bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perioperative Outcomes of Major Noncardiac Surgery in Adults with Congenital Heart Disease
Authors: Maxwell Bryan G. , Wong Jim K. , Kin Cindy , Lobato Robert L. 
Published: July 2013

Abstract

Background:
An increasing number of patients with congenital heart disease are surviving to adulthood. Consensus guidelines and expert opinion suggest that noncardiac surgery is a high-risk event, but few data describe perioperative outcomes in this population.

Methods:
By using the Nationwide Inpatient Sample database (years 2002 through 2009), the authors compared patients with adult congenital heart disease (ACHD) who underwent noncardiac surgery with a non-ACHD comparison cohort matched on age, sex, race, year, elective or urgent or emergency procedure, van Walraven comborbidity score, and primary procedure code. Mortality and morbidity were compared between the two cohorts.

Results:
A study cohort consisting of 10,004 ACHD patients was compared with a matched comparison cohort of 37,581 patients. Inpatient mortality was greater in the ACHD cohort (407 of 10,004 [4.1%] vs. 1,355 of 37,581 [3.6%]; unadjusted odds ratio, 1.13; P = 0.031; adjusted odds ratio, 1.29; P < 0.001). The composite endpoint of perioperative morbidity was also more commonly observed in the ACHD cohort (2,145 of 10.004 [21.4%] vs. 6,003 of 37,581 [16.0%]; odds ratio, 1.44; P < 0.001). ACHD patients comprised an increasing proportion of all noncardiac surgical admissions over the study period (P value for trend is <0.001), and noncardiac surgery represented an increasing proportion of all ACHD admissions (P value for trend is <0.001).

Conclusions:
Compared with a matched control cohort, ACHD patients undergoing noncardiac surgery experienced increased perioperative morbidity and mortality. Within the limitations of a retrospective analysis of a large administrative dataset, this finding demonstrates that this is a vulnerable population and suggests that better efforts are needed to understand and improve the perioperative care they receive.
Asymptotic analysis of double-carrier, space-charge-limited transport in organic light-emitting diodes
Authors: Feicht Sarah E. , Schnitzer Ory , Khair Aditya S. 
Published: July 2013

We analyse electron and hole transport in organic light-emitting diodes (OLEDs) via the drift–diffusion equations. We focus on space-charge-limited transport, in which rapid variations in charge carrier density occur near the injecting electrodes, and in which the electric field is highly non-uniform. This motivates our application of singular asymptotic analysis to the drift–diffusion equations. In the absence of electron–hole recombination, our analysis reveals three regions within the OLED: (i) ‘space-charge layers’ near each electrode whose width

is much smaller than the device width

, wherein carrier densities decay rapidly and the electric field is intense; (ii) a ‘bulk’ region whose width is on the scale of

, where carrier densities are small; and (iii) intermediate regions bridging (i) and (ii). Our analysis shows that the current

scales as

, where

is the applied voltage,

is the permittivity and

is the electric mobility, in contrast to the familiar diffusion-free scaling

. Thus, diffusion is seen to lead to a large

increase in current. Finally, we derive an asymptotic recombination–voltage relation for a kinetically limited OLED, in which charge recombination occurs on a much longer time scale than diffusion and drift.
FLOWERING LOCUS C EXPRESSOR Family Proteins Regulate FLOWERING LOCUS C Expression in Both Winter-Annual and Rapid-Cycling Arabidopsis
Authors: Ding Lei , Kim Sang Yeol , Michaels Scott D. 
Published: July 2013

Abstract
Many naturally occurring Arabidopsis (Arabidopsis thaliana) are very late flowering, unless flowering is promoted by a prolonged period of cold (e.g. winter) known as vernalization. In these winter-annual strains, flowering prior to winter is blocked by the synergistic interaction of FRIGIDA (FRI) and FLOWERING LOCUS C (FLC). FLC acts as a strong floral inhibitor, and FRI is required for high levels of FLC expression. Vernalization, in turn, leads to an epigenetic down-regulation of FLC expression. Most rapid-cycling Arabidopsis carry loss-of-function mutations in FRI, leading to low levels of FLC and rapid flowering in the absence of vernalization. Recent work has shown that FRI acts as a scaffolding protein for the assembly of a FRI complex (FRI-C) that includes both general transcription and chromatin-modifying factors, as well as FRI-specific components such as FRI-LIKE1, FRI ESSENTIAL1 (FES1), SUPPRESSOR OF FRI4 (SUF4), and FLC EXPRESSOR (FLX). Here, we show that FLX-LIKE4 (FLX4) is a novel component of the FRI-C and is essential for the activation of FLC by FRI. Both FLX and FLX4 contain leucine zipper domains that facilitate interaction with FRI. In addition, FLX and FLX4 interact with each other and show synergistic transcription activation activity. Interestingly, we show that FLX, FLX4, FES1, and SUF4 are required for basal levels of FLC expression in the absence of FRI. Thus, components of the FRI-C play a role in the regulation of FLC expression in both FRI-containing winter annuals, as well as fri-null rapid-cycling strains.
Transitional care to adult ADHD services in a North West England district
Authors: Ogundele Michael O. 
Published: July 2013

PurposeADHD is the commonest neurodevelopmental disorder of children and adolescents. ADHD is no longer conceptualized as a predominantly childhood disorder but is a chronic disorder that persists into adolescence and adulthood. The paper aims to analyse the transitional care of adolescents diagnosed with ADHD in childhood into adult specialist ADHD services in a local district. The paper also seeks to review current practice and to design a multi‐disciplinary transitional care pathway to adult services for adolescents with complex health needs based on best practice and available clinical guidelines.Design/methodology/approachAdolescents diagnosed with ADHD from childhood who were eligible for transition to adult ADHD services and who reached the age of 16 years over a period of two years consecutively (July 2009 to June 2011) were studied by a retrospective analysis of their clinical records. The current transitional care pathway was reviewed and revised.FindingsOut of 504 patients on the specialist ADHD database, 104 adolescents were eligible for transition to adult services. A total of 19 patients (18 per cent) were referred to CAMHS. A total of 68 adolescents (65 per cent) were discharged from the paediatric services following voluntary discontinuation of medications and non‐attendance at follow‐up clinics. Only 16 patients (15 per cent) were successfully referred to the specialist adult ADHD services (three of them already discharged). A multi‐disciplinary transitional care pathway to adult services for young people with complex health needs and learning difficulties and information for the carers and young people have been designed and adopted in the local city borough, agreed by all the stakeholders.Practical implicationsA total of 73 per cent of eligible patients were either discharged or lost to follow‐up. There must be some flexibility in the referral pathway to the adult ADHD services to allow some of the adolescents who were previously lost to follow‐up to be re‐referred by other primary or secondary care healthcare professionals if the need arises in the future.Originality/valueThe paper shows that there is a high rate of discontinuation of medications, loss to follow‐up and a remarkably low rate of successful transition to locally commissioned adult ADHD services among adolescents diagnosed with ADHD in childhood.
Country image as a nation‐branding tool
Authors: Hakala Ulla , Lemmetyinen Arja , Kantola Satu‐Päivi 
Published: July 2013

PurposeThe purpose of this paper is to examine the country image of Finland among potential travellers and potential consumers of Finnish products. Three research questions are addressed, each of which contributes to the overall aim: What is the level of awareness about Finland among the respondents? How is the awareness constructed in terms of dimensions? Where does the image stem from (the source)?Design/methodology/approachA survey was conducted among US, French and Swiss university students. Given the high number of respondents who had not visited Finland, the analysis focused on non‐visitors. Six hypotheses were formulated based on existing theory.FindingsAwareness is a key indicator of people's knowledge about the existence of a country. Branding may be an elementary tool in enhancing awareness as well as altering or reinforcing stereotypical views. The results of this study bring out the cross‐cultural aspects.Research limitations/implicationsIncluding the respondents’ sources of information enhances the results of previous studies on country image. The findings contribute to the theoretical discussion on the source of the image and the factors that affect it.Practical implicationsKnowledge of the information sources and their role in image building will help destination marketers to influence potential travellers, including non‐visitors, and thereby increase the likelihood of a first or repeat visit.Originality/valueTo the authors’ knowledge, this is the first study to focus on awareness of a country among non‐visitors.
Improving operating room first start efficiency – value of both checklist and a pre‐operative facilitator
Authors: PANNI M. K. , SHAH S. J. , CHAVARRO C. , RAWL M. , WOJNARWSKY P. K. , PANNI J. K. 
Published: July 2013

BackgroundThere are multiple components leading to improved operating room efficiency. We undertook a project focusing on first case starts; accounting for each delay component on a global basis. Our hypothesis was there would be a reduction in first start delays after we implemented strategies to address the issues identified through this accounting process.MethodsAn orange sheet checklist was implemented, with specific items that needed to be clear prior to roll back to the operating room (OR), and an OR facilitator was employed to intervene whenever there were any missing items needed for a specific patient. We present the data from this quality improvement project over an 18‐month period.ResultsInitially, 10.07 (± 0.73) delayed first starts occurred per day but declined steadily over time to a low of 4.95 (± 0.38) per day after 6 months (−49.2 %, P < 0.001). By the end of the project, the most common reasons for delay still included late surgical attending (19%), schedule changes (14%) as well as ‘other reasons’ (13%), but with an overall reduction per day of each. Total anaesthesia delay initially totalled 11% of the first start delays, but was negligible (< 1%) at the project's completion.ConclusionsWhile we have a challenging operating room environment based on our patient population, multiple trainees in both the surgery and anaesthesiology teams: an orange sheet – pre‐operative checklist in addition to a dedicated pre‐operative facilitator; allowed us to make a substantial improvement in our first start on time starts.
A Study of Forty‐seven Single Nucleotide Polymorphisms among Recurrent Miscarriage Using Classification and Regression Tree Analysis
Authors: Parveen Farah , Agrawal Suraksha 
Published: July 2013

ProblemSuccessful pregnancy is the result of multiple genetic and non‐genetic factors. Associations of various SNPs described in this study have not revealed any conclusive results. We have analyzed 47 SNPs using statistical tools like multidimensional regression, classification regression tree, and logistic regression.Method of studyTwo hundred women with at least three consecutive unexplained spontaneous abortions before 20th week of gestation and 300 control women without any history of recurrent miscarriages (RM) were genotyped using PCR, RFLP and sequencing.ResultsOur results revealed that Leptin 2549 C/A (rs7799039) and TNF‐α 238 (rs361525) may play an important role in the maintenance of pregnancy. TNF‐α 238 may act as a protective SNP and Leptin 2549 C/A as a susceptible marker among women with RM cases.ConclusionsPresent study demonstrated an association with Leptin 2549C/A (rs7799039) and TNF‐α (rs361525) gene polymorphism among RM cases.
Sex differences in risk factors for retinopathy in non‐diabetic men and women: The Tromsø Eye Study
Authors: Bertelsen Geir , Peto Tunde , Lindekleiv Haakon , Schirmer Henrik , Solbu Marit D. , Toft Ingrid , Sjølie Anne Katrin , Njølstad Inger 
Published: July 2013

Abstract.Purpose:  To determine the prevalence and risk factors for retinopathy in a nondiabetic population.Methods:  The study population included 5869 participants without diabetes aged 38–87 years from the Tromsø Eye Study, a substudy of the population‐based Tromsø Study in Norway. Retinal images from both eyes were graded for retinopathy. We collected data on risk factors from self‐report questionnaires, clinical examinations, laboratory measurements and case note reviews. The cross‐sectional relationship between potential risk factors and retinopathy was assessed using logistic regression analysis.Results:  The overall prevalence of retinopathy was 14.8%. Men had a higher prevalence of retinopathy compared with women (15.9% versus 14.0%, p = 0.04). In men, retinopathy was associated with hypertension (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.24–2.04) and HbA1c (OR per %, 1.41; 95% CI, 1.01–1.96). In women, retinopathy was associated with age (OR per 10 years, 1.32; 95% CI, 1.14–1.52), log‐transformed urinary albumin excretion (OR per log unit, 1.46; 95% CI, 1.14–1.87) and hypertension (OR, 1.36; 95% CI, 1.08–1.71). In women, retinopathy was associated with very low levels of urinary albumin excretion (urinary albumin/creatinine ratio >0.43 mg/mmol).Conclusion:  This study confirms results from previous studies on the strong association between blood pressure and retinopathy. A novel finding is the sex differences in risk factors for retinopathy, suggesting a sex difference in the pathogenesis leading to retinopathy.
Intraocular pressure changes over 21 years – a longitudinal age‐cohort study in northern Sweden
Authors: Åström Siv , Stenlund Hans , Lindén Christina 
Published: July 2013

Abstract.Purpose:  To follow intraocular pressure (IOP) and the influence of pseudoexfoliation (PEX) and cataract extraction in an age‐cohort in northern Sweden; patients were followed prospectively for 21 years from age 66 to 87 years.Methods:  Three Hundred and thirty‐nine individuals, randomly selected from an age‐cohort born in 1915 underwent ophthalmological examination including measurement of IOP with Goldmann applanation tonometry, screening for PEX and glaucoma. Follow‐up examinations were performed three times with 7‐year intervals. Medical records were reviewed for dates of cataract surgery and glaucoma treatment. A linear mixed model was used to analyse the impact of sex, eye (right/left), PEX, cataract extraction and time on IOP.Results:  Without cataract surgery, the IOP from age of 66 to 87 years, increased by 0.05 mmHg/year (p < 0.001). If cataract surgery was included in the model, no significant change in IOP over time was found. The estimated contribution of PEX to IOP was +2.05 mmHg (p < 0.001), and the contribution of cataract surgery was −2.13 mmHg (p < 0.001). The mean IOP in women was 1.22 mmHg higher than in men (p = 0.001).Conclusion:  A small but statistically significant increase in IOP with age was detected when excluding eyes that had undergone cataract surgery. PEX was associated with a higher IOP and cataract extraction with a lower.
Tuberous sclerosis complex without tubers and subependymal nodules: a phenotype–genotype study
Authors: Boronat S. , Shaaya E.A. , Doherty C.M. , Caruso P. , Thiele E.A. 
Published: July 2013

AbstractTuberous sclerosis complex (TSC) is caused by a mutation in the TSC1 or TSC2 genes. However, 15% of patients have no mutation identified. Tubers and subependymal nodules (SENs) are the typical brain lesions in TSC and are present in 90–95% of patients. The objective of this study is to characterize the specific genotype–phenotype of patients without these lesions. We analyzed the features of 11 patients without typical TSC neuroanatomic features. Ten had TSC1/TSC2 mutational analysis, which was negative. Clinically they had lesions thought to be of neural crest (NC) origin, such as hypomelanotic macules, facial angiofibromas, cardiac rhabdomyomas, angiomyolipomas, and lymphangioleiomyomatosis. We hypothesize that patients without tubers and SENs reflect mosaicism caused by a mutation in TSC1 or TSC2 in a NC cell during embryonic development. This may explain the negative results in TSC1 and TSC2 testing in DNA from peripheral leukocytes.
Parameters associated with short‐ and midterm survival in bridging to lung transplantation with extracorporeal membrane oxygenation
Authors: Weig Thomas , Irlbeck Michael , Frey Lorenz , Zwißler Bernhard , Winter Hauke , Preissler Gerhard , Schramm Rene , Neurohr Claus , Dolch Michael E. 
Published: July 2013

AbstractPatients with terminal lung failure may be bridged to lung transplantation (LTX) by extracorporeal membrane oxygenation (ECMO). With the present shortage of donor organs and the high level of invasiveness of ECMO treatment, appropriate selection criteria for bridge to transplant need to be defined.We report retrospective data from 26 patients on ECMO listed for LTX. Seven patients were successfully transplanted (LTX‐s). Six patients survived until transplantation, but died intra‐ or post‐operatively (LTX‐ns). Thirteen patients died before transplantation (Fail).There was no difference between LTX‐s and the 19 overall non‐survivors (NS) prior to ECMO initiation with regard to demographic data or ventilator parameters except for higher PaO2/FiO2 in the LTX‐s. Time on ECMO pre‐LTX did not differ in the LTX‐s and LTX‐ns groups. SOFA score was lower in LTX‐s when compared to LTX‐ns before ECMO (p = 0.0155), during bridging (p = 0.028), and right before transplantation (p = 0.0038). Maximal bilirubin during bridging and bilirubin prior to transplantation was markedly elevated in the LTX‐ns group [4.2 (2.4–4.7) vs. 1.1 (0.8–2.0) mg/dL; p = 0.0266 and 1.6 (1.2–3.0) vs. 0.5 (0.5–0.5) mg/dL; p = 0.0047).Bridging to LTX is a challenging but viable option for selected patients. Special consideration should be given to hepatic function.
Mangrove expansion and salt marsh decline at mangrove poleward limits
Authors: Saintilan Neil , Wilson Nicholas C. , Rogers Kerrylee , Rajkaran Anusha , Krauss Ken W. 
Published: July 2013

AbstractMangroves are species of halophytic intertidal trees and shrubs derived from tropical genera and are likely delimited in latitudinal range by varying sensitivity to cold. There is now sufficient evidence that mangrove species have proliferated at or near their poleward limits on at least five continents over the past half century, at the expense of salt marsh. Avicennia is the most cold‐tolerant genus worldwide, and is the subject of most of the observed changes. Avicennia germinans has extended in range along the USA Atlantic coast and expanded into salt marsh as a consequence of lower frost frequency and intensity in the southern USA. The genus has also expanded into salt marsh at its southern limit in Peru, and on the Pacific coast of Mexico. Mangroves of several species have expanded in extent and replaced salt marsh where protected within mangrove reserves in Guangdong Province, China. In south‐eastern Australia, the expansion of Avicennia marina into salt marshes is now well documented, and Rhizophora stylosa has extended its range southward, while showing strong population growth within estuaries along its southern limits in northern New South Wales. Avicennia marina has extended its range southwards in South Africa. The changes are consistent with the poleward extension of temperature thresholds coincident with sea‐level rise, although the specific mechanism of range extension might be complicated by limitations on dispersal or other factors. The shift from salt marsh to mangrove dominance on subtropical and temperate shorelines has important implications for ecological structure, function, and global change adaptation.
Development of a complex intervention to improve health literacy skills
Authors: Austvoll‐Dahlgren Astrid , Danielsen Stein , Opheim Elin , Bjørndal Arild , Reinar Liv Merete , Flottorp Signe , Oxman Andrew David , Helseth Sølvi 
Published: July 2013

AbstractBackgroundProviding insight into the developmental processes involved in building interventions is an important way to ensure methodological transparency and inform future research efforts. The objective of this study was to describe the development of a web portal designed to improve health literacy skills among the public.MethodsThe web portal was tailored to address three key barriers to obtaining information, using the conceptual frameworks of shared decision‐making and evidence‐based practice and based on explicit criteria for selecting the content and form of the intervention.ResultsThe web portal targeted the general public and took the form of structured sets of tools. Content included: an introduction to research methods, help on how to find evidence‐based health information efficiently based on the steps of evidence‐based practice, an introduction to critical appraisal, information about patient participation rights in decision‐making, and a decision aid for consultations.ConclusionsThe web portal was designed in a systematic and transparent way and address key barriers to obtaining and acting upon reliable health information. The web portal provides open access to the tools and can be used independently by health care users, or during consultations with health professionals.
Effect of emulsifier type and concentration, aqueous phase volume and wax ratio on physical, material and mechanical properties of water in oil lipsticks
Authors: Beri A. , Norton J. E. , Norton I. T. 
Published: July 2013

SynopsisObjectivesWater‐in‐oil emulsions in lipsticks could have the potential to improve moisturizing properties and deliver hydrophilic molecules to the lips. The aims of this work were (i) to investigate the effect of emulsifier type (polymer vs. monomer, and saturated vs. unsaturated chain) and concentration on droplet size and (ii) to investigate the effect of wax ratio (carnauba wax, microcrystalline wax, paraffin wax and performalene) and aqueous phase volume on material properties (Young's modulus, point of fracture, elastic modulus and viscous modulus).MethodsEmulsion formation was achieved using a high shear mixer.ResultsResults showed that the saturated nature of the emulsifier had very little effect on droplet size, neither did the use of an emulsifier with a larger head group (droplet size ~18–25 μm). Polyglycerol polyricinoleate (PGPR) resulted in emulsions with the smallest droplets (~3–5 μm), as expected from previous studies that show that it produces a thick elastic interface. The results also showed that both Young's modulus and point of fracture increase with increasing percentage of carnauba wax (following a power law dependency of 3), but decrease with increasing percentage of microcrystalline wax, suggesting that the carnauba wax is included in the overall wax network formed by the saturated components, whereas the microcrystalline wax forms irregular crystals that disrupt the overall wax crystal network. Young's modulus, elastic modulus and viscous modulus all decrease with increasing aqueous phase volume in the emulsions, although the slope of the decrease in elastic and viscous moduli is dependent on the addition of solid wax, as a result of strengthening the network.ConclusionsThis work suggests the potential use for emulsions in lipstick applications, particularly when PGPR is used as an emulsifier, and with the addition of solid wax, as it increases network strength.