bluuebunny/crossref_metadata_2025 huggingface dataset:
Guidelines for quantifying iron overload
Authors: Wood John C.
Published: November 2014

Both primary and secondary iron overload are increasingly prevalent in the United States because of immigration from the Far East, increasing transfusion therapy in sickle cell disease, and improved survivorship of hematologic malignancies. This chapter describes the use of historical data, serological measures, and MRI to estimate somatic iron burden. Before chelation therapy, transfusional volume is an accurate method for estimating liver iron burden, whereas transferrin saturation reflects the risk of extrahepatic iron deposition. In chronically transfused patients, trends in serum ferritin are helpful, inexpensive guides to relative changes in somatic iron stores. However, intersubject variability is quite high and ferritin values may change disparately from trends in total body iron load over periods of several years. Liver biopsy was once used to anchor trends in serum ferritin, but it is invasive and plagued by sampling variability. As a result, we recommend annual liver iron concentration measurements by MRI for all patients on chronic transfusion therapy. Furthermore, it is important to measure cardiac T2* by MRI every 6-24 months depending on the clinical risk of cardiac iron deposition. Recent validation data for pancreas and pituitary iron assessments are also presented, but further confirmatory data are suggested before these techniques can be recommended for routine clinical use.
Prognostic significance of early molecular response in chronic myeloid leukemia patients treated with tyrosine kinase inhibitors
Authors: Yeung David T. , Mauro Michael J.
Published: November 2014

A 55-year-old man presented with splenomegaly (10 cm below left costal margin) and leucocytosis (145 × 109/L). Differential showed neutrophilia with increased basophils (2%), eosinophils (1.5%), and left shift including myeloblasts (3%). A diagnosis of chronic myeloid leukemia in chronic phase was established after marrow cytogenetics demonstrated the Philadelphia chromosome. Molecular studies showed a BCR-ABL1 qPCR result of 65% on the International Scale. Imatinib therapy at 400 mg daily was initiated due to patient preference, with achievement of complete hematological response after 4 weeks of therapy. BCR-ABL1 at 1 and 3 months after starting therapy was 37% and 13%, respectively (all reported on International Scale). Is this considered an adequate molecular response?
A practical approach to relapsed multiple myeloma
Authors: Mikhael Joseph R.
Published: November 2014

There has been tremendous progress made in multiple myeloma in the last decade, resulting in improved overall survival for all patients, including those with high-risk disease and those ineligible for transplantation. However, despite the addition of several novel agents, unprecedented response rates, and our ability to achieve complete remission in the majority of patients, the disease remains incurable in nearly all and will require repeated therapies. With many options available to the clinician, there is no simple or ideal sequence of treatments that has been established, so the choice of relapsed therapy is based on a series of factors that include response and tolerability of prior therapies, risk status, available novel agents, aggressiveness of relapse, renal function, performance status, cost, etc. This chapter provides practical guidance in selecting relapsed therapies structured through a series of 5 questions that can inform the decision. Specific emphasis is placed on the 2 most recent novel agents, carfilzomib and pomalidomide, but agents in development are also included.
How does JAK2V617F contribute to the pathogenesis of myeloproliferative neoplasms?
Authors: Chen Edwin , Mullally Ann
Published: November 2014

A decade on from the discovery of the JAK2V617F mutation in the majority of patients with myeloproliferative neoplasms (MPNs), JAK2V617F is now firmly installed in the hematology curriculum of medical students and the diagnostic-testing algorithm of clinicians. Furthermore, the oral JAK1/JAK2 inhibitor ruxolitinib, rationally designed to target activated JAK2 signaling in MPN, has been approved by the Food and Drug Administration (FDA) of the United States for the past 3 years for the treatment of intermediate- and advanced-phase myelofibrosis. Notwithstanding this, JAK2V617F continues to stimulate the MPN research community and novel insights into understanding the mechanisms by which JAK2V617F contributes to the pathogenesis of MPN are continually emerging. In this chapter, we focus on recent advances in 4 main areas: (1) the molecular processes coopted by JAK2V617F to induce MPN, (2) the role that JAK2V617F plays in phenotypic diversity in MPN, (3) the functional impact of JAK2V617F on hematopoietic stem cells, and (4) therapeutic strategies to target JAK2V617F. Although great strides have been made, significant deficits still exist in our understanding of the precise mechanisms by which JAK2V617F-mutant hematopoietic stem cells emerge and persist to engender clonal hematopoiesis in MPN and in developing strategies to preferentially target the JAK2V617F-mutant clone therapeutically. Critically, although myelofibrosis remains arguably the greatest clinical challenge in JAK2V617F-mediated MPN, the current understanding of myelofibrosis-specific disease biology remains quite rudimentary. Therefore, many important biological questions pertaining to JAK2V617F will continue to engage and challenge the MPN research community in the coming decade.
Central venous catheter–related thrombosis
Authors: Geerts William
Published: November 2014

Thrombotic complications associated with the use of central venous catheters (CVCs) are common and lead to distressing patient symptoms, catheter dysfunction, increased risk of infections, long-term central venous stenosis, and considerable costs of care. Risk factors for catheter-related thrombosis include use of larger, multilumen, and peripherally inserted catheters in patients with cancer receiving chemotherapy. Symptomatic catheter-related thrombosis is treated with anticoagulation, generally without removing the catheter. The intensity and duration of anticoagulation depend on the extent of thrombosis, risk of bleeding, and need for continued use of a CVC. To date, the clinical benefit of prophylactic doses of anticoagulant has been disappointing and these agents are not used routinely for this purpose. This chapter focuses on recent evidence, remaining controversies, and practical approaches to reducing the burden of thrombosis associated with CVCs.
Genetic basis of congenital platelet disorders
Authors: Hinckley Jesse , Di Paola Jorge
Published: November 2014

Over the past 4 decades, a better understanding of the genetic origins of inherited platelet disorders has illuminated avenues of investigation in megakaryopoiesis and has identified targets of pharmacologic intervention. Many of these discoveries have been translated into clinical medicine. The success of inherited platelet disorder research is underpinned by broader advances in methodology through the biochemical and molecular revolution of the 20th and 21st centuries, respectively. Recently, modern genomics techniques have affected platelet and platelet disorders research, allowing for the discovery of several genes involved in platelet production and function and for a deeper understanding of the RNA and miRNA networks that govern platelet function. In this short review, we focus on recent developments in the genetic elucidation of several disorders of platelet number and in the molecular architecture that determines the “genetic makeup” of a platelet in health and disease.
Pregnancy and venous thromboembolism: ‘TIPPS’ for risk stratification
Authors: Rodger Marc
Published: November 2014

Pregnancy-associated venous thromboembolism (VTE) is a leading cause of maternal mortality, but is relatively uncommon. It is clear that the antepartum and postpartum periods have different magnitudes of risk and distinct risk factors for VTE and therefore must be considered separately. Absolute daily risks of VTE must be understood and explored when deciding to prescribe antepartum or postpartum thromboprophylaxis and must also be balanced against the downsides of prophylaxis. When the risks for VTE and bleeding are both low, other burdens of thromboprophylaxis must be weighed in and a decision made after an individualized patient values- and patient preferences–based discussion. Risk stratification is essential to ensure that the practicing clinician strikes the right balance.
Anticoagulation in pregnancy complications
Authors: Middeldorp Saskia
Published: November 2014

Women with acquired and inherited thrombophilia are thought to be at increased risk for pregnancy complications, including recurrent pregnancy loss and, depending on the type of thrombophilia, severe preeclampsia. This review discusses the associations between the types of thrombophilia and types of complications, as well as the currently available clinical trial evidence regarding the use of aspirin and heparin to prevent these pregnancy complications. In women with antiphospholipid syndrome, guidelines recommend prescribing aspirin and heparin to women with recurrent miscarriage. The same regimen is suggested for late pregnancy complications by some, but not all, experts. Aspirin or low-molecular-weight heparin to improve pregnancy outcome in women with unexplained recurrent miscarriage has no benefit and should not be prescribed. Whether anticoagulant therapy prevents recurrent miscarriage in women with inherited thrombophilia or in women with severe pregnancy complications remains controversial because of inconsistent results from trials. Aspirin modestly decreases the risk of severe preeclampsia in women at high risk.
Platelets: more than a sack of glue
Authors: Weyrich Andrew S.
Published: November 2014

Platelets are primary effector cells in hemostasis. Emerging evidence over the last decade, however, demonstrates that platelets also have critical roles in immunity and inflammation. These nontraditional functions of platelets influence the development, progression, and evolution of numerous diseases, including arthritis, cancer, cardiovascular disease, and infectious syndromes. This chapters reviews recently discovered attributes of platelets that contribute to human disease, paying particular attention to the inflammatory activities of this anucleate cytoplast.
Flamethrowers: blood cells and cancer thrombosis risk
Authors: Pabinger Ingrid , Posch Florian
Published: November 2014

Cancer patients are at an increased risk of venous thromboembolism. The clotting system is activated in most cancer patients, which is reflected by specific parameters such as an increased thrombin generation and elevated D-dimer levels. Blood cells, especially WBCs and platelets, play an important role in this activation process. Neutrophils and monocytes are subpopulations of WBCs that increase the thrombotic potential by different mechanisms. Neutrophils are activated by tumor cells and can release DNA, generating highly thrombogenic neutrophil extracellular traps. Monocytes are able to synthesize and express significant quantities of procoagulant tissue factor on their surfaces upon activation. An increased risk of VTE has been found in patients with solid tumors and elevated platelet count and in those with high-grade gliomas and low platelet count. Small circulating membrane vesicles, also called microparticles (MPs), which largely derive from platelets, contribute to the procoagulant potential. Specifically, procoagulant MPs could play a role in tumor-associated thrombosis in pancreatic cancer. Interventional studies are under way that are investigating the benefits of thromboprophylaxis in patients identified to be at high risk of VTE through risk-scoring models that include blood count parameters. The “flames” thrown by blood cells, such as neutrophil extracellular traps and MPs, although exciting, still have to be investigated for their usefulness in the clinical setting.
Breakthrough: new guidance for silent cerebral ischemia and infarction in sickle cell disease
Authors: Quinn Charles T.
Published: November 2014

Silent cerebral infarction (SCI) is a highly prevalent and morbid condition in sickle cell disease (SCD). SCI can occur beginning in the first year of life and becomes more common with increasing age. Potentially modifiable risk factors for SCI include anemia and blood pressure. Headache does not appear to be associated with SCI, so neurologically normal children with headache do not necessarily warrant screening MRI for SCI. SCI does affect cognition, but biological determinants of cognition are not more important than socioeconomic factors. The recent identification of acute silent cerebral ischemic events indicates that the total burden of ischemic injury to the brain in SCD is far greater than previously realized. Acute anemic events appear to increase the risk of acute silent cerebral ischemic events and SCI dramatically. The medical management of SCI is not yet defined, but documentation of the presence of SCI may qualify affected individuals for special resources because comprehensive interventions are needed to optimize patients' academic and vocational outcomes.
Epigenetic targeting and personalized approaches for AML
Authors: Roboz Gail J.
Published: November 2014

Acute myeloid leukemia (AML) is a genetically heterogeneous clonal hematopoietic stem cell disorder and the majority of patients with AML die from their disease. The treatment paradigms for AML were developed decades ago and, although there have been improvements in the outcomes of selected younger patients and those with specific cytogenetic and molecular genetic characteristics, the overall survival for older patients remains dismal. Over the last few years, next-generation sequencing technologies have identified recurrent mutations in genes encoding proteins involved in the epigenetic regulation of transcription in most patients with AML. This discovery has led to new insights into the role of the epigenome in AML and opens the possibility of epigenetically targeted therapies. This chapter describes how epigenetic dysregulation plays a role in AML and highlights current and future treatment strategies that attempt to exploit epigenetic targets.
Leukocytapheresis for the treatment of hyperleukocytosis secondary to acute leukemia
Authors: Aqui Nicole , O'Doherty Una
Published: November 2014

Patients presenting with new or recurrent acute leukemia, particularly of the myeloid lineage, with WBC counts exceeding 100 × 109/L are often considered for leukocytapheresis, especially if they are experiencing symptoms of leukostasis. These symptoms are thought to occur because of blast aggregates and WBC thrombi in the circulation, which reduce blood flow. Leukostasis may cause various complications, including hyperviscosity syndrome, vascular occlusion resulting in intracranial hemorrhages and respiratory failure, and perivascular leukemic infiltrates. Leukostasis occurs more commonly with a high WBC count and with leukemias of monocytoid lineage such as acute myelomonocytic leukemia, which is a reflection of the nature of the leukemic blasts. Leukocytapheresis is used in an effort to quickly decrease a patient's circulating blast count, which can both prevent the development of leukostasis and provide symptomatic relief of leukostasis. However, the impact of leukocytapheresis on early- and long-term mortality is controversial, with several studies producing conflicting results. In this chapter, the pathophysiology of leukostasis, performance of leukocytapheresis, and efficacy of this treatment are reviewed.
Bleeding complications of targeted oral anticoagulants: what is the risk?
Authors: Levine Michael , Goldstein Joshua N.
Published: November 2014

The vitamin K antagonists (VKAs) are a widely used class of agent to prevent thromboembolism. In recent years, numerous alternatives to VKAs have been developed, the target-specific oral anticoagulants (TSOACs), which are available in clinical practice. Currently available agents target thrombin and factor Xa. The most significant side effect of these agents, as with VKAs, is the development of bleeding complications. In this review, the risks of major bleeding complications with the TSOACs will be discussed. Data from meta-analyses, randomized controlled trials, and observational studies will be used to highlight bleeding complications associated with TSOACs and warfarin. We highlight the most common causes of major bleeding, GI and intracranial hemorrhage.
Future prospects for contact factors as therapeutic targets
Authors: Gailani David
Published: November 2014

Anticoagulants currently used in clinical practice to treat or prevent thromboembolic disease are effective, but place patients at increased risk for serious bleeding because they interfere with plasma enzymes (thrombin and factor Xa) that are essential for hemostasis. In the past 10 years, work with genetically altered mice and studies in baboons and rabbits have demonstrated that the plasma contact proteases factor XI, factor XII, and prekallikrein contribute to the formation of occlusive thrombi despite having limited roles in hemostasis. In the case of factor XI, epidemiologic data from human populations indicate that elevated levels of this protein increase risk for stroke and venous thromboembolism and may also influence risk for myocardial infarction. These findings suggest that inhibiting contact activation may produce an antithrombotic effect without significantly compromising hemostasis. This chapter reviews strategies that are being developed for therapeutic targeting of factor XI and factor XII and their performances in preclinical and early human trials.
Management of VWD
Authors: Neff Anne T. , Sidonio Robert F.
Published: November 2014

VWD is the most common inherited bleeding disorder known. It is caused by a deficiency or dysfunction of the VWF molecule. Bleeding risk varies between modest increases in bleeding seen only with procedures to major risk of spontaneous hemorrhage depending upon the type of VWD. The treatment approach to VWD has changed little in the past 2 decades, but there are numerous subtleties in optimal management. Management includes the prevention or treatment of bleeding by raising endogenous VWF levels with medications such as desmopressin or providing exogenous VWF concentrates. Fibrinolytic inhibitors and topical hemostatic agents are also effective adjunctive measures. Bleeding specific to women presents a special challenge because of heavy menstrual bleeding and pregnancy. Successful management of pregnancy in patients with VWD involves coordination with obstetrics, anesthesia, and the coagulation laboratory monitoring VWF:RCo and FVIII:C levels. Prophylactic treatment with VWF concentrates is emerging as an effective preventive therapy in patients with severe disease. Antibodies to VWF present a special challenge in the management of rare patients with type 3 disease. New therapies on the horizon include recombinant VWF, anti-VWF aptamers, and medications such as IL-11 to raise VWF levels. The key to effective treatment of VWD is an accurate diagnosis of the specific type and selection of hemostatic products appropriate for the clinical situation.
The science behind the hypoxic niche of hematopoietic stem and progenitors
Authors: Nombela-Arrieta César , Silberstein Leslie E.
Published: November 2014

In blood, oxygen is transported principally by hemoglobin tetrameric molecules in erythocytes, which allow for the delivery to tissue cells. When anemia occurs, such as perisurgically or after trauma, blood transfusion is administered to replace the deficit in oxygen-carrying capacity. During embryogenesis and later in adult life, tissue oxygen levels control multiple key cellular functions. Low tissue oxygen levels in particular are physiologically relevant to stem cells by controlling their metabolism and cell fate. In adult life, hematopoietic stem cells reside in specified BM microenvironments/niches, where their quiescence and differentiation are presumably also influenced by cell-intrinsic and cell-extrinsic (niche) factors. Novel imaging technologies have allowed determination of the spatial localization of hematopoietic stem/progenitor cells (HSPCs), as well as the topography of oxygen distribution in BM cavities. Together, these recent advances have contributed to the emergence of a novel model that challenges the previous concept of a hypoxic hematopoietic stem cell niche characterized by poorly perfused endosteal zones with the deepest hypoxia. HSPCs display a hypoxic phenotype despite residing in close association with arterial or sinusoidal vascular networks. The entire BM cavity is hypoxic and unexpectedly exhibits an opposite oxygen gradient to the one initially proposed because arteriole-rich endosteal zones are relatively less hypoxic than deeper regions of the BM perfused by dense sinusoidal networks. Therefore, further studies are warranted to elucidate to what extent differences in oxygen tensions in these diverse microenvironments influence HSPC homeostasis.
Chimeric antigen receptor T-cell therapy for ALL
Authors: Maude Shannon L. , Shpall Elizabeth J. , Grupp Stephan A.
Published: November 2014

Relapsed and refractory leukemias pose substantial challenges in both children and adults, with very little progress being made in more than a decade. Targeted immunotherapy using chimeric antigen receptor (CAR)-modified T cells has emerged as a potent therapy with an innovative mechanism. Dramatic clinical responses with complete remission rates as high as 90% have been reported using CAR-modified T cells directed against the B-cell-specific antigen CD19 in patients with relapsed/refractory acute lymphoblastic leukemia. Supraphysiologic T-cell proliferation, a hallmark of this therapy, contributes to both efficacy and the most notable toxicity, cytokine release syndrome, posing a unique challenge for toxicity management. Further studies are necessary to identify additional targets, standardize approaches to cytokine release syndrome management, and determine the durability of remissions.
Cytotoxic T lymphocytes for leukemia and lymphoma
Authors: Bollard Catherine M. , Barrett A. John
Published: November 2014

This chapter focuses on the recent advances in adoptive T-cell immunotherapies, not only for patients after hematopoietic stem cell transplantation, but also in the autologous setting using T cells early in the disease process for the treatment of the highest-risk patients with leukemias and lymphomas. The particular emphasis is to highlight the role of T-cell therapies for hematologic malignancies using a non-gene-transfer approach to direct specificity, including the clinical use of T-cell therapies for EBV-associated lymphomas and strategies for targeting nonviral lymphoma- and leukemia-associated antigens.
HIV-associated non-Hodgkin lymphoma: viral origins and therapeutic options
Authors: Krishnan Amrita , Zaia John A.
Published: November 2014

HIV infection is associated with an increased risk of malignancy, especially B-cell lymphoid malignancies. Many of these lymphomas are further driven by concomitant infection with viruses such as Epstein-Barr virus or Human Herpesvirus 8, the latter being implicated in uncommon types of lymphomas seen in the setting of HIV-1 infection. Treatment outcomes have improved due to infusional chemotherapy, high-dose chemotherapy, and effective antiretroviral therapy. Successful functional cure of HIV-1 infection has been demonstrated with the use of allogeneic hematopoietic stem cell transplantation. This result spurred a change in the field of HIV-1 management so that, ultimately, the goals of therapy would shift from not only curing the underlying lymphoma, but also curing the HIV-1 infection. Treatment options will be discussed with an emphasis on hematopoietic cell-based therapy for the underlying HIV infection.
SAViNE: social network analysis - inspired content delivery network deployment and experimentation
Authors: Leivadeas Aris , Papagianni Chrysa , Papavassiliou Symeon
Published: November 2014

Over the last years, the content delivery network (CDN) market has been witnessing globally an increase in the development of cloud-based CDNs, as they constitute a viable and cost-effective alternative to traditional commercial CDNs. Towards that direction, Social-Aware Virtual Network Embedding (SAViNE) for wireless content delivery within the OpenLab project aims at establishing, assessing, and prototyping a novel framework for deploying a CDN over the wireless cloud. Specifically, the goal of SAViNE is to provide experimental validation of the efficiency of social network analysis (SNA) - inspired surrogate server placement strategies, devised for fostering content delivery. The proposed framework has been integrated with the OpenLab experimental facilities, providing a run-time environment for CDN deployment, operation, and performance evaluation over the wireless environment. The framework’s feasibility and scalability is experimentally validated. The study is complemented with repeatability evaluation of experimental measurements, related to the resulting CDN’s operational efficiency.
Effect of porous polycaprolactone beads on bone regeneration: preliminary
in vitro
and
in vivo
studies
Authors: Byun June-Ho , Lee Han A Reum , Kim Tae Ho , Lee Jin Ho , Oh Se Heang
Published: November 2014

Background

For the effective bone regeneration with appropriate pathological/physiological properties, a variety of bone fillers have been adapted as a therapeutic treatment. However, the development of ideal bone fillers is still remained as a big challenge in clinical practice. The main aims of this study are i) fabrication of a highly porous PCL beads; and ii) the estimation of the potential use of the porous PCL beads as a bone filler through preliminary animal study.

Results

The porous PCL beads with size range of 53 ~ 600 μm (425 ~ 500 μm dominantly) are fabricated by a spray/precipitation method using a double nozzle spray and PCL solution (in tetraglycol). The PCL beads show highly porous inner pore structure and the pores are interconnected with outer surface pores. For the preliminary animal study, we recognize that the porous PCL bead can induce the new bone formation from the outer surface of bone defect toward the bone marrow cavity through the bead matrix.

Conclusions

From the preliminary results, we can suggest that the highly porous PCL beads may be a promising candidate as a bone filler (scaffolding matrix) for the effective bone regeneration.
Drug resistance genomics of the antimalarial drug artemisinin
Authors: Winzeler Elizabeth A , Manary Micah J
Published: November 2014

Across the globe, over 200 million annual malaria infections result in up to 660,000 deaths, 77% of which occur in children under the age of five years. Although prevention is important, malaria deaths are typically prevented by using antimalarial drugs that eliminate symptoms and clear parasites from the blood. Artemisinins are one of the few remaining compound classes that can be used to cure multidrug-resistant Plasmodium falciparum infections. Unfortunately, clinical trials from Southeast Asia are showing that artemisinin-based treatments are beginning to lose their effectiveness, adding renewed urgency to the search for the genetic determinants of parasite resistance to this important drug class. We review the genetic and genomic approaches that have led to an improved understanding of artemisinin resistance, including the identification of resistance-conferring mutations in the P. falciparum kelch13 gene.
Anthraquinonyl glycoside facilitates the standardization of graphene electrodes for the impedance detection of lectins
Authors: Zhu Bi-Wen , Cai Liang , He Xiao-Peng , Chen Guo-Rong , Long Yi-Tao
Published: November 2014

Background

Construction of electrochemical impedance sensors by the self-assembly technique has become a promising strategy for the `label-free' detection of protein-ligand interactions. However, previous impedance sensors are devoid of an inherent electrochemical signal, which limits the standardization of the sensors for protein recognition in a reproducible manner.

Results

We designed and synthesized an anthraquinonyl glycoside (AG) where the anthraquinone (AQ) moiety can bind to the surface of a graphene-based working electrode while the glycoside serving as a ligand for lectin. By measuring the inherent voltammetric signal of AQ, the glycosides decorated on the working electrode could be simply quantified to obtain electrodes with a unified signal window. Subsequently, impedance analysis showed that the `standardized' electrodes gave a reproducible electrochemical response to a selective lectin with no signal variation in the presence of unselective proteins.

Conclusion

Anthraquinone-modified ligands could be used to facilitate the standardization of electrochemical impedance sensors for the reproducible, selective analysis of ligand-protein interactions.
Pedagogical challenges in nurse education - a case study focusing on the completion rate in theoretical education at a Swedish University
Authors: Emilsson Maria , Gellerstedt Martin , Skyvell Nilsson Maria , Berndtsson Ina , Johansson Kristina , Pennbrant Sandra
Published: November 2014

Background

The purpose of this survey was to relate completion rate and results on national clinical final examinations to student’s admission background and examination results for nursing and medical courses.

Methods

The research data were based on a quantitative case study, with 286 nursing students, using statistical analysis.

Results

The programme’s overall completion rate was 76%, i.e. almost one out of four students did not complete the programme. The higher students’ upper secondary/high school grades, the fewer attempts they needed to pass the nursing and medical courses exams (p < 0.001). The average examination attempts needed to pass courses in medical science was significantly greater than the number needed to pass courses in nursing science (p < 0.001). In a multivariate analysis both upper secondary/high school grades and average examination attempts needed to pass were significant predictors for national clinical final examination score.

Conclusions

In sum, upper secondary/high school grades and examination attempts needed, especially for courses in medical science, may be regarded as important indicators of achieved knowledge and skills which are tested in the national final examination.
Nelly Don’s 1916 pink gingham apron frock: an illustration of the middle-class American housewife’s shifting role from producer to consumer
Authors: Whang Mikyoung , Haar Sherry
Published: November 2014

Nelly Don created a stylish, practical, affordable pink gingham housedress in 1916, quickly selling out her first order of 216 dresses at Peck’s Dry Goods Company in Kansas City. This study investigated the reasons behind the success of her dress, and found that during the early 20th century, women’s roles shifted from that of producer to consumer, and that clothing was a visible reflection of this shift. Specific design attributes and social appeal contributed to the success of the housedress. Integrating trendy design elements into an affordable housedress along with the growing demand for a stylish, yet practical housedress induced by consumption culture in the early 20th century facilitated the success of Nelly Don’s pink gingham housedress. As such, Nelly Don’s 1916 housedress reflected social and cultural change in this transitional period, and exemplified the shifting role of the middle-class American housewife by offering an alternative to the traditional Mother Hubbard housedress as well as a lifestyle free of long hours spent sewing.
Investigating the influence of mineralogy and pore shape on the velocity of carbonate rocks: Insights from extant global data sets
Authors: Kittridge Mark G.
Published: November 2014

Using a variety of recent public-domain data sets comprising porosity, velocity (P- and S-waves), and, in most cases, mineralogy and petrographic data, I created an extensive global data set and evaluated the importance of mineralogy and pore type on the elastic properties behavior of carbonate core plugs. Results from this investigation clearly illuminated the potential for overinterpreting elastic properties behavior as a function of pore type(s) when mineralogy was not explicitly included in the analysis. Rock-physics analysis using a combination of heuristic and theoretical models illustrated that mineralogy exerted a significant additional variation on velocity at a given porosity. Failure to account for mineralogy exacerbated inferences about the effect of pore type(s) made using a comparison of P-wave velocity to an inappropriate empirical model (Wyllie) that did not account for pore shape(s). In this analysis, extreme variability in carbonate velocity was observed in only portions of two data sets, when mineralogy was explicitly considered and robust models that accounted for inclusion (pore) shape were used. Results from this analysis resulted in a recommended workflow, including a rock-physics template and dry-rock modulus diagnostics, for the evaluation of lab-based carbonate rock-physics data. The workflow was amenable to further integration with well-based data and other core-based petrophysical measurements (e.g., electrical properties).
Predictive Analytics for Readmission of Patients with Congestive Heart Failure
Authors: Bardhan Indranil , Oh Jeong-ha (Cath) , Zheng Zhiqiang (Eric) , Kirksey Kirk
Published: November 2014

Mitigating preventable readmissions, where patients are readmitted for the same primary diagnosis within 30 days, poses a significant challenge to the delivery of high-quality healthcare. Toward this end, we develop a novel, predictive analytics model, termed as the beta geometric Erlang-2 (BG/EG) hurdle model, which predicts the propensity, frequency, and timing of readmissions of patients diagnosed with congestive heart failure (CHF). This unified model enables us to answer three key questions related to the use of predictive analytics methods for patient readmissions: whether a readmission will occur, how often readmissions will occur, and when a readmission will occur. We test our model using a unique data set that tracks patient demographic, clinical, and administrative data across 67 hospitals in North Texas over a four-year period. We show that our model provides superior predictive performance compared to extant models such as the logit, BG/NBD hurdle, and EG hurdle models. Our model also allows us to study the association between hospital usage of health information technologies (IT) and readmission risk. We find that health IT usage, patient demographics, visit characteristics, payer type, and hospital characteristics, are significantly associated with patient readmission risk. We also observe that implementation of cardiology information systems is associated with a reduction in the propensity and frequency of future readmissions, whereas administrative IT systems are correlated with a lower frequency of future readmissions. Our results indicate that patient profiles derived from our model can serve as building blocks for a predictive analytics system to identify CHF patients with high readmission risk.
The Cross Attributes Flexible Substitution Logit: Uncovering Category Expansion and Share Impacts of Marketing Instruments
Authors: Liu Qiang , Steenburgh Thomas J. , Gupta Sachin
Published: November 2014

Different objectives such as category demand expansion or market share stealing warrant the use of different marketing instruments. To help brand managers make informed decisions, it is essential that marketing mix models appropriately measure their effects. Random Utility Models that have been applied to this problem might not be adequate because they do not allow the effects of marketing instruments of one brand to spillover to preference for competing alternatives. Additionally, they have the Invariant Proportion of Substitution (IPS) property, which in some situations imposes counter-intuitive restrictions on individual choice behavior. Recognizing that effects of marketing instruments can spill across brands in a category, we propose an alternative choice model that relaxes the IPS property: the cross attributes flexible substitution logit model. We apply the model in two very different empirical settings, i.e., consumer choices of brands of refrigerated yogurt, and prescription-writing choices of physicians in the hyperlipidemia category. In both settings the proposed model provides consistent evidence that certain marketing instruments produce sales gains primarily from growing the category pie, while others produce gains from stealing share. By contrast, the random coefficient logit and generalized nested logit models both predict that gains from all marketing instruments would have similar sources.
Corporate General Counsel and Financial Reporting Quality
Authors: Hopkins Justin J. , Maydew Edward L. , Venkatachalam Mohan
Published: November 2014

We examine the role of general counsel (GC) in firms' financial reporting quality. GCs have a broad oversight role within the firm, including keeping the firm in compliance with laws and regulations and dealing with potential violations with respect to financial reporting. Several high-profile U.S. Securities and Exchange Commission (SEC) investigations have resulted in lawsuits or indictments against GCs for perpetrating financial fraud and caused many to ask: where were the gatekeepers? As such, we examine the conditions under which GCs may stray from their primary role as gatekeepers. Mainly, we empirically investigate claims that compensation can impair the independence or compromise the professional judgment of a GC. We measure the level of compensation using the GC’s presence or absence in the top five officers of the firm by compensation. Results are consistent with GCs straying from their role as gatekeepers, to some extent, when highly compensated in a manner similar to the CEO and CFO. In particular, firms with highly compensated GCs have lower financial reporting quality and more aggressive accounting practices, including management of the litigation reserve. However, the results also show that highly compensated GCs play an important gatekeeping role in keeping the firm in compliance with generally accepted accounting principles. Thus, highly compensated GCs appear to tolerate moderately aggressive behavior but constrain it such that it would not result in violation of securities laws and jeopardize their standing within the firm.

This paper was accepted by Mary Barth, accounting.
Borrowing money from a patient's relative and failing to repay it
Authors: Castledine George
Published: November 2014

A district nursing sister appeared before the Professional Conduct Committee and was represented by the RCN. She was facing a charge of ‘inappropriately’ accepting £1500 from the wife of a former patient.
Reflective practice and guided discovery: clinical supervision
Authors: Todd Gillian , Freshwater Dawn
Published: November 2014

This article explores the parallels between reflective practice as a model for clinical supervision, and guided discovery as a skill in cognitive psychotherapy. A description outlining the historical development of clinical supervision in relationship to positional papers and policies is followed by an exposé of the difficulties in developing a clear, consistent model of clinical supervision with a coherent focus; reflective practice is proposed as a model of choice for clinical supervision in nursing. The article examines the parallels and processes of a model of reflection in an individual clinical supervision session, and the use of guided discovery through Socratic dialogue with a depressed patient in cognitive psychotherapy. Extracts from both sessions are used to illuminate the subsequent discussion.
Clinical evaluation of an electronic pressure-relieving mattress
Authors: Knowles Cathy , Horsey Irene
Published: November 2014

A 12-month clinical evaluation of the Talley Quattro Deep Cell 2000 mattress manufactured by Talley Medical was undertaken on both a trauma and surgical ward at the Royal Devon and Exeter Hospital. An identified registered nurse coordinated the evaluation with support from tissue viability clinical nurse specialists. Data on patients, including diagnosis, Waterlow score, pressure area condition and general comments by nurses and patients, were collected. The evaluation involved 35 patients who were at high- to very-high risk of pressure sore formation. The results showed that 16 out of 40 sores healed during the evaluation period and 16 sores remained unchanged. Only one patient develped broken skin while nursed on the mattress. Seventeen patients maintained tissue integrity. Although the study was limited the results suggest that the Talley Quattro Deep Cell 2000 mattress is useful in preventing and managing pressure sores in high-to very high-risk patients.
The development of mental health care pathways: friend or foe?
Authors: Jones Adrian
Published: November 2014

Greater emphasis is being placed on mental health services to be more responsive to clinical variation. Care pathways can standardize clinician response to established diagnostic groups such as schizophrenia. This article disusses care pathways using the findings of a research study carried out in London to explore the development and implementation of a care pathway. Respondents encountered many difficulties such as the principles behind individualized care and generic roles and responsibilities in preformulating their work into a care pathway sequence. This article concludes with areas for further application and research.
Confidentiality 11: terminal illness and the duty of confidentiality
Authors: Dimond Bridgit
Published: November 2014

David Jones returned from theatre where the surgeon had simply opened and closed him up with a diagnosis of inoperable cancer. His wife and daughter came to see him later and were informed of this by Staff Nurse Grey. They decided that David should not be told. What is the law?
Wound irrigation techniques: new Steripod normal saline
Authors: Williams Clare
Published: November 2014

Wound cleansing is performed on a regular basis by many healthcare professionals. However, the modern concept of cleansing has not always been a priority in wound management. There are many questions which challenge those responsible for cleaning wounds such as how often a wound should be cleaned and which techniques should be used. This article begins with a brief guide to wound cleansing and then focuses on the new Steripod normal saline produced by SSL International.
An introduction to radiation protection in veterinary radiography
Authors: Baker Martin A
Published: November 2014

Radiation protection is an important consideration for veterinary nurses working with x-rays. This article explains the primary concerns and actions required in order to comply with current guidance. Proper justification of the procedure, keeping exposures as low as reasonably practicable (ALARP) and monitoring exposure to radiation are key elements in radiation safety. Becoming proficient at radiography is also imperative as it reduces the number of exposures required and often the amount of radiation used per examination. Proper training and awareness of the potential risks are therefore essential for the veterinary nurse in order to work safely with x-ray equipment. Other practical suggestions for keeping radiation exposure to the patient and staff to a minimum are discussed.
Mitral valve disease and dilated cardiomyopathy in canines
Authors: Pace Charlotte
Published: November 2014

Heart disease can occur at any stage, either as a result of a congenital defect, such as a stenosis of one of the valves, or with degeneration over time. The two most common acquired diseases in dogs are mitral valve disease (MVD) and dilated cardiomyopathy (DCM). MVD can take years to develop from the first time it is diagnosed, whereas some cases can present with congestive heart failure (CHF) and need emergency treatment. DCM can have a long asymptomatic period eventually leading to CHF, if not preempted by sudden death. This article will discuss MVD and DCM, focussing on aetiology of both diseases, the diagnostic tests required and subsequent management aims.
Influence of Measurement Position, Tree Diameter, and Bulk Wood Density on Models that Predict Wave Propagation Velocity in Logs According to the Velocity in Trees
Authors: Bertoldo Cinthya , Gonçalves Raquel
Published: November 2014

The propagation velocity of ultrasonic waves from measurements in trees is numerically different from the velocity obtained from measurements in logs, even in freshly felled logs, and the latter velocity is better correlated with the quality of the wood. The differences can be explained by the basic and fundamental aspects of wave propagation; however, these aspects are difficult to consider in practical applications. Thus, the present study examined parameters that are more easily obtained in the field and considered to provide an equivalent log velocity based on living tree velocities. The results indicate that base logs are better correlated with the velocities measured in trees, because the measurement in trees is performed at the stem base. However, the inclusion of the diameter at breast height (DBH) can produce a model with the same prediction accuracy as that of logs obtained from the whole tree. The inclusion of the green density does not improve estimations of the velocity of logs using the velocity obtained for the tree. Considering that DBH is a parameter often used in forest management, this result can be useful for improving the accuracy of wood-quality predictions from acoustic trials in standing forests.
Sequence Artifacts in DNA from Formalin-Fixed Tissues: Causes and Strategies for Minimization
Authors: Do Hongdo , Dobrovic Alexander
Published: November 2014

BACKGROUND

Precision medicine is dependent on identifying actionable mutations in tumors. Accurate detection of mutations is often problematic in formalin-fixed paraffin-embedded (FFPE) tissues. DNA extracted from formalin-fixed tissues is fragmented and also contains DNA lesions that are the sources of sequence artifacts. Sequence artifacts can be difficult to distinguish from true mutations, especially in the context of tumor heterogeneity, and are an increasing interpretive problem in this era of massively parallel sequencing. Understanding of the sources of sequence artifacts in FFPE tissues and implementation of preventative strategies are critical to improve the accurate detection of actionable mutations.

CONTENT

This mini-review focuses on DNA template lesions in FFPE tissues as the source of sequence artifacts in molecular analysis. In particular, fragmentation, base modification (including uracil and thymine deriving from cytosine deamination), and abasic sites are discussed as indirect or direct sources of sequence artifacts. We discuss strategies that can be implemented to minimize sequence artifacts and to distinguish true mutations from sequence artifacts. These strategies are applicable for the detection of actionable mutations in both single amplicon and massively parallel amplicon sequencing approaches.

Because FFPE tissues are usually the only available material for DNA analysis, it is important to maximize the accurate informational content from FFPE DNA. Careful consideration of each step in the work flow is needed to minimize sequence artifacts. In addition, validation of actionable mutations either by appropriate experimental design or by orthogonal methods should be considered.
On Cross-Border Mergers and Product Differentiation
Authors: Beladi Hamid , Chakrabarti Avik , Marjit Sugata
Published: November 2014

We construct a general equilibrium model of an oligopolistic industry that allows us to capture the role of product differentiation in the incentives for and implications of cross-border mergers. We show that a rise in the degree of product differentiation will compress the extensive margins of trade and, at the same time, reduce the gains from cross-border mergers. We also demonstrate how cross-border mergers can mitigate the effect of product differentiation on the extensive margins of trade.