bluuebunny/crossref_metadata_2025_split huggingface dataset:
Change in Off-Label Use of Bone Morphogenetic Protein in Spine Surgery and Associations with Adverse Outcome
Authors: Poeran Jashvant , Opperer Mathias , Rasul Rehana , Mazumdar Madhu , Girardi Federico P. , Hughes Alexander P. , Memtsoudis Stavros G. , Vougioukas Vassilios 
Published: January 2016

Study Design Retrospective cohort study. Objective The U.S. Food and Drug Administration issued a warning in 2008 against off-label bone morphogenetic protein (BMP-2) use. We aimed to determine (off-label) BMP-2 use in two periods and associations with complications. Methods We included 340,393 patients undergoing spinal fusions from the Premier Perspective database (2006 to 2012). BMP-2 use was determined from billing in 2006 to 2008 versus 2009 to 2012. Outcomes included revisions, length of hospital stay (LOHS), and cost of hospital stay (COH). Multilevel regressions measured associations between BMP-2 and outcomes; odds ratios (ORs) and 95% confidence intervals (CIs) are reported. Results BMP-2 use decreased from 18.7% in 2006 to 11.5% in 2012. Off-label use remains but is decreasing, particularly for cervical anterior (5.1 versus 2.0%) and cervical posterior procedures (15.3 versus 8.5%; both p < 0.01 comparing 2006 to 2008 with 2009 to 2012). BMP-2 remains associated with increased LOHS (median 2 versus 3 days; both periods) and COH (median $15,455 versus $27,881 in 2006 to 2008; $17,007 versus $30,331 in 2009 to 2012). Adjusted ORs for the association between BMP-2 and adverse outcomes were generally lower in 2009 to 2012 compared with 2006 to 2008. Most notably, we demonstrate lower ORs for revision after cervical fusions in 2009 to 2012 (OR 1.67, CI 1.01 to 2.78) compared with 2006 to 2008 (OR 2.43, CI 1.66 to 3.54). Conclusions Using a previously untapped data source, we show decreased (off-label) BMP-2 use in spinal fusions, particularly in cervical fusions. Although there was a tendency of decreased odds in 2009 to 2012, higher resource utilization and odds for complications remain in patients using BMP-2. A national registry or prospective observational studies will benefit the ongoing discussion.
The Effects of Smoking and Smoking Cessation on Spine Surgery: A Systematic Review of the Literature
Authors: Jackson Keith L. , Devine John G. 
Published: January 2016

Study Design Literature review. Objective The aim of this literature review was to detail the effects of smoking in spine surgery and examine whether perioperative smoking cessation could mitigate these risks. Methods A review of the relevant literature examining the effects of smoking and cessation on surgery was conducted using PubMed, Google Scholar, and Cochrane databases. Results Current smokers are significantly more likely to experience pseudarthrosis and postoperative infection and to report lower clinical outcomes after surgery in both the cervical and lumbar spines. Smoking cessation can reduce the risks of these complications depending on both the duration and timing of tobacco abstinence. Conclusion Smoking negatively affects both the objective and subjective outcomes of surgery in the lumbar and cervical spine. Current literature supports smoking cessation as an effective tool in potentially mitigating these unwanted outcomes. Future investigations in this field should be directed toward developing a better understanding of the complex relationship between smoking and poorer outcomes in spine surgery as well as developing more efficacious cessation strategies.
Destination evaluation through the prioritization of competitiveness pillars: the case of Brazil.
Authors: Gândara J. M. , Chim-Miki A. F. 
Published: January 2016

Abstract

This chapter analyses the tourism competitiveness of Curitiba, Parana, through the determination of the level of efficiency and the prioritization of competitiveness determinants. The determinants used in this analysis were based on the tourism competitiveness pillars defined by the Ministry of Tourism (MTur) in Brazil. The relevance of each pillar was first evaluated through a focus group technique with the participation of tourism stakeholders. Building on the qualitative results of the group of tourism experts, the efficiency of factors of competitiveness at the destination was evaluated. This allowed the prioritization of actions for improving destination competitiveness from a policy point of view. This research validated a methodology to understand the data available from the MTur, and also developed a simple methodology to apply to cities.
Networking for sustainable cultural tourism activities and dynamics: the case of Oporto.
Authors: Stević I. , Breda Z. 
Published: January 2016

Abstract

This chapter elaborates on the networking nature of sustainable cultural tourism activities and dynamics in the Historic Centre of Oporto, Portugal. The chapter aims to (1) understand and discuss the importance of networking at the cultural tourism level; (2) identify if there is an official network of stakeholders involved in management, planning, organization, strategic decisions and protection of the heritage site, or merely collaboration among them; and (3) identify the main difficulties and challenges when it comes to management, preservation and protection of cultural heritage and sustainable tourism development at the World Heritage Site.
IREN, a novel EF-hand motif-containing nuclease, functions in the degradation of nuclear DNA during the hypersensitive response cell death in rice
Authors: Ootsubo Yuka , Hibino Takanori , Wakazono Takahito , Mukai Yukio , Che Fang-Sik 
Published: January 2016

Abstract
The hypersensitive response (HR), a type of programmed cell death that is accompanied by DNA degradation and loss of plasma membrane integrity, is a common feature of plant immune responses. We previously reported that transcription of IREN which encodes a novel EF-hand containing plant nuclease is controlled by OsNAC4, a key positive regulator of HR cell death. Transient overexpression of IREN in rice protoplasts also led to rapid DNA fragmentation, while suppression of IREN using RNA interference showed remarkable decrease of DNA fragmentation during HR cell death. Maximum DNA degradation associated with the recombinant IREN was observed in the presence of Ca2+ and Mg2+ or Ca2+ and Mn2+. Interestingly, DNA degradation mediated by the recombinant IREN was completely abolished by Zn2+, even when Ca2+, Mg2+, or Mn2+ were present in the reaction buffer. These data indicate that IREN functions in the degradation of nuclear DNA during HR cell death.
Diagnostics and control for the steady state and pulsed tokamak DEMO
Authors: Orsitto F.P. , Villari R. , Moro F. , Todd T.N. , Lilley S. , Jenkins I. , Felton R. , Biel W. , Silva A. , Scholz M. , Rzadkiewicz J. , Duran I. , Tardocchi M. , Gorini G. , Morlock C. , Federici G. , Litnovsky A. 
Published: January 2016

AbstractThe present paper is devoted to a first assessment of the DEMO diagnostics systems and controls in the context of pulsed and steady state reactor design under study in Europe. In particular, the main arguments treated are: (i) The quantities to be measured in DEMO and the requirements for the measurements; (ii) the present capability of the diagnostic and control technology, determining the most urgent gaps, and (iii) the program and strategy of the research and development (R&D) needed to fill the gaps. Burn control, magnetohydrodynamic stability, and basic machine protection require improvements to the ITER technology, and moderated efforts in R&D can be dedicated to infrared diagnostics (reflectometry, electron cyclotron emission, polarimetry) and neutron diagnostics. Metallic Hall sensors appear to be a promising candidate for magnetic measurements in the high neutron fluence and long/steady state discharges of DEMO.
Implementing balanced harvesting: practical challenges and other implications
Authors: Reid David G. , Graham Norman , Suuronen Petri , He Pingguo , Pol Michael 
Published: January 2016

Abstract
Balanced harvesting (BH) has been proposed as an alternative to the paradigm of more selective fishing as practiced in most European and North American fisheries management. We examine options for the implementation of BH and evaluate the issues raised in such an implementation. Implementation is considered at the whole ecosystem level, in terms of the patterns of removal for all species, both commercial and bycatch. We suggest that a “laissez-faire” approach analogous to the African lakes where BH was first observed is inappropriate in managed developed world fisheries. We consider two further approaches: focusing on either the species caught or on the sizes of animal alone. We find that aiming to harvest all species with an exploitation rate appropriate to their productivity would require a degree of micro-management that is probably unachievable, with all captured species “choking” the fishery in sequence. The size-based approach works with an exploitation rate appropriate to the productivity at size, with no consideration of the species involved. This might superficially be easier to implement, as management would involve a limited number of size classes only. However, problems may arise due to the likely faster capture of the more easily catchable fish, and also likely targeting of the more valuable species within a size class. We identify a possible third option of “broad brush” métier-based management that may resolve some of these problems. Other issues include the management of protected, endangered, and threatened species (including mammals, reptiles, and birds), the management of already severely depleted stocks, and the capture of benthic invertebrates.
Impact of electronic personal health record use on engagement and intermediate health outcomes among cardiac patients: a quasi-experimental study
Authors: Toscos Tammy , Daley Carly , Heral Lisa , Doshi Riddhi , Chen Yu-Chieh , Eckert George J , Plant Robert L , Mirro Michael J 
Published: January 2016

Abstract
Objectives To determine the impact of tethered personal health record (PHR) use on patient engagement and intermediate health outcomes among patients with coronary artery disease (CAD).
Methods Adult CAD patients ( N = 200) were enrolled in this prospective, quasi-experimental observational study. Each patient received a PHR account and training on its use. PHRs were populated with information from patient electronic medical records, hosted by a Health Information Exchange. Intermediate health outcomes including blood pressure, body mass index, and hemoglobin A1c (HbA1c) were evaluated through electronic medical record review or laboratory tests. Trends in patient activation measure® (PAM) were determined through three surveys conducted at baseline, 6 and 12 months. Frequency of PHR use data was collected and used to classify participants into groups for analysis: Low , Active , and Super users.
Results There was no statistically significant improvement in patient engagement as measured by PAM scores during the study period. HbA1c levels improved significantly in the Active and Super user groups at 6 months; however, no other health outcome measures improved significantly. Higher PAM scores were associated with lower body mass index and lower HbA1c, but there was no association between changes in PAM scores and changes in health outcomes. Use of the PHR health diary increased significantly following PHR education offered at the 6-month study visit and an elective group refresher course.
Conclusions The study findings show that PHR use had minimal impact on intermediate health outcomes and no significant impact on patient engagement among CAD patients.
NIHAO V: too big does not fail – reconciling the conflict between ΛCDM predictions and the circular velocities of nearby field galaxies
Authors: Dutton Aaron A. , Macciò Andrea V. , Frings Jonas , Wang Liang , Stinson Gregory S. , Penzo Camilla , Kang Xi 
Published: January 2016

Abstract
We compare the half-light circular velocities, V1/2, of dwarf galaxies in the Local Group to the predicted circular velocity curves of galaxies in the Numerical Investigations of Hundred Astrophysical Objects (NIHAO) suite of Λ cold dark matter (ΛCDM) simulations. We use a subset of 34 simulations in which the central galaxy has a stellar luminosity in the range 0.5 × 105 &lt; LV/ L⊙ &lt; 2 × 108. The NIHAO galaxy simulations reproduce the relation between stellar mass and halo mass from abundance matching, as well as the observed half-light size versus luminosity relation. The corresponding dissipationless simulations overpredict the V1/2, recovering the problem known as too big to fail (TBTF). By contrast, the NIHAO simulations have expanded dark matter haloes, and provide an excellent match to the distribution of V1/2 for galaxies with LV ≳ 2 × 106  L⊙. For lower luminosities, our simulations predict very little halo response, and tend to overpredict the observed circular velocities. In the context of ΛCDM, this could signal the increased stochasticity of star formation in haloes below Mhalo ∼ 1010 M⊙, or the role of environmental effects. Thus, haloes that are ‘TBTF’, do not fail ΛCDM, but haloes that are ‘too small to pass’ (the galaxy formation threshold) provide a future test of ΛCDM.
Toroidal vortices as a solution to the dust migration problem
Authors: Lorén-Aguilar Pablo , Bate Matthew R. 
Published: January 2016

Abstract
In an earlier letter, we reported that dust settling in protoplanetary discs may lead to a dynamical dust–gas instability that produces global toroidal vortices. In this Letter, we investigate the evolution of a dusty protoplanetary disc with two different dust species (1 mm and 50 cm dust grains), under the presence of the instability. We show how toroidal vortices, triggered by the interaction of mm grains with the gas, stop the radial migration of metre-sized dust, potentially offering a natural and efficient solution to the dust migration problem.
Case-Based Review: meningioma
Authors: Fogh Shannon E. , Johnson Derek R. , Barker Fred G. , Brastianos Priscilla K. , Clarke Jennifer L. , Kaufmann Timothy J. , Oberndorfer Stephan , Preusser Matthias , Raghunathan Aditya , Santagata Sandro , Theodosopoulos Philip V. 
Published: January 2016

AbstractMeningioma is by far the most common primary intracranial tumor in adults. Treatment of meningioma is complex due to a tremendous amount of variability in tumor behavior. Many patients are incidentally found to have tumors that will remain asymptomatic throughout their lives. It is important to identify these patients so that they can be spared from potentially morbid interventions. On the other end of the spectrum, high-grade meningiomas can behave very aggressively. When treatment is necessary, surgical resection is the cornerstone of meningioma therapy. Studies spanning decades have demonstrated that extent of resection correlates with prognosis. Radiation therapy, either in the form of external beam radiation therapy or stereotactic radiosurgery, represents another important therapeutic tool that can be used in place of or as a supplement to surgery. There are no chemotherapeutic agents of proven efficacy against meningioma, and chemotherapy treatment is generally reserved for patients who have exhausted surgical and radiotherapy options. Ongoing and future studies will help to answer unresolved questions such as the optimum use of radiation in resected WHO grade II meningiomas and the efficacy of additional chemotherapy agents.
Intratumoral Heterogeneity for Ki-67 Index in Invasive Breast Carcinoma: A Study on 131 Consecutive Cases
Authors: Boros Monica , Moncea Denisa , Moldovan Cosmin , Podoleanu Cristian , Georgescu Rares , Stolnicu Simona 
Published: January 2016

Introduction:
In addition to conventional histopathologic parameters, the assessment of proliferation is a major factor in treatment decision in breast carcinoma patients. The aim of this study was to assess whether Ki-67 heterogeneity in invasive breast carcinomas could have an impact over treatment decision.

Materials and Methods:
Immunohistochemistry for Ki-67 was evaluated in resection specimens of 131 consecutive invasive breast carcinomas. Heterogeneity was defined as the presence of a low (<17%) and high (>35%) proliferative activity within the same tumor in the same histologic section. The rest of the cases were defined as homogenous. Clinical-pathologic features were also analyzed.

Results:
A total of 107 (81.67%) of the cases were homogenous and 24 of 131 cases (18.32%) showed heterogeneity as defined above. Among these, 10 (41.6%) cases showed a gradient of increasing staining toward the tumor edge and 14 (58.4%) cases showed hot spots. In general, the proliferative activity varied from 1% to 90% in different areas of the tumor. A higher incidence of breast carcinoma was observed after menopause in both groups (83.33% in heterogeneous cases and 79.43% in homogeneous cases) (P=0.783). These groups were similar as far as the most frequent histologic types were concerned: no special type (95.83% vs. 56.07%) (P=0.0001). Tumor histologic grade, T and N stage were similar in both groups. We noted a higher proportion of stage N3 cases in the heterogeneous tumor group (54.16% vs. 34.57%) (P=0.14). Prognostic markers analysis in the heterogeneous cases revealed 100% positivity for hormone receptors (compared with 94.65%) and a much higher proportion of HER2-negative cases (87.5% vs. 73.83%) (P=0.19).

Conclusion:
As Ki-67 heterogeneity can be encountered in breast carcinomas and Ki-67 value could have an impact on clinical decisions, it is mandatory to evaluate the whole specimen and not only the core biopsy specimen and to correlate it with mitotic count.
Immunohistochemical Expression of Progesterone Receptors in Nonmeningothelial Central Nervous System Tumors
Authors: Mezmezian Mónica B. , B. Carassai Mónica , Dopazo Valeria , Deforel María L. , Puzzo María Á. 
Published: January 2016

Introduction:
Immunostaining of progesterone receptors (PRs) has been described as a prognostic factor related to recurrences in meningiomas. However, its expression in other primary intracranial tumors has been poorly studied. In this paper, we compare the pattern of expression of the receptor in meningiomas with that of nonmeningothelial intracranial tumors to evaluate its value in the diagnosis of the former.

Materials and Methods:
A total of 42 nonmeningothelial intracranial tumors (21 glioblastomas, 4 anaplastic oligodendrogliomas, 4 oligodendrogliomas, 1 pilomyxoid astrocytoma, 3 ependymomas, 8 schwannomas, 1 chordoid chordoma) and 32 meningiomas (1 rhabdoid, 1 papillary, 5 atypical, 7 with histologic features of more aggressive behavior, 1 microcyst, 8 meningothelial, 7 transitional, 2 fibroblastic) were studied for PR by immunohistochemistry.

Results:
About 73.8% of the nonmeningothelial tumors and 100% of the meningiomas were positive for the receptor, the difference being statistically significant (P=0.0017). The mean percentage of positive tumor cells per high-power field was frequently higher than 30% in meningiomas and lower than 10% in nonmeningothelial tumors (P=0.0001).

Conclusions:
Although we detected that immunostaining for the PR is more frequently observed in meningiomas, we confirmed its expression in diverse nonmeningothelial primary intracranial tumors. Immunohistochemistry for PR would be useful in the diagnosis of meningioma only when its positivity shows a mean higher than 30% of the positive tumor cells per high-power field.
Postponement adoption in manufacturers of tomato-derived products
Authors: Ferreira Karine Araujo , Alcantara Rosane Lúcia Chicarelli 
Published: January 2016

Purpose
– The purpose of this paper is to investigate the application of postponement strategies in companies that produce tomato-derived products in order to identify the types of postponement adopted by these companies, the implementation process, and the major changes after their adoption.

Design/methodology/approach
– Three exploratory case studies were carried out in manufacturers of tomato products, where interviews were conducted with general managers in the manufacturing and logistics sectors.

Findings
– The application of time and form postponement was verified in the companies studied, and the implementation of the postponement strategy led to changes in the productive process of tomato-derived products. These changes involved the movement of the decoupling point and the increase in the make-to-order production, which had positive impacts on the businesses.

Research limitations/implications
– This paper analyzed the application of postponement in a specific sector of the food industry. Future research must analyze the application of this strategy in other segments of the food industry and other sectors as well.

Practical implications
– The information acquired in this can contribute to a more adequate application of postponement in a little-known industry sector.

Originality/value
– In addition to further discussion on the issue and verification of postponement application in food companies, this research presents information to assist the adoption, use, and consolidation of the postponement strategy.
The consumer testing of food package graphic design
Authors: Hamlin Robert P 
Published: January 2016

Purpose
– This purpose of this paper is to present a technique for measuring the impact of package graphic designs on consumer choice and purchase intentions. The technique allows several proposed graphic designs for the same product to be compared, both with one another and with their immediate competitors up to a maximum of eight designs.

Design/methodology/approach
– The approach is based upon a fractionally replicated Latin square design with two sets of four package graphic designs and five consumer groups as the independent variables. The dependent variable is consumer choice.

Findings
– Three fully worked examples of the test are presented. The results show that graphic design has a massive and statistically significant impact on consumer choice, ceteris paribus. The test is able to discriminate strongly between package graphic designs that only apparently differ in detail.

Research limitations/implications
– The results show that graphic design has a significant impact upon consumer choice, but it also shows that this impact is highly product and situation specific. This may have considerable implications for any claimed wider “empirical generalisations” relating to the impact of graphic designs, or components thereof, on food consumer choice.

Practical implications
– The methodology presented allows graphic designs to be tested before they enter the marketplace. It replaces opinion with a reliable and quantifiable output that can be easily interfaced with econometric and market share models that have been developed within the choice modelling literature.

Originality/value
– This appears to be the first paper to appear within the literature that presents a reliable, simple and easily administered test that is capable of quantifying the performance of alternative graphic designs on food packaging.