bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disclosing clinical adverse events to patients: can practice inform policy?
Authors: Sorensen Ros , Iedema Rick , Piper Donella , Manias Elizabeth , Williams Allison , Tuckett Anthony 
Published: October 2009

AbstractObjectives  To understand patients’ and health professionals’ experience of Open Disclosure and how practice can inform policy.Background  Open Disclosure procedures are being implemented in health services worldwide yet empirical evidence on which to base models of patient–clinician communication and policy development is scant.Design, setting and participants  A qualitative method was employed using semi‐structured open‐ended interviews with 154 respondents (20 nursing, 49 medical, 59 clinical/administrative managerial, 3 policy coordinators, 15 patients and 8 family members) in 21 hospitals and health services in four Australian states.Results  Both patients and health professionals were positive about Open Disclosure, although each differed in their assessments of practice effectiveness. We found that five major elements influenced patients’ and professionals’ experience of openly disclosing adverse events namely: initiating the disclosure, apologizing for the adverse event, taking the patient’s perspective, communicating the adverse event and being culturally aware.Conclusions  Evaluating the impact of Open Disclosure refines policy implementation because it provides an evidence base to inform policy. Health services can use specific properties relating to each of the five Open Disclosure elements identified in this study as training standards and to assess the progress of policy implementation. However, health services must surmount their sensitivity to revealing the extent of error so that research into patient experiences can inform practice and policy development.
Impact of normal saline infusion on postoperative metabolic acidosis
Authors: MANN CHRISTIAN , HELD ULRIKE , HERZOG SUSANNE , BAENZIGER OSKAR 
Published: October 2009

SummaryBackground:  Standard base excess (SBE) is an important parameter for guiding fluid management in postoperative metabolic acidosis. However, individual SBE components, notably the chloride effect (Cleff), provide valuable additional information. Cleff is the deviation of the strong ion difference (SID) from normal caused by chloride loss or increase and represents the effect on SBE of an abnormal chloride–sodium ratio. Many centers use normal saline (NS) for intravascular volume therapy. In this study, we examined the impact of NS infusion on SBE and its chloride‐driven component (Cleff) in postoperative children.Methods:  The study was conducted in 119 children who underwent post‐heart surgery in a Swiss pediatric intensive care unit. The 72‐h postoperative course was divided into six observation periods, during which NS input and its impact on SBE and Cleff were measured per period in each patient, and the results compared between patients infused and not infused with NS during each period.Results:  Normal saline was infused in 168/625 observation periods if indicated by volume deficit. Postoperative metabolic acidosis and the acidifying Cleff were aggravated in the first 12 postoperative hours. Over the 72 h, NS infusion simultaneously lowered SBE by −0.06 mm·ml−1·kg−1 body weight infused and Cleff by −0.07 mm.Conclusions:  Implementing serial Cleff assessment could improve postoperative management by disclosing or excluding hyperchloremia as a cause of acidosis undetectable from SBE alone. Calculating the chloride‐driven acidifying side effect of NS infusion using Cleff improves the interpretation of SBE values and can optimize fluid management in postoperative metabolic acidosis.
Microbial community structure in autotrophic nitrifying granules characterized by experimental and simulation analyses
Authors: Matsumoto Shinya , Katoku Mayu , Saeki Goro , Terada Akihiko , Aoi Yoshiteru , Tsuneda Satoshi , Picioreanu Cristian , Van Loosdrecht Mark C. M. 
Published: October 2009

SummaryThis study evaluates the community structure in nitrifying granules (average diameter of 1600 μm) produced in an aerobic reactor fed with ammonia as the sole energy source by a multivalent approach combining molecular techniques, microelectrode measurements and mathematical modelling. Fluorescence in situ hybridization revealed that ammonia‐oxidizing bacteria dominated within the first 200 μm below the granule surface, nitrite‐oxidizing bacteria a deeper layer between 200 and 300 μm, while heterotrophic bacteria were present in the core of the nitrifying granule. Presence of these groups also became evident from a 16S rRNA clone library. Microprofiles of NH4+, NO2–, NO3– and O2 concentrations measured with microelectrodes showed good agreement with the spatial organization of nitrifying bacteria. One‐ and two‐dimensional numerical biofilm models were constructed to explain the observed granule development as a result of the multiple bacteria–substrate interactions. The interaction between nitrifying and heterotrophic bacteria was evaluated by assuming three types of heterotrophic bacterial growth on soluble microbial products from nitrifying bacteria. The models described well the bacterial distribution obtained by fluorescence in situ hybridization analysis, as well as the measured oxygen, nitrite, nitrate and ammonium concentration profiles. Results of this study are important because they show that a combination of simulation and experimental techniques can better explain the interaction between nitrifying bacteria and heterotrophic bacteria in the granules than individual approaches alone.
Role of distinct dimorphic transitions in territory colonizing and formation of yeast colony architecture
Authors: Vopálenská Irena , Št'ovíček Vratislav , Janderová Blanka , Váchová Libuše , Palková Zdena 
Published: October 2009

SummaryMicrobial populations in nature often form organized multicellular structures (biofilms, colonies) occupying different surfaces including host tissues and medical devices. How yeast cells within such populations cooperate and how their dimorphic switch to filamentous growth is regulated are therefore important questions. Studying population development, we discovered that Saccharomyces cerevisiae microcolonies early after their origination from one cell successfully occupy the territory via dimorphic transition, which is induced by ammonia and other volatile amines independently on cell ploidy and nutrients. It results in oriented pseudohyphal cell expansion in the direction of ammonia source, which consequently leads to unification of adjacent microcolonies to one more numerous entity. The further population development is accompanied by another dimorphic switch, which is strictly dependent on Flo11p adhesin and is indispensable for proper formation of biofilm‐like aerial 3‐D colony architecture. In this, Flo11p is required for both elongation of cells organized to radial clusters (formed earlier within the colony) and their subsequent pseudohyphal expansion. Just before this expansion, Flo11p relocalizes from the bud‐neck of radial cell clusters also to the tip of elongated cells.
Bacterial community shifts in taxa and diversity in response to localized organic loading in the deep sea
Authors: Goffredi Shana K. , Orphan Victoria J. 
Published: October 2009

SummaryThe deep sea is a unique and extreme environment characterized by low concentrations of highly recalcitrant carbon. As a consequence, large organic inputs have potential to cause significant perturbation. To assess the impact of organic enrichment on deep sea microbial communities, we investigated bacterial diversity in sediments underlying two whale falls at 1820 and 2893 m depth in Monterey Canyon, as compared with surrounding reference sediment 10–20 m away. Bacteroidetes, Epsilonproteobacteria and Firmicutes were recovered primarily from whale fall‐associated sediments, while Gammaproteobacteria and Planctomycetes were found primarily within reference sediments. Abundant Deltaproteobacteria were recovered from both sediment types, but the Desulfobacteraceae and Desulfobulbaceae families were observed primarily beneath the whale falls. UniFrac analysis revealed that bacterial communities from the two whale falls (∼30 km apart) clustered to the exclusion of corresponding reference sediment communities, suggesting that deposition of whale fall biomass is more influential on deep sea microbial communities than specific seafloor location. The bacterial population at whale‐1820 at 7 months post deposition was less diverse than reference sediments, with Delta‐ and Epsilonproteobacteria and Bacteroidetes making up 89% of the community. At 70 months, bacterial diversity in reference sediments near whale‐2893 had decreased as well. Over this time, there was a convergence of each community's membership at the phyla level, although lower‐taxonomic‐level composition remained distinct. Long‐term impact of organic carbon loading from the whale falls was also evident by elevated total organic carbon and enhanced proteolytic activity for at least 17–70 months. The response of the sedimentary microbial community to large pulses of organic carbon is complex, likely affected by increased animal bioturbation, and may be sustained over time periods that span years to perhaps even decades.
An ectobiont‐bearing foraminiferan, Bolivina pacifica, that inhabits microxic pore waters: cell‐biological and paleoceanographic insights
Authors: Bernhard Joan M. , Goldstein Susan T. , Bowser Samuel S. 
Published: October 2009

SummaryThe presence of tests (shells) in foraminifera could be taken as an indicator that this protist taxon is unlikely to possess ectosymbionts. Here, however, we describe an association between Bolivina pacifica, a foraminiferan with a calcareous test, and a rod‐shaped microbe (bacterium or archaeon) that is directly associated with the pores of the foraminiferan's test. In addition to these putative ectosymbionts, B. pacifica has previously undescribed cytoplasmic plasma membrane invaginations (PMIs). These adaptations (i.e. PMIs, ectobionts), along with the clustering of mitochondria under the pores and at the cell periphery, suggest active exchange between the host and ectobiont. The B. pacifica specimens examined were collected from sediments overlain by oxygen‐depleted bottom waters (0.7 μM) of the Santa Barbara Basin (California, USA). An ultrastructural comparison between B. pacifica from the Santa Barbara Basin and a congener (Bolivina cf. B. lanceolata) collected from well‐oxygenated sediments (Florida Keys) suggests that PMIs, ectobionts and peripherally distributed mitochondria are all factors that promote inhabitation of microxic environments by B. pacifica. The calcitic δ13C signatures of B. pacifica and of a co‐occurring congener (B. argentea) that lacks ectobionts differ by > 1.5‰, raising the possibility that the presence of ectobionts can affect incorporation of paleoceanographic proxies.
How Do Students Learn Theology?
Authors: Saines Don 
Published: October 2009

AbstractThis paper explores the way students learn theology through a small qualitative research project. It is undertaken in conversation with current higher education learning theory. This learning theory suggests that it is important to discover how a student conceptualizes learning and how they perceive the teaching environment. Students interviewed increasingly spoke of the value of this academic or more cognitive side of learning as they learned “deep approaches.” Important in this movement to deep, transformational learning was the presence of a relational teaching environment in which peers and teachers played a crucial role. This present study offers support to the view that the tradition of the learning community remains important for deploying deep approaches to the learning of theology in higher education. The paper argues that these relational principals of teaching and learning remain important in the face of the increased use of technology‐based tools and other pedagogical challenges to theological education today.
Variable selection method for quantitative trait analysis based on parallel genetic algorithm
Authors: Mukhopadhyay Siuli , George Varghese , Xu Hongyan 
Published: October 2009

SummarySelection of important genetic and environmental factors is of strong interest in quantitative trait analyses. In this study, we use parallel genetic algorithm (PGA) to identify genetic and environmental factors in genetic association studies of complex human diseases. Our method can take account of both multiple markers across the genome and environmental factors, and also can be used to do fine mapping based on the results of haplotype analysis to select the markers that are associated with the quantitative traits. Using both simulated and real examples, we show that PGA is able to choose the variables correctly and is also an easy‐to‐use variable selection tool.
Influence of smoking abstinence and nicotine replacement therapy on heart rate and QT time‐series
Authors: Lewis M. J. , Balaji G. , Dixon H. , Syed Y. , Lewis K. E. 
Published: October 2009

SummaryMany smokers attempt to quit without using nicotine replacement therapy (NRT) or pharmacotherapy, i.e. ‘cold‐turkey’. The cardiac implications of this are important but are incompletely understood. Previous studies have associated smoking cessation with improvements in heart rate (HR) and its variability, but its influence on QT time‐series is unclear. Furthermore, the relative influence on these parameters of acute nicotine withdrawal and of NRT has not been adequately compared. Additional insight might come from analysing the dynamic (e.g. fractal) properties of electrocardiographic data during different levels of nicotine exposure. We examined the influence of smoking cessation, during cold‐turkey and subsequent NRT, on HR and QT time‐series during 30 days of smoking abstinence. Seven smokers and sixteen healthy non‐smokers received ECG monitoring at baseline (Day 0). Smokers subsequently refrained from smoking without using NRT for 24 h, and then received NRT for 29 days. ECG monitoring was repeated at Days 1, 7, 30. Following smoking cessation we observed that: HR and rate‐corrected QT were both reduced, heart rate variability (HRV) increased (improved), and QT variability index (QTVI) showed signs of improvement (trend only). Improvements in HR and QT were maintained throughout NRT use, whilst improvements in HRV and QTVI were sustained for at least the early stages of NRT. The dynamic (multifractal) properties of HR and QT were similar for smokers and non‐smokers, and were unchanged by smoking abstinence or NRT. Our results provide tentative evidence that electrocardiographic improvements during a cold‐turkey smoking quit attempt (acute nicotine withdrawal) are maintained during NRT pharmacotherapy.
ASDIN: Patency Rates for Angioplasty in the Treatment of Pacemaker‐Induced Central Venous Stenosis in Hemodialysis Patients: Results of a Multi‐Center Study
Authors: Asif Arif , Salman Loay , Carrillo Roger G. , Garisto Juan D. , Lopera Gustavo , Barakat Urwa , Lenz Oliver , Yevzlin Alexander , Agarwal Anil , Gadalean Florin , Sachdeva Bharat , Vachharajani Tushar J. , Wu Steven , Maya Ivan D. , Abreo Ken 
Published: October 2009

AbstractWhile hemodialysis access ligation has been used to manage pacemaker (PM) and implantable cardioverter‐defibrillator (ICD) lead‐induced central venous stenosis (CVS), percutaneous transluminal balloon angioplasty (PTA) has also been employed to manage this complication. The advantages of PTA include minimal invasiveness and preservation of arteriovenous access for hemodialysis therapy. In this multi‐center study we report the patency rates for PTA to manage lead‐induced CVS. Consecutive PM/ICD chronic hemodialysis patients with an arteriovenous access referred for signs and symptoms of CVS due to lead‐induced CVS were included in this analysis. PTA was performed using the standard technique. Technical and clinical success was examined. Technical success was defined as the ability to successfully perform the procedure. Clinical success was defined as the ability to achieve amelioration of the signs and symptoms of CVS. Both primary and secondary patency rates were also analyzed. Twenty‐eight consecutive patients underwent PTA procedure. Technical success was 95%. Postprocedure clinical success was achieved in 100% of the cases where the procedure was successful. The primary patency rates were 18% and 9% at 6 and 12 months, respectively. The secondary patency rates were 95%, 86%, and 73% at 6, 12, and 24 months, respectively. On average, 2.1 procedures/year were required to maintain secondary patency. There were no procedure‐related complications. This study finds PTA to be a viable option in the management of PM/ICD lead‐induced CVS. Additional studies with appropriate design and sample size are required to conclusively establish the role of PTA in the management of this problem.
Salvage of Accidentally Sectioned Peritoneal Catheter: Report of Three Cases
Authors: Hooper Casandra Puig , Rivera Maite , Marcén Roberto , Martins Judith , Teruel Jose Luis , De La Morena Carmina , Ortuno Joaquin 
Published: October 2009

AbstractPeritoneal dialysis (PD) accounts for 6% of patients on maintenance dialysis. There are several factors responsible for this low prevalence. Transfer of patients to hemodialysis when any problem in the technique is present is probably one of the most frequent reasons. Thus, when a problem in the PD catheter appears they are routinely removed instead of subjecting to salvage procedures. We report three cases of accidental cutting of the peritoneal catheter and present the steps taken to salvage the catheter without discontinuing the technique and avoiding withdrawal of the catheter.
Reverse‐Loop Upper Arm Arteriovenous Graft for Chronic Hemodialysis
Authors: Yang Wen‐Shin , Chen Tzu‐Chun , Chen Jer‐Shen , Chan Chih‐Yang 
Published: October 2009

AbstractOptions for an upper arm arteriovenous graft (AVG) commonly include the placement of a straight prosthetic graft connecting the brachial artery to the axillary vein. However, such configuration leads to underutilization of the upper arm veins, resulting in the loss of venous capital in the upper arm for future secondary fistula creation. In this retrospective analysis, we evaluated seven patients who had upper‐arm AVGs created in a reverse‐loop configuration. The prosthetic graft was created by connecting the brachial artery close to the cubital fossa and tunneled subcutaneously in a looped fashion distally thereby connecting the basilic or deep brachial vein just above the elbow. Endpoints were interventions, thrombosis, and loss of access at the last examination. The brachial vein was used in two patients and the basilic vein in the other five. The median duration of follow‐up with 100% patency of the AVGs was 10.0 (range, 3.0–25.0) months. Patients were able to achieve a target hemodialysis dose with a (Kurea × td)/Vurea value of 1.4 (range, 1.2–1.5). The median flow rates achieved were 205.0 (range, 203.3–236.7) and 266.7 (range, 203.3–276.7) ml/minute at the first and 3‐month dialysis sessions, respectively. The median dialysis venous pressures were 128.0 (range, 108.3–178.0) and 131.0 (range, 116.7–148.7) mmHg at the first and third month after operation, respectively. The median peak systolic velocity ratios of artery–graft and vein–graft junctions were 2.1 (range, 1.4–2.4) and 3.0 (range, 2.3–3.8) cm/second, respectively. In conclusion, this is a logical approach for patients who have exhausted their forearm vessels for AVG creation. In addition, it also provides a platform for future creation of a secondary fistula in the upper arm.
Carotid Stent‐Supported Angioplasty via Radiobrachial Route
Authors: Janjua Nazli , Verma Navin , Alkawi Ammar , Kirmani Jawad F. , Qureshi Adnan I. 
Published: October 2009

ABSTRACTEndovascular stent‐supported angioplasty is a treatment option for atherosclerotic disease of the cervical internal carotid artery in high‐risk patients. The traditional transfemoral approach is not suitable for patients who suffer from common femoral artery or abdominal aorta atheropathy. We report a case of carotid stent deployment using the radial route in a 68‐year‐old man with type B aortic dissection, having severe right internal carotid artery origin stenosis, presenting with ipsilateral retinal ischemic events. Technical aspects of carotid stenting via the radial approach are described and the related literature is discussed.
Diffusion Tensor Imaging and Fiber‐Tracking in Marchiafava‐Bignami Disease
Authors: Sair Haris I. , Mohamed Feroze B. , Patel Sunil , Kanamalla Uday S. , Hershey Beverly , Hakma Zakaria , Faro Scott H. 
Published: October 2009

ABSTRACTMarchiafava‐Bignami disease, a rare disorder most commonly seen in patients with a history of alcohol consumption, involves demyelination and subsequent necrosis of the corpus callosum. Diffusion tensor imaging demonstrates regional abnormalities in the corpus callosum that are not evident by conventional magnetic resonance imaging (MRI). Furthermore, fiber‐tracking demonstrates significant disruption of axonal fiber bundles within the corpus callosum, most marked within the body, corresponding to the clinical finding of interhemispheric disconnection, which is characteristic of the disease.
Three‐Dimensional Anisotropy Contrast Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction (3DAC PROPELLER) on a 3.0T System: A New Modality for Routine Clinical Neuroimaging
Authors: Nakada Tsutomu , Matsuzawa Hitoshi , Fujii Yukihiko , Takahashi Hitoshi , Nishizawa Masatoyo , Kwee Ingrid L. 
Published: October 2009

ABSTRACT Background. Clinical magnetic resonance imaging (MRI) has recently entered the “high‐field” era, and systems equipped with 3.0–4.0T superconductive magnets are becoming the gold standard for diagnostic imaging. While higher signal‐to‐noise ratio (S/N) is a definite advantage of higher field systems, higher susceptibility effect remains to be a significant trade‐off. To take advantage of a higher field system in performing routine clinical images of higher anatomical resolution, we implemented a vector contrast image technique to 3.0T imaging, three‐dimensional anisotropy contrast (3DAC), with a PROPELLER (Periodically Rotated Overlapping Parallel Lines with Enhanced Reconstruction) sequence, a method capable of effectively eliminating undesired artifacts on rapid diffusion imaging sequences. Methods. One hundred subjects (20 normal volunteers and 80 volunteers with various central nervous system diseases) participated in the study. Anisotropic diffusion‐weighted PROPELLER images were obtained on a General Electric (Waukesha, WI, USA) Signa 3.0T for each axis, with b‐value of 1100 sec/mm2. Subsequently, 3DAC images were constructed using in‐house software written on MATLAB (MathWorks, Natick, MA, USA). Results. The vector contrast allows for providing exquisite anatomical detail illustrated by clear identification of all major tracts through the entire brain. 3DAC images provide better anatomical resolution for brainstem glioma than higher‐resolution T2 reversed images. Degenerative processes of disease‐specific tracts were clearly identified as illustrated in cases of multiple system atrophy and Joseph–Machado disease. Conclusion. Anatomical images of significantly higher resolution than the best current standard, T2 reversed images, were successfully obtained. As a technique readily applicable under routine clinical setting, 3DAC PROPELLER on a 3.0T system will be a powerful addition to diagnostic imaging.