bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharyngeal Gonorrhoea in Women: An Important Reservoir for Increasing Neisseria gonorrhoea Prevalence in Urban Australian Heterosexuals?
Authors: Lusk M. Josephine , Uddin Ruby N. N. , Lahra Monica M. , Garden Frances L. , Kundu Ratan L. , Konecny Pam
Published: June 2013

We aim to characterize sexual behavioral aspects of heterosexual Neisseria gonorrhoea (NG) acquisition in two Sexually Transmitted Diseases clinics in Sydney, Australia, in 2008–2012. Of 167 NG cases, 102 were heterosexually acquired with a trend of increasing NG prevalence in heterosexuals from 1.1% (95% CI 0.6–2.1) in 2008 to 3.0% (95% CI 2.0–4.0) in 2012 (P=0.027). Of heterosexual male cases, unprotected fellatio was the likely sexual activity for NG acquisition in 21/69 (30.4%) and commercial sex work (CSW) contact the likely source in 28/69 (40.6%). NG prevalence overall in CSW (2.2%) was not significantly higher than in non-CSW (1.2%) (P=0.15), but in 2012 there was a significant increase in NG prevalence in CSW (8.6%) compared to non-CSW (1.6%) (P<0.001). Pharyngeal NG was found in 9/33 (27.3%) female cases. Decreased susceptibility to ceftriaxone (MIC ≥ 0.03 mg/L) occurred in 2.5% NG isolates, none heterosexually acquired. All were azithromycin susceptible. A significant trend of increasing prevalence of heterosexual gonorrhoea in an urban Australian STD clinic setting is reported. We advocate maintenance of NG screening in women, including pharyngeal screening in all women with partner change who report fellatio, as pharyngeal NG may be an important reservoir for heterosexual transmission. Outreach to CSW should be enhanced.
Single Nucleotide Polymorphism in the Promoter of the Human Interleukin-13 Gene Is Associated with Asthma in Malaysian Adults
Authors: Radhakrishnan Ammu Kutty , Raj Vijaya Lechimi , Tan Lee-Keng , Liam Chong-Kin
Published: June 2013

Asthma susceptibility genes are mapped to a region on human chromosome 5q31-q33, which contains a cluster of proinflammatory cytokine genes such as interleukin-13 (IL-13), which is associated with asthma. This study investigated the allele frequencies of two single nucleotide polymorphisms (SNPs) (−1111C>T and 4257C>A) in theIL-13gene between asthmatics and healthy volunteers as well as the relationship between these SNPs and IL-13 production. DNA extracted from buffy coat of asthmatic and control subjects was genotyped using the PCR-RFLP method. Amount of IL-13 produced by mitogen-stimulated peripheral blood leucocytes PBLs (PBLs) was determined by ELISA. The frequencies of the −1111C and 4257G wild-type alleles were 0.52 and 0.55 in asthmatics and were 0.67 and 0.56 in controls. A significant (P<0.05) association was found between genotype and allele frequencies of SNP at position −1111C>T between asthmatic and control groups (OR, 1.810; 95% CI = 1.184 to 2.767;P<0.05). The mitogen-stimulated PBLs from asthmatics produced higher amounts of IL-13 production (P<0.001). The 4257GA heterozygous and 4257AA homozygous mutant alleles were associated with higher IL-13 production in asthmatics (P<0.05). Our results show that the −1111T mutant allele are associated with asthma and the 4257A mutant alleles are associated with elevated IL-13 production.
The CpG Island Methylator Phenotype: What's in a Name?
Authors: Hughes Laura A.E. , Melotte Veerle , de Schrijver Joachim , de Maat Michiel , Smit Vincent T.H.B.M. , Bovée Judith V.M.G. , French Pim J. , van den Brandt Piet A. , Schouten Leo J. , de Meyer Tim , van Criekinge Wim , Ahuja Nita , Herman James G. , Weijenberg Matty P. , van Engeland Manon
Published: June 2013

Although the CpG island methylator phenotype (CIMP) was first identified and has been most extensively studied in colorectal cancer, the term “CIMP” has been repeatedly used over the past decade to describe CpG island promoter methylation in other tumor types, including bladder, breast, endometrial, gastric, glioblastoma (gliomas), hepatocellular, lung, ovarian, pancreatic, renal cell, and prostate cancers, as well as for leukemia, melanoma, duodenal adenocarninomas, adrenocortical carcinomas, and neuroblastomas. CIMP has been reported to be useful for predicting prognosis and response to treatment in a variety of tumor types, but it remains unclear whether or not CIMP is a universal phenomenon across human neoplasia or if there should be cancer-specific definitions of the phenotype. Recently, it was shown that somatic isocitrate dehydrogenase-1 (IDH1) mutations, frequently observed in gliomas, establish CIMP in primary human astrocytes by remodeling the methylome. Interestingly, somatic IDH1 and IDH2 mutations, and loss-of-function mutations in ten-eleven translocation (TET) methylcytosine dioxygenase-2 (TET2) associated with a hypermethylation phenotype, are also found in multiple enchondromas of patients with Ollier disease and Mafucci syndrome, and leukemia, respectively. These data provide the first clues for the elucidation of a molecular basis for CIMP. Although CIMP appears as a phenomenon that occurs in various cancer types, the definition is poorly defined and differs for each tumor. The current perspective discusses the use of the term CIMP in cancer, its significance in clinical practice, and future directions that may aid in identifying the true cause and definition of CIMP in different forms of human neoplasia. Cancer Res; 73(19); 5858–68. ©2013 AACR.
First FDA Approval of Dual Anti-HER2 Regimen: Pertuzumab in Combination with Trastuzumab and Docetaxel for HER2-Positive Metastatic Breast Cancer
Authors: Blumenthal Gideon M. , Scher Nancy S. , Cortazar Patricia , Chattopadhyay Somesh , Tang Shenghui , Song Pengfei , Liu Qi , Ringgold Kimberly , Pilaro Anne M. , Tilley Amy , King Kathryn E. , Graham Laurie , Rellahan Barbara L. , Weinberg Wendy C. , Chi Bo , Thomas Colleen , Hughes Patricia , Ibrahim Amna , Justice Robert , Pazdur Richard
Published: June 2013

On June 8, 2012, the U.S. Food and Drug Administration (FDA) approved pertuzumab (Perjeta, Genentech) for use in combination with trastuzumab (Herceptin, Genentech) and docetaxel for the treatment of patients with HER2-positive metastatic breast cancer (MBC) who have not received prior anti-HER2 therapy or chemotherapy for metastatic disease. Approval was based on the results of a randomized, double-blind, placebo-controlled trial conducted in 808 patients with HER2-positive MBC. Patients were randomized (1:1) to receive pertuzumab (n = 402) or placebo (n = 406) in combination with trastuzumab and docetaxel. The primary endpoint was progression-free survival (PFS) and a key secondary endpoint was overall survival (OS). A statistically significant improvement in PFS (difference in medians of 6.1 months) was observed in patients receiving pertuzumab [HR, 0.62; 95% confidence interval (CI), 0.51–0.75; P < 0.0001]. A planned interim analysis suggested an improvement in OS (HR, 0.64; 95% CI, 0.47–0.88; P = 0.0053) but the HR and P value did not cross the stopping boundary. Common adverse reactions (>30%) observed in patients on the pertuzumab arm included diarrhea, alopecia, neutropenia, nausea, fatigue, rash, and peripheral neuropathy. No additive cardiac toxicity was observed. Significant manufacturing issues were identified during the review. On the basis of substantial evidence of efficacy for pertuzumab in MBC and the compelling public health need, FDA did not delay availability to patients pending final resolution of all manufacturing concerns. Therefore, FDA approved pertuzumab but limited its approval to lots not affected by manufacturing problems. The applicant agreed to multiple manufacturing and testing postmarketing commitments under third-party oversight to resolve manufacturing issues. Clin Cancer Res; 19(18); 4911–6. ©2013 AACR.
Incidence and Clinical Significance of Aberrant T-Cell Marker Expression on Diffuse Large B-Cell Lymphoma Cells
Authors: Suzuki Yuhko , Yoshida Tsutomu , Wang Guoqin , Aoki Takumi , Katayama Takuji , Miyamoto Shunsuke , Miyazaki Koji , Iwabuchi Keiichi , Danbara Mikio , Nakayama Meijin , Horie Ryouichi , Nakamine Hirokazu , Sato Yuichi , Nakamura Naoya , Niitsu Nozomi
Published: June 2013

Introduction: Aberrant expression of T-cell markers is occasionally observed in B-cell lymphomas. We conducted a retrospective study to establish its incidence and to determine its relationship with clinical features of patients with diffuse large B-cell lymphoma (DLBCL). Patients and Methods: We reviewed DLBCL patients diagnosed between January 2002 and April 2009. Patients fulfilled the following criteria: (1) age >18 years, (2) HIV negative, (3) B-cell lymphoma confirmed by restricted expression of surface immunoglobulin light chains by flow cytometry (FCM). Aberrant T-cell marker expression (ATCME) was defined as positivity for CD2, CD3, CD4, CD7, and/or CD8 on DLBCL cells by FCM. Phenotyping was also performed by immunohistochemistry (IHC). Patients were grouped according to positive or negative ATCME and their clinical features including survival were compared. Results: Of 150 patients, 11 (7.3%) showed ATCME; CD2 and CD7 were most often expressed. ATCME was less often detected and the signal was weaker using IHC. There were no statistically significant differences in clinical features between the two groups. Conclusions: FCM may be useful to detect ATCME in a small amount of lymphoma cells. The mechanism responsible for ATCME, and whether it contributes in any way to the pathogenesis of B-cell neoplastic transformation, requires clarification.
Exhaled Nitric Oxide as Screening Tool in Subjects with Suspected Asthma without Reversibility
Authors: Katsoulis K. , Ganavias L. , Michailopoulos P. , Bikas C. , Dinapogias E. , Kontakiotis T. , Kostikas K. , Loukides S.
Published: June 2013

Background: As fractional exhaled nitric oxide (FeNO) has been evaluated only in certain settings for asthma diagnosis, we investigated whether FeNO values could predict positive methacholine challenge testing (expressed as PD20) in subjects with suspected asthma but without spirometric reversibility. Methods: Subjects with asthma-like symptoms and negative bronchodilation test were initially evaluated to undergo FeNO measurement and methacholine bronchial challenge. Diagnostic performance of FeNO to predict PD20 to methacholine <800 μg was examined by constructing receiver-operating characteristic curves. Results: A total of 112 subjects met the inclusion criteria. In all subjects, FeNO >32 ppb was associated with a sensitivity of 0.47 and a specificity of 0.85 for the identification of the PD20 <800 μg (AUC = 0.691, 95% CI = 0.6-0.775, p = 0.00002). In smokers, FeNO >11 ppb was associated with a sensitivity of 0.85 and a specificity of 0.5 for the identification of PD20 <800 μg (AUC = 0.625, 95% CI = 0.45-0.772, p = 0.18), while in atopics a FeNO level >26 ppb was associated with a sensitivity of 0.55 and a specificity of 0.85 (AUC = 0.677, 95% CI = 0.53-0.8, p = 0.02). Conclusions: In subjects with symptoms compatible with asthma but without spirometric reversibility, specific cutoff levels for FeNO levels significantly predict the positive methacholine challenge, with significant confounding factors being atopy and current smoking.
Self-Limited Effusion Large B-Cell Lymphoma: Two Cases of Effusion Lymphoma Maintaining Remission after Drainage Alone
Authors: Nakatsuka Shin-ichi , Kimura Hayato , Nagano Teruaki , Fujita Masashi , Kanda Takashi , Iwata Takashi , Hashimoto Koji
Published: June 2013

We report two cases of human herpesvirus-8 (HHV-8)-negative large B-cell lymphoma involving pericardial and/or pleural effusion that regressed after drainage alone. Case 1 is a 70-year-old man showing massive pericardial effusion. Cytology of the drained effusion showed monotonous infiltration of CD3-, CD20+, CD79a+, and CD138- large B-cells. Monoclonality was shown by Southern blot analysis. Case 2 is a 70-year-old man with massive pericardial and bilateral pleural effusion. Cytology of pericardial effusion showed infiltration of CD20+, CD45RO-, CD138-, immunoglobulin lambda chain+, and kappa chain- large B cells. In both cases, effusion resolved after drainage and no relapse has been observed. HHV-8 was not demonstrated in either case. Clinical presentation of our two cases resembled primary effusion lymphoma (PEL), but cytomorphology, immunophenotype, and prognosis were clearly distinct from those of PEL. HHV-8-negative effusion lymphomas might include prognostically favorable self-limited tumors that could regress without any cytotoxic therapy.
Immunologic Effects of Omalizumab in Children with Severe Refractory Atopic Dermatitis: A Randomized, Placebo-Controlled Clinical Trial
Authors: Iyengar Shuba Rajashri , Hoyte Elizabeth G. , Loza Angelica , Bonaccorso Salvatore , Chiang David , Umetsu Dale T. , Nadeau Kari Christine
Published: June 2013

Background: Severe refractory atopic dermatitis (AD) is a chronic, debilitating condition that is associated with elevated serum immunoglobulin E (IgE) levels. Thymic stromal lymphopoietin (TSLP), thymus and activation-regulated chemokine (TARC) and OX40 ligand (OX40L) are important immunologic factors involved in the pathogenesis of AD. Omalizumab, an anti-IgE antibody indicated for use in allergic asthma, is implicated in regulating allergen presentation by dendritic cells and the T cell response during the effector phases of allergic disease. We investigated if anti-IgE therapy modulates the allergen-specific responses mediated by the TSLP pathway in young patients with severe refractory AD. Methods: This was a randomized, double-blind, placebo-controlled study of 8 patients between the ages of 4 and 22 years (mean = 11.6 years) with severe refractory AD (clinical trials.gov NCT01678092). Serum IgE ranged from 218 to 1,890 (mean = 1,068 IU/ml). Subjects received omalizumab (n = 4) or placebo (n = 4) every 2-4 weeks over 24 weeks using a regimen extrapolated from the package insert. TSLP, TARC, OX40L and other cytokines involved in AD were measured by using cytometric bead arrays. Results: All patients receiving omalizumab had strikingly decreased levels of TSLP, OX40L, TARC (involved in Th2 polarization) and interleukin (IL)-9 compared to placebo. In addition, there was a marked increase in IL-10, a tolerogenic cytokine, in the omalizumab-treated group. Patients on anti-IgE therapy had an improvement in clinical outcomes as measured by the SCORAD system; however, these effects were comparable to improvements in the control group. Conclusions: Anti-IgE therapy with omalizumab decreases levels of cytokines that are involved in Th2 polarization and allergic inflammation, including TSLP, TARC and OX40L.
Organic Chemicals in Diesel Exhaust Particles Enhance Picryl Chloride-Induced Atopic Dermatitis in NC/Nga Mice
Authors: Sadakane Kaori , Ichinose Takamichi , Takano Hirohisa , Yanagisawa Rie , Inoue Ken-ichiro , Kawazato Hiroaki , Yasuda Aiko , Hayakawa Kazuichi
Published: June 2013

Background: Diesel exhaust particles (DEP) have been reported to worsen allergic airway inflammation in mice. Recently, the organic chemical components of DEP (DEP-OC) were found to be important contributors to the aggravation of allergic airway inflammation in mice. The purpose of this study was to examine the effects of DEP-OC on atopic dermatitis (AD)-like skin lesions induced by picryl chloride (PiCl) in NC/Nga mice. Methods: DEP were extracted with benzene/ethanol, and the soluble organic fraction formed the DEP-OC. NC/Nga male mice received simultaneous application of DEP-OC and/or PiCl on their ears once a week for 9 or 3 weeks. We evaluated skin lesions by noting scaling, eruption, excoriation, erosion, hemorrhage, pathologic changes, production of cytokines, and IgE level in the serum. Results: PiCl application alone produced progressively severe AD-like skin lesions. The application of PiCl plus DEP-OC resulted in a marked worsening of skin lesions in the early stages of AD. Moreover, mast cell counts significantly increased in the subcutaneous tissue. Administration of PiCl combined with DEP-OC resulted in a greater increase in the local expression of interleukin-4, keratinocyte chemoattractant, and neutrophils in subcutaneous tissue compared with PiCl treatment alone. In contrast, the combination treatment produced lower levels of IFN-γ compared with PiCl treatment alone. Conclusions: DEP-OC application to the skin aggravated PiCl-induced AD. This aggravation may be due to activation of the Th2-associated immune responses by the organic chemicals in DEP.
Frequency and Activation of CD4+CD25high FoxP3+ Regulatory T Cells in Peripheral Blood from Children with Atopic Allergy
Authors: Stelmaszczyk-Emmel Anna , Zawadzka-Krajewska Anna , Szypowska Agnieszka , Kulus Marek , Demkow Urszula
Published: June 2013

Background: Atopic allergy is among the immune tolerance-related disorders resulting from a failure of the regulatory network. Regulatory T cells (Tregs) play a leading role in the development of homeostasis in the immune system. The aim of this study was to determine the role of Tregs in the pathogenesis of atopic diseases in children by exploring the relationship between Treg frequency, activation markers and the clinical manifestations of the disease. Methods: Twenty allergic and 50 healthy children were enrolled to the study. Peripheral blood mononuclear cells were stained with monoclonal antibodies (anti-CD25-CD4-CD127-FoxP3-CD69-CD71) and evaluated using flow cytometry. Tregs were identified as CD4+CD25+/highFoxP3+CD127- T cells. Results: The percentage of Tregs in allergic patients (2.3%) was significantly decreased in comparison to healthy controls (4.6%, p = 0.003). The frequency of Tregs in patients with symptoms of atopic dermatitis and/or food allergy (1.7%) was significantly lower than in patients without these symptoms (2.9%, p = 0.04). A significant correlation between the percentage of Tregs and the sIgE serum concentration was observed (p = 0.037). Relative fluorescence intensities of FoxP3 expression in allergic patients were higher than in healthy controls (p = 0.00004). The frequency of CD4+CD25highCD127-CD71+ cells did not differ between the groups. Conclusions: Tregs display substantial deficiencies in atopic children, especially in children with multiorgan involvement, compared to patients with single organ manifestations. Additionally, there is an association between Tregs and the sIgE serum concentration. Better identification and characterization of Tregs in allergy is needed as they limit responses to foreign antigens, thereby minimizing T cell-mediated immunopathology in allergic diseases.
Optimizing the Use of a Skin Prick Test Device on Children
Authors: Buyuktiryaki Betul , Sahiner Umit Murat , Karabulut Erdem , Cavkaytar Ozlem , Tuncer Ayfer , Sekerel Bulent Enis
Published: June 2013

Background: Studies comparing skin prick test (SPT) devices have revealed varying results in performance and there is little known about their use on children. Methods: We performed 2 complementary studies to test the sensitivity, reproducibility and acceptability of commercially available SPT devices (Stallerpoint, Antony, France) using different application techniques. In the first part, histamine/saline was put on as a drop by use of a vial (V), and in the second part it was transferred from a well with the aid of the test device (W). The techniques were as follows: apply vertical pressure (Stallerpoint-VP or Stallerpoint-WP), apply vertical pressure with 90° clockwise rotation (Stallerpoint-VC or Stallerpoint-WC) and apply vertical pressure with 90° clockwise and counter-clockwise rotations (Stallerpoint-VCC or Stallerpoint-WCC). For comparison, ALK Lancet was used with a technique of ‘drop and apply vertical pressure'. Results: In the first part, sensitivities of the Stallerpoint-VC (96.6%), Stallerpoint-VCC (95.5%) and ALK Lancet (93.2%) techniques were superior (p < 0.001) to the other Stallerpoint-VP and Stallerpoint-WP techniques (76.1 and 46.6%). Intrapatient coefficient of variation (CV) values were 15.0, 18.9, 15.4, 22.4 and 48.5%, respectively. Interpatient CV ranged between 22.8 and 55.1%. In the second part, the Stallerpoint-WC (98.8%), WCC (97.5%) and ALK Lancet (98.8%) techniques yielded high sensitivities, whereas the sensitivity of Stallerpoint-WP (28.7%) was very low. There were false-positive reactions in the Stallerpoint-VCC and WCC techniques. Conclusion: In children, the SPT technique was found to be as important as the testing device. Stallerpoint-VC and WC techniques are reliable, tolerable and comparable with the ALK Lancet technique.
Combining Analyses of Basophil Allergen Threshold Sensitivity, CD-sens, and IgE Antibodies to Hydrolyzed Wheat, ω-5 Gliadin and Timothy Grass Enhances the Prediction of Wheat Challenge Outcome
Authors: Nilsson N. , Nilsson C. , Hedlin G. , Johansson S.G.O. , Borres M.P. , Nopp A.
Published: June 2013

Background: Wheat is a common food causing allergy which has implications on the quality of life. The diagnosis of IgE-mediated wheat allergy is based on the clinical history and presence of IgE antibodies (IgE-Ab) in skin or blood, and the results of an oral food challenge which is time consuming and associated with risks. An improved diagnostic workup is needed for wheat allergy. The objective was to examine the relationship between wheat challenge, CD-sens and IgE-Ab to related allergens in wheat-allergic children and investigate if a combination of different markers could enhance the prediction of challenge outcome. Method: Twenty-four children (aged 1-15 years) with a wheat allergy diagnosis underwent an open wheat challenge. CD-sens and IgE-Ab to wheat, hydrolyzed wheat protein (HWP), ω-5 gliadin and timothy grass were analyzed and related to the challenge outcome. Results: A positive challenge was seen in 12/24 children. Children reacting to the challenge had higher IgE-Ab concentrations to wheat, ω-5 gliadin and HWP (p < 0.01) and a tendency to higher wheat CD-sens values (p = 0.08) than nonreacting children. Combining wheat CD-sens >150 and IgE-Ab to wheat >20 kUA/l, or ω-5 gliadin >0.1 kUA/l predicted the challenge outcome in 83% of the patients. Most children with IgE-Ab to wheat also had IgE-Ab to timothy. Seven of 9 challenge-positive children had a positive CD-sens to HWP and IgE-Ab to HWP >8 kUA/l. Conclusion: Combining CD-sens and IgE-Ab to wheat or wheat components could be useful in the diagnosis and follow-up of wheat-allergic children.
Anisakis Allergy Component-Resolved Diagnosis: Clinical and Immunologic Differences between Patients from Italy and Spain
Authors: Caballero Maria Luisa , Asero Riccardo , Antonicelli Leonardo , Kamberi Erilda , Colangelo Caterina , Fazii Paolo , de Burgos Carmen , Rodriguez-Perez Rosa
Published: June 2013

Background:Anisakissimplex is the main organism responsible for the zoonotic disease anisakiasis which follows the ingestion of live larvae present in raw or undercooked marine fish. Clinical features include severe epigastric pain, frequently accompanied by severe allergic reactions. We investigated the prevalence of immunoglobulin E (IgE) specific for 5 Anisakis allergens in Italian patients sensitized or allergic to the parasite. The results were compared with those obtained previously in a similar Spanish population. Patients and Methods: We conducted a descriptive, cross-sectional validation study. Asymptomatic Anisakis-sensitized subjects (15 Italian and 17 Spanish) and Anisakis allergic-patients (42 Italian and 35 Spanish) were studied by ImmunoCAP, Western-blotting with nAni s 4 and dot-blotting with rAni s 1, rAni s 5, rAni s 9 and rAni s 10. Results:Anisakis IgE CAP classes 1 or 2 were associated with a high probability of asymptomatic sensitization (66.7%) while CAP classes 4 or above, were associated with a very high probability of allergy to Anisakis (95.2%). The most frequently detected allergen among Italian and Spanish allergic patients was Ani s 1. All of the Spanish patients versus 76.2% of the Italian patients recognized at least one of the allergens tested. Patients suffering from gastrointestinal symptoms only were significantly more frequent among the Italians whereas the Spanish presented more frequently with urticaria, angioedema or anaphylaxis. Conclusions:Anisakis hypersensitivity shows different immunological patterns in different European countries. Allergen component diagnosis might help us to better understand this complex entity. Anisakis-specific IgE levels may have moderate prognostic significance.
Are 5-7 Days of Folic Acid Supplementation Necessary prior to Pemetrexed Observations from a Case Series
Authors: Griffin Benjamin R. , Stephens Elisabeth K. , Jatoi Aminah
Published: June 2013

Objective: Current regulatory guidelines advise 5-7 days of folic acid supplementation prior to pemetrexed. Although taking folic acid during and after pemetrexed therapy is important, it remains unclear whether premedication is truly necessary, particularly as it can be inconvenient for patients, can contribute to their anxiety by delaying chemotherapy, and can create challenges in scheduling chemotherapy. Methods and Results: We retrospectively sought to identify and evaluate outcomes among non-small cell lung cancer patients who received less than the advised folic acid premedication. Only 8 patients were identified. However, upon critical examination of first-cycle chemotherapy outcomes, we observed no major adverse events with a shortened course of folic acid premedication. Conclusion: In the very rare circumstance where urgent therapy is warranted, a healthcare provider can lookto this small case series and find modest precedent for the safe administration of pemetrexed in the absence of a full week of folic acid premedication.
Optimal In-Hospital and Discharge Medical Therapy in Acute Coronary Syndromes in Kerala
Authors: Huffman Mark D. , Prabhakaran Dorairaj , Abraham Adangapuram Kurien , Krishnan Mangalath Narayanan , Nambiar Asokan Cheviri , Mohanan Padinhare Purayil
Published: June 2013

Background—

In-hospital and postdischarge treatment rates for acute coronary syndrome (ACS) remain low in India. However, little is known about the prevalence and associations of the package of optimal ACS medical care in India. Our objective was to define the prevalence, associations, and impact of optimal in-hospital and discharge medical therapy in the Kerala ACS Registry of 25 718 admissions.

Methods and Results—

We defined optimal in-hospital ACS medical therapy as receiving the following 5 medications: aspirin, clopidogrel, heparin, β-blocker, and statin. We defined optimal discharge ACS medical therapy as receiving all of the above therapies except heparin. Comparisons by optimal versus nonoptimal ACS care were made via Student
t
test for continuous variables and χ
2
test for categorical variables. We created random effects logistic regression models to evaluate the association between Global Registry of Acute Coronary Events risk score variables and optimal in-hospital or discharge medical therapy. Optimal in-hospital and discharge medical care were delivered in 40% and 46% of admissions, respectively. Wide variability in both in-hospital and discharge medical care was present, with few hospitals reaching consistently high (>90%) levels. Patients receiving optimal in-hospital medical therapy had an adjusted odds ratio (95% confidence interval)=0.93 (0.71, 1.22) for in-hospital death and an adjusted odds ratio (95% confidence interval)=0.79 (0.63, 0.99) for major adverse cardiovascular event rates. Patients who received optimal in-hospital medical care were far more likely to receive optimal discharge care (adjusted odds ratio [95% confidence interval] = 10.48 [9.37, 11.72]).

Conclusions—

Strategies to improve in-hospital and discharge medical therapy are needed to improve local process-of-care measures and ACS outcomes in Kerala.
No Man Is an Island: Early Modern Globalization, Knowledge Networks, and George Psalmanazar’s Formosa
Authors: Breen Benjamin
Published: June 2013

Abstract

The 1600-1800 period was an era of global travel and encounters. Yet this “early modern globalization” was highly unstable, characterized by miscommunications and doubts regarding the credibility of both individual witnesses and the facts they adduced. The Formosan hoax of George Psalmanazar (1679?-1763) offers a unique perspective on these themes. Although Psalmanazar was a fraud, his inventions about the island of Formosa circulated widely in different languages, nations, and inscriptive contexts. The divergence between Psalmanazar’s personal credibility and the longevity of his invented facts sheds light on the nature of evidence and information networks in early modern globalization. This episode highlights the imperfect and contested nature of early modern communication networks.
Negotiating with Insurgents: Changing Perceptions or Changing Politics?
Authors: Urlacher Brian R.
Published: June 2013

Abstract

High costs have long been seen as motivating conflict participants to seek peace. This article discusses two types of deviations from the “hurting-stalemate” logic: negotiations in the absence of high costs and non-negotiation in the face of high costs. Two prominent explanations for these deviations are discussed and evaluated, initially through a statistical analysis of peace overtures in intrastate conflicts and then through a case study of the Indian civil war in Kashmir. The results suggest that theoretical explanations focusing on the preferences and political strength of leaders have traction at all levels of violence. Variables associated with shifts in perception, such as leadership change or political shocks, seem to have different effects as the level of violence in a conflict changes.
The Domestic Fruits of Diplomacy: Mediation and Presidential Approval
Authors: Todhunter James P.
Published: June 2013

Abstract

The notion that national leaders use foreign policy actions for domestic political benefit is widely accepted in the foreign policy literature, but has only been studied with regard to foreign policy involving the use of force. Literature on third-party mediation has emerged separately and has not taken mediators’ domestic political motivations and constraints into account when explaining mediation occurrence and outcomes. Diplomatic efforts such as mediation should be appealing to leaders seeking to impress their domestic audience because it provides them with a low risk opportunity to appear competent to their domestic audience. While mediation is a regular occurrence in US foreign policy, its public visibility varies greatly. However, models of presidential media coverage suggest that media outlets are likely to pay a disproportionate amount of attention to presidents and their high level surrogates while engaging in diplomacy overseas. The article proposes that the higher the profile of the official an administration sends to mediate a crisis overseas, the greater the increase in the president’s approval rating. Additionally, the public’s attentiveness to foreign policy should condition the effect of a high profile mediator on presidential approval. As foreign policy becomes more salient to the public, the effect of a higher profile mediator on presidential approval should be greater. Empirical results support the argument.
Reflections on Ireland’s Chairmanship in Office of the OSCE, 2012
Authors: Cogan Frank
Published: June 2013

Ireland’s first Chairmanship in Office of the OSCE in 2012 came at a time when the organisation was facing a number of internal and external challenges and was suffering from significant internal divisions. Despite the challenges faced by Ireland, as a small country in the midst of a recession, the Chairmanship was broadly successful; the Dublin Ministerial Council adopted some important decisions; most of its modest and realistic objectives were successfully achieved and some progress was recorded in handling protracted conflicts. The one area in which there was disappointment was in the Human Dimension; this was largely due to structural flaws within the Organisation and divisions among its members.
Relationship Between the Anatomical Structure and the Swelling of Conditioned Wood Surfaces
Authors: Dünisch Oliver
Published: June 2013

The influence of swelling on the roughness of rehydrated, machinery-treated wood surfaces of Millettia laurentii De Wild. (Wengé) was studied under controlled climate conditions. The surface roughness of transverse, radial, and tangential planes was quantified by high resolution laserscan measurements with an accuracy of ±2 μm and an optical resolution of 8 × 50 μm. The surface profiles were compared with the anatomical structure of the xylem in the surface layer of the samples. The surface roughness of swollen samples increased significantly compared to unswollen samples. Higher surface roughness was found on swollen radial and tangential planes compared to swollen transverse planes. The high increase in roughness of conditioned radial and tangential planes was due to the higher swelling of tissue zones dominated by fibres compared to zones dominated by axial parenchyma, ray parenchyma, and vessels. In thinner rehydrated samples the surface roughness was lower than in thicker samples. Although the increase of surface roughness of the rehydrated samples was only in the range of 10 to 60 μm in these experiments, the gloss level of rehydrated coated surfaces decreased significantly. The results are discussed with special regard to high quality surface finishing of wooden furniture.
Heavy Precipitation Events in a Warmer Climate: Results from CMIP5 Models
Authors: Scoccimarro Enrico , Gualdi Silvio , Bellucci Alessio , Zampieri Matteo , Navarra Antonio
Published: June 2013

In this work, the authors investigate possible changes in the distribution of heavy precipitation events under a warmer climate, using the results of a set of 20 climate models taking part in phase 5 of Coupled Model Intercomparison Project (CMIP5). Future changes are evaluated as the difference between the last four decades of the twenty-first century and the twentieth century, assuming the representative concentration pathway 8.5 (RCP8.5) scenario. As a measure of the width of the right tail of the precipitation distribution, the authors use the difference between the 99th and the 90th percentiles. Despite a slight tendency to underestimate the observed heavy precipitation, the considered CMIP5 models well represent the observed patterns in terms of the ensemble average, during both boreal summer and winter seasons for the 1997–2005 period. Future changes in average precipitation are consistent with previous findings based on models from phase 3 of CMIP (CMIP3). CMIP5 models show a projected increase for the end of the twenty-first century of the width of the right tail of the precipitation distribution, particularly pronounced over India, Southeast Asia, Indonesia, and central Africa during boreal summer, as well as over South America and southern Africa during boreal winter.
Ailing bones and failing kidneys: a case of chronic cadmium toxicity
Authors: Chakraborty Sutirtha , Dutta Arup R , Sural Saubhik , Gupta Debkishore , Sen Susruta
Published: June 2013

Heavy metal toxicity is often caused by occupational exposure. Chronic cadmium toxicity is a significant health concern among workers engaged in zinc smelting, battery production and silver jewellery industries, particularly in developing countries. We report the case of a 48-year-old man who presented with severe osteoporosis, impaired renal function and acquired Fanconi syndrome. He was finally diagnosed with chronic cadmium toxicity resulting from long-term occupational exposure. Cadmium has a long biological half-life and there is no effective treatment for people who are exposed to it. Therefore, an early diagnosis and prevention of further exposure are important.
The Dragon Nests: China’s Energy Engagement of the Middle East
Authors: Dorraj Manochehr , English James
Published: June 2013

China is the largest consumer of energy, the leading exporter of manufactured goods and possesses the second largest economy in the world. The great dragon’s current economic activity extends to all corners of the world, including the hydrocarbon-rich Middle East. Since becoming a net importer of oil in 1993, China’s engagement of the Middle East has focused heavily on energy acquisition as the country urgently needs reliable sources of oil and natural gas to continue its unprecedented economic rise. For now, Middle Eastern countries seem amenable to the nesting dragon, whose increasing energy consumption, rapidly expanding economy, lack of colonial history and a policy of ‘offend no one’, its vast cash reserves and a willingness to pay premium prices for energy sources render it a highly appealing partner, capable of balancing the hegemonic policies and unipolar presence of the US. This article provides a summary of China’s expanding energy relations with seven major energy producing states of the Middle East, namely Saudi Arabia, Iran, Iraq, Kuwait, Oman, UAE and Qatar, and assesses the political implications of China’s burgeoning relationship with the region.
Sino-Turkish Strategic Partnership: Prudent Hedging or Irreversible Shift?
Authors: Kumar Atul
Published: June 2013

The accelerated growth of Sino-Turkish relations indicates their increasing convergence on foreign, economic and security policies, despite several constraints. The deterioration of Turco-American relationship and frustrated Turkish ambitions of EU membership, coupled with a desire to diversify its arms acquisitions and balance its foreign policy, have led to the readjustments in its foreign and security policy. This realignment has resulted in closer Sino-Turkish partnership and emergence of the strategic cooperation. In China, a growing realisation has emerged in favour of Turkey’s geo-strategic and geopolitical importance and its potential as a market for Chinese defence exports. Turkey as a client may impart much sought after international credibility to Chinese weapon manufacturers and a base in Turkey would enhance Chinese access to regional markets. Hence, China has increasingly courted Turkey and Chinese companies have increased their operations inside Turkey. In addition, there are significant convergences between both armed forces on issues of national security, separatism and terrorism. Consequently, strategic cooperation between China and Turkey has increased considerably in the last decade.
China’s Policy on the Middle East Peace Process after the Cold War
Authors: Chaziza Mordechai
Published: June 2013

This article focuses on China’s policy towards the peace process in the Middle East after the end of the Cold War and the American influence on Chinese policy. China has always charted its policy on the Arab-Israeli peace process to be ‘balanced diplomacy’, maintaining friendly relations with Arab countries, while not neglecting its relationship with Israel. Furthermore, China’s policy regarding the Israeli-Arab peace process contains contradictory elements in its dual relations with the ‘peace camp’ and the ‘radical camp’ in the Middle East. Chinese diplomacy finds itself in a complex dilemma, balancing the perils and prospects of its economic and strategic goals in the Middle East and the international arena. As a permanent member of the UN Security Council, China states that it shares the great burden of ensuring that the Middle Eastern peace process is managed correctly. However, its declaration is merely diplomatic rhetoric; Beijing does not actively endeavour to advance the peace process but is mainly interested in promoting its own economic interests and balancing the US hegemony in the region. Therefore, its approach is chiefly one of conflict management, rather than conflict resolution. Paradoxically, by trying to maintain good economic relations with everyone, it helps strengthen forces opposed to peace, such as Iran and Hamas.
Vibration analysis of functionally graded nanocomposite cylinders reinforced by wavy carbon nanotube based on mesh-free method
Authors: Moradi-Dastjerdi Rasool , Pourasghar Amin , Foroutan Mehrdad , Bidram Morteza
Published: June 2013

This work reports the effect of nanotube aspect ratio on the free vibration characteristics of a functionally graded nanocomposite cylinders reinforced by wavy single-walled carbon nanotubes (CNTs) based on mesh-free method. In this simulation, an axisymmetric model is used and axisymmetric natural frequencies of CNT reinforced composite cylinders are presented. The material properties of functionally graded CNT reinforced composites are assumed to be graded in the thickness direction and are estimated by a micromechanical model. The effect of the waviness of the CNTs and its parameters are studied. In the mesh-free analysis, moving least squares shape functions are used for approximation of displacement field in the weak form of motion equation, and the transformation method is used for the imposition of essential boundary conditions. It is observed that the waviness significantly reduces the effective reinforcement of the nanocomposites. The effective moduli and frequency response are very sensitive to the waviness but this sensitivity decreases with the increase of the waviness. The validity of the Young's modulus and the frequency response were assessed by a comparison with available literature data, providing a good agreement.
Characterization of oil palm ash (OPA) and thermal properties of OPA-filled natural rubber compounds
Authors: Ooi Zhong Xian , Ismail Hanafi , Bakar Azhar Abu
Published: June 2013

In the present study, characterization and morphological study of oil palm ash (OPA) and thermal properties of OPA-filled natural rubber (NR) compounds were carried out. The morphological study revealed that the OPA particle was irregular with rough surface and porous structure. Energy dispersive x-ray analysis and an x-ray fluorescence spectrometry indicated that silicon was the highest component in OPA. Fourier transform infrared analysis and x-ray diffraction indicated that the main mineralogical components in OPA were quartz and calcite. The study results of the OPA-filled NR compounds showed that the thermal resistance and retention properties after thermal ageing were notably enhanced with the addition of OPA and improved as the OPA loading was increased.
Populism versus Neoliberalism
Authors: Duckett Jane , Langer Ana Inés
Published: June 2013

Research on the Chinese media has concentrated on understanding party-state control over an increasingly commercialized industry. And it has usually focused on reporting issues over which the central party-state has a clear and unified position. This article explores how the Chinese media reported a domestic policy issue—health reform—on which the party-state had no unified position. It examines three print publications during a major health care system review and consultation between 2005 and 2009 to see how much diversity there was in the reporting, what the principal narratives were, and which actors had voice. It finds the media took diverse positions, with narratives centering on market and state roles in health, but a vocal minority of pro-market articles challenged the dominant pro-state reporting. But pro-state positions were populist and paternalist, speaking for “the people” rather than giving them a direct voice. The neoliberal, pro-market challenge, meanwhile, was elitist, with the media venturing only at the margins to demand rights for vulnerable people and greater public participation in policy making.
Dual averaging method for solving multi-agent saddle-point problems with quantized information
Authors: Yuan Deming , Ma Qian , Wang Zhen
Published: June 2013

In this paper we study the multi-agent saddle-point problems where multiple agents try to collectively optimize a sum of local convex–concave functions, each of which is available to one specific agent in the network. We propose a distributed primal–dual subgradient method under the constraint that agents can only communicate quantized information. The method can be implemented over a time-varying network while satisfying some standard connectivity conditions. We provide convergence results and convergence rate estimates for the proposed method. In particular, we provide an error bound on its convergence rate to highlight the dependence on the quantization resolution. We have also provided a numerical example to show the effectiveness of the proposed method.
Road Safety as a Shared Responsibility and a Public Problem in Swedish Road Safety Policy
Authors: McAndrews Carolyn
Published: June 2013

Sweden’s road safety policy, Vision Zero, seeks to eliminate deaths and serious injuries from traffic crashes, and it recognizes that the bottleneck in improving road safety is displacing mobility as the main priority of the road transportation system. This analysis considers the theory and practice of Vision Zero, first interpreting its proposed changes to responsibility for road safety, and then examining how it has been implemented. The research methods include document analyses, field observations, and interviews with Swedish safety practitioners. This study found that Vision Zero’s main innovation is its explicit call for experts to have causal responsibility for injuries. Moreover, Vision Zero expands the responsibility attributed to road users, who are called on to voice demand for safety improvements to civil servants and elected officials. However, Vision Zero also needed to create institutions through which experts could be accountable for their new causal responsibility, and it needed to support popular organizing around traffic injury prevention. I suggest that a major limitation to increasing the status of road safety as a public problem is that it is generally understood as a private problem and changing this perception through policy requires a more deeply engaged public process.
Barriers and facilitators to care for the terminally ill: A cross-country case comparison study of Canada, England, Germany, and the United States
Authors: Klinger Christopher A , Howell Doris , Zakus David , Deber Raisa B
Published: June 2013

Background:

Why do many patients not die at their preferred location?

Aim:

Analyze system-level characteristics influencing the ability to implement best practices in delivering care for terminally ill adults (barriers and facilitators).

Design:

Cross-country comparison study from a “most similar—most different” perspective, triangulating evidence from a scoping review of the literature, document analyses, and semi-structured key informant interviews.

Setting:

Case study of Canada, England, Germany, and the United States.

Results:

While similar with regard to leading causes of death, patient needs, and potential avenues to care, different models of service provision were employed in the four countries studied. Although hospice and palliative care services were generally offered with standard care along the disease continuum and in various settings, and featured common elements such as physical, psycho-social, and spiritual care, outcomes (access, utilization, etc.) varied across jurisdictions. Barriers to best practice service provision included legislative (including jurisdictional), regulatory (e.g. education and training), and financial issues as well as public knowledge and perception (“giving up hope”) challenges. Advance care planning, dedicated and stable funding toward hospice and palliative care, including caregiver benefits, population aging, and standards of practice and guidelines to hospice and palliative care, were identified as facilitators.

Conclusion:

Successful implementation of effective and efficient best practice approaches to care for the terminally ill, such as shared care, requires concerted action to align these system-level characteristics; many factors were identified as being essential but not sufficient. Policy implementation needs to be tailored to the respective health-care system(s), monitored, and fine-tuned.