bluuebunny/crossref_metadata_2025 huggingface dataset:
Distending Straight‐Masculine Time: A Phenomenology of the Disabled Speaking Body
Authors: Pierre Joshua St.
Published: November 2014

Drawing upon feminist, queer, and crip phenomenology, this essay argues that the distinct temporality of the lived, stuttering body disturbs the normalized “choreography” of communication and thereby threatens the disabled speaker's recognition as a speaking subject. Examined through the phenomenology of Maurice Merleau‐Ponty and Alfred Schutz, the disabled speaking body is temporally “out of step” with the normalized bodily rhythms and pace of communicative practices in relation to both lived and objective time. Disciplined for his incalculable and therefore irrational bodily choreography, the disabled speaker is foregrounded against an objective, instrumentally ordered world constituted by a disembodied and hegemonic “straight‐masculine” time. Although dominant communicative choreographies may often be unlivable for disabled speakers, cripping communicative time rejects the cardinal value of futurity and invites interlocutors to gather in a noninstrumentalized and nonproductive present. This reshaping of communicative space enacts new modes of relationality and opens up an array of communicative futures suppressed or cut off by straight‐masculine time.
Low‐Temperature Sintered K0.5Na0.5NbO3‐Based Ceramics for Vibratory Gyro‐sensor Applications
Authors: Wong Mau Tak , Kwok Kin Wing
Published: November 2014

0.91K0.47Na0.47Li0.06NbO3‐0.09NaSbO3 lead‐free piezoelectric ceramics were prepared at 1000°C using a sintering aid comprising of Cu and Ba in a molar ratio of 71.5/28.5. A dense structure with a high density of 4.43 g/cm3 was obtained for the ceramic added with 2.5 wt% of the sintering aid. Probably due to the smaller grains and doping of Cu2+, the piezoelectric coefficient and dielectric loss were reduced to 120 pC/N and 1.0%, respectively. The ceramics were then fabricated into vibratory gyro sensors of dimensions 0.6 mm × 0.6 mm × 4 mm; and good sensitivity (~0.7 mV/dps) was obtained in the range of −360 to 360 dps.
Effect of Laser Drilling on the Microstructure and Luminescence of YAG:Ce,Si Phosphor Ceramics
Authors: Nien Yung‐Tang , Ma Chia‐Wei , Chen In‐Gann
Published: November 2014

Y3Al5O12:Ce,Si (YAG:Ce,Si) phosphor ceramics prepared by a solid‐state reaction method were drilled with an array of holes in a diameter of 100 μm. The laser‐induced heat‐affected zone surrounding the laser‐drilled holes with a ring width of about 150 μm was analyzed to consist of Y4Al2O9, YAlO3, and Al2O3 phases, induced by the phase transformations from the YAG melt during laser drilling. Photoluminescence study of the YAG:Ce,Si phosphor ceramic indicated variable blue light transmission and yellow emission, suggesting the potential of tuning blue/yellow intensity ratio as well as precise color control of light‐emitting diodes.
THE NON‐OPERATIVE MANAGEMENT OF GALLSTONES
Authors: Sali Avni , Iser John
Published: November 2014

During the last decade the non‐surgical management of gallbladder stones has become possible. Oral chenodeoxycholic acid (CDCA) and more recently, ursodeoxycholic acid (UDCA), have proved to be safe and effective. For the treatment of bile duct stones, various methods including flushing, chemical dissolution and mechanical procedures are now available. A combination of these techniques can be used in a logical sequence and should enable the successful treatment of most patients with bile ducts stones.
OPERATIVE LIVER BIOPSY ABNORMALITIES IN PATIENTS WITH FUNCTIONAL DISORDERS OF THE BILIARY TRACT
Authors: Ham J. M. , Bolin T. D. , Stevenson D. , Jefferies S. , Liddelow A.
Published: November 2014

The group of conditions variously termed biliary dyskinesia, acalculous cholecystitis, biliary pain without stones, or functional disorders of the biliary tract, is poorly defined clinically, and no consistent pathological abnormalities have been previously described in patients with this diagnosis. In this paper we report histological abnormalities encountered in operative liver biopsies in such patients.

The criteria for the diagnosis of a functional biliary tract disorders were: pain typical of biliary pain, negative results of investigations for organic biliary tract or other gastrointestinal disease, and reproduction of the patient's symptoms by cholecystokinin, or morphine, or both. Twenty of 45 patients with a presumptive diagnosis satisfied these criteria, and had a wedge liver biopsy at the time of operation. The 20 liver biopsy specimens were compared in a blind fashion with similar ones taken from patients having diagnostic laparotomies: patients with stones confined to the gallbladder; patients with gallstone pancreatitis; and patients with proven common bile duct stones. The biopsy findings were found to be similar to those in the latter two groups. Thus the abnormalities were similar to those found in partial or intermittent biliary obstruction, and it is suggested that they may be due to intermittent increases in biliary pressure.
UNRESECTABLE MALIGNANT OBSTRUCTION OF THE BILE DUCTS
Authors: Wong John , Lim S. T. K. , Lam K. H. , Ong G. B.
Published: November 2014

Over a 13‐year period we encountered 135 patients with malignant obstruction of the bile ducts, and in 81 of these patients only palliative surgery was possible. The type of operation was largely determined by the site and nature of the obstruction and the condition of the patient. The operative mortality of palliative operation was 37%. Relief of jaundice or pruritus was obtained in 68%, and this figure included a number of patients who died in the first 30 days. The majority of survivors lived for between three and four months after operation, although occasional patients have lived for more than one year.
CHOLEDOCHAL CYST: A REVIEW OF SEVEN CASES FROM AUCKLAND
Authors: Raudkivi Peter J. , Ferguson R. Stuart
Published: November 2014

This is a short review of the operative experience during the last decade with seven patients who presented with a choledochal cyst. A choledochal cyst is reported for the first time in a Polynesian. The relevant literature is briefly reviewed, with particular attention to operative management, which was found to carry a 10% mortality.
POSTTRAUMATIC VASCULAR MALFORMATIONS OF THE ORBIT
Authors: Connelley T. J.
Published: November 2014

The close association of the external and internal carotid circulations in the orbital cavity is well recognized. Two cases are presented in which local trauma to the orbit apparently resulted in the formation of an arteriovenous fistula. These lesions progressively expanded, producing classical features of proptosis, chemosis, and bruit. The investigation by selective angiograms and the surgical management of these malformations are discussed. A further case is presented in which an early lesion was noted in angiography after a head injury, with subsequent disappearance of the lesion some weeks later.
STENOTIC CONDITIONS OF THE LUMBAR SPINAL CANAL: CHANGES IN SURGICAL TECHNIQUES IN THE MANAGEMENT OF LOW BACK DISABILITY1
Authors: Selecki Borys Romuald
Published: November 2014

The diagnostic recognition of acquired stenotic conditions in the lumbar spinal canal occurring from the fifth to the eighth decades of life had led to a significant change in surgical techniques during the last ten years. This communication presents a comparison of surgical techniques used by the author in two consecutive series of patients operated for low back, lumbosciatic, and spondylotic caudal disability syndromes during the period 1965 to 1969 inclusive (100 patients) and 1976 and 1977 (105 patients). Interlaminar discectomy was carried out in 88%, and laminectomy with spinal nerve nerolysis in 12%, of the 1965 – 1969 series. Discectomy by interlaminar approach was carried out in only 10% of the 1976 – 1977 series; all other patients had laminectomies with or without discectomies. Early follow‐up results in the recent series indicate a significant (20%) increase in the number of patients who resumed their previous occupations as compared with those in the previous series.
SUPRACLAVICULAR TRACTION INJURIES OF THE BRACHIAL PLEXUS
Authors: Brophy Brian P.
Published: November 2014

Thirty supraclavicular traction injuries of the brachial plexus are reported. Young motor cyclists are frequently involved. Recovery is slow and often incomplete. Myelography remains the most useful investigation for prognostic purposes. The management of intractable pain is discussed. An early assessment of prognosis is an important fact in planning and supervising the long‐term management of these patients.
THE TREATMENT OF CARCINOMA OF THE STOMACH
Authors: Hughes E. S. R. , Johnson W. R.
Published: November 2014

A personal series of 220 patients with carcinoma of the stomach have been reviewed. Approximately 30% were regarded as suitable for curative resection; approximately 30% of the patients who underwent curative excision, survived five years; and approximately 30% surviving five years died of the disease before the 10th year. There were no early endoscopically diagnosed tumours in this series.
THE ORGANIZATION, METHODS, AND EXPERIENCE OF A PARENTERAL NUTRITION SERVICE
Authors: Thomas Robert J. S.
Published: November 2014

Malnutrition is an important component of prolonged illness. Parenteral nutrition can improve nutritional status, and its use is now common practice in certain disease states. In this paper the methods used by a parenteral nutrition service are described. The indications for, results from, and complications of, this form of therapy are also documented. This has been done on the basis of results obtained from a prospective survey of the use of parenteral nutrition in a major hospital over a one‐year period.
IMMUNE REACTIONS IN PATIENTS WITH BLADDER AND PROSTATIC CANCER1
Authors: Phillips T. M. , Lewis M. G.
Published: November 2014

Although there are many reports of cellular immune reactions in bladder and prostatic carcinoma patients, few have demonstrated the presence of humoral reactivity.

The use of microtechniques, especially the enzyme‐linked immunosorbent assay (ELISA), has made sequential studies possible on patients with early or small tumours. Using this assay, the presence of serum antibodies has been demonstrated in both bladder and prostate patients, the specificities of these reactions being checked against a battery of different tumours and normal tissues.

In many of the patients, with low or transient antibody levels, the presence of circulating immune complexes was shown by the Raji cell assay and analysed by double counter‐current immunoelectrophoresis (DCIE). The content of these complexes appeared to be either antibody and tumour antigen or antibody and antiimmunoglobulin.

In a small series of cryosurgically treated prostatic carcinoma patients, the course of these antibodies was monitored over several weeks, and the fluctuations in antibody levels were related to the presence of these different types of complexes.
SPONTANEOUS PERFORATION OF THE COMMON BILE DUCT: REPORT OF A CASE
Authors: Plehwe Walter E. , Glenn David C.
Published: November 2014

A case is reported of spontaneous perforation of the common bile duct in a 59‐year‐old woman. Recurrent episodes of epigastric and right hypochondriac pain over one year culminated in the onset of obstructive jaundice. There were no signs of peritonitis, and laparotomy revealed an abscess surrounding a perforation in the common bile duct just distal to the cystic duct. A cholesterol gallstone was present at the site of perforation. A paracolon bacterium, providence alcalifaciens, was isolated from the abscess. The patient made an uncomplicated recovery after cholecystectomy and drainage of the bile duct.
BRONCHOBILIARY FISTULA DUE TO HYDATID DISEASE: A CASE REPORT
Authors: Matar K. , Gardner M. A. H. , Courtice B. H. , Lomas C.
Published: November 2014

A case of bronchobiliary fistula due to transdiaphragmatic rupture of hepatic echinococcal cyst is described. The importance of excluding associated extrahepatic biliary obstruction is emphasized. Successful treatment involves relief of this obstruction as well as management of both the pleural space and pulmonary complications.
INSTRUMENTAL REMOVAL OF RETAINED STONES AFTER CHOLEDOCHOTOMY
Authors: Vellar Ivo D. , Gilford Eric , Incani Frank , McCoy James , Buls John
Published: November 2014

Despite the widespread use of operative cholangiography and choledoschoscopy. stones are still left behind after exploration of the common bile duct. Reoperation is associated with a significant morbidity and mortality. The use of a steerable catheter‐basket technique has enabled stones to be removed from the biliary tract in the vast majority of cases without significant complications and has practically eliminated the need for further surgery.
Insulating and Other Physical Properties of CoO‐Doped Zinc Oxyfluoride‐Borate Glass‐Ceramics
Authors: Naresh Padamati , Naga Raju Goli , Gandhi Yerramreddy , Piasecki Michal , Veeraiah Nalluri
Published: November 2014

Zinc oxy fluoro borate glasses mixed with different concentrations of CoO (ranging from 0 to 2.0 mol%) are synthesized and subsequently crystallized. The scanning electron microscopy pictures have exhibited crystallinity. Differential scanning calorimetric studies have indicated that the prepared samples consist of multiple crystal phases. The X‐ray diffraction patterns have indicated that the glass‐ceramic samples are composed of αZn(BO2)2, (Zn)3(BO3)2, CoF2, CoF3, Co3FB7O13, ZnCo2O4, Co3O4 crystalline phases. The optical absorption and photoluminescence studies have indicated that there is a gradual increase of tetrahedral cobalt ion concentration with increase of CoO concentration in the glass network. IR spectroscopic studies have pointed out increased degree of polymerization of the zinc oxy fluoro borate glass network with increase of CoO content. The analysis of results of dielectric properties indicated increase of insulating strength of the glass‐ceramics with increase of CoO content. Finally, the dielectric breakdown strength of the samples is measured at room temperature in air medium and it is found to increase from 12.9 to 19.2 kV/cm with increase of CoO from 0.2 to 2.0 mol%. The reasons for such increase of breakdown strength are discussed quantitatively in terms of dielectric parameters with aid of data on spectroscopic properties.
Zr4+/Ti4+ Codiffusion Characteristics in Lithium Niobate
Authors: Zhang De‐Long , Qiu Cong‐Xian , Du Wen‐Jie , Wong Wing‐Han , Pun Edwin Yue‐Bun
Published: November 2014

Zr4+/Ti4+‐codoped LiNbO3 plates were prepared by local codiffusion of stacked ZrO2 and Ti metal films coated onto Z‐cut congruent LiNbO3 substrates in wet O2 at 1060°C. The metal and oxide films have different thicknesses and coating sequences. After diffusion, the Zr4+ doping effect on the refractive index of LiNbO3 and the Li2O out‐diffusion issue were studied by the prism coupling technique. The codiffusion characteristics of Zr4+ and Ti4+ were studied by secondary ion mass spectrometry. The results show that the Zr4+ doping has little contribution to the refractive index of the crystal. Li2O out‐diffusion is not measurable. In the Zr4+‐only diffusion case, the diffusivity of Zr4+ is four times smaller than that of Ti4+. In the Zr4+/Ti4+ codiffusion case, the Ti4+ codiffusion assists the Zr4+ diffusion. The Zr4+ diffusivity increases linearly by two more times with the increase in initial Ti film thickness from 0 to 200 nm. On the other hand, the Zr4+ affects the Ti4+ diffusion little. Neither the ZrO2 film thickness nor the coating sequence of Ti metal and ZrO2 oxide films influences the diffusivity of the two ions. All the codiffusion characteristics are explained. A Zr4+/Ti4+ codiffusion model is suggested that consists of two independent diffusion equations with a Zr4+ diffusivity dependent of Ti4+ concentration and a constant Ti4+ diffusivity. In addition, the existence of a waveguide in the Zr4+/Ti4+‐codoped layer is verified experimentally, and the optical‐damage‐resistant feature of the waveguide is verified by two‐beam hologram recording experimental results.
Zinc Oxide Nanowire Decorated Single‐Use Electrodes for Electrochemical DNA Detection
Authors: Congur Gulsah , Ates Elif Selen , Afal Aysegul , Unalan Husnu Emrah , Erdem Arzum
Published: November 2014

The surfaces of pencil graphite electrodes (PGEs) were decorated with zinc oxide nanowires (ZnO NWs) for the electrochemical detection of nucleic acids. ZnO NWs were synthesized through simple hydrothermal method. PGEs decorated with ZnO NWs (ZnO NW/PGEs) were electrochemically characterized through cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS) following morphological characterization through transmission (TEM) and scanning electron microscopy (SEM). Enhanced sensor response obtained using ZnO NW/PGEs contrary to the bare PGE (control) samples. Our preliminary results simply reveal the potential of combining ZnO NWs with disposable sensor technology for the electrochemical detection of DNA.
Nursing casualization and communication: a critical ethnography
Authors: Batch Mary , Windsor Carol
Published: November 2014

Aim

The aim was to explore the relationship between nursing casualization and the culture of communication for nurses in a healthcare facility.

Background

Casualization, or non‐standard work, is the use of temporary, contract, part‐time and casual labour. An increase in casual labour has been part of a global shift in work organization aimed at creating a more flexible and cheaper workforce. It has been argued that flexibility of labour has enabled nurses to manage both non‐work related needs and an increasingly complex work environment. Yet no research has explored casualization and how it impacts on the communication culture for nurses in a healthcare facility.

Design

Critical ethnography.

Methods

Methods included observation, field notes, formal interviews and focus groups. Data collection was undertaken over the 2 years 2008–2009.

Results

The concepts of knowing and belonging were perceived as important to nursing teamwork and yet the traditional time/task work model, designed for a full‐time workforce, marginalized non‐standard workers. The combination of medical dominance and traditional stereotyping of the nurse and work as full‐time shaped the behaviours of nurses and situated casual workers on the periphery. The overall finding was that entrenched systemic structures and processes shaped the physical and cultural dimensions of a contemporary work environment and contributed to an ineffective communication culture.

Conclusion

Flexible work is an important feature of contemporary nursing. Traditional work models and nurse attitudes and practices have not progressed and are discordant with a contemporary approach to nursing labour management.
A mobile gamification learning system for improving the learning motivation and achievements
Authors: Su C‐H. , Cheng C‐H.
Published: November 2014

This paper aims to investigate how a gamified learning approach influences science learning, achievement and motivation, through a context‐aware mobile learning environment, and explains the effects on motivation and student learning. A series of gamified learning activities, based on MGLS (Mobile Gamification Learning System), was developed and implemented in an elementary school science curriculum to improve student motivation and to help students engage more actively in their learning activities. The responses to our questionnaire indicate that students valued the outdoor learning activities made possible by the use of a smartphone and its functions. Pre‐ and post‐test results demonstrated that incorporating mobile and gamification technologies into a botanical learning process could achieve a better learning performance and a higher degree of motivation than either non‐gamified mobile learning or traditional instruction. Further, they revealed a positive relationship between learning achievement and motivation. The correlation coefficient for ARCS dimensions and post‐test shows that the ARCS‐A (attention) is greater than ARCS‐R, ARCS‐C and ARCS‐S. This means that the attention (ARCS‐A) of this system is an important dimension in this research. The results could provide parents, teachers and educational organizations with the necessary data to make more relevant educational decision.
Do reciprocal associations exist between social and language pathways in preschoolers with autism spectrum disorders?
Authors: Bennett Teresa A. , Szatmari Peter , Georgiades Katholiki , Hanna Steven , Janus Magdelena , Georgiades Stelios , Duku Eric , Bryson Susan , Fombonne Eric , Smith Isabel M. , Mirenda Pat , Volden Joanne , Waddell Charlotte , Roberts Wendy , Vaillancourt Tracy , Zwaigenbaum Lonnie , Elsabbagh Mayada , Thompson Ann ,   The Pathways in ASD Study Team
Published: November 2014

Background

Differences in how developmental pathways interact dynamically in children with autism spectrum disorder (ASD) likely contribute in important ways to phenotypic heterogeneity. This study aimed to model longitudinal reciprocal associations between social competence (SOC) and language (LANG) pathways in young children with ASD.

Methods

Data were obtained from 365 participants aged 2–4 years who had recently been diagnosed with an ASD and who were followed over three time points: baseline (time of diagnosis), 6‐ and 12 months later. Using structural equation modeling, a cross‐lagged reciprocal effects model was developed that incorporated auto‐regressive (stability) paths for SOC (using the Socialization subscale of the Vineland Adaptive Behavior Scales‐2) and LANG (using the Preschool Language Scale‐4 Auditory Comprehension subscale). Cross‐domain associations included within‐time correlations and lagged associations.

Results

SOC and LANG were highly stable over 12 months. Small reciprocal cross‐lagged associations were found across most time points and within‐time correlations decreased over time. There were no differences in strength of cross‐lagged associations between SOC‐LANG and LANG‐SOC across time points. Few differences were found between subgroups of children with ASD with and without cognitive impairment.

Conclusions

Longitudinal reciprocal cross‐domain associations between social competence and language were small in this sample of young children with ASD. Instead, a pattern emerged to suggest that the two domains were strongly associated around time of diagnosis in preschoolers with ASD, and then appeared to become more independent over the ensuing 12 months.
Probiotic Properties of Enterococcus Strains Isolated from the Silage
Authors: Li Beibei , Zhen Hong , Zhang Xiaoyan , Wang Song , Zhang Yifei , Fang Zhijia , Huang Zhiwei , Shi Ping
Published: November 2014

This study aimed to identify and evaluate the probiotic properties of five Enterococcus strains isolated from the silage using in vitro screening assays. Their metabolites, antibiotic susceptibility, antimicrobial activity, as well as their survival in the gastrointestinal tract (GIT) and adhesive ability to human intestinal cells were investigated. Among eight selected antibiotics, all the isolates showed sensitive traits to six particular antibiotics including tetracycline and vancomycin. L2–L5 showed inhibition zones against Escherichia coli and Salmonella except that L6 only inhibited the growth of E. coli. The GIT proved that all the strains were able to survive in low pH and bile salt conditions and they all can adhere to LS‐174T intestinal cells. L2 and L5 were then chosen to examine their competition activity toward E. coli and inflammatory response. The results showed that both strains exhibited strong competition activities toward E. coli. The displacement ratios were 98.4 and 97.7%, respectively. Compared with E. coli, L2 showed lower stimulation of interleukin (IL)‐8 and IL‐1β, while L5 induced higher levels of cytokines to provoke an inflammatory response. Finally, the in vivo effect of L2 was investigated. The data showed that L2 was harmless. The results obtained suggest that L2 is potentially probiotic.

Practical Application

Enterococci are lactic acid bacteria that occur frequently in large numbers in various foods including vegetable, meat and dairy products. However, some of these bacteria are also recognized as nosocomial pathogens. Several properties may be evaluated to prove the potential of the bacteria before using them as probiotics. Results of this study indicated that five Enterococcus strains isolated from the mixed grass and corn stalk silage exhibited different capacties of antibiotic susceptibility, antimicrobial activity, tolerance to gastrointestinal conditions, adhesion to intestinal cells, and competitive exclusion of E. coli adhesion to epithelial cells and stimulation of immunity. Among these strains, L2 shows above‐average results in all probiotic criteria observed in vitro. Additionally, L2 was evaluated to be safe in mice feeding. The findings of our study suggest that L2 isolated from the silage may be potentially used as probiotic in humans.
Complementary roles of the neuron‐enriched endosomal proteins NEEP21 and calcyon in neuronal vesicle trafficking
Authors: Muthusamy Nagendran , Chen Yong‐Jun , Yin Dong‐Min , Mei Lin , Bergson Clare
Published: November 2014

Understanding mechanisms governing the trafficking of transmembrane (TM) cargoes to synapses and other specialized membranes in neurons represents a long‐standing challenge in cell biology. Investigation of the neuron‐enriched endosomal protein of 21 kDa (NEEP21, or NSG1or P21) and Calcyon (Caly, or NSG3) indicates that the emergence of the NEEP21/Caly/P19 gene family could play a vital role in the success of these mechanisms in vertebrates. The upshot of a sizeable body of work is that the NEEP21 and Caly perform distinct endocytic and recycling functions, which impact (i) α amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic acid‐type glutamate receptor trafficking at excitatory synapses; (ii) transport to/in neuronal axons; as well as (iii) proteolytic processing of amyloid precursor protein and neuregulin 1, suggesting roles in neuron development, synaptic function, and neurodegeneration. We argue that their distinct effects on cargo endocytosis and recycling depend on interactions with vesicle trafficking and synaptic scaffolding proteins. As they play complementary, but opposing roles in cargo endocytosis, recycling, and degradation, balancing NEEP21 and Caly expression levels or activity could be important for homeostasis in a variety of signaling pathways, and also lead to a novel therapeutic strategy for disorders like Alzheimer's disease and schizophrenia.

image

This review focuses on two closely related, neuron‐enriched endosomal proteins: NEEP21 and Calcyon which perform distinct roles in regulating receptor endocytosis, recycling, and degradation. Based on an in‐depth examination of the literature, we argue that these two proteins carry out complementary yet sometimes opposing vesicle trafficking functions that impact excitatory transmission, transcytosis, axonal transport, and also proteolytic processing by beta‐secretase I (BACE1). Finally, we propose that balancing NEEP21 and Calcyon expression and/or activity could be important for homeostasis in a variety of signaling pathways, and also lead to a novel therapeutic strategy for disorders like Alzheimer's disease and schizophrenia. AMPA = α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic acid receptor; NMDA = N‐Methyl‐D‐aspartate.
Progesterone and allopregnanolone improves stroke outcome in male mice via distinct mechanisms but neither promotes neurogenesis
Authors: Lee Rona J , Kim Joon Kyung , Chao Diana , Kuo Lisa , Mally Adheip , McClean Megan E. , Pemberton Heather E. , Wilmington Andrew R. , Wong Jennifer , Murphy Sean P.
Published: November 2014

Based on the outcome of a number of experimental studies, progesterone (PROG) holds promise as a new therapy for stroke. To understand more about the mechanisms involved, we administered PROG (or the major metabolite, allopregnanolone, ALLO), intra‐peritoneally, for a period of 24 h after transient middle cerebral artery occlusion to male mice variably expressing intracellular progesterone receptors (iPR) A/B. Effects on infarct volume and neurogenesis were then assessed up to 1 month later. Predictably, infarct volume in wild‐type mice receiving either drug was significantly smaller. However, mice heterozygous for iPRs A/B showed protection by ALLO but not by PROG. There was robust amplification of cell division in the wall of the lateral ventricle on the injured side of the brain, these cells migrated into the striatum and lateral cortex, and a significant number survived for at least 3 weeks. However, very few doublecortin‐positive cells emerged from the subventricular zone and subsequent expression of NeuN in these newborn neurons was extremely rare. Neither PROG nor ALLO amplified the rate of neurogenesis, suggesting that the long‐term benefits of acute drug administration results from tissue preservation.

image

Male mice derive long‐lasting benefit from progesterone and allopregnanolone after ischemic stroke. In mice heterozygous for iPRs, only allopregnanolone proved effective, suggesting distinct mechanisms. Abundant newborn cells were found in the wall of the lateral ventricle on the injured side (many doublecortin‐positive), some migrated into the striatum and lateral cortex, but very few survived as mature neurons. Neurosteroid administration did not amplify this process.
Yesterday's Heroes: Compensation and Risk at Financial Firms
Authors: CHENG ING‐HAW , HONG HARRISON , SCHEINKMAN JOSÉ A.
Published: November 2014

Many believe that compensation, misaligned from shareholders’ value due to managerial entrenchment, caused financial firms to take risks before the financial crisis of 2008. We argue that, even in a classical principal‐agent setting without entrenchment and with exogenous firm risk, riskier firms may offer higher total pay as compensation for the extra risk in equity stakes borne by risk‐averse managers. Using long lags of stock price risk to capture exogenous firm risk, we confirm our conjecture and show that riskier firms are also more productive and more likely to be held by institutional investors, who are most able to influence compensation.
Paediatric short case examination
Authors: Isaacs David
Published: November 2014

The short case is a highly artificial scenario, in which the examination candidate is given little or no history and instructed to examine one system or one aspect of a patient and draw conclusions. Despite their artificiality, short cases test clinical skills which senior paediatricians value and consider essential qualities of a competent physician. This article presents some general suggestions on an approach to doing short case examinations.
Metabolic syndrome in mental health and addiction treatment: a quantitative study
Authors: Flynn M. , Houtjes W. , Merks A. , van Mierlo A. , van de Wetering B.
Published: November 2014

Accessible summary

Patients with mental illnesses have been found to shorter life expectancy due to an increased risk of heart disease.

Some medication used to treat mental illnesses have been linked to weight gain and other physical change that make patients susceptible to heart disease.

In order to reduce this risk it is important that health professionals regularly measure and monitor signs of these physical changes.

This research has found that measuring both waist circumference and blood pressure of patients is a safe and reliable way to way to monitor patients.

To identify if combined blood pressure and waist circumference measurements are reliable predictor of metabolic syndrome, a descriptive correlational design was used to examine the sensitivity and specificity of screening techniques used to detect metabolic syndrome. Data were collected regarding waist circumference, body mass index, blood pressure, fasting blood glucose, triglycerides and high‐density lipoproteins. Blood pressure and waist circumference measurements demonstrated high significance, sensitivity and specificity as screening instruments for metabolic syndrome. Combined waist circumference and blood pressure measurements may be clinically useful for a quick and reliable detection of metabolic syndrome in patients with addiction and comorbid mental health problems.
Development of a measure for maternal confidence in knowledge and understanding and examination of psychosocial influences at the time of a child's heart surgery
Authors: Tallon Mary M. , Kendall Garth E. , Snider Paul D.
Published: November 2014

Purpose

The purpose was to develop a maternal confidence in knowledge and understanding scale (Maternal Knowledge and Understanding Scale [MKUS]) and examine the effect of psychosocial factors at the time of a child's heart surgery.

Design and Methods

Using cross‐sectional design, the MKUS was developed and tested. Validated instruments were used to examine the impact of psychosocial factors.

Results

The MKUS showed acceptable internal consistency (Cronbach's alpha .78). Higher levels of maternal anxiety and lower levels of social support were associated with lower MKUS scores (p < .05).

Practice Implications

A measure of maternal confidence in knowledge and understanding could draw attention to psychosocial factors and opportunities to enhance nursing support.
Influence of hepatitis B virus reactivation on the recurrence of HBV‐related hepatocellular carcinoma after curative resection in patients with low viral load
Authors: Sohn W. , Paik Y.‐H. , Cho J. Y. , Ahn J. Ma , Choi G. S. , Kim J. M. , Kwon C. H. , Joh J. W. , Sinn D. H. , Gwak G.‐Y. , Choi M. S. , Lee J. H. , Koh K. C. , Paik S. W. , Yoo B. C.
Published: November 2014

It is unclear whether the reactivation of hepatitis B virus (HBV) influences the prognosis of hepatocellular carcinoma (HCC) after resection in patients with chronic hepatitis B. The aim of this study was to identify the influence of HBV reactivation on the recurrence of hepatitis B‐related HCC after curative resection in patients with low viral load (HBV DNA <2000 IU/mL). We retrospectively analysed a total of 130 patients who underwent curative resection for HBV‐related early stage HCC (single nodule; <5 cm/two or three nodules; <3 cm) with pre‐operative HBV DNA levels <2000 IU/mL with serial HBV DNA tests. The predictive factors including HBV reactivation for the recurrence of HBV‐related HCC after curative resection were investigated. Fifty‐three patients (41%) had HBV reactivation after resection among 130 patients. HBV reactivation was observed in 22 of 53 patients with undetectable baseline HBV DNA and in 31 of 77 patients with detectable baseline HBV DNA. Cumulative recurrence rates after resection at 1, 2 and 3 years were 17.0%, 23.3% and 31.4%, respectively. The multivariable analysis demonstrated that the risk factors for the recurrence were the presence of microvascular invasion (hazard ratio (HR) 2.62, P = 0.003), multinodularity (HR 4.61, P = 0.005), HBV reactivation after resection (HR 2.03, P = 0.032) and HBeAg positivity (HR 2.06, P = 0.044). HBV reactivation after curative resection is associated with the recurrence of HBV‐related HCC in patients with low viral load.
Cerebral amyloid angiopathy related hemorrhage after stroke thrombolysis: Case report and literature review
Authors: Mattila Olli S. , Sairanen Tiina , Laakso Elina , Paetau Anders , Tanskanen Maarit , Lindsberg Perttu J.
Published: November 2014

Cerebral amyloid angiopathy (CAA) predisposes to symptomatic intracerebral hemorrhage (sICH) after combined thrombolytic and anticoagulant treatment of acute myocardial infarction. However, the role of CAA in stroke thrombolysis has not been established. Here, we describe a confirmed case of CAA‐related hemorrhage in a patient receiving thrombolysis for acute ischemic stroke. On autopsy, immunohistochemistry revealed amyloid‐β positive staining in thickened cortical and meningeal arteries at sites of hemorrhage. Further research is urgently needed to determine the hemorrhage risk related to CAA in stroke thrombolysis and develop better diagnostic tools to identify CAA in the emergency room.
Role for mammalian chitinase 3‐like protein 1 in traumatic brain injury
Authors: Wiley Clayton A. , Bonneh‐Barkay Dafna , Dixon C. Edward , Lesniak Andrew , Wang Guoji , Bissel Stephanie J. , Kochanek Patrick M.
Published: November 2014

Traumatic brain injury (TBI) is accompanied by inflammatory infiltrates and CNS tissue response. The astrocytosis associated with TBI has been proposed to have both beneficial and detrimental effects on surviving neural tissue. We recently observed prominent astrocytic expression of YKL‐40/chitinase 3‐like protein 1 (CHI3L1) associated with severity of brain injury. The physiological role of CHI3L1 in the CNS is unknown; however, its distribution at the perimeter of contusions and temporal course of expression suggested that in TBI it might be an important component of the astrocytic response to modulate CNS inflammation. To address this hypothesis, we used serially sectioned brains to quantitatively compare the neuropathological outcomes of TBI produced by controlled cortical impact in wild type (WT) and chi3l1 knockout (KO) mice where the murine YKL‐40 homologue, breast regression protein 39 (BRP‐39/CHI3l1), had been homozygously disrupted. At 21 days post‐injury, chi3l1 KO mice displayed greater astrocytosis (increased GFAP staining) in the hemispheres ipsilateral and contralateral to impact compared with WT mice. Similarly, Iba1 expression as a measure of microglial/macrophage response was significantly increased in chi3l1 KO compared with WT in the hemisphere contralateral to impact. We conclude that astrocytic expression of CHI3L1 limits the extent of both astrocytic and microglial/macrophage facets of neuroinflammation and suggests a novel potential therapeutic target for modulating neuroinflammation.
Metastatic ovarian carcinoma to the brain: An approach to identification and classification for neuropathologists
Authors: Nafisi Houman , Cesari Matthew , Karamchandani Jason , Balasubramaniam Gayathiri , Keith Julia Lee
Published: November 2014

Brain metastasis is an uncommon but increasing manifestation of ovarian epithelial carcinoma and neuropathologists' collective experience with these tumors is limited. We present clinicopathological characteristics of 13 cases of brain metastases from ovarian epithelial carcinoma diagnosed at two academic institutions. The mean ages at diagnosis of the ovarian carcinoma and their subsequent brain metastases were 58.7 and 62.8 years, respectively. At the time of initial diagnosis of ovarian carcinoma the majority of patients had an advanced stage and none had brain metastases as their first manifestation of malignancy. Brain metastases tended to be multiple with ring‐enhancing features on neuroimaging. Primary tumors and their brain metastases were all high‐grade histologically and the histologic subtypes were: nine high‐grade serous carcinoma (HGSC) cases, two clear cell carcinoma (CCC) cases and a single case each of carcinosarcoma and high‐grade adenocarcinoma. A recommended histo‐ and immunopathological approach to these tumours are provided to aid neuropathologists in the recognition and classification of metastatic ovarian carcinoma to the brain.
Two cases of atypical meningioma with pulmonary metastases: A comparative cytogenetic analysis of chromosomes 1p and 22 and a review of the literature
Authors: Frydrychowicz Clara , Holland Heidrun , Hantmann Helene , Gradistanac Tanja , Hoffmann Karl T. , Mueller Wolf , Meixensberger Juergen , Krupp Wolfgang
Published: November 2014

We present two cases of atypical meningioma WHO grade II with a history of multiple local recurrences and late pulmonary metastases. Comparative cytogenetic analyses on 1p and 22q confirmed clonal origin of the primary intracranial meningiomas and the pulmonary metastases in both cases. These cases illustrate the importance of close neuroradiological follow‐up to detect tumor recurrence in patients with atypical meningiomas WHO grade II even with clinically stable disease and should sensitize clinicians to late extracranial metastases of these tumors, especially to the lung. In an effort to elucidate common clinical features of metastatic meningiomas, especially to the lung, the literature was reviewed from 1995 to 2014, identifying a total of 45 published cases.
Prevalence and risk factors for dysphagia: a USA community study
Authors: Cho S. Y. , Choung R. S. , Saito Y. A. , Schleck C. D. , Zinsmeister A. R. , Locke G. R. , Talley N. J.
Published: November 2014

Background

Dysphagia is considered an alarm symptom but detailed population‐based data on dysphagia are lacking. We aimed to estimate in a representative USA Caucasian population, the prevalence of dysphagia and potential risk factors.

Methods

A modified version of the previously validated Bowel Disease Questionnaire was mailed to a population‐based cohort (n = 7640) of Olmsted County, MN. Dysphagia was measured by one validated question ‘In the last year, how often have you had difficulty swallowing (a feeling that food sticks in your throat or chest)?’ The medical records were reviewed for organic causes of dysphagia. The associations of reported frequency of dysphagia with potential risk factors were assessed using logistic regression models.

Key Results

The sex‐specific, age‐adjusted (US White 2000) prevalence for dysphagia experienced at least weekly was 3.0% (95% CI: 2.2, 3.7) in females and 3.0% (95% CI: 2.0, 4.0) in males. Those with frequent heartburn (OR = 5.9 [4.0, 8.6]) and acid regurgitation (OR = 10.6 [6.8, 16.6]) were significantly more likely to report frequent dysphagia. Proton pump inhibitor (PPI) use was significantly associated with frequent (3.1, 95% CI 2.2, 4.4) and infrequent dysphagia (1.5, 955 CI 1.3, 1.8). Gastro‐esophageal reflux disease (GERD) was the most common diagnosis in those reporting dysphagia on the medical record; other organic explanations were rare and only found in the frequent dysphagia group.

Conclusions & Inferences

Frequent dysphagia is not rare in the community (3%), occurs in both women and men across all adult age groups, and is most likely to indicate underlying GERD.
Critical success factors in awareness of and choice towards low vision rehabilitation
Authors: Fraser Sarah A. , Johnson Aaron P. , Wittich Walter , Overbury Olga
Published: November 2014

Purpose

The goal of the current study was to examine the critical factors indicative of an individual's choice to access low vision rehabilitation services.

Methods

Seven hundred and forty‐nine visually impaired individuals, from the Montreal Barriers Study, completed a structured interview and questionnaires (on visual function, coping, depression, satisfaction with life). Seventy‐five factors from the interview and questionnaires were entered into a data‐driven Classification and Regression Tree Analysis in order to determine the best predictors of awareness group: positive personal choice (I knew and I went), negative personal choice (I knew and did not go), and lack of information (Nobody told me, and I did not know).

Results

Having a response of moderate to no difficulty on item 6 (reading signs) of the Visual Function Index 14 (VF‐14) indicated that the person had made a positive personal choice to seek rehabilitation, whereas reporting a great deal of difficulty on this item was associated with a lack of information on low vision rehabilitation. In addition to this factor, symptom duration of under nine years, moderate difficulty or less on item 5 (seeing steps or curbs) of the VF‐14, and an indication of little difficulty or less on item 3 (reading large print) of the VF‐14 further identified those who were more likely to have made a positive personal choice. Individuals in the lack of information group also reported greater difficulty on items 3 and 5 of the VF‐14 and were more likely to be male.

Conclusions

The duration‐of‐symptoms factor suggests that, even in the positive choice group, it may be best to offer rehabilitation services early. Being male and responding moderate difficulty or greater to the VF‐14 questions about far, medium‐distance and near situations involving vision was associated with individuals that lack information. Consequently, these individuals may need additional education about the benefits of low vision services in order to make a positive personal choice.
Infection of Cardiovascular Implantable Electronic Devices: Detection with Sonication, Swab Cultures, and Blood Cultures
Authors: ROHACEK MARTIN , ERNE PAUL , KOBZA RICHARD , PFYFFER GABY E. , FREI RENO , WEISSER MAJA
Published: November 2014

Background

The number of patients with cardiovascular implantable electronic devices (CIEDs) is increasing. The purpose of this study was to compare three methods (sonication, swab cultures, and blood cultures) to detect bacteria in infections of CIEDs.

Methods

Patients with pocket infection of CIEDs and/or CIED‐associated infective endocarditis were prospectively included. Generators and leads were sonicated together. Swab cultures of the generator pocket and blood cultures were performed.

Results

Between January 2009 and September 2012, 18 patients with a CIED infection were recorded, including two definite and four possible CIED‐IEs. In 17 patients, blood cultures were performed and the device was analyzed by sonication. A swab culture from the device pocket was performed in 16 cases. Ten (59%) patients received antibiotic therapy before the device was removed. In 15 of 16 cases (94%), bacteria were detected by sonication, while bacteria were detected in only nine (56%) and seven (41%) cases by swab—and blood cultures, respectively. In four cases (24%), sonication was the only method that detected bacteria. The following bacteria were detected by sonication: methicillin‐sensitive Staphylococcus aureus (MSSA; n = 6), coagulase‐negative staphylococci (CNS; n = 3), Propionibacterium acnes (n = 2), Staphylococcus lugdunensis (n = 1), MSSA/Pseudomonas aeruginosa (n = 1),Bacillus cereus (n = 1), MSSA/P. acnes (n = 1), andP. acnes/CNS (n = 1). All positive swab cultures and all positive blood cultures but one grew the same bacteria as sonication fluid cultures.

Conclusion

Sonication can be more sensitive than swab cultures or blood cultures in detecting bacteria in infections of CIEDs.
Changing patterns of antigen exposure and their impact on the prevalence of allergy
Authors: Chang Tse Wen
Published: November 2014

Industrial development has advanced at a varying pace in different parts of the world over the past 200 years. Inhabitants of the most industrially advanced regions have experienced major changes in patterns of antigen exposure to infectious agents and to environmental biologic substances. This article analyzes the major factors that affect the amounts and variety of antigens to which the immune system of a young child is exposed. Depending on individual living environments and lifestyles, the types of antigen exposure of young children are graded into five patterns: ‘primitive’, ‘pre‐modern’, ‘early modern’, ‘modern’, and ‘ultramodern’. These patterns represent increasing deviation from the pattern of human immune system exposure to antigens prior to the industrial revolution. This article further discusses how such changes in antigen exposure have affected the immunologic system, especially with regard to the development of total IgE and allergic response‐relevant antigen‐specific IgE, and how the patterns of antigen exposure are related to the propensity to develop allergy.