bluuebunny/crossref_metadata_2025 huggingface dataset:
Determinants of Increased Primary Health Care Use in Cancer Survivors
Authors: Heins Marianne , Schellevis Francois , Rijken Mieke , van der Hoek Lucas , Korevaar Joke
Published: October 2012

Purpose

The number of cancer survivors is increasing, and patients with cancer often experience long-lasting consequences of cancer and its treatment. Because of the variety of health problems and high prevalence of comorbidity, primary care physicians (PCPs) seem obvious candidates to take care of these patients, and insight into primary health care (PHC) use of cancer survivors is needed. We aimed to find determinants for PHC use in cancer survivors.

Methods

Using data from the Netherlands Information Network of Primary Care, we determined the volume of PHC use in 1,256 adult patients with breast cancer, 503 patients with prostate cancer, and 487 patients with colorectal cancer 2 to 5 years after diagnosis and compared this with age- and sex-matched controls without cancer from the same practice. We also examined whether age, comorbidity, and time since diagnosis were related to PHC use.

Results

The mean annual number of primary care contacts was increased compared with control patients by 24% in patients with breast cancer (P < .001) and by 33% in patients with prostate cancer (P < .001). This difference remained constant between 2 and 5 years after diagnosis. In patients with colon cancer, the difference with controls tended to decrease with age (12% per 10 years; P = .005).

Conclusion

PHC use is significantly increased 2 to 5 years after diagnosis of cancer, especially in younger patients without a chronic disease. Given the expected increase in cancer survivors, PCPs should prepare themselves for this increasing amount of aftercare. The development of multidisciplinary care standards for cancer survivors could be helpful.
Comparative Effectiveness Research Paradigm: Implications for Systematic Reviews and Clinical Practice Guidelines
Authors: Brouwers Melissa C. , Thabane Lehana , Moher David , Straus Sharon E.
Published: October 2012

Purpose

The objectives of this article are (1) to examine the similarities and differences between comparative effectiveness research (CER) and evidence-based medicine (EBM); (2) to describe the implications of CER for systematic review methodologies in oncology; and (3) to address the transition from systematic reviews to guideline development and the implications of CER in this process.

Method

An analysis of the principles and methods of CER was undertaken in light of EBM, systematic reviews, and guidelines.

Results and Conclusion

There is considerable overlap between the principles and methods of the two paradigms. The focus on best care options in the context of routine practice is a more central tenet of the CER paradigm. Thus, its value is not that it is the first paradigm to recognize the importance of a patient-focused approach in the research community, but rather, given the attention it has garnered, the CER paradigm may be precisely the reminder and push required to: one, influence how systematic questions are framed so that a more patient-relevant perspective is achieved; two, broaden the types of study designs that are valued and to include those, such as pragmatic trials and observational studies, that are better able to answer effectiveness questions; three, accelerate the development and application of statistical methods that enable indirect comparisons of cancer care options; and four, create clinical practice guidelines that are better positioned to improve quality of care and system performance. Over time, we will see if the CER paradigm lives up to its potential.
Comparative Effectiveness Research: The Experience of the National Institute for Health and Clinical Excellence
Authors: Sorenson Corinna , Drummond Michael , Chalkidou Kalipso
Published: October 2012

Purpose

To assess the relevance of the experience of the National Institute for Health and Clinical Excellence (NICE) in the United Kingdom to the comparative effectiveness research (CER) initiative in the United States.

Methods

The activities of NICE were reviewed to assess its experience in analytic methods, engagement with stakeholders, communication of findings, and implementation of recommendations.

Results

The main lessons for the United States from the experience of NICE relate to how the institute has gathered, synthesized, and used information on the clinical and cost effectiveness of health care interventions. The experience of NICE suggests that ways will have to be found to reconcile the differing stakeholder perspectives on the value of health care. Given the emphasis in the United States on being patient centered, there will be situations where patients' expectations for the provision of care far exceed that which payers feel should be made available on grounds of value for money. Explicit restrictions on access to care based on CER like those found in the United Kingdom are unlikely, but alternative solutions, such as value-based reimbursement, will need to be pursued if unnecessary expenditures are to be avoided. It will also be important that the CER initiative show some impact on the use of health care resources. The longer that NICE has been in existence in the United Kingdom, questions about its impact have been more frequently asked, given the resources devoted to its activities.

Conclusion

Although there are distinct differences between the health systems of the United Kingdom and United States, lessons can be learned from examining the successes and challenges experienced by NICE.
Communicating and Understanding the Purpose of Pediatric Phase I Cancer Trials
Authors: Cousino Melissa K. , Zyzanski Stephen J. , Yamokoski Amy D. , Hazen Rebecca A. , Baker Justin N. , Noll Robert B. , Rheingold Susan R. , Geyer J. Russell , Alexander Stewart C. , Drotar Dennis , Kodish Eric D.
Published: October 2012

Purpose

Quality informed consent should provide a clear understanding of the purpose of the research. Given the ethical challenges of pediatric phase I cancer trials, it is important to investigate physician-parent communication during informed consent conferences (ICCs) and parental understanding of the purpose of these studies.

Methods

In the multisite Informed Consent in Pediatric Phase I Cancer Trials study, 85 ICCs for phase I research between June 2008 and May 2011 were directly observed, and 60 parents were subsequently interviewed. The scientific purpose was defined as composite understanding of drug safety, dose finding, and dose escalation. We determined the frequency with which physicians explained these and other phase I–related concepts during the ICC. Parent interviews were analyzed to determine understanding.

Results

The child was present at 83 of 85 ICCs. Only 32% of parents demonstrated substantial understanding of the scientific purpose of phase I cancer trials; 35% demonstrated little or no understanding. Parents of higher socioeconomic status and racial majority status were more likely to understand the scientific purpose. Factors associated with understanding included physician explanation of the goal of the applicable phase I protocol offered (explained in 85% of ICCs) and explanation of the dose cohorts (explained in 43% of ICCs). Physicians explained drug safety in 23% of ICCs, dose finding in 52% of ICCs, and dose escalation in 53% of ICCs.

Conclusion

Many parents of children participating in phase I trials do not understand the purpose of these trials. Physician-parent communication about the purpose of phase I research is lacking during ICCs.
Myeloproliferative Neoplasm (MPN) Symptom Assessment Form Total Symptom Score: Prospective International Assessment of an Abbreviated Symptom Burden Scoring System Among Patients With MPNs
Authors: Emanuel Robyn M. , Dueck Amylou C. , Geyer Holly L. , Kiladjian Jean-Jacques , Slot Stefanie , Zweegman Sonja , te Boekhorst Peter A.W. , Commandeur Suzan , Schouten Harry C. , Sackmann Federico , Kerguelen Fuentes Ana , Hernández-Maraver Dolores , Pahl Heike L. , Griesshammer Martin , Stegelmann Frank , Doehner Konstanze , Lehmann Thomas , Bonatz Karin , Reiter Andreas , Boyer Francoise , Etienne Gabriel , Ianotto Jean-Christophe , Ranta Dana , Roy Lydia , Cahn Jean-Yves , Harrison Claire N. , Radia Deepti , Muxi Pablo , Maldonado Norman , Besses Carlos , Cervantes Francisco , Johansson Peter L. , Barbui Tiziano , Barosi Giovanni , Vannucchi Alessandro M. , Passamonti Francesco , Andreasson Bjorn , Ferarri Maria L. , Rambaldi Alessandro , Samuelsson Jan , Birgegard Gunnar , Tefferi Ayalew , Mesa Ruben A.
Published: October 2012

Purpose

Myeloproliferative neoplasm (MPN) symptoms are troublesome to patients, and alleviation of this burden represents a paramount treatment objective in the development of MPN-directed therapies. We aimed to assess the utility of an abbreviated symptom score for the most pertinent and representative MPN symptoms for subsequent serial use in assessing response to therapy.

Patients and Methods

The Myeloproliferative Neoplasm Symptom Assessment Form total symptom score (MPN-SAF TSS) was calculated as the mean score for 10 items from two previously validated scoring systems. Questions focus on fatigue, concentration, early satiety, inactivity, night sweats, itching, bone pain, abdominal discomfort, weight loss, and fevers.

Results

MPN-SAF TSS was calculable for 1,408 of 1,433 patients with MPNs who had a mean score of 21.2 (standard deviation [SD], 16.3). MPN-SAF TSS results significantly differed among MPN disease subtypes (P < .001), with a mean of 18.7 (SD, 15.3), 21.8 (SD, 16.3), and 25.3 (SD, 17.2) for patients with essential thrombocythemia, polycythemia vera, and myelofibrosis, respectively. The MPN-SAF TSS strongly correlated with overall quality of life (QOL; r = 0.59; P < .001) and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) functional scales (all P < .001 and absolute r ≥ 0.50 except social functioning r = 0.48). No significant trends were present when comparing therapy subgroups. The MPN-SAF TSS had excellent internal consistency (Cronbach's α = .83). Factor analysis identified a single underlying construct, indicating that the MPN-SAF TSS is an appropriate, unified scoring method.

Conclusion

The MPN-SAF TSS is a concise, valid, and accurate assessment of MPN symptom burden with demonstrated clinical utility in the largest prospective MPN symptom study to date. This new prospective scoring method may be used to assess MPN symptom burden in both clinical practice and trial settings.
Recommendations for Incorporating Patient-Reported Outcomes Into Clinical Comparative Effectiveness Research in Adult Oncology
Authors: Basch Ethan , Abernethy Amy P. , Mullins C. Daniel , Reeve Bryce B. , Smith Mary Lou , Coons Stephen Joel , Sloan Jeff , Wenzel Keith , Chauhan Cynthia , Eppard Wayland , Frank Elizabeth S. , Lipscomb Joseph , Raymond Stephen A. , Spencer Merianne , Tunis Sean
Published: October 2012

Examining the patient's subjective experience in prospective clinical comparative effectiveness research (CER) of oncology treatments or process interventions is essential for informing decision making. Patient-reported outcome (PRO) measures are the standard tools for directly eliciting the patient experience. There are currently no widely accepted standards for developing or implementing PRO measures in CER. Recommendations for the design and implementation of PRO measures in CER were developed via a standardized process including multistakeholder interviews, a technical working group, and public comments. Key recommendations are to include assessment of patient-reported symptoms as well as health-related quality of life in all prospective clinical CER studies in adult oncology; to identify symptoms relevant to a particular study population and context based on literature review and/or qualitative and quantitative methods; to assure that PRO measures used are valid, reliable, and sensitive in a comparable population (measures particularly recommended include EORTC QLQ-C30, FACT, MDASI, PRO-CTCAE, and PROMIS); to collect PRO data electronically whenever possible; to employ methods that minimize missing patient reports and include a plan for analyzing and reporting missing PRO data; to report the proportion of responders and cumulative distribution of responses in addition to mean changes in scores; and to publish results of PRO analyses simultaneously with other clinical outcomes. Twelve core symptoms are recommended for consideration in studies in advanced or metastatic cancers. Adherence to methodologic standards for the selection, implementation, and analysis/reporting of PRO measures will lead to an understanding of the patient experience that informs better decisions by patients, providers, regulators, and payers.
Comparative Effectiveness Research, Genomics-Enabled Personalized Medicine, and Rapid Learning Health Care: A Common Bond
Authors: Ginsburg Geoffrey S. , Kuderer Nicole M.
Published: October 2012

Despite stunning advances in our understanding of the genetics and the molecular basis for cancer, many patients with cancer are not yet receiving therapy tailored specifically to their tumor biology. The translation of these advances into clinical practice has been hindered, in part, by the lack of evidence for biomarkers supporting the personalized medicine approach. Most stakeholders agree that the translation of biomarkers into clinical care requires evidence of clinical utility. The highest level of evidence comes from randomized controlled clinical trials (RCTs). However, in many instances, there may be no RCTs that are feasible for assessing the clinical utility of potentially valuable genomic biomarkers. In the absence of RCTs, evidence generation will require well-designed cohort studies for comparative effectiveness research (CER) that link detailed clinical information to tumor biology and genomic data. CER also uses systematic reviews, evidence-quality appraisal, and health outcomes research to provide a methodologic framework for assessing biologic patient subgroups. Rapid learning health care (RLHC) is a model in which diverse data are made available, ideally in a robust and real-time fashion, potentially facilitating CER and personalized medicine. Nonetheless, to realize the full potential of personalized care using RLHC requires advances in CER and biostatistics methodology and the development of interoperable informatics systems, which has been recognized by the National Cancer Institute's program for CER and personalized medicine. The integration of CER methodology and genomics linked to RLHC should enhance, expedite, and expand the evidence generation required for fully realizing personalized cancer care.
Importance of Health Information Technology, Electronic Health Records, and Continuously Aggregating Data to Comparative Effectiveness Research and Learning Health Care
Authors: Miriovsky Benjamin J. , Shulman Lawrence N. , Abernethy Amy P.
Published: October 2012

Rapidly accumulating clinical information can support cancer care and discovery. Future success depends on information management, access, use, and reuse. Electronic health records (EHRs) are highlighted as a critical component of evidence development and implementation, but to fully harness the potential of EHRs, they need to be more than electronic renderings of the traditional paper medical chart. Clinical informatics and structured accessible secure data captured through EHR systems provide mechanisms through which EHRs can facilitate comparative effectiveness research (CER). Use of large linked administrative databases to answer comparative questions is an early version of informatics-enabled CER familiar to oncologists. An updated version of informatics-enabled CER relies on EHR-derived structured data linked with supplemental information to provide patient-level information that can be aggregated and analyzed to support hypothesis generation, comparative assessment, and personalized care. As implementation of EHRs continues to expand, electronic databases containing information collected via EHRs will continuously aggregate; aggregating data enhanced with real-time analytics can provide point-of-care evidence to oncologists, tailored to patient-level characteristics. The system learns when clinical care informs research, and insights derived from research are reinvested in care. Challenges must be overcome, including interoperability, standardization, access, and development of real-time analytics.
Phase III Trial of Chemoradiotherapy for Anaplastic Oligodendroglioma: Long-Term Results of RTOG 9402
Authors: Cairncross Gregory , Wang Meihua , Shaw Edward , Jenkins Robert , Brachman David , Buckner Jan , Fink Karen , Souhami Luis , Laperriere Normand , Curran Walter , Mehta Minesh
Published: October 2012

Purpose

Anaplastic oligodendrogliomas, pure (AO) and mixed (anaplastic oligoastrocytoma [AOA]), are chemosensitive, especially if codeleted for 1p/19q, but whether patients live longer after chemoradiotherapy is unknown.

Patients and Methods

Eligible patients with AO/AOA were randomly assigned to procarbazine, lomustine, and vincristine (PCV) plus radiotherapy (RT) versus RT alone. The primary end point was overall survival (OS).

Results

Two hundred ninety-one eligible patients were randomly assigned: 148 to PCV plus RT and 143 to RT. For the entire cohort, there was no difference in median survival by treatment (4.6 years for PCV plus RT v 4.7 years for RT; hazard ratio [HR] = 0.79; 95% CI, 0.60 to 1.04; P = .1). Patients with codeleted tumors lived longer than those with noncodeleted tumors (PCV plus RT: 14.7 v 2.6 years, HR = 0.36, 95% CI, 0.23 to 0.57, P < .001; RT: 7.3 v 2.7 years, HR = 0.40, 95% CI, 0.27 to 0.60, P < .001), and the median survival of those with codeleted tumors treated with PCV plus RT was twice that of patients receiving RT (14.7 v 7.3 years; HR = 0.59; 95% CI, 0.37 to 0.95; P = .03). For those with noncodeleted tumors, there was no difference in median survival by treatment arm (2.6 v 2.7 years; HR = 0.85; 95% CI, 0.58 to 1.23; P = .39). In Cox models that included codeletion status, the adjusted OS for all patients was prolonged by PCV plus RT (HR = 0.67; 95% CI, 0.50 to 0.91; P = .01).

Conclusion

For the subset of patients with 1p/19q codeleted AO/AOA, PCV plus RT may be an especially effective treatment, although this observation was derived from an unplanned analysis.
The Programming of Cardiac Hypertrophy in the Offspring by Maternal Obesity Is Associated with Hyperinsulinemia, AKT, ERK, and mTOR Activation
Authors: Fernandez-Twinn Denise S. , Blackmore Heather L. , Siggens Lee , Giussani Dino A. , Cross Christine M. , Foo Roger , Ozanne Susan E.
Published: October 2012

Human and animal studies suggest that suboptimal early nutrition during critical developmental periods impacts long-term health. For example, maternal overnutrition during pregnancy and lactation in mice programs insulin resistance, obesity, and endothelial dysfunction in the offspring. Here we investigated the effects of diet-induced maternal obesity on the offspring cardiac phenotype and explored potential underlying molecular mechanisms. Dams fed the obesogenic diet were heavier (P < 0.01) and fatter (P < 0.0001) than controls throughout pregnancy and lactation. There was no effect of maternal obesity on offspring body weight or body composition up to 8 wk of age. However, maternal obesity resulted in increased offspring cardiac mass (P < 0.05), increased heart-body weight (P < 0.01), heart weight-tibia length (P < 0.05), increased left ventricular free wall thickness and area (P < 0.01 and P < 0.05, respectively), and increased myocyte width (P < 0.001). Consistent with these structural changes, the expression of molecular markers of cardiac hypertrophy were also increased [Nppb(BNP), Myh7-Myh6(βMHC-αMHC) (both P < 0.05) and mir-133a (P < 0.01)]. Offspring were hyperinsulinemic and displayed increased insulin action through AKT (P < 0.01), ERK (P < 0.05), and mammalian target of rapamycin (P < 0.05). p38MAPK phosphorylation was also increased (P < 0.05), suggesting pathological remodeling. Increased Ncf2(p67phox) expression (P < 0.05) and impaired manganese superoxide dismutase levels (P < 0.01) suggested oxidative stress, which was consistent with an increase in levels of 4-hydroxy-2-trans-nonenal (a measure of lipid peroxidation). We propose that maternal diet-induced obesity leads to offspring cardiac hypertrophy, which is independent of offspring obesity but is associated with hyperinsulinemia-induced activation of AKT, mammalian target of rapamycin, ERK, and oxidative stress.
The Effects of Chronic Administration of Testosterone Propionate with or without Estradiol on the Sexual Behavior and Plasma Steroid Levels of Aged Female Rats
Authors: Jones Sherri Lee , Ismail Nafissa , King Leonora , Pfaus James G.
Published: October 2012

Low sexual desire concomitant with feelings of distress is reported in naturally and surgically menopausal women. A combination of estradiol (E2) and testosterone (T) restores sexual desire and interest in these women. The central mechanisms by which E2 and T act to restore desire are poorly understood. Here we examined the effect of chronic treatment with testosterone propionate (TP) administered by a sc SILASTIC brand capsule in aged ovary-intact female rats. Females were first treated with TP alone, followed by a second phase when TP was administered in combination with estradiol benzoate (EB; 10 μg) by sc injection 48 h prior to testing (EB+TP). Each phase consisted of 5 test days at 4-d intervals. Appetitive and consummatory female sexual behaviors were observed in bilevel chambers, and plasma E2 and T concentrations were measured with ELISA. Sexual solicitations and hops and darts were facilitated by the highest TP dose, and the lordosis quotient was increased by the two highest TP doses when administered alone, coinciding with an increase in plasma T, but those behavioral effects were not maintained across time. The lordosis quotient was inversely related to the TP dose in the EB+TP phase. These results suggest that the administration of TP by sc capsules to aged female rats facilitates appetitive and consummatory sexual behaviors; however, chronic treatment appears to be inhibitory. This is the first study to assess sexual behavior after SILASTIC brand implants of TP in the aged female rat. Additional research is needed to elucidate the mechanisms underlying the effects of T on female sexual function.
In Vivo 17β-Estradiol Treatment Contributes to Podocyte Actin Stabilization in Female db/db Mice
Authors: Catanuto Paola , Fornoni Alessia , Pereira-Simon Simone , Wu Fayi , Burnstein Kerry L. , Xia Xiaomei , Conti Francesco , Lenzi Andrea , Elliot Sharon
Published: October 2012

We recently showed that 17β-estradiol (E2) treatment ameliorated type 2 diabetic glomerulosclerosis in mice in part by protecting podocyte structure and function. Progressive podocyte damage is characterized by foot process effacement, vacuolization, detachment of podocytes from the glomerular basement membrane, and apoptosis. In addition, podocytes are highly dependent on the preservation of their actin cytoskeleton to ensure proper function and survival. Because E2 administration prevented podocyte damage in our study on diabetic db/db mice and has been shown to regulate both actin cytoskeleton and apoptosis in other cell types and tissues, we investigated whether actin remodeling and apoptosis were prevented in podocytes isolated from E2-treated diabetic db/db mice. We performed G-actin/F-actin assays, Western analysis for Hsp25 expression, Ras-related C3 botulinum toxin substrate 1 (Rac1) activity, and apoptosis assays on previously characterized podocytes isolated from both in vivo-treated placebo and E2 female db/db mice. We found that in vivo E2 protects against a phenotype change in the cultured podocytes characterized by a percent increase of F-actin vs. G-actin, suppression of Hsp25 expression and transcriptional activation, increase of Rac1 activity, and decreased apoptotic intermediates. We conclude from these studies that E2 treatment protects against podocyte damage and may prevent/reduce diabetes-induced kidney disease.
A rare case of aggressive squamous cell carcinoma of the bladder in pregnancy
Authors: Church E , Dieh A
Published: October 2012

We report a rare case of an aggressive squamous cell carcinoma of the bladder in a young primigravid woman with recurrent urinary tract infections and microscopic haematuria. An emergency caesarean section was performed at 37 weeks gestation for suspected placental abruption; however, she was found to have frank haematuria. Postnatally, an advanced bladder tumour was diagnosed. She required renal dialysis, a radical cystectomy and radiotherapy but sadly died seven months after diagnosis. This case illustrates the importance of thorough investigation of haematuria in pregnancy. Cystoscopy and even tumour resection can be safely performed in pregnancy. Although squamous cell carcinomas account for only 2% of bladder tumours in developed countries, they tend to be large and deeply invasive, requiring radical surgery and chemotherapy or radiotherapy. Management should be multidisciplinary and treatment individualized due to the significant clinical and emotional challenges which arise when a woman develops a malignancy in pregnancy or the puerperium.
Adaptive Path Relinking for Vehicle Routing and Scheduling Problems with Product Returns
Authors: Tarantilis Christos D. , Anagnostopoulou Afroditi K. , Repoussis Panagiotis P.
Published: October 2012

This paper deals with one-to-many-to-one vehicle routing and scheduling problems with pickups and deliveries and studies the effect of various backhauling strategies. Initially, focus is given on problem instances with clustered backhauls where all delivery customers must be visited before pickup customers. Afterward, operational settings with mixed backhauls and varying visiting sequence restrictions with respect to the capacity of the vehicles are examined. The proposed solution method evolves a set of reference solutions on the basis of a novel Adaptive Path Relinking framework. The latter encompasses an adaptive multisolution recombination procedure to generate provisional solutions based on the recurrence of particular solution attributes. On return, these solutions are used as guiding points for performing search trajectories from initial reference solutions via tunneling. Computational results on benchmark data sets of the literature illustrate the competitiveness and robustness of the proposed approach compared to state-of-the-art solution methods for well-known vehicle routing and scheduling problems. Finally, various experiments are also reported to demonstrate the economic effect of different mixing levels and densities of linehaul and backhaul customers.
Learning from complex policy evaluations
Authors: Downe James , Martin Steve , Bovaird Tony
Published: October 2012

Recognition of the importance of interactions between policies has fuelled demand for larger, longer-term, more holistic studies of their impacts and effectiveness. The broader perspective provided by evaluations of this kind appears to have been useful to policy makers, but their scale and complexity present practical and methodological challenges. Research funders need to commission and coordinate groups of studies rather than procuring research on an ad-hoc basis. Researchers need to be willing to share data and develop methods of collecting evidence relating to overarching themes as opposed to more narrowly defined programme and policy objectives.
Viktor Kopp und die Anfänge der sowjetisch-deutschen Beziehungen 1919 bis 1921
Authors: Černoperov Vasilij L.
Published: October 2012

Vorspann

Der Name des bolschewistischen Revolutionärs und Diplomaten Viktor Kopp sagt nur wenigen Spezialisten etwas. Dabei spielte er als Vertreter Moskaus in Berlin während der unruhigen Jahre zwischen dem Abbruch der diplomatischen Beziehungen des Deutschen Reiches mit Sowjetrussland Ende 1918 und ihrer Wiederaufnahme in Rapallo im April 1922 eine Schlüsselrolle. Kopp wollte nicht weniger erreichen als eine sowjetisch-deutsche Allianz, um das Versailler System kriegerisch zu sprengen und so den Weg zur Ausdehnung der „Weltrevolution“ nach Westen freizumachen. Der russische Historiker Vasilij Černoperov rekonstruiert auf der Basis intensiver Quellenstudien Kopps Ideen und Aktivitäten, die Grenzen ihrer Durchsetzbarkeit und ihre letztendlichen Wirkungen.
Das „Spinnennetz“ des internationalen Terrorismus
Authors: Riegler Thomas
Published: October 2012

Vorspann

Ein Attentat, das nicht stattfand und doch unvergessen blieb, weil seine Folgen unabsehbar gewesen wären. Es hätte das überbesetzte Transitlager für sowjetische Juden im österreichischen Schönau treffen und das tödliche Werk der palästinensischen Terrororganisation „Schwarzer September“ sein sollen. Thomas Riegler, Historiker in Wien, zeigt, wer die Geiselnahme plante und weshalb diese vereitelt werden konnte. Er legt dabei ein dichtes, halb Europa und den Nahen Osten umspannendes Netzwerk von Akteuren und Helfern offen, zu dem - überraschender Weise - auch Rechtsradikale gehörten.
Prophylactic Probiotics to Prevent Death and Nosocomial Infection in Preterm Infants
Authors: Rojas Mario A. , Lozano Juan M. , Rojas Maria X. , Rodriguez Viviana A. , Rondon Martin A. , Bastidas Jaime A. , Perez Luis A. , Rojas Catherine , Ovalle Oscar , Garcia-Harker Jorge E. , Tamayo Maria E. , Ruiz Gloria C. , Ballesteros Adriana , Archila Maria M. , Arevalo Mauricio
Published: October 2012

BACKGROUND AND OBJECTIVE:

It has been suggested that probiotics may decrease infant mortality and nosocomial infections because of their ability to suppress colonization and translocation of bacterial pathogens in the gastrointestinal tract. We designed a large double-blinded placebo-controlled trial using Lactobacillus reuteri to test this hypothesis in preterm infants.

METHODS:

Eligible infants were randomly assigned during the first 48 hours of life to either daily probiotic administration or placebo. Infants in the intervention group were administered enterally 5 drops of a probiotic preparation containing 108 colony-forming units of L reuteri DSM 17938 until death or discharge from the NICU.

RESULTS:

A total of 750 infants ≤2000 g were enrolled. The frequency of the primary outcome, death, or nosocomial infection, was similar in the probiotic and placebo groups (relative risk 0.87; 95% confidence interval: 0.63–1.19; P = .376). There was a trend toward a lower rate of nosocomial pneumonia in the probiotic group (2.4% vs 5.0%; P = .06) and a nonsignificant 40% decrease in necrotizing enterocolitis (2.4% vs 4.0%; P = .23). Episodes of feeding intolerance and duration of hospitalization were lower in infants ≤ 1500 g (9.6% vs 16.8% [P = .04]; 32.5 days vs 37 days [P = .03]).

CONCLUSIONS:

Although L reuteri did not appear to decrease the rate of the composite outcome, the trends suggest a protective role consistent with what has been observed in the literature. Feeding intolerance and duration of hospitalization were decreased in premature infants ≤1500 g.
Impact of Sleep Extension and Restriction on Children’s Emotional Lability and Impulsivity
Authors: Gruber Reut , Cassoff Jamie , Frenette Sonia , Wiebe Sabrina , Carrier Julie
Published: October 2012

OBJECTIVE:

To examine the impact of moderate sleep extension and restriction on child behavior in school.

METHODS:

We conducted a randomized parallel group study to determine the impact of an experimental sleep extension (addition of 1 hour of sleep relative to baseline habitual sleep duration on weekdays) and experimental sleep restriction (elimination of 1 hour of sleep relative to baseline habitual sleep duration on weekdays) on child behavior in school. The primary outcome measures were scores on the Conners’ Global Index Scale, as determined by teachers blinded to sleep status of the participants. A sample of 34 typically developing children aged 7 to 11 years with no reported sleep problems and no behavioral, medical, or academic issues participated in the study.

RESULTS:

Our main findings were that (1) a cumulative extension of sleep duration of 27.36 minutes was associated with detectable improvement in Conners’ Global Index–derived emotional lability and restless-impulsive behavior scores of children in school and a significant reduction in reported daytime sleepiness; and (2) a cumulative restriction of sleep of 54.04 minutes was associated with detectable deterioration on such measures.

CONCLUSIONS:

A modest extension in sleep duration was associated with significant improvement in alertness and emotional regulation, whereas a modest sleep restriction had opposite effects.
Antecedents of Neonatal Encephalopathy in the Vermont Oxford Network Encephalopathy Registry
Authors: Nelson Karin B. , Bingham Peter , Edwards Erika M. , Horbar Jeffrey D. , Kenny Michael J. , Inder Terrie , Pfister Robert H. , Raju Tonse , Soll Roger F.
Published: October 2012

BACKGROUND:

Neonatal encephalopathy (NE) is a major predictor of death and long-term neurologic disability, but there are few studies of antecedents of NE.

OBJECTIVES:

To identify antecedents in a large registry of infants who had NE.

METHODS:

This was a maternal and infant record review of 4165 singleton neonates, gestational age of ≥36 weeks, meeting criteria for inclusion in the Vermont Oxford Network Neonatal Encephalopathy Registry.

RESULTS:

Clinically recognized seizures were the most prevalent condition (60%); 49% had a 5-minute Apgar score of ≤3 and 18% had a reduced level of consciousness. An abnormal maternal or fetal condition predated labor in 46%; maternal hypertension (16%) or small for gestational age (16%) were the most frequent risk factors. In 8%, birth defects were identified. The most prevalent birth complication was elevated maternal temperature in labor of ≥37.5°C in 27% of mothers with documented temperatures compared with 2% to 3.2% in controls in population-based studies. Clinical chorioamnionitis, prolonged membrane rupture, and maternal hypothyroidism exceeded rates in published controls. Acute asphyxial indicators were reported in 15% (in 35% if fetal bradycardia included) and inflammatory indicators in 24%. Almost one-half had neither asphyxial nor inflammatory indicators. Although most infants with NE were observably ill since the first minutes of life, only 54% of placentas were submitted for examination.

CONCLUSIONS:

Clinically recognized asphyxial birth events, indicators of intrauterine exposure to inflammation, fetal growth restriction, and birth defects were each observed in term infants with NE, but much of NE in this large registry remained unexplained.
Effects of Glutamine on Brain Development in Very Preterm Children at School Age
Authors: de Kieviet Jorrit F. , Oosterlaan Jaap , Vermeulen R. Jeroen , Pouwels Petra J. W. , Lafeber Harrie N. , van Elburg Ruurd M.
Published: October 2012

OBJECTIVES:

The amino acid glutamine has been shown to reduce the number of serious neonatal infections in very preterm children, which may benefit long-term brain development. The aims of the current follow-up study were to (1) determine the long-term effects of glutamine-enriched feeding in the first month after birth in very preterm children on measures of brain development at school age, and (2) elucidate a potential mediating role of serious neonatal infections.

METHODS:

Fifty-two very preterm children who originally took part in a randomized controlled trial on enteral glutamine supplementation between day 3 and 30 after birth participated at a mean (SD) age of 8.6 (0.3) years. Measures of brain development included volumetric outcomes of major brain structures, as well as fractional anisotropy (FA) values of major white matter tracts.

RESULTS:

Glutamine supplementation in the first month was associated with medium-sized increases in white matter (d = 0.54, P = .03), hippocampus (d = 0.47, P = .02), and brain stem (d = 0.54, P = .04) volumes at school age. Exploratory analyses using an uncorrected P value indicated higher FA values of the bilateral cingulum hippocampal tract in the glutamine group. All differences were either strongly associated (hippocampus volume, brain stem volume, and FA values of cingulum hippocampal tract) or completely mediated (white matter volume) by the lower number of serious neonatal infections in the glutamine group.

CONCLUSIONS:

Short-term glutamine supplementation after birth increases white matter, hippocampus, and brain stem volumes in very preterm children at school age, mediated by a decrease in serious neonatal infections.
Variations in Children’s Dental Service Use Based on Four National Health Surveys
Authors: Romaire Melissa A. , Bell Janice F. , Huebner Colleen E.
Published: October 2012

OBJECTIVE:

To compare estimates of dental service use and delayed dental care across 4 national surveys of children’s health.

METHODS:

Among children 2 to 17 years of age, prevalence estimates of the use of any dental services, preventive dental services, and delayed dental care in the past year were obtained from the 2003 and 2007 National Survey of Children’s Health, the 2003–2004 National Health and Nutrition Examination Survey (NHANES), the 2003 and 2007 National Health Interview Survey, and the 2003 and 2007 Medical Expenditure Panel Survey. Trends in parent-reported dental use, including delayed care, by sociodemographic characteristics were assessed by using logistic regression and odds ratios.

RESULTS:

Data collection methodologies varied across the 4 surveys, and estimates of dental service use varied accordingly. Surveys differed in the survey items used, recall time frames, and protocols for eliciting visit history. As a result, estimates of any dental use ranged from 52% to 81%, whereas estimates of preventive dental use ranged from 67% to 78%. Rates of delayed dental care were low, ranging from 3% to 8%; however, surveys showed consistent sociodemographic disparities in use of dental services and delayed dental care.

CONCLUSIONS:

Each survey has a unique approach to defining and eliciting parents’ reports of children’s dental service use, which could result in under- or overestimation of the number and nature of children’s dental services. Each survey’s methodology must be considered when accepting population-based estimates of dental service use to monitor progress in achieving national oral health goals.
Sexual Activity–Related Outcomes After Human Papillomavirus Vaccination of 11- to 12-Year-Olds
Authors: Bednarczyk Robert A. , Davis Robert , Ault Kevin , Orenstein Walter , Omer Saad B.
Published: October 2012

OBJECTIVE:

Previous surveys on hypothesized sexual activity changes after human papillomavirus (HPV) vaccination may be subject to self-response biases. To date, no studies measured clinical markers of sexual activity after HPV vaccination. This study evaluated sexual activity–related clinical outcomes after adolescent vaccination.

METHODS:

We conducted a retrospective cohort study utilizing longitudinal electronic data from a large managed care organization. Girls enrolled in the managed care organization, aged 11 through 12 years between July 2006 and December 2007, were classified by adolescent vaccine (HPV; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed; quadrivalent meningococcal conjugate) receipt. Outcomes (pregnancy/sexually transmitted infection testing or diagnosis; contraceptive counseling) were assessed through December 31, 2010, providing up to 3 years of follow-up. Incidence rate ratios comparing vaccination categories were estimated with multivariate Poisson regression, adjusting for health care–seeking behavior and demographic characteristics.

RESULTS:

The cohort included 1398 girls (493 HPV vaccine–exposed; 905 HPV vaccine–unexposed). Risk of the composite outcome (any pregnancy/sexually transmitted infection testing or diagnosis or contraceptive counseling) was not significantly elevated in HPV vaccine–exposed girls relative to HPV vaccine–unexposed girls (adjusted incidence rate ratio: 1.29, 95% confidence interval [CI]: 0.92 to1.80; incidence rate difference: 1.6/100 person-years; 95% CI: −0.03 to 3.24). Incidence rate difference for Chlamydia infection (0.06/100 person-years [95% CI: −0.30 to 0.18]) and pregnancy diagnoses (0.07/100 person-years [95% CI: −0.20 to 0.35]), indicating little clinically meaningful absolute risk differences.

CONCLUSIONS:

HPV vaccination in the recommended ages was not associated with increased sexual activity–related outcome rates.
Use of Plasma Rich in Growth Factor for Schneiderian Membrane Management During Maxillary Sinus Augmentation Procedure
Authors: Taschieri Silvio , Corbella Stefano , Del Fabbro Massimo
Published: October 2012

The aim of this pilot study was to present a novel technique for the management of the Schneiderian membrane during maxillary sinus lift surgery using plasma rich in growth factors (PRGF). Eight maxillary sinuses were augmented in 8 patients. Two small perforations of the Schneiderian membrane occurred during the lifting procedure, which were solved using the PRGF clot before grafting the site with PRGF and anorganic bovine bone. With the exception of 1 patient who experienced pain following an acute sinus infection after 3 days of uneventful healing, the patients' postoperative quality of life was generally good. The most common complication (50% of cases) was hematoma, which disappeared after 1 week. Despite the limitations of this study concerning the sample size and the study design, the use of PRGF may be helpful in reducing complications following sinus lift surgery. More well-designed studies, with larger sample size, are needed to validate this protocol.
Modelagem, construção e análise de desempenho do flickermeter IEC
Authors: Macedo Jr. José Rubens , Colnago Guilherme P. , Sousa Gilberto C. Drumond , Vieira José Luiz de Freitas , Trarbach Emerson , Simonetti Domingos S. L.
Published: October 2012

O presente trabalho apresenta a modelagem passo a passo do flickermeter baseado no protocolo IEC 61000-4-15, implementado em ambiente computacional Matlab-Simulink®. O referido modelo constitui uma ferramenta de grande utilidade nas simulações e estudos associados com a qualidade da energia elétrica, notadamente relacionados com o fenômeno da flutuação de tensão nos sistemas de potência. Adicionalmente, o trabalho apresenta uma nova proposta de implementação do bloco 5 do flickermeter IEC, responsável pela análise estatstica dos registros de sensação instantânea de flicker e pelo cálculo do indicador de severidade de flicker de curta duração (Pst). Por fim, são apresentados os resultados dos testes de calibração do modelo desenvolvido, assim como os testes de desempenho de um medidor (hardware) desenvolvido utilizando-se o modelo de flickermeter proposto no presente trabalho.
Chaveamento controlado de linhas de transmissão: uma abordagem em tempo real via RTDS™
Authors: Dantas Karcius Marcelus Colaço , Neves Washington Luiz Araújo , Fernandes Jr. Damásio , Cardoso Gustavo de Alcântara , Fonseca Luiz Carlos de Alcântara
Published: October 2012

O objetivo deste trabalho é apresentar um método para chaveamento controlado de disjuntores de linhas de transmissão e desenvolver um dispositivo para controlar o fechamento dos seus contatos. A estratégia de chaveamento consiste em encontrar um instante apropriado para o fechamento do disjuntor e é baseada em um algoritmo simples de detecção de passagem por zero. Pela primeira vez, o método é avaliado em tempo real usando um RTDS TM (Real Time Digital Simulator) e sua implementação se dá de duas formas: na primeira, utiliza-se a ferramenta CBuilder do RTDS TM e na segunda, utiliza-se um DSP (Digital Signal Processor) como dispositivo de controle. Dados do sistema elétrico da CHESF são utilizados para estudos de caso. Diferentes operações de chaveamento são analisadas: energização e religamento de linhas com compensação em derivação, considerando os efeitos da carga residual. O desempenho do método proposto é comparado com o método de resistores de pré-inserção. As simulações confirmam a eficiência do chaveamento controlado, o qual é economicamente mais atrativo.
Virtual interpolation of discrete multi-objective programming solutions with probabilistic operation
Authors: Silva Ricardo C. , Arruda Edilson F. , Ourique Fabrício O.
Published: October 2012

This work presents a novel framework to address the long term operation of a class of multi-objective programming problems. The proposed approach considers a stochastic operation and evaluates the long term average operating costs/profits. To illustrate the approach, a two-phase method is proposed which solves a prescribed number of K mono-objective problems to identify a set of K points in the Pareto-optimal region. In the second phase, one searches for a set of non-dominated probability distributions that define the probability that the system operates at each point selected in the first phase, at any given operation period. Each probability distribution generates a vector of average long-term objectives and one solves for the Pareto-optimal set with respect to the average objectives. The proposed approach can generate virtual operating points with average objectives that need not have a feasible solution with an equal vector of objectives. A few numerical examples are presented to illustrate the proposed method.
Controle por realimentação de saída e modos deslizantes via função de chaveamento periódica aplicado ao problema de busca extremal
Authors: Oliveira Tiago Roux , Peixoto Alessandro Jacoud , Hsu Liu
Published: October 2012

Este artigo trata do projeto de controle por modos deslizantes para o rastreamento de trajetória em plantas monovariáveis incertas com grau relativo unitário e com sinal de ganho de alta frequência desconhecido, i.e., a direção de controle é assumida desconhecida. Demonstra-se que é possível obter rastreamento global e exato utilizando-se apenas realimentação de saída por meio de uma função de chaveamento periódica e filtros de entrada e saída. Uma vantagem significante desse novo esquema é sua robustez à direção de controle variante no tempo que foi teoricamente justificada para variações do tipo salto e testada com sucesso através de simulações. Essa propriedade torna a abordagem adequada para resolver problemas de busca extremal. Uma aplicação à otimização não-derivativa ilustra a viabilidade prática do esquema de controle proposto.
Algoritmo evolutivo para a estimação da frequência em sistemas elétricos utilizando FPGAS
Authors: Coury Denis V , Delbem Alexandre C. B , Oleskovicz Mário , Simões Eduardo V , Barbosa Daniel , Carvalho Janison R. de
Published: October 2012

Este trabalho apresenta uma técnica eficiente para a estimação da frequência em Sistemas Elétricos de Potência (SEPs) baseada em Algoritmos Genéticos (AGs). A estimação da frequência de um sinal elétrico é modelada como um problema de otimização. A motivação do uso de AGs nesta abordagem é a sua intrínseca robustez ao ruído presente nos sinais. O AG proposto é implementado em um dispositivo FPGA (Field-Programmable Gate Array) e 0 procedimento de estimação da frequência é realizado em tempo real. Isto é possível devido: (a) ao paralelismo implícito dos FPGAs no processamento das instruções, (b) a escolha de operadores apropriados dos AGs para explorar este paralelismo e (c) a determinação da arquitetura do circuito para FPGA que paraleliza o AG, assegurando um desempenho satisfatório. Para a avaliação do desempenho da metodologia proposta, um SEP com condições de operação típicas foi modelado através do software ATP (Alternative Transients Program). Os sinais gerados deste sistema foram processados pela abordagem AG/FPGA proposta, sendo as respostas decorrentes da mesma comparada às respostas de um relé comercial. Resultados bastante promissores foram alcançados com a metodologia proposta.