bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Hyponatremia in Acute Stroke Stage with Three-Year Mortality in Patients with First-Ever Ischemic Stroke
Authors: Huang Wen-Yi , Weng Wei-Chieh , Peng Tsung-I , Chien Yu-Yi , Wu Chia-Lun , Lee Meng , Hung Cheng-Chieh , Chen Kuan-Hsing
Published: June 2012

Background: Hyponatremia is the most common electrolyte disorder in hospitalized patients, and is frequently a marker of a significant underlying disease. The prognostic value of hyponatremia in patients with acute first-ever ischemic stroke is not known. We aimed to analyze whether hyponatremia in the acute stroke stage contributed to the risk of mortality or recurrent stroke in these patients. Methods: We studied 925 patients presenting with acute first-ever ischemic stroke between 2002 and 2004. Sodium levels were obtained on arrival at the emergency room within 3 days of acute stroke onset. Hyponatremia was defined as a serum sodium concentration of 134 mmol/l or less. Clinical presentation, stroke risk factors, associated medical disease, and outcome were recorded. All patients were followed for 3 years for survival analysis. A multivariate Cox proportional hazards model was used to identify risk factors for 3-year mortality in these patients. We also constructed Kaplan-Meier survival curves, and compared groups with hyponatremia and normonatremia by means of log rank tests for significant differences. Results: Among the patients with acute first-ever ischemic stroke, 107 (11.6%) were hyponatremic. Among stroke risk factors, the prevalence of diabetes mellitus was significantly higher among hyponatremic patients (p < 0.001). Prevalence of chronic renal insufficiency was also higher in the hyponatremic group (p = 0.002). Clinical presentations, such as the length of acute ward stay, initial impaired consciousness, and clinical course in acute stroke were similar among normo- and hyponatremic patients. Among the complications, pneumonia and urinary tract infection were significantly higher in hyponatremic than in normonatremic patients. After multivariate logistic regression analysis, diabetes mellitus and chronic renal insufficiency were associated with hyponatremia in these patients. Kaplan-Meier analysis indicated that the survival rate was significantly lower in hyponatremic patients than in normonatremic patients (log rank test; p value <0.001). After multivariate Cox proportional hazards model analysis, hyponatremia was a significant predictor of 3-year mortality in these patients after adjustment for related variables (p value = 0.003, hazard ratio = 2.23, 95% confidence interval: 1.30–3.82). Conclusion: Hyponatremia in the acute stroke stage is a predictor of 3-year mortality in patients with acute first-ever ischemic stroke that is independent of other clinical predictors of adverse outcome.
The Intracranial Vertebral Artery: A Neglected Species
Authors: Caplan Louis R.
Published: June 2012

Among posterior circulation arteries, the intracranial vertebral artery (ICVA) has been given the least attention, especially concerning treatment of occlusive lesions. Early clinicopathological studies showed that the ICVA was often occluded in patients with lateral medullary and posterior inferior cerebellar infarcts. Severe stenosis or occlusion of the ICVA was the most common arterial lesion among the 408 patients in the New England Medical Center Posterior Circulation Registry (NEMC-PCR). In this registry, the distal portion of the artery was most often involved, sometimes with spread into the basilar artery. ICVA occlusive lesions were often bilateral and very often accompanied by basilar and cervical vertebral artery occlusive lesions. Patients with bilateral ICVA occlusions often had attacks of dizziness, blurred vision, and ataxia during months and years but rarely later developed disabling infarction. Most posterior circulation infarcts in patients with ICVA occlusive lesions were located in the middle and distal posterior circulation territories and were rostral to the medulla and inferior cerebellum. Although diagnostic techniques now image the ICVA and its lesions well, the optimal treatment of patients with various ICVA occlusive lesions has very rarely been analyzed or reported. The therapeutics of patients with ICVA disease is uncharted territory and begs for attention and clarification.
The extent of P2Y12 inhibition by clopidogrel in diabetes mellitus patients with acute coronary syndrome is not related to glycaemic control: Roles of white blood cell count and body weight
Authors: El Ghannudi Soraya , Hess Sebastien , Reydel Antje , Crimizade Ulun , Jesel Laurence , Radulescu Bogdan , Wiesel Marie L. , Gachet Christian , Ohlmann Patrick , Morel Olivier
Published: June 2012

It was the study objective to determine whether glycaemic control affects the extent of platelet inhibition by thienopyridines as assessed by vasodilator-stimulated phosphoprotein flow cytometry (VASP-FCT) in patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI) during acute coronary syndrome (ACS). Although the proportion of high on-treatment residual platelet reactivity is higher in DM, the contributions of glycaemic control and other factors associated with DM, such as excess body weight and inflammation, to this impaired platelet inhibition by thienopyridines have not yet been fully characterised. In this study, the extent of P2Y12 ADP receptor pathway inhibition was evaluated by the VASP-FCT. Platelet activation was expressed as the platelet reactivity index (PRI). Low response to clopidogrel (LR) was defined as a PRI of >61%. Four hundred forty-five consecutive ACS patients (DM = 160, NDM = 285) were enrolled. The proportion of LR was higher in DM patients (50 vs. 37.5%). In DM, PRI was not correlated with glycosylated haemoglobin (HbA1c) or glycaemia. In a univariate analysis, LR was associated with age, male sex, overweight, and white blood cell count (WBC). In a multivariate analysis, WBC >10,000 and body weight >80 kg were the sole independent predictors of LR to clopidogrel (hazard ratio (HR) 3.02 [1.36–6.68], p=0.006 and HR 2.47 [1.14–5.35], p = 0.021, respectively). Conversely, in non-DM patients, ST-elevation myocardial infarction was the sole independent predictor of LR. In conclusion, in ACS DM patients undergoing PCI, the extent of P2Y12 inhibition by clopidogrel is not related to glycaemic control but is related to body weight and inflammatory status as assessed by the WBC.
An indirect comparison of dabigatran, rivaroxaban and apixaban for atrial fibrillation
Authors: Ansell Jack , Mantha Simon
Published: June 2012

New oral anticoagulant drugs are emerging as alternatives to warfarin for the prevention of stroke in patients with non-valvular atrial fibrillation. Two agents are direct factor Xa inhibitors (rivaroxaban and apixaban), and the third is a direct thrombin inhibitor (dabigatran). They have been separately compared to warfarin in large randomised trials. Our objective was to indirectly compare the three agents to each other for major efficacy and safety outcomes. Studies were assessed for comparability and the odds ratios of selected outcomes for each anticoagulant versus one another were estimated indirectly. The three cohorts differed significantly in terms of CHADS2 score and the number of individuals with a past history of stroke, transient ischemic attack or systemic embolism. The estimated odds ratio of stroke or systemic embolism was 1.35 for rivaroxaban vs dabigatran 150 mg (p=0.04), 0.97 for rivaroxaban versus dabigatran 110 mg (p=0.81), 1.22 for apixaban versus dabigatran 150 mg (p=0.18), 0.88 for apixaban versus dabigatran 110 mg (p=0.34) and 0.90 for apixaban versus rivaroxaban (p=0.43). The estimated odds ratio of major bleeding was 1.10 for rivaroxaban versus dabigatran 150 mg (p=0.36), 1.28 for rivaroxaban versus dabigatran 110 mg (p=0.02), 0.74 for apixaban versus dabigatran 150 mg (p=0.004), 0.87 for apixaban versus dabigatran 110 mg (p=0.17) and 0.68 for apixaban versus rivaroxaban (p<0.001). In conclusion, the available data indicate no significant difference in efficacy between dabigatran 150 mg and apixaban for the prevention of stroke or systemic embolism in patients with non-valvular atrial fibrillation. It appears however that apixaban is associated with less major bleeding than dabigatran 150 mg or rivaroxaban and that rivaroxaban is less effective than dabigatran 150 mg in preventing stroke or systemic embolism. Such an indirect comparison should be used only to generate hypotheses which need to be tested in a dedicated randomised trial comparing the three drugs directly.
An innovative flow cytometric approach for small-size platelet microparticles: Influence of calcium
Authors: Montoro-García Silvia , Shantsila Eduard , Orenes-Piñero Esteban , Lozano María , Lip Gregory Y. H.
Published: June 2012

Microparticles (MPs) are small submicron membrane-derived vesicles shed from a variety of cells and they have been implicated in different disorders. Accordingly, understanding of physiological characteristics of MPs and improvement of methods of their quantification are important for further advance in the field. Although flow cytometry is the most widely applied technique for MP analysis, it is limited by lack of adequate standardisation. Annexin V (AnV), which binds surface phos-phatidylserine (PS) with high affinity, has been long regarded as a marker of MPs, but AnV binding is Ca2+-dependent and it is unclear how [Ca2+] concentrations could affect AnV binding to MPs and its enumeration. MPs from citrated and heparinised plasma were labelled with AnV, anti-CD42b and quantified using an Apogee A50 flow cytometer. The small-size MP gate was defined with the use of size beads (from 0.1 to 0.5 μm) and confirmed with an in vitro assessment of platelet stimulation. Biotinylated anti-CD42b antibodies were then bound to streptavidin conjugated with different fluorochromes, leading to an amplified signal of platelet MPs (PMPs). Moderate increase of [Ca2+] concentrations in the annexin V staining buffer allows initial plasma recalcification and more accurate MP quantification in citrated plasma. Thrombin stimulation of platelet-free plasma containing only MPs did not produce any changes in the concentration of AnV+ MPs, but decreased the anti-CD42b binding. The results also indicate that prolonged storage and thrombin induce the release of AnV+ MPs whereas PS exposure in pre-existent MPs is not affected by thrombin. In conclusion, we present a sensitive protocol for the analysis of circulating and in vitro induced small-size PMPs that might contribute to future cardiovascular and clinical research.

Note: The editorial process for this article was fully handled by Prof. Christian Weber, Editor-in-Chief.
Predictive Value of Beat-to-Beat QT Variability Index Across the Continuum of Left Ventricular Dysfunction
Authors: Tereshchenko Larisa G. , Cygankiewicz Iwona , McNitt Scott , Vazquez Rafael , Bayes-Genis Antoni , Han Lichy , Sur Sanjoli , Couderc Jean-Philippe , Berger Ronald D. , de Luna Antoni Bayes , Zareba Wojciech
Published: June 2012

Background—

The goal of the present study was to determine the predictive value of beat-to-beat QT variability in heart failure patients across the continuum of left ventricular dysfunction.

Methods and Results—

Beat-to-beat QT variability index (QTVI), log-transformed heart rate variance, normalized QT variance, and coherence between heart rate variability and QT variability have been measured at rest during sinus rhythm in 533 participants of the Muerte Subita en Insuficiencia Cardiaca heart failure study (mean age, 63.1±11.7; men, 70.6%; left ventricular ejection fraction >35% in 254 [48%]) and in 181 healthy participants from the Intercity Digital Electrocardiogram Alliance database. During a median of 3.7 years of follow-up, 116 patients died, 52 from sudden cardiac death (SCD). In multivariate competing risk analyses, the highest QTVI quartile was associated with cardiovascular death (subhazard ratio, 1.67 [95% CI, 1.14–2.47];
P
=0.009) and, in particular, with non-SCD (subhazard ratio, 2.91 [1.69–5.01];
P
<0.001). Elevated QTVI separated 97.5% of healthy individuals from subjects at risk for cardiovascular (subhazard ratio, 1.57 [1.04–2.35];
P
=0.031) and non-SCD in multivariate competing risk model (subhazard ratio, 2.58 [1.13–3.78];
P
=0.001). No interaction between QTVI and left ventricular ejection fraction was found. QTVI predicted neither noncardiac death (
P
=0.546) nor SCD (
P
=0.945). Decreased heart rate variability rather than increased QT variability was the reason for increased QTVI in the present study.

Conclusions—

Increased QTVI because of depressed heart rate variability predicts cardiovascular mortality and non-SCD but neither SCD nor extracardiac mortality in heart failure across the continuum of left ventricular dysfunction. Abnormally augmented QTVI separates 97.5% of healthy individuals from heart failure patients at risk.
Differential Effects of Adenosine on Pulmonary Vein Ectopy After Pulmonary Vein Isolation
Authors: Cheung Jim W. , Ip James E. , Chung Jeffrey H. , Markowitz Steven M. , Liu Christopher F. , Thomas George , Lee Joseph M. , Lessner Seth J. , Lerman Bruce B.
Published: June 2012

Background—

The mechanism of pulmonary vein (PV) triggers of atrial fibrillation remains unclear. We performed adenosine (ADO) testing after PV isolation to characterize spontaneous dissociated PV rhythm and ADO-induced PV ectopy.

Methods and Results—

Seventy-four patients (61 men; age, 61±10 years) undergoing PV isolation for atrial fibrillation were studied. For each isolated PV, dissociated ectopy was recorded and ADO was administered. After isolation of 270 PVs, 50 PVs with dissociated ectopy were identified. In 42 PVs exhibiting PV rhythm, ADO resulted in PV rhythm suppression in 35 (83%) PVs, with all occurring during ADO-induced bradycardia, and in PV rhythm acceleration in 13 (31%) PVs, with all occurring after resolution of ADO-induced bradycardia. In 11 PVs, both ADO-induced PV rhythm acceleration and suppression were seen. Among 220 electrically silent PVs, ADO induced PV ectopy in 28 (13%) veins. The timing of ADO-induced PV ectopy with respect to ADO effects on heart rate varied. ADO induced PV ectopy during the early phase of ADO effect only in 12 PVs, during the late phase of ADO effect only in 8 PVs, and during both early and late phases of ADO effect in 8 PVs.

Conclusions—

The mechanism of spontaneous PV rhythm after isolation is likely automaticity, given the close association of ADO effects on PV rhythm with its chronotropic and dromotropic effects. However, ADO can induce PV ectopy in electrically silent PVs in a manner not closely tied to its effects on heart rate and may be because of the activation of autonomic triggers.
Ascending Aortic and Main Pulmonary Artery Areas Derived From Cardiovascular Magnetic Resonance as Reference Values for Normal Subjects and Repaired Tetralogy of Fallot
Authors: Kutty Shelby , Kuehne Titus , Gribben Paul , Reed Eric , Li Ling , Danford David A. , Beerbaum Philipp B.J. , Sarikouch Samir
Published: June 2012

Background—

Cardiac magnetic resonance (CMR) imaging is an important clinical tool for serial follow-up of patients with congenital heart disease, but normative data for great vessel dimensions in pediatric subjects are scarce. We investigated the ascending aortic (AO) and main pulmonary artery dimensions in normal children and young adults in comparison with a cohort of patients with repaired tetralogy of Fallot (TOF).

Methods and Results—

Subjects were prospectively enrolled for cardiac magnetic resonance after a standardized protocol in 14 participating centers of the German Competence Network for Congenital Heart Defects. All studies were performed in 1.5-T scanners and used single-slice multiphase acquisitions steady-state free precession and velocity-encoded cine. AO and main pulmonary artery areas were measured. The cohort consisted of 483 subjects: 105 normal controls (55 men; 50 women; and median age, 14 years) and 378 patients with repaired TOF (210 men; 168 women; and median age, 16 years). Among TOF, 35 (9%) had pulmonary atresia, 98 (26%) had a palliative procedure before repair, the mean age at repair was 2.9 years, and 82 (23%) used a transannular patch repair. Great vessel areas correlated well with body surface area and age in controls and reference Z-score values were derived. Z scores for ascending AO areas were larger in TOF compared with controls (mean Z score =1.95,
P
=0.001). In TOF, pulmonary atresia (
P
=0.003), male sex (
P
=0.01) and previous palliations (
P
=0.046) were associated with larger AO areas. Main pulmonary artery area Z scores in surgically modified TOF were smaller on an average than controls (mean Z score =−0.293
P
=0.001) but not small to the same extent as the AO was large.

Conclusions—

This study provides cardiac magnetic resonance reference Z scores for great vessel areas in normal children and adolescents in comparison with a large contemporary cohort of repaired TOF. Male sex, pulmonary atresia, and previous palliations emerged as predictors for larger AO dimensions in TOF.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00266188.
Bicuspid Aortic Valve Is Associated With Altered Wall Shear Stress in the Ascending Aorta
Authors: Barker Alex J. , Markl Michael , Bürk Jonas , Lorenz Ramona , Bock Jelena , Bauer Simon , Schulz-Menger Jeanette , von Knobelsdorff-Brenkenhoff Florian
Published: June 2012

Background—

Hemodynamics may play a role contributing to the progression of bicuspid aortic valve (BAV) aortopathy. This study measured the impact of BAV on the distribution of regional aortic wall shear stress (WSS) compared with control cohorts.

Methods and Results—

Local WSS distribution was measured in the thoracic aorta of 60 subjects using 4-dimensional (4D) flow-sensitive magnetic resonance imaging. WSS analysis included 15 BAV patients: 12 with fusion of the right-left coronary cusp (6 stenotic) and 3 with fusion of the right and noncoronary cusp. The right-left BAV cohort was compared with healthy subjects (n=15), age-appropriate subjects (n=15), and age-/aorta size–controlled subjects (n=15). Compared with the age-appropriate and age-/aorta size–matched controls, WSS patterns in the right-left BAV ascending aorta were significantly elevated, independent of stenosis severity (peak WSS=0.9±0.3 N/m
2
compared with 0.4±0.3 N/m
2
in age-/aorta size–controlled subjects;
P
<0.001). Time-resolved (cine) 2D images of the bicuspid valves were coregistered with 4D flow data, directly linking cusp fusion pattern to a distinct ascending aortic flow jet pattern. The observation of right-anterior ascending aorta wall/jet impingement in right-left BAV patients corresponded to regions with statistically elevated WSS. Alternative jetting patterns were observed in the right and noncoronary cusp fusion patients.

Conclusions—

The results of this study demonstrate that bicuspid valves induced significantly altered ascending aorta hemodynamics compared with age- and size-matched controls with tricuspid valves. Specifically, the expression of increased and asymmetric WSS at the aorta wall was related to ascending aortic flow jet patterns, which were influenced by the BAV fusion pattern.
Left Ventricular Remodeling and Improvement in Diastolic Function After Balloon Aortic Valvuloplasty for Congenital Aortic Stenosis
Authors: Friedman Kevin G. , McElhinney Doff B. , Colan Steven D. , Porras Diego , Powell Andrew J. , Lock James E. , Brown David W.
Published: June 2012

Background—

In congenital aortic stenosis, chronic pressure load has detrimental effects on left ventricular (LV) systolic and diastolic function. Reduction in LV pressure load with balloon aortic valvuloplasty (BAVP) may improve diastolic function.

Methods and Results—

Echocardiographic and catheterization data for 25 consecutive patients undergoing BAVP for congenital aortic stenosis were retrospectively analyzed. Median age at BAVP was 11.5 years (3.2–40.1). LV end-diastolic pressure was elevated (≥15 mm Hg) in 72% of patients, with a median of 17 mm Hg (range, 9–24). With BAVP, median aortic stenosis gradient was reduced from 63 mm Hg (range, 44–105) to 30 mm Hg (range, 10–43). Aortic regurgitation increased from trivial (none to mild) to mild (trivial to moderate). Pre-BAVP early diastolic mitral inflow velocity/tissue Doppler early diastolic velocity (E/E´) correlated with LV end-diastolic pressure (
r
=0.52,
P
=0.007). On follow-up echocardiography (median, 11 months after BAVP), aortic stenosis gradient was lower (
P
<0.001) and degree of AR was higher (
P
=0.01) compared with pre-BAVP echocardiograms. LV end-diastolic volume
z
-score increased (
P
=0.02), LV mass was unchanged, and LV mass:volume decreased (
P
=0.002). Mitral annular and septal E´ (
P
<0.001) were higher and E/E´ was lower after dilation (10.8 versus 14.2,
P
<0.001). Lower pre-BAVP E/E´ and lower pre-BAVP LV mass
z
-score were associated with lower post-BAVP E/E.

Conclusion—

After BAVP, LV remodeling characterized by an increase in EDV and decrease in LV mass:volume occurs and echocardiographic measures of diastolic function and LV end-diastolic pressure improve in most patients. Risk factors for persistent diastolic dysfunction include higher pre-BAVP LV mass
z
-score and worse pre-BAVP diastolic function.
Adult Bone Marrow Cell Therapy Improves Survival and Induces Long-Term Improvement in Cardiac Parameters
Authors: Jeevanantham Vinodh , Butler Matthew , Saad Andre , Abdel-Latif Ahmed , Zuba-Surma Ewa K. , Dawn Buddhadeb
Published: June 2012

Background—

Despite rapid clinical translation and widespread enthusiasm, the therapeutic benefits of adult bone marrow cell (BMC) transplantation in patients with ischemic heart disease continue to remain controversial. A synthesis of the available data is critical to appreciate and underscore the true impact of this promising approach.

Methods and Results—

A total of 50 studies (enrolling 2625 patients) identified by database searches through January 2012 were included. Weighted mean differences for changes in left ventricular (LV) ejection fraction, infarct size, LV end-systolic volume, and LV end-diastolic volume were estimated with random-effects meta-analysis. Compared with control subjects, BMC-treated patients exhibited greater LV ejection fraction (3.96%; 95% confidence interval, 2.90–5.02;
P
<0.00001) and smaller infarct size (−4.03%, 95% confidence interval, −5.47 to −2.59;
P
<0.00001), LV end-systolic volume (−8.91 mL; 95% confidence interval, −11.57 to −6.25;
P
<0.00001), and LV end-diastolic volume (−5.23 mL; 95% confidence interval, −7.60 to −2.86;
P
<0.0001). These benefits were noted regardless of the study design (randomized controlled study versus cohort study) and the type of ischemic heart disease (acute myocardial infarction versus chronic ischemic heart disease) and persisted during long-term follow-up. Importantly, all-cause mortality, cardiac mortality, and the incidence of recurrent myocardial infarction and stent thrombosis were significantly lower in BMC-treated patients compared with control subjects.

Conclusions—

Transplantation of adult BMCs improves LV function, infarct size, and remodeling in patients with ischemic heart disease compared with standard therapy, and these benefits persist during long-term follow-up. BMC transplantation also reduces the incidence of death, recurrent myocardial infarction, and stent thrombosis in patients with ischemic heart disease.
‘They attacked the city’: Security intelligence, the sociology of protest policing and the anarchist threat at the 2010 Toronto G20 summit
Authors: Monaghan Jeffrey , Walby Kevin
Published: June 2012

Contributing to the sociological literature on protest policing at international summits, this article analyses security intelligence practices related to the 2010 G20 meetings in Toronto, Canada. Drawing from the results of access to information requests with policing and intelligence agencies at municipal, provincial and federal levels, the authors demonstrate the central role of intelligence and threat assessments in international summit policing. Focusing on intelligence practices and police training targeting the ‘anarchist threat’, they show how intelligence agencies conflated anarchism with criminality and targeted this purported menace for strategic incapacitation through a process referred to here as threat amplification. After analysing intelligence and police training for the Toronto G20, the authors discuss the implications of their findings for the sociology of protest policing. Comparing the ideas of strategic incapacitation and ‘intelligent control’, they suggest that the enfolding of security intelligence into international summit policing has intensified the practice of ‘making up’ threat categories and strategically targeting groups that fall outside the institutionalized spectrum of negotiation and accommodation.
Level-I Trauma Center Effects on Return-to-Work Outcomes
Authors: Prada Sergio I. , Salkever David , MacKenzie Ellen J.
Published: June 2012

Background: Injury is the leading cause of death for persons aged 1-44 years in the United States. Injuries have a substantial economic cost. For that reason, regional systems of trauma care in which the more acutely injured patients are transported to Level-I (L-I) trauma centers (TCs) has been widely advocated. However, the cost of TC care is high, raising questions about the value of such an approach. Objectives: To study L-I TC effectiveness and study return-to-work (RTW) outcomes. Research Design: Using data from National Study on the Costs and Outcomes of Trauma, the authors address the issue of selection bias by comparing naive estimates to matching techniques, as well as to nonlinear instrumental variable models (2SRI) and bivariate probit estimators. Subjects: Individuals ages 18-64 who were mainly working before traumatic injury. Patients selected for the study were treated at 69 hospitals located in 12 states in the United States. N = 1790. Measures: Treatment is binary indicator on whether treated at L-I TC. Outcome is binary indicator on whether returned to work within 3 months after injury. Covariates include: demographics, pre-injury characteristics (job, health and insurance status), injury descriptors, other income sources, etc. Results: Across all models that control for unobserved factors, the authors find that L-I TC treatment is positively associated with RTW within 3 months after injury. The estimated average marginal effect of treatment on the probability of RTW ranges from 23 to 38 percentage points. Conclusions: Benefits of L-I TC care extend beyond mortality and morbidity.
Post-Political Regulation: Soft Power and Post-Political Visions in Global Governance
Authors: Garsten Christina , Jacobsson Kerstin
Published: June 2012

The debate on global governance points to shifts in the type and nature of regulation as well as in the set of actors involved. The article introduces a novel way of conceptualizing the changes, namely a move towards post-political forms of regulation (see also Garsten and Jacobsson, 2007). Drawing on Chantal Mouffe’s notion of ‘the post-political vision’, the article argues that many contemporary forms of regulation are premised on consensual relationships as the basis for regulatory activity. These regulatory practices tend to narrow down the conflictual space, thereby exerting a form of soft power. Moreover, in the post-political forms of regulation, unequal power relations tend to be rendered invisible. The empirical cases discussed are voluntary regulatory arrangements, more specifically the Open Method of Coordination of the EU (OMC) and CSR (Corporate Social Responsibility) initiatives.
A linear actuated chain test rig capable of accelerated test speeds and continuous wear measurements
Authors: Burgess Stuart C , Pyper Torquil , Ling Chung Seng
Published: June 2012

This article presents a novel linear actuated chain test rig, which is capable of accelerated test speeds and continuous wear measurements. The ability to measure chain wear in situ saves time and expense compared to a conventional sprocket driven rig because the traditional rig requires the chain to be dismantled in order to monitor wear. In situ chain measurement reduces errors significantly. The novel test rig does not have a traditional set up of rotary driven sprocket and chain but uses a pneumatic linear actuator to articulate a short section of chain, which is preloaded between two cantilevers. This design leads to a compact rig with only few moving parts and allows accelerated testing at high frequencies. Linear encoder displacement transducers are used to measure changes in chain length down to 0.06 µm at a rate of 4000 readings per second. Sample wear tests on different chains have been conducted to compare life test results with conventional sprocket-driven tests rig. A good correlation was obtained between the steady-state wear rate for three different brands of roller chain.
Aeolian vibration of a single conductor with a Stockbridge damper
Authors: Barry Oumar , Oguamanam Donatus CD , Lin Der Chyan
Published: June 2012

The planar vibrational response of a single conductor with an attached Stockbridge damper is investigated. The mathematical model accounts for the two-way coupling between the conductor and the damper, the flexural rigidity of both the damper and the conductor, and the mass of the two counterweights of the damper. Hence, the dynamic behaviors of the damper and conductor are simultaneously assessed. Both free and forced vibration analyses are implemented via the use of a finite element code developed in MATLAB. The results of the force vibration analyses show that the effectiveness of Stockbridge dampers depends on their location, mass, and excitation frequency.
Sensitivity for a microresonant beam pressure sensor with docks
Authors: Xu Lizhong , Chang Wenjuan
Published: June 2012

The microresonant pressure sensor with docks has a relatively high sensitivity. However, the sensitivity calculation of the microresonant pressure sensor is approximate and independent on the film pressure. Here, the dynamic equations of the microresonant beam with docks are deduced and its equations of the natural frequency are given. The relationship between microbeam stress and dock width of the sensor is determined. The sensitivity of the sensor to film pressure is investigated. The results show that the sensitivity of the microsensor to pressure changes with film pressure, and the sensitivity is large for relatively small film pressure. The system parameters such as length and thickness of the beam, length and thickness of the pressure film, and dock width have effects on the sensitivity of the microsensor to pressure. The film thickness has the most obvious effects on the sensitivity. These results are useful for the analysis and design of the operating behavior of the sensor.
Three in a million: An epistemological study of a Portsmouth art project
Authors: Skinner Patricia
Published: June 2012

This article examines the public art project One Million Pebbles, which took place in and around Portsmouth, UK, between the mid 1990s and 2010. Conceived and directed by sculptor Pete Codling, the project’s origins, influences and impact are examined from a number of disciplinary perspectives, including history, art and anthropology. An unexpected outcome of the project has been the phenomenon of collecting the individual pebbles that were made, and this is also analysed with attention being paid to its subversive nature when set against the artist’s original aims for the project.
Multifaceted determinants of online non-prescription drug information seeking and the impact on consumers’ use of purchase channels
Authors: Holtgräfe Catherine , Zentes Joachim
Published: June 2012

The growing importance of the Internet as an information and purchasing channel is drawing widespread attention from marketing decision makers. Nevertheless, the relevance of the Internet to the so-called self-medication market in Germany has been paid barely enough attention. Our study aims to contribute insights concerning the penetration of the Internet in this market, as well as to give an overview of the critical determinants of Internet use for non-prescription drug information seeking, such as the accessibility of professional information, trust in health professionals’ opinion and the ability to search online, as well as the perceived usefulness and credibility of online non-prescription drug information. Furthermore, we demonstrate that the preferred use of the Internet as a non-prescription drug information source positively influences the choice of unconventional purchase channels for non-prescription drugs and negatively affects the use of stationary pharmacies.
Development and validation of finite element model of helmet impact test
Authors: Teng Tso-Liang , Liang Cho-Liang , Nguyen Van-Hai
Published: June 2012

Recently, many researchers have investigated helmet design with respect to helmet performance in shock absorption tests. The finite element method contributes greatly to helmet test modeling. Finite element simulations are also indispensable to evaluate head injury criteria. This study performs finite element analyses of helmet impact tests using LS-DYNA software. To compensate for lack of oblique impact tests in helmet standards, this article considers two oblique impact tests. It measures linear accelerations, rotation accelerations, and impact forces of the headform from helmet test simulations. To verify the accuracy of the proposed method, this study compares simulation results with experimental data. The results of this method fit the experimental results well, implying that the numerical method is a practical approach to helmet design problems. Furthermore, the helmet test model proposed here has potential for guiding the future development of helmet technologies.
ADA-EASD diabetes guidance: individualised treatment of hyperglycaemia
Authors: Day Caroline
Published: June 2012

Hyperglycaemia is a significant contributor to the morbidity and premature mortality of type 2 diabetes. There are several glucose lowering agents, with each class having a different mechanisms of action, but their utilisation has to be considered within the context of disease pathogenesis; appropriateness of the agent for the patient, patient lifestyle and personal circumstance, and to some extent treatment costs. The most recent joint policy statement from the American Diabetes Association and the European Association for the Study of Diabetes addresses these issues and provides guidance on strategies for a patient centred approach to the implementation of evidence based medicine. Glycaemic targets are flexible, but early intervention, and therapy as intensive as individual circumstance dictates are recommended.
Advance care planning in COPD
Authors: Simpson Catherine
Published: June 2012

Chronic obstructive pulmonary disease (COPD) in advanced stages runs an unpredictable downward course with increasingly frequent, ultimately fatal exacerbations. Worldwide financial and human costs are huge. Responsibility for initiating advance care planning in COPD has usually fallen to the physicians. The tendency has been to avoid this aspect of care, which can result in inadequate, rushed, reactive, crisis decision-making in the form of a “code status” discussion. In this article, I review the relevant literature and report findings from a qualitative study designed within my doctoral program to explore the question, “What is required for meaningful and effective advance care planning in the context of advanced COPD?” I describe the “collaborative care” approach to advance care planning I used with eight patients and carers living with advanced COPD. Along with a skilled clinician facilitator, user-friendly education elements, and attention to readiness, unique aspects of the approach included a focus on caring, engaging hope, facilitator reflective praxis, and contextual sensitivity. This approach has significant potential for enhancing decision making and goal setting, efficiency of resource utilization, and satisfaction with outcomes. Done well, it may reclaim the care element in advance care planning as it addresses barriers cited by physicians and patients/families.
After It’s Too Late
Authors: Hopkins Daniel J. , McCabe Katherine T.
Published: June 2012

Does a black mayor’s inauguration influence American cities’ policies? The heated rhetoric surrounding some black–white elections suggests that it might. Past research is divided. Yet this question has not been addressed in years or with many observations. This article uses novel data sets including 167 elections and 108 black mayors to examine their impact on fiscal and employment policies. Empirically it uses multiple approaches including regression discontinuity design. In most observable policy areas, the inauguration of a black mayor leads to policies that are indistinguishable from cities where black mayors do not govern. Police hiring represents an exception, with black mayors hiring more black officers. These results suggest a disconnect between the racially polarized elections that produce black mayors and the governance that follows. They raise concerns about the potential of city elections to induce accountability, and they reinforce the centrality of criminal justice as an urban political issue.
Evolution of the study coordinator role: The 28-year experience in Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC)
Authors: Larkin Mary E , Lorenzi Gayle M , Bayless Meg , Cleary Patricia A , Barnie Annette , Golden Ellen , Hitt Susan , Genuth Saul
Published: June 2012

Background

The role of the study coordinator (SC) in multicenter studies of long duration has received limited attention.

Purpose

To describe the evolution of the SC’s role during the 28-year Diabetes Control and Complications Trial (DCCT) and its follow-up study, the Epidemiology of Diabetes Interventions and Complications (EDIC) study.

Methods

The evolution of the SC’s position from the traditional role of protocol implementation to that of research collaborator and co-investigator, based on personal experience and observation, is described in detail. Findings from a survey regarding professional demographics and job satisfaction, completed by all 28 SCs in 2010, provided additional information. We used dimensions of the SC’s role specific to DCCT/EDIC to construct a classification schema of functions and responsibilities that describe the SC’s role.

Results

Among the 28 SCs, 24 were nurses, 12 held bachelor’s degrees, 11 had a master’s degree, 19 were certified diabetes educators (CDEs), 12 had worked with DCCT/EDIC for more than 20 years, and 5 had been with the study since its inception (>26 years). Responses confirmed a high degree of functional consistency across sites with data acquisition, performing study procedures, recruitment and consent for additional ancillary studies, regulatory management, scheduling, clinical consultation, and ongoing contact with study participants frequently reported. Study-wide leadership activities, a category not generally included in the usual SC role, were reported by approximately 30% of the SCs. The level of professional satisfaction was high with two-thirds being very satisfied, one-third moderately to quite satisfied, and none dissatisfied.

Limitations

The limitations include a relatively small sample size, self-reported data, and a single long-term multicenter trial and observational follow-up study on which we based our findings and conclusions.

Conclusions

By optimizing their organizational and scientific contributions to the overall research endeavor, SCs in DCCT/EDIC have made major contributions to the unprecedented success of the study and report high job satisfaction. The efforts of the SCs have been integral to the remarkably high participant retention and data completion rates. The DCCT/EDIC experience may serve as a model for the role of the SC in future diabetes and other multicenter clinical trials.
Specialised design for dementia
Authors: Habell Martin
Published: June 2012

Demographic trends point to a fast-rising demand for elderly dementia care – but ordinary elderly care environments are unsuitable for dementia, which requires specialised accommodation. This paper concerns itself with the health and behaviour benefits of the special environment and not the available care and medication. Compared with traditional elderly care, space requirements are larger, there are security and care issues, as well as light, sleep, sensory and exercise aspects. The internal environment can be used for therapeutic benefit, using movement, memory trails, behaviour cues, signage, sun light therapy, light spectrum control and landscape. Special planning can mitigate antisocial behaviour, agitation, anxiety and confusion. It can provide scope for family involvement. To date, care has made blanket unspecialised provision. There is a need for a coherent and comprehensive approach to the total environment and to view it as a tool for care. This paper records the features developed in the design of specialised dementia care buildings by the author as part of a sequence of care homes evolved and adapted with feedback.
Pharmacokinetics, Safety, and Tolerability Following the Administration of a Single Dose of a Combination Tablet Containing Sumatriptan and Naproxen Sodium in Adolescent Patients With Migraine and in Healthy Adult Volunteers
Authors: Berges Alienor , Robertson Jonathan , Upward James , Meyers Scott , Chen Chao
Published: June 2012

Objective: The objective was to compare the pharmacokinetics of sumatriptan and naproxen in adolescent migraineurs and healthy adults after administration of sumatriptan/naproxen sodium combination tablets. Design: The design was an open‐label, randomized, parallel group study. Adolescent migraineurs (12–17 years) and healthy adults received 1 dose of sumatriptan/naproxen: 10 mg/60 mg, 30 mg/180 mg, or 85 mg/500 mg. Pharmacokinetic and safety assessments were conducted. Results: Sumatriptan achieved Cmax rapidly (median tmax: 0.8–1.5 hours for adolescents, 0.5–2.0 hours for adults); elimination was also rapid (geometric mean t½: <2 hours for adolescents, 1.9–2.4 hours for adults). Compared with sumatriptan, naproxen was absorbed and eliminated more slowly (median tmax: 1.0–4.0 hours for adolescents, 1.0–3.0 hours for adults; geometric mean t½: 13.4–16.3 hours for adolescents, 14.3–16.6 hours for adults). Sumatriptan Cmax and AUC were similar for adolescents and adults for the 85 mg/500 mg dose; exposure for the 2 lower doses showed slight differences (not significant). Naproxen Cmax and AUC were comparable between the 2 groups at all doses. Increases in sumatriptan Cmax and AUC were dose proportional; for naproxen, slightly less than proportional. The tablets were generally well tolerated. Conclusion: Sumatriptan and naproxen pharmacokinetics were not dissimilar between adolescent migraineurs and healthy adults.
Pharmacokinetics and Bioequivalence Evaluation of 2 Cefadroxil Suspensions in Healthy Egyptian Male Volunteers
Authors: Mansour Noha O.
Published: June 2012

The objective of this study was to evaluate the bioavailability of 2 brands of cefadroxil monohydrate suspensions, Curisafe (500 mg cefadroxil monohydrate/5 mL; test) relative to Duricef (500 mg cefadroxil monohydrate/5 mL; reference). This in vivo study was conducted according to a single‐center, randomized, single‐dose, laboratory‐blinded, 2‐period, 2‐sequence, crossover design with a washout period of 1 week. Under fasting conditions, 24 healthy Egyptian adult male volunteers were randomly allocated to receive a single dose of either test or reference product. Blood samples were collected at specified time intervals, and plasma was analyzed for cefadroxil concentration using a validated high‐performance liquid chromatography assay method. The pharmacokinetic parameters Cmax, AUC0‐t, AUC0‐∞, tmax, Ke, and t1/2 were determined from plasma concentration‐time profiles. The 90% confidence intervals for the ratio Cmax, AUC0‐t, and AUCt‐∞ of the test product over those of reference were within the acceptable range (0.8–1.25) for bioequivalence. On the basis of these results, the 2 cefadroxil formulations are considered bioequivalent.
Drug-induced thrombocytopenia: MIBS trumps LIBS
Authors: Chong Beng H.
Published: June 2012

Understanding the pathogenesis of drug-induced immune thrombocytopenia is the key to better patient management. In this issue of Blood, Bougie and colleagues provide further useful insights into the mechanism of thrombocytopenia caused by arginine-glycine-aspartic acid (RGD) mimetic drugs.1
The counter regulatory response induced by CpG oligonucleotides prevents bleomycin induced pneumopathy
Authors: Kinjo Takeshi , Tomaru Koji , Haines Diana C , Klinman Dennis M
Published: June 2012

Bleomycin (BLM) induces life-threatening pneumonitis and pulmonary fibrosis in 20% of patients, limiting its use as a chemotherapeutic agent. Oligonucleotides expressing immunostimulatory CpG motifs (CpG ODN) stimulate cells that express Toll-like receptor 9 to initiate an inflammatory response. This short-lived inflammation is physiologically suppressed by a counter-regulatory process that peaks five days later. Using a murine model of BLM-induced lung injury, the effect of CpG ODN treatment on pulmonary inflammation, fibrosis and mortality was examined. Administering CpG ODN 5 days before BLM (so that the peak of the counter-regulatory process induced by CpG ODN coincided with BLM delivery) resulted in a dose-dependent reduction in pulmonary toxicity (p < 0.005). Delaying the initiation of therapy until the day of or after BLM administration worsened the inflammatory process, consistent with the counter-regulatory process rather than initial pro-inflammatory response being critical to CpG induced protection. The protection afforded by CpG ODN correlated with reduced leukocyte accumulation and inflammatory cytokine/chemokine production in the lungs. These changes were associated with the increased production of IL-10, a critical element of the counter-regulatory process triggered by CpG ODN, and the concomitant down-regulation of BLM-induced IL-17A and TGF-β1 (which promote pulmonary toxicity). This work represents the first example of the physiologic counter-regulation of TLR induced immune activation being harnessed to block an unrelated inflammatory response.
Contrasting patterns of genetic divergence in two sympatric pseudo-metallophytes: Rumex acetosa L. and Commelina communis L.
Authors: Ye M , Liao B , Li JT , Mengoni A , Hu M , Luo WC , Shu WS
Published: June 2012

Background

Patterns of genetic divergence between populations of facultative metallophytes have been investigated extensively. However, most previous investigations have focused on a single plant species making it unclear if genetic divergence shows common patterns or, conversely, is species-specific. The herbs Rumex acetosa L. and Commelina communis L. are two pseudo-metallophytes thriving in both normal and cupriferous soils along the middle and lower reaches of the Yangtze River in China. Their non-metallicolous and metallicolous populations are often sympatric thus providing an ideal opportunity for comparative estimation of genetic structures and divergence under the selective pressure derived from copper toxicity.

Results

In the present study, patterns of genetic divergence of R. acetosa and C. communis , including metal tolerance, genetic structure and genetic relationships between populations, were investigated and compared using hydroponic experiments, AFLP, ISSR and chloroplast genetic markers. Our results show a significant reduction in genetic diversity in metallicolous populations of C. communis but not in R. acetosa . Moreover, genetic differentiation is less in R. acetosa than in C. communis , the latter species also shows a clustering of its metallicolous populations.

Conclusions

We propose that the genetic divergences apparent in R. acetosa and C. communis , and the contrasting responses of the two species to copper contamination, might be attributed to the differences in their intrinsic physiological and ecological properties. No simple and generalised conclusions on genetic divergence in pseudo-metallophytes can thus be drawn.