of the analgesic response to acupuncture for any type of pain. However, the available physiological evidence provides a convincing rationale and one which warrants research.

Objective

The objective of this paper is to debate the available physiological evidence for a rapid analgesic response to acupuncture in the context of the needs of the patient with cancer BTP, current interventions, acupuncture technique and the practical considerations involved in administering treatment rapidly and safely.

Conclusion

Current evidence suggests that acupuncture has the potential to produce rapid and effective analgesia when needles are inserted deeply enough and manipulated sufficiently. For cancer BTP this represents a possible adjunctive treatment, and consideration should be given to administering acupuncture alongside ‘rescue’ doses of medication to ‘kick-start’ the analgesic response before the medication takes effect. However, research is needed to provide evidence that acupuncture is effective for BTP in cancer, and the feasibility, practicality and safety of patients administering acupuncture themselves must also be taken into account.
Republished review: An update on contraindications for lung function testing
Authors: Cooper Brendan G
Published: September 2011

Guidelines on contraindications for lung function tests have been based on expert opinion from >30 years ago. High-risk contraindications to lung function testing are associated with cardiovascular complications such as myocardial infarct, pulmonary embolism or ascending aortic aneurysm. Slightly less risky but still serious contraindications are predominantly centred on recovery from major thoracic, abdominal or head surgery. Less serious surgical procedures will present a possible risk, but the RR depends upon whether the lung function is essential or can wait until the patient’s condition improves. In recent decades there have been moves towards less invasive surgical techniques, keyhole surgery and new technology such as laser surgery which minimise the amount of collateral damage to surrounding tissues. In thoracic surgery there is a shift in emphasis to quicker postsurgical mobility. Furthermore there has been little analysis of the scientific facts behind the current recommendations and contraindications. The principle absolute and relative contraindications are in need of revision, and recommended times of abstaining from lung function tests needs to be reviewed. This review aims to outline the key issues and suggests newer recommendations for contraindications for performing lung function using a risk matrix, as well as offering alternative approaches to testing patients who may be at risk of complication from testing. In general, the previous recommendation of waiting for 6 weeks after surgical procedures or medical complications before performing lung function can often now be reduced to <3 weeks with modern less invasive surgical techniques.
SOIL–VEGETATION–ATMOSPHERE INTERACTION BY A MULTIPHYSICS APPROACH
Authors: HEMMATI SAHAR , GATMIRI BEHROUZ , CUI YU-JUN , VINCENT MARC
Published: September 2011

Ground settlement can damage light buildings supported by shallow foundations through cracking. The prediction and modeling of tree roots effect on soil water content and consequently the soil settlements needs a comprehensive analysis of the interactions between tree roots, soil, and water. Root water uptake by trees depends on soil conditions, climatic parameters, and vegetation type. A two-dimensional root-water-uptake model is implemented in a fully coupled thermo-hydro-mechanic finite element program, θ-STOCK. Evapotranspiration from the soil surface covered by grasses is calculated using energy balance and water balance on the surface of soil. The tree roots are modeled as sink terms which are distributed vertically for homogeneous canopy such as forests, or laterally in the case of single tree or a row of trees. The distribution of sink term depends of geometry of root zone and type of canopy. Two case studies are used for verification of implemented model by comparing the modeling results with the measured water content reduction in the zones influenced by tree roots. The soil settlements due to these water content reductions are also calculated.
MULTISCALE COMPUTATIONAL EVALUATION OF ELASTO-VISCOPLASTIC DEFORMATION BEHAVIOR OF AMORPHOUS POLYMER CONTAINING MICROSCOPIC HETEROGENEITY DURING UNIAXIAL TENSILE TEST
Authors: UCHIDA MAKOTO , TADA NAOYA
Published: September 2011

The two-scale elasto-viscoplastic deformation behavior of amorphous polymer was investigated using the large deformation finite element homogenization method. In order to enable a large time increment for the simulation step in the plastic deformation stage, the tangent modulus method is introduced into the nonaffine molecular chain network theory, which is used to represent the deformation behavior of pure amorphous polymer. Two kinds of heterogeneous microstructures were prepared in this investigation. One was the void model, which contains uniformly or randomly distributed voids, and the other was the heterogeneous strength (HS) model, which contains a distribution of initial shear strength. In the macroscopic scale, initiation and propagation processes of necking during uniaxial tension were considered. The macroscopic nominal stress–strain relation was strongly characterized by the volume fraction and distribution of voids for the void model and by the width of the strength distribution for the HS model. Non-uniform deformation behaviors in microscopic and macroscopic scales are closely related to each other for amorphous polymers because continuous stretching and hardening in the localized zone of the microstructure brings about an increase in macroscopic deformation resistance. Furthermore, computational results obtained from the homogenization model are compared to those obtained from the full-scale finite element model, and the effect of the scale difference between microscopic and macroscopic fields is discussed.
Discovering Multidimensional Correlations among Regulatory Requirements to Understand Risk
Authors: Gandhi R. A. , Lee S. W.
Published: September 2011

Security breaches most often occur due to a cascading effect of failure among security constraints that collectively contribute to overall secure system behavior in a socio-technical environment. Therefore, during security certification activities, analysts must systematically take into account the nexus of causal chains that exist among security constraints imposed by regulatory requirements. Numerous regulatory requirements specified in natural language documents or listed in spreadsheets/databases do not facilitate such analysis. The work presented in this article outlines a stepwise methodology to discover and understand the multidimensional correlations among regulatory requirements for the purpose of understanding the potential for risk due to noncompliance during system operation. Our lattice algebraic computational model helps estimate the collective adequacy of diverse security constraints imposed by regulatory requirements and their interdependencies with each other in a bounded scenario of investigation. Abstractions and visual metaphors combine human intuition with metrics available from the methodology to improve the understanding of risk based on the level of compliance with regulatory requirements. In addition, a problem domain ontology that classifies and categorizes regulatory requirements from multiple dimensions of a socio-technical environment promotes a common understanding among stakeholders during certification and accreditation activities. A preliminary empirical investigation of our theoretical propositions has been conducted in the domain of The United States Department of Defense Information Technology Security Certification and Accreditation Process (DITSCAP). This work contributes a novel approach to understand the level of compliance with regulatory requirements in terms of the potential for risk during system operation.
A Compiler for Multimodal Scenarios
Authors: Maoz Shahar , Harel David , Kleinbort Asaf
Published: September 2011

We exploit the main similarity between the aspect-oriented programming paradigm and the inter-object, scenario-based approach to specification, in order to construct a new way of executing systems based on the latter. Specifically, we transform multimodal scenario-based specifications, given in the visual language of
live sequence charts
(LSC), into what we call
scenario aspects
, implemented in AspectJ. Unlike synthesis approaches, which attempt to take the inter-object scenarios and construct intra-object state-based per-object specifications or a single controller automaton, we follow the ideas behind the LSC play-out algorithm to coordinate the simultaneous monitoring and direct execution of the specified scenarios. Thus, the structure of the specification is reflected in the structure of the generated code; the high-level inter-object requirements and their structure are not lost in the translation.

The transformation/compilation scheme is fully implemented in a UML2-compliant tool we term the
S2A compiler
(for Scenarios to Aspects), which provides full code generation of reactive behavior from inter-object multimodal scenarios. S2A supports advanced scenario-based programming features, such as multiple instances and exact and symbolic parameters. We demonstrate our work with an application whose inter-object behaviors are specified using LSCs. We discuss advantages and challenges of the compilation scheme in the context of the more general vision of scenario-based programming.
Partial convex recolorings of trees and galled networks
Authors: Moran Shlomo , Snir Sagi , Sung Wing-Kin
Published: September 2011

A coloring of a graph is convex if the vertices that pertain to any color induce a connected subgraph; a partial coloring (which assigns colors to a subset of the vertices) is convex if it can be completed to a convex (total) coloring. Convex coloring has applications in fields such as phylogenetics, communication or transportation networks, etc.

When a coloring of a graph is not convex, a natural question is how far it is from a convex one. This problem is denoted asconvex recoloring(CR). While the initial works on CR defined and studied the problem on trees, recent efforts aim at either generalizing the underlying graphs or specializing the input colorings.

In this work, we extend the underlying graph and the input coloring to partially colored galled networks. We show that although determining whether a coloring is convex on an arbitrary network is hard, it can be found efficiently on galled networks. We present a fixed parameter tractable algorithm that finds the recoloring distance of such a network whose running time is quadratic in the network size and exponential in that distance. This complexity is achieved by amortized analysis that uses a novel technique for contracting colored graphs that seems to be of independent interest.
Cake cutting really is not a piece of cake
Authors: Edmonds Jeff , Pruhs Kirk
Published: September 2011

We consider the well-known cake cutting problem in which a protocol wants to divide a cake among
n
≥ 2 players in such a way that each player believes that they got a fair share. The standard Robertson-Webb model allows the protocol to make two types of queries, Evaluation and Cut, to the players. A deterministic divide-and-conquer protocol with complexity
O
(
n
log
n
) is known. We provide the first a Ω(
n
log
n
) lower bound on the complexity of any deterministic protocol in the standard model. This improves previous lower bounds, in that the protocol is allowed to assign to a player a piece that is a union of intervals and only guarantee approximate fairness. We accomplish this by lower bounding the complexity to find, for a single player, a piece of cake that is both rich in value, and thin in width. We then introduce a version of cake cutting in which the players are able to cut with only finite precision. In this case, we can extend the Ω(
n
log
n
) lower bound to include randomized protocols.
Fully compressed suffix trees
Authors: Russo Luís M. S. , Navarro Gonzalo , Oliveira Arlindo L.
Published: September 2011

Suffix trees are by far the most important data structure in stringology, with a myriad of applications in fields like bioinformatics and information retrieval. Classical representations of suffix trees require Θ(
n
log
n
) bits of space, for a string of size
n
. This is considerably more than the
n
log
2
σ bits needed for the string itself, where σ is the alphabet size. The size of suffix trees has been a barrier to their wider adoption in practice. Recent compressed suffix tree representations require just the space of the compressed string plus Θ(
n
) extra bits. This is already spectacular, but the linear extra bits are still unsatisfactory when σ is small as in DNA sequences. In this article, we introduce the first compressed suffix tree representation that breaks this Θ(
n
)-bit space barrier. The Fully Compressed Suffix Tree (FCST) representation requires only sublinear space on top of the compressed text size, and supports a wide set of navigational operations in almost logarithmic time. This includes extracting arbitrary text substrings, so the FCST replaces the text using almost the same space as the compressed text. An essential ingredient of FCSTs is the lowest common ancestor (LCA) operation. We reveal important connections between LCAs and suffix tree navigation. We also describe how to make FCSTs dynamic, that is, support updates to the text. The dynamic FCST also supports several operations. In particular, it can build the static FCST within optimal space and polylogarithmic time per symbol. Our theoretical results are also validated experimentally, showing that FCSTs are very effective in practice as well.
Spatial hardware implementation for sparse graph algorithms in GraphStep
Authors: Delorimier Michael , Kapre Nachiket , Mehta Nikil , Dehon André
Published: September 2011

How do we develop programs that are easy to express, easy to reason about, and able to achieve high performance on massively parallel machines? To address this problem, we introduce GraphStep, a domain-specific compute model that captures algorithms that act on static, irregular, sparse graphs. In GraphStep, algorithms are expressed directly without requiring the programmer to explicitly manage parallel synchronization, operation ordering, placement, or scheduling details. Problems in the sparse graph domain are usually highly concurrent and communicate along graph edges. Exposing concurrency and communication structure allows scheduling of parallel operations and management of communication that is necessary for performance on a spatial computer. We study the performance of a semantic network application, a shortest-path application, and a max-flow/min-cut application. We introduce a language syntax for GraphStep applications. The total speedup over sequential versions of the applications studied ranges from a factor of 19 to a factor of 15,000. Spatially-aware graph optimizations (e.g., node decomposition, placement and route scheduling) delivered speedups from 3 to 30 times over a spatially-oblivious mapping.
Cooperative evolution of services in ubiquitous computing environments
Authors: Tacconi David , Miorandi Daniele , Carreras Iacopo , Pellegrini Francesco De , Chlamtac Imrich
Published: September 2011

As the number and capabilities of mobile devices is rapidly increasing, new challenges arise in the way services are currently designed. Users are seeking for more complex and advanced functionalities able to satisfy their increasing requirements. As a consequence, in ubiquitous environments, a different way to design services has to be introduced in order to guarantee services always up to date in a transparent and efficient way. In this paper, we present and analyze a framework for distributed cooperative service evolution in a wireless nomadic environment. In particular, we assume a disconnected network architecture, where users' mobility is exploited to achieve a scalable behavior, and communication is based on localized peer-to-peer interactions among neighboring nodes. Service management is achieved by introducing autonomic services, whose operations are based on a distributed evolution process, which draws tools and concepts from evolutionary computation (and genetic algorithms in particular). The latter relies on the concept of
recombination
, i.e., the exchange of information among service users, which collaborate to enhance their
fitness
, defined as the ability of the actual service to fulfill user's requirements. We introduce a general framework for analyzing service recombination policies and exploit results from martingales theory to study their convergence properties.
Extramedullary Hematopoiesis: An Unusual Finding in Subdural Hematomas
Authors: Li Rong , Reddy Vishnu V. B. , Palmer Cheryl Ann
Published: September 2011

We present a case of a 59-year-old man who was found to have clusters of hyperchromatic, small, round nucleated cells within a subdural hematoma removed after a skull fracture. Immunohistochemistry study confirmed that the cells were hematopoietic components predominantly composed of normoblasts. In this paper, we describe the clinical and pathological findings. A brief review of published information on extramedullary hematopoiesis in subdural hematoma and the mechanisms of pathogenesis are also discussed. While extramedullary hematopoiesis is seen anecdotally by neuropathologists in chronic subdural hematomas, only a few cases are documented in the literature. Furthermore, extramedullary hematopoiesis in subdural hematoma can pose a diagnostic challenge for general pathologists who encounter subdural hematoma evacuations seldom in their surgical pathology practices.
Ripples Make Waves: Binding Structured Activity and Plasticity in Hippocampal Networks
Authors: Sadowski Josef H. L. P. , Jones Matthew W. , Mellor Jack R.
Published: September 2011

Establishing novel episodic memories and stable spatial representations depends on an exquisitely choreographed, multistage process involving the online encoding and offline consolidation of sensory information, a process that is largely dependent on the hippocampus. Each step is influenced by distinct neural network states that influence the pattern of activation across cellular assemblies. In recent years, the occurrence of hippocampal sharp wave ripple (SWR) oscillations has emerged as a potentially vital network phenomenon mediating the steps between encoding and consolidation, both at a cellular and network level by promoting the rapid replay and reactivation of recent activity patterns. Such events facilitate memory formation by optimising the conditions for synaptic plasticity to occur between contingent neural elements. In this paper, we explore the ways in which SWRs and other network events can bridge the gap between spatiomnemonic processing at cellular/synaptic and network levels in the hippocampus.
ALK Mutations Conferring Differential Resistance to Structurally Diverse ALK Inhibitors
Authors: Heuckmann Johannes M. , Hölzel Michael , Sos Martin L. , Heynck Stefanie , Balke-Want Hyatt , Koker Mirjam , Peifer Martin , Weiss Jonathan , Lovly Christine M. , Grütter Christian , Rauh Daniel , Pao William , Thomas Roman K.
Published: September 2011

Purpose: EML4–ALK fusions define a subset of lung cancers that can be effectively treated with anaplastic lymphoma kinase (ALK) inhibitors. Unfortunately, the duration of response is heterogeneous and acquired resistance limits their ultimate efficacy. Thus, a better understanding of resistance mechanisms will help to enhance tumor control in EML4–ALK-positive tumors.

Experimental Design: By applying orthogonal functional mutagenesis screening approaches, we screened for mutations inducing resistance to the aminopyridine PF02341066 (crizotinib) and/or the diaminopyrimidine TAE684.

Results: Here, we show that the resistance mutation, L1196M, as well as other crizotinib resistance mutations (F1174L and G1269S), are highly sensitive to the structurally unrelated ALK inhibitor TAE684. In addition, we identified two novel EML4–ALK resistance mutations (L1198P and D1203N), which unlike previously reported mutations, induced resistance to both ALK inhibitors. An independent resistance screen in ALK-mutant neuroblastoma cells yielded the same L1198P resistance mutation but defined two additional mutations conferring resistance to TAE684 but not to PF02341066.

Conclusions: Our results show that different ALK resistance mutations as well as different ALK inhibitors impact the therapeutic efficacy in the setting of EML4–ALK fusions and ALK mutations. Clin Cancer Res; 17(23); 7394–401. ©2011 AACR.
Effects of Hydrogen Sulfide Synthesis Inhibitors on Posthypoxic Ventilatory Behavior in the C57BL/6J Mouse
Authors: Donovan Lucas M. , Moore Michael W. , Gillombardo Carl B. , Chai Sam , Strohl Kingman P.
Published: September 2011

Background: H2S synthesis inhibitors (HSSI) have been shown to impact respiratory control. For instance, the HSSI hydroxylamine (HA) decreases the respiratory discharge rate from isolated medullary sections, and HA in addition to other HSSIs propargylglycine and amino-oxyacetic acid (AOAA) have been found to reduce hypoxic responsiveness. Objectives: The aim of this study was to determine if administration of HSSIs could improve respiratory stability in an intact organism prone to recurrent central apneas. Methods: Saline and HSSI compounds were administered to C57BL/6J mice (n = 24), a strain predisposed to recurrent central apneas, prior to measurement of hypoxic and posthypoxic ventilatory behavior. Results: Administration of HA and AOAA resulted in a significantly smaller percentage of animals expressing one or more apneas during reoxygenation compared to saline control, and animals given AOAA demonstrated a smaller coefficient of variation for frequency during reoxygenation, a marker suggesting greater respiratory stability. This occurred despite varying effects of the three HSSI compounds on hypoxic ventilatory response. Conclusions: Instability and pause expression are improved by targeting H2S synthesis, an effect not predicted by effects on hypoxic responsiveness.
Effect of Simvastatin on Expression of Transforming Growth Factor-β and Collagen Type IV in Rat Mesangial Cells
Authors: Li Yan-Bo , Yin Jia-Jing , Wang Hong-Jie , Wang Jun , Tian Hui , Yang Min
Published: September 2011

Objective: Diabetic nephropathy is characterized by the accumulation of extracellular matrix in the glomerular mesangium as a result of an imbalance between matrix synthesis and degradation. Since simvastatin has been proposed to decrease renal interstitial fibrosis, we hypothesized that the protective effect of statins was related to the expression of transforming growth factor-β (TGF-β) and type IV collagen (Col IV). Methods: Cultured rat mesangial cells (RMC) were exposed to high glucose (HG), advanced glycosylation end products (AGE) or H2O2 in the absence and presence of simvastatin. Expression of TGF-β and Col IV was determined by Western blotting. Results: Coincubation of RMC with HG, AGE or H2O2 resulted in a significant increase of the expression of TGF-β and Col IV (p < 0.05). Simvastatin significantly inhibited HG-, AGE- or H2O2-induced expression of TGF-β and Col IV (p < 0.05). Moreover, simvastatin also inhibited HG-, AGE- and H2O2-induced activation of p38 mitogen-activated protein kinase, which indicated that the preventive effect of simvastatin on TGF-β and Col IV may be associated with p38. Conclusion: These findings suggest that simvastatin can reduce HG-, AGE- and H2O2-induced expression of TGF-β and Col IV by inhibition of the p38 pathway.
Co-Administration of Ondansetron Decreases the Analgesic Efficacy of Tramadol in Humans
Authors: Vale C. , Oliveira F. , Assunção J. , Fontes-Ribeiro C. , Pereira F.
Published: September 2011

Tramadol, a central analgesic acting on serotonin neurotransmission, is often co-used with ondansetron, a 5-HT3 antagonist, for the management of postoperative pain to decrease nausea and vomiting. The aim of the study is to test the hypothesis that this drug combination raises tramadol requirement by patient-controlled analgesia (PCA). Forty patients undergoing hernioplasty or thyroidectomy were enrolled in a randomized, controlled study and allocated to receive ondansetron 4 mg i.v. (n = 20) or saline (n = 20). At 0, 1, 2, 4 and 24 h of PCA, tramadol consumption was evaluated. Tramadol consumption (mg × kg–1 × h–1) was higher in the ondansetron group at the 2-hour time point compared to the control group (0.24 ± 0.1 vs. 0.17 ± 0.16; p = 0.01). Our study suggests that ondansetron acutely reduces the analgesic efficacy of tramadol.
Sputum YKL-40 Levels and Pathophysiology of Asthma and Chronic Obstructive Pulmonary Disease
Authors: Otsuka Kojiro , Matsumoto Hisako , Niimi Akio , Muro Shigeo , Ito Isao , Takeda Tomoshi , Terada Kunihiko , Yamaguchi Masafumi , Matsuoka Hirofumi , Jinnai Makiko , Oguma Tsuyoshi , Nakaji Hitoshi , Inoue Hideki , Tajiri Tomoko , Iwata Toshiyuki , Chin Kazuo , Mishima Michiaki
Published: September 2011

Background: Recent evidence suggests that YKL-40, also called chitinase-3-like-1 protein, is involved in the pathogenesis of asthma and chronic obstructive pulmonary disease (COPD). Details of sputum YKL-40 in asthma and COPD, however, remain unknown. Objectives: To clarify associations of sputum YKL-40 levels with clinical indices in asthma and COPD. Methods: Thirty-nine patients with asthma, 14 age-matched never-smokers as controls, 45 patients with COPD, and 7 age-matched smokers as controls were recuited for this study. Sputum YKL-40 levels were measured and YKL-40 expression in sputum cells was evaluated by immunocytochemistry. Results: Sputum YKL-40 levels were higher in patients with COPD (346 ± 325 ng/ml) than in their smoker controls (125 ± 122 ng/ml; p < 0.05), but were not significantly different between patients with asthma (117 ± 170 ng/ml) and their controls (94 ± 44 ng/ml; p = 0.15). In patients with asthma only, sputum YKL-40 levels were positively correlated with disease severity (r = 0.34, p = 0.034) and negatively correlated with pre- and postbronchodilator %FEV1 (r = –0.47 and –0.42, respectively; p < 0.01) and forced mid-expiratory flow (r = –0.48 and –0.46, respectively, p < 0.01). Sputum YKL-40 levels were positively correlated with sputum neutrophil counts in asthma (r = 0.55, p < 0.001) and with neutrophil and macrophage counts in COPD (r = 0.45 and 0.65, respectively, p < 0.01). YKL-40 was expressed in the cytoplasm of sputum neutrophils and macrophages in all groups. Conclusions: Elevated sputum YKL-40 reflects airflow obstruction in asthma whereas the roles of YKL-40 in the proximal airways in COPD remain to be elucidated.
Catheter Ablation of Atrial Fibrillation in Patients With Chronic Lung Disease
Authors: Roh Seung-Young , Choi Jong-Il , Lee June Young , Kwak Jae-Jin , Park Jae-Seok , Kim Ji-Bak , Lim Hong-Euy , Kim Young-Hoon
Published: September 2011

Background—

Chronic lung disease (CLD) is one of the important underlying diseases of atrial fibrillation (AF). The outcomes after radiofrequency catheter ablation of AF in patients with CLD have not yet been reported. We investigated the electroanatomic alterations in pulmonary veins (PVs) in CLD patients with AF and assessed their effect on the outcomes of radiofrequency catheter ablation of AF.

Method and Results—

We assessed 15 patients who had CLD and underwent radiofrequency catheter ablation of AF. CLD included chronic obstructive pulmonary disease, a tuberculosis-destroyed lung, and interstitial lung disease. For controls, we selected 60 sex-, age-, and procedure era–matched non-CLD patients who received radiofrequency catheter ablation for AF (4 controls for each CLD patient). Eight patients had chronic obstructive pulmonary disease, 6 had a tuberculosis-destroyed lung, and 1 had interstitial lung disease. PV morphology in the affected lung was altered significantly, ie, obliteration, pulling of the PVs toward the destroyed lung, or compensatory bulging of the PV antrum. These alterations were related to arrhythmogenicity in 6 (40%) of 15 patients with CLD. Non-PV foci were more common in the CLD group (4/15, 26.7%) than in the control group (3/60, 5.0%;
P
=0.025). All non-PV foci were located in the right atrium. The AF recurrence rate in the CLD group (26.7%, 4/15) was similar to that in the control group (18.3%, 11/60;
P
=0.45).

Conclusions—

Significant alteration of PV anatomy was related to arrhythmogenicity, and non-PV foci from the right atrium were commonly observed in the CLD group. Radiofrequency catheter ablation can be performed safely for AF in CLD patients with a comparable success rate to that in patients with normal lungs.
Impact of Exercise on Heart Rate Recovery
Authors: Jolly Michael A. , Brennan Danielle M. , Cho Leslie
Published: September 2011

Background—

Abnormal heart rate recovery (HRR) has been shown to predict mortality. Although small studies have found that HRR can be improved with cardiac rehabilitation, it is unknown whether an improvement would affect mortality. The aim of this study was to determine whether HRR could be improved with cardiac rehabilitation and whether it would be predictive of mortality.

Methods and Results—

We evaluated 1070 consecutive patients who underwent exercise stress testing before and after completion of a phase 2 cardiac rehabilitation program. Heart rate recovery, defined as the difference between heart rate at peak exercise and exactly 1 minute into the recovery period, and mortality were followed up as the primary end points. Of 544 patients with abnormal baseline HRR, 225 (41%) had normal HRR after rehabilitation. Of the entire cohort, 197 patients (18%) died. Among patients with an abnormal HRR at baseline, failure to normalize after rehabilitation predicted a higher mortality (
P
<0.001). After multivariable adjustment, the presence of an abnormal HRR at exit was predictive of death in all patients (hazard ratio, 2.15; 95% confidence interval 1.43–3.25). Patients with abnormal HRR at baseline who normalized afterward had survival rates similar to those of the group with normal HRR at baseline and after cardiac rehabilitation (
P
=0.143).

Conclusions—

Heart rate recovery improved after phase 2 cardiac rehabilitation in the overall cohort. There was a strong association of abnormal HRR at exit with all-cause mortality. Patients with abnormal HRR at baseline who normalized HRR with exercise had a mortality similar to that of individuals with baseline normal HRR.
Blood Pressure Targets Recommended by Guidelines and Incidence of Cardiovascular and Renal Events in the Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial (ONTARGET)
Authors: Mancia Giuseppe , Schumacher Helmut , Redon Josep , Verdecchia Paolo , Schmieder Roland , Jennings Garry , Yusoff Khalid , Ryden Lars , Liu G. Lisheng , Teo Koon , Sleight Peter , Yusuf Salim
Published: September 2011

Background—

Hypertension treatment guidelines recommend that blood pressure (BP) be lowered to <140/90 mm Hg, but that a reduction to <130/80 mm Hg be adopted in patients at high cardiovascular (CV) risk. We investigated the CV and renal benefits associated with these BP targets in the high-CV-risk population of the Ongoing Telmisartan Alone and in Combination With Ramipril Global End Point Trial (ONTARGET).

Methods and Results—

Patients were divided into 4 groups according to the proportion of in-treatment visits before the occurrence of an event (<25%–>75%) in which BP was reduced to <140/90 or <130/80 mm Hg. After adjustment for demographic and clinical variables, a progressive increase in the proportion of visits in which BP was reduced to <140/90 or <130/80 mm Hg was associated with a progressive reduction in the risk of stroke, new onset of microalbuminuria or macroalbuminuria, and return to normoalbuminuria in albuminuric patients. An increased frequency of BP control to either target did not have any consistent effect on the adjusted risk of myocardial infarction and heart failure. The adjusted risk of CV events was reduced by increasing the frequency of BP control to <140/90 mm Hg, but not to <130/80 mm Hg. Similar findings were obtained for the achievement of the BP target in the visit preceding a CV event.

Conclusion—

The more frequent achievement of the BP targets recommended by guidelines led to cerebrovascular and renal protection, but did not increase cardiac protection. Overall, CV protection was favorably affected by the less tight but not by the tighter BP target.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00153101.
Cardiomyocyte-Specific Deletion of the Vitamin D Receptor Gene Results in Cardiac Hypertrophy
Authors: Chen Songcang , Law Christopher S. , Grigsby Christopher L. , Olsen Keith , Hong Ting-Ting , Zhang Yan , Yeghiazarians Yerem , Gardner David G.
Published: September 2011

Background—

A variety of studies carried out using either human subjects or laboratory animals suggest that vitamin D and its analogues possess important beneficial activity in the cardiovascular system. Using Cre-Lox technology we have selectively deleted the vitamin D receptor (VDR) gene in the cardiac myocyte in an effort to better understand the role of vitamin D in regulating myocyte structure and function.

Methods and Results—

Targeted deletion of the exon 4 coding sequence in the VDR gene resulted in an increase in myocyte size and left ventricular weight/body weight versus controls both at baseline and following a 7-day infusion of isoproterenol. There was no increase in interstitial fibrosis. These knockout mice demonstrated a reduction in end-diastolic and end-systolic volume by echocardiography, activation of the fetal gene program (ie, increased atrial natriuretic peptide and alpha skeletal actin gene expression), and increased expression of modulatory calcineurin inhibitory protein 1 (MCIP1), a direct downstream target of calcineurin/nuclear factor of activated
T
cell signaling. Treatment of neonatal cardiomyocytes with 1,25-dihydroxyvitamin D partially reduced isoproterenol-induced MCIP1 mRNA and protein levels and MCIP1 gene promoter activity.

Conclusions—

Collectively, these studies demonstrate that the vitamin D-VDR signaling system possesses direct, antihypertrophic activity in the heart. This appears to involve, at least in part, suppression of the prohypertrophic calcineurin/NFAT/MCIP1 pathway. These studies identify a potential mechanism to account for the reported beneficial effects of vitamin D in the cardiovascular system.
Peak Oxygen Uptake Correlates With Survival Without Clinical Deterioration in Ambulatory Children With Dilated Cardiomyopathy
Authors: Giardini Alessandro , Fenton Matthew , Andrews Rachel E. , Derrick Graham , Burch Michael
Published: September 2011

Background—

Children stable at home with dilated cardiomyopathy remain at risk of death; there is evidence of survival benefit for transplantation out to 4 years postoperatively. The limited supply of donor organs makes risk stratification imperative, but although cardiopulmonary exercise test is well established as a powerful tool in adults with heart failure, no published studies have linked oxygen uptake to prognosis in children.

Methods and Results—

Between 2001 and 2009, using cardiopulmonary exercise test and echocardiography, we studied 82 children (mean age, 13.5±2.3 years) with dilated cardiomyopathy. All were ambulatory, outpatients, and >120 cm in height. All children completed a symptom-limited maximal exercise test. Resting left ventricular shortening fraction was 20±9%; peak heart rate was 87±13% of predicted; peak oxygen uptake (V̇
o
2
) was 67±22% of predicted; and ventilatory efficiency was 32±8. Follow-up was available for 100% of the children, and was a mean of 32.3±7.5 months. Eighteen patients reached the defined clinical end point of death or listing for urgent heart transplantation. On univariate analysis, left ventricular shortening fraction, peak heart rate, peak V̇
o
2
, peak systolic blood pressure, and ventilatory efficiency were all associated with adverse outcome. On multivariable Cox analysis, only peak V̇
o
2
(
P
=0.003) was associated with the study end point. Patients with a peak V̇
o
2
≤62% of predicted had a higher 24-month event rate (50.6% versus 4.4%; hazard ratio, 10.78).

Conclusions—

We have demonstrated that a cardiopulmonary exercise test is feasible in ambulatory children with dilated cardiomyopathy who are >120 cm height and for the first time have linked peak V̇
o
2
with outcome in children.
Threshold of Soluble Fms-Like Tyrosine Kinase 1/Placental Growth Factor Ratio for the Imminent Onset of Preeclampsia
Authors: Ohkuchi Akihide , Hirashima Chikako , Matsubara Shigeki , Takahashi Kayo , Matsuda Yoshio , Suzuki Mitsuaki
Published: September 2011

It has not been clarified whether thresholds of soluble fms-like tyrosine kinase 1 (sFlt-1), placental growth factor (PlGF), soluble endoglin, and the sFlt-1/PlGF ratio for the imminent onset of preeclampsia (PE) exist. We hypothesized that onset thresholds for the imminent onset of PE could be determined by the distributions of these 4 markers just after the onset of PE. Study subjects were 51 PE after the onset of PE; 36 of PE, 20 of gestational hypertension, 142 of a small-for-gestational-age infant, and 400 of normal pregnant controls at 19 to 25 and 27 to 31 weeks of gestation in a prospective cohort study. The current data supported our hypothesis that onset thresholds of sFlt-1 and the sFlt-1/PlGF ratio exist. The onset thresholds of the sFlt-1/PlGF at 26 to 31 weeks of gestation were useful for detecting imminent PE with the onset at <36 weeks of gestation, showing sensitivity of 0.36 and a positive likelihood ratio and 95th percent CIs of 38 (11–132); when positive, PE occurred at 2.2±0.6 weeks (range: 1.4–3.0 weeks) after the measurement of the sFlt-1/PlGF ratio. The combination of sFlt-1 at 26 to 31 weeks of gestation, past history of gestational hypertension or PE, prepregnancy body mass index, and mean blood pressure at 16 to 23 weeks of gestation was useful for detecting PE with onset of <36 weeks of gestation, showing sensitivity of 0.82, and a positive likelihood ratio (95% CI) of 42 (20–88). In conclusion, the onset threshold of sFlt-1/PlGF existed and might be useful for detecting the imminent onset of PE.
Analysis of the Atlantic Meridional Mode Using Linear Inverse Modeling: Seasonality and Regional Influences
Authors: Vimont Daniel J.
Published: September 2011

Predictability and variability of the tropical Atlantic Meridional Mode (AMM) is investigated using linear inverse modeling (LIM). Analysis of the LIM using an “energy” norm identifies two optimal structures that experience some transient growth, one related to El Niño–Southern Oscillation (ENSO) and the other to the Atlantic multidecadal oscillation (AMO)/AMM patterns. Analysis of the LIM using an AMM-norm identifies an “AMM optimal” with similar structure to the second energy optima (OPT2). Both the AMM-optimal and OPT2 exhibit two bands of SST anomalies in the mid- to high-latitude Atlantic. The AMM-optimal also contains some elements of the first energy optimal (ENSO), indicating that the LIM captures the well-known relationship between ENSO and the AMM.

Seasonal correlations of LIM predictions with the observed AMM show enhanced AMM predictability during boreal spring and for long-lead (around 11–15 months) forecasts initialized around September. Regional LIMs were constructed to determine the influence of tropical Pacific and mid- to high-latitude Atlantic SST on the AMM. Analysis of the regional LIMs indicates that the tropical Pacific is responsible for the AMM predictability during boreal spring. Mid- to high-latitude SST anomalies contribute to boreal summer and fall AMM predictability, and are responsible for the enhanced predictability from September initial conditions. Analysis of the empirical normal modes of the full LIM confirms these physical relationships. Results indicate a potentially important role for mid- to high-latitude Atlantic SST anomalies in generating AMM (and tropical Atlantic SST) variations, though it is not clear whether those anomalies provide any societally useful predictive skill.
A Remotely Operated Lidar for Aerosol, Temperature, and Water Vapor Profiling in the High Arctic
Authors: Nott G. J. , Duck T. J. , Doyle J. G. , Coffin M. E. W. , Perro C. , Thackray C. P. , Drummond J. R. , Fogal P. F. , McCullough E. , Sica R. J.
Published: September 2011

A Rayleigh–Mie–Raman lidar has been installed and is operating in the Polar Environment Atmospheric Research Laboratory at Eureka in the High Arctic (79°59′N, 85°56′W) as part of the Canadian Network for the Detection of Atmospheric Change. The lidar operates in both the visible and ultraviolet and measures aerosol backscatter and extinction coefficients, depolarization ratio, tropospheric temperature, and water vapor mixing ratio. Variable field of view, aperture, and filtering allow fine-tuning of the instrument for different atmospheric conditions. Because of the remote location, operations are carried out via a satellite link. The instrument is introduced along with the measurement techniques utilized and interference filter specifications. The temperature dependence of the water vapor signal depends on the filter specifications, and this is discussed in terms of minimizing the uncertainty of the water vapor mixing ratio product. Finally, an example measurement is presented to illustrate the potential of this instrument for studying the Arctic atmosphere.
What Is Islamophobia and How Much Is There? Theorizing and Measuring an Emerging Comparative Concept
Authors: Bleich Erik
Published: September 2011

Islamophobia is an emerging comparative concept in the social sciences. Yet there is no widely accepted definition of Islamophobia that permits systematic comparative and causal analysis. This article explores how the term Islamophobia has been deployed in public and scholarly debates, emphasizing that these discussions have taken place on multiple registers. It then draws on research on concept formation, prejudice, and analogous forms of status hierarchies to offer a usable social scientific definition of Islamophobia as indiscriminate negative attitudes or emotions directed at Islam or Muslims. The article discusses the types of indicators that are most appropriate for measuring Islamophobia as well as the benefits of concept development for enabling comparative and causal analysis.
National Models of Integration in Europe
Authors: Bertossi Christophe
Published: September 2011

The concept of models of immigrant integration (e.g., French assimilation, Dutch and British multiculturalism) has had a vibrant career in comparative research on Western Europe, accounting for and explaining many national differences. This concept, however, is problematic because it suffers from normative and theoretical misconceptions. Through a comparison of France, Britain, and the Netherlands, this article discusses key problems affecting the use of national integration models in the literature and proposes ways to overcome them. It argues that models should not be considered as homogeneous and stable cultural entities—and even less as independent variables—but as complex structures of reference on the basis of which a multiplicity of conceptions of identity, equality, and inclusion are developed by a wide range of social agents in each national context.