bluuebunny/crossref_metadata_2025 huggingface dataset:
Fitting in
Authors: Fox Robert
Published: August 2013

Purpose

Integration of library services via automated means does not require that the patron make abrupt shifts between interfaces or tools in order to take advantage of the vast array of resources a modern academic library provides. This can be accomplished in a seamless manner. This column aims to explore ways in which libraries can leverage the data sources of their parent institution to provide robust resources in the environments where their constituents typically perform their day to day work.

Design/methodology/approach

A literature review was done, but the column primarily relies on the experience of the author.

Findings

This column just scratches the surface for how libraries can better “fit in” with their parent institutions by leveraging already existing data sources. While this requires a high degree of cooperation with institutional partners, the return on that investment is very valuable.

Originality/value

Integration services are a key area in the provisioning of library services and content. Institutional data sources provide a rich source of information for catering library resources and content to individual students and faculty.
Can business leaders build teams like Alex Ferguson?
Authors: Denton Alan
Published: August 2013

Purpose

This paper aims to look at the leadership lessons which can be learnt from Scottish soccer coach, Alex Ferguson.

Design/methodology/approach

The paper examines the characteristics and methods of Alex Ferguson's leadership style and how managers in business can apply the wider principles that underlie them.

Findings

Just like football teams, businesses have long periods of fantastic success as well as times when winning titles or new business seems an unattainable goal. A great leader takes their team through good times and bad. With the enrolment and engagement of their people, they too can be a true leader and someone that people actively choose to commit to and follow.

Originality/value

The author believes that managers can learn much from Ferguson's principles of leadership.
Teamwork within the Nordic model
Authors: Rolfsen Monica
Published: August 2013

Purpose

The purpose of this editorial is to introduce the special issue from the IWOT conferences in 2012, focusing on teamwork within the Nordic model.

Design/methodology/approach

The paper identifies the content of the Nordic model and discusses how it is relevant for high performing autonomous teams, especially connected to teams with a high level of autonomy.

Findings

Shared leadership is positive for team performance when team autonomy is high. The paper identifies eight important variables for creating high performing cross‐functional teams, the role of trust between workers and supervisors in order to unlock standards, and emphasizes the role of industrial relations as an important support system for team work.

Originality/value

This editorial provides an overview of the Nordic perspective of autonomous teams contained in the special issue which comprises four original articles that are examples of latest developments in this research area. Each of these articles contains a brief introduction on how they contribute to filling in gaps in the literature.
Multidisciplinary teamwork is an important issue to healthcare professionals
Authors: Bitter Justin , van Veen‐Berkx Elizabeth , Gooszen Hein G. , van Amelsvoort Pierre
Published: August 2013

Purpose

The aim of this paper is to describe the factors that contribute to understanding how collaboration improves performance in operating rooms (ORs) after introducing the concept of cross‐functional OR scheduling teams.

Design/methodology/approach

The concept was investigated at Radboud University Nijmegen Medical Center (RUNMC) in The Netherlands and used on an innovative path based on socio‐technical systems (STS) principles designed to address non‐routine tasks, variety, interferences and errors related to OR scheduling, with the aim of increasing both staff productivity and patient safety. The effects of implementing preoperative cross‐functional teams in the OR were compared qualitatively. The researcher observed all of the team meetings, available data and documentation, and 13 semi‐structured interviews were performed with team members for collecting additional data.

Findings

In the literature, it was found that the theory of socio‐technical systems and the fields of group dynamics and self‐managing teams fit the OR setting. The author applied six elements of these theories (setting common goals, cohesion, openness, single‐loop and double‐loop learning, feedback, and control options) to the aspects found in the study. The qualitative findings revealed that high‐performing teams were able to identify bottlenecks in order to improve continuity of care. The cross‐functional teams used several performance indicators to gain insight into their own performance. Consequently, through collaboration, these teams were able to minimise interference and therefore learn. Cross‐functional teams learned how to address interferences and improve their quality of service through improved collaboration and the improved use of control mechanisms.

Practical implications

This research highlights the importance of team‐based approaches and the need to improve collaboration between healthcare professionals.

Originality/value

The paper confirms the value of implementing the socio‐technical systems theory to improve collaboration between healthcare professionals. This case study is a valuable contribution, as it focuses on team‐based organisation in preparing an OR schedule.
Hedgerows surrounding organic apple orchards in north‐west Spain: potential to conserve beneficial insects
Authors: Miñarro Marcos , Prida Eduardo
Published: August 2013

Flowering plant species in hedgerows may be food sources for beneficial insects and therefore play a role in biodiversity conservation and agroecosystem functioning. Research was conducted in eight organic cider‐apple orchards in Asturias (north‐west Spain) aiming to (i) identify the native flowering plants in the surrounding hedgerows and (ii) assess the attractiveness of those flowers for beneficial insects, such as pollinators and natural enemies of pests.

A total of 7745 flowers belonging to 63 plant species were recorded in the hedgerows from May to September 2012. Flower abundance and species richness decreased as the season progressed. Orchard differences were observed for plant species richness but not for the total number of flowers in the hedgerows, likely as a result of similar management among orchards.

Hymenoptera pollinators (honey bees, bumblebees and wild bees) accounted for 37.8% of the total insects recorded visiting flowers, whereas predatory hoverflies (14.9%) were the dominant natural enemies.

The attractiveness for insects was assessed for 21 of the flowering plant species identified in the hedgerows. Flowering plants differed in the number of taxa that they attracted and in their attractiveness for particular insect groups and for insects as a whole.

The present study described the floral composition of the hedgerows that surround apple orchards and identified the local floral resources that could provide benefits for farmers by improving ecosystem services of pollination and biological control of pests.
Elevated serum levels of anti‐Müllerian hormone can be introduced as a new diagnostic marker for polycystic ovary syndrome
Authors: Sahmay Sezai , Atakul Nil , Aydogan Begüm , Aydın Yavuz , Imamoglu Metehan , Seyisoglu Hakan
Published: August 2013

Objective

To determine the possible role of anti‐Müllerian hormone (AMH) in the diagnosis of polycystic ovary syndrome (PCOS) with a larger population of women and to evaluate its role as a new diagnostic marker.

Design

Cross‐sectional study.

Setting

University hospital.

Population

A total of 570 women, with PCOS (n = 419) and without PCOS (n = 151).

Methods

Serum basal hormone; AMH, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, and thyroid‐stimulating hormone (TSH) levels were measured. Mean hormone levels were compared and the predictive value of serum AMH level was evaluated with the use of the receiver operating characteristic (ROC) curve analysis.

Results

No statistically significant differences were found between PCOS women and control groups in terms of age, body mass index and TSH levels. Differences between mean serum, FSH, LH and estradiol levels and LH/FSH ratio were found to be statistically significant (p < 0.001). Mean serum AMH level was higher in PCOS women than in controls (7.34 vs. 2.24 ng/mL, p < 0.001). The area under the ROC curve assay yielded a satisfactory result of 0.916 (95% confidence interval 0.897–0.935, p < 0.0001). The best compromise between 89.8% specificity and 80% sensitivity was obtained with a cut‐off value of 3.94 ng/mL for PCOS diagnosis.

Conclusions

Serum AMH measurement is very valuable in the diagnosis of PCOS women. The serum AMH level in women with hyperandrogenism or oligo‐anovulation could indicate the diagnosis of PCOS when reliable ultrasonography data are not available or when typical clinical and laboratory findings are not available. The serum AMH level is a new and useful diagnostic tool in PCOS diagnosis.
What makes maternity teams effective and safe? Lessons from a series of research on teamwork, leadership and team training
Authors: Siassakos Dimitrios , Fox Robert , Bristowe Katherine , Angouri Jo , Hambly Helen , Robson Lauren , Draycott Timothy J.
Published: August 2013

We describe lessons for safety from a synthesis of seven studies of teamwork, leadership and team training across a healthcare region. Two studies identified successes and challenges in a unit with embedded team training: a staff survey demonstrated a positive culture but a perceived need for greater senior presence; training improved actual emergency care, but wide variation in team performance remained. Analysis of multicenter simulation records showed that variation in patient safety and team efficiency correlated with their teamwork but not individual knowledge, skills or attitudes. Safe teams tended to declare the emergency earlier, hand over in a more structured way, and use closed‐loop communication. Focused and directed communication was also associated with better patient‐actor perception of care. Focus groups corroborated these findings, proposed that the capability and experience of the leader is more important than seniority, and identified teamwork and leadership issues that require further research.
Companion animal veterinarians' use of clinical communication skills
Authors: McArthur ML , Fitzgerald JR
Published: August 2013

Objective

To describe the communication techniques used by clients and veterinarians during companion animal visits in Australia.

Design

A cross‐sectional descriptive study.

Methods

A total of 64 veterinary consultations were audiotaped and analysed with the Roter Interaction Analysis System (RIAS); clients completed appointment level measures, including their satisfaction and perceptions of relational communication.

Results

Participants were 24 veterinarians and 64 clients. Statements intended to reassure clients were expressed frequently in the consultations, but in 59% of appointments empathy statements were not expressed towards either the client or the patient. In 10% of appointments, veterinarians did not used any open‐ended questions. Overall client satisfaction was high and veterinarians' expressions of empathy directed to the client resulted in higher levels of client satisfaction. Clients' perceptions of relational communication were related to several veterinarian and client nonverbal scales.

Conclusions

A focus on developing evidence‐based clinical communication skills is expected to further enhance the veterinarian–client–patient relationship and associated clinical outcomes. Particular recommendations include the development of a broader emotion‐handling repertoire, increased emphasis on the use of open‐ended enquiry, including assessment of the client's perspective, as well as attention to aspects of nonverbal communication. The study provides preliminary evidence for the importance of verbal expressions of empathy during the companion animal consultation.
Tiger snake (Notechis scutatus) envenomation in a horse
Authors: Cullimore AM , Lester GD , Swindells KL
Published: August 2013

Background

A 7‐year‐old Thoroughbred gelding presented with muscle fasciculation, reluctance to move, profuse sweating, tachycardia, tachypnoea and a localised, unilateral swelling on the muzzle. History and physical examination were suggestive of snake envenomation.

Methods

A sandwich ELISA for the detection of snake venom was performed on serum and urine samples.

Result

The test performed on urine confirmed a diagnosis of tiger snake envenomation.

Conclusion

The response to treatment with antivenom and supportive medical therapy was excellent.
Encephalomyocarditis virus infection in a splenectomised calf
Authors: Diallo IS , Carter PD , Storie G
Published: August 2013

Background

Encephalomyocarditis (EMC) caused by EMC virus (EMCV) was diagnosed in a 5‐month‐old splenectomised calf, which died suddenly on an experimental farm that had a high infestation of rodents.

Results

At postmortem examination, the lungs were dark purple and diffusely congested. On histological examination, the calf had severe necrotising myocarditis. EMCV was isolated from the heart. The polyprotein gene of the EMCV isolate was amplified by PCR and had 85–91% identity with published EMCV sequences, including 89% identity with isolates from Queensland. On phylogenetic analysis, the polyprotein gene had highest sequence identity with South Korean EMCV strain, CBNU.

Conclusion

This is the first report of naturally occurring EMC in cattle in Australia and the first report of naturally occurring bovine EMC from which EMCV has been isolated.
Neospora caninum and reproductive wastage in extensively managed Queensland beef herds
Authors: Fordyce G , Holroyd RG , Taylor J , Kirkland PD
Published: August 2013

Objective

To compare reproduction in extensively managed, tropically adapted beef cows that were either seropositive or seronegative to Neospora caninum.

Design

Longitudinal study of cows within management groups.

Methods

Compare pregnancy with weaning outcomes for 502 seropositive and 3255 seronegative cows in 25 management groups.

Results

We found N. caninum in all herds, with an average of 20% of 2640 tested animals seropositive within management group; prevalence varied between 0% and 94%. At 7 of 10 sites assessed, there was evidence of horizontal transmission of N. caninum. There was no overall difference in pregnancy rate (79% vs 75%; P > 0.05), reproductive wastage after confirmed pregnancy diagnosis (11% vs 10%; P > 0.05) or weaning rate (67% vs 68%; P > 0.05) between seronegative and seropositive cows, respectively. In one herd where a combination of risk factors for N. caninum was present, a significant reduction in pregnancy rate occurred after the 6 months mating (85% vs 69%; P < 0.05). The fetal and calf losses observed were lowest in south‐east Queensland (4.3% of 117 pregnancies), highest in north‐west Queensland (15.5% of 413 pregnancies) and intermediate in north‐east Queensland (10.2% of 1625 pregnancies). Other infectious agents that are known to cause reproductive wastage were endemic in many herds, though none appeared to cause significant fetal or calf loss in this study.

Conclusion

Despite a high prevalence of N. caninum, there was no apparent effect on beef cattle reproduction, but there is potential to cause reproductive wastage if known risk factors to neosporosis are in effect.
Development of Anti‐Inflammatory Drugs – the Research and Development Process
Authors: Knowles Richard Graham
Published: August 2013

The research and development process for novel drugs to treat inflammatory diseases is described, and several current issues and debates relevant to this are raised: the decline in productivity, attrition, challenges and trends in developing anti‐inflammatory drugs, the poor clinical predictivity of experimental models of inflammatory diseases, heterogeneity within inflammatory diseases, ‘improving on the Beatles’ in treating inflammation, and the relationships between big pharma and biotechs. The pharmaceutical research and development community is responding to these challenges in multiple ways which it is hoped will lead to the discovery and development of a new generation of anti‐inflammatory medicines.
Mindfulness‐based cognitive therapy for depression in adolescents
Authors: Ames Catherine S. , Richardson Jessica , Payne Susanna , Smith Patrick , Leigh Eleanor
Published: August 2013

Background

Mindfulness‐Based Cognitive Therapy (MBCT) has been shown to be effective in preventing relapse of depression in adults, but has not previously been applied to adolescents who have residual symptoms of depression following treatment.

Method

An 8‐week MBCT group was adapted for adolescents, and evaluated using qualitative and quantitative measures.

Results

Participants report high levels of satisfaction with the group intervention. Qualitative analysis of semi‐structured interviews provides areas for future development of this intervention. Pilot data indicate reductions in depressive symptoms, alongside positive change in mindfulness skills, quality of life and rumination.

Conclusions

Preliminary evidence for the use of MBCT with this group of adolescents is provided.
Toward the successful delivery of lysosomal enzymes across the blood–brain barrier
Authors: Urayama Akihiko
Published: August 2013

The development of enzyme replacement therapy (ERT) has been one of the most remarkable successes of translational studies, bridging laboratory discoveries to clinical settings. Although ERT is very effective in clearing peripheral tissue storage in many lysosomal storage diseases (LSD), negotiating the blood‐brain barrier (BBB) remains a key challenge in delivering corrective lysosomal enzymes into the brain. In recent years, brain delivery of lysosomal enzymes has been vigorously pursued for treating neurodegenerative LSD. Delivery strategies include high‐dose and long‐term treatment regimens, manipulation of receptor‐mediated transport, biochemical engineering of enzymes, use of transport vectors, and enzyme administration by alternative routes. Most studies have investigated biochemical or histological improvements in central nervous system (CNS) storage after treatment. Few studies, however, have directly focused on the mechanisms of lysosomal enzyme transport across the BBB. In previous studies, we discovered that the luminally expressed mannose 6‐phosphate/insulin‐like growth factor‐II receptor is a universal transporter of lysosomal enzymes. We and others have also successfully manipulated receptor‐mediated transport by using endogenous characteristics of the BBB. Interestingly, accumulating evidence indicates that some lysosomal enzymes employ multiple mechanisms for their transport across the BBB. This review provides a detailed discussion of the kinetics of lysosomal enzyme transport across the BBB, and the manipulation of transport characteristics based on studies of the transport of β‐glucuronidase, sulfamidase, arylsulfatase A and acid α‐glucosidase. Furthermore, recent achievements in treating abnormalities in CNS storage and their contribution to developing new therapeutic approaches are also discussed.
Does neuroinflammation induce systemic aging?
Authors: Nakahara Jin
Published: August 2013

A recent article published in Nature presents intriguing data suggesting that the activation of neuronal nuclear factor‐κB (NF‐κB) in the mediobasal hypothalamus (MBH) causes systemic aging through reduced secretion of gonadotropin‐releasing hormone, an anti‐aging hormone. Microglial inflammation in MBH also seems to induce neuronal NF‐κB. These results raise the possibility that neuroinflammation orchestrates systemic aging.
The Influence of Personality on a Group‐Level Process: Shy Hermit Crabs Make Longer Vacancy Chains
Authors: Briffa Mark
Published: August 2013

Animal personality has been investigated in a variety of contexts but few studies have investigated the effects of individual‐level traits on processes that occur at the group or population level. Vacancy chains describe sequences of linked vacancy moves in systems where individuals use discrete and reuseable resource units. When a new resource unit becomes available, this can cause a cascade of moves between resource units, beyond the first individual that encounters the new unit. Thus, vacancy chains can drive the distribution of resources through a population. Here, I investigate the effect of variation in boldness on movements between vacant gastropod shells in the hermit crab Pagurus bernhardus. Boldness was quantified using the duration of a startle response, which varied consistently between individuals. In groups of five crabs, introduction of a single new shell led to aggregate benefits, in terms of improving shell quality, across all group members. Boldness did not influence the extent of these benefits or the extent to which they were distributed between crabs of different sizes. Initially, vacancy chains were longer, indicating that more individuals moved between shells, for bold groups compared with shy groups. After 24 h, however, the chain length was longer for shy groups. Thus, although participation in a vacancy chain may lead to similar benefits, these could be more widespread for groups comprising shy individuals that show long startle responses, low inquisitiveness and low aggression. Similar effects on resource acquisition could be present in other examples of animals that utilise reusable resource units and show consistent between‐individual differences in behaviour.
Synovial herniation as a complication of arthroscopy in a Thoroughbred yearling
Authors: Marshall K. M. , Adkins A. R.
Published: August 2013

This paper reports the successful use of a half limb cast to treat prior failures in healing of a synovial hernia in a Thoroughbred yearling. The hernia was due to a nonhealing arthroscopy portal and was confirmed using ultrasonography and positive contrast arthrography to visualise the communication between the metacarpophalangeal joint and subcutaneous space. Surgery was performed 3 times, due to failure of healing of the joint capsule and recurrence of clinical signs. A half limb cast applied following the final surgery effected a repair. At 2 months post surgery there was no recurrence of the subcutaneous swelling and at 3 months post surgery a repeat positive contrast arthrogram confirmed healing of the hernia.
Insulin dysregulation
Authors: Frank N. , Tadros E. M.
Published: August 2013

Abnormalities of insulin metabolism include hyperinsulinaemia and insulin resistance, and these problems are collectively referred to asinsulin dysregulationin this review. Insulin dysregulation is a key component of equine metabolic syndrome: a collection of endocrine and metabolic abnormalities associated with the development of laminitis in horses, ponies and donkeys. Insulin dysregulation can also accompany prematurity and systemic illness in foals. Causes of insulin resistance are discussed, including pathological conditions of obesity, systemic inflammation and pituitarypars intermediadysfunction, as well as the physiological responses to stress and pregnancy. Most of the discussion of insulin dysregulation to date has focused on insulin resistance, but there is increasing interest in hyperinsulinaemia itself and insulin responses to feeding. An oral sugar test or in‐feed oral glucose tolerance test can be performed to assess insulin responses to dietary carbohydrates, and these tests are now recommended for use in clinical practice. Incretin hormones are likely to play an important role in postprandial hyperinsulinaemia and are the subject of current research. Insulin resistance exacerbates hyperinsulinaemia, and insulin sensitivity can be measured by performing a combined glucose‐insulin test or i.v. insulin tolerance test. In both of these tests, exogenous insulin is administered and the rate of glucose uptake into tissues measured. Diagnosis and management of hyperinsulinaemia is recommended to reduce the risk of laminitis. The terminsulin dysregulationis introduced here to refer collectively to excessive insulin responses to sugars, fasting hyperinsulinaemia and insulin resistance, which are all components of equine metabolic syndrome.
Spatial and temporal variability of biomarkers and microbial diversity reveal metabolic and community flexibility in Streamer Biofilm Communities in the Lower Geyser Basin, Yellowstone National Park
Authors: Schubotz F. , Meyer‐Dombard D. R. , Bradley A. S. , Fredricks H. F. , Hinrichs K.‐U. , Shock E. L. , Summons R. E.
Published: August 2013

Detailed analysis of 16S rRNA and intact polar lipids (IPLs) from streamer biofilm communities (SBCs), collected from geochemically similar hot springs in the Lower Geyser Basin, Yellowstone National Park, shows good agreement and affirm that IPLs can be used as reliable markers for the microbial constituents of SBCs. Uncultured Crenarchaea are prominent in SBS, and their IPLs contain both glycosidic and mixed glyco‐phospho head groups with tetraether cores, having 0–4 rings. Archaeal IPL contributions increase with increasing temperature and comprise up to one‐fourth of the total IPL inventory at >84 °C. At elevated temperatures, bacterial IPLs contain abundant glycosidic glycerol diether lipids. Diether and diacylglycerol (DAG) lipids with aminopentanetetrol and phosphatidylinositol head groups were identified as lipids diagnostic of Aquificales, while DAG glycolipids and glyco‐phospholipids containing N‐acetylgycosamine as head group were assigned to members of the Thermales. With decreasing temperature and concomitant changes in water chemistry, IPLs typical of phototrophic bacteria, such as mono‐, diglycosyl, and sulfoquinovosyl DAG, which are specific for cyanobacteria, increase in abundance, consistent with genomic data from the same samples. Compound‐specific stable carbon isotope analysis of IPL breakdown products reveals a large isotopic diversity among SBCs in different hot springs. At two of the hot springs, ‘Bison Pool’ and Flat Cone, lipids derived from Aquificales are enriched in 13C relative to biomass and approach values close to dissolved inorganic carbon (DIC) (approximately 0‰), consistent with fractionation during autotrophic carbon fixation via the reversed tricarboxylic acid pathway. At a third site, Octopus Spring, the same Aquificales‐diagnostic lipids are 10‰ depleted relative to biomass and resemble stable carbon isotope values of dissolved organic carbon (DOC), indicative of heterotrophy. Other bacterial and archaeal lipids show a similar variance, with values resembling the DIC or DOC pool or a mixture thereof. This variance cannot be explained by hot spring chemistry or temperature alone, but instead, we argue that intermittent input of exogenous organic carbon can result in metabolic shifts of the chemotrophic communities from autotrophy to heterotrophy and vice versa.
Life cycle greenhouse gas emissions of furniture and bioenergy production from oil palm trunks
Authors: Rettenmaier Nils , Keller Heiko , Reinhardt Guido A.
Published: August 2013

The palm oil industry constantly attempts to increase the sustainability along the entire palm oil value chain. One important strategy is to utilize all co‐products. Oil palm trunks, which become available upon replanting of existing plantations, represent an important and increasing flow of underexploited biomass. In recent years, innovative technologies are emerging to use them for producing furniture or plywood or providing bioenergy. We assessed the life cycle greenhouse gas emissions of such products and the greenhouse gas emission savings due to replaced alternative products. Although challenging material properties result in a relatively high energy demand and related greenhouse gas emissions in the oil palm wood processing, substantial reductions in greenhouse gas emissions can arise from producing furniture or bioenergy from oil palm trunks, especially if the process energy demand is met by the energy recovery from oil palm wood‐processing residues.
How Does Islamist Local Governance Affect the Lives of Women?
Authors: Blaydes Lisa
Published: August 2013

How do women fare under rule by Islamists? Whereas some scholarly work suggests that Islamists are effective at providing the type of social services that benefit women most, other studies contend that Islamic groups support “pro‐male” policies and cultural interventions that disadvantage the well‐being of women. In order to adjudicate between these views, I compare two neighborhoods in Greater Cairo that are similar on a number of dimensions but in one, a militant Islamist group came to dominate local politics, whereas in the other, strongmen ruled the streets in the absence of a strong state presence. Using an original data set of retrospective health histories for women in each neighborhood, I find that women subject to governance by the Islamic group enjoyed better outcomes related to reproductive health than a statistically matched set of women in the comparable neighborhood while being no more likely to marry early or drop out of school.
Improved Pharmacokinetics of Sumatriptan With Breath Powered™ Nasal Delivery of Sumatriptan Powder
Authors: Obaidi Mohammad , Offman Elliot , Messina John , Carothers Jennifer , Djupesland Per G. , Mahmoud Ramy A.
Published: August 2013

Objectives.—

The purpose of this study was to directly compare the pharmacokinetic (PK) profile of 22‐mg sumatriptan powder delivered intranasally with a novel Breath Powered™ device (11 mg in each nostril) vs a 20‐mg sumatriptan liquid nasal spray, a 100‐mg oral tablet, and a 6‐mg subcutaneous injection.

Background.—

A prior PK study found that low doses of sumatriptan powder delivered intranasally with a Breath Powered device were efficiently and rapidly absorbed. An early phase clinical trial with the same device and doses found excellent tolerability with high response rates and rapid onset of pain relief, approaching the benefits of injection despite significantly lower predicted drug levels.

Methods.—

An open‐label, cross‐over, comparative bioavailability study was conducted in 20 healthy subjects at a single center in the USA. Following randomization, fasted subjects received a single dose of each of the 4 treatments separated by a 7‐day washout. Blood samples were taken pre‐dose and serially over 14 hours post‐dose for PK analysis.

Results.—

Quantitative measurement of residuals in used Breath Powered devices demonstrated that the devices delivered 8 ± 0.9 mg (mean ± standard deviation) of sumatriptan powder in each nostril (total dose 16 mg). Although the extent of systemic exposure over 14 hours was similar following Breath Powered delivery of 16‐mg sumatriptan powder and 20‐mg liquid nasal spray (area under the curve [AUC]0‐∞ 64.9 ng*hour/mL vs 61.1 ng*hour/mL), sumatriptan powder, despite a 20% lower dose, produced 27% higher peak exposure (Cmax 20.8 ng/mL vs 16.4 ng/mL) and 61% higher exposure in the first 30 minutes compared with the nasal spray (AUC0‐30 minutes 5.8 ng*hour/mL vs 3.6 ng*hour/mL). The magnitude of difference is larger on a per‐milligram basis. The absorption profile following standard nasal spray demonstrated bimodal peaks, consistent with lower early followed by higher later absorptions. In contrast, the profile following Breath Powered delivery showed higher early and lower late absorptions. Relative to the 100‐mg oral tablet (Cmax 70.2 ng/mL, AUC0‐∞, 308.8 ng*hour/mL) and 6‐mg injection (Cmax 111.6 ng/mL, AUC0‐∞ 128.2 ng*hour/mL), the peak and overall exposure following Breath Powered intranasal delivery of sumatriptan powder was substantially lower.

Conclusions.—

Breath Powered intranasal delivery of sumatriptan powder is a more efficient form of drug delivery, producing a higher peak and earlier exposure with a lower delivered dose than nasal spray and faster absorption than either nasal spray or oral administration. It also produces a significantly lower peak and total systemic exposure than oral tablet or subcutaneous injection.
HIV testing of patients diagnosed with tuberculosis increased in Denmark during the period from 2007 to 2009
Authors: Perch M , Andersen PH , Kok‐Jensen A
Published: August 2013

We examined the trends of HIV testing among patients notified with TB in Denmark during a 3‐year period from 2007 to 2009. We were able to obtain HIV testing status for 96%. There was a significant increase of patients examined for HIV infection during the 3‐year period. HIV prevalence among HIV‐tested TB patients in Denmark is much higher than in the average population. It seems there is an increasing awareness in Denmark towards testing TB cases for HIV co‐infection.
Association of injecting drug use and late enrolment in HIV medical care in Odessa Region, Ukraine
Authors: Kiriazova TK , Postnov OV , Perehinets IB , Neduzhko OO
Published: August 2013

Objectives

Late entry of HIV‐positive persons into specialized care is a significant challenge to limiting the spread of the HIV epidemic. In 2008–2010, only 54% of 108 116 persons who tested HIV positive enrolled in care at AIDS Centers in Ukraine, and almost half of new AIDS cases are found in patients with first‐time HIV diagnoses. We aimed to identify factors associated with delayed enrolment in HIV care in Odessa Region, Ukraine.

Methods

We conducted a retrospective data analysis of patients who enrolled in HIV care in 1995–2010, comparing patients on the basis of the reported route of HIV transmission (injecting drug use or sexual transmission). The nonparametric Mann−Whitney U‐test was used to compare the groups.

Results

During the period analysed, the delay in enrolment in HIV care among people who inject drugs (PWID) in Odessa Region was longer than that among people infected via sexual transmission. The mean delay in enrolment in care among PWID increased over time for men and women; their mean age at the time of enrolment also gradually increased. Urban residents accounted for the majority of HIV cases, with some growth in the proportion of rural residents.

Conclusions

People who acquired HIV via injecting drug use showed later enrolment in HIV care compared with people infected via sexual transmission. There is an urgent need to improve HIV counselling and referral services, taking into account differences in the behaviour of drug‐using and non‐drug‐using populations.
Routine HIV testing in the emergency department: tough lessons in sustainability
Authors: Rayment M , Rae C , Ghooloo F , Doku E , Hardie J , Finlay S , Gidwani S , Atkins M , Roberts P , Sullivan AK
Published: August 2013

Objectives

Routine HIV testing in nonspecialist settings has been shown to be acceptable to patients and staff in pilot studies. The question of how to embed routine HIV testing, and make it sustainable, remains to be answered.

Methods

We established a service of routine HIV testing in an emergency department (ED) in London, delivered by ED staff as part of routine clinical care. All patients aged 16 to 65 years were offered an HIV test (latterly the upper age limit was removed). Meetings were held weekly and two outcome measures examined: test offer rate (coverage) and test uptake. Sustainability methodology (process mapping; plan‐do‐study‐act (PDSA) cycles) was applied to maximize these outcome measures.

Results

Over 30 months, 44 582 eligible patients attended the ED. The mean proportion offered an HIV test was 14%, varying from 6% to 54% per month over the testing period. The mean proportion accepting a test was 63% (range 33–100%). A total of 4327 HIV tests have been performed. Thirteen patients have been diagnosed with HIV infection (0.30%). PDSA cycles having the most positive and sustained effects on the outcome measures include the expansion to offer blood‐based HIV tests in addition to the original oral fluid tests, and the engagement of ED nursing staff in the programme.

Conclusions

HIV testing can be delivered in the ED, but constant innovation and attention have been required to maintain it over 30 months. Patient uptake remains high, suggesting acceptability, but time will be required before true embedding in routine clinical practice is achieved.
Quality of HIV care in the United Kingdom: key indicators for the first 12 months from HIV diagnosis
Authors: Delpech V , Brown AE , Croxford S , Chau C , Polavarapu V , Cooper N , Rooney G , Yin Z
Published: August 2013

Objectives

Prompt HIV diagnosis and treatment are associated with increased longevity and reduced transmission. The aim of the study was to examine late diagnoses and to assess the quality of care following diagnosis.

Methods

National surveillance and cohort data were used to examine late HIV diagnoses and to assess the quality of care received in the 12 months following HIV diagnosis.

Results

In 2011, 79% (4910/6219) of persons (15 years and over) diagnosed with HIV infection had CD4 counts reported within 3 months; of these, 49% were diagnosed late (CD4 count < 350 cells/μL). Adults aged 50 years and over were more likely to be diagnosed late (67%) compared with those aged 15–24 years (31%). Sixty‐four per cent of heterosexual men were diagnosed late compared with 46% of women and 36% of men who have sex with men (MSM) (P < 0.01). The percentage of late diagnoses was highest among black African adults (66%) compared with other ethnicities; 96% of black African adults diagnosed late were born abroad. Overall, 88% and 97% of patients were linked to care within 1 and 3 months of diagnosis, respectively, with little variation by demographics and exposure category. The crude 1‐year mortality rate was 31.6 per 1000 persons diagnosed in 2010. It was highest among adults diagnosed late (40.3/1000 versus 5.2/1000 for prompt diagnoses) and particularly among those aged 50 years and over. Excluding deaths, 85% of the 5833 diagnosed in 2010 were retained in care in 2011; 92% of the 2264 adults diagnosed late in 2010 received antiretroviral therapy by the end of 2011.

Conclusions

The National Health Service provides high‐quality care to persons newly diagnosed with HIV infection in the UK, with no evidence of health inequalities. Despite excellent care, half of adults are diagnosed late according to the threshold at which national guidelines recommend treatment should begin. Such patients have an 8‐fold increased risk of 1‐year mortality compared with those diagnosed promptly. Reducing late diagnosis of HIV infection remains a public health priority in the UK.
Week 96 analysis of rilpivirine or efavirenz in HIV‐1‐infected patients with baseline viral load ≤ 100 000 copies/mL in the pooled ECHO and THRIVE phase 3, randomized, double‐blind trials
Authors: Molina J‐M , Clumeck N , Orkin C , Rimsky LT , Vanveggel S , Stevens M ,   ECHO and THRIVE Study Groups
Published: August 2013

Objectives

These 96‐week, ECHO/THRIVE pooled analyses evaluated data for antiretroviral treatment‐naïve, HIV‐1‐infected adults with viral load (VL) ≤ 100 000 HIV‐1 RNA copies/mL receiving rilpivirine or efavirenz.

Methods

ECHO and THRIVE were phase 3, randomized, double‐blind trials. Patients received rilpivirine 25 mg once daily (qd) or efavirenz 600 mg qd, with a fixed (ECHO) or investigator‐chosen (THRIVE) nucleoside/tide reverse transcriptase inhibitor (N[t]RTI) background regimen. Response rate (the percentage of patients with VL < 50 copies/mL, using an intent‐to‐treat‐population, time‐to‐loss‐of‐virological‐response algorithm), virological failure (VF), resistance development, safety and tolerability were evaluated.

Results

Baseline characteristics were comparable between the rilpivirine (n = 368) and efavirenz (n = 329) groups. At week 96, response rates [84% for rilpivirine vs. 80% for efavirenz; difference 4.0%; 95% confidence interval (CI) –1.7% to 9.7%] and incidences of VF for the resistance analysis (VFres) (8% for rilpivirine vs. 6% for efavirenz; P = 0.46) were similar in the two groups. Among patients with VFres, a comparable proportion in each group developed nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance‐associated mutations (RAMs). Among those with VFres, more patients in the rilpivirine group than in the efavirenz group developed N[t]RTI RAMs, mostly M184I/V. The mean (95% CI) CD4 cell count increased from baseline to week 96 by 224 (208–240) cells/μL in the rilpivirine group and by 206 (188–225) cells/μL in the efavirenz group. Treatment‐related grade 2–4 overall adverse events, any rash and dizziness were less frequent for rilpivirine than for efavirenz (P < 0.0001).

Conclusions

Rilpivirine demonstrated antiviral efficacy similar to that of efavirenz in antiretroviral treatment‐naïve adults with baseline VL ≤ 100 000 copies/mL over 96 weeks. Frequencies of VFres and emergent NNRTI RAMs in each group were similar. More patients with VFres in the rilpivirine group than in the efavirenz group developed N[t]RTI RAMs (mostly M184I/V). Rilpivirine had a more favourable safety/tolerability profile than efavirenz.
Prognostic significance of the interval between the initiation of antiretroviral therapy and the initiation of anti‐tuberculosis treatment in HIV/tuberculosis‐coinfected patients: results from the TREAT Asia HIV Observational Database
Authors: Han SH , Zhou J , Lee MP , Zhao H , Chen Y‐MA , Kumarasamy N , Pujari S , Lee C , Omar SFS , Ditangco R , Phanuphak N , Kiertiburanakul S , Chaiwarith R , Merati TP , Yunihastuti E , Tanuma J , Saphonn V , Sohn AH , Choi JY ,   TREAT Asia HIV Observational Database
Published: August 2013

Objectives

We evaluated the effect of the time interval between the initiation of antiretroviral therapy (ART) and the initiation of tuberculosis (TB) treatment on clinical outcomes in HIV/TB‐coinfected patients in an Asian regional cohort.

Methods

Adult HIV/TB‐coinfected patients in an observational HIV‐infected cohort database who had a known date of ART initiation and a history of TB treatment were eligible for study inclusion. The time interval between the initiation of ART and the initiation of TB treatment was categorized as follows: TB diagnosed while on ART, ART initiated ≤ 90 days after initiation of TB treatment (‘early ART’), ART initiated > 90 days after initiation of TB treatment (‘delayed ART’), and ART not started. Outcomes were assessed using survival analyses.

Results

A total of 768 HIV/TB‐coinfected patients were included in this study. The median CD4 T‐cell count at TB diagnosis was 100 [interquartile range (IQR) 40‐208] cells/μL. Treatment outcomes were not significantly different between the groups with early ART and delayed ART initiation. Kaplan−Meier analysis indicated that mortality was highest for those diagnosed with TB while on ART (3.77 deaths per 100 person‐years), and the prognoses of other groups were not different (in deaths per 100 person‐years: 2.12 for early ART, 1.46 for delayed ART, and 2.94 for ART not started). In a multivariate model, the interval between ART initiation and TB therapy initiation did not significantly impact all‐cause mortality.

Conclusions

A negative impact of delayed ART in patients coinfected with TB was not observed in this observational cohort of moderately to severely immunosuppressed patients. The broader impact of earlier ART initiation in actual clinical practice should be monitored more closely.
A randomized clinical trial comparing metabolic parameters after 48 weeks of standard‐ and low‐dose stavudine therapy and tenofovir disoproxil fumarate therapy in HIV‐infected South African patients
Authors: Menezes CN , Crowther NJ , Duarte R , Van Amsterdam D , Evans D , Dickens C , Dix‐Peek T , Rassool M , Prinsloo A , Raal F , Sanne I
Published: August 2013

Objectives

Low‐dose stavudine therapy may have a lower toxicity profile compared with standard dose. A randomized controlled trial comparing these two doses of stavudine with tenofovir disoproxil fumarate (tenofovir DF) was performed to assess the effects on anthropometry, markers of inflammation, and lipid and glucose metabolism in Black South African patients.

Methods

Sixty patients were randomized 1:1:1 to either standard‐dose (30–40 mg) or low‐dose (20–30 mg) stavudine or tenofovir DF (300 mg), each combined with lamivudine and efavirenz, for 48 weeks. Anthropometry, markers of inflammation, and lipid and glucose metabolism were assessed using standard techniques.

Results

In all three treatment arms, there was a significant increase in lipid levels over the study period. At 48 weeks, fasting glucose level (P < 0.005) and homeostasis model assessment (HOMA) score (P < 0.05) increased significantly in the standard‐dose stavudine arm, as did insulin and C‐peptide levels in both the standard‐ and low‐dose stavudine arms. At week 48, a significant decrease (P < 0.05) in adiponectin was noted in the standard‐dose stavudine arm, but there was an increase (P < 0.005) in the tenofovir DF arm. In both the stavudine arms, significant increases in anthropometric measures occurred at 24 weeks but these decreased by week 48. Mitochondrial toxicities occurred in both the stavudine arms. Immunological and virological outcomes were similar for all three arms.

Conclusions

This study highlights the occurrence of metabolic abnormalities with both stavudine and tenofovir DF treatment. Awareness of the potential increased cardiovascular risk should be of concern with the use of both these therapies.
Geological framework and fission track dating of pseudotachylyte of the Atotsugawa Fault, Magawa area, central Japan
Authors: Takagi Hideo , Tsutsui Kosuke , Arai Hiroyoshi , Iwano Hideki , Danhara Tohru
Published: August 2013

This paper describes newly discovered pseudotachylyte along the Atotsugawa Fault at the Magawa outcrop, where this fault divides Quaternary deposits in the SW from Triassic Hida granitic rocks to the NE. Within several meters of the fault surface, pseudotachylyte veins are found with a thickness of less than 10 cm, but are displaced by fault brecciation. Zircon fission track dating of pseudotachylyte samples yields ages of 48.6–50.2 Ma (sample AT‐A), 55.1 Ma (AT‐A'‐1) and 60.9 Ma (AT‐D‐1); the latter is similar to the fission track ages of 56.1–60.1 Ma for granitic protoliths. The results of fission track length analyses in zircon suggest that pseudotachylytes (AT‐A and AT‐D‐1) and protolith granite are mostly annealed. Consequently, the pseudotachylyte (AT‐A) reached the highest temperature during 48.6–50.2 Ma, thereby resetting the fission track system totally in zircon during faulting. Another pseudotachylyte (AT‐A'‐1) and its wall rock granite contain shortened tracks within zircon grains suggesting partial annealing. The age distribution pattern of the former also contains decomposed age after the normality test (Shapiro–Wilk test) in which the major age yields 52.5 Ma. Accordingly, these pseudotachylytes yield a peak age of about 50 Ma, whereas the peak ages of one pseudotachylyte (AT‐D‐1) and the protolith Hida granitic rocks are about 60 Ma, representing the thermal effects not caused by frictional heating but by intrusions of Late Cretaceous to Paleogene granitoids that are probably concealed below the exposed Triassic Hida granitic rocks. Such thermal effects did not affect the K–Ar muscovite age (149 Ma) for the protolith granite because of the higher closure temperature of this system. Using the new geochronological data, we can elucidate the cooling history of the Hida granitic rocks, and constrain the timing of the main pulse of pseudotachylyte generation along the Atotsugawa Fault at about 50 Ma.