bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of various hygrothermal environments on the failure of adhesively bonded composite single-lap joints
Authors: Jeong Mun-Gyu , Kweon Jin-Hwe , Choi Jin-Ho
Published: March 2013

The effect of moisture and temperature on the strength of composite single-lap bonded joints were extensively investigated. Secondary bonded-joint specimens were immersed in tap water and 3.5% salt water at 71°C for different durations up to a maximum of 300 days. A total of 160 specimens were tested under six different moisture contents and two different temperature environments. Test results showed that while the strengths of the joints with 2.1% or more tap water moisture content decreased compared with those of dry joints, the strengths of pre-saturated joints with up to 1.0% moisture content increased at both room and elevated temperature. However, the strengths of saturated joints at 2.5% moisture content decreased by 34% (room temperature) and 44% (71°C) compared with those of the dry joints. In the joints with 1.0% or lower moisture content, the higher temperature environments resulted in slightly increased strengths, whereas the elevated temperature degraded the strengths in the joints with 2.1% or greater moisture content. The major failure modes of the joints were delamination and intralaminar failure of the composite adherend; the joints with high moisture content tested under elevated temperature showed cohesive failure of adhesive. The strengths and failure modes of the joints that were immersed in salt water did not show a remarkable difference from the joints that absorbed tap water.
Vancouver’s “EcoDensity” Planning Initiative: A Struggle over Hegemony?
Authors: Rosol Marit
Published: March 2013

The proclaimed aim of EcoDensity, an initiative of the former mayor of Vancouver, Canada, was the achievement of a more sustainable city development through densification of existing neighbourhoods. Since the invention of EcoDensity in summer 2006 it has become a highly debated topic. This paper aims at a critical analysis of how a planning strategy of densification tried to tie itself onto a discourse of sustainability, and also how it had to re-invent and reform itself through contestation and public debate in order to gain acceptance. Thus, the development of the strategy and its contestation are the focus of this paper. Theoretically informed by the theory on hegemony by Laclau and Mouffe, the paper shows why EcoDensity has been—although eventually approved by Council—a failing hegemonic strategy. By referring to a theory on hegemony, the paper theoretically captures practices and struggles around a particular ‘urban sustainability fix’.
Competitiveness AND Sustainability: Can ‘Smart City Regionalism’ Square the Circle?
Authors: Herrschel Tassilo
Published: March 2013

Increasingly, the widely established, globalisation-driven agenda of economic competitiveness meets a growing concern with sustainability. Yet, the practical and conceptual co-existence—or fusion—of these two agendas is not always easy. This includes finding and operationalising the ‘right’ scale of governance, an important question for the pursuit of the distinctly transscalar nature of these two policy fields. ‘New regionalism’ has increasingly been discussed as a pragmatic way of tackling the variable spatialities associated with these policy fields and their changing articulation. This paper introduces ‘smart (new) city-regionalism’, derived from the principles of smart growth and new regionalism, as a policy-shaping mechanism and analytical framework. It brings together the rationales, agreed principles and legitimacies of publicly negotiated polity with collaborative, network-based and policy-driven spatiality. The notion of ‘smartness’, as suggested here as central feature, goes beyond the implicit meaning of ‘smart’ as in ‘smart growth’. When introduced in the later 1990s the term embraced a focus on planning and transport. Since then, the adjective ‘smart’ has become used ever more widely, advocating innovativeness, participation, collaboration and co-ordination. The resulting ‘smart city regionalism’ is circumscribed by the interface between the sectorality and territoriality of policy-making processes. Using the examples of Vancouver and Seattle, the paper looks at the effects of the resulting specific local conditions on adopting ‘smartness’ in the scalar positioning of policy-making.
Laparoscopic‐Assisted Percutaneous Endoscopic Gastrostomy
Authors: Shimizu Yoshiyuki , Okuyama Hiroomi , Sasaki Takashi , Nose Satoko , Saka Ryuta
Published: March 2013

Background/Purpose: Percutaneous endoscopic gastrostomy (PEG) is a simplified catheter placement procedure for alimentation. Although the endoscopic approach to gastrostomy tube placement is a safe and well‐tolerated procedure in most patients, the PEG procedure is difficult in elderly patients disabled since childhood who have severe scoliosis and malpositioning of the stomach. We describe a simple and effective laparoscopic‐assisted PEG (LAPEG) technique that can be used for catheter placement in severely disabled patients. Methods: Thirteen severely disabled patients aged 14–57 years underwent gastrostomy tube placement with the LAPEG technique. After general anesthesia was achieved, an endoscope was placed into the stomach. Then, a 5‐mm camera port was inserted at the umbilicus, and a 3‐mm working port was inserted to identify and lift the optimal site for gastrostomy tube placement. After the 4‐point fixation of the stomach, the 20‐Fr gastrostomy tube was placed under endoscopic and laparoscopic observation. Results: All patients tolerated the procedure well, and there were no major complications. The procedure was successful, and all patients could feed via the tube. Conclusions: Elderly disabled patients who have been bedridden since childhood often have severe scoliosis and malpositioning of the stomach. Our LAPEG procedure is effective, well tolerated, and safe for gastrostomy tube placement in such elderly patients.
Determination of the mutagenic and genotoxic potential of simulated leachate from an automobile workshop soil on eukaryotic system
Authors: Alabi Okunola Adenrele , Omosebi Omotoyosi , Chizea Ifychukwwu
Published: March 2013

Contamination of soil and water bodies with spent engine oil and petroleum products is a serious ecological problem, primarily in the automobile workshops and garages. This has potential short and chronic adverse health risks. Information is currently scarce on the potential mutagenicity and genotoxicity of such wastes. In this study, the potential mutagenic and genotoxic effects of simulated leachate from automobile workshop soil in Sagamu, Ogun state, Nigeria, were investigated. The assays utilized were bone marrow micronucleus (MN) and chromosome aberration (CA), sperm morphology and sperm count in mice. The physicochemical analysis of the leachate was also carried out. Experiments were carried out at concentrations of 1, 5, 10, 25, 50, 75 and 100% (volume per volume; leachate:distilled water) of the leachate sample. MN analysis showed a concentration-dependent induction of micronucleated polychromatic erythrocytes across the treatment groups. In the CA test, there was concentration-dependent significant reduction in mitotic index and induction of different types of CAs. Assessment of sperm shape showed a significant increase in sperm abnormalities with significant decrease in mean sperm count in treated groups. Heavy metals analyzed in the tested sample are believed to contribute significantly to the observed genetic damage. This indicates that automobile workshop soil-simulated leachate contains potential genotoxic agents and constitutes a genetic risk in exposed human population.
Limbic Encephalitis Associated With Elevated Antithyroid Antibodies
Authors: Hacohen Yael , Joseph Sonia , Kneen Rachel , Eunson Paul , Lin Jean-Pierre , Vincent Angela , Lim Ming
Published: March 2013

Immune-mediated limbic encephalitis affects both adults and children. Patients typically present with seizures, memory problems, and imaging changes in the medial temporal lobes. Both paraneoplastic and nonparaneoplastic forms have been described in which the antibody to the voltage-gated potassium channel-complex associated protein, leucine-rich glioma-inactivated 1, is most commonly reported. Elevated antithyroid antibodies have also been reported in a range of neurological syndromes with encephalopathy, such as limbic encephalitis, often collectively termed Hashimoto encephalopathy, a condition whereby corticosteroids responsiveness with a complete recovery is commonly observed. Here we describe 3 children presenting with limbic encephalitis with elevated thyroid antibodies that did not respond to corticosteroids alone and required more aggressive immunotherapy, mirroring the slower treatment response that is more frequently seen in other immune-mediated forms of limbic encephalitis.
Long-Term Accidental Overdose of Levetiracetam in an Infant
Authors: Özkale Yasemin , Özkale Murat , Saygi Semra , Erol Ilknur
Published: March 2013

Levetiracetam is one of the new anticonvulsant drugs that has a high therapeutic index and potential antiepileptogenic effects. Herein, we report a patient with multidrug refractory epilepsy and Ohtahara syndrome who was accidentally administered 300 mg/kg/d for 35 days by her mother. To our knowledge, there are only a few cases of accidental overdose of levetiracetam in pediatric patients reported in the literature, and this case study is the first to report such a high and long-term dose in an infant who showed no adverse effects.
Drug Information—The Systematic Approach
Authors: Nathan Joseph P.
Published: March 2013

Proper drug information (DI) skills are essential for being a competent pharmacy practitioner. To effectively manage DI queries and clinical dilemmas, the practitioner should follow a systematic approach that includes identifying the requester, determining the “true” DI need and obtaining background information, categorizing the question, performing the search and analyzing the information, disseminating the information, and following up when appropriate. The practitioner must be mindful to couple the published literature with clinical experience, knowledge, and logic in order to achieve optimal clinical outcomes.
ℒ1 adaptive attitude control of satellites in elliptic orbits using solar radiation pressure
Authors: Lee Keum W , Singh Sahjendra N
Published: March 2013

The development of an ℒ1 adaptive control system for the control of satellites in elliptic orbits using solar radiation pressure is the subject of this article. The nonaffine-in-control spacecraft model includes the gravity gradient torque, the control torque produced by two solar flaps, and external time-varying disturbance torque. The objective is to control the pitch angle of the spacecraft using the solar flaps. The design is based on the ℒ1 adaptive control theory for the control of nonlinear nonautonomous uncertain systems. The control system includes an adaptation law based on the state prediction error. Unlike traditional adaptive systems, the control input is obtained by filtering an estimated control signal through a low-pass filter. In the closed-loop system, the designed adaptive law accomplishes large angle maneuver. A special feature of the control system using filtered signal is that it is possible to select large adaptation gains for fast adaptation and to obtain quantifiable performance bounds. Simulation results are presented which show that in the closed-loop system, precise pitch angle control is accomplished, despite parameter uncertainties and external disturbance input in the model.
Auxetic honeycombs with lossy polymeric infills for high damping structural materials
Authors: Murray Gabriel J , Gandhi Farhan
Published: March 2013

Structural grade materials with Young’s Modulus in the gigapascal range generally have very low damping, leading to requirement for auxiliary damping treatments in many applications. This article examines whether a high Young’s Modulus and damping level can simultaneously be realized by introducing lossy polymeric infills into auxetic aluminum honeycombs. Using finite element analysis, auxetic honeycombs with varying cell geometry and infill stiffness, loaded in the x- and y-directions, are examined. From the results, it is observed that the best performance is achieved when auxetic honeycombs with shallow inclined walls and short vertical walls are loaded in the x-direction. Young’s Modulus in excess of 10 GPa is achievable in combination with a loss factor of 5%. If a higher loss factor of 10% is required, Young’s Modulus in the range of 5.5–6.5 GPa can still be realized. The high loss factors achieved are attributed to the very high local strain levels in the polymeric infill in the central region of the cell between the top and the bottom cell walls, which are in close proximity, further increased by the large negative Poisson’s ratios of the configuration.
The Experience of Younger Adults Following Myocardial Infarction
Authors: Andersson Ewa Kazimiera , Borglin Gunilla , Willman Ania
Published: March 2013

The aim of this study was to elucidate the meaning of the experience of younger people (< 55 years) during their first year following a myocardial infarction. We analyzed 17 interviews using a phenomenological–hermeneutic method. The core theme and central phenomenon was the everyday fight to redress the balance in life, which encompassed an existential, physical, and emotional battle to regain a foothold in daily life. The aftermath of a life-threatening event involved a process of transition while at the same time creating a new meaning in life. Lack of energy and its impact on the complex interplay of midlife combined with unreasonable demands from employers and health care professionals seemed to color the experience of the informants. The knowledge gained in this study can constitute a valuable contribution to overall quality assurance in nursing care and the development of nursing interventions for the cardiac rehabilitation of younger patients.
Does End-of-Life Decision Making Matter?:
Authors: Ko Eunjeong , Nelson-Becker Holly
Published: March 2013

This qualitative pilot study explored perspectives, needs, and concerns relating to advance care planning among older homeless adults. Twenty-one older adults residing at a transitional housing facility in an urban area of the West coast were interviewed in person. Key emergent themes included discomfort with the topic, trust in God’s decisions, physicians preferred as decision makers, and planning is important but not an immediate concern. Further, people who are homeless want to be approached with sensitivity. Instead of simply eliciting life-sustaining treatment preferences of homeless people, health care professionals should assess their unique concerns and needs regarding death and dying, prepare them to consider their possible end-of-life situation, and assist them to plan in accordance with their needs.
Polyps and Polypoid Lesions of the Colon
Authors: Mansoor Sharmeen , Dolkar Tsetan , El-Fanek Hani
Published: March 2013

Context. A significant portion of colorectal biopsies are performed for evaluation of polyps or polypoid lesions. Accurately identifying these lesions will promote better patient care. Objective. Review of the pathology of major colon polyps and polypoid lesions and highlight the most diagnostically useful features and their molecular biology. Data source. Review of recent literature. Conclusions. Polypoid lesions of the colon can be thought of to be under 3 broad categories: syndromic, mesenchymal, and epithelial.
Posterior Ankle Impingement
Authors: Giannini Sandro , Buda Roberto , Mosca Massimiliano , Parma Alessandro , Di Caprio Francesco
Published: March 2013

Posterior ankle impingement is a common cause of chronic ankle pain and results from compression of bony or soft tissue structures during ankle plantar flexion. Bony impingement is most commonly related to an os trigonum or prominent trigonal process. Posteromedial soft tissue impingement generally arises from an inversion injury, with compression of the posterior tibiotalar ligament between the medial malleolus and talus. Posterolateral soft tissue impingement is caused by an accessory ligament, the posterior intermalleolar ligament, which spans the posterior ankle between the posterior tibiofibular and posterior talofibular ligaments. Finally, anomalous muscles have also been described as a cause of posterior impingement.
Optimization of hexametaphosphate-assisted extraction and functional characterization of palm kernel cake protein
Authors: Chee Kah-Leong , Ayob Mohd-Khan
Published: March 2013

Response surface methodology was applied to study the optimization of palm kernel cake protein (PKCP) hexametaphosphate-assisted extraction. The optimum PKCP yield (28.37%) when extracted using 1.50% sodium hexametaphosphate (SHMP) of pH 10, at 50 °C, and the 1:70 (w/v) ratio of cake-to-solvent was significantly ( P < 0.05) higher than the protein yield from an alkaline (pH 10) extraction (8.12 ± 0.24%). Differential scanning calorimetry (DSC) analysis showed a higher denatured temperature (99.78 °C) for PKCP as compared with alkaline extracted one (96.96 °C), suggesting that a less denatured protein population is obtained. Electrophoresis of the PKCP revealed that the protein has 11 bands with MW ranging from 2.11 to 83.19 kDa. Relative to soy protein isolate, PKCP showed higher surface hydrophobicity (165.96 vs. 51.51), better solubility at pH 7 (87.65% vs. 41.21%), oil-binding capacity (7.73 vs. 2.96 g/g) and emulsifying activity (178.50 vs. 32.57 m2/g), but lower water-binding capacity (0.36 vs. 11.70 g/g), emulsifying stability (32.24% vs. 43.08%), foaming capacity (20.8% vs. 100.0%) and foam stability (3.80 vs. 19.20 ml). PKCP contained the highest amount of glutamic acid (16.86 g/100 g protein) and followed by arginine (10.78 g/100 g protein). With respect to the 1991 standard of the FAO/WHO for preschool children, PKCP’s essential amino acid profile showed deficiencies. Therefore, it can be used as a complementary protein source by supplementing with a tryptophan-rich source, as this was the limiting amino acid.
The power of music in the lives of older adults
Authors: Creech Andrea , Hallam Susan , McQueen Hilary , Varvarigou Maria
Published: March 2013

A compelling body of research demonstrates that music continues to offer powerful potential for enhancing health and well-being in old age. Active music-making has been found to provide a source of enhanced social cohesion, enjoyment, personal development, and empowerment, and to contribute to recovery from depression and maintenance of personal well-being throughout these latter stages of adult life. Within a context where life expectancy at age 65 years is rising rapidly and yet where increasing numbers of older people are reported to be living in isolation or suffering from depression, this body of research has important implications for understanding how access to active music-making may enhance the lives of older people. This article reviews a body of literature relating to specific benefits of active participation in music-making amongst older people. A case study is presented, illustrating some of the key points from the literature. Some barriers to participation are identified and implications for older people and their carers are discussed.
Teasing, laughing and disciplinary humor: Staff–youth interaction in detention home treatment
Authors: Gradin Franzén Anna , Aronsson Karin
Published: March 2013

This study explores how disciplinary humor is deployed to shape and reshape social order in inter-generational encounters. Data are drawn from an ethnographic study of staff–resident encounters at a treatment home for boys (including about 30 hours of video recordings), focusing on sequential patterns in the local design of jokes and teasing, analyzing language and multimodal interaction in detail. It was found that staff and boys recurrently laughed together and teased each other by invoking local hierarchical positions such as child–adult. The intrinsic ambiguity of humor and teasing allowed staff members to engage in temporary breaches of social order, while simultaneously enforcing local rules of conduct. Similarly, the boys would joke with the staff, exaggerating or transgressing institutional and generational divides. But ultimately, the joking could also be seen to remind the participants of the very hierarchies that separate staff from residents and men from boys, or adults from children.
New Media Geographies and the Middle East
Authors: Christensen Miyase
Published: March 2013

This special issue of Television & New Media brings together current research on media technologies, society, and culture in the Middle East from diverse methodological and analytical perspectives. The topics addressed cover a wide spectrum: circulation of Arab music videos and public discourse; Lebanese bloggers and mediated public spheres; transnational television audiences and ontological security; social media, TV talk shows, and political change in Egypt; youth-generated Arab media and cultural politics; and the Arab Spring as an ephemeral communicative space. Together, the articles provide a panorama of how today’s multimodal media geographies and engaged actors reinscribe public cultures and politics in the Middle East.
Neck Strength Imbalance Correlates With Increased Head Acceleration in Soccer Heading
Authors: Dezman Zachary D.W. , Ledet Eric H. , Kerr Hamish A.
Published: March 2013

Background:

Soccer heading is using the head to directly contact the ball, often to advance the ball down the field or score. It is a skill fundamental to the game, yet it has come under scrutiny. Repeated subclinical effects of heading may compound over time, resulting in neurologic deficits. Greater head accelerations are linked to brain injury. Developing an understanding of how the neck muscles help stabilize and reduce head acceleration during impact may help prevent brain injury.

Hypothesis:

Neck strength imbalance correlates to increasing head acceleration during impact while heading a soccer ball.

Study Design:

Observational laboratory investigation.

Methods:

Sixteen Division I and II collegiate soccer players headed a ball in a controlled indoor laboratory setting while player motions were recorded by a 14-camera Vicon MX motion capture system. Neck flexor and extensor strength of each player was measured using a spring-type clinical dynamometer.

Results:

Players were served soccer balls by hand at a mean velocity of 4.29 m/s (±0.74 m/s). Players returned the ball to the server using a heading maneuver at a mean velocity of 5.48 m/s (±1.18 m/s). Mean neck strength difference was positively correlated with angular head acceleration (rho = 0.497; P = 0.05), with a trend toward significance for linear head acceleration (rho = 0.485; P = 0.057).

Conclusion:

This study suggests that symmetrical strength in neck flexors and extensors reduces head acceleration experienced during low-velocity heading in experienced collegiate players.

Clinical Relevance:

Balanced neck strength may reduce head acceleration cumulative subclinical injury. Since neck strength is a measureable and amenable strength training intervention, this may represent a modifiable intrinsic risk factor for injury.
Prolonged Refractory Hypotension Secondary to Amlodipine Overdose
Authors: Kambali Shrinivas , Alalawi Raed , Nugent Kenneth
Published: March 2013

Calcium channel blocker overdose is one of the leading causes of overdose death among cardiovascular medications. We present a patient with the highest reported dose of amlodipine ingestion in combination pill. She was asymptomatic initially and soon became hypotensive and obtunded. She was intubated for airway protection, gastric lavage was done, and activated charcoal was given. She was resuscitated with 4L 0.9% normal saline, calcium chloride, glucagon, insulin, and glucose infusions. Her hypotension worsened necessitating use of norepinephrine 200 µg/min, phenylephrine 200 µg/min, dopamine 50 µg/kg/min, and vasopressin 0.06 U/min concurrently. She continued to improve and was weaned off vasopressors and mechanical ventilation. Few cases of extremely high-dose ingestion have been reported. Patients may be normotensive but rapidly progress to shock depending on ingested dose. High doses are associated with shock, bradycardia, pulmonary edema, renal failure, and heart failure. The primary goal is to maintain adequate circulation. Therapy includes intravenous fluids, insulin, glucagon, vasopressors, calcium infusion, and atropine. Based on our patient and a review of literature, we conclude that patients with near-fatal calcium channel blocker ingestion usually have good outcomes with appropriate use of high-dose vasopressors, glucagon, and insulin.
Integration of Administrative Data and Chart Review for Reporting Health Care Utilization Among Children With Sickle Cell Disease
Authors: Raphael Jean L. , Tran Xuan G. , Mueller Brigitta U. , Giardino Angelo P.
Published: March 2013

Health care utilization of children with sickle cell disease (SCD) has been well documented due to an increase in the use of administrative data sets. While use of such data sources is relatively efficient and low cost, questions remain as to whether they provide sufficient information to fully characterize health care use. The aim of this study was to determine whether administrative data have the capacity to fully assess health care utilization among children with SCD. We studied the health care utilization of 154 low-income children with SCD in a managed care organization combining administrative data and medical record review. In our comparison, we found that administrative claims provided key information on the scope and location of health service use and that sole reliance on medical record review may undercount unique members and encounters.
Extending and Withholding Forgiveness to Josh Hamilton
Authors: Sanderson Jimmy , Emmons Betsy
Published: March 2013

Forgiveness plays a prominent role in social interaction yet has received scant attention in the parasocial realm. This research addresses this gap by investigating people extending or declining forgiveness to Major League Baseball player Josh Hamilton after an alcohol relapse. A thematic analysis of 474 postings in a discussion forum on the Texas Rangers official website was conducted. Analysis revealed that fans forgave Hamilton through (a) support; (b) “addiction is hard” narratives; (c) human condition attributions; and (d) justification and that forgiveness was withheld due to perceptions of Hamilton’s character flaws. The results suggest that when athletes transgress and accept responsibility, it facilitates increased similarity with fans who then engage in supportive communication, including forgiveness. Nevertheless, transgressions also may preclude forgiveness as some fans are unwilling to chance recidivism. The study concludes with implications and directions for future research, which include a recommendation that professional athletes accept responsibility for their wrongdoings to cultivate fan support and hasten the image repair process.
AAV-mediated expression of an ADAMTS13 variant prevents shigatoxin-induced thrombotic thrombocytopenic purpura
Authors: Jin Sheng-Yu , Xiao Juan , Bao Jialing , Zhou Shangzhen , Wright J. Fraser , Zheng X. Long
Published: March 2013

Key Points

Administration of AAV8-hAAT-mdtcs vector results in sustained expression of plasma ADAMTS13 activity and antigen. The AAV8-mediated expression of ADAMTS13 variant is a safe and efficacious approach for treatment of a murine model of TTP.
Use of tiotropium Respimat Soft Mist InhalerversusHandiHaler and mortality in patients with COPD
Authors: Verhamme Katia M.C. , Afonso Ana , Romio Silvana , Stricker Bruno C. , Brusselle Guy G.O. , Sturkenboom Miriam C.J.M.
Published: March 2013

Tiotropium, a long-acting anticholinergic, is deliveredviaHandiHaler orviaRespimat. Randomised controlled trials suggest that use of tiotropium Respimat increases the risk of dying. We compared the risk of mortality between tiotropium RespimatversusHandiHaler.

Within the Integrated Primary Care Information database, we defined a source population of patients, aged ≥40 years, with ≥1 year of follow-up. Based on prescription data, we defined episodes of tiotropium use (Respimat or HandiHaler). The risk of mortality, within these episodes, was calculated using a Cox proportional hazard regression analysis.

From the source population, 11 287 patients provided 24 522 episodes of tiotropium use. 496 patients died while being exposed to HandiHaler or Respimat. Use of Respimat was associated with almost 30% increased risk of dying (adjusted HR 1.27, 95% CI 1.03–1.57) with the highest risk for cardiovascular/cerebrovascular death (adjusted HR 1.56, 95% CI 1.08–2.25). The risk was higher in patients with co-existing cardiovascular disease (adjusted HR 1.36, 95% CI 1.07–1.73) than in patients without (adjusted HR 1.02, 95% CI 0.61–1.71).

Use of tiotropium Respimat was associated with an almost 30% increase of mortality compared with HandiHaler and the association was the strongest for cardiovascular/cerebrovascular death. It is unclear whether this association is causal or due to residual confounding by chronic obstructive pulmonary disease severity.
Relevance of an extensive follow-up after surgery for nonsmall cell lung cancer
Authors: Gourcerol Delphine , Scherpereel Arnaud , Debeugny Stephane , Porte Henri , Cortot Alexis B. , Lafitte Jean-Jacques
Published: March 2013

There are no international guidelines for an appropriate and cost-effective follow-up for resected nonsmall cell lung cancer (NSCLC).

We retrospectively reviewed the outcome of NSCLC patients after curative surgery. Follow-up included physical examination and chest radiography every 3 months, and chest computed tomography (CT) scan, bronchoscopy, abdominal ultrasound, brain CT scan and bone scan every 6 months for 3 years, then every year over the following 2 years. Prognostic factors and costs were analysed.

Median overall survival following surgery for NSCLC in 162 patients was 38.5 months. Recurrence occurred in 85 (52.5%) patients including 41 (48%) symptomatic subjects. Disease-free survival was similar between patients with asymptomatic recurrenceversussymptomatic patients (11.4versus12 months; p=0.41). Recurrence was detected by physical examination or chest radiography in 47 (55.3%) patients. Curative-intent therapy was provided in 18 (41%) out of 44 patients with asymptomatic recurrence and in four (10%) out of 41 symptomatic cases (p=0.001). Median overall survival from time of recurrence was higher in asymptomatic patients than in symptomatic patients (15.5versus7.2 months; p=0.001). The cost per year of life gained was USD32 700 (€22 397).

An extensive follow-up, with acceptable cost, may improve the outcome of patients with resected NSCLC through detection of asymptomatic recurrences; however, validation by prospective studies is required.
Simple functional performance tests and mortality in COPD
Authors: Puhan Milo A. , Siebeling Lara , Zoller Marco , Muggensturm Patrick , ter Riet Gerben
Published: March 2013

Exercise tests are important to characterise chronic obstructive pulmonary disease patients and predict their prognosis, but are often not available outside of rehabilitation or research settings. Our aim was to assess the predictive performance of the sit-to-stand and handgrip strength tests.

The prospective cohort study in Dutch and Swiss primary care settings included a broad spectrum of patients (n=409) with Global Initiative for Chronic Obstructive Lung Disease stages II to IV. To assess the association of the tests with outcomes, we used Cox proportional hazards (mortality), negative binomial (centrally adjudicated exacerbations) and mixed linear regression models (longitudinal health-related quality of life) while adjusting for age, sex and severity of disease.

The sit-to-stand test was strongly (adjusted hazard ratio per five more repetitions of 0.58, 95% CI 0.40–0.85; p=0.004) and the handgrip strength test moderately strongly (0.84, 95% CI 0.72–1.00; p=0.04) associated with mortality. Both tests were also significantly associated with health-related quality of life but not with exacerbations. The sit-to-stand test alone was a stronger predictor of 2-year mortality (area under curve 0.78) than body mass index (0.52), forced expiratory volume in 1 s (0.61), dyspnoea (0.63) and handgrip strength (0.62).

The sit-to-stand test may close an important gap in the evaluation of exercise capacity and prognosis of chronic obstructive pulmonary disease patients across practice settings.
CFTR dysfunction induces vascular endothelial growth factor synthesis in airway epithelium
Authors: Martin Clémence , Coolen Nathalie , Wu Yongzheng , Thévenot Guiti , Touqui Lhousseine , Prulière-Escabasse Virginie , Papon Jean-François , Coste André , Escudier Estelle , Dusser Daniel J. , Fajac Isabelle , Burgel Pierre-Régis
Published: March 2013

Peribronchial angiogenesis may occur in cystic fibrosis and vascular endothelial growth factor (VEGF)-A regulates angiogenesis in airways.

Peribronchial vascularity and VEGF-A expression were examined using immunocytochemistry and morphometric analysis in lung sections obtained in 10 cystic fibrosis patients at transplantationversus10 control nonsmokers, and in two strains of Cftr-deficient mice versus wild-type littermates. Airway epithelial NCI-H292 cells and primary cultures of noncystic fibrosis human airway epithelial cells were treated with cystic fibrosis transmembrane conductance regulator (CFTR) inhibitors (CFTR-inh172or PPQ-102) or transfected with a CFTR small interfering (si)RNA with or without a selective epidermal growth factor receptor tyrosine kinase inhibitor. Concentrations of VEGF-A and phosphorylated epidermal growth factor receptor were measured by ELISA.

Peribronchial vascularity was increased in cystic fibrosis patients, but not inCftr-deficient mice. VEGF-A immunostaining was localised to airway epithelium and was increased in cystic fibrosis patients and inCftr-deficient mice. In cultured airway epithelial cells, treatment with CFTR inhibitors or transfection with CFTR siRNA induced a twofold increase in VEGF-A production. CFTR inhibitors triggered epidermal growth factor receptor phosphorylation that was required for VEGF-A synthesis.

Cystic fibrosis airways at transplantation showed increased peribronchial vascularity and epithelial VEGF-A expression. CFTR dysfunction triggered epithelial synthesis of VEGF-A, which may contribute to vascular remodelling.
Sputum induction to aid diagnosis of smear-negative or sputum-scarce tuberculosis in adults in HIV-endemic settings
Authors: Peter Jonathan G. , Theron Grant , Singh Nevanda , Singh Avani , Dheda Keertan
Published: March 2013

Sputum induction can aid tuberculosis (TB) diagnosis, but adult data from HIV-endemic environments are limited, and it is unclear how performance varies depending on the clinical context (in-patientversusoutpatient), HIV status and whether patients are smear-negative or sputum-scarce.

696 adults with suspected smear-negative or sputum-scarce TB from Cape Town (South Africa) were referred for routine sputum induction. Liquid culture forMycobacterium tuberculosisserved as the reference standard.

82% (573 out of 696) of patients provided a specimen ≥1 mL, 83% (231 out of 278) of which were of adequate quality. 15% (96 out of 652) of sputum induction specimens were culture-positive, and this yield was higher among inpatientsversusoutpatients (17% (71 out of 408)versus10% (25 out of 244), p=0.01) and HIV-infectedversusuninfected patients (17% (51 out of 294)versus9% (16 out of 173), p=0.02), but similar for CD4 (>200versus≤200 cells·μL−1) and patient (smear-negativeversussputum-scarce) subcategories. Overall sensitivity (95% CI) of smear-microscopy was 49% (39–59%), higher among in-patientsversusoutpatients (55% (43–67%)versus32% (14–50%), p=0.05), but unaffected by HIV co-infection, CD4 count or patient type. 29% (203 out of 696) of patients commenced anti-TB treatment and sputum induction offered microbiological confirmation and susceptibility testing in only 47% (96 out of 203).

Under programmatic conditions in an HIV-endemic environment although the yield of culture was approximately two-fold higher amongst HIV-infected patients and inpatients, a fifth of all patients were unable to provide a specimen following sputum induction. Same-day microbiological diagnosis was only possible in ∼50% of patients.
Clostridium difficile infection in Italian urban hospitals: data from 2006 through 2011
Authors: Di Bella Stefano , Musso Maria , Cataldo Maria A , Meledandri Marcello , Bordi Eugenio , Capozzi Daniela , Cava Maria C , Chiaradonna Patrizia , Prignano Grazia , Petrosillo Nicola
Published: March 2013

Background

In developed countries, Clostridium difficile infection (CDI) represents an emerging threat in terms of morbidity and mortality rates. In our country limited CDI epidemiological data can be found.

We have conducted a 6-year retrospective study to evaluate the incidence of CDI in Italian urban hospitals.

Methods

Stool samples tested for C. difficile toxins from January 2006 to December 2011 in 5 large hospitals in Rome, Italy, were considered in the analysis. Repeated samples taken ≤ 2 months after a positive result were excluded.

Results

A total of 402 CDI episodes were identified. The incidence of CDI episodes progressively increased from 0.3 in 2006 to 2.3 per 10,000 patient-days in 2011. CDI episodes mostly occurred in patients > 60 years of age (77%). The >80 year-old age class reported the highest percentage of CDI episodes on tested samples (16%). Eighty percent (80%) of CDI episodes occurred in medical wards followed by surgery (10.2%) and intensive care units (9.8%).

Conclusions

A significant increasing incidence of CDI episodes over the study period was observed during the years (p<.001), particularly in the older age groups. Medical wards experienced the highest number of CDI episodes as compared to intensive care and surgical wards. The increasing rate of CDI episodes over the last six years in our country, is alarming; urgent improvements in the surveillance systems and control programs are advisable.
The Fit for School health outcome study - a longitudinal survey to assess health impacts of an integrated school health programme in the Philippines
Authors: Monse Bella , Benzian Habib , Naliponguit Ella , Belizario Vincente , Schratz Alexander , van Palenstein Helderman Wim
Published: March 2013

Background

Child health in many low- and middle-income countries lags behind international goals and affects children’s education, well-being, and general development. Large-scale school health programmes can be effective in reducing preventable diseases through cost-effective interventions. This paper outlines the baseline and 1-year results of a longitudinal health study assessing the impact of the Fit for School Programme in the Philippines.

Methods

A longitudinal 4-year cohort study was conducted in the province of Camiguin, Mindanao (experimental group); an external concurrent control group was studied in Gingoog, Mindanao. The study has three experimental groups: group 1—daily handwashing with soap, daily brushing with fluoride toothpaste, biannual deworming with 400 mg albendazole (Essential Health Care Program [EHCP]); group 2—EHCP plus twice-a-year access to school-based Oral Urgent Treatment; group 3—EHCP plus weekly toothbrushing with high-fluoride concentration gel. A non-concurrent internal control group was also included. Baseline data on anthropometric indicators to calculate body mass index (BMI), soil-transmitted helminths (STH) infection in stool samples, and dental caries were collected in August 2009 and August 2010. Data were analysed to assess validity of the control group design, baseline, and 1-year results.

Results

In the cohort study, 412 children were examined at baseline and 341 1 year after intervention. The baseline results were in line with national averages for STH infection, BMI, and dental caries in group 1 and the control groups. Children lost to follow-up had similar baseline characteristics in the experimental and control groups. After 1 year, group 1 showed a significantly higher increase in mean BMI and lower prevalence of moderate to heavy STH infection than the external concurrent control group. The increases in caries and dental infections were reduced but not statistically significant. The results for groups 2 and 3 will be reported separately.

Conclusions

Despite the short 1-year observation period, the study found a reduction in the prevalence of moderate to heavy STH infections, a rise in mean BMI, and a (statistically non-significant) reduction in dental caries and infections. The study design proved functional in actual field conditions. Critical aspects affecting the validity of cohort studies are analysed and discussed.

Trial registration

DRKS00003431 WHO Universal Trial NumberU1111-1126-0718
Determinants of health literacy and health behavior regarding infectious respiratory diseases: a pathway model
Authors: Sun Xinying , Shi Yuhui , Zeng Qingqi , Wang Yanling , Du Weijing , Wei Nanfang , Xie Ruiqian , Chang Chun
Published: March 2013

Background

Health literacy has been defined as the degree to which individuals have the capacity to obtain, process, and understand the basic health information and services needed to make appropriate health decisions. Currently, few studies have validated the causal pathways of determinants of health literacy through the use of statistical modeling. The purpose of the present study was to develop and validate a health literacy model at an individual level that could best explain the determinants of health literacy and the associations between health literacy and health behaviors even health status.

Methods

Skill-based health literacy test and a self-administrated questionnaire survey were conducted among 3222 Chinese adult residents. Path analysis was applied to validate the model.

Results

The model explained 38.6% of variance for health literacy, 11.7% for health behavior and 2.3% for health status: (GFI = 0.9990; RMR = 0.0521; χ2 = 10.2151, P = 0.1159). Education has positive and direct effect on prior knowledge (β = 0.324) and health literacy (β = 0.346). Health literacy is also affected by prior knowledge (β = 0.245) and age (β = -0.361). Health literacy is a direct influencing factor of health behavior (β = 0.101). The most important factor of health status is age (β = 0.107). Health behavior and health status have a positive interaction effect.

Conclusion

This model explains the determinants of health literacy and the associations between health literacy and health behaviors well. It could be applied to develop intervention strategies to increase individual health literacy, and then to promote health behavior and health status.
The association between asthma control, health care costs, and quality of life in France and Spain
Authors: Doz Marianne , Chouaid Christos , Com-Ruelle Laure , Calvo Eduardo , Brosa Max , Robert Julien , Decuypère Laurent , Pribil Celine , Huerta Alicia , Detournay Bruno
Published: March 2013

Background

Current asthma management guidelines are based on the level of asthma control. The impact of asthma control on health care resources and quality of life (QoL) is insufficiently studied. EUCOAST study was designed to describe costs and QoL in adult patients according to level of asthma control in France and Spain.

Methods

An observational cost of illness study was conducted simultaneously in both countries among patients age greater or equal to 18 with a diagnosis of asthma for at least 12 months. Patients were recruited prospectively by GPs in 2010 in four waves to avoid a seasonal bias. Health care resources utilization of the three months before the inclusion was collected through physician questionnaires. Asthma control was evaluated using 2009 GINA criteria over a 3-month period. QoL was assessed using EQ-5D-3L®.

Results

2,671 patients (France: 1,154; Spain: 1,517) were enrolled. Asthma was controlled in 40.6% [95% CI: 37.7% - 43.4%] and 29.9% [95% CI: 27.6% - 32.3%] of French and Spanish patients respectively.

For all types of costs, the percentage of patients using health care resources varied significantly according to the level of asthma control. The average cost (euros/3-months/patient) of controlled asthma was €85.4 (SD: 153.5) in France compared with €314.0 (SD: 2,160.4) for partially controlled asthma and €537.9 (SD: 2,355.7) for uncontrolled asthma (p<0.0001). In Spain, the corresponding figures were €152.6 (SD: 162.1), €241.2 (SD: 266.8), and €556.8 (SD: 762.4). EQ-5D-3L® score was higher (p<0.0001) in patients with controlled asthma compared to partially controlled and uncontrolled asthma in both countries (respectively 0.88; 0.78; 0.63 in France and 0.89; 0.82; 0.69 in Spain).

Conclusions

In both countries, patients presenting with uncontrolled asthma had a significantly higher asthma costs and lower scores of Qol compared to the others.
Intervention of Electroacupuncture on Spinal p38 MAPK/ATF-2/VR-1 Pathway in Treating Inflammatory Pain Induced by CFA in Rats
Authors: Fang Jian-Qiao , Du Jun-Ying , Liang Yi , Fang Jun-Fan
Published: March 2013

Background

Previous studies have demonstrated that p38 MAPK signal transduction pathway plays an important role in the development and maintenance of inflammatory pain. Electroacupuncture (EA) can suppress the inflammatory pain. However, the relationship between EA effect and p38 MAPK signal transduction pathway in inflammatory pain remains poorly understood. It is our hypothesis that p38 MAPK/ATF-2/VR-1 and/or p38 MAPK/ATF-2/COX-2 signal transduction pathway should be activated by inflammatory pain in CFA-injected model. Meanwhile, EA may inhibit the activation of p38 MAPK signal transduction pathway. The present study aims to investigate that anti-inflammatory and analgesic effect of EA and its intervention on the p38 MAPK signal transduction pathway in a rat model of inflammatory pain.

Results

EA had a pronounced anti-inflammatory and analgesic effect on CFA-induced chronic inflammatory pain in rats. EA could quickly raise CFA-rat's paw withdrawal thresholds (PWTs) and maintain good and long analgesic effect, while it subdued the ankle swelling of CFA rats only at postinjection day 14. EA could down-regulate the protein expressions of p-p38 MAPK and p-ATF-2, reduced the numbers of p-p38 MAPK-IR cells and p-ATF-2-IR cells in spinal dorsal horn in CFA rats, inhibited the expressions of both protein and mRNA of VR-1, but had no effect on the COX-2 mRNA expression.

Conclusions

The present study indicates that inhibiting the activation of spinal p38 MAPK/ATF-2/VR-1 pathway may be one of the main mechanisms via central signal transduction pathway in the process of anti-inflammatory pain by EA in CFA rats.