bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tragic Choices and Moral Compromise: The Ethics of Allocating Kidneys for Transplantation
Authors: HOFFMASTER BARRY , HOOKER CLIFF 
Published: September 2013

ContextFor almost a decade, the Kidney Transplantation Committee of the United Network for Organ Sharing has been striving to revise its approach to allocating kidneys from deceased donors for transplantation. Two fundamental values, equality and efficiency, are central to distributing this scarce resource. The prevailing approach gives primacy to equality in the temporal form of first‐come, first‐served, whereas the motivation for a new approach is to redeem efficiency by increasing the length of survival of transplanted kidneys and their recipients. But decision making about a better way of allocating kidneys flounders because it is constrained by the amorphous notion of “balancing” values.MethodsThis article develops a more fitting, productive approach to resolving the conflict between equality and efficiency by embedding the notion of compromise in the analysis of a tragic choice provided by Guido Calabresi and Philip Bobbitt. For Calabresi and Bobbitt, the goals of public policy with respect to tragic choices are to limit tragedy and to deal with the irreducible minimum of tragedy in the least offensive way. Satisfying the value of efficiency limits tragedy, and satisfying the value of equality deals with the irreducible minimum of tragedy in the least offensive way. But both values cannot be completely satisfied simultaneously. Compromise is occasioned when not all the several obligations that exist in a situation can be met and when neglecting some obligations entirely in order to fulfill others entirely is improper. Compromise is amalgamated with the notion of a tragic choice and then used to assess proposals for revising the allocation of kidneys considered by the Kidney Transplantation Committee.FindingsCompromise takes two forms in allocating kidneys: it occurs within particular approaches to allocating kidneys because neither equality nor efficiency can be fully satisfied, and it occurs over the course of sequential approaches to allocating kidneys that cycle between preferring equality and efficiency. Ross and colleagues’ Equal Opportunity Supplemented by Fair Innings proposal for allocating kidneys best exemplifies the rationality of compromise as a way of achieving the goals of making a tragic choice.ConclusionsThe attempt to design a policy for allocating kidneys from deceased donors for transplantation by balancing the values of equality and efficiency is misguided and unhelpful. Instead policymaking should both incorporate compromise into discrete approaches to allocating kidneys and extend compromise over sequential approaches to allocating kidneys.
Phylogenetic resolution power of microsatellites and various single‐nucleotide polymorphism types assessed in 10 divergent chicken populations
Authors: Granevitze Z. , David L. , Twito T. , Weigend S. , Feldman M. , Hillel J. 
Published: September 2013

SummaryThere has been some debate over the question of which types of DNA variation are most appropriate to accurately reconstruct evolutionary events. We compared the capacity of microsatellites (STRs) and various types of single‐nucleotide polymorphism (SNP) loci in the chicken genome. The SNP types differ in their location: in exons, introns and promoters. Genetic distances between all possible pairs of 10 populations were calculated for each marker type. STR loci, which are much more polymorphic than are SNPs, are considered to have occurred at recent time compared with old evolutionary events of SNPs. Using structure software, STR loci assigned individuals to their population much more correctly than did any other marker types, whereas SNPs at promoter regions gave the poorest ascription. Furthermore, 29 STR markers were even better than all 152 SNPs together. Ancient evolutionary events that produced genetic differences between the most distant populations such as Red Jungle Fowl and domestic chicken were detected better by exons and introns than by STR loci and promoters. The significant interactions found between marker types and populations suggest that marker types had different phylogenetic histories, possibly related to a different timescale.
Aged Care Assessment Service practitioners: A review of current practice for assessment of cognition of older people of culturally and linguistically diverse backgrounds in Victoria
Authors: Vrantsidis Freda , LoGiudice Dina , Rayner Victoria , Dow Briony , Antonopoulos Stephanie , Runci Susannah , O'Connor Daniel W. , Haralambous Betty 
Published: September 2013

AimThis paper describes current practices and gaps identified by Aged Care Assessment Service (ACAS) clinicians in the assessment of cognition of clients of culturally and linguistically diverse (CALD) background in Victoria.MethodA web‐based survey, exploring practices and challenges faced by clinicians in assessing CALD clients and their families, was sent to all Victorian ACAS managers to distribute to their teams. Three focus groups were also conducted with ACAS clinicians to further explore these issues.ResultsSeventy‐nine web‐based surveys were returned and 21 ACAS clinicians attended a focus group. Challenges reported included the availability and quality of interpreters, and variability in training received and confidence in assessing cognitive impairment in CALD clients.ConclusionACAS clinicians reported that assessment of cognition for those of CALD background was challenging. Based on this feedback, practice tip sheets were developed as educational aids to assist ACAS staff.
Emergency obstetric simulation training: How do we know where we are going, if we don't know where we have been?
Authors: Calvert Katrina L. , Mcgurgan Paul M. , Debenham Edward M. , Gratwick Frances J. , Maouris Panos 
Published: September 2013

BackgroundObstetric emergencies contribute significantly to maternal morbidity and mortality. Current training in the management of obstetric emergencies in Australia and internationally focusses on utilising a multidisciplinary simulation‐based model. Arguments for and against this type of training exist, using both economic and clinical reasoning.AimsTo identify the evidence base for the clinical impact of simulation training in obstetric emergencies and to address some of the concerns regarding appropriate delivery of obstetric emergency training in the Australian setting.MethodsA literature search was performed to identify research undertaken in the area of obstetric emergency training. The initial literature search using broad search terms identified 887 articles which were then reviewed and considered for inclusion if they provided original research with a specific emphasis on the impact of training on clinical outcomes.ResultsNinety‐two articles were identified, comprising evidence in the following clinical situations: eclampsia, shoulder dystocia, postpartum haemorrhage, maternal collapse, cord prolapse and teamwork training. Evidence exists for a benefit in knowledge or skills gained from simulation training and for the benefit of training in small units without access to high‐fidelity equipment or facilities.ConclusionsEvidence exists for a positive impact of training in obstetric emergencies, although the majority of the available evidence applies to evaluation at the level of participants’ confidence, knowledge or skills rather than at the level of impact on clinical outcomes. The model of simulation‐based training is an appropriate one for the Australian setting and should be further utilised in rural and remote settings.
Accuracy of sonographic prediction of birth weight
Authors: Oliver Melissa , McNally Glenn , Leader Leo 
Published: September 2013

Many clinicians use ultrasound estimates of fetal weight to assess fetal growth. This study assessed the accuracy of the Hadlock IV equation, the equation used at the Royal Hospital for Women, Randwick, NSW, in estimating birth weight. The accuracy of the Hadlock IV equation was assessed based on systematic and random error as well as absolute error. 709 women who underwent ultrasound examination within 8 weeks of delivery between January 2009–May 2011 were included. 305 women underwent ultrasound less than 2 weeks before delivery. The systematic, random and absolute errors of the Hadlock IV equation were −0.47, 27.45 and 8.52%, respectively. This study demonstrates that clinicians may rely on ultrasound estimates of fetal weight performed by well‐trained staff in a tertiary institution within 2 weeks of delivery. The accuracy diminishes as the interval between testing and delivery increases. Absolute errors tended to increase with increasing birth weight for all ultrasound‐delivery intervals.
Changes in angiogenesis and hypoxia‐inducible factor‐1α protein expression in relapsed/refractory indolent non‐Hodgkin lymphomas
Authors: Minoia Carla , Quero Carmela , Asselti Mariaconsilia , Galise Ida , Marzano Alessia L. , Iacobazzi Angela , Rana Antonio , Merchionne Francesca , Serratì Simona , De Tullio Giacoma , Quintana Giovanni , Casiello Michela , Maiorano Eugenio , Simone Giovanni , Zito Francesco A. , Iacopino Pasquale , Guarini Attilio 
Published: September 2013

SummaryAngiogenesis is involved in the pathogenesis and progression of non‐Hodgkin lymphomas (NHL), and hypoxia‐inducible factor‐1α (HIF‐1α, also termed HIF1A) might contribute to this process. Currently, there is no direct evidence that the clinical progression of indolent NHL is associated with angiogenesis, and the expression of HIF‐1α at recurrence is unknown. Matched lymph node biopsies at diagnosis and recurrence of relapsed/refractory indolent NHL patients were analysed by immunohistochemical and morphometric analysis. We observed an increased vascular network and HIF‐1α protein expression in the second biopsy, providing direct evidence that angiogenesis is an essential process for disease progression.
UGT1A1*6,1A7*3, and 1A9*22 genotypes predict severe neutropenia in FOLFIRI‐treated metastatic colorectal cancer in two prospective studies in Japan
Authors: Hazama Shoichi , Mishima Hideyuki , Tsunedomi Ryouichi , Okuyama Yusuke , Kato Takeshi , Takahashi Ken‐ichi , Nozawa Hiroshi , Ando Hideaki , Kobayashi Michiya , Takemoto Hiroyoshi , Nagata Naoki , Kanekiyo Shinsuke , Inoue Yuka , Hamamoto Yoshihiko , Fujita Yusuke , Hinoda Yuji , Okayama Naoko , Oba Koji , Sakamoto Jun‐ichi , Oka Masaaki 
Published: September 2013

Retrospective studies have suggested that UDP‐glucuronosyltransferase (UGT)1A1, UGT1A7, and UGT1A9 predict severe toxicity and efficacy of irinotecan‐containing regimens. We prospectively evaluated the impact of UGT1A genotypes and haplotypes on severe toxicity and efficacy in patients treated with fluorouracil, leucovorin, and irinotecan combination chemotherapy (FOLFIRI) for metastatic colorectal cancer (mCRC) from the two prospective multicenter phase II studies in Japan. The FLIGHT1 study was a first‐line FOLFIRI trial, and FLIGHT2 was a FOLFOX‐refractory, second‐line FOLFIRI trial. A total of 73 patients agreed to additional analysis, and were genotyped for UGT1A polymorphisms, UGT1A1*28 (TA6>TA7), UGT1A1*6 (211G>A), UGT1A1*27 (686C>A), UGT1A1*60 (−3279T>G), UGT1A1*93 (−3156G>A), UGT1A7 (−57T>G), UGT1A7*3 (387T>G, 622T>C), and UGT1A9*22 (T9>T10). Of 73 patients, 34 developed G3/4 severe hematological toxicities. The toxicities were significantly more frequent in patients with UGT1A1*6 (211A), UGT1A7 (387G), and UGT1A9*22 reference alleles (T9). Haplotype I, which consists of all favorable alleles, was associated with a significant reduction in hematologic toxicity (P = 0.031). In contrast, haplotype II, which contains four high‐risk alleles, showed significantly higher hematologic toxicity than the other haplotypes (P = 0.010). Six out of seven patients who were homozygous for UGT1A1*28 or *6 experienced severe hematological toxicity despite the fact that their response rate was not impaired (42.9%). We concluded that UGT1A polymorphisms, especially UGT1A1*6, are important for the prediction of severe toxicity of FOLFIRI in northeast Asian populations. In this regard, haplotype analyses should substantially impact the prediction of severe hematological toxicities of FOLFIRI. (Clinical Trial Registration: UMIN000002388 and UMIN000002476).
Long‐term improvements in oral communication skills and quality of peer relations in children with cochlear implants: parental testimony
Authors: Bat‐Chava Y. , Martin D. , Imperatore L. 
Published: September 2013

AbstractBackgroundFew research studies have examined longitudinal improvements in oral communication skills and quality of peer relationships of children with implants. Moreover, although the emerging literature suggests that improvement in social functioning follows improvement in oral communication, it is still unknown what factors enhance or impede the relations between these constructs.MethodsBased on parent interviews, the current study examined the long‐term improvements in speech and oral language skills and relationships with hearing peers in 19 implanted children.ResultsResults demonstrate that on average, children continue to improve in oral communication skills and quality of peer relationships even years after implantation, especially those with initial poorer skills. While oral communication ability and quality of peer relationships are strongly associated at each time point, gains in these two variables are associated only for some of the children. Other factors, including self‐confidence and peer acceptance, seem to moderate this relationship. Qualitative data are presented to illustrate these relations among variables and to assist in theory building.ConclusionsThe results highlight the need for more specific examination of various developmental periods in combination with the progress of oral communication and peer relationships among children with implants.
CLIPPERS: chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. Review of an increasingly recognized entity within the spectrum of inflammatory central nervous system disorders
Authors: Dudesek A , Rimmele F , Tesar S , Kolbaske S , Rommer P S , Benecke R , Zettl U K 
Published: September 2013

SummaryChronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a recently defined inflammatory central nervous system (CNS) disorder, prominently involving the brainstem and in particular the pons. The condition features a combination of clinical symptoms essentially referable to brainstem pathology and a characteristic magnetic resonance imaging (MRI) appearance with punctate and curvilinear gadolinium enhancement ‘peppering’ the pons. The radiological distribution is focused in the pons and adjacent rhombencephalic structures such as the cerebellar peduncles, cerebellum, medulla and the midbrain. While the lesion burden with a perivascular pattern is typically most dense in these pontine and peripontine regions, enhancing lesions may additionally extend into the spinal cord and supratentorial structures such as the thalamus, basal ganglia, capsula interna, corpus callosum and the cerebral white matter. Another core feature is clinical and radiological responsiveness to glucocorticosteroid (GCS)-based immunosuppression. As withdrawal of GCS treatment results commonly in disease exacerbation, long-term immunosuppressive therapy appears to be mandatory for sustained improvement. Diagnosis of CLIPPERS is challenging, and requires careful exclusion of alternative diagnoses. A specific serum or cerebrospinal fluid (CSF) biomarker for the disorder is currently not known. Pathogenesis of CLIPPERS remains poorly understood, and the nosological position of CLIPPERS has still to be established. Whether CLIPPERS represents an independent, actual new disorder or a syndrome that includes aetiologically heterogeneous diseases and/or their prestages remains a debated and not finally clarified issue. Clinicians and radiologists should be aware of this condition and its differential diagnoses, given that CLIPPERS constitutes a treatable condition and that patients may benefit from an early introduction of GCS ensued by long-term immunosuppression. Based on previous reports in literature – currently encompassing more than 50 reported cases of CLIPPERS – this review addresses clinical features, diagnostic criteria, differential diagnoses and therapeutic management of this peculiar disorder.
How immunosuppressive therapy affects T cells from kidney transplanted patients of different age: the role of latent cytomegalovirus infection
Authors: Welzl K , Weinberger B , Kronbichler A , Sturm G , Kern G , Mayer G , Grubeck-Loebenstein B , Koppelstaetter C 
Published: September 2013

SummaryThe average age of patients receiving renal transplantation is increasing as programmes have been established which support the donation of organs from elderly donors to older recipients. Little is known about the effect of immunosuppressive therapy on the immune system of older patients. In this study, T cell function and the composition of the T cell repertoire were analysed in immunosuppressed renal transplant recipients of different age and cytomegalovirus (CMV) status in comparison to age- and CMV-matched controls. Independent of age and CMV status, the production of interleukin (IL)-2 and interferon (IFN)-γ by T cells was decreased in the patient groups and autologous serum from patients was capable of inhibiting the proliferation of CD3+ T cells. CXCR5 expression on T cells was increased in patients versus controls reflecting reduced endogenous IL-2 signalling under immunosuppressive therapy. In CMV-seronegative patients kidney transplantation and immunosuppressive therapy did not induce changes in the CD8+ T cell pool, but there was a moderate increase in CD4+CD28− effector T cells when compared to age-matched controls. In contrast, latent CMV infection triggered a shift from early to late differentiated CD4+ and CD8+ T cells in patients and controls. This shift was most pronounced in elderly transplant patients under immunosuppressive therapy. In conclusion, our results demonstrate that immunosuppressive therapy following kidney transplantation is effective in patients older than 65 years. Latent CMV infection, however, accelerates age-related changes in the T cell repertoire in elderly people under immunosuppressive therapy. These patients should therefore be monitored with special care.
Sustained improvement of gas exchange and lung mechanics by vaporized perfluorocarbon inhalation in piglet acute lung injury model
Authors: Wang Xiaoguang , Zhang Jianpeng , Li Xiaoling , Liu Youning , Yang Haibo , Zhao Xiaowei , Xie Lixin , Yin Lihua 
Published: September 2013

AbstractIntroductionNew methods for perfluorocarbon (PFC) application have been proposed which include aerosolization and vaporization. However, the experimental documentation of efficacy of vaporization of PFC in the treatment of acute respiratory distress syndrome (ARDS) is still lacking.ObjectivesThis study aims to examine the effects of vaporized PFC on gas exchange and lung mechanics in a piglet model with ARDS.MethodsLung injury was induced in 16 piglets by infusing detergent through tracheal intubation. Eight piglets were treated with vaporized PFC for 2 h followed by 6 h of volume‐controlled ventilation. Another eight piglets receiving 8 h volume‐controlled ventilation were used as controls. Blood gases, lung mechanical and hemodynamic parameters were measured.ResultsVaporized PFC treatment significantly increased oxygenation index (P/F ratio) and static lung compliance (Cst) 2 h after therapy compared with the control group (P < 0.05). The P/F ratio reached a peak 5.5 h after the therapy and remained at an increased level for at least 6 h compared with the control group (P < 0.001). Additionally, 6 h post treatment, peak inspiratory pressure was significantly reduced in PFC group when compared with the control group (P < 0.05), and Cst was significantly higher in the PFC group than in the control group (P = 0.001).ConclusionsInhalation of vaporized PFC results in sustained improvement of pulmonary gas exchange and lung mechanics in a detergent‐induced animal model of lung injury. Therefore, the non‐invasive vaporization application technique would be a reasonable alternative to administer perfluorocarbons in severe lung injury.
Biogeographical regions and phytogeography of the eucalypts
Authors: González‐Orozco Carlos E. , Thornhill Andrew H. , Knerr Nunzio , Laffan Shawn , Miller Joseph T. 
Published: September 2013

AbstractAimTo map spatial patterns of species richness, species endemism and species turnover of the eucalypts; to propose a biogeographical regionalization of eucalypts based on species turnover; and to identify the environmental correlates of these patterns.LocationAustralia andMalesia.MethodsWe analysed 798 eucalypt species (Angophora,CorymbiaandEucalyptus) with distributions acrossAustralia andMalesia using square cells with a resolution of 100 × 100 km. Species richness, endemism and species turnover were calculated. Phytogeographical regions were identified using an agglomerative cluster analysis derived from a matrix of pairwiseSimpson's beta (βsim) dissimilarity values. Eleven environmental variables were used to analyse the environmental correlates of species turnover. Non‐metric multidimensional scaling (NMDS) of the βsim,Getis‐OrdGi* hotspot spatial statistics and an ordination of the βsim‐NMDSwere used to investigate the environmental drivers at the continental level and for each of the phytogeographical regions.ResultsWe identified three centres of species richness and fourteen of endemism, of which several are newly identified. The main centres of species richness agree with previous studies. Six major eucalypt phytogeographical regions are proposed based on the species turnover: monsoon, tropical/subtropical, south‐east, south‐west,Eremaean north andEremaean south. These findings are supported by significant environmental differences of theNMDSvectors and theGi* statistics. The environmental drivers of species turnover are broadly consistent with the continental patterns of summer and winter rainfall below and above theTropic ofCapricorn.Main conclusionsThe proposed phytogeographical regions are similar to theAustralian biomes. Climate is the main driver of the phytogeographical regions, varying from region to region. Comprehensive bioregionalization frameworks and phytogeography updates, as proposed here, are fundamental for enhancing our understanding of the spatial distribution of biodiversity and therefore benefit global biogeography and help planners to identify regions of high conservation relevance.