bluuebunny/crossref_metadata_2025 huggingface dataset:
Providing Nutrition Support in the Electronic Health Record Era
Authors: Vanek Vincent W.
Published: October 2012

Background: Data are not available on the quantity or quality of nutrition support content in the currently available electronic health record (EHR) systems. Materials and Methods: A survey study of the American Society for Parenteral and Enteral Nutrition membership regarding the safety and efficacy of nutrition documentation and the ordering process for oral diets, oral supplements, tube feedings, and parenteral nutrition in currently used EHRs was conducted. The responses were converted to a rating of excellent, good, fair, poor, or unacceptable for each component. Results: The survey responders rated all 5 of the above EHR nutrition components only as fair. There were no differences between disciplines regarding how they rated these nutrition components. The responders who had been using their EHR for more than 10 years rated these components as fair to good, which was significantly better than those responders who have been using their EHR for less than a year, who rated these components from poor to fair. There was some variation in ratings given to the 7 different EHR vendors used by the responders, with 2 vendors having significantly poorer ratings than the other vendors. However, even the top‐rated vendors received ratings of only fair. Conclusions: This study should be a wake‐up call for EHR developers/vendors, healthcare systems, and clinicians that the nutrition and nutrition support content of the current EHRs needs significant improvements. Nutrition support clinicians need to be actively involved in optimizing this EHR content.
Extending product lifecycle management for manufacturing knowledge sharing
Authors: Chungoora Nitishal , Gunendran George A , Young Robert IM , Usman Zahid , Anjum Najam A , Palmer Claire , Harding Jenny A , Case Keith , Cutting-Decelle Anne-Françoise
Published: October 2012

Product lifecycle management provides a framework for information sharing that promotes various types of decision-making procedures. For product lifecycle management to advance towards knowledge-driven decision support, then this demands more than simply exchanging information. There is, therefore, a need to formally capture best practice through-life engineering knowledge that can be fed back across the product lifecycle. This article investigates the interoperable manufacturing knowledge systems concept. Interoperable manufacturing knowledge systems use an expressive ontological approach that drives the improved configuration of product lifecycle management systems for manufacturing knowledge sharing. An ontology of relevant core product lifecycle concepts is identified from which viewpoint-specific domains, such as design and manufacture, can be formalised. Essential ontology-based mechanisms are accommodated to support the verification and sharing of manufacturing knowledge across domains. The work has been experimentally assessed using an aerospace compressor disc design and manufacture example. While it has been demonstrated that the approach supports the representation of disparate design and manufacture perspectives as well as manufacturing knowledge feedback in a timely manner, areas for improvement have also been identified for future work.
General Music Across the Life Span
Authors: Thibeault Matthew
Published: October 2012

This column explores aspects of general music with adult learners through the work of Dr. Sam Reese, who teaches jazz to lifelong learners through the Osher Lifelong Learning Institute. The author describes a visit to a session of the class focused on an in-depth exploration of Keith Jarrett’s 1978 recording of “My Song.” The article also contains an interview with Dr. Reese and Jean Peters, a student in the class. The interview touched on the value of having the class members attend live jazz, reflections on working with lifelong learners, aspects of the “Three-Minute Masterpieces” approach to class, and specific uses of technology in the class.
Prediction of cement damage for the Stanmore and Charnley femoral stems
Authors: Ramos António , Relvas Carlos , Completo António , Simões José A
Published: October 2012

Charnley and Stanmore cemented femoral stems are of the most studied stems and in vivo long-term results up to 15 and 20 years, respectively, have been published. The in vitro study hereby described correlates biomechanical factors such as stem position in the femoral canal, cement thickness and fatigue cracks with in vivo published results. Four of each femoral stems were loaded and tested in fatigue simulating stair climbing during one million cycles at 2 Hz. After the fatigue experiments all implanted femurs were sectioned and analyzed. Correlation between in vivo long-term published results with debonding and cracking was performed. Finite element models of the Stanmore and Charnley stems were used to predict tensile and compression stresses in the cement mantle to detect the critical regions and correlate these with experimental results. Within the analysis of the sections we observed some defects relatively to the positioning of the stems. The Stanmore stem was mainly placed in a valgus position while the Charnley stem was in a varus position. The number of cracks in the stem–cement interface was more visible for the Charnley stems. The lateral aspect was the most critical since more cracks were visible. Cement damage was more pronounced proximally and especially where cancellous bone presents higher thickness. The stems presented different behaviors in the cement–bone interface. The finite element results showed agreement between the maximum principal stresses and the regions of more cracks. The in vitro results are comparable with long-term in vivo published results. The experimental study hereby described can be used as a pre-clinical test to predict the performance of new implants before being launched into the market.
Micromechanically informed constitutive model and anisotropic damage characterization of Cosserat continuum for granular materials
Authors: Li Xikui , Du Youyao , Duan Qinglin
Published: October 2012

The microstructures of granular materials are represented by Voronoi cells generated with a Voronoi tessellation of discrete particle assembly. A Voronoi cell model including not only the reference particle laid inside the Voronoi cell but also its intermediate neighboring particles is presented to formulate micromechanically based macroscopic constitutive relations and constitutive modular tensors of effective Cosserat continuum. The anisotropy of effective Cosserat continuum due to intrinsic characters and deformation-induced evolutions of microstructure of granular materials of the Voronoi cell is quantitatively demonstrated. The derived micromechanically informed macroscopic constitutive relation of effective Cosserat continuum reveals that the Cauchy stresses are not only constitutively related to the strains but also to the curvatures defined in Cosserat continuum, likewise, the couple stresses are not only constitutively related to the curvatures but also to the strains. The derived modular tensors are verified by comparisons of them with those given for classical isotropic Cosserat continuum and are used to identify the elastic constitutive parameters of isotropic Cosserat continuum. The micromechanically informed macroscopic damage factor tensor to characterize anisotropic material damage of effective Cosserat continuum is formulated with no need specifying macroscopic phenomenological damage criterion and damage evolution law. The principal directions and values of the derived damage factor tensor along with numerical results reveal the microscopic mechanisms of macroscopic damage phenomenon, i.e. loss of contacts, re-orientation of contacts of the reference particle with its intermediate neighboring particles and concomitant volumetirc dilatation of the Voronoi cell.
Modeling creep damage of an aluminum–silicon eutectic alloy
Authors: Altenbach Holm , Kozhar Sergii , Naumenko Konstantin
Published: October 2012

Aluminum–silicon casting alloys are widely used in the automotive industry. The aim of this article is to analyze creep and creep damage of the eutectic AlSi12CuNiMg cast piston alloy and to present a constitutive model that reflect basic features of deformation, aging and damage behavior. Creep tests and force-controlled low cycle fatigue tests are carried out at several levels of temperature. Creep curves exhibit classical three stages. The tertiary creep stage is controlled by damage processes, mainly due to failure of the brittle inclusions and aging processes of the aluminum matrix. Ruptured specimens are analyzed with the help of optical and scanning electron microscopy to establish the fracture mode. A constitutive model is developed to describe the high temperature creep and ratcheting behavior. The proposed model involves three state variables including a back stress, an aging parameter and a damage variable. The model is calibrated against the creep and tensile curves and verified by numerical simulations of cyclic creep tests.
Cerebrovascular Remodeling and Epilepsy
Authors: Marchi Nicola , Lerner-Natoli Mireille
Published: October 2012

The role of the blood-brain barrier (BBB) in epilepsy has evolved from an obstacle for drug brain delivery to an etiological factor contributing to seizures. Recent evidence has shown cerebrovascular angiogenesis and increased BBB permeability in the epileptic foci of patients and in experimental models of seizure. The molecular players involved in cerebrovascular remodeling in the epileptic brain are similar to those reported for other brain disorders. The question arises whether pharmacological solutions restoring a proper BBB permeability and preventing dysregulated angiogenesis could be also beneficial in mitigating seizures. We now summarize the available data supporting the role of vascular remodeling and angiogenesis in the epileptic brain, taking into account that the BBB is a multi-cellular structure, reacting to physiological and pathological stimuli. Drugs targeting aberrant angiogenesis could be beneficial in reducing seizure burden when used in combination with available anti-epileptic drugs. We also offer an overview of novel cellular players, such as pericytes, which may participate in cerebrovascular remodeling in the epileptic brain. The possible role of angiogenesis in drug-resistant forms of epilepsy associated with neurovascular dysplasia is discussed. Finally, we speculate on whether the formation of leaky BBB vessels could have an impact on the cerebrovascular rheology and on the physiological mechanisms regulating brain homeostasis.
Synchronization and anti-synchronization of chaos for a multi-degree-of-freedom dynamical system by control of velocity
Authors: Qin Weiyang , Jiao Xudong , Sun Tao
Published: October 2012

For multi-degree-of-freedom dynamical systems, a novel control method was proposed to realize synchronization and anti-synchronization of chaos between the original and derived systems. The presented method was proved theoretically and realized by linear coupling of velocity. Furthermore, for any coupling coefficient larger than the critical value, the two systems can continue synchronization and anti-synchronization by the coupling method. This means that the synchronization and anti-synchronization can be kept within a wide range of coupling parameters. The simulation results for Duffing and Mathieu systems proved that the proposed method was correct and effective.
Self-Esteem, Self-Efficacy, and Resources in Adults With ADHD
Authors: Newark Patricia Elizabeth , Elsässer Marina , Stieglitz Rolf-Dieter
Published: October 2012

Objective: The purpose of this study is to shed light on therapy-relevant factors, such as self-esteem, self-efficacy, and resources in adults with ADHD in comparison with a healthy control group. Method: A total of 43 adults who met Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) criteria for ADHD in adulthood were matched with a nonclinical sample in terms of age and gender. All participants ( N = 86) were assessed with self-ratings: Symptom Checklist-90–Revised (SCL-90-R), Rosenberg Self-Esteem Scale, General Perceived Self-Efficacy Scale, and Dick’s Resources Checklist. Results: Adults with ADHD showed lower levels of self-esteem and self-efficacy when compared with the control group. The authors found some, but not all, of the resources of adults with ADHD to be reduced. In other words, people with ADHD seem to possess specific resources. Conclusion: Our results have important implications for the treatment of adult ADHD and suggest that specific therapy programs should include resources-oriented modules for enhancing self-esteem, self-efficacy, and fostering strengths.
Are ASD and ADHD a Continuum? A Comparison of Pathophysiological Similarities Between the Disorders
Authors: Kern Janet K. , Geier David A. , Sykes Lisa K. , Geier Mark R. , Deth Richard C.
Published: October 2012

Objective: The objective of this study was to review and compare the similarities between autism spectrum disorder (ASD) and ADHD with regard to symptomatology, neurological deficits, metabolic and endocrine-related conditions, and brain pathology. Method: A comprehensive review of the relevant research literature was carried out. Results: A number of important similarities between ASD and ADHD were identified, including recent increases in prevalence, male-biased incidence, shared involvement of sensory processing, motor and impulse control, abnormal patterns of neural connectivity, and sleep disturbances. Studies suggest involvement of androgen metabolism, impaired methylation, and heavy metal toxicity as possible contributing factors for both disorders. Conclusion: ASD and ADHD share a number of features and pathophysiological conditions, which suggests that the two disorders may be a continuum and have a common origin.
Rethinking benchmark dates in International Relations
Authors: Buzan Barry , Lawson George
Published: October 2012

International Relations has an ‘orthodox set’ of benchmark dates by which much of its research and teaching is organized: 1500, 1648, 1919, 1945 and 1989. This article argues that International Relations scholars need to question the ways in which these orthodox dates serve as internal and external points of reference, think more critically about how benchmark dates are established, and generate a revised set of benchmark dates that better reflects macro-historical international dynamics. The first part of the article questions the appropriateness of the orthodox set of benchmark dates as ways of framing the discipline’s self-understanding. The second and third sections look at what counts as a benchmark date, and why. We systematize benchmark dates drawn from mainstream International Relations theories (realism, liberalism, constructivism/English School and sociological approaches) and then aggregate their criteria. The fourth section of the article uses this exercise to construct a revised set of benchmark dates which can widen the discipline’s theoretical and historical scope. We outline a way of ranking benchmark dates and suggest a means of assessing recent candidates for benchmark status. Overall, the article delivers two main benefits: first, an improved heuristic by which to think critically about foundational dates in the discipline; and, second, a revised set of benchmark dates which can help shift International Relations’ centre of gravity away from dynamics of war and peace, and towards a broader range of macro-historical dynamics.
Factish relations: Affective bodies in diabetes treatment
Authors: Danholt Peter
Published: October 2012

Chronic diseases pose a major challenge to contemporary western healthcare systems, and consequently there are numerous initiatives designed to meet these challenges. Patient empowerment is considered to be extremely important in chronic disease management. But what does it mean to become an ‘active patient’, managing a condition? This article argues that people are always active in shaping their agency and the agency of numerous others, and that we need to attend to these processes of configuration in order to better understand and conceptualize the problem of chronic disease management. This article analyses the daily practices of people with Type 2 Diabetes, with the use of what is described as the ‘sociology of attachment’ in the field of science and technology studies. The implications of seeing and analysing chronic conditions in this manner are that determinist understandings of chronic conditions are challenged. Accordingly, an experimental and constructive attitude towards the production and assembling of the chronically ill body is enabled. Such an attitude holds that relations with multiple other bodies and entities, such as technologies, the disease, medication and so on continuously and relentlessly affect how the condition unfolds and consequently, the room for interventional strategies and transformation of the chronically ill body is enlarged.
Translating biomedical science into clinical practice: Molecular diagnostics and the determination of malignancy
Authors: Cox Helen , Webster Andrew
Published: October 2012

The identification of new biomarkers that help understand the epidemiological basis of patterns of malignancy at a population level is reshaping conceptions of health, disease and normality. These developments create new challenges for clinicians and the ways in which they work with scientists and engage with patients. Bioclinical collectives, an assemblage of laboratory and clinical evidence and practice, comprise different expert groups of scientists and clinicians who typically enact their expertise through boundary work to establish some degree of jurisdictional authority over their practice. Serra (2010) has argued for the existence of ‘medical technocracies’ wherein each speciality involved defines the boundaries between themselves in daily medical practices and use technology as a resource to construct their particular strategies. In this article we explore these two aspects of biomedical expertise – the collective and the boundaried domains of diagnostic practice (especially in regard to clinical utility) – to understand how haematological malignancy and disease are perceived and managed. The empirical data for the article are based on extensive primary research in hospitals based in the north of the UK, and among clinicians and laboratory scientists working in haematological malignancies. Our chosen field of inquiry – a haematological malignancy diagnostic service in the UK – is a particularly rich site through which to explore these twin aspects.
University Restructuring and the Reconfiguration of Faculty Members’ Work Context in a Public State University in Mexico
Authors: Montero-Hernandez Virginia , Levin John S.
Published: October 2012

This study describes the effects of neo-liberal restructuring for universities upon the reconfiguration of academics’ work context in a public state university in Mexico. Findings show that implementation of the federal program titled Faculty Enhancement Program during the late 1990s created a separation between traditional and new academic practices and values in the university. Analysis of the context illustrates ways in which State interventions lead to tensions over institutional goals and specifically the work of faculty.
Embracing Vulnerability: Completing the Autofictive Circle in Health Profession Education
Authors: Gingras Jacqui
Published: October 2012

In this autoethnography regarding the writing and sharing of an educational autofiction, I explore the vulnerability inherent in moving from the imagined to the real in a pedagogical context. Autoethnographic fiction is a scholarly method with the potential to disrupt traditional, science-based discourses dominant in health profession education. This potential was enacted in a senior undergraduate dietetics class when students were invited to read and write their own autoethnographies. Marked by vulnerability, I came to embody the transformative theory of being unfinalized as I endeavoured to resist the way things have always been in dietetics and make visible the emotional process of writing autoethnographic fiction as a move towards personal and social transformation.
Randomized Trial of Supervised Versus Unsupervised Optokinetic Exercise in Persons With Peripheral Vestibular Disorders
Authors: Pavlou Marousa , Bronstein Adolfo M. , Davies Rosalyn A.
Published: October 2012

Background. Visual vertigo (VV) symptoms improve only when customized vestibular rehabilitation (VR) integrates exposure to optokinetic stimuli (OK). However, equipment is expensive, biweekly sessions are not standard practice, and therapy is often unsupervised. Methods. A controlled, parallel-group comparison was made of patients’ responses to an 8-week customized program incorporating OK training via a full-field visual environment rotator (group OKF) or DVD (an optokinetic disc or drum rotating at 40° or 60° s−1), supervised (group OKS) or unsupervised (group OKU). A total of 60 participants with chronic peripheral vestibular symptoms were randomly allocated to 1 of 3 treatment groups: group OKF (n = 20) or OKS (n = 20), in which participants attended weekly sessions and were prescribed customized home exercises incorporating the DVD, or group OKU (n = 20) who practiced customized exercises and the DVD unsupervised. Treatment response was assessed at baseline and at 8 weeks with dynamic posturography, Functional Gait Assessment (FGA), and questionnaires for symptoms, symptom triggers, and psychological state. Results. No significant between-group differences were present at baseline or at post interventions. All groups showed significant within-group improvements for vestibular (ie, lightheadedness), VV, and autonomic symptoms ( P < .05). Posturography and FGA improved significantly for groups OKF and OKS ( P ≤ .01) as well as anxiety scores for group OKS ( P < .05) and depression for group OKF ( P < .05). Migraine significantly affected VV improvement (migraineurs improved more; P = .01). The drop-out rate was 55% for group OKU and 10% for each supervised group ( P < .01). Conclusions. The DVD may be an effective and economical method of integrating OK into VR. However, rehabilitation should be supervised for greater compliance and improvements, particularly for postural stability and psychological state.
Deficits in Motor Response to Avoid Sudden Obstacles During Gait in Functional Walkers Poststroke
Authors: van Swigchem Roos , van Duijnhoven Hanneke J. R. , den Boer Jasper , Geurts Alexander C. , Weerdesteyn Vivian
Published: October 2012

Background. Safe community ambulation requires the capacity to adapt gait to environmental changes on short notice. Reduced adaptability may contribute to an increased risk for falls. Objective. This study investigated gait adaptability in community-dwelling persons poststroke and sought to understand some of the mechanisms of reduced adaptability. Methods. Participants were 25 poststroke persons (Functional Ambulation Categories score 5) and 25 healthy controls of similar age. During treadmill walking, 30 obstacles were suddenly dropped in front of the affected leg or left leg of controls. The participants had to avoid the obstacle by either lengthening or shortening the ongoing stride. The obstacle avoidance success rates were determined. Electromyography activity of bilateral biceps femoris, rectus femoris, tibialis anterior, and gastrocnemius medialis muscles was recorded as well as concomitant knee and hip angle courses and spatial characteristics of the avoiding stride. Results. Poststroke persons demonstrated markedly decreased obstacle avoidance success rates, most prominently under time pressure. They showed normal avoidance strategies but had delayed and reduced electromyography responses, smaller joint angle deviations from unperturbed walking, and smaller horizontal margins from the foot to the obstacle. Conclusions. Even in persons who were only mildly affected by stroke, gait adaptability may be reduced, which may place them at risk of falling. Delayed and decreased muscle responses were identified as one possible mechanism with diminished ability to adapt the length of the avoiding stride. Rehabilitation interventions could focus on these impairments.
Traumatic Pseudoaneurysm of the Posterior Tibial Artery Treated by Endovascular Coil Embolization
Authors: Singh Dishan , Ferero Andrea
Published: October 2012

Pseudoaneurysms of the posterior tibial artery are rare, but a high index of suspicion should be maintained in evaluating patients who present with a painful swelling after arterial trauma. We report a case of a posterior tibial artery pseudoaneurysm in a young patient sustained from a laceration and associated profuse arterial bleeding. Because of the risk of rupture and the presence of an infection and high venous flow, an embolization of the aneurysm proximally and distally was carried out after verifying that distal collateral circulation ensured foot vascularization. Endovascular treatment of a pseudoaneurysm seems to be a safe therapeutic and noninvasive choice, particularly in young patients in whom the presence of collaterals guarantees distal vascularization and in whom the procedure can be safely performed in the presence of a superficial wound infection.

Levels of Evidence: Therapeutic Level IV, Case Study
Venous Thromboembolism and Foot and Ankle Surgery
Authors: Hentges Matthew J. , Peterson Kyle S. , Catanzariti Alan R. , Mendicino Robert W.
Published: October 2012

Abstract: Significant patient morbidity and mortality is associated with the development of venous thromboembolism (VTE) following orthopedic surgery. The majority of the literature supports proper prophylaxis following major orthopedic surgery involving hip and knee procedures. Foot and ankle surgery, however, is starkly contrasted because of the lack of recommendations. This article provides a comprehensive overview of the risk factors and incidence of VTE in foot and ankle surgery while also outlining the newest literature guidelines for prophylaxis.
Limb Salvage of Ankle Fracture Dislocation With LIMA External Fixator
Authors: Ross Adrianne JinLing , Little Jessica , Seligson David
Published: October 2012

Open ankle fractures with dislocation are potentially limb-threatening injuries with complications ranging from infection to amputation. External fixation has been used in trauma institutions for limb salvage, particularly in the setting of extensive soft tissue compromise. The authors present a case of an elderly woman with an open ankle fracture dislocation who underwent a staged surgical approach. A LIMA external fixator was used in conjunction with antibiotic beads and subsequent definitive open reduction with internal fixation. At 5-year follow-up, the patient demonstrated pain-free range of motion with a return to activity comparable to the preinjury state. The authors highlight the benefit of procedure staging in the presence of a severe fracture dislocation of the tibiotalar joint.

Levels of Evidence: Therapeutic, Level IV: Case Study
Case Report
Authors: Brown Michael J. C. , Yeoman Thomas F. M. , Roberts Sam , Pillai Anand
Published: October 2012

Brachymetatarsia is an abnormal shortening of a metatarsal. It causes disruption of the normal metatarsal parabola, resulting in metatarsalgia, calluses and dislocation of the digits. Patients often express discontent with the appearance of their feet. Lengthening by distraction osteogenesis and 1-stage intercalary bone grafting procedures are the mainstays of operative treatment. We present a modified 1-stage technique, combining the use of a Chevron osteotomy of the fourth metatarsal with shortening osteotomies of the second and third metatarsals. Bone removed from the third metatarsal was used to lengthen the fourth. The Chevron segments provided mediolateral, dorsoplantar, and rotational stability. The technique was used on both feet of 1 patient. The mean increase in AOFAS score was 34.5 (right foot, 46; left foot, 23.) There were no complications. A 1-stage technique does not require an external fixator or postoperative manipulation and has a quicker healing time. Taking the bone graft from neighboring metatarsals decreases the discrepancy between metatarsal lengths. A smaller increase in the length of the fourth ray is then required, and the chance of neurovascular injury as a result of soft-tissue stretching is minimized. This technique allows restoration of the metatarsal parabola and provides good correction, immediate stability, and good integration.

Levels of Evidence: Therapeutic Level IV, Case Study
Magnetic Resonance Imaging Versus Musculoskeletal Ultrasound for Identification and Localization of Plantar Plate Tears
Authors: Klein Erin E. , Weil Lowell , Weil Lowell Scott , Knight Jessica
Published: October 2012

Purpose: Plantar plate injuries have been identified as a cause of forefoot pain and deformity. Magnetic resonance imaging (MRI) and musculoskeletal ultrasound (US) have been suggested as appropriate imaging modalities for this pathology. A comparison of these two modalities utilizing intra-operatively pathology as the reference standard has not been published. Methodology: 51 feet of 42 consecutive patients presenting to clinic with forefoot pain and a suspected unilateral plantar plate tear at the 2nd metatarsophalangeal (MTP) joint were identified. A two plane (longitudinal and transverse) US was performed on the painful second MTP joint. Longitudinal ultrasound images were graded as ‘torn’ or ‘intact’. Transverse ultrasound images were used to localize pathology. All ultrasound exams were performed by the same reconstructive foot & ankle fellow. A pre-operative MRI was performed on these patients and read by a Fellowship Trained Musculoskeletal Radiologist. The physicians reading US and the MRI were blinded to each other’s findings. Results: All 51 feet were examined intra-operatively. 46 plantar plate tears were identified. The sensitivity, specificity, positive predictive value and negative value of MRI were 73.9%, 100%, 100%, 29.4% respectively while the same values for US were 91.5%, 25%, 91.5%, 25% respectively. MRI identified 4 collateral ligaments tears not identified on ultrasound. Discussion & Conclusions: Both MRI and US are appropriate modalities for imaging of the plantar plate. While US is a highly sensitive exam, MRI is a more specific exam. Overall these results do not suggest that MR should be replaced by US in all cases.

Level of Evidence: Diagnostic, Level I
Pneumococcal Meningitis, Cerebral Venous Thrombosis, and Cervical Arterial Dissection
Authors: Panicio Mauricio Isaac , Foresto Renato Demarchi , Mateus Lucas , Monzillo Paulo Helio , Alves Monique Bueno , Silva Gisele Sampaio
Published: October 2012

Background:

Pneumococcal meningitis in adults is widely associated with intracranial complications, which occur in up to 74.7% of the patients.

Method:

Case report.

Results:

We report the case of a 40-year-old white female with pneumococcal meningitis after a sinus surgery, who developed a concomitant cerebral venous thrombosis and multiple cervical artery dissections. Following treatment with antibiotics and intravenous heparin, she had complete neurological recovery.

Conclusions:

Vascular complications should always be remembered and adequately treated in patients with bacterial meningitis. Cervical arterial dissections should be investigated as potential embolic sources of intracranial ischemic lesions.
Revisiting the Multicultural Experience–Creativity Link
Authors: Cheng Chi-Ying , Leung Angela K.-y.
Published: October 2012

A growing literature provides evidence for the multicultural experience–creativity link such that exposure to the juxtaposition of two cultures facilitates individual creativity.  The underlying mechanisms for this relationship, however, are still far from being well explored.  Drawing upon the novel perspective of motivated cognition, we hypothesize that two factors interact to affect creative outcomes: (a) perceived cultural distance between the two juxtaposed cultures, and (b) comparison mind-sets.  Specifically, we argue that individuals’ creative performance will be increased only when a difference mind-set is employed to process the cultural stimuli that are sufficiently different from each other.  In two studies, individuals exposed to dual cultural primes with higher levels of perceived cultural distance consistently performed more adeptly in creative insight tasks when they personally predisposed to or experimentally manipulated to adopt a difference (vs. similarity) mind-set.  Theoretical and practical implications are discussed.
Gene Fusion Markup Language: a prototype for exchanging gene fusion data
Authors: Kalyana-Sundaram Shanker , Shanmugam Achiraman , Chinnaiyan Arul M
Published: October 2012

Background

An avalanche of next generation sequencing (NGS) studies has generated an unprecedented amount of genomic structural variation data. These studies have also identified many novel gene fusion candidates with more detailed resolution than previously achieved. However, in the excitement and necessity of publishing the observations from this recently developed cutting-edge technology, no community standardization approach has arisen to organize and represent the data with the essential attributes in an interchangeable manner. As transcriptome studies have been widely used for gene fusion discoveries, the current non-standard mode of data representation could potentially impede data accessibility, critical analyses, and further discoveries in the near future.

Results

Here we propose a prototype, Gene Fusion Markup Language (GFML) as an initiative to provide a standard format for organizing and representing the significant features of gene fusion data. GFML will offer the advantage of representing the data in a machine-readable format to enable data exchange, automated analysis interpretation, and independent verification. As this database-independent exchange initiative evolves it will further facilitate the formation of related databases, repositories, and analysis tools. The GFML prototype is made available athttp://code.google.com/p/gfml-prototype/.

Conclusion

The Gene Fusion Markup Language (GFML) presented here could facilitate the development of a standard format for organizing, integrating and representing the significant features of gene fusion data in an inter-operable and query-able fashion that will enable biologically intuitive access to gene fusion findings and expedite functional characterization. A similar model is envisaged for other NGS data analyses.
The human "magnesome": detecting magnesium binding sites on human proteins
Authors: Piovesan Damiano , Profiti Giuseppe , Martelli Pier Luigi , Casadio Rita
Published: October 2012

Background

Magnesium research is increasing in molecular medicine due to the relevance of this ion in several important biological processes and associated molecular pathogeneses. It is still difficult to predict from the protein covalent structure whether a human chain is or not involved in magnesium binding. This is mainly due to little information on the structural characteristics of magnesium binding sites in proteins and protein complexes. Magnesium binding features, differently from those of other divalent cations such as calcium and zinc, are elusive. Here we address a question that is relevant in protein annotation: how many human proteins can bind Mg2+? Our analysis is performed taking advantage of the recently implemented Bologna Annotation Resource (BAR-PLUS), a non hierarchical clustering method that relies on the pair wise sequence comparison of about 14 millions proteins from over 300.000 species and their grouping into clusters where annotation can safely be inherited after statistical validation.

Results

After cluster assignment of the latest version of the human proteome, the total number of human proteins for which we can assign putative Mg binding sites is 3,751. Among these proteins, 2,688 inherit annotation directly from human templates and 1,063 inherit annotation from templates of other organisms. Protein structures are highly conserved inside a given cluster. Transfer of structural properties is possible after alignment of a given sequence with the protein structures that characterise a given cluster as obtained with a Hidden Markov Model (HMM) based procedure. Interestingly a set of 370 human sequences inherit Mg2+ binding sites from templates sharing less than 30% sequence identity with the template.

Conclusion

We describe and deliver the "human magnesome", a set of proteins of the human proteome that inherit putative binding of magnesium ions. With our BAR-hMG, 251 clusters including 1,341 magnesium binding protein structures corresponding to 387 sequences are sufficient to annotate some 13,689 residues in 3,751 human sequences as "magnesium binding". Protein structures act therefore as three dimensional seeds for structural and functional annotation of human sequences. The data base collects specifically all the human proteins that can be annotated according to our procedure as "magnesium binding", the corresponding structures and BAR+ clusters from where they derive the annotation (http://bar.biocomp.unibo.it/mg).
Modelling osteomyelitis
Authors: Liò Pietro , Paoletti Nicola , Moni Mohammad Ali , Atwell Kathryn , Merelli Emanuela , Viceconti Marco
Published: October 2012

Background

This work focuses on the computational modelling of osteomyelitis, a bone pathology caused by bacteria infection (mostlyStaphylococcus aureus). The infection alters the RANK/RANKL/OPG signalling dynamics that regulates osteoblasts and osteoclasts behaviour in bone remodelling, i.e. the resorption and mineralization activity. The infection rapidly leads to severe bone loss, necrosis of the affected portion, and it may even spread to other parts of the body. On the other hand, osteoporosis is not a bacterial infection but similarly is a defective bone pathology arising due to imbalances in the RANK/RANKL/OPG molecular pathway, and due to the progressive weakening of bone structure.

Results

Since both osteoporosis and osteomyelitis cause loss of bone mass, we focused on comparing the dynamics of these diseases by means of computational models. Firstly, we performed meta-analysis on a gene expression data of normal, osteoporotic and osteomyelitis bone conditions. We mainly focused on RANKL/OPG signalling, the TNF and TNF receptor superfamilies and the NF-kB pathway. Using information from the gene expression data we estimated parameters for a novel model of osteoporosis and of osteomyelitis. Our models could be seen as a hybrid ODE and probabilistic verification modelling framework which aims at investigating the dynamics of the effects of the infection in bone remodelling. Finally we discuss different diagnostic estimators defined by formal verification techniques, in order to assess different bone pathologies (osteopenia, osteoporosis and osteomyelitis) in an effective way.

Conclusions

We present a modeling framework able to reproduce aspects of the different bone remodeling defective dynamics of osteomyelitis and osteoporosis. We report that the verification-based estimators are meaningful in the light of a feed forward between computational medicine and clinical bioinformatics.
Modelling and performance analysis of clinical pathways using the stochastic process algebra PEPA
Authors: Yang Xian , Han Rui , Guo Yike , Bradley Jeremy , Cox Benita , Dickinson Robert , Kitney Richard
Published: October 2012

Background

Hospitals nowadays have to serve numerous patients with limited medical staff and equipment while maintaining healthcare quality. Clinical pathway informatics is regarded as an efficient way to solve a series of hospital challenges. To date, conventional research lacks a mathematical model to describe clinical pathways. Existing vague descriptions cannot fully capture the complexities accurately in clinical pathways and hinders the effective management and further optimization of clinical pathways.

Method

Given this motivation, this paper presents a clinical pathway management platform, the Imperial Clinical Pathway Analyzer (ICPA). By extending the stochastic model performance evaluation process algebra (PEPA), ICPA introduces a clinical-pathway-specific model: clinical pathway PEPA (CPP). ICPA can simulate stochastic behaviours of a clinical pathway by extracting information from public clinical databases and other related documents using CPP. Thus, the performance of this clinical pathway, including its throughput, resource utilisation and passage time can be quantitatively analysed.

Results

A typical clinical pathway on stroke extracted from a UK hospital is used to illustrate the effectiveness of ICPA. Three application scenarios are tested using ICPA: 1) redundant resources are identified and removed, thus the number of patients being served is maintained with less cost; 2) the patient passage time is estimated, providing the likelihood that patients can leave hospital within a specific period; 3) the maximum number of input patients are found, helping hospitals to decide whether they can serve more patients with the existing resource allocation.

Conclusions

ICPA is an effective platform for clinical pathway management: 1) ICPA can describe a variety of components (state, activity, resource and constraints) in a clinical pathway, thus facilitating the proper understanding of complexities involved in it; 2) ICPA supports the performance analysis of clinical pathway, thereby assisting hospitals to effectively manage time and resources in clinical pathway.
Dotted collar placed around carotid artery induces asymmetric neointimal lesion formation in rabbits without intravascular manipulations
Authors: Kivelä Antti , Hartikainen Juha , Ylä-Herttuala Seppo
Published: October 2012

Background

Neointimal formation in atherosclerosis has been subject for intense research. However, good animal models mimicking asymmetrical lesion formation in human subjects have been difficult to establish. The aim of this study was to develop a model which would lead to the formation of eccentric lesions under macroscopically intact non-denuded endothelium.

Methods

We have developed a new collar model where we placed two cushions or dots inside the collar. Arterial lesions were characterized using histology and ultrasound methods.

Results

When this dotted collar was placed around carotid and femoral arteries it produced asymmetrical pressure on adventitia and a mild flow disturbance, and hence a change in shear stress. Our hypothesis was that this simple procedure would reproducibly produce asymmetrical lesions without any intraluminal manipulations. Intima/media ratio increased towards the distal end of the collar with the direction of blood flow under macroscopically intact endothelium. Macrophages preferentially accumulated in areas of the thickest neointima thus resembling early steps in human atherosclerotic plaque formation. Proliferating cells in these lesions and underlying media were scarce at eight weeks time point.

Conclusion

The improved dotted collar model produces asymmetrical human-like atherosclerotic lesions in rabbits. This model should be useful in studies regarding the pathogenesis and formation of eccentric atherosclerotic lesions.
Acute pulmonary embolism in the era of multi-detector CT: a reality in sub-Saharan Africa
Authors: Tambe Joshua , Moifo Boniface , Fongang Emmanuel , Guegang Emilienne , Juimo Alain Georges
Published: October 2012

Background

The advantages of multi-detector computed tomography (MDCT) have made it the imaging modality of choice for some patients with suspected cardiothoracic disease, of which pulmonary embolism (PE) is an exponent. The aim of this study was to assess the incidence of PE in patients with clinical suspicion of acute PE using MDCT in a sub-Saharan setting, and to describe the demographic characteristics of these patients.

Methods

Consecutive records of patients who underwent MDCT pulmonary angiography for suspected acute PE over a two-year period at the Radiology Department of a university-affiliated hospital were systematically reviewed. All MDCT pulmonary angiograms were performed with a 16-detector computed tomography (CT) scanner using real-time bolus tracking technique. Authorization for the study was obtained from the institutional authorities.

Results

Forty-one MDCT pulmonary angiograms were reviewed of which 37 were retained. Of the 4 excluded studies, 3 were repeat angiograms and 1 study was not technically adequate. Twelve of 37 patients (32.4%) had CT angiograms that were positive for PE, of which 7 were males. The mean age of these patients was 47.6±10.5 years (age range from 33 to 65 years). Twenty five patients out of 37 (67.6%) had CT angiograms that were negative for PE. Eleven PE-positive patients (91.7%) had at least 1 identifiable thromboembolic risk factor whilst 5 PE-negative patients (20%) also had at least a thromboembolic risk factor. The relative risk of the occurrence of PE in patients with at least a thromboembolic risk factor was estimated at 14.4.

Conclusion

Acute PE is a reality in sub-Saharan Africa, with an increased likelihood of MDCT evidence in patients with clinical suspicion of PE who have at least a thromboembolic risk factor. The increasing availability of MDCT will help provide more information on the occurrence of PE in these settings.
The association of sleep difficulties with health-related quality of life among patients with fibromyalgia
Authors: Wagner Jan-Samuel , DiBonaventura Marco D , Chandran Arthi B , Cappelleri Joseph C
Published: October 2012

Background

Difficulty sleeping is common among patients with fibromyalgia (FM); however, its impact on health-related quality of life (HRQoL) is not well understood. The aim of the current study was to assess the burden of sleep difficulty symptoms on HRQoL among patients with FM.

Methods

The current study included data from the 2009 National Health and Wellness Survey (N=75,000), which is a cross-sectional, Internet-based survey representative of the adult US population. The prevalence of sleep difficulty symptoms among patients with FM (n=2,196) were compared with matched controls (n=2,194), identified using propensity-score matching. Additionally, the relationship between the number of sleep difficulty symptoms (none, one, or two or more) and HRQoL (using the SF-12v2) was assessed using regression modeling, controlling for demographic and health history variables.

Results

Of the 2,196 patients with FM, 11.2% reported no sleep difficulty symptoms, 25.7% reported one sleep difficulty symptom, and 63.05% reported two or more sleep difficulty symptoms. The prevalence of sleep difficulty symptoms was significantly higher than matched controls. Patients with one and two sleep difficulty symptoms both reported significantly worse HRQoL summary and domain scores relative to those with no sleep difficulty symptoms (all p<.05). Further, the relationship between sleep difficulty symptoms and HRQoL was significantly different between those with FM than matched controls, suggesting a uniqueness of the burden of sleep difficulties within the FM population.

Conclusions

Among the FM population, sleep difficulty symptoms were independently associated with clinically-meaningful decrements in mental and physical HRQoL. These results suggest that greater emphasis in the treatment of sleep difficulty symptoms among the FM population may be warranted.