bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined Testing of High-Sensitivity Troponin T and Copeptin on Presentation at Prespecified Cutoffs Improves Rapid Rule-Out of Non–ST-Segment Elevation Myocardial Infarction
Authors: Giannitsis Evangelos , Kehayova Tzveta , Vafaie Mehrshad , Katus Hugo A
Published: August 2011

BACKGROUND

Two recent clinical trials showed that adding copeptin to a conventional cardiac troponin assay improved diagnostic performance for patients with chest pain early after symptom onset. We prospectively tested whether copeptin adds information to that provided by a high-sensitivity cardiac troponin T (hscTnT) assay in the early evaluation of patients with suspected acute myocardial infarction, particularly non–ST-segment elevation myocardial infarction (non-STEMI).

METHODS

We enrolled 503 patients with suspected acute coronary syndrome and onset of chest pain occurring within the previous 12 h. Copeptin was measured on presentation, and hscTnT was measured serially at baseline and after 3 and 6 h. We used ROC curve analysis and likelihood ratio χ2 statistics for nested models. Diagnostic sensitivities, specificities, positive predictive values (PPVs), and negative predictive values (NPVs) were calculated for admission values of copeptin alone, hscTnT alone, and the combination of both markers.

RESULTS

For ruling out non-STEMI (after excluding STEMI), an hscTnT concentration <14 ng/L (99th percentile) plus a copeptin concentration <14 pmol/L yielded a diagnostic sensitivity of 97.7% (95% CI, 91.9%–99.7%), an NPV of 99.03% (95% CI, 96.6%–99.9%), a diagnostic specificity of 55.9% (95% CI, 50.6%–61.0%), and a PPV of 34.4% (95% CI, 28.5%–40.7%). ROC curve analysis of the continuous biomarker values on admission demonstrated no added value of using this marker combination for ruling out non-STEMI when hscTnT was used as the standard for diagnosing non-STEMI.

CONCLUSIONS

A strategy using copeptin with hscTnT at prespecified cutoffs improves the ruling out of non-STEMI, compared with using hscTnT alone; thus, this strategy could help to obviate a prolonged stay in the emergency department.
Real‐time remote diagnostics for ecology: Wheeler et al.'s vision realized
Authors: Kean John M , Vink Cor J , Till Corina , Crosby Trevor K , Marris John WM , Fagan Laura
Published: August 2011

Real‐time remote diagnostic tools may help to overcome the “taxonomic impediment” of dwindling and geographically fragmented taxonomic expertise. We tested several real‐time remote microscopy systems based on desktop videoconferencing or virtual research environments (VREs) using standardized performance tests and real diagnostic challenges. All performed well, but ease of use was greatest for those systems with a dedicated audio channel, a remote pointer, and control over image quality. The greatest impediment to implementation was the need to overcome internet firewall restrictions. We also implemented a remote specimen viewing system for the New Zealand Arthropod Collection, and compared its performance and cost with that of the conventional specimen loan system. Successful real‐time remote identifications were made on a wide variety of arthropod taxa, and there were major benefits: specimen access was more timely, operational costs were lowered, and the risk of specimen damage was reduced. Widespread adoption of such systems may help to overcome the taxonomic challenges facing the disciplines of ecology and evolution.
Localization of osteopontin and osterix in periodontal tissue during orthodontic tooth movement in rats
Authors: Kim Ji-Youn , Kim Byung-In , Jue Seong-Suk , Park Jae Hyun , Shin Je-Won
Published: August 2011

Objective:

To evaluate the localization of osteopontin (OPN) and osterix in periodontal tissue during experimental tooth movement with heavy force in rats.

Materials and Methods:

Nickel-titanium closed-coil springs were used to create a 100 g mesial force to the maxillary first molars. On days 3, 7, 10, and 14 after force application, histological changes in periodontium were examined by immunohistochemistry using proliferating cell nuclear antigen (PCNA), OPN, and osterix.

Results:

PCNA-positive cells were found close to the alveolar bone and cementum on both sides. OPN-positive cells were observed along the cementing line of the cementum and bone on both sides and also were visible along with newly formed fibers in the periodontal ligament on the tension side. Osterix-positive cells were strongly detected on the surface of the alveolar bone and cementum on both sides.

Conclusions:

During tooth movement, periodontal remodeling occurs on both sides. These results indicate that OPN and osterix may play an important role of differentiation and osteoblasts and cementoblasts matrix formation during periodontal tissue remodeling.
Transvesicular percutaneous cystolithotomy for the retrieval of cystic and urethral calculi in dogs and cats: 27 cases (2006–2008)
Authors: Runge Jeffrey J. , Berent Allyson C. , Mayhew Philipp D. , Weisse Chick
Published: August 2011

Objective—To describe the use of transvesicular percutaneous cystolithotomy for the retrieval of cystic and urethral calculi and to report the outcome in dogs and cats.

Design—Retrospective case series.

Animals—23 dogs and 4 cats.

Procedures—Medical records were reviewed for signalment, procedure time, stone number, stone location, pre- and postoperative radiographs, procedure-associated complications, and short-term outcome. A ventral midline approach was made into the abdomen over the urinary bladder apex. A screw cannula was inserted at the bladder apex for normograde rigid and flexible cystourethroscopy. All uroliths were removed via a stone basket device and retrograde flushing and suction. Long-term follow-up (1 year after surgery) information was obtained by telephone or e-mail contact with owners.

Results—27 animals with cystic and urethral calculi were included. Median patient weight was 8.3 kg (18.3 lb; range, 1.8 to 42.6 kg [4.0 to 93.7 lb]). Urolith number ranged from 1 to > 35 (median, 7). Urolith size ranged from < 1 to 30 mm (median, 4.5 mm). Fifteen of the 27 animals had a previous cystotomy (range, 1 to 5 procedures). Median procedure time was 66 minutes (range, 50 to 80 minutes). All patients were discharged within 24 hours. No postoperative complications were reported at the time of suture removal. At the time of long-term follow-up, the 22 clients that could be contacted were satisfied with the procedure.

Conclusions and Clinical Relevance—Transvesicular percutaneous cystolithotomy may decrease the need for urethrotomy, serial transurethral endoscopic procedures, and abdominal insufflation associated with other minimally invasive interventions currently available. This procedure also provided excellent visualization for bladder and urethral luminal inspection.
Clinical features and epidemiology of cryptococcosis in cats and dogs in California: 93 cases (1988–2010)
Authors: Trivedi Sameer R. , Sykes Jane E. , Cannon Matthew S. , Wisner Erik R. , Meyer Wieland , Sturges Beverly K. , Dickinson Peter J. , Johnson Lynelle R.
Published: August 2011

Objective—To compare clinical features of cryptococcosis among cats and dogs in California, determine whether the distribution of involved tissues differs from distribution reported previously in a study in southeastern Australia, and identify Cryptococcus spp isolated from the study population.

Design—Retrospective case series.

Animals—62 cats and 31 dogs with cryptococcosis.

Procedures—Medical records of cats and dogs with cryptococcosis were reviewed. Information collected included geographic location, species, signalment, and tissues or organs involved. Cryptococcosis was confirmed via serology, cytology, histology, or microbial culture, and molecular typing was performed. Odds ratios and 95% confidence intervals were calculated to determine significant associations among variables. Other comparisons were evaluated via χ2 or unpaired t tests.

Results—American Cocker Spaniels were overrepresented, compared with other dog breeds. Serum cryptococcal antigen test results were positive in 51 of 53 cats and 15 of 18 dogs tested. Cryptococcus gattii was more commonly detected in cats (7/9 for which species identification was performed), and Cryptococcus neoformans was more commonly detected in dogs (6/8). Six of 7 C gattii isolates from cats were molecular type VGIII. Distribution of involved tissues was different between cats and dogs in California and between populations of the present study and those of the previously reported Australian study.

Conclusions and Clinical Relevance—Strains of Cryptococcus spp appeared to have host specificity in dogs and cats. Differences in lesion distribution between geographic locations may reflect strain differences or referral bias. Antigen assays alone may not be sufficient for diagnosis of cryptococcosis in cats and dogs.
Bladder inversion and secondary hematuria in a 6-month-old domestic shorthair cat
Authors: Adin Christopher A. , Chew Dennis J. , Heng Hock Gan , Townsend Katy L. , Karnik Ketaki
Published: August 2011

Case Description—A 6-month-old female domestic shorthair cat was admitted for evaluation of intermittent clinical signs of hematuria and inappropriate urination for the past 2 months.

Clinical Findings—Transabdominal ultrasonography revealed a multilayered mass in the urinary bladder apex consistent with full-thickness invagination of the bladder wall.

Treatment and Outcome—Exploratory surgery was performed, and partial inversion of the urinary bladder was confirmed. The invaginated bladder apex was manually reduced, and partial cystectomy was performed to remove the invaginated section of bladder wall. Histologic findings were consistent with vascular congestion and edema secondary to partial invagination. Bacterial culture of a section of the bladder mucosa demonstrated concurrent bacterial urinary tract infection. Clinical signs resolved following surgical resection of the bladder apex and antimicrobial treatment for the concurrent urinary tract infection.

Clinical Relevance—Partial invagination of the urinary bladder should be considered in the differential diagnosis for cats with clinical signs of hematuria, stranguria, and inappropriate urination. A diagnosis may be made on the basis of detection of invaginated tissue in the bladder apex during abdominal ultrasonography.
Comparison of three point-of-care blood glucose meters for use in adult and juvenile alpacas
Authors: Tennent-Brown Brett S. , Koenig Amie , Williamson Lisa H. , Boston Raymond C.
Published: August 2011

Objective—To compare the performance of 3 point-of-care glucose meters in adult and juvenile alpacas with that of a laboratory-based analyzer.

Design—Evaluation study.

Animals—35 adult alpacas and 21 juvenile alpacas.

Procedures—Whole blood samples obtained via jugular venipuncture were tested with all 3 point-of-care glucose meters; plasma samples were also tested with 1 of those meters. Glucose concentrations determined by use of the point-of-care meters were compared with results from the laboratory-based analyzer.

Results—Plasma glucose concentrations determined by use of the laboratory-based analyzer ranged from 36 to 693 mg/dL. Over the entire range of glucose concentrations tested, the Lin concordance correlation coefficient (agreement) was significant and excellent for all comparisons. Concordance decreased for 1 glucometer when testing whole blood samples over a narrower range of glucose concentrations (50 to 200 mg/dL). Bias was typically small (< 10 mg/dL) for 3 of the 4 comparisons but considerable for 1 meter with the use of whole blood. The limits of agreement were wide for all comparisons over the entire range of glucose concentrations tested but decreased to within acceptable limits when the narrower glucose range (50 to 200 mg/dL) was analyzed for 3 of the comparisons. For samples with a PCV < 25%, bias and the limits of agreement were greater for one of the meters tested.

Conclusions and Clinical Relevance—Discrepancies between point-of-care glucose meters and reference techniques can be considerable in alpacas, emphasizing the importance of assessing individual meter performance in a target population.
Occupational Safety and Health Studies in Nepal
Authors: Joshi SK , Shrestha S , Vaidya S
Published: August 2011

Occupational safety and health are key issues today, with growing industrialization and labor market. To introduce and maintain a high standard of safety and health at workplace, it is essential to have an overall picture of the present workplace scenario, different hazards and probable health effects. This is a review of all previously published articles on occupational safety and health in Nepal. Key words such as Nepal, Occupation, Safety, and Health were used to search for relevant articles in PUBMED and Google Scholar. A total of 15 research articles were found, which dealt with different forms of work, like agriculture, health services, child labor, small scale household industries, brick kilns, and textile factories. The overall status of occupational safety and health does not look satisfactory. Standard work situations and criteria have to be set up and regular monitoring should be done to ensure the maintenance of quality at work. Key Words: environment; exposure; hazards; labor; work place DOI: http://dx.doi.org/10.3126/ijosh.v1i1.4725 International Journal of Occupational Safety and Health, Vol 1 (2011) 19-26
Congratulations on the new occupational health journal
Authors: Skyberg Knut
Published: August 2011

DOI: http://dx.doi.org/10.3126/ijosh.v1i1.5225 International Journal of Occupational Safety and Health, Vol 1 (2011) 3-4
Technique of cervicothoracic junction pedicle subtraction osteotomy for cervical sagittal imbalance: report of 11 cases
Authors: Deviren Vedat , Scheer Justin K. , Ames Christopher P.
Published: August 2011

Object

Sagittal imbalance of the cervicothoracic spine often causes severe pain and loss of horizontal gaze. Historically, the Smith-Peterson osteotomy has been used to restore sagittal balance. Cervicothoracic junction pedicle subtraction osteotomy (PSO) offers more controlled closure and greater biomechanical stability but has been infrequently reported in the literature. This study details the cervicothoracic PSO technique in 11 cases and correlates clinical kyphosis (chin-brow to vertical angle [CBVA]) with radiographic measurements.

Methods

Between February 2008 and September 2010, 11 patients (mean age 70 years) underwent a modified PSO (10 at C-7, 1 at T-1) for treatment of sagittal imbalance. Preoperative and postoperative sagittal plane radiographic measurements were made. The CBVA was measured on clinical photographs. Operative technique and perioperative correction were reported for all 11 patients and long-term follow-up data was reported for 9 patients, in whom the mean duration of follow-up was 23 months. Outcome measures used for these 9 patients were the Neck Disability Index, the 36-Item Short Form Health Survey (SF-36), and a visual analog scale for neck pain.

Results

The mean values for estimated blood loss, surgical time, and hospital stay in the 11 patients were 1100 ml, 4.3 hours, and 9.9 days, respectively. The mean preoperative and immediate postoperative values (± SD) for cervical sagittal imbalance were 7.9 ± 1.4 cm and 3.4 ± 1.7 cm. The mean overall correction was 4.5 ± 1.5 cm (42.8%), the mean PSO correction 19.0°, and the mean CBVA correction 36.7°. There was essentially no correlation between preoperative C2–T1 radiographic kyphosis and preoperative CBVA (R2= 0.0165). There was a moderate correlation with PSO correction angle and postoperative CBVA (R2= 0.38). There was a significant decrease in both the Neck Disability Index (51.1 to 38.6, p = 0.03) and visual analog scale scores for neck pain (8.1 to 3.9, p = 0.0021). The SF-36 physical component summary scores increased by 18.4% (30.2 to 35.8) with no neurological complications.

Conclusions

The cervicothoracic junction PSO is a safe and effective procedure for the management of cervicothoracic kyphotic deformity. It results in excellent correction of cervical kyphosis and CBVA with a controlled closure and improvement in health-related quality-of-life measures even at early time points.
Horizontal C-1 fractures in association with unstable distraction injuries of the craniocervical junction
Authors: Vilela Marcelo D. , Bransford Richard J. , Bellabarba Carlo , Ellenbogen Richard G.
Published: August 2011

Object

Horizontal fractures of the anterior arch of the atlas not associated with odontoid fractures have been regarded as stable fractures that can be simply treated with a cervical collar. The authors report that C-1 horizontal fractures also occur in association with severe distraction injuries of the craniocervical junction.

Methods

The authors retrospectively reviewed imaging studies obtained in all surviving patients in whom unstable distraction injuries of the craniocervical junction were diagnosed and in whom surgery was performed at their institution between 1995 and 2009. All patients who also had a C-1 horizontal fracture as a component of their spinal injury were included in the study.

Results

Of 47 patients with unstable craniocervical distraction injuries, 5 patients had a horizontal fracture through the anterior ring of C-1: 1 patient had a primarily C1–2 distractive injury whereas 4 others had a grossly unstable injury across the occipitoatlantal junction (occipitoatlantal dissociation).

Conclusions

The finding of a C-1 horizontal fracture does not always reflect a benign injury and its presence should heighten the concern of a more severe and unstable injury at the craniocervical junction.
Molecular signaling in pathogenesis of craniosynostosis: the role of fibroblast growth factor and transforming growth factor–β
Authors: Chim Harvey , Manjila Sunil , Cohen Alan R. , Gosain Arun K.
Published: August 2011

The interplay of signals between dura mater, suture mesenchyme, and brain is essential in determining the fate of cranial sutures and the pathogenesis of premature suture fusion leading to craniosynostosis. At the forefront of research into suture fusion is the role of fibroblast growth factor and transforming growth factor–β, which have been found to be critical in the cell-signaling cascade involved in aberrant suture fusion. In this review, the authors discuss recent and ongoing research into the role of fibroblast growth factor and transforming growth factor–β in the etiopathogenesis of craniosynostosis.
Chance fractures in the pediatric population
Authors: Le Tien V. , Baaj Ali A. , Deukmedjian Armen , Uribe Juan S. , Vale Fernando L.
Published: August 2011

Object

The pediatric Chance fracture (PCF) is an uncommon injury, but it has been increasingly reported. Knowledge is limited to few case reports and short series. To understand the various aspects of this injury, the authors reviewed the current literature.

Methods

A literature search was conducted using the PubMed and Ovid online databases and relevant key words. All articles that were in English and provided information regarding PCF as a sole or part of the objective were retrieved.

Results

Seventy-three articles were found to fulfill the inclusion criteria. Relevant information about PCF collected from these articles included: 1) mode of trauma, 2) associated injuries, 3) radiological classification, and 4) treatment.

Conclusions

Chance fractures in children are potentially devastating injuries largely caused by motor vehicle collisions, and these fractures may be more common than previously thought. Concomitant intraabdominal injuries are common and should be suspected, particularly when a seat belt sign is observed. Blunt abdominal aortic injuries are rarely associated, but should be evaluated for and treated appropriately. Magnetic resonance imaging is best for defining ligamentous injury, which aids in defining the pattern of injury, facilitating appropriate treatment regimens.
Chiari malformation Type I and syrinx in children undergoing magnetic resonance imaging
Authors: Strahle Jennifer , Muraszko Karin M. , Kapurch Joseph , Bapuraj J. Rajiv , Garton Hugh J. L. , Maher Cormac O.
Published: August 2011

Object

Chiari malformation Type I (CM-I) with an associated spinal syrinx is a common pediatric diagnosis. A better understanding of the relative age-related prevalence and MR imaging characteristics of these associated conditions may lead to improved treatment decisions.

Methods

The authors performed a retrospective review of 14,116 consecutive individuals 18 years of age or younger who had undergone brain or cervical spine MR imaging at the University of Michigan between November 1997 and August 2008. In the patients with CM-I, demographic, clinical, and radiographic information was recorded.

Results

Five hundred nine children (3.6%) with CM-I were identified. Among these patients, 23% also had a spinal cord syrinx, and 86% of the syringes were found in the cervical spine. The MR imaging prevalence of CM-I with a syrinx was 1.2% in girls and 0.5% in boys (p < 0.0001). The severity of impaired CSF flow at the foramen magnum was associated with the amount of tonsillar herniation (p < 0.0001) and conformation of the tonsils (p < 0.0001). Patients with CM-I were treated surgically in 35% of cases; these patients exhibited more severe tonsillar herniation (p < 0.0001) and impaired CSF flow (p < 0.0001) as compared with those who did not undergo surgery. On imaging, 32% of all the patients with CM-I were considered symptomatic by the treating physician. Patients were more likely to be considered symptomatic if they were female, had a syrinx, displayed abnormal tonsillar pulsations, or had a greater amount of tonsillar herniation.

Conclusions

In this study the authors describe the age-related prevalence and MR imaging characteristics of CM-I and its association with a syrinx and other abnormalities in a large group of children who underwent MR imaging for any indication. Syringes are more common in older children, in girls, and in patients with a greater degree of tonsillar descent and CSF flow impairment.
Natural history of Chiari malformation Type I following decision for conservative treatment
Authors: Strahle Jennifer , Muraszko Karin M. , Kapurch Joseph , Bapuraj J. Rajiv , Garton Hugh J. L. , Maher Cormac O.
Published: August 2011

Object

The natural history of the Chiari malformation Type I (CM-I) is incompletely understood. The authors report on the outcome of a large group of patients with CM-I that were initially selected for nonsurgical management.

Methods

The authors identified 147 patients in whom CM-I was diagnosed on MR imaging, who were not offered surgery at the time of diagnosis, and in whom at least 1 year of clinical and MR imaging follow-up was available after the initial CM-I diagnosis. These patients were included in an outcome analysis.

Results

Patients were followed clinically and by MR imaging for a mean duration of 4.6 and 3.8 years, respectively. Of the 147 patients, 9 had new symptoms attributed to the CM-I during the follow-up interval. During this time, development of a spinal cord syrinx occurred in 8 patients; 5 of these patients had a prior diagnosis of a presyrinx state or a dilated central canal. Spontaneous resolution of a syrinx occurred in 3 patients. Multiple CSF flow studies were obtained in 74 patients. Of these patients, 23 had improvement in CSF flow, 39 had no change, and 12 showed worsening CSF flow at the foramen magnum. There was no significant change in the mean amount of cerebellar tonsillar herniation over the follow-up period. Fourteen patients underwent surgical treatment for CM-I. There were no differences in initial cerebellar tonsillar herniation or CSF flow at the foramen magnum in those who ultimately underwent surgery compared with those who did not.

Conclusions

In patients with CM-Is that are selected for nonsurgical management, the natural history is usually benign, although spontaneous improvement and worsening are occasionally seen.
Endoscopically assisted versus open repair of sagittal craniosynostosis: the St. Louis Children's Hospital experience
Authors: Shah Manish N. , Kane Alex A. , Petersen J. Dayne , Woo Albert S. , Naidoo Sybill D. , Smyth Matthew D.
Published: August 2011

Object

This study investigated the differences in effectiveness and morbidity between endoscopically assisted wide-vertex strip craniectomy with barrel-stave osteotomies and postoperative helmet therapy versus open calvarial vault reconstruction without helmet therapy for sagittal craniosynostosis.

Methods

Between 2003 and 2010, the authors prospectively observed 89 children less than 12 months old who were surgically treated for a diagnosis of isolated sagittal synostosis. The endoscopic procedure was offered starting in 2006. The data associated with length of stay, blood loss, transfusion rates, operating times, and cephalic indices were reviewed.

Results

There were 47 endoscopically treated patients with a mean age at surgery of 3.6 months and 42 patients with open-vault reconstruction whose mean age at surgery was 6.8 months. The mean follow-up time was 13 months for endoscopic versus 25 months for open procedures. The mean operating time for the endoscopic procedure was 88 minutes, versus 179 minutes for the open surgery. The mean blood loss was 29 ml for endoscopic versus 218 ml for open procedures. Three endoscopically treated cases (6.4%) underwent transfusion, whereas all patients with open procedures underwent transfusion, with a mean of 1.6 transfusions per patient. The mean length of stay was 1.2 days for endoscopic and 3.9 days for open procedures. Of endoscopically treated patients completing helmet therapy, the mean duration for helmet therapy was 8.7 months. The mean pre- and postoperative cephalic indices for endoscopic procedures were 68% and 76% at 13 months postoperatively, versus 68% and 77% at 25 months postoperatively for open surgery.

Conclusions

Endoscopically assisted strip craniectomy offers a safe and effective treatment for sagittal craniosynostosis that is comparable in outcome to calvarial vault reconstruction, with no increase in morbidity and a shorter length of stay.
Multidisciplinary management of childhood brain tumors: a review of outcomes, recent advances, and challenges
Authors: Pollack Ian F.
Published: August 2011

Object

Brain tumors are the most common category of childhood solid tumors. In the 1970s and 1980s, treatment protocols for benign tumors focused almost exclusively on surgery, with radiation treatment as a salvage modality, whereas the management of malignant tumors employed a combination of surgery, radiation therapy, and chemotherapy, with therapeutic approaches such as “8-in-1” chemotherapy often applied across histological tumor subsets that are now recognized to be prognostically distinct. During the ensuing years, treatment has become increasingly refined, based on clinical and, more recently, molecular factors, which have supported risk-adapted treatment stratification. The goal of this report is to provide an overview of recent progress in the field.

Methods

A review of the literature was undertaken to examine recent advances in the management of the most common childhood brain tumor subsets, and in particular to identify instances in which molecular categorization and treatment stratification offer evidence or promise for improving outcome.

Results

For both medulloblastomas and infant tumors, refinements in clinical and molecular stratification have already facilitated efforts to achieve risk-adapted treatment planning. Current treatment strategies for children with these tumors focus on improving outcome for tumor subsets that have historically been relatively resistant to therapy and reducing treatment-related sequelae for children with therapy-responsive tumors. Recent advances in molecular categorization offer the promise of further refinements in future studies. For children with ependymomas and low-grade gliomas, clinical risk stratification has facilitated tailored approaches to therapy, with improvement of disease control and concomitant reduction in treatment sequelae, and recent discoveries have identified promising therapeutic targets for molecularly based therapy. In contrast, the prognosis remains poor for children with diffuse intrinsic pontine gliomas and other high-grade gliomas, despite recent identification of biological correlates of tumor prognosis and elucidation of molecular substrates of tumor development.

Conclusions

Advances in the clinical and molecular stratification for many types of childhood brain tumors have provided a foundation for risk-adapted treatment planning and improvements in outcome. In some instances, molecular characterization approaches have also yielded insights into new therapeutic targets. For other tumor types, outcome remains discouraging, although new information regarding the biological features critical to tumorigenesis are being translated into novel therapeutic approaches that hold promise for future improvements.
Combined metopic and sagittal craniosynostosis: is it worse than sagittal synostosis alone?
Authors: Terner Jordan S. , Travieso Roberto , Lee Su-shin , Forte Antonio J. , Patel Anup , Persing John A.
Published: August 2011

Object

Combined metopic and sagittal craniosynostosis is a common variant of the nonsyndromic, multiplesuture synostoses. It is unknown whether this combined form causes reduced intracranial volume (ICV) and potentially more brain dysfunction than sagittal synostosis alone. This study is a volumetric comparison of these 2 forms of craniosynostosis.

Methods

The authors conducted a retrospective chart and CT review of 36 cases of isolated sagittal synostosis or combined metopic and sagittal synostosis, involving patients seen between 1998 and 2006. Values were obtained for the intracranial compartment, brain tissue, CSF space, and ventricular volumes. Patients with craniosynostosis were then compared on these measures to 39 age- and sex-matched controls.

Results

In patients with isolated sagittal synostosis and in those with combined metopic and sagittal synostosis, there was a trend toward smaller ICV than in controls (p < 0.1). In female patients older than 4.5 months of age, there was also a trend toward smaller ICV in patients with the combined form than in those with sagittal synostosis alone (p < 0.1), and the ICV of patients with the combined form was significantly smaller than the volume in controls in the same age group (p < 0.05). Brain tissue volume was significantly smaller in both patient groups than in controls (p < 0.05). Ventricular volume was significantly increased (compared with controls) only in the patients with isolated sagittal synostosis who were younger than 4.5 months of age (p < 0.05). Overall CSF space, however, was significantly larger in both patient groups in patients younger than 4.5 months of age (p < 0.05).

Conclusions

These findings raise concerns about intracranial and brain volume reduction in patients with sagittal and combined metopic and sagittal synostoses and the possibility that this volume reduction may be associated with brain dysfunction. Because the ICV reduction is greater in combined metopic and sagittal synostosis in patients older than 4.5 months of age than in sagittal synostosis in this age group, the potential for brain dysfunction may be particularly true for these younger infants.
Endoscope-assisted strip craniectomy and postoperative helmet therapy for treatment of craniosynostosis
Authors: Berry-Candelario John , Ridgway Emily B. , Grondin Ronald T. , Rogers Gary F. , Proctor Mark R.
Published: August 2011

Object

The primary goals of treatment in the infant with craniosynostosis are to correct the deformity and allow for adequate brain growth in as safe and effective a manner as possible. Herein, the authors present the results of treating craniosynostosis using an endoscope-assisted strip craniectomy and postoperative helmet therapy (EASC + PHT) in the hopes of providing further evidence of its role in the treatment of multiple different forms of craniosynostosis. This is a retrospective review of the patients treated with this technique at Children's Hospital Boston.

Methods

The electronic medical records of all children with craniosynostosis treated using this technique were reviewed retrospectively. A priori, data were collected for deformity type, patient age at surgery, number of transfusions, operative time, length of hospital stay, and anthropometric measurements.

Results

One hundred seventy-three patients (61 females and 112 males) were treated at our institution between July 2004 and March 2011 with EASC + PHT. The mean operative time was 46.30 minutes. Eight (4.6%) of the 173 patients received blood transfusions. The average length of hospital stay was 1.35 days, with the majority of patients being discharged the day after surgery. All complications and any patient who required additional craniofacial reconstructions are discussed. In addition, a subgroup analysis was done for patients who had undergone surgery and had longer than 1 year of follow-up.

Conclusions

The authors' growing database of patients supports the experiences described by others that early treatment of craniosynostosis with an EASC + PHT is a safe and efficacious technique. In addition, cost reduction due to decreased hospital stay and limitation of blood transfusions are demonstrable benefits associated with the use of this technique.
What is it about the Book? Semantic and Material Dimensions in the Mediation of the Word of God
Authors: Horsfield Peter , Asamoah-Gyadu Kwabena
Published: August 2011

When the Christian Bible is referred to as the ‘Word of God’, the common understanding is that this refers to its textual content. There are, however, a variety of other uses made of the bible that point to an understanding of the Word of God as not just the textual content but also the material book itself. This article explores a number of uses of the physical bible as an instrument of spiritual mediation or power that have been practised since the early days of Christianity to the present time. Some of the understandings underlying these material practices are explored, along with differences in the religious-cultural context that sustain these different views, including the differences in religious hermeneutics between the oral and written word, the importance of the concept of the book in Christian identity, the relationship of fetishism and theological understanding, and cultural differences in understanding the relationship between textual and material signification.
Domains Selection for Patient-Reported Outcomes: Current Activities and Options for Future Methods
Authors: TUGWELL PETER S. , PETERSSON INGEMAR F. , BOERS MAARTEN , GOSSEC LAURE , KIRWAN JOHN R. , RADER TAMARA , SANDERSON TESSA C. , van de LAAR MART A. , UEFFING ERIN , WITTER JAMES P.
Published: August 2011

Introduction.

Over the years, Outcome Measures in Rheumatology Clinical Trials (OMERACT) has worked toward consensus on core sets for outcome measurement in specific rheumatologic diseases. OMERACT core sets refer to the minimum number of domains and instruments essential to address the desired outcomes in trials. “Domains” are the attributes of an activity or function. This article discusses the need for an open process for selecting domains, existing frameworks for choosing domains, and the importance of describing the methods for selecting domains.

Methods.

We reviewed the domains selection process of 3 OMERACT groups working on patient-reported outcomes (PRO). We categorized these methods in a hierarchy of comprehensiveness and examined the extent to which they address related issues.

Results.

There was agreement that a gold standard for domain selection would include 3 important aspects: following a framework, remaining true to the clinical question, and including the clinically relevant outcomes for both benefits and harms.

Discussion.

OMERACT participants agreed that a guide for the options for developing domains that meet the OMERACT Filter would be useful. More discussion and explanation is needed to outline outcomes related to the patient perspective that are not covered by the current version of the International Classification of Functioning, Disability and Health (ICF) and to explain the usefulness of the population/intervention/comparison/outcome (PICO) structure in domain selection. Future OMERACT work includes addressing these issues and developing a framework based on the ICF to support comprehensive outcome measurements.
Patient Perspective: Choosing or Developing Instruments
Authors: KIRWAN JOHN R. , FRIES JAMES F. , HEWLETT SARAH , OSBORNE RICHARD H.
Published: August 2011

Previous Outcome Measures in Rheumatology (OMERACT) meetings recognized that patients view outcomes of intervention from a different perspective. This preconference position paper briefly sets out 2 patient-reported outcome (PRO) instrument approaches, the PROMISE computer adaptive testing (CAT) system and development of a rheumatoid arthritis-specific questionnaire to measure fatigue; a tentative proposal for a PRO instrument development pathway is also made.
Developing a Construct to Evaluate Flares in Rheumatoid Arthritis: A Conceptual Report of the OMERACT RA Flare Definition Working Group: Table 1.
Authors: ALTEN RIEKE , POHL CHRISTOF , CHOY ERNEST H. , CHRISTENSEN ROBIN , FURST DANIEL E. , HEWLETT SARAH E. , LEONG AMYE , MAY JAMES E. , SANDERSON TESSA C. , STRAND VIBEKE , WOODWORTH THASIA G. , BINGHAM CLIFTON O. ,   The OMERACT RA Flare Definition Working Group
Published: August 2011

Rheumatoid arthritis (RA) patients and healthcare professionals (HCP) recognize that episodic worsening disease activity, often described as a “flare,” is a common feature of RA that can contribute to impaired function and disability. However, there is no standard definition to enable measurement of its intensity and impact. The conceptual framework of the Outcome Measures in Rheumatology Clinical Trials (OMERACT) RA Flare Definition Working Group includes an anchoring statement, developed at OMERACT 9 in 2008: “flare in RA” is defined as worsening of signs and symptoms of sufficient intensity and duration to lead to change in therapy. Subsequently, domains characterizing flare have been identified by comprehensive literature review, patient focus groups, and patient/HCP Delphi exercises. This led to a consensus regarding preliminary domains and a research agenda at OMERACT 10 in May 2010. The conceptual framework of flare takes into account validated approaches to measurement in RA: (1) various disease activity indices (e.g., Disease Activity Score, Clinical Disease Activity Index, Simplified Disease Activity Index); (2) use of patient-reported outcomes (PRO); and (3) characterization of minimally clinically detectable and important differences (MCDD, MCID). The measurement of RA flare is composed of data collection assessing a range of unique domains describing key features of RA worsening at the time of patient self-report of flare, and then periodically for the duration of the flare. The components envisioned are: (1) Patient self-report using a “patient global question” with well characterized and validated anchors; (2) Patient assessment using a flare questionnaire and PRO available at the time of each self-report; (3) Physician/HCP assessment of disease activity status; and (4) Physician’s determination whether to change treatment. In randomized controlled trials and observational studies, such a conceptual approach is intended to lead to a valid measure of this outcome/response, thus expanding an understanding of the true impact of a therapy to limit disease activity. Clinically, this approach is intended to enhance patient-HCP communication. This article describes the conceptual framework being used by the OMERACT RA Flare Definition Working Group in developing a standardized method for description and measurement of “flare in RA” to guide individual patient treatment.
The PROMIS of Better Outcome Assessment: Responsiveness, Floor and Ceiling Effects, and Internet Administration
Authors: FRIES JAMES , ROSE MATTHIAS , KRISHNAN ESWAR
Published: August 2011

Objective.

Use of item response theory (IRT) and, subsequently, computerized adaptive testing (CAT), under the umbrella of the NIH-PROMIS initiative (National Institutes of Health – Patient-Reported Outcomes Measurement Information System), to bring strong new assets to the development of more sensitive, more widely applicable, and more efficiently administered patient-reported outcome (PRO) instruments. We present data on current progress in 3 crucial areas: floor and ceiling effects, responsiveness to change, and interactive computer-based administration over the Internet.

Methods.

We examined nearly 1000 patients with rheumatoid arthritis and related diseases in a series of studies including a one-year longitudinal examination of detection of change; compared responsiveness of the Legacy SF-36 and HAQ-DI instruments with IRT-based instruments; performed a randomized head-to-head trial of 4 modes of item administration; and simulated the effect of lack of floor and ceiling items upon statistical power and sample sizes.

Results.

IRT-based PROMIS instruments are more sensitive to change, resulting in the potential to reduce sample size requirements substantially by up to a factor of 4. The modes of administration tested did not differ from each other in any instance by more than one-tenth of a standard deviation. Floor and ceiling effects greatly reduce the number of available subjects, particularly at the ceiling.

Conclusion.

Failure to adequately address floor and ceiling effects, which determine the range of an instrument, can result in suboptimal assessment of many patients. Improved items, improved instruments, and computer-based administration improve PRO assessment and represent a fundamental advance in clinical outcomes research.
Valuing Health for Clinical and Economic Decisions: Directions Relevant for Rheumatologists
Authors: HARRISON MARK J. , BANSBACK NICK J. , MARRA CARLO A. , DRUMMOND MICHAEL , TUGWELL PETER S. , BOONEN ANNELIES
Published: August 2011

The quality-adjusted life-year (QALY) is a construct that integrates the value or preference for a health state over the period of time in that health state. The main use of QALY is in cost-utility analysis, to help make resource allocation decisions when faced with choices. Although the concept of the QALY is appealing, there is ongoing debate regarding their usefulness and approaches to deriving QALY. In 2008, OMERACT engaged in an effort to agree on QALY approaches that can be used in rheumatology. Based on a Web questionnaire and a subsequent meeting, rheumatologists questioned whether it was relevant for OMERACT (1) to investigate use of a QALY that represents the patients’ perspective, (2) to explore the validity of the visual analog scale (VAS) to value health, and (3) to understand the validity of mapping health-specific instruments on existing preference instruments. This article discusses the pros and cons of these points in light of current insight from the point of view of health economics and decision-making theory. It also considers the further research agenda toward a QALY approach in rheumatology.
Stroke as a Complication of H1N1 Influenza Infection: A Case Study
Authors: Krummel-McCracken Kirsten
Published: August 2011

In June 2010, the Centers for Disease Control and Prevention ended the US public health emergency for the H1N1 pandemic with estimates for total cases, hospitalizations, and deaths counted from April 2009 to April 2010. By the end of this period, the human H1N1 virus was estimated to have been responsible for 12470 deaths in the United States. Most deaths associated with the seasonal flu or H1N1 infection are due to complications such as secondary infections. Experts are finding, however, that a small percentage of these deaths or comorbid conditions may be caused by disseminated intravascular coagulation, and stroke can be a sequela of disseminated intravascular coagulation. This case study describes the clinical course of a patient who had multiple strokes due to disseminated intravascular coagulation triggered by H1N1 infection. Useful clinical information about disseminated intra-vascular coagulation is detailed for nursing practice. Implications of the possible link between H1N1 infection (and influenza A and B) and stroke resulting from disseminated intravascular coagulation are discussed.
Introdução ao METS – Preservação e Intercâmbio de Objetos Digitais
Authors: Rodrigues Nelson de Almeida
Published: August 2011

O Metadata Encoding & Transmission Standard (METS) é um XML Schema elaborado sob o patrocínio da Digital Library Federation e mantido pela Biblioteca do Congresso Norte Americano que permite criar uma rica estrutura capaz de registrar, não apenas os múltiplos tipos de metadados usados para descrever o acervo de uma biblioteca digital, como também, os próprios objetos digitais, seja para gerenciá-los, seja para permitir o intercâmbio entre diferentes instituições. Este artigo apresenta os problemas motivadores da sua criação e sua origem histórica no projeto Making of America II. Descreve a finalidade de cada um dos elementos XML que formam o vocabulário desse padrão e ilustra o emprego de alguns deles com exemplos codificados em XML, o que requer um conhecimento básico desta linguagem para melhor compreensão. Expressa sua relação com o modelo Open Archival Information System como um significativo exemplo de sua aplicação e, por fim, aborda outros padrões criados com propósitos semelhantes.
Uso de resumos e palavras-chave em Ciências Sociais: uma avaliação
Authors: Gonçalves Aline Lima
Published: August 2011

Este trabalho tem como objetivo avaliar resumos e palavras-chave de artigos de periódicos publicados em Ciências Sociais por autores brasileiros, a fim de identificar as principais características desses elementos e como isso afeta a representação e recuperação de informação nessa área. Para isso, foi feita uma avaliação de 151 resumos de artigos produzidos por professores da Universidade de São Paulo em três disciplinas, Antropologia, Ciência Política e Sociologia, na tentativa de descobrir como os autores exploraram os tipos de resumo (descritivo, informativo ou descritivo-informativo); num segundo tópico, foram avaliadas as palavras-chave que acompanhavam o resumo e o seu potencial como complemento deste e como ferramenta para relacionar disciplinas. Observou-se que os autores preferem resumos descritivos em detrimento dos informativos, e que, apesar da falta de padronização, as palavras-chave fornecidas pelos autores podem ser usadas como complemento dos resumos e como indicador de algumas relações interdisciplinares. Conclui-se que, apesar da importância de resumos e palavras-chave como elementos de representação de informação, suas funções são pouco exploradas nas Ciências Sociais, o que pode afetar negativamente a recuperação da informação.
Medición de la capacidad docente de la colección de una biblioteca universitaria
Authors: Costamagna María Teresa
Published: August 2011

El objetivo del trabajo esta enfocado en la medición de la capacidad docente de la colección física de una biblioteca universitaria a través de los documentos solicitados por los profesores de una cátedra en la bibliografía básica de los programas de estudio. La metodología aplicada se centra cualitativamente en los materiales documentarios contrastándolos con las bibliografías aplicando el análisis de citas, los hallazgos revelan la existencia de un ajuste global medio entre la colección y los requerimientos de los usuarios, se recomienda posibilitar la disponibilidad de títulos faltantes por medio de su adquisición, como así también propender a tomar en cuenta tanto a la información electrónica y los espacios virtuales como a las redes de bibliotecas afines.