bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pathological confirmation of nerve‐sparing types performed during robot‐assisted radical prostatectomy (RARP)
Authors: Ko Woo Jin , Hruby Gregory W. , Turk Andrew T. , Landman Jaime , Badani Ketan K. 
Published: August 2012

What's known on the subject? and What does the study add?
Incremental nerve‐sparing techniques (NSTs) improve postoperative erectile function after robot‐assisted radical prostatectomy (RARP).
However, there are no studies to date that histologically confirm the surgeon intended NST. Thus, in the present study, we histologically confirmed that the surgeon performed the nerve preservation as his intended NSTs during RARP. Also, we found that there was more variability in fascia width outcome on the left side compared with the right. Therefore, when performing nerve preservation on the surgeon's non‐dominant side, we need to pay more close attention.
Objectives
To confirm that the surgeon achieved true intended histological nerve sparing during robot‐assisted radical prostatectomy (RARP) by studying RP specimens.
To aid the novice robotic surgeon to develop the skills of RARP.
Patients and Methods
Between June 2008 and May 2009, 122 consecutive patients underwent RARP by a single surgeon (K.K.B.). The degree of nerve sparing (wide resection [WR], interfascial nerve sparing [ITE‐NS], intrafascial nerve sparing [ITR‐NS]) on both sides was recorded. The posterior sectors of RP specimens from distal, mid, and proximal parts were evaluated.
Fascia width (FW) of each position in RP specimens were compared across nerve‐sparing types (NSTs). FW was recorded at 15 ° intervals (3–9 o'clock position), measured as the distance between the outermost prostate gland and surgical margin.
The slides were reviewed by an experienced uropathologist who was ‘blinded’ to the NST.
Results
In all, 93 men were included. The overall mean (sd) FW was the greatest in the order of WR, ITE‐NS, and ITR‐NS, at 2.42 (1.62), 1.71 (1.40) and 1.16 (1.08) mm, respectively (P < 0.001). FW was statistically significantly correlated with the surgical technique used. When the surgeon intended to perform various levels of nerve sparing, these were reflected in the FW.
Interestingly, the left‐side FW showed more variability than the right side. We suspect that this was a result of the surgeon's right‐hand dominance.
Erectile function (EF) recovery rate according to NST was 88.9%, 77.3%, 65.6%, 56.3%, and 0% in bilateral ITR‐NS, ITR‐NS/ITE‐NS, bilateral ITE‐NS, ITE‐NS/WR, and bilateral WR, respectively.
To further validate and confirm these preliminary findings, additional studies involving multicentre cohorts would be required.
Conclusions
The surgeon intended dissection and FW correlate, with ITR‐NS providing the narrowest FW and the EF recovery rate was the highest in bilateral ITR‐NS. There was more variability in FW outcome on the left side than the right.
The novice robotic surgeon should consider this variability when performing RARP. It may have implications for technique improvement on nerve preservation for EF.
Where There is Discord, Can They Bring Harmony? Managing Intra-Party Dissent on European Integration in the Conservative Party
Authors: Lynch Philip , Whitaker Richard 
Published: August 2012

Research Highlights and Abstract The Conservative Party became more united around a soft Eurosceptic position in opposition, but internal divisions are evident on the scale and pace of change to the UK's relationship with the EU. Conservative Party leaders have employed a range of methods to manage intra-party dissent on European integration: intervention in candidate selection, patronage, discipline, policy compromises, permitting low-cost dissent, referendum pledges and reducing issue salience. Dissent on European integration tends to be higher when the Conservatives are in office because governing parties cannot individually control the EU agenda, must take difficult decisions and may have to sacrifice their preferred positions to broker compromises. Eurosceptic dissent has increased because Conservative policy has been diluted in coalition and the crisis in the Eurozone has raised the salience of the EU issue, but Eurosceptic rebels are not a cohesive group and this limits their influence. Divisions on European integration were prominent in the Conservative Party in the 1990s, but abated in opposition. In this period, the party became more cohesive in terms of attitudes on Europe as it embraced soft Euroscepticism. However, differences over the desired scale and pace of changes to Britain's relationship with the European Union saw dissent increase as the party entered coalition government with the Liberal Democrats. This article examines the effectiveness of various approaches to management of dissent on Europe utilised by the party leadership: intervention in candidate selection; patronage and discipline; permitting limited dissent; policy compromise and deferred decisions; pledging referendums; and agenda setting and issue salience. It shows that intra-party divisions on European integration are particularly difficult to manage and suggests that dissent on the issue may often be higher in governing parties than those in opposition.
Contextual task difficulty modulates stimulus discrimination: Electrophysiological evidence for interaction between sensory and executive processes
Authors: Fedota John R. , McDonald Craig G. , Roberts Daniel M. , Parasuraman Raja 
Published: August 2012

AbstractThe occipital‐temporal N1 component of the event‐related potential (ERP) has previously been shown to index a stimulus discrimination process. However, the N1 has not consistently been shown to be sensitive to the difficulty of stimulus discrimination. Here, we manipulated the difficulty of stimulus discrimination by modulating the similarity between serially presented targets and nontargets. The same target stimulus was employed in both easy and difficult discrimination contexts, and these physically identical target stimuli elicited a larger N1 and smaller P3b in the difficult task context. Moreover, when targets were incorrectly categorized, N1 amplitude was diminished and a P3b was not elicited. These findings provide evidence that the N1 component reflects a sensory discrimination process that is modulated by executive control, and that this component can index discrimination errors when stimulus discrimination is difficult.
Factors influencing choice of surgical route of repair of genitourinary fistula, and the influence of route of repair on surgical outcomes: findings from a prospective cohort study
Authors: Frajzyngier V , Ruminjo J , Asiimwe F , Barry TH , Bello A , Danladi D , Ganda SO , Idris S , Inoussa M , Lynch M , Mussell F , Podder DC , Barone MA 
Published: August 2012

Please cite this paper as: Frajzyngier V, Ruminjo J, Asiimwe F, Barry T, Bello A, Danladi D, Ganda S, Idris S, Inoussa M, Lynch M, Mussell F, Podder D, Barone M. Factors influencing choice of surgical route of repair of genitourinary fistula, and the influence of route of repair on surgical outcomes: findings from a prospective cohort study. BJOG 2012;119:1344–1353.Objective  The abdominal route of genitourinary fistula repair may be associated with longer term hospitalisation, hospital‐associated infection and increased resource requirements. We examined: (1) the factors influencing the route of repair; (2) the influence of the route of repair on fistula closure 3 months following surgery; and (3) whether the influence of the route of repair on repair outcome varied by whether or not women met the published indications for abdominal repair.Design  Prospective cohort study.Setting  Eleven health facilities in sub‐Saharan Africa and Asia.Population  The 1274 women with genitourinary fistula presenting for surgical repair services.Methods  Risk ratios (RRs) and 95% confidence intervals (95% CIs) were generated using log‐binomial and Poisson (log‐link) regression. Multivariable regression and propensity score matching were employed to adjust for confounding.Main outcome measures  Abdominal route of repair and fistula closure at 3 months following fistula repair surgery.Results  Published indications for abdominal route of repair (extensive scarring or tissue loss, genital infibulation, ureteric involvement, trigonal, supratrigonal, vesico‐uterine or intracervical location or other abdominal pathology) predicted the abdominal route [adjusted risk ratio (ARR), 15.56; 95% CI, 2.12–114.00]. A vaginal route of repair was associated with increased risk of failed closure (ARR, 1.41; 95% CI, 1.05–1.88); stratified analyses suggested elevated risk among women meeting indications for the abdominal route.Conclusions  Additional studies powered to test effect modification hypotheses are warranted to confirm whether the abdominal route of repair is beneficial for certain women.
Who can provide effective and safe termination of pregnancy care? A systematic review*
Authors: Renner R‐M , Brahmi D , Kapp N 
Published: August 2012

Background  Unsafe termination of pregnancy is a major contributor to maternal morbidity and mortality. Task sharing termination of pregnancy services between physicians and mid‐level providers, a heterogeneous group of trained healthcare providers, such as nurses, midwives and physician assistants, has become a key strategy to increase access to safe pregnancy termination care.Objectives  To systematically review the evidence to assess whether termination of pregnancy services by nonphysician providers can be performed safely and effectively.Search strategy  We searched the Cochrane Central Register of Controlled Trials, MEDLINE, MEDLINE in process and other nonindexed citations and POPLINE.Selection criteria  We included randomised controlled trials (RCTs), as well as clinical studies, using study designs that compared efficacy, safety and acceptability of termination of pregnancy services by physicians versus other provider groups.Data collection and analysis  Two reviewers independently extracted the data, and we performed a meta‐analysis where appropriate using RevMan. Quality assessment of the data used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.Main results  We identified five controlled studies comprising 8908 women undergoing first‐trimester surgical termination of pregnancy (one RCT and three prospective cohort studies) and medical termination of pregnancy (one RCT). The mid‐level provider group included midwives, nurses, auxiliary nurse midwives and physician assistants trained in termination of pregnancy services. Safety and efficacy outcomes, including incomplete termination of pregnancy, haemorrhage, injury to the uterus or cervix, did not differ significantly between providers.Author’s conclusions  Limited evidence indicates that trained mid‐level providers may effectively and safely provide first‐trimester surgical and medical termination of pregnancy services. Data are limited by the scarcity of RCTs and biases of the cohort studies.
Patterns of Distribution and Environmental Correlates of Macroalgal Assemblages and Sediment Chlorophyll A in Oregon Tidal Wetlands
Authors: Janousek Christopher N. , Folger Christina L. 
Published: August 2012

Algae have important functional roles in estuarine wetlands. We quantified differences in macroalgal abundance, composition and diversity, and sediment chl a and pheophytin a (pheo a) among three National Wetlands Inventory (NWI) emergent marsh classes in four Oregon estuaries spanning a range of riverine to marine dominance. We also assessed the strength of macroalgal‐vascular plant associations and the degree to which environmental variables correlated with algal community metrics in marsh and woody wetlands. The frequency of occurrence of most macroalgal genera, total benthic macroalgal cover, macroalgal diversity, and sediment chl a content were several times higher in low emergent marsh than in high marsh or palustrine tidal marsh. Conversely, pheo a: chl a ratios were highest in high and palustrine marsh. Attached macroalgae (Fucus and Vaucheria) were strongly associated with plants common at lower tidal elevations such as Sarcocornia perennis and Jaumea carnosa; Ulva (an unattached alga) was not strongly associated with any common low marsh plants. In structural equation models, intertidal elevation was the most influential predictor of macroalgal cover and richness and chl a; light availability and soil salinity played secondary roles. Although common taxa such as Ulva spp. occurred across a broad range of salinities, wetlands with oligohaline soils (salinity < 5) had the lowest macroalgal diversity and lower sediment chl a. These types of baseline data on algal distributions are critical for evaluating the structural and functional impacts of future changes to coastal estuaries including sea‐level rise (SLR), altered salinity dynamics, and habitat modification.
Prefrailty and Chronic Morbidity in the Youngest Old: An Insight from the Lausanne Cohort Lc65+
Authors: Danon‐Hersch Nadia , Rodondi Nicolas , Spagnoli Jacques , Santos‐Eggimann Brigitte 
Published: August 2012

ObjectivesTo estimate the prevalence of prefrailty, frailty, comorbidity, and disability in the youngest old and to identify chronic diseases associated with individual frailty criteria.DesignPopulation‐based cohort study of noninstitutionalized elderly adults at baseline; cross‐sectional analysis.SettingLausanne, Switzerland.ParticipantsOne thousand two hundred eighty‐three individuals with complete data on frailty, aged 65 to 70 (58.5% women).MeasurementsFrailty was assessed according to an adaptation of Fried's criteria (shrinking, weakness, exhaustion, slowness, and low activity, three criteria needed for the diagnosis of frailty, 1 to 2 for prefrailty). Other outcomes were diseases diagnosed by a doctor (≥2 chronic diseases: comorbidity) and limitations in activities of daily living (ADLs, basic and instrumental).ResultsAt baseline, of 1,283 participants 71.1% were classified as nonfrail, 26.4% as prefrail, and 2.5% as frail. The proportion of women increased across these three groups (56.5%, 62.8%, and 71.9%, respectively; P = .01), as did the proportion of individuals with one or more chronic diseases (68.0%, 82.8%, and 90.6%, respectively; P < .001) and the proportion with basic or instrumental ADL disability (1.6%, 10.3%, and 59.4%, respectively; P < .001). Weakness (low grip strength) was the most frequent criterion (14.3%). Prefrail participants had significantly more comorbidity and ADL disability than nonfrail participants (P < .001). When present in isolation, weakness was associated with two to three times greater prevalence of coronary heart disease, other heart diseases, diabetes mellitus, and arthritis. Similarly, a significant association was identified between exhaustion and depression.ConclusionPrefrailty is common in the youngest old. The most prevalent frailty criterion is weakness, which is associated with cardiovascular diseases. Longitudinal studies of the evolution of prefrailty should explore the role of potential interactions between individual frailty criteria and specific chronic diseases.
Do Depressive Symptoms and Gait Speed Impairment Predict Each Other's Incidence? A 16‐Year Prospective Study in the Community
Authors: Sanders Joost B. , Bremmer Marijke A. , Deeg Dorly J. H. , Beekman Aartjan T. F. 
Published: August 2012

ObjectivesTo investigate whether gait speed predicts incident depressive symptoms and whether depressive symptoms predict incident gait speed impairment; to ascertain the presence of shared risk factors for these associations.DesignTheLongitudinalAgingStudyAmsterdam, a prospective cohort study with five follow‐up cycles over 16 years.SettingPopulation based.ParticipantsOne thousand nine hundred twenty‐eight respondents for incident depressive symptoms (mean age 68.9 ± 8.5) and 1,855 respondents for incident gait speed impairment (mean age 68.0 ± 8.2).MeasurementsDepressive symptoms were measured using theCenter forEpidemiologicStudiesDepressionScale; gait speed was measured, back and forth, during a 3‐m walk as quickly as possible, with a 180° turn. Multivariate analyses were performed for both sexes usingCox regression.ResultsIncident depressive symptoms occurred in 24% of respondents. In univariate analyses, gait speed at baseline predicted incident depressive symptoms in men and women; after adjustment for covariates, this association persisted in men only. Examining the reverse association, 34% of respondents developed gait speed impairment. Depressive symptoms at baseline were univariately associated with incident gait speed impairment in women but not in men; this association did not persist after adjustment. The bidirectional associations did not share the same explanatory variables.ConclusionGait speed predicts depressive symptoms in men. The geriatric giants of depressive symptoms and slowed gait speed in late life appear to result from different pathologies, both of which therefore require their own treatment strategies.
Serum Albumin in Relation to Change in Muscle Mass, Muscle Strength, and Muscle Power in Older Men
Authors: Snyder Caryn K. , Lapidus Jodi A. , Cawthon Peggy M. , Dam Thuy‐Tien L. , Sakai Lynn Y. , Marshall Lynn M. 
Published: August 2012

ObjectivesTo investigate the relationship between serum albumin and change in muscle mass, grip strength, and leg power.DesignProspective cohort.SettingSix U.S. academic medical centers.ParticipantsCommunity‐dwelling men aged 65 and older participating in the Osteoporotic Fractures in Men (MrOS) Study.MeasurementsSerum albumin was measured at baseline in 5,534 participants. Baseline serum albumin was examined in relation to change in appendicular skeletal muscle (ASM) mass, grip strength, and leg power after 2 and 4.6 years. Two‐year change in serum albumin was examined with respect to simultaneous change in these outcomes in 1,267 participants.ResultsBaseline serum albumin <40 g/L was not associated with 2‐ or 4.6‐year change in ASM mass, grip strength, or leg power before or after adjustment for confounders. There was no association between serum albumin change and change in grip strength. A statistically significant trend was observed between serum albumin change and change in ASM mass, but there was substantial overlap across confidence intervals (CIs). Participants with a marked decrease (>3 g/L) and mild decrease (1–2 g/L) in serum albumin over 2 years exhibited a modest change of −8.9 W (95% CI = −25.6 to −7.8 W) and −6.3 W (95% CI = −21.2 to −8.5 W) of leg power, respectively (P for trend = .02), compared with those with no decrease in albumin concentration.ConclusionSerum albumin demonstrated modest and inconsistent trends with loss of muscle mass and function. Low serum albumin within the normal range is not a risk factor for this process in elderly men.
Update on Midlevel Provider Utilization in U.S. Emergency Departments, 2006 to 2009
Authors: Wiler Jennifer L. , Rooks Sean P. , Ginde Adit A. 
Published: August 2012

ACADEMIC EMERGENCY MEDICINE 2012; 19:986–989 © 2012 by the Society for Academic Emergency MedicineAbstractObjectives:  Previous studies have noted a sharp increase in utilization of physician assistants (PAs) and nurse practitioners (NPs), up to 13% of all U.S. emergency department (ED) visits in 2005. The authors sought to reevaluate utilization and visit acuity for these midlevel providers (MLPs) in U.S. EDs from 2006 to 2009.Methods:  This was a secondary analysis of the 2006–2009 National Hospital Ambulatory Medical Care Surveys (NHAMCS), using the “providers seen” fields to categorize visits. Demographic, visit, and hospital characteristics of visits seen by MLPs only were compared to those seen by MLPs with physician involvement and by physicians only.Results:  Of the estimated 496 million U.S. ED visits from 2006 to 2009, 5.8% (95% confidence interval [CI] = 4.7% to 7.1%) were seen by MLPs only and 7.4% (95% CI = 6.3% to 8.5%) by MLPs with physician involvement. The annual proportions of visits seen by MLPs only for 2006 to 2009 ranged from 5.4% to 6.0% without an obvious trend. Acuity of MLP‐only visits in 2006–2009 was similar to prior 1993–2005 data for arrival by ambulance (6.5% vs. 6.0%), urgent/emergent triage acuity (33% vs. 37%), and hospital admission (3.3% vs. 3.0%). From 2006 through 2009, 64% of EDs utilized MLPs, with higher utilization in urban (72%, 95% CI = 64% to 78%) compared to nonurban EDs (51%, 95% CI = 39% to 63%). However, among EDs that did utilize MLPs, nonurban EDs had MLPs without physician involvement see a median 27% of all ED visits, compared to 7.5% for urban EDs.Conclusions:  Despite a rapid expansion of MLP utilization in U.S. EDs, recent growth appears to have plateaued. The scope of practice of MLPs in EDs does not appear to be rapidly expanding. Urban EDs use MLPs more than nonurban EDs, but among EDs that use MLPs, nonurban EDs had MLPs see a larger proportion of overall ED visits.
Effect of γ‐aminobutyric acid on growth performance and immune function in chicks under beak trimming stress
Authors: XIE Wan‐ying , HOU Xin‐yan , YAN Feng‐bin , SUN Gui‐rong , HAN Rui‐li , KANG Xiang‐tao 
Published: August 2012

ABSTRACTThis experiment was undertaken to examine the effect of beak trimming stress on the growth performance and immune system, and to consider possible roles of γ‐aminobutyric acid (GABA) in this stress response. Results showed that body weight, feed intake and relative spleen weight were significantly increased by GABA at 80 mg/kg (P < 0.05) under beak trimming stress, whereas the relative organ weights of the bursa of fabricius and thymus were not significantly affected (P > 0.05). Adrenocorticotropic hormone concentration in serum was highest for chicks fed the GABA‐deficient water and was significantly decreased by the supplement of GABA at days 1, 3 and 5 after beak trimming (P < 0.05). The supplement of GABA significantly increased the proportions of CD4+ and CD8+ lymphocytes, especially at the dose of 60 mg/kg (P < 0.05). The levels of interleukin (IL)‐1β, lipopolysaccharide‐induced tumor necrosis factor‐α and IL‐6 in serum were significantly decreased by GABA at 80 mg/kg (P < 0.05). All the three cytokines expressed in the spleen were significantly decreased by GABA at 80 mg/kg when birds were under beak trimming stress (P < 0.05). It is concluded that beak trimming suppressed the immune response of chicks, whereas the immune response of chicks could be improved by GABA supplementation.