bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined Endocardial and Epicardial Catheter Ablation in Arrhythmogenic Right Ventricular Dysplasia Incorporating Scar Dechanneling Technique
Authors: Berruezo Antonio , Fernández-Armenta Juan , Mont Lluís , Zeljko Hrvojka , Andreu David , Herczku Csaba , Boussy Tim , Tolosana Jose María , Arbelo Elena , Brugada Josep
Published: December 2011

Background—

Ventricular tachycardia (VT) ablation in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) has a low success rate. A more extensive epicardial (Epi) arrhythmogenic substrate could explain the low efficacy. We report the results of combined endocardial (Endo) and Epi VT ablation and conducting channel (CC) elimination.

Methods and Results—

Eleven consecutive patients with ARVD/C were included in the study. A high-density 3D Endo (321±93 sites mapped) and Epi (302±158 sites mapped) electroanatomical voltage map was obtained during sinus rhythm to define scar areas (<1.5 mV) and CCs inside the scars, between scars, or between the tricuspid annulus and a scar. The end point of the ablation procedure was the elimination of all identified CCs (scar dechanneling) and the abolition of all inducible VTs. The mean procedure and fluoroscopy time were 177±63 minutes and 20±8 minutes, respectively. Epi scar area was larger in all cases (26±18 versus 94±45 cm
2
,
P
<0.01). The combined Endo and Epi VT ablation eliminated all clinical and induced VTs, and the addition of scar dechanneling resulted in noninducibility in all cases. Seven patients continued on sotalol. During a median follow-up of 11 months (6–24 months), only 1 (9%) patient had a VT recurrence. There was a single major bleeding event that did not preclude a successful procedure.

Conclusions—

Combined Endo and Epi mapping reveals a wider Epi VT substrate in patients with ARVD/C with clinical VTs. As a first-line therapy, combined Endo and Epi VT ablation incorporating scar dechanneling achieves a very good short- and midterm success rate.
Comparing Large-Scale Hydrological Model Simulations to Observed Runoff Percentiles in Europe
Authors: Gudmundsson Lukas , Tallaksen Lena M. , Stahl Kerstin , Clark Douglas B. , Dumont Egon , Hagemann Stefan , Bertrand Nathalie , Gerten Dieter , Heinke Jens , Hanasaki Naota , Voss Frank , Koirala Sujan
Published: December 2011

Large-scale hydrological models describing the terrestrial water balance at continental and global scales are increasingly being used in earth system modeling and climate impact assessments. However, because of incomplete process understanding and limits of the forcing data, model simulations remain uncertain. To quantify this uncertainty a multimodel ensemble of nine large-scale hydrological models was compared to observed runoff from 426 small catchments in Europe. The ensemble was built within the framework of the European Union Water and Global Change (WATCH) project. The models were driven with the same atmospheric forcing data. Models were evaluated with respect to their ability to capture the interannual variability of spatially aggregated annual time series of five runoff percentiles—derived from daily time series—including annual low and high flows. Overall, the models capture the interannual variability of low, mean, and high flows well. However, errors in the mean and standard deviation, as well as differences in performance between the models, became increasingly pronounced for low runoff percentiles, reflecting the uncertainty associated with the representation of hydrological processes, such as the depletion of soil moisture stores. The large spread in model performance implies that any single model should be applied with caution as there is a great risk of biased conclusions. However, this large spread is contrasted by the good overall performance of the ensemble mean. It is concluded that the ensemble mean is a pragmatic and reliable estimator of spatially aggregated time series of annual low, mean, and high flows across Europe.
Linking Personal Values to Energy-Efficient Behaviors in the Home
Authors: Mirosa Miranda , Lawson Rob , Gnoth Daniel
Published: December 2011

Laddering techniques are used to identify personal values underlying a range of 21 potential energy-saving behaviors or purchases. At an individual level, ladders (or means-end chains) are quite simple; when aggregated, however, they are complex and show many different paths between underlying values and behaviors. The values identified can promote energy-efficient behaviors or act as obstacles to change. The value “pleasure,” for example, was found to influence energy-efficient behavior, such as hanging the laundry on the line, and inefficient behavior, such as taking long showers. Results show that values relating to “achievement” are most influential on the way people use energy in the home. Thus, social marketing campaigns promoting energy efficiency and conservation should tap into achievement values such as capability and intelligence because these campaigns are more likely to be effective than those that use other types of appeal.
Supercritical CO2 in injection molding can produce open porous polyurethane scaffolds – a parameter study
Authors: Wu Hong-Bin , Haugen Håvard J , Wintermantel Erich
Published: December 2011

There are several methods of producing open porous polymer structures for medical use. However, very few are applicable to industries and are therefore limited to both number of samples and batch variations. This study presents an industrial microcellular injection molding process, known as MuCell® technology, which was used to produce highly porous scaffolds of thermoplastic polyurethane. A parameter study was performed to quantify and analyze the effect of the processing parameters on the porous structure. Six key parameters (gas content, weight reduction, injection speed, mold temperature, plasticizing pressure, and temperature) were tested with an iteration method. The pore structure was determined with advanced micro Computer Tomography algorithm. All key processing parameters were identified. Gas content and weight reduction showed a more profound effect on the pore morphology than other parameters on the pore structure. It was possible to produce scaffolds with open porosity as high as 71%. The study concludes that MuCell® technology is an accurate and liable production method for large-scale production of open porous thermoplastic polyurethane scaffolds, and supercritical fluid could, therefore, be a potential production method for polymer scaffolds.
Reliability of Reduced-thickness and Thinly Veneered Lithium Disilicate Crowns
Authors: Silva N.R.F.A. , Bonfante E.A. , Martins L.M. , Valverde G.B. , Thompson V.P. , Ferencz J.L. , Coelho P.G.
Published: December 2011

The present investigation hypothesized that the reliability of reduced-thickness monolithic lithium disilicate crowns is high relative to that of veneered zirconia (Y-TZP) and comparable with that of metal ceramic (MCR) systems. CAD/CAM first mandibular molar full-crown preparations were produced with uniform thicknesses of either 1.0-mm or 2.0-mm occlusal and axial reduction, then replicated in composite for standard crown dies. Monolithic 1.0-mm (MON) and 2.0-mm CAD/CAM lithium disilicate crowns, the latter with a buccal thin veneer (BTV) of 0.5 mm, were fabricated and then sliding-contact-fatigued (step-stress method) until failure or suspension ( n = 18/group). Crack evolution was followed, and fractography of post mortem specimens was performed and compared with that of clinical specimens. Use level probability Weibull calculation (use load = 1,200 N) showed interval overlaps between MON and BTV. There was no significant difference between the Weibull characteristic failure loads of MON and BTV (1,535 N [90% CI 1,354–1,740] and 1,609 N [90% CI 1,512–1,712], respectively), which were significantly higher than that of Y-TZP (370 N [90% CI 322–427]) and comparable with that of MCR (1,304 N [90% CI 1,203–1,414]), validating the study hypothesis.
A Comparison of the LR and DFIT Frameworks of Differential Functioning Applied to the Generalized Graded Unfolding Model
Authors: Carter Nathan T. , Zickar Michael J.
Published: December 2011

Recently, applied psychological measurement researchers have become interested in the application of the generalized graded unfolding model (GGUM), a parametric item response theory model that posits an ideal point conception of the relationship between latent attributes and observed item responses. Little attention has been given to considerations for the detection of differential item functioning (DIF) under the GGUM. In this article, the authors present a Monte Carlo simulation meant to assess the efficacy of the likelihood ratio (LR) and differential functioning of items and tests (DFIT) frameworks, two popular ways of detecting DIF. Findings indicate a marked superiority of the LR approach over DFIT in terms of true and false positive rates under the GGUM. The discussion centers on possible explanations for the poor performance of the DFIT framework in detecting DIF under the GGUM and addresses limitations of the current study as well as future research directions.
Ethanol Lock Therapy in Reducing Catheter‐Related Bloodstream Infections in Adult Home Parenteral Nutrition Patients
Authors: John Bijo K. , Khan Maqsood A. , Speerhas Rex , Rhoda Kristen , Hamilton Cindy , DeChicco Robert , Lopez Rocio , Steiger Ezra , Kirby Donald F.
Published: December 2011

Background

Equivocal data demonstrate the efficacy of ethanol lock therapy (ELT) in preventing catheter‐related bloodstream infections (CRBSIs) in home parenteral nutrition (HPN) patients, but it is not currently a standard of practice. The objective of this study is to investigate the efficacy of ELT in reducing the incidence of CRBSIs in HPN patients.

Methods

Medical records from the Cleveland Clinic database of adult HPN patients with CRBSIs placed on prophylactic ELT were retrospectively studied from January 2006 to August 2009 (n = 31). Outcomes were compared pre‐ and post‐ELT with the patients serving as their own controls. Medical‐grade (70%) ethanol was instilled daily into each lumen of the central venous catheter (CVC) between PN infusion cycles. Comparative analysis was performed using McNemar's test and Wilcoxon ranked tests.

Results

Thirty‐one patients had 273 CRBSI‐related admissions prior to ELT in comparison to 47 CRBSI‐related admissions post‐ELT. Adjusted data for only tunneled CVC pre‐ and post‐ELT showed a similar reduction of CRBSI‐related admissions from 10.1 to 2.9 per 1000 catheter days (P < .001). There was also a statistically significant reduction in culture‐positive CRBSIs and number of catheters changed pre‐ and post‐ELT. There were no reported side effects or complications in any patient undergoing ELT.

Conclusions

This study supports the efficacy and safety of ELT in reducing CRBSI‐related admissions in HPN patients and potentially helps reduce the burden of CRBSI‐related healthcare costs. This novel technique shows great promise as a standard prophylaxis for CRBSI in HPN patients and must be incorporated in routine practice.
A Brief Program Improves Counseling of Mothers With Children Who Have Persistent Aggression
Authors: Scholer Seth J. , Reich Stephanie M. , Boshers Robyn B. , Bickman Len
Published: December 2011

Objective: To assess whether a multimedia program can affect counseling behavior related to one of the strongest risk factors for violence later in life, persistent early childhood aggression. Method: The design was a controlled trial with unobtrusive measurement in a clinic setting. A researcher, pretending to be the mother of a 2 ½ year old boy, called 19 pediatric residents during clinic hours and requested advice on how to manage her child’s persistently hurtful behavior. The intervention was a 40-min lecture focusing on a multimedia program, Play Nicely, which teaches accepted strategies for managing aggression in young children ages 1-7 years. Residents’ responses were blindly assessed to determine the treatment effect of the intervention. Results: Compared with the control group (C), residents in the intervention (I) group were more likely to recommend setting the rule (I: 100% vs. C: 31%, p = .01), redirecting (I: 83% vs. C: 8%, p = .003), promoting empathy (I: 50% vs. C: 0%, p = .02), and more likely to discourage the use of physical punishment (I: 83% vs. C: 31%). These are the primary strategies encouraged by the intervention. The magnitude of the effect size was very large for each of these three strategies, ranging from d = 1.1 to 2.3. Conclusions: A brief intervention can improve the counseling behavior of primary care physicians regarding persistent childhood aggression. The findings have implications for child abuse prevention, violence prevention, medical education, and how to improve anticipatory guidance within primary care.
The Relationship Between Social Support and Adolescent Dating Violence
Authors: Richards Tara N. , Branch Kathryn A.
Published: December 2011

Although much research has focused on the function of social support in adult intimate partner violence, little is known about the role of social support in adolescent dating violence. This study is an exploratory analysis of the independent impact of social support from friends and family on the risk of adolescent dating violence perpetration and victimization among a large sample of youth ( n = 970). Approximately, 21% of the sample reported experiencing victimization in a dating relationship whereas 23% indicated perpetrating dating violence. Male youth reported significantly more involvement in dating violence as both perpetrators and victims. Negative binomial regression modeling indicated that increased levels of support from friends was associated with significantly less dating violence perpetration and victimization; however, when gendered models were explored, the protective role of social support was only maintained for female youth. Family support was not significantly related to dating violence in any model. Implications for dating violence curriculum and future research are addressed.
Insomnia, Nightmare Frequency, and Nightmare Distress in Victims of Sexual Abuse
Authors: Steine Iris M. , Krystal John H. , Nordhus Inger H. , Bjorvatn Bjørn , Harvey Allison G. , Eid Jarle , Grønli Janne , Milde Anne M. , Pallesen Ståle
Published: December 2011

In this study of victims of sexual abuse, the aim was to investigate the role of perceived social support and abuse characteristics in self-reported insomnia, nightmare frequency, and nightmare distress. Four hundred sixty Norwegian victims of sexual abuse completed a questionnaire assessing perceived social support, abuse characteristics, insomnia, nightmare frequency, and nightmare distress. Results show that higher levels of perceived social support were related to lower scores on all symptom outcome measures. Abuse involving oral, genital, or anal penetration was related to more insomnia symptoms. Longer duration of abuse and threatening conducted by the perpetrator were related to higher nightmare frequency, while threats and abuse involving penetration were related to higher degrees of distress associated with nightmares. In conclusion, the present study provides preliminary data indicating that perceived social support may affect the nature of sleep difficulties in sexual abuse victims. Also, more severe forms of sexual abuse are related to higher levels of sleep difficulties.
Relying on Writing Consultants
Authors: Mackiewicz Jo
Published: December 2011

Colleges of business grapple with a perceived lack of quality in their graduates’ professional writing and recognize students’ need to learn disciplinary discourses. This article describes the motivation, design, and preliminary outcomes of a business-writing prototype at Auburn University. Writing consultants trained in business communication worked with one class on a substantial writing project. They provided conferencing and written feedback, greatly lowering the faculty workload. Student surveys and informal interviews indicate that students, faculty, and consultants were satisfied with this prototype program.
‘Big stuff in a beautiful way with interesting people’: The spiritual discourse in UK religious television
Authors: Noonan Caitriona
Published: December 2011

This article critically examines changes in the style and tone of religious broadcasting. Increasingly, a discourse of spirituality and faith is used by television producers to describe and discuss their output, as these are seen as less contentious and more audience-friendly ways of promoting faith-based programming. However, these themes continue to be framed within a recognizable set of religious traditions, mainly Christian. Combining interviews with producers and analysis of the BBC series Extreme Pilgrim (2008), this article examines the representation of spirituality as it is visualized and narrated. It analyses how this representation challenges traditional religious institutions, the new role it creates for broadcasters within lifestyle television, and discusses whether this subjective position can be conveyed authentically through the medium of television. The future of religious broadcasting rests on finding sustainable formats, yet these lifestyle formats offer distinct challenges in relation to their successful production and reproduction.
The secularism of the state and the secularism of consumption: ‘Honesty’, ‘treason’ and the dynamics of religious visibility on television in India and Turkey
Authors: Ohm Britta
Published: December 2011

This article questions the assumption that the increase in visibility of religion in mass-mediated content is indicative of greater impact of religion in the public and state sphere and of a process of de-secularization. It argues that expressions of Hinduism and Islam have become inseparable from secularist histories in the respective countries. The analysis emphasizes a necessary distinction between piety, public popular culture and political activism in the name of a national religious majority, and shows that in its appropriation and redefinition of secularism and employment of religious symbolism, Hindu nationalist mobilization and governance in India are related more closely to sacralization of secularism in historical Turkish nationalism than to the Islamic movement. In both countries, we can observe a retreat rather than a greater media presence of the pious and sacred in the face of neonationalism and commercialization, which in each case produces a democratically precarious public popular culture.
Media and the imagination of religion in contemporary global culture
Authors: Hoover Stewart M.
Published: December 2011

This article argues for an invigorated scholarship of religion within cultural studies. It suggests that this is justified both on its own terms and because there is evidence that the interaction of media and religion is creating entirely new forms of the religious in contemporary public life. Religion persists in history, but it persists in part because of its mediation and this persistent, mediated religion constitutes a new evolution. The article presents a range of contexts where this can be seen to be happening, not least those contexts most involved in contemporary cultural globalization.
Validity Evidence for the Test of Silent Reading Efficiency and Comprehension (TOSREC)
Authors: Johnson Evelyn S. , Pool Juli L. , Carter Deborah R.
Published: December 2011

An essential component of a response to intervention (RTI) framework is a screening process that is both accurate and efficient. The purpose of this study was to analyze the validity evidence for the Test of Silent Reading Efficiency and Comprehension (TOSREC) to determine its potential for use within a screening process. Participants included 226 students in Grades 1 to 5. Validity evidence was analyzed through (a) correlation with performance on concurrent, individually administered oral reading fluency (ORF) measures, (b) correlation with performance on concurrently administered reading comprehension measures, (c) correlation of fall and winter TOSREC performance with a state reading outcome measure administered in spring, (d) a binary classification analysis to predict whether students met grade-level performance benchmarks on a state reading assessment, and (e) a stepwise regression analysis examining the variance in performance on a state assessment accounted for by TOSREC and ORF. The concurrent correlations of TOSREC with ORF were high, with the exception of the fall fourth grade administration. Correlations of TOSREC and outcome measures were consistent with those of ORF. The binary classification analysis examining the TOSREC’s ability to accurately predict those students who did not meet grade-level performance benchmarks on the state’s reading assessment demonstrated high classification accuracy (90%) as well as high sensitivity (78%) and specificity (86%). Finally, a regression analysis indicated that the TOSREC accounted for additional unique variance in state assessment performance above and beyond ORF. Implications for practice are discussed.
Transformative Learning
Authors: Closs Lisiane , Antonello Claudia Simone
Published: December 2011

Due to the growing learning demands requested of managers in the workplace and to the importance of their role for organizations and society, the need for broadening management education perspectives is suggested. The article reviews Brazilian studies published on management learning, which highlights the importance of reflection and critical reflection in learning processes, albeit the latter, crucial for work, citizenship and moral decision making is still less evident in the fields of management learning and management education. Thus, the purpose of this article is to argue that transformative learning theory, which stimulates critical reflection that favors autonomous thinking and liberates conditioned assumptions about the world, others and oneself, may contribute to management education development, encouraging more collaborative, responsible, and ethical ways to manage organizations.
Activation of stress response gene SIRT1 by BCR-ABL promotes leukemogenesis
Authors: Yuan Hongfeng , Wang Zhiqiang , Li Ling , Zhang Hao , Modi Hardik , Horne David , Bhatia Ravi , Chen WenYong
Published: December 2011

The tyrosine kinase inhibitor imatinib is highly effective in the treatment of chronic myelogenous leukemia (CML), but primary and acquired resistance of CML cells to the drug offset its efficacy. Molecular mechanisms for resistance of CML to tyrosine kinase inhibitors are not fully understood. In the present study, we show that BCR-ABL activates the expression of the mammalian stress response gene SIRT1 in hematopoietic progenitor cells and that this involves STAT5 signaling. SIRT1 activation promotes CML cell survival and proliferation associated with deacetylation of multiple SIRT1 substrates, including FOXO1, p53, and Ku70. Imatinib-mediated inhibition of BCR-ABL kinase activity partially reduces SIRT1 expression and SIRT1 inhibition further sensitizes CML cells to imatinib-induced apoptosis. Knockout of SIRT1 suppresses BCR-ABL transformation of mouse BM cells and the development of a CML-like myeloproliferative disease, and treatment of mice with the SIRT1 inhibitor tenovin-6 deters disease progression. The combination of SIRT1 gene knockout and imatinib treatment further extends the survival of CML mice. Our results suggest that SIRT1 is a novel survival pathway activated by BCR-ABL expression in hematopoietic progenitor cells, which promotes oncogenic transformation and leukemogenesis. Our findings suggest further exploration of SIRT1 as a therapeutic target for CML treatment to overcome resistance.
Gastric transit and small intestinal transit time and motility assessed by a magnet tracking system
Authors: Worsøe Jonas , Fynne Lotte , Gregersen Tine , Schlageter Vincent , Christensen Lisbet A , Dahlerup Jens F , Rijkhoff Nico JM , Laurberg Søren , Krogh Klaus
Published: December 2011

Background

Tracking an ingested magnet by the Magnet Tracking System MTS-1 (Motilis, Lausanne, Switzerland) is an easy and minimally-invasive method to assess gastrointestinal transit. The aim was to test the validity of MTS-1 for assessment of gastric transit time and small intestinal transit time, and to illustrate transit patterns detected by the system.

Methods

A small magnet was ingested and tracked by an external matrix of 16 magnetic field sensors (4 × 4) giving a position defined by 5 coordinates (position:x, y, z, and angle: θ, ϕ). Eight healthy subjects were each investigated three times: (1) with a small magnet mounted on a capsule endoscope (PillCam); (2) with the magnet alone and the small intestine in the fasting state; and (3) with the magnet alone and the small intestine in the postprandial state.

Results

Experiment (1) showed good agreement and no systematic differences between MTS-1 and capsule endoscopy when assessing gastric transit (median difference 1 min; range: 0-6 min) and small intestinal transit time (median difference 0.5 min; range: 0-52 min). Comparing experiments (1) and (2) there were no systematic differences in gastric transit or small intestinal transit when using the magnet-PillCam unit and the much smaller magnetic pill. In experiments (2) and (3), short bursts of very fast movements lasting less than 5% of the time accounted for more than half the distance covered during the first two hours in the small intestine, irrespective of whether the small intestine was in the fasting or postprandial state. The mean contraction frequency in the small intestine was significantly lower in the fasting state than in the postprandial state (9.90 min-1vs. 10.53 min-1) (p = 0.03).

Conclusion

MTS-1 is reliable for determination of gastric transit and small intestinal transit time. It is possible to distinguish between the mean contraction frequency of small intestine in the fasting state and in the postprandial state.
The role of ALOX5AP, LTA4H and LTB4R polymorphisms in determining baseline lung function and COPD susceptibility in UK smokers
Authors: Tulah Asif S , Parker Stuart G , Moffatt Miriam F , Wardlaw Andrew J , Connolly Martin J , Sayers Ian
Published: December 2011

Background

We have previously shown evidence that polymorphisms within genes controlling leukotriene B4 (LTB4) production (ALOX5AP and LTA4H) are associated with asthma susceptibility in children. Evidence also suggests a potential role of LTB4 in COPD disease mechanisms including recruitment of neutrophils to the lung. The aim of the current study was to see if these SNPs and those spanning the receptor genes for LTB4 (LTB4R1 and LTB4R2) influence baseline lung function and COPD susceptibility/severity in smokers.

Methods

Eight ALOX5AP, six LTA4H and six LTB4R single nucleotide polymorphisms (SNPs) were genotyped in a UK Smoking Cohort (n = 992). Association with baseline lung function (FEV1 and FEV1/FVC ratio) was determined by linear regression. Logistic regression was used to compare smoking controls (n = 176) with spirometry-defined COPD cases (n = 599) and to more severe COPD cases (GOLD stage 3 and 4, n = 389).

Results

No association with ALOX5AP, LTA4H or LTB4R survived correction for multiple testing. However, we showed modest association with LTA4H rs1978331C (intron 11) with increased FEV1 (p = 0.029) and with increased FEV1/FVC ratio (p = 0.020).

Conclusions

These data suggest that polymorphisms spanning ALOX5AP, LTA4H and the LTB4R locus are not major determinants of baseline lung function in smokers, but provide tentative evidence for LTA4H rs1978331C (intron 11) in determining baseline FEV1 and FEV1/FVC ratio in Caucasian Smokers in addition to our previously identified role in asthma susceptibility.
A survey of engagement and competence levels in interventions and activities in a community mental health workforce in England
Authors: Lang Linda , Orton Sophie , Sallah David , Hewitt-Moran Teresa , Zhang Dongmei , Cullen Sean , Dixon Sheila , Bell Brian , Bell David , Meeson Lesley , Chen Ruoling
Published: December 2011

Background

National Health Service (NHS) mental health workforce configuration is at the heart of successful delivery, and providers are advised to produce professional development strategies. Recent policy changes in England have sharpened the focus on competency based role development. We determined levels of intervention activities, engagement and competence and their influencing factors in a community-setting mental health workforce.

Methods

Using a modified questionnaire based on the Yorkshire Care Pathways Model we investigated 153 mental health staff working in Coventry and Warwickshire NHS Trust. A median score of competence was computed across 10 cluster activities. Low engagement and competence levels were examined in a logistic regression model.

Results

In 220 activities, Monitoring risk was the highest rate of engagement (97.6%) and Group psychological therapy/Art/Drama therapy was the lowest engagement (3.6%). The median competence level based on all activities was 3.95 (proficient). There were significant differences in the competence level among professional groups; non-qualified support group (3.00 for competent), Counsellor/Psychologist/Therapist (3.38), Occupational therapists (3.76), Nurses (4.01), Medical staff (4.05), Social workers (4.25) and Psychologists (4.62 for proficient/expert). These levels varied with activity clusters; the lowest level was for Counsellor/Psychologist/Therapist in the accommodation activity (1.44 novice/advance beginner) and the highest for Occupational therapists in personal activity (4.94 expert). In a multivariate analysis, low competence was significantly related to non-qualified community support professions, late time of obtaining first qualification, more frequencies of clinical training, and training of cognitive behavioural therapy. The associations were similar in the analysis for 10 activity clusters respectively.

Conclusions

There was a reasonable competence level in the community-setting mental health workforce, but competence varied with professional groups and cluster activities. New staff and other non-qualified support professions need to receive efficient training, and the training content is more important than frequency to increase level of competence.
Earlier surgical intervention in congenital heart disease results in better outcome and resource utilization
Authors: Panni Roheena Z , Ashfaq Awais , Amanullah Muhammad M
Published: December 2011

Background

Congenital heart disease (CHD) accounts for a major proportion of disease in the pediatric age group. The objective of the study was to estimate the cost of illness associated with CHD pre, intra and postoperatively; among patients referred to a tertiary care hospital in Karachi, Pakistan. This is the first study conducted to estimate the cost of managing CHD in Pakistan.

Methods

A prevalence based cost of illness study design was used to estimate the cost of cardiac surgery (corrective & palliative) for congenital heart defects in children ≤ 5 years of age from June 2006 to June 2009. A total of 120 patients were enrolled after obtaining an informed consent and the data was collected using a pre-tested questionnaire.

Results

The mean age at the time of surgery in group A (1-12 mo age) was 6.08 ± 2.80 months and in group B (1-5 yrs) was 37.10 ± 19.94 months. The cost of surgical admission was found to be significantly higher in the older group, p = 0.001. The total number and cost of post-operative outpatient visits was also higher in group B, p = 0.003. Pre and post operative hospital admissions were not found to be significantly different among the two groups, p = 0.166 and 0.627, respectively. The number of complications were found to be different between the two groups (p = 0.019). Majority of these were contributed by hemorrhage and post-operative seizures.

Conclusion

This study concluded that significant expenditure is incurred by people with CHD; with the implication that resources could be saved by earlier detection and awareness campaigns.
The effects of varying protein and energy intakes on the growth and body composition of very low birth weight infants
Authors: Costa-Orvay Juan Antonio , Figueras-Aloy Josep , Romera Gerardo , Closa-Monasterolo Ricardo , Carbonell-Estrany Xavier
Published: December 2011

Objective

To determine the effects of high dietary protein and energy intake on the growth and body composition of very low birth weight (VLBW) infants.

Study design

Thirty-eight VLBW infants whose weights were appropriate for their gestational ages were assessed for when they could tolerate oral intake for all their nutritional needs. Thirty-two infants were included in a longitudinal, randomized clinical trial over an approximate 28-day period. One control diet (standard preterm formula, group A, n = 8, 3.7 g/kg/d of protein and 129 kcal/kg/d) and two high-energy and high-protein diets (group B, n = 12, 4.2 g/kg/d and 150 kcal/kg/d; group C, n = 12, 4.7 g/kg/d and 150 kcal/kg/d) were compared. Differences among groups in anthropometry and body composition (measured with bioelectrical impedance analysis) were determined. An enriched breast milk group (n = 6) served as a descriptive reference group.

Results

Groups B and C displayed greater weight gains and higher increases in fat-free mass than group A.

Conclusion

An intake of 150 kcal/kg/d of energy and 4.2 g/kg/d of protein increases fat-free mass accretion in VLBW infants.
Orf virus DNA vaccines expressing ORFV 011 and ORFV 059 chimeric protein enhances immunogenicity
Authors: Zhao Kui , He Wenqi , Gao Wei , Lu Huijun , Han Tiesuo , Li Jing , Zhang Ximu , Zhang Bingbing , Wang Gaili , Su Gaoli , Zhao Zhihui , Song Deguang , Gao Feng
Published: December 2011

Background

ORFV attenuated live vaccines have been the main prophylactic measure against contagious ecthyma in sheep and goats in the last decades, which play an important role in preventing the outbreak of the disease. However, the available vaccines do not induce lasting immunity in sheep and goats. On the other hand, variation in the terminal genome of Orf virus vaccine strains during cell culture adaptation may affect the efficacy of a vaccine. Currently, there are no more effective antiviral treatments available for contagious ecthyma.

Results

We constructed three eukaryotic expression vectors pcDNA3.1-ORFV011, pcDNA3.1-ORFV059 and pcDNA3.1-ORFV011/ORFV059 and tested their immunogenicity in mouse model. High level expression of the recombinant proteins ORFV011, ORFV059 and ORFV011/ORFV059 was confirmed by western blotting analysis and indirect fluorescence antibody (IFA) tests. The ORFV-specific antibody titers and serum IgG1/IgG2a titers, the proliferation of lymphocytes and ORFV-specific cytokines (IL-2, IL-4, IL-6, IFN-γ, and TNF-α) were examined to evaluate the immune responses of the vaccinated mice. We found that mice inoculated with pcDNA3.1-ORFV 011/ORFV059 had significantly stronger immunological responses than those inoculated with pcDNA3.1-ORFV011, pcDNA3.1-ORFV059, or pcDNA3.1-ORFV011 plus pcDNA3.1-ORFV059. Compared to other vaccine plasmids immunized groups, pcDNA3.1-ORFV011/ORFV059 immunized group enhances immunogenicity.

Conclusions

We concluded that DNA vaccine pcDNA3.1-ORFV011/ORFV059 expressing ORFV011 and ORFV059 chemeric-proteins can significantly improve the potency of DNA vaccination and could be served as more effective and safe approach for new vaccines against ORFV.
Reconciling research and implementation in micro health insurance experiments in India: study protocol for a randomized controlled trial
Authors: Doyle Conor , Panda Pradeep , Van de Poel Ellen , Radermacher Ralf , Dror David M
Published: December 2011

Background

Microinsurance or Community-Based Health Insurance is a promising healthcare financing mechanism, which is increasingly applied to aid rural poor persons in low-income countries. Robust empirical evidence on the causal relations between Community-Based Health Insurance and healthcare utilisation, financial protection and other areas is scarce and necessary. This paper contains a discussion of the research design of three Cluster Randomised Controlled Trials in India to measure the impact of Community-Based Health Insurance on several outcomes.

Methods/Design

Each trial sets up a Community-Based Health Insurance scheme among a group of micro-finance affiliate families. Villages are grouped into clusters which are congruous with pre-existing social groupings. These clusters are randomly assigned to one of three waves of implementation, ensuring the entire population is offered Community-Based Health Insurance by the end of the experiment. Each wave of treatment is preceded by a round of mixed methods evaluation, with quantitative, qualitative and spatial evidence on impact collected. Improving upon practices in published Cluster Randomised Controlled Trial literature, we detail how research design decisions have ensured that both the households offered insurance and the implementers of the Community-Based Health Insurance scheme operate in an environment replicating a non-experimental implementation.

Discussion

When a Cluster Randomised Controlled Trial involves randomizing within a community, generating adequate and valid conclusions requires that the research design must be made congruous with social structures within the target population, to ensure that such trials are conducted in an implementing environment which is a suitable analogue to that of a non-experimental implementing environment.
Altered Expression of Diacylglycerol Kinase Isozymes in Regenerating Liver
Authors: Nakano Tomoyuki , Hozumi Yasukazu , Iwazaki Kiyoshi , Okumoto Kazuo , Iseki Ken , Saito Takafumi , Kawata Sumio , Wakabayashi Ichiro , Goto Kaoru
Published: December 2011

The liver possesses the capacity to restore its function and mass after injury. Liver regeneration is controlled through complicated mechanisms, in which the phosphoinositide (PI) cycle is shown to be activated in hepatocytes. Using a rat partial hepatectomy (PH) model, the authors investigated the expression of the diacylglycerol kinase (DGK) family, a key enzyme in the PI cycle, which metabolizes a lipid second-messenger diacylglycerol (DG). RT-PCR analysis shows that DGKζ and DGKα are the major isozymes in the liver. Results showed that in the process of regeneration, the DGKζ protein, which is detected in the nucleus of a small population of hepatocytes in normal liver, is significantly increased in almost all hepatocytes. However, the mRNA levels remain largely unchanged. Double labeling with bromodeoxyuridine (BrdU), an S phase marker, reveals that DGKζ is expressed independently of DNA synthesis or cell proliferation. However, DGKα protein localizes to the cytoplasm in normal and regenerating livers, but immunoblot analysis reveals that the expected (80 kDa) and the lower (70 kDa) bands are detected in normal liver, whereas at day 10 after PH, the expected band is solely recognized, showing a different processing pattern of DGKα in liver regeneration. These results suggest that DGKζ and DGKα are involved, respectively, in the nucleus and the cytoplasm of hepatocytes in regenerating liver.
Multiplex Immunoassays of Peptide Hormones Extracted from Formalin-Fixed, Paraffin-Embedded Tissue Accurately Subclassify Pituitary Adenomas
Authors: Strathmann Frederick G , Borlee Grace , Born Donald E , Gonzalez-Cuyar Luis F , Huber Bertrand R , Baird Geoffrey S
Published: December 2011

BACKGROUND

The current gold standard for diagnostic classification of many solid-tissue neoplasms is immunohistochemistry (IHC) performed on formalin-fixed, paraffin-embedded (FFPE) tissue. Although IHC is commonly used, there remain important issues related to preanalytic variability, nonstandard methods, and operator bias that may contribute to clinically significant error. To increase the quantitative accuracy and reliability of FFPE tissue–based diagnosis, we sought to develop a clinical proteomic method to characterize protein expression in pathologic tissue samples rapidly and quantitatively.

METHODS

We subclassified FFPE tissue from 136 clinical pituitary adenoma samples according to hormone translation with IHC and then extracted tissue proteins and quantified pituitary hormones with multiplex bead-based immunoassays. Hormone concentrations were normalized and compared across diagnostic groups. We developed a quantitative classification scheme for pituitary adenomas on archived samples and validated it on prospectively collected clinical samples.

RESULTS

The most abundant relative hormone concentrations differentiated sensitively and specifically between IHC-classified hormone-expressing adenoma types, correctly predicting IHC-positive diagnoses in 85% of cases overall, with discrepancies found only in cases of clinically nonfunctioning adenomas. Several adenomas with clinically relevant hormone-expressing phenotypes were identified with this assay yet called “null” by IHC, suggesting that multiplex immunoassays may be more sensitive than IHC for detecting clinically meaningful protein expression.

CONCLUSIONS

Multiplex immunoassays performed on FFPE tissue extracts can provide diagnostically relevant information and may exceed the performance of IHC in classifying some pituitary neoplasms. This technique is simple, largely amenable to automation, and likely applicable to other diagnostic problems in molecular pathology.
Experimental Evidence for Nitrogen as a Deep Acceptor in ZnO
Authors: Tarun M.C. , Iqbal M. Zafar , McCluskey M.D. , Huso J. , Bergman L.
Published: December 2011

While zinc oxide is a promising material for blue and UV solid-state lighting devices, the lack of p-type doping has prevented ZnO from becoming a dominant material for optoelectronic applications. Over the past decade, numerous reports have claimed that nitrogen is a viable p-type dopant in ZnO. However, recent calculations by Lyons, Janotti, and Van de Walle [Appl. Phys. Lett. 95, 252105 (2009)] suggest that nitrogen is a deep acceptor. In our work, we performed photoluminescence (PL) measurements on bulk, single crystal ZnO grown by chemical vapor transport. Nitrogen doping was achieved by growing in ammonia. In prior work at room temperature, we observed a broad PL band at ∼1.7 eV, with an excitation threshold of ∼2.2 eV, consistent with the calculated configuration-coordinate diagram. In the present work, at liquid-helium temperatures, the PL emission increases in intensity and red-shifts by ∼0.2 eV. A peak is observed at 3.267 eV, which we tentatively attribute to an exciton bound to a nitrogen acceptor. Our experimental results indicate that nitrogen is indeed a deep acceptor and cannot be used to produce p-type ZnO.
Nitrocellulose and BKNO3 Based Igniters for Gun Systems.
Authors: Rozumov Eugene , Adam Carlton P. , Manning Thelma G. , Laquidara Joseph M. , Chung Kimberly , Park Duncan , Panchal Viral
Published: December 2011

Common igniters such as black powder, benite, and boron potassium nitrate (BKNO3) are routinely employed in all calibers of gun systems. Armament Research Development Engineering Center (ARDEC) has pursued efforts to improve the ignition of gun propellants which has been demonstrated to be the root cause of many tribulations for gun systems. We have developed several extrudable nitrocellulose-BKNO3 based igniter materials that are more energetic, and exhibit smaller ignition delay times than most traditional igniters. We have demonstrated this via static firing. High speed video during static testing has demonstrated significantly more consistent, intense, and rapid flame generation in comparison to Benite leading to improved ignition effectiveness of the propellant bed.
Gaussian distribution of Schottky barrier heights on SnO2 nanowires
Authors: Amorim Cleber A. , Berengue Olivia M. , Araújo Luana , Leite Edson R. , Chiquito Adenilson J.
Published: December 2011

In this work, we studied metal/SnO2 junctions using transport properties. Parameters such as barrier height, ideality factor and series resistance were estimated at different temperatures. Schottky barrier height showed a small deviation of the theoretical value mainly because the barrier was considered fixed as described by ideal thermionic emission-diffusion model. These deviations have been explained by assuming the presence of barrier height inhomogeneities. Such assumption can also explain the high ideality factor as well as the Schottky barrier height and ideality factor dependence on temperature.
Intravenous Sedation for Implant Surgery: Midazolam, Butorphanol, and Dexmedetomidine Versus Midazolam, Butorphanol, and Propofol
Authors: Kawaai Hiroyoshi , Tomita Shu , Nakaike Yoshihiro , Ganzberg Steven , Yamazaki Shinya
Published: December 2011

We compared the amnesic action, recovery process, and satisfaction of patients and surgeons after the use of 2 different sedation regimens for 40 patients undergoing scheduled implant surgery. Butorphanol, midazolam, dexmedetomidine (BMD) was administered to 20 patients who were maintained with continuous infusion of dexmedetomidine after the induction with butorphanol and midazolam, and butorphanol, midazolam, propofol (BMP) was administered to 20 patients who were maintained with continuous infusion of propofol after the induction with butorphanol and midazolam. To assess the amnesic action, the memory of local anesthesia, auditory memory, and visual memory were evaluated. The Trieger Dot Test (TDT) was applied during the recovery process. A questionnaire regarding the patient's feelings of the management of sedation was taken from each patient and was also filled out by the surgeon. The comparison between groups was analyzed by the Mann-Whitney U test. No significant differences in the amnesic action and the TDT were noted. Both methods also satisfied the patients and surgeons, as determined by the questionnaire results. In conclusion, both sedation regimens are appropriate for implant surgery.
Novel Approach to More Effective Plug and Abandonment Cementing Techniques
Authors: Ferg Thomas E. , Lund Hans-Jacob , Mueller Dan , Myhre Morten , Larsen Arne , Andersen Patrick , Lende Gunnar , Hudson Charlie , Prestegaard Cato , Field David
Published: December 2011

The effectiveness of a permanent abandonment plug is measured by its ability to bridge the wellbore cross section both vertically and horizontally, including all annuli, with a plugging medium which can withstand the rigors of the environment to which it is exposed (Figure 1 – Barrier Requirements). The most common method for placing a plug in cased hole with an uncemented annulus has required section milling of the casing, making a clean out run and underreaming of the open hole prior to placing a balanced cement plug. A new method is presented which creates a permanent abandonment plug through the use of a system which perforates uncemented casing, washes the annular space and then mechanically places the cement across the wellbore cross section in a single run. This paper outlines the design methods, laboratory testing and operational elements that were assessed during the development phase, as well as the results of field trials used to qualify this technique.