bluuebunny/crossref_metadata_2025 huggingface dataset:
Dielectric and piezoelectric properties of PVDF/PZT composites: A review
Authors: Jain Anjana , K. J. Prashanth , Sharma Asheesh Kr. , Jain Arpit , P.N Rashmi
Published: May 2015

Smart materials, which exhibit piezoelectricity, find an eclectic range of applications in the industry. The direct piezoelectric effect has been widely used in sensor design, and the inverse piezoelectric effect has been applied in actuator design. Ever since 1954, PZT and BaTiO3 were widely used for sensor and actuator applications despite their toxicity, brittleness, inflexibility, etc. With the discovery of PVDF in 1969, followed by development of copolymers, a flexible, easy to process, nontoxic, high density alternate with high piezoelectric voltage coefficient was available. In the past 20 years, heterostructural materials like polymer ceramic composites, have received lot of attention, since these materials combine the excellent pyroelectric and piezoelectric properties of ceramics with the flexibility, processing facility, and strength of the polymers resulting in relatively high dielectric permittivity and breakdown strength, which are not attainable in a single phase piezoelectric material. The current review article is an attempt to provide a compendium of all the work carried out with reference to PVDF‐PZT composites. The review article evaluates the effect of grain size, content and other factors under the purview of dielectric and piezoelectric properties while evaluating the sensitivity of the material for sensor application. POLYM. ENG. SCI., 55:1589–1616, 2015. © 2015 Society of Plastics Engineers
Polystyrene‐montmorillonite core–shell particles via Pickering emulsion polymerization and their use as reinforcing additives for polypropylene and ethylene vinyl acetate
Authors: Moustafa A.B. , Abd El‐Aziz M.E. , Rabea A.M. , Essawy H.A.
Published: May 2015

Solid particles can be used as stabilizers for oil/water (o/w) emulsions instead of the conventional surfactants. Emulsion polymerization of styrene, as an example of polymerizable oil, was started in the current study after ultrasonication of the monomer into aqueous phase with aid of montmorillonite nanoplatelets as solid stabilizer. Imaging using a field emission scanning electron microscopy equipped with energy dispersive X‐ray unit as well as transmission electron microscopy proved the formation of polystyrene/montmorillonite as core–shell hybrid latex particles via Pickering mode of emulsification. The mechanical properties of polypropylene (PP) and ethylene vinyl acetate copolymer (EVA) were studied after addition of various loadings of these hybrids (2, 4, 8, 12, and 14 wt%). It could be ensured that the tolerance of PP towards phase separation caused by the insertion of the core–shell particles was higher than that of EVA, which translates into different extents of reinforcements. POLYM. ENG. SCI., 55:1546–1552, 2015. © 2015 Society of Plastics Engineers
Fabrication of 5.2% efficient Cu2ZnSn(S,Se)4 solar cells using DC‐sputtered metal precursors followed by sulfo‐selenization
Authors: Yang Han Sung , Agawane Ganesh , Shin Seung Wook , Vanalakar Sharadrao , Jung Woo Lim , Kim Jin Hyeok
Published: May 2015

In this study, we report Cu2ZnSn(S,Se)4 (CZTSSe) thin films synthesized by using a rapid thermal annealing process of direct current sputtered precursors under a sulfur and selenium atmosphere. X‐ray diffraction and Raman spectroscopy investigations showed formation of CZTSSe absorber layer without any secondary phase. X‐ray fluorescence spectroscopy showed a stoichiometric absorber layer has been formed which is suitable for use in solar cells. The best thin film solar cell of CZTSSe showed a photovoltaic performance of 5.2% efficiency (Voc: 585.0 mV, Jsc: 17.0 mA/cm2 and FF: 52.0%). This is the highest efficiency reported for CZTSSe prepared from sputtered Cu/Zn/Sn precursors followed by sulfo‐selenization using powder sources. (© 2015 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)
Crafting Business Architecture: the Antecedents of Business Model Design
Authors: Amit Raphael , Zott Christoph
Published: May 2015

Anchored in the broad design literature, we derive four antecedents of business model design: goals, templates, stakeholder activities, and environmental constraints. These business model design antecedents are illustrated using interview data from nine new ventures in the peer‐to‐peer lending space. We proceed with the theoretical development to link the design antecedents to the design themes of business models and conclude with implications for business model research and entrepreneurial leaders. Copyright © 2015 Strategic Management Society.
The cyclical nature of depressed mood and future risk: Depression, rumination, and deficits in emotional clarity in adolescent girls
Authors: Rubenstein Liza M. , Hamilton Jessica L. , Stange Jonathan P. , Flynn Megan , Abramson Lyn Y. , Alloy Lauren B.
Published: May 2015

Deficits in emotional clarity, the understanding and awareness of one's own emotions and the ability to label them appropriately, are associated with increased depressive symptoms. Surprisingly, few studies have examined factors associated with reduction in emotional clarity for adolescents, such as depressed mood and ruminative response styles. The present study examined rumination as a potential mediator of the relationship between depressive symptoms and changes in emotional clarity, focusing on sex differences. Participants included 223 adolescents (51.60% female, Mean age = 12.39). Controlling for baseline levels of emotional clarity, initial depressive symptoms predicted decreases in emotional clarity. Further, rumination prospectively mediated the relationship between baseline depressive symptoms and follow‐up emotional clarity for girls, but not boys. Findings suggest that depressive symptoms may increase girls' tendencies to engage in repetitive, negative thinking, which may reduce the ability to understand and label emotions, a potentially cyclical process that confers vulnerability to future depression.
Subjective memory impairment: No suitable criteria for case‐finding of dementia in primary care
Authors: Eichler Tilly , Thyrian Jochen René , Hertel Johannes , Wucherer Diana , Michalowsky Bernhard , Reiner Katinka , Dreier Adina , Kilimann Ingo , Teipel Stefan , Hoffmann Wolfgang
Published: May 2015

Introduction

Subjective memory impairment (SMI) might be used for the case‐finding of dementia. Present analyses aim to determine the diagnostic value and the predictive ability of SMI and related worries for the discrimination of patients screened positive or negative for dementia.

Methods

The analyses are based on data derived from the ongoing German general practioner (GP)‐based, randomized controlled trial DelpHi‐MV. A total of 5106 patients (age ≥ 70, living at home) were first asked for SMI and related worries and then screened for dementia in 110 participating GP practices (November 2011 to August 2014; preliminary data) using the DemTect.

Results

A total number of 2556 patients (50%) stated that they experience SMI and 892 patients (17%) screened positive for dementia. The sensitivity of SMI for the correct classification of positively screened patients was 54%, the positive predictive value (PPV) 19%. The specificity of SMI was 51%; the negative predictive value (NPV) 84%. Among 2480 patients with SMI, 45% reported SMI‐related worries (sensitivity 52%; specificity 57%; PPV 22%; NPV 84%). Receiver operating characteristics analyses showed no statistically significant improvement in the area under the curves when using SMI or related worries as predictors (additional to age and sex) for the discrimination between positively and negatively screened patients.

Discussion

The analyses showed that the risk of overlooking cognitive impairment in the subgroup of patients who state that they do not experience SMI would be unreasonable high. Thus, the results provide clear evidence that neither SMI nor related worries can be used as a valid criteria to decide whether an elderly primary care patient should be tested for dementia.

Trials registration: ClinicalTrials.gov Identifier: NCT01401582.
Georgia on my mind? Russian sanctions and the end of the ‘Rose Revolution’
Authors: Newnham Randall E.
Published: May 2015

In recent years Russia has launched a concerted effort to undermine pro-Western regimes in the former Soviet area by using economic sanctions. Most studies of this economic offensive have focused on Russia's obvious use of natural gas as a political weapon. This paper adds to that literature by showing how the Kremlin in fact uses many kinds of sanctions simultaneously. The case of Georgia illustrates this clearly. To undermine President Saakashvili Moscow used not only energy sanctions, but also trade and financial sanctions, as well as restrictions on Georgian migrant workers. As this case shows, democratic regimes may be particularly vulnerable to such economic sanctions, since even a relatively small economic decline can cause an incumbent to lose an election. The Russian effort in Georgia seems to have succeeded, as Saakashvili's party was driven from office in the 2012 and 2013 elections by Georgian Dream, a new coalition founded by Bidzina Ivanishvili, a billionaire who made his fortune in Russia. However, Ivanishvili has now found that he, too, faces Russian economic pressure.
Identity politics: Exploring Georgian foreign policy behavior
Authors: Kakachia Kornely , Minesashvili Salome
Published: May 2015

This paper analyses the extent to which Georgia's pro-Western foreign policy orientation stems from ideas and identity rather than from materialist and systemic factors alone. Finding such narrow approaches insufficient for explaining small state behavior, and drawing on liberal and constructivist approaches to international relations theory, the article argues that Georgia's foreign policy orientation has a strong basis in the widespread ideological perception amongst the local political elite that Georgia “belongs” in the West. Based on this theoretical framework, this paper provides a historical overview of Georgia's foreign policy, tracing the evolution of Georgia's identity from seeing itself as “Christian” in contrast to its Islamic neighbors, to identifying as European in contrast to a modern, Russian “other”. As Georgia attempts to construct a collective international identity, the devotion to the idea of Euro-Atlantic integration as a “sacred destiny” amongst the country's elite has significant foreign policy implications. This article overviews the current challenges and dilemmas of self-identification and investigates the roles that national identity and the prevailing “European” identity play in Georgia's quest for “desovietization”.
Unusual structures of TTTA repeats in icaC gene of Staphylococcus aureus
Authors: Guo Pei , Lam Sik Lok
Published: May 2015

One and two TTTA repeat expansions have been found in the coding region of icaC gene of Staphylococcus aureus variants which influence the expression of IcaC protein and alter the phenotype. Yet, the mechanism of these small‐size TTTA repeat expansions remains unclear. In this study, we performed high‐resolution nuclear magnetic resonance spectroscopic studies on TTTA repeats. Our results show that a DNA sequence containing three TTTA repeats can fold into dumbbell structures with a 3′ or 5′‐overhang. Exchange of these dumbbells makes the sequence behave like a 2‐nt TT mini‐loop at 25 °C. The occurrence of these mini‐loop and dumbbell structures in the nascent strand during DNA replication provides possible mechanistic pathways which account for one and two repeat expansions.
Contact genomics: scaffolding and phasing (meta)genomes using chromosome 3D physical signatures
Authors: Flot Jean-François , Marie-Nelly Hervé , Koszul Romain
Published: May 2015

High‐throughput DNA sequencing technologies are fuelling an accelerating trend to assemblede novo or resequence the genomes of numerous species as well as to complete unfinished assemblies. While current DNA sequencing technologies remain limited to reading stretches of a few hundreds or thousands of base pairs, experimental and computational methods are continuously improving with the goal of assembling entire genomes from large numbers of short DNA sequences. However, the algorithms that piece together DNA strands face important limitations due, notably, to the presence of repeated sequences or of multiple haplotypes within one genome, thus leaving many assemblies incomplete. Recently, the realization that the physical contacts experienced by a portion of a DNA molecule could be used as a robust and quantitative assay to determine its genomic position has led to the emerging field of contact genomics, which promises to revolutionize current genome assembly approaches by exploiting the flexible polymer properties of chromosomes. Here we review the current applications of contact genomics to genome scaffolding, haplotyping and metagenomic assembly, then outline the future developments we envision.
MicroRNA‐19a regulates proliferation and apoptosis of castration‐resistant prostate cancer cells by targeting BTG1
Authors: Lu Kai , Liu Chunhui , Tao Tao , Zhang Xiaowen , Zhang Lei , Sun Chao , Wang Yiduo , Chen Shuqiu , Xu Bin , Chen Ming
Published: May 2015

MicroRNAs (miRNAs) play a significant role in tumor development. Recent studies indicate that miRNAs are implicated in prostate cancer (PCa). In this study, we found that miR‐19a expression was significantly increased in castration‐resistant prostate cancer (CRPC) tissues compared with androgen‐dependent prostate cancer (ADPC) tissues. We found that inhibiting the overexpression of miR‐19a in CRPC cells suppressed proliferation and increased apoptosis. Additionally, we found that miR‐19a repressed BTG1 expression by binding to its 3′‐untranslated region. The overexpression of BTG1 in CRPC cells significantly suppressed proliferation and increased apoptosis. We conclude that miR‐19a regulates proliferation and apoptosis of CRPC cells by directly targeting the tumor suppressor gene BTG1.
Mutational analysis of HIV‐2 Vpx shows that proline residue 109 in the poly‐proline motif regulates degradation of SAMHD1
Authors: Ciftci Halil Ibrahim , Fujino Haruna , Koga Ryoko , Yamamoto Minami , Kawamura Sogo , Tateishi Hiroshi , Iwatani Yasumasa , Otsuka Masami , Fujita Mikako
Published: May 2015

In this study, we performed a mutational analysis to determine whether the mechanism by which HIV‐2 Vpx confers the capacity for infectivity and viral replication in macrophages is solely dependent on its ability to degrade the host antiviral factor SAMHD1. Contrary to expectations, we demonstrated that P109 in the C‐terminal poly‐proline motif of HIV‐2 Vpx has two unique roles: to facilitate the specific degradation of SAMHD1 in macrophages, and to facilitate multimerization of Vpx, therefore preventing SAMHD1 degradation in the presence of high levels of Vpx.
VPS29–VPS35 intermediate of retromer is stable and may be involved in the retromer complex assembly process
Authors: Fuse Atsuhito , Furuya Norihiko , Kakuta Soichiro , Inose Aki , Sato Masumi , Koike Masato , Saiki Shinji , Hattori Nobutaka
Published: May 2015

Retromer is a complex of proteins that functions in the endosome‐to‐Golgi retrieval cargo transport pathway. VPS35 works as the central subunit of retromer to recognize the cargos and binds with VPS29 and VPS26 via distinct domains. We show that deficiency of VPS35 or VPS29 accompanies degradation of other subunits, whereas VPS26 deficiency had no effect on VPS29 and VPS35 levels. Although VPS35 forms VPS26–VPS35 and VPS29–VPS35 sub‐complexes with similar efficiency in vitro, VPS26–VPS35 was more easily degradable by the ubiquitin–proteasome‐system than VPS29–VPS35. These results indicate that VPS29 and VPS35 form a biologically stable sub‐complex in vivo.
inv (4)(p13q13) in patient with essential thrombocythemia
Authors: Aydin Cigdem , Salim Ozan , Yucel Orhan Kemal , Undar Levent , Karauzum Sibel Berker
Published: May 2015

The inv (4)(p13q13) cytogenetic abnormality is uncommon in hematologic malignancies. So far, it has not been previously reported in patients with essential thrombocythemia (ET). We report a first case of ET with inv (4)(p13q13) karyotype in a 69-year-old female patient who developed myelofibrosis at follow up. Conventional cytogenetic analysis from a bone marrow sample showed 46, XX, inv (4)(p13q13) [3]/46, XX [4] at diagnosis and subsequent analysis revealed the same abnormal karyotype during the myelofibrosis phase (46, XX, inv (4)(p13q13) [13]/46, XX [26]). The prognostic significance of this chromosomal abnormality is unknown.
Corticosteroid responses following hypoxic preconditioning provide neuroprotection against subsequent hypoxic‐ischemic brain injury in the newborn rats
Authors: Feng Yangzheng , Bhatt Abhay J.
Published: May 2015

Limited research has evaluated the corticosteroids (CS) response in hypoxic preconditioning (PC) induced neuroprotection against subsequent hypoxic‐ischemic (HI) brain injury in newborns. To measure, CS response to hypoxic PC, at postnatal day 6 (P6), rat pups were randomly divided into sham, NoPC (exposure to 21% O2) and PC (exposure to 8% O2 for 3 h) groups. In a separate experiment, at P6, rat pups were randomly divided into three groups (sham, NoPC + HI, PC + HI). Rat pups in NoPC + HI and PC + HI groups, respectively had normoxic or hypoxic exposure for 3 h at P6 and then had the right carotid artery permanently ligated followed by 140 min of hypoxia at P7 (HI). Plasma CS levels were measured at 0.5, 1, 3, 6 and 12 h after hypoxic PC and hypoxic PC followed by HI. To investigate whether CS response to hypoxic PC provides neuroprotection against HI, at P6, rat pups were randomly divided into five groups. Fifteen minutes prior to PC or normoxic exposure, rat pups in DMSO + PC + HI and DMSO + NoPC + HI groups received DMSO while in RU486 + PC + HI and RU486 + NoPC + HI groups received RU486 (glucocorticoid receptor blocker, 60 mg/kg) s.c., respectively. Afterwards, rat pups were exposed to normoxia (DMSO + NoPC + HI, RU486 + NoPC + HI) or hypoxia (DMSO + PC + HI, RU486 + PC + HI) for 3 h and then HI 24 h later (P7). Rat pups at the corresponding age without any exposure to PC or HI or RU486/DMSO were used as sham. We found that hypoxic PC caused CS surge as well as augmented CS surge and preserved the glucocorticoid feedback regulation after HI. Hypoxic PC reduced HI induced early and delayed brain damage. RU486 partially but significantly inhibited hypoxic PC induced neuroprotection.
Fistula after attended delivery and the challenge of obstetric care capacity in the eastern Democratic Republic of Congo
Authors: Benfield Nerys , Young‐Lin Nichole , Kimona Christophe , Kalisya Luc M. , Kisindja Rogatien M.
Published: May 2015

Objective

To analyze the history of women with fistula in the eastern Democratic Republic of Congo (DRC) to understand the determinants of fistula development.

Methods

In a retrospective observational study, data were analyzed from a survey of all women who underwent surgical fistula repair at HEAL Africa Hospital, Goma, between April 1, 2009, and March 1, 2012. Characteristics and obstetric histories were obtained by self‐report.

Results

The mean age of the 202 participants at treatment was 30.7 years (range 5–69). The mean duration of fistula was 45.6 months (range 0–600). In total, 171 (91.4%) fistulas were caused by obstructed labor, and 147 (86.5%) were vesicovaginal. Most women (129/175 [73.8%]) reported having received care during early labor under the supervision of a nurse or doctor in a healthcare facility. Among 176 women for whom delivery data were available, 102 (57.9%) delivered at a hospital, 42 (23.8%) at a health center, and 32 (18.2%) at home. Only 46 (26.3%) of 175 women were transferred to a higher level of care during labor.

Conclusions

In the eastern DRC, efforts to enable transport to a healthcare facility and to encourage attended births must be accompanied by improvements in the capacity of existing facilities and in the training of staff to enable the timely diagnosis of labor abnormalities and appropriate intervention.
Prevention of mother‐to‐child transmission of syphilis and HIV in China: What drives political prioritization and what can this tell us about promoting dual elimination?
Authors: Wu Dadong , Hawkes Sarah , Buse Kent
Published: May 2015

Objective

The present study aims to identify reasons behind the lower political priority of mother‐to‐child transmission (MTCT) of syphilis compared with HIV, despite the former presenting a much larger and growing burden than the latter, in China, over the 20 years prior to 2010.

Methods

We undertook a comparative policy analysis, based on informant interviews and documentation review of control of MTCT of syphilis and HIV, as well as nonparticipant observation of relevant meetings/trainings to investigate agenda‐setting prior to 2010.

Results

We identified several factors contributing to the lower priority accorded to MTCT of syphilis: relative neglect at a global level, dearth of international financial and technical support, poorly unified national policy community with weak accountability mechanisms, insufficient understanding of the epidemic and policy options, and a prevailing negative framing of syphilis that resulted in significant stigmatization.

Conclusion

A dual elimination goal will only be reached when prioritization of MTCT of syphilis is enhanced in both the international and national agendas.
The cost‐effectiveness of 10 antenatal syphilis screening and treatment approaches in Peru, Tanzania, and Zambia
Authors: Terris‐Prestholt Fern , Vickerman Peter , Torres‐Rueda Sergio , Santesso Nancy , Sweeney Sedona , Mallma Patricia , Shelley Katharine D. , Garcia Patricia J. , Bronzan Rachel , Gill Michelle M. , Broutet Nathalie , Wi Teodora , Watts Charlotte , Mabey David , Peeling Rosanna W. , Newman Lori
Published: May 2015

Objective

Rapid plasma reagin (RPR) is frequently used to test women for maternal syphilis. Rapid syphilis immunochromatographic strip tests detecting only Treponema pallidum antibodies (single RSTs) or both treponemal and non‐treponemal antibodies (dual RSTs) are now available. This study assessed the cost‐effectiveness of algorithms using these tests to screen pregnant women.

Methods

Observed costs of maternal syphilis screening and treatment using clinic‐based RPR and single RSTs in 20 clinics across Peru, Tanzania, and Zambia were used to model the cost‐effectiveness of algorithms using combinations of RPR, single, and dual RSTs, and no and mass treatment. Sensitivity analyses determined drivers of key results.

Results

Although this analysis found screening using RPR to be relatively cheap, most (> 70%) true cases went untreated. Algorithms using single RSTs were the most cost‐effective in all observed settings, followed by dual RSTs, which became the most cost‐effective if dual RST costs were halved. Single test algorithms dominated most sequential testing algorithms, although sequential algorithms reduced overtreatment. Mass treatment was relatively cheap and effective in the absence of screening supplies, though treated many uninfected women.

Conclusion

This analysis highlights the advantages of introducing RSTs in three diverse settings. The results should be applicable to other similar settings.
Introduction of rapid syphilis testing in antenatal care: A systematic review of the impact on HIV and syphilis testing uptake and coverage
Authors: Swartzendruber Andrea , Steiner Riley J. , Adler Michelle R. , Kamb Mary L. , Newman Lori M.
Published: May 2015

Background

Global guidelines recommend universal syphilis and HIV screening for pregnant women. Rapid syphilis testing (RST) may contribute toward achievement of universal screening.

Objectives

To examine the impact of RST on syphilis and HIV screening among pregnant women.

Search strategy

We searched MEDLINE for English‐ and non‐English language articles published through November, 2014.

Selection criteria

We included studies that used a comparative design and reported on syphilis and HIV test uptake among pregnant women in low‐ and middle‐income countries (LMICs) following introduction of RST.

Data collection and analysis

Data were extracted from six eligible articles presenting findings from Asia, Africa, and Latin America.

Main results

All studies reported substantial increases in antenatal syphilis testing following introduction of RST; the latter did not appear to adversely impact antenatal HIV screening levels at sites already offering rapid HIV testing and may increase HIV screening among pregnant women in some settings. Qualitative data revealed that women were highly satisfied with RST. Nevertheless, ensuring adequate training for healthcare workers and supplies of commodities were cited as key implementation barriers.

Conclusions

RST may increase antenatal syphilis and HIV screening and contribute to the improvement of antenatal care in LMICs.
Lessons learned from integrating simultaneous triple point‐of‐care screening for syphilis, hepatitis B, and HIV in prenatal services through rural outreach teams in Guatemala
Authors: Smith Adriana , Sabidó Meritxell , Camey Elsy , Batres Anabelle , Casabona Jordi
Published: May 2015

Mother‐to‐child‐transmission of HIV, syphilis, and hepatitis B virus (HBV) remains a challenge in Guatemala, especially in rural regions. A triple antenatal screening program for these infections using point‐of‐care (POC) testing offered through outreach teams was implemented in the municipality of Puerto de San José. One year following program implementation, antenatal care coverage increased to 99.6% (32.5% increase, P < 0.001), testing uptake increased to 50.3% for HIV and syphilis (143.9% (P < 0.001) and 1.3% (P = 0.89) increase, respectively), and HBV testing increased from 0 to 42.2%. Lessons learned showed that, despite the expansion of triple antenatal POC screening in rural Guatemala, a shortage of healthcare workers and poor supply chain management limited screening uptake. Moreover, training is essential to help health workers overcome their fear of communicating positive results and improve partner notification. Engagement of community health workers was essential to build local capacity and facilitate community acceptance.
Elimination of mother‐to‐child transmission of HIV and syphilis: A dual approach in the African Region to improve quality of antenatal care and integrated disease control
Authors: Newman Owiredu Morkor , Newman Lori , Nzomo Theresa , Conombo Kafando Ghislaine , Sanni Saliyou , Shaffer Nathan , Bucagu Maurice , Peeling Rosanna , Mark Jennifer , Diop Toure Isseu
Published: May 2015

The World Health Organization's (WHO) Strategic Framework for the Elimination of New HIV Infections among Children in Africa by 2015 identifies important synergies for the elimination of mother‐to‐child transmission of HIV and syphilis in terms of prevention interventions, implementation logistics and service delivery, monitoring and evaluation systems, and need for sustained political commitment. The WHO advocates the use of an integrated, rights‐based dual approach with partnerships and collaboration to make the best use of available resources. Through a consultative approach, six countries in the African Region committed to dual elimination and developed and implemented action plans for this purpose. Where interest and commitment are high, this may also be possible and effective in other African countries.
Estimating the uptake of maternal syphilis screening and other antenatal interventions before and after national rollout of syphilis point‐of‐care testing in Ghana
Authors: Dassah Edward T. , Adu‐Sarkodie Yaw , Mayaud Philippe
Published: May 2015

Objective

To compare the uptake of maternal syphilis and HIV screening, intermittent preventive treatment for malaria, and tetanus toxoid administration in three regions of Ghana, before and after the rollout of syphilis point‐of‐care tests (POCTs).

Methods

Antenatal register records were reviewed in 15 selected health facilities over an eight‐month period, 16 months apart. Register records had been evaluated using the maternal record booklets as a gold standard in a separate prior survey.

Results

In the evaluation study, the sensitivity of register data was low, ranging from 33.3% for tetanus toxoid administration to 53.8% for syphilis serology. In total, 8282 antenatal client records (4141 in each period) were reviewed. Less than a third of pregnant women received any single intervention at either period (ranging from 17.8% for tetanus toxoid to 29.8% for HIV testing). Overall, HIV screening had a marginal absolute increase of about 2% while the remaining interventions experienced non‐significant absolute decreases of 4.1 to11.1%. When adjusting for under‐recording, syphilis screening uptake was 50% before and 33.6% after the introduction of POCTs.

Conclusion

Use of POCTs for syphilis did not result in increased uptake. Routine monitoring of antenatal interventions using the antenatal register may result in underestimation of their uptake.
The need for further integration of services to prevent mother‐to‐child transmission of HIV and syphilis in Mwanza City, Tanzania
Authors: Balira Rebecca , Mabey David , Weiss Helen , Ross David Anthony , Changalucha John , Watson‐Jones Deborah
Published: May 2015

Objective

To assess the operational integration of maternal HIV testing and syphilis screening in Mwanza, Tanzania.

Methods

Interviews were conducted with 76 health workers (HW) from three antenatal clinics (ANC) and three maternity wards in 2008–2009 and 1137 consecutive women admitted for delivery. Nine ANC health education sessions and client flow observations were observed.

Results

Only 25.0% of HWs reported they had received training in both prevention of mother‐to‐child transmission (PMTCT) and syphilis screening. HIV and syphilis tests were sometimes performed in different rooms and results recorded in separate registers with different formats and the results were not always given by the same person. At delivery, most women had been tested for both HIV (79.4%) and syphilis (88.1%) during pregnancy. Of those not tested antenatally for each infection, 70.1% were tested for HIV at delivery but none for syphilis.

Conclusion

Integration of maternal HIV and syphilis screening was limited. Integrated care guidelines and related health worker training should address this gap.
Bottlenecks in the implementation of essential screening tests in antenatal care: Syphilis, HIV, and anemia testing in rural Tanzania and Uganda
Authors: Baker Ulrika , Okuga Monica , Waiswa Peter , Manzi Fatuma , Peterson Stefan , Hanson Claudia
Published: May 2015

Objective

To identify and compare implementation bottlenecks for effective coverage of screening for syphilis, HIV, and anemia in antenatal care in rural Tanzania and Uganda; and explore the underlying determinants and perceived solutions to overcome these bottlenecks.

Methods

In this multiple case study, we analyzed data collected as part of the Expanded Quality Management Using Information Power (EQUIP) project between November 2011 and April 2014. Indicators from household interviews (n = 4415 mothers) and health facility surveys (n = 122) were linked to estimate coverage in stages of implementation between which bottlenecks can be identified. Key informant interviews (n = 15) were conducted to explore underlying determinants and analyzed using a framework approach.

Results

Large differences in implementation were found within and between countries. Availability and effective coverage was significantly lower for all tests in Uganda compared with Tanzania. Syphilis screening had the lowest availability and effective coverage in both countries. The main implementation bottleneck was poor availability of tests and equipment. Key informant interviews validated these findings and perceived solutions included the need for improved procurement at the central level.

Conclusion

Our findings reinforce essential screening as a missed opportunity, caused by a lack of integration of funding and support for comprehensive antenatal care programs.
Cortical microinfarcts on 3T MRI: Clinical correlates in memory‐clinic patients
Authors: van Veluw Susanne J. , Hilal Saima , Kuijf Hugo J. , Ikram Mohammad Kamran , Xin Xu , Yeow Tan Boon , Venketasubramanian Narayanaswamy , Biessels Geert Jan , Chen Christopher
Published: May 2015

Introduction

This is the first study to assess cerebral microinfarcts (CMIs) on 3 tesla (3T) magnetic resonance imaging (MRI) in a memory clinic population.

Methods

We included 238 consecutive patients (aged 72.5 ± 9.1 years) from a memory clinic in Singapore. All patients underwent extensive neurological and neuropsychological testing and 3T MRI on the same day. Cortical CMI rating criteria were adapted from a previous study on 7T MRI. We analyzed the frequency and association of cortical CMIs with demographic, clinical, cognition, and other MRI findings.

Results

Seventy‐five patients (32%) had cortical CMIs (median 1, range 1–43). Patients with CMIs showed worse cognitive functioning on MMSE, and in the domains of language and visuoconstruction. The presence of CMIs was related to other markers of small vessel disease, but most strongly larger cortical infarcts. Patients with CMIs were more often diagnosed with vascular dementia.

Discussion

Cortical CMIs on 3T MRI are a novel marker of cerebrovascular disease in dementia.
Evaluation of the anti-inflammatory and antioxidant effects of the sucralfate in diversion colitis
Authors: Martinez Carlos Augusto Real , Rodrigues Murilo Rocha , Sato Daniela Tiemi , da Silva Camila Morais Gonçalves , Kanno Danilo Toshio , Mendonça Roberta Laís dos Santos , Pereira José Aires
Published: May 2015

Sucralfate enemas present good results in the treatment of colitis, however the mechanism of action of the drug is not yet fully clarified.

Objective To evaluate the anti-inflammatory and antioxidant effects of sucralfate enemas in diversion colitis model.

Method Thirty-six Wistar rats underwent intestinal bypass by end colostomy in the descending colon and distal mucous fistula. The animals were divided into 3 experimental groups according to the daily dose of enemas received containing 0.9% SF, sucralfate enemas or sucralfate enemas 1 g/kg/day or 2 g/kg/day. Each group was divided into two subgroups according to euthanasia to be performed 2–4 weeks after derivation. The tissue grade of inflammation was assessed histologically, and neutrophil infiltration by the tissue expression of myeloperoxidase (MPO) identified by immunohistochemistry and quantified by computerized morphometry. Oxidative stress was measured by tissue levels of malondialdehyde (MDA). To compare the results the Student's t test variance was used, and also the variance by ANOVA test, establishing a level of significance of 5% (p < 0.05) for both.

Results The intervention with sucralfate enemas showed improvement in the intensity of tissue inflammation related to the concentration used and the duration of the intervention. Intervention with sucralfate enemas reduced the tissue levels of MPO, independent of concentration or time of intervention (p < 0.01). There was a reduction of MDA levels in animals irrigated with sucralfate enemas, independent of concentration or duration of the intervention (p < 0.01).

Conclusion Enemas with sucralfate enemas reduce inflammation, neutrophil infiltration and oxidative stress in the excluded colon suggesting topical application of the substance to be a valid therapeutic option for the treatment of diversion colitis.
Thymosin‐β4 is a determinant of drug sensitivity for Fenretinide and Vorinostat combination therapy in neuroblastoma
Authors: Cheung Belamy B. , Tan Owen , Koach Jessica , Liu Bing , Shum Michael S.Y. , Carter Daniel R. , Sutton Selina , Po'uha Sela T. , Chesler Louis , Haber Michelle , Norris Murray D. , Kavallaris Maria , Liu Tao , O'Neill Geraldine M. , Marshall Glenn M.
Published: May 2015

Retinoids are an important component of neuroblastoma therapy at the stage of minimal residual disease, yet 40–50% of patients treated with 13‐cis‐retinoic acid (13‐cis‐RA) still relapse, indicating the need for more effective retinoid therapy. Vorinostat, or Suberoylanilide hydroxamic acid (SAHA), is a potent inhibitor of histone deacetylase (HDAC) classes I & II and has antitumor activity in vitro and in vivo. Fenretinide (4‐HPR) is a synthetic retinoid which acts on cancer cells through both nuclear retinoid receptor and non‐receptor mechanisms. In this study, we found that the combination of 4‐HPR + SAHA exhibited potent cytotoxic effects on neuroblastoma cells, much more effective than 13‐cis‐RA + SAHA. The 4‐HPR + SAHA combination induced caspase‐dependent apoptosis through activation of caspase 3, reduced colony formation and cell migration in vitro, and tumorigenicity in vivo. The 4‐HPR and SAHA combination significantly increased mRNA expression of thymosin‐beta‐4 (Tβ4) and decreased mRNA expression of retinoic acid receptor α (RARα). Importantly, the up‐regulation of Tβ4 and down‐regulation of RARα were both necessary for the 4‐HPR + SAHA cytotoxic effect on neuroblastoma cells. Moreover, Tβ4 knockdown in neuroblastoma cells increased cell migration and blocked the effect of 4‐HPR + SAHA on cell migration and focal adhesion formation. In primary human neuroblastoma tumor tissues, low expression of Tβ4 was associated with metastatic disease and predicted poor patient prognosis. Our findings demonstrate that Tβ4 is a novel therapeutic target in neuroblastoma, and that 4‐HPR + SAHA is a potential therapy for the disease.
Maximum Power During Vertical Jump and Isometric Knee Extension Torque Alter Mobility Performance: A Cross‐Sectional Study of Healthy Individuals
Authors: Tsubaki Atsuhiro , Kubo Masayoshi , Kobayashi Ryosaku , Jigami Hirofumi , Sugawara Kazuhiro , Takahashi Hideaki E.
Published: May 2015

Objective

To provide reference values of muscle function (MF) and mobility performance (MP) and to clarify the effects of MF on MP.

Design

A normative cross‐sectional study.

Setting

An urban area of Niigata, Japan.

Participants

A total of 401 individuals (210 men and 191 women) with a mean age of 41.8 years (range, 7‐79 years) who lived in the community and did not have impairments in activities of daily living.

Methods

Grip strength, isometric knee extension torque (IKET), and maximum ground reaction force (Fmax) and maximum power (Pmax) during a vertical jump were used as measurements of MF. The chair‐rise test (CRT) and the timed “Up and Go” test (TUG) were used to assess MP.

Main Outcome Measurements

Mean values of GS, IKET, CRT, TUG, Fmax, and Pmax were calculated according to age and gender. A stepwise multiple regression analysis was used to identify MF factors with an effect on CRT and TUG in participants ≥20 years of age.

Results

Our results showed that all MF parameters were decreased in individuals ≥20 years of age compared to those <20 years old. Moreover, all of the MP parameters increasingly deteriorated with increasing age. CRT and TUG were affected by Pmax and IKET in men and by IKET in women according to logistic regression analysis.

Conclusion

The study findings suggest that muscle power affects MP more than the muscle strength in persons aged ≥20 years.
Effect of Hypertonic Saline in Intra‐Articular Hydraulic Distension for Adhesive Capsulitis
Authors: Lee Jong Hwa , Kim Sang Beom , Lee Kyeong Woo , Lee Sook Joung , Lee Jae Uk
Published: May 2015

Background

Maintaining the integrity of the capsule along with infusing a sufficient amount of fluid is 1 of the therapeutic concepts in intra‐articular hydraulic distension (IHD) for adhesive capsulitis. It has been known that hypertonic saline solution decreases tissue edema and increases the fluid volume within the epidural space, causing microdissection, in epidural adhesiolysis.

Objective

To investigate the effect of hypertonic saline solution in capsule‐preserving intra‐articular hydraulic distension (CPIHD) for adhesive capsulitis.

Design

Prospective randomized controlled trial.

Setting

University outpatient clinic of physical medicine and rehabilitation.

Participants

A total of 64 patients who were diagnosed as adhesive capsulitis of shoulder were randomly assigned to 1 of 2 treatment groups. The hypertonic saline group was treated by CPIHD with hypertonic saline (3% NaCl), and the normal saline group with normal saline solution (0.9% NaCl).

Methods

Both groups were treated with CPIHD, a method that preserves the capsule with maximal distension without inducing capsule rupture. The volume of saline solution necessary to adequately distend the capsule was recorded. Injection materials contained 4 mL of 1% lidocaine, 1 mL of triamcinolone (10 mg), and saline solution (hypertonic or normal saline). The intra‐articular injection was monitored with ultrasound to maximize the infused volume while preserving the capsule.

Main Outcome Measurements

The Shoulder Pain and Disability Index (SPADI) and shoulder passive range of motion (PROM) was measured before the procedure and 2 weeks after CPIHD.

Results

The mean CPIHD volume was 20.2 ± 5.2 mL for the hypertonic saline group and 19.5 ± 5.9 mL for the normal saline group. The hypertonic saline group showed statistically significant improvement in shoulder PROM and SPADI score compared with the normal saline group. Side effects such as soreness or complications related to injection were not reported.

Conclusions

Our results suggest that CPIHD with hypertonic saline solution is more effective than that using normal saline solution in patients with adhesive capsulitis.
Complete Spinal Accessory Nerve Palsy From Carrying Climbing Gear
Authors: Coulter Jess M. , Warme Winston J.
Published: May 2015

We report an unusual case of spinal accessory nerve palsy sustained while transporting climbing gear. Spinal accessory nerve injury is commonly a result of iatrogenic surgical trauma during lymph node excision. This particular nerve is less frequently injured by blunt trauma. The case reported here results from compression of the spinal accessory nerve for a sustained period—that is, carrying a load over the shoulder using a single nylon rope for 2.5 hours. This highlights the importance of using proper load-carrying equipment to distribute weight over a greater surface area to avoid nerve compression in the posterior triangle of the neck. The signs and symptoms of spinal accessory nerve palsy and its etiology are discussed. This report is particularly relevant to individuals involved in mountaineering and rock climbing but can be extended to anyone carrying a load with a strap over one shoulder and across the body.
Plato's Anti-hedonism and the Protagoras
Authors: Shaw J. Clerk
Published: May 2015

Plato often rejects hedonism, but in the Protagoras, Plato's Socrates seems to endorse hedonism. In this book, J. Clerk Shaw removes this apparent tension by arguing that the Protagoras as a whole actually reflects Plato's anti-hedonism. He shows that Plato places hedonism at the core of a complex of popular mistakes about value and especially about virtue: that injustice can be prudent, that wisdom is weak, that courage is the capacity to persevere through fear, and that virtue cannot be taught. The masses reproduce this system of values through shame and fear of punishment. The Protagoras and other dialogues depict sophists and orators who have internalized popular morality through shame, but who are also ashamed to state their views openly. Shaw's reading not only reconciles the Protagoras with Plato's other dialogues, but harmonizes it with them and even illuminates Plato's wider anti-hedonism.
Catholicism and the Great War
Authors: Houlihan Patrick J.
Published: May 2015

This transnational comparative history of Catholic everyday religion in Germany and Austria-Hungary during the Great War transforms our understanding of the war's cultural legacy. Challenging master narratives of secularization and modernism, Houlihan reveals that Catholics from the losing powers had personal and collective religious experiences that revise the decline-and-fall stories of church and state during wartime. Focusing on private theologies and lived religion, Houlihan explores how believers adjusted to industrial warfare. Giving voice to previously marginalized historical actors, including soldiers as well as women and children on the home front, he creates a family history of Catholic religion, supplementing studies of the clergy and bishops. His findings shed new light on the diversity of faith in this period and how specifically Catholic forms of belief and practice enabled people from the losing powers to cope with the war much more successfully than previous cultural histories have led us to believe.
King William's Tontine
Authors: Milevsky Moshe
Published: May 2015

In a time before bonds, treasury notes, or central banks, there were tontines. These were schemes in which a group of investors lent money to a government, corporation, or king, similar to a modern-day loan syndicate. But unlike conventional debt, periodic interest payments were distributed only to survivors. As tontine nominees died, the income of survivors correspondingly increased. Morbid, perhaps, but this was one of the earliest forms of longevity insurance in which the pool shared the risk. Moshe Milevsky tells the story of the first tontine issued by the English government in 1693, known as King William's tontine, intended to finance the war against French King Louis XIV. He explains how tontines work, the financial and economic thinking behind them, as well as why they fell into disrepute. Milevsky concludes with a provocative argument that suitably modified tontines should be resurrected for twenty-first century retirement income planning.
Climate Change as Social Drama
Authors: Smith Philip , Howe Nicolas
Published: May 2015

Climate change is not just a scientific fact, nor merely a social and political problem. It is also a set of stories and characters that amount to a social drama. This drama, as much as hard scientific or political realities, shapes perception of the problem. Drs Smith and Howe use the perspective of cultural sociology and Aristotle's timeless theories about narrative and rhetoric to explore this meaningful and visible surface of climate change in the public sphere. Whereas most research wants to explain barriers to awareness, here we switch the agenda to look at the moments when global warming actually gets attention. Chapters consider struggles over apocalyptic scenarios, explain the success of Al Gore and An Inconvenient Truth, unpack the deeper social meanings of the climate conference and 'Climategate', critique failed advertising campaigns and climate art, and question the much touted transformative potential of natural disasters such as Superstorm Sandy.