bluuebunny/crossref_metadata_2025_split huggingface dataset:
Critical appraisal of volumetric-modulated arc therapy compared with electrons for the radiotherapy of cutaneous Kaposi’s sarcoma of lower extremities with bone sparing
Authors: Nicolini G , Abraham S , Fogliata A , Jordaan A , Clivio A , Vanetti E , Cozzi L 
Published: February 2013

Objective:
To evaluate the use of volumetric-modulated arc therapy [VMAT, RapidArc® (RA); Varian Medical Systems, Palo Alto, CA] for the treatment of cutaneous Kaposi’s sarcoma (KS) of lower extremities with adequate target coverage and high bone sparing, and to compare VMAT with electron beam therapy.

Methods:
10 patients were planned with either RA or electron beams. The dose was prescribed to 30 Gy, 10 fractions, to mean the planning target volume (PTV), and significant maximum dose to bone was limited to 30 Gy. Plans were designed for 6-MV photon beams for RA and 6 MeV for electrons. Dose distributions were computed with AcurosXB® (Varian Medical Systems) for photons and with a Monte Carlo algorithm for electrons.

Results:
V 90% was 97.3±1.2 for RA plans and 78.2±2.6 for electrons; similarly, V 107% was 2.5±2.2 and 37.7±3.4, respectively. RA met coverage criteria. Concerning bone sparing, D 2% was 29.6±1.1 for RA and 31.0±2.4 for electrons. Although acceptable for bone involvement, pronounced target coverage violations were obtained for electron plans. Monitor units were similar for electrons and RA, although for the latter they increased when superior bone sparing was imposed. Delivery times were 12.1±4.0 min for electrons and 4.8±1.3 min for the most modulated RA plans.

Conclusion:
High plan quality was shown for KS in the lower extremities using VMAT, and this might simplify their management in comparison with the more conventional usage of electrons, particularly in institutes with limited staff resources and heavy workloads.

Advances in knowledge:
VMAT is also dosimetrically extremely advantageous in a typology of treatments where electron beam therapy is mainly considered to be effective owing to the limited penetration of the beams.
Hardware Support for Authentication in Cyber Physical Systems
Authors: Sander Oliver , Klimm Alexander , Becker Jürgen 
Published: February 2013

Abstract
The efficiency and benefit of Cyber Physical Systems (CPS) depend heavily on interconnection of individual devices or nodes. Exchange of data, information relevant to an overall task or functionality is the key to many applications such as smart grids, smart cities, and many others. Trustworthiness of data is needed to make such systems successful. To be able to fulfill policies to guarantee the safety of all entities within a CPS and to provide security measures to enforce these cryptographic solutions have to be embedded. As we show in this paper it is possible to integrate security building blocks in ultra-small devices to provide essential properties for secure embedded systems. With proper policies, high cryptographic standards, rising acceptance by users, and provable security and safety measures, CPS will open countless possibilities to increase efficiency in many aspects of our everyday lives.
Observation of Electromigration Voiding in Cu Lines
Authors: Lee Seok-Hee , Bravman John C. , Flinn Paul A. , Arnaud Lucile 
Published: February 2013

ABSTRACTCu film characteristics and in-situ observation of electromigration voiding in passivated Cu lines are reported. Measured grain size distribution show a median grain size of 0.4 μm. A 3 μm wide, 800 μm long line passivated with 5000 Å of SiO2 was tested in a high voltage scanning electron microscopy (HVSEM), enabling dynamic in-situ events to be recorded. Electromigration voiding in this line showed some similarity to that previously observed in polygranular Al lines. Transmission electron microscopy was used to study the microstructure of the passivated Cu lines.
Modeling Stress Evolution in Electromigration
Authors: Thouless M. D. 
Published: February 2013

ABSTRACTDiffusional mechanisms of electromigration and stress relaxation involve the flow of atoms in response to a gradient in chemical potential along an interface. This gradient in chemical potential may be provided by the component of an electric field parallel to the interface, or it may be established by the normal component of stresses along it. In either case, considerations of continuity of the potential dictate that diffusive flow must also be induced along any other boundary that intersects the interface. As an example, in this paper, a model system that contains grain boundaries normal to an applied electric field is analyzed. While the electric field does not directly induce diffusion along these grain boundaries, it is shown that a complimentary flux must be induced along them. The effect of this flux on electromigration is discussed in this paper. Furthermore, it is well-known that non-homogeneous diffusion of matter along boundaries induces elastic distortions and stress gradients. These in turn, influence the diffusion process. The effect of these elastic distortions on the atomic flux has been examined by considering diffusion along a single interface in an elastic medium. Prior studies of diffusional cavity growth have established the magnitudes of non-dimensional time-scales over which the deposition of atoms along the grain boundaries can be assumed to be essentially uniform. Such an assumption considerably simplifies analyses for stress evolution in these problems. The appropriate time-scales over which such a simplification can be made for electromigration are discussed in this paper, and illustrated by some model calculations.
Modeling the Mechanisms of Cu-Enhanced Median Time to Failure in Al-Cu Interconnects Under Electromigration
Authors: Low K. S. , Shih W. C. , Greer A. L. , Ghiti A. , O'Neill A. G. 
Published: February 2013

ABSTRACTA finite-element model is used to simulate electromigration voiding and failure in Al-Cu interconnects. The modeling includes the fluxes of Al and Cu atoms in the grain-boundary network, and is used to study the mechanisms by which Cu as a solute improves the reliability of Al metallization. A possible mechanism for the Cu to reduce the grain-boundary diffusiv-ity of Al is explored, and it is shown that with appropriate parameters this can reproduce the observed increases in lifetime. Also investigated are the effects of electromigration-induced non-uniformity in the Cu distribution and the role of Al2Cu precipitates as reservoirs for Cu.
Effect of Acid Spending on Etching and Acid-Fracture Conductivity
Authors: Pournik M.. , Li L.. , Smith B.. , Nasr-El-Din H.A.. A. 
Published: February 2013

Summary
In acid fracturing, while the near-wellbore area of the fracture receives live, unspent acid, sections of the fracture farther down the length receive partially spent acid because of the acid's reaction with the rock. As a result, there is a distribution of acid concentration along the fracture length. However, almost all experimental studies on acid-fracture conductivity have been conducted with live acid, which is representative of what occurs near the wellbore.
An experimental study was conducted to investigate the effect of spent acids on the resulting fracture conductivity in a laboratory facility designed to perform acid-fracture-conductivity characterization. Gelled HCl acid systems with different degrees of acid spending were used to etch fractured cores under identical treatment conditions, which were set to mimic field conditions. Detailed etched surface characterization, fluid analysis, and conductivity measurements were performed on acid-etched fracture faces.
Experimental results show that the amount of rock dissolved and the actual etching pattern depend highly on acid concentration. While there was less fracture-face etching with more spent acid systems, the etching pattern also changed with acid spending, which sometimes offset the additional etched volume of unspent acid. As a result, the retained conductivity was generally higher for more spent acid, and the decline in conductivity with closure stress was more subtle with the spent acid, probably because of less weakening of the fracture face.
While there have been many developments in enhancing the etched length of acid-fractured wells, a major reason for the lack of long etched fractures is acid spending along the fracture. In order to understand the etched fracture profile, there is a need to realize how the degree of acid spending limits etching and affects the resulting fracture conductivity. On the basis of the newly discovered effect of acid spending on conductivity, acid-etched length and conductivity can be predicted more accurately and acid-fracture treatments better designed.
Ionizing Radiation Exposure among Kidney Transplant Recipients Due to Medical Imaging during the Pretransplant Evaluation
Authors: Nguyen Kim N. , Patel Anup M. , Weng Francis L. 
Published: February 2013

Summary

Background and objectives
Kidney transplant recipients are at increased risk for malignancies. One recognized risk for malignancy is ionizing radiation. The purpose of this study was to determine, among kidney transplant recipients, the medical imaging procedures that contribute to radiation exposure and their cumulative radiation exposure, as a result of their pretransplant evaluation.

Design, setting, participants, & measurements
Medical records of patients who received a first, kidney-alone transplant during 2008 at a single transplant center were examined. This study identified medical imaging procedures that were performed as prerequisites for deceased donor wait-listing or receipt of live donor kidney transplants and to maintain active status on the wait list. Frequencies of medical imaging procedures and cumulative effective doses of radiation were calculated.

Results
Among the 172 kidney transplant recipients, 905 procedures were performed. Seventy patients (40.7%) were exposed to low dose (0–20 mSv), 51 (29.7%) were exposed to moderate dose (>20–50 mSv), 28 (16.3%) were exposed to high dose (>50–100 mSv), and 23 (13.4%) were exposed to very high dose (>100 mSv) cumulative effective radiation. Nuclear stress tests accounted for 82.9% of the total radiation exposure. In multivariate analysis, older age, diabetes, and black race were associated with exposure to >20 mSv radiation during the pretransplant evaluation.

Conclusions
Kidney transplant recipients are exposed to large amounts of ionizing radiation from medical imaging during the pretransplant evaluation. The effects of radiation upon malignancy risk and strategies to reduce this radiation exposure warrant further investigation.
Removal of Duodenum Elicits GLP-1 Secretion
Authors: Muscogiuri Giovanna , Mezza Teresa , Prioletta Annamaria , Sorice Gian Pio , Clemente Gennaro , Sarno Gerardo , Nuzzo Gennaro , Pontecorvi Alfredo , Holst Jens J. , Giaccari Andrea 
Published: February 2013

OBJECTIVE
To evaluate the effect of removal of the duodenum on the complex interplay between incretins, insulin, and glucagon in nondiabetic subjects.

RESEARCH DESIGN AND METHODS
For evaluation of hormonal secretion and insulin sensitivity, 10 overweight patients without type 2 diabetes (age 61 ± 19.3 years and BMI 27.9 ± 5.3 kg/m2) underwent a mixed-meal test and a hyperinsulinemic-euglycemic clamp before and after pylorus-preserving pancreatoduodenectomy for ampulloma.

RESULTS
All patients experienced a reduction in insulin (P = 0.002), C-peptide (P = 0.0002), and gastric inhibitory peptide (GIP) secretion (P = 0.0004), while both fasting and postprandial glucose levels increased (P = 0.0001); GLP-1 and glucagon responses to the mixed meal increased significantly after surgery (P = 0.02 and 0.031). While changes in GIP levels did not correlate with insulin, glucagon, and glucose levels, the increase in GLP-1 secretion was inversely related to the postsurgery decrease in insulin secretion (R2 = 0.56; P = 0.012) but not to the increased glucagon secretion, which correlated inversely with the reduction of insulin (R2 = 0.46; P = 0.03) and C-peptide (R2 = 0.37; P = 0.04). Given that the remaining pancreas presumably has preserved intraislet anatomy, insulin secretory capacity, and α- and β-cell interplay, our data suggest that the increased glucagon secretion is related to decreased systemic insulin.

CONCLUSIONS
Pylorus-preserving pancreatoduodenectomy was associated with a decrease in GIP and a remarkable increase in GLP-1 levels, which was not translated into increased insulin secretion. Rather, the hypoinsulinemia may have caused an increase in glucagon secretion.
Impact of Baseline Insulin Regimen on Glycemic Response to a Group Medical Clinic Intervention
Authors: Crowley Matthew J. , Melnyk Stephanie D. , Coffman Cynthia J. , Jeffreys Amy S. , Edelman David 
Published: February 2013

OBJECTIVE
Group medical clinics (GMC) combine medication management and self-management training, and may improve diabetes outcomes. It remains unclear which patients benefit most from GMC. This secondary analysis examined the impact of baseline insulin regimen on GMC response.

RESEARCH DESIGN AND METHODS
We analyzed a trial of 239 veterans with type 2 diabetes randomized to GMC or usual care (UC). We categorized baseline insulin regimen as the following: no insulin; basal insulin only; or complex insulin (basal–prandial or mixed regimens). Using linear mixed models adjusted for clustering within GMC, we evaluated the differential impact of GMC relative to UC on hemoglobin A1c (HbA1c) and self-efficacy among patients on different baseline insulin regimens.

RESULTS
From linear mixed models, the effect of GMC on HbA1c differed by baseline insulin regimen versus UC (P = 0.05); there was no differential effect on self-efficacy (P = 0.29). Among those using complex insulin regimens at baseline, GMC reduced HbA1c by study end compared with UC (−1.0%; 95% CI −1.8 to −0.2; P = 0.01). We found no such HbA1c difference between GMC and UC patients using no insulin (P = 0.65) or basal insulin only (P = 0.71). There were no clinically significant differences in hypoglycemia by baseline insulin regimen and intervention group.

CONCLUSIONS
We found that compared with UC, GMC lowered HbA1c specifically among patients using complex insulin regimens at study baseline, which may relate to this group’s demanding medication and self-management requirements. Implementing GMC among patients using complex insulin regimens may maximize this care delivery strategy’s potential.
Clinical Reasoning and Advanced Practice Privileges Enable Physical Therapist Point-of-Care Decisions in the Military Health Care System: 3 Clinical Cases
Authors: Rhon Daniel I. , Deyle Gail D. , Gill Norman W. 
Published: February 2013

Background and PurposePhysical therapists frequently make important point-of-care decisions for musculoskeletal injuries and conditions. In the Military Health System (MHS), these decisions may occur while therapists are deployed in support of combat troops, as well as in a more traditional hospital setting. Proficiency with the musculoskeletal examination, including a fundamental understanding of the diagnostic role of musculoskeletal imaging, is an important competency for physical therapists. The purpose of this article is to present 3 cases managed by physical therapists in unique MHS settings, highlighting relevant challenges and clinical decision making.Case DescriptionThree cases are presented involving conditions where the physical therapist was significantly involved in the diagnosis and clinical management plan. The physical therapist's clinical privileges, including the ability to order appropriate musculoskeletal imaging procedures, were helpful in making clinical decisions that facilitate timely management. The cases involve patients with an ankle sprain and Maisonneuve fracture, a radial head fracture, and a pelvic neoplasm referred through medical channels as knee pain.OutcomesClinical pathways from point of care are discussed, as well as the reasoning that led to decisions affecting definitive care for each of these patients. In each case, emergent treatment and important combat evacuation decisions were based on a combination of examination and management decisions.DiscussionPhysical therapists can provide important contributions to the primary management of patients with musculoskeletal conditions in a variety of settings within the MHS. In the cases described, advanced clinical privileges contributed to the success in this role.
Psychometric Properties of the Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) in Patients With Musculoskeletal Disorders: A Replication Study With Additional Findings
Authors: Riddle Daniel L. , Stratford Paul W. , Carter Tracy L. , Cleland Joshua A. 
Published: February 2013

BackgroundThe Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) is a recently developed self-report outcome instrument designed to measure the extent of activity limitation as defined by the World Health Organization.ObjectiveThe purposes of the study were to replicate some aspects of the original study of the OPTIMAL Difficulty and Confidence scales and to conduct additional psychometric tests.DesignA cross-sectional design was used in the study.MethodsOf a total of 1,150 patients who received treatment at 4 outpatient centers over the study period, 1,030 patients were recruited for this study and completed the OPTIMAL instrument and previously validated region-specific functional status measures. A variety of analytic methods were used to examine the extent of redundancy between the OPTIMAL Difficulty and Confidence scales, as well as the internal consistency reliability, standard error of measurement, known-groups validity, and convergent validity of OPTIMAL Difficulty Scale scores.ResultsThe OPTIMAL Difficulty and Confidence scale scores were found in a factor analysis to be load-based on anatomical region rather than on difficulty and confidence concepts. Internal consistency reliability for the subscales of the Confidence Scale varied and was .80 or higher for the lower-extremity subscale but .50 or less for the trunk and upper-extremity subscales.LimitationsOnly cross-sectional relationships were examined, and another pure measure of activity limitation was not used for comparison.ConclusionsThe findings generally did not support the psychometric properties of the OPTIMAL instrument. Although not conclusive, the data suggested that the OPTIMAL Difficulty and Confidence scales demonstrate substantial overlap. Reliability was generally low, with the exception of the lower-extremity subscale. Scores for the subscales of the Difficulty Scale differentiated among patients with lower-extremity versus trunk or upper-extremity diagnoses, but associations with previously validated region-specific measures were generally weak or absent. Clinicians treating outpatients with musculoskeletal disorders should consider alternative measures when attempting to quantify the extent of activity limitations.
Determining the elements of procedural quality
Authors: Berkowitz Oren , Jones Kristen , Lunsford L. Dade , Kondziolka Douglas 
Published: February 2013

Object
The definition and determination of quality health care is an important topic. The purpose of this study was to develop a longitudinal method to define a quality procedure by creating a formal approach to pre- and postoperative outcomes documentation. The authors worked to define quality outcomes by first documenting the patient's condition. Goals were determined together by the surgeon and the patient and then were evaluated to see if those goals were met.

Methods
The population consisted of cancer patients with newly diagnosed metastatic brain disease who were scheduled to undergo stereotactic radiosurgery. Surgeons recorded perioperatively objective information related to preoperative goals, clinical findings, surgical performance and/or error, and whether goals were met. In addition, patients completed pre- and postprocedure questionnaires (Rand 36-Item Short-Form Health Survey 1.0 [SF-36]).

Results
Procedural goals, defined as completing radiosurgery without error or complication and same-day discharge, were met in all patients. The clinically predetermined goal of tumor palliation was met in all but 1 patient at follow-up. The SF-36 scores remained stable except for the general health domain, which was lower (p = 0.006).

Conclusions
Procedural goals can be defined and objectively measured serially. The authors think that quality care can be defined as a process that achieves predefined goals without significant error and maintains or improves health.
Inferring Community Structure in Healthcare Forums
Authors: Årsand E. , Fernandez-Luque L. , Lauritzen J. , Hartvigsen G. , Chomutare T. 
Published: February 2013

SummaryBackground: Detecting community structures in complex networks is a problem interesting to several domains. In healthcare, discovering communities may enhance the quality of web offerings for people with chronic diseases. Understanding the social dynamics and community attachments is key to predicting and influencing interaction and information flow to the right patients.Objectives: The goal of the study is to empirically assess the extent to which we can infer meaningful community structures from implicit networks of peer interaction in online healthcare forums.Methods: We used datasets from five online diabetes forums to design networks based on peer-interactions. A quality function based on user interaction similarity was used to assess the quality of the discovered communities to complement existing homophily measures.Results: Results show that we can infer meaningful communities by observing forum interactions. Closely similar users tended to co-appear in the top communities, suggesting the discovered communities are intuitive. The number of years since diagnosis was a significant factor for cohesiveness in some diabetes communities.Conclusion: Network analysis is a tool that can be useful in studying implicit networks that form in healthcare forums. Current analysis informs further work on predicting and influencing interaction, information flow and user interests that could be useful for personalizing medical social media.
La pénalisation de l'usage de stupéfiants en France au miroir des statistiques administratives
Authors: Obradovic Ivana 
Published: February 2013

Contrairement à l’opinion courante selon laquelle la loi du 31 décembre 1970 serait de moins en moins appliquée, l’analyse des statistiques policières et judiciaires montre que la pénalisation de l’usage de stupéfiants est de plus en plus systématique en France. L’interprétation des évolutions dans la répression de l’usage de stupéfiants révèle différents usages possibles des chiffres. Si on réduit la pénalisation au rapport entre usagers interpellés et condamnés, elle a en effet reculé ; si on la comprend comme un recours accru au système pénal pour traiter les affaires d’usage, y compris en amont des tribunaux, on conclut au contraire à une pénalisation renforcée et à une diversification des modes de sanction de l’usage de stupéfiants entre 1986 et 2009.
Anorexie et maternité : un ventre plein pour apaiser un ventre vide ?
Authors: Gandouly Marion 
Published: February 2013

Résumé La grossesse et les remaniements psychiques qu’elle induit sont aujourd’hui au cœur des préoccupations de nombreux psychanalystes, tant cette période peut être source du meilleur comme du pire. Sous l’effet de la transparence psychique, les fantasmes régressifs et les remémorations infantiles affluent à la conscience, permettant parfois à certaines problématiques, restées jusqu’alors latentes, de trouver une issue positive. Qu’en serait-il alors pour des femmes présentant des antécédents d’anorexie ? Cette authenticité psychique, cette folie maternelle ordinaire, pourrait-elle être l’occasion d’un remaniement identitaire leur permettant de se libérer de l’emprise maternelle, en accédant au statut de femme et à celui de mère, si longtemps refusés ?