bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ethanol from sugarcane in Brazil: a ‘midway’ strategy for increasing ethanol production while maximizing environmental benefits
Authors: Buckeridge Marcos S. , De Souza Amanda P. , Arundale Rebecca A. , Anderson‐Teixeira Kristina J. , DeLucia Evan 
Published: September 2011

AbstractThis article reviews the history and current state of ethanol production from sugarcane in Brazil and presents a strategy for improving ecosystem services and production. We propose that it is possible to produce ethanol from sugarcane while maintaining or even recovering some of Brazil's unique neotropical biodiversity and ecosystem climate services. This approach to the future of sustainable and responsible ethanol production is termed the ‘midway’ strategy. The ‘midway’ strategy involves producing the necessary biotechnology to increase productivity while synergistically protecting and regenerating rainforest. Three main areas of scientific and technological advance that are key to realizing the ‘midway’ strategy are: (i) improving the quality of scientific data on sugarcane biology as pertains to its use as a bioenergy crop; (ii) developing technologies for the use of bagasse for cellulosic ethanol; and (iii) developing policies to improve the ecosystem services associated with sugarcane landscapes. This article discusses these three issues in the general context of biofuels production and highlights examples of scientific achievements that are already leading towards the ‘midway’ strategy.
Thrombomodulin Gene Variants Are Associated With Increased Mortality After Coronary Artery Bypass Surgery in Replicated Analyses
Authors: Lobato Robert L. , White William D. , Mathew Joseph P. , Newman Mark F. , Smith Peter K. , McCants Charles B. , Alexander John H. , Podgoreanu Mihai V. ,   for the Duke Perioperative Genetics and Safety Outcomes (PEGASUS) Investigative Team
Published: September 2011

Background—
We tested the hypothesis that genetic variation in thrombotic and inflammatory pathways is independently associated with long-term mortality after coronary artery bypass graft (CABG) surgery.

Methods and Results—

Two separate cohorts of patients undergoing CABG surgery at a single institution were examined, and all-cause mortality between 30 days and 5 years after the index CABG was ascertained from the National Death Index. In a discovery cohort of 1018 patients, a panel of 90 single-nucleotide polymorphisms (SNPs) in 49 candidate genes was tested with Cox proportional hazard models to identify clinical and genomic multivariate predictors of incident death. After adjustment for multiple comparisons and clinical predictors of mortality, the homozygote minor allele of a common variant in the thrombomodulin (
THBD
) gene (rs1042579) was independently associated with significantly increased risk of all-cause mortality (hazard ratio, 2.26; 95% CI, 1.31 to 3.92;
P
=0.003). Six tag SNPs in the
THBD
gene, 1 of which (rs3176123) in complete linkage disequilibrium with rs1042579, were then assessed in an independent validation cohort of 930 patients. After multivariate adjustment for the clinical predictors identified in the discovery cohort and multiple testing, the homozygote minor allele of rs3176123 independently predicted all-cause mortality (hazard ratio, 3.6; 95% CI, 1.67 to 7.78;
P
=0.001).

Conclusions—

In 2 independent cardiac surgery cohorts, linked common allelic variants in the
THBD
gene are independently associated with increased long-term mortality risk after CABG and significantly improve the classification ability of traditional postoperative mortality prediction models.
Use of Mathematical Modeling to Compare and Predict Hemodynamic Effects Between Hybrid and Surgical Norwood Palliations for Hypoplastic Left Heart Syndrome
Authors: Hsia Tain-Yen , Cosentino Daria , Corsini Chiara , Pennati Giancarlo , Dubini Gabriele , Migliavacca Francesco ,   for the Modeling of Congenital Hearts Alliance (MOCHA) Investigators
Published: September 2011

Background—
Combining bilateral pulmonary artery banding with arterial duct stenting, the hybrid approach achieves stage 1 palliation for hypoplastic left heart syndrome with different flow characteristics than those after the surgical Norwood procedures. Accordingly, we used computational modeling to assess some of these differences, including influence on systemic and cerebral oxygen deliveries.

Methods and Results—

A 3-dimensional computational model of hybrid palliation was developed by the finite volume method, along with models of the Norwood operation with a modified Blalock-Tausig or right ventricle–to–pulmonary artery shunt. Hybrid circulation was modeled with a 7-mm ductal stent and bilateral pulmonary artery banding to a 2-mm diameter. A 3.5-mm conduit was used in the Blalock-Tausig shunt model, whereas a 5-mm conduit was used in the right ventricle–to–pulmonary artery shunt model. Coupled to all the models was an identical hydraulic network that described the entire circulatory system based on pre–stage 2 hemodynamics. This clinically validated multiscale approach predicts flow dynamics, as well as global cardiac output, mixed venous oxygen saturation, and systemic and cerebral oxygen delivery. Compared with either of the Norwood models, the hybrid palliation had higher pulmonary-to-systemic flow ratio and lower cardiac output. Total systemic oxygen delivery was markedly reduced in the hybrid palliation (Blalock-Tausig shunt 591, right ventricle–to–pulmonary artery shunt 640, and hybrid 475 mL · min
−1
· m
−2
). Cerebral oxygen delivery was similarly lower in the hybrid palliation.

Conclusions—
These computational results suggest that the hybrid approach may provide inferior systemic and cerebral oxygen deliveries compared with either of the 2 surgical Norwood procedures before stage 2 palliation.
Off-Pump Bilateral Versus Single Skeletonized Internal Thoracic Artery Grafting in High-Risk Patients
Authors: Kinoshita Takeshi , Asai Tohru , Suzuki Tomoaki , Kambara Atsushi , Matsubayashi Keiji 
Published: September 2011

Background—
We compared the outcomes in propensity score-matched high-risk patients (European System for Cardiac Operative Risk Evaluation [EuroSCORE] ≥5) undergoing off-pump coronary artery bypass graft surgery using bilateral or single skeletonized internal thoracic artery (ITA).

Methods and Results—

Of 794 consecutive patients undergoing isolated coronary artery bypass graft surgery (788 by the off-pump technique without emergent conversion to cardiopulmonary bypass), the 536 who had a EuroSCORE ≥5 and underwent off-pump skeletonized single (n=236) or bilateral (n=300) ITA were retrospectively analyzed after excluding the 6 who were transferred to our hospital after receiving percutaneous cardiopulmonary support, the 45 who had only 1 target in the left-side coronary area, and the 207 with EuroSCORE <5. A total of 235 pairs were matched using propensity scores calculated from 7 preoperative factors (C statistic, 0.65). The rate of postoperative complications was similar between the groups. The mean observation period was 3.2 years. The 5-year estimated survival rate free from overall death and cardiac event in patients receiving bilateral versus single ITA grafting was 85.8±5.5% versus 74.8±4.9% (
P
=0.002) and 87.4±4.6% versus 66.1±5.7% (
P
=0.001), respectively. In multivariate Cox proportional hazard models, bilateral ITA grafting was significantly associated with a lower risk of overall death (hazard ratio, 0.56; 95% CI, 0.32 to 0.87;
P
=0.009) and cardiac event (hazard ratio, 0.40; 95% CI, 0.24 to 0.69;
P
=0.001).

Conclusions—
In high-risk patients, off-pump skeletonized left-sided bilateral in situ ITA grafting is associated with lower risk of overall death and cardiac event than single ITA grafting without increased operative risk.
Neurological Outcomes After Immediate Aortic Repair for Acute Type A Aortic Dissection Complicated by Coma
Authors: Tsukube Takuro , Hayashi Taro , Kawahira Toshihiro , Haraguchi Tomonori , Matsukawa Ritsu , Kozawa Shuichi , Ogawa Kyoichi , Okita Yutaka 
Published: September 2011

Background—
Management of acute type A aortic dissection (AADA) complicated by coma remains controversial. We analyzed our experience in managing AADA complicated by coma to determine the relationship of duration of preoperative coma to postoperative neurological recovery.

Methods and Results—
Between September 2003 and October 2010, 181 patients with AADA were treated, including 27 presenting with coma (Glasgow Coma Scale <11) on arrival. Twenty-one patients were repaired immediately (immediate group); time from onset of symptoms to operating room was <5 hours. For brain protection, deep hypothermia with antegrade cerebral perfusion was used, and postoperative therapeutic hypothermia with magnesium treatment was performed. Six patients initially were managed medically, and 3 of them were followed by eventual repair because time from onset was >5 hours (delayed group). The preoperative National Institutes of Health Stroke Scale score was 31.4±6.6 in the immediate group and 28.3±9.5 in the delayed group. Hospital mortality was 14% in the immediate group and 67% in the delayed group. Full recovery of consciousness was achieved in 86% of patients in the immediate group and in 17% in the delayed group. In immediate group, the postoperative National Institutes of Health Stroke Scale score significantly improved to 6.4±8.4, cumulative survival rate was 71.8% in 3 years, and independence in daily activities was achieved in 52% (11/21).

Conclusions—
Aortic repair, if performed immediately from the onset of symptoms, showed satisfactory recovery of consciousness and neurological function in patients with AADA complicated by coma. In this patient population, immediate aortic repair is warranted.
Reoperation of Left Heart Valve Bioprostheses According to Age at Implantation
Authors: Chan Vincent , Malas Tarek , Lapierre Harry , Boodhwani Munir , Lam B-Khanh , Rubens Fraser D. , Hendry Paul J. , Masters Roy G. , Goldstein William , Mesana Thierry G. , Ruel Marc 
Published: September 2011

Background—
Evidence supporting the use of bioprostheses for heart valve replacement in young adults is accumulating. However, reoperation data, which may help guide clinical decision making in young patients, remains poorly defined in the literature.

Methods and Results—

We examined the need for reoperation in 3975 patients who underwent first-time bioprosthetic aortic valve replacement (AVR) (n=3152) or mitral valve replacement (MVR) (n=823). There were 895 patients below the age of 60 years at bioprosthesis implant (AVR, n=636; MVR, n=259). The median interval to reoperation of contemporary, stented aortic bioprostheses was 7.74 years (95% CI 7.28 to 9.97 years) in patients less than 40 years, and 12.93 years (95% CI 11.10 to 15.76 years) in patients between 40 and 60 years of age. Multivariable risk factors associated with reoperation following bioprosthetic AVR include age (hazard ratio [HR] 0.94 per year, 95% CI 0.91 to 0.96,
P
<0.001) and concomitant coronary artery bypass grafting (HR 0.34, 95% CI 0.11 to 0.99,
P
=0.04). The median interval to reoperation of contemporary mitral bioprostheses was 8.11 years (95% CI 5.79 to 16.50 years) in patients less than 40 years, and 10.14 years (95% CI 8.64 to 11.14 years) in patients between 40 and 60 years of age. As for AVR, age (HR 0.96 per year, 95% CI 0.95 to 0.98,
P
<0.001) and concomitant coronary artery bypass grafting (HR 0.55, 95% CI 0.32 to 0.93,
P
=0.03) were associated with decreased reoperation risk following bioprosthetic MVR.

Conclusions—
These data constitute clinically relevant age-specific prognostic information regarding reoperation in young patients, who may wish to select a bioprosthesis at initial left heart valve replacement.
Rottlerin Increases Cardiac Contractile Performance and Coronary Perfusion Through BK
Ca++
Channel Activation After Cold Cardioplegic Arrest in Isolated Hearts
Authors: Clements Richard T. , Cordeiro Brenda , Feng Jun , Bianchi Cesario , Sellke Frank W. 
Published: September 2011

Background—
Cardioplegia and cardiopulmonary bypass (CP/CPB) subjects myocardium to complex injurious stimuli that can result in cardiomyocyte and vascular contractile abnormalities. Rottlerin, originally identified as a delta-protein kinase C inhibitor, has a number of known additional effects that may be beneficial in the setting of CP/CPB. We tested the hypothesis that rottlerin mitigates deleterious effects associated with CP/CPB.

Methods and Results—

Langendorff-perfused isolated rat hearts were subjected to 2 hours intermittent cold (10°C) CP (St Thomas II) followed by 30 minutes normothermic reperfusion. CP was delivered every 30 minutes for 1 minute. Hearts were treated with rottlerin 1 μmol/L (CP+R) (n=7) or without rottlerin (CP) (n=9), and the BK
Ca++
channel inhibitor paxilline 100 nmol/L was supplied in the CP. Hearts constantly perfused with KHB served as controls (n=6). Baseline parameters of cardiac function were similar between groups. CP resulted in reduced cardiac function (left ventricular diastolic pressure, 39±3.8%; ±dP/dt, 32±4.4%, −41±5.1% decrease compared to baseline). Treatment with rottlerin 1 μmol/L significantly improved CP-induced cardiac function (left ventricular diastolic pressure, 20±5.9%; ±dP/dt, 5.2±4.5%, −11.6±4.7% decrease versus baseline;
P
<0.05 CP+R versus CP). Rottlerin also caused a significant increase in coronary flow postreperfusion (CP, 34±4.2% decrease from baseline; CP+R, 26±9.6% increase over baseline;
P
=0.01). Independent of vascular effects, CP significantly decreased isolated myocyte contraction, which was restored by rottlerin treatment. The BK
Ca++
channel inhibitor greatly reduced the majority of beneficial effects associated with rottlerin.

Conclusions—
Rottlerin significantly improves cardiac performance after CP arrest through improved cardiomyocyte contraction and coronary perfusion.
Use of Fresh Decellularized Allografts for Pulmonary Valve Replacement May Reduce the Reoperation Rate in Children and Young Adults
Authors: Cebotari Serghei , Tudorache Igor , Ciubotaru Anatol , Boethig Dietmar , Sarikouch Samir , Goerler Adelheid , Lichtenberg Artur , Cheptanaru Eduard , Barnaciuc Sergiu , Cazacu Anatol , Maliga Oxana , Repin Oleg , Maniuc Liviu , Breymann Thomas , Haverich Axel 
Published: September 2011

Background—
Degeneration of xenografts or homografts is a major cause for reoperation in young patients after pulmonary valve replacement. We present the early results of fresh decellularized pulmonary homografts (DPH) implantation compared with glutaraldehyde-fixed bovine jugular vein (BJV) and cryopreserved homografts (CH).

Methods and Results—

Thirty-eight patients with DPH in pulmonary position were consecutively evaluated during the follow-up (up to 5 years) including medical examination, echocardiography, and MRI. These patients were matched according to age and pathology and compared with BJV (n=38) and CH (n=38) recipients. In contrast to BJV and CH groups, echocardiography revealed no increase of transvalvular gradient, cusp thickening, or aneurysmatic dilatation in DPH patients. Over time, DPH valve annulus diameters converge toward normal
z
-values. Five-year freedom from explantation was 100% for DPH and 86±8% and 88±7% for BJV and CH conduits, respectively. Additionally, MRI investigations in 17 DPH patients with follow-up time >2 years were compared with MRI data of 20 BJV recipients. Both patient groups (DPH and BJV) were at comparable ages (mean, 12.7±6.1 versus 13.0±3.0 years) and have comparable follow-up time (3.7±1.0 versus 2.7±0.9 years). In DPH patients, the mean transvalvular gradient was significantly (
P
=0.001) lower (11 mm Hg) compared with the BJV group (23.2 mm Hg). Regurgitation fraction was 14±3% and 4±5% in DPH and BJV groups, respectively. In 3 DPH recipients, moderate regurgitation was documented after surgery and remained unchanged in follow-up.

Conclusions—
In contrast to conventional homografts and xenografts, decellularized fresh allograft valves showed improved freedom from explantation, provided low gradients in follow-up, and exhibited adaptive growth.
Targeted Regional Injection of Biocomposite Microspheres Alters Post–Myocardial Infarction Remodeling and Matrix Proteolytic Pathways
Authors: Dixon Jennifer A. , Gorman Robert C. , Stroud Robert E. , Mukherjee Rupak , Meyer Evan C. , Baker Nathaniel L. , Morita Masato , Hamamoto Hirotsugu , Ryan Liam P. , Gorman Joseph H. , Spinale Francis G. 
Published: September 2011

Background—
Although localized delivery of biocomposite materials, such as calcium hydroxyapatite (CHAM), have been demonstrated to potentially attenuate adverse left ventricular (LV) remodeling after myocardial infarction (MI), the underlying biological mechanisms for this effect remain unclear. This study tested the hypothesis that targeted CHAM injections would alter proteolytic pathways (matrix metalloproteinases [MMPs] and tissue inhibitors of MMPs [TIMPs]) and would be associated with parameters of post-MI LV remodeling.

Methods and Results—

MI was induced in adult sheep followed by 20 targeted injections of a total volume of 1.3 mL (n=6) or 2.6 mL of CHAM (n=5) or saline (n=13) and LV end-diastolic volume (EDV) and MMP/TIMP profiles in the MI region were measured at 8 weeks after MI. LV EDV decreased with 2.6 mL CHAM versus MI only (105.4±7.5 versus 80.6±4.2 respectively,
P
<0.05) but not with 1.3 mL CHAM (94.5±5.0,
P
=0.32). However, MI thickness increased by 2-fold in both CHAM groups compared with MI only (
P
<0.05). MMP-13 increased 40-fold in the MI only group (
P
<0.05) but fell by >6-fold in both CHAM groups (
P
<0.05). MMP-7 increased approximately 1.5-fold in the MI only group (
P
<0.05) but decreased to referent control values in both CHAM groups in the MI region (
P
<0.05). Collagen content was reduced by approximately 30% in the CHAM groups compared with MI only (
P
<0.05).

Conclusions—
Differential effects on LV remodeling and MMP/TIMP profiles occurred with CHAM. Thus, targeted injection of a biocomposite material can favorably affect the post-MI remodeling process and therefore holds promise as a treatment strategy in and of itself, or as a matrix with potentially synergistic effects with localized pharmacological or cellular therapies.
Do they all perform alike? An examination of perceived performance, citizen satisfaction and trust with US federal agencies
Authors: Morgeson Forrest V. , Petrescu Claudia 
Published: September 2011

What drives citizen satisfaction and trust with US federal government agencies? Are these determinants constant across agencies, or do they differ? In this article, we examine elements of citizen perceived performance as determinants of satisfaction and trust in federal agencies using a multi-year, cross-sectional, multi-agency sample of respondents. Focusing on six high-incidence federal agencies experienced by a large cross-section of American citizens, we observe differences in the determinants of satisfaction and trust, which include perceptions of the quality of the services experienced and the information provided, demographic factors, citizen expectations, and e-government adoption. We discuss these differences, with a particular focus on the implications of these findings for the practice of performance benchmarking. Given that one central objective of a variety of recent federal initiatives has been to better measure bureaucratic performance with the goal of improving the quality of services delivered to citizens through benchmarking, these findings highlight the complexity of government efforts to realize this goal. In conclusion, suggestions for improving cross-agency benchmarking are provided. Points for practitioners The key finding in this article for public administration and management practitioners relates to the difficulties inherent in identifying benchmarking partners, and thus in effectively benchmarking performance across agencies with the goal of identifying best practices useful in improving performance. These difficulties arise from the differential nature of what determines citizen satisfaction across agencies with different missions, purposes and goals. An alternative strategy for identifying benchmarking partners based on similarities in satisfaction determinants — what we call ‘benchmark partner selection by determinants’ — is discussed.
Administering the Common Agricultural Policy in Bulgaria and Romania: obstacles to accountability and administrative capacity
Authors: Wegener Stefan , Labar Kelly , Petrick Martin , Marquardt Doris , Theesfeld Insa , Buchenrieder Gertrud 
Published: September 2011

The introduction of the Common Agricultural Policy (CAP) of the European Union was an important step for Bulgaria and Romania. However, their administrative capacity for managing CAP instruments is still evolving, and they face challenges in delivering services that are crucial for implementing the CAP measures. This article, based on semi-structured interviews among key actors, explores administrative obstacles. The analysis is structured according to the two complementary concepts of accountability and administrative capacity. The findings show that the main accountability problems are related to a complex administrative structure and to the large number of smallholders, which necessitates greater administrative efforts than in established member states. Moreover, due to a lack of representative farmers’ associations, farmers, and particularly small farmers, have no clear means to voice their concerns. The main problems concerning administrative capacity are related to deficient data collection and processing, over-centralized decision-making, and limited coordination among agencies. Points for practitioners To improve the delivery of services in new member states such as Bulgaria and Romania, the CAP should pay greater attention to the specific conditions of transition countries, such as their high share of smallholders. It should be determined whether some responsibilities could be devolved to lower administration levels, e.g. by decentralizing decision-making authorities. Moreover, integrated agricultural offices should be established to house front office agencies in the same buildings, a more comprehensive and tailored system of human resource management should be developed, and the outreach of farmers’ associations should be further advanced and facilitated.
Monitoring the quality of total hip replacement in a tertiary care department using a cumulative summation statistical method (CUSUM)
Authors: Biau D. J. , Meziane M. , Bhumbra R. S. , Dumaine V. , Babinet A. , Anract P. 
Published: September 2011

The purpose of this study was to define immediate post-operative ‘quality’ in total hip replacements and to study prospectively the occurrence of failure based on these definitions of quality. The evaluation and assessment of failure were based on ten radiological and clinical criteria. The cumulative summation (CUSUM) test was used to study 200 procedures over a one-year period. Technical criteria defined failure in 17 cases (8.5%), those related to the femoral component in nine (4.5%), the acetabular component in 32 (16%) and those relating to discharge from hospital in five (2.5%). Overall, the procedure was considered to have failed in 57 of the 200 total hip replacements (28.5%). The use of a new design of acetabular component was associated with more failures. For the CUSUM test, the level of adequate performance was set at a rate of failure of 20% and the level of inadequate performance set at a failure rate of 40%; no alarm was raised by the test, indicating that there was no evidence of inadequate performance. The use of a continuous monitoring statistical method is useful to ensure that the quality of total hip replacement is maintained, especially as newer implants are introduced.