bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence of species recruitment and development of hot desert hypolithic communities
Authors: Makhalanyane Thulani P. , Valverde Angel , Lacap Donnabella C. , Pointing Stephen B. , Tuffin Marla I. , Cowan Don A.
Published: October 2012

Hypoliths, photosynthetic microbial assemblages found underneath translucent rocks, are widely distributed within the western region of the Namib Desert and other similar environments. Terminal restriction fragment length polymorphism (T‐RFLP) analysis was used to assess the bacterial community structure of hypoliths and surrounding soil (below and adjacent to the hypolithic rock) at a fine scale (10 m radius). Multivariate analysis of T‐RFs showed that hypolithic and soil communities were structurally distinct. T‐RFLP‐derived operational taxonomic units were linked to 16S rRNA gene clone libraries. Applying the ecological concept of ‘indicator species’, six and nine indicator lineages were identified for hypoliths and soil, respectively. Hypolithic communities were dominated by cyanobacteria affiliated to Pleurocapsales, whereas actinobacteria were prevalent in the soil. These results are consistent with the concept of species sorting and suggest that the bottom of the quartz rocks provides conditions suitable for the development of discrete and demonstrably different microbial assemblages. However, we found strong evidence for neutral assembly processes, as almost 90% of the taxa present in the hypoliths were also detected in the soil. These results suggest that hypolithons do not develop independently from microbial communities found in the surrounding soil, but selectively recruit from local populations.
Anti‐Bacterial Factors Secreted From Cumulus Cells of Ovulated COCs Enhance Sperm Capacitation During In Vitro Fertilization
Authors: Shimada Masayuki , Mihara Toshihiro , Kawashima Ikko , Okazaki Tetsuji
Published: October 2012

Problem

The aim of this study was to find immune‐related genes expressed in cumulus cells of ovulated cumulus oocyte complexes (COCs) and to clear the functional roles during fertilization process.

Method of study

Ovulated COCs were collected from oviduct 16 hr after the hCG injections followed by eCG priming. The cumulus cells were used for RT‐PCR or western blotting study. COCs were also used for in vitro fertilization study.

Results

Cramp, Trf, Lyz2, S100a8, and S100a9 were expressed in cumulus cells during ovulation process. The protein levels of CRAMP or transferrin were detected in ovulated COCs and then secreted into hyaluronan‐rich matrix. The high dose of these factors reduced the proliferative activity of E. coli; however, the lower levels of them significantly increased the rate of fertilization in in vitro via the induction of sperm capacitation.

Conclusion

Cumulus‐secreted anti‐bacterial factors act on sperm to induce sperm capacitation.
Speckle‐tracking analysis based on 2D echocardiography does not reliably measure left ventricular torsion
Authors: Parisi Valentina , Losi Maria Angela , Contaldi Carla , Chiacchio Elena , Pastore Fabio , Scatteia Alessandra , Giamundo Alessandra , Nardo Carlo di , Lombardi Raffaella , Betocchi Sandro
Published: October 2012

Purpose

Worldwide left ventricular (LV) twist is measured by 2D speckle tracking acquiring apical short axis at a LV level where papillary muscles are no longer visible; however, we hypothesized that this methodological recommendation is not enough accurate to obtain a reliable measurement of apical rotation.

Methods

We measured twist and untwist rate in 30 healthy subjects by following the earlier method. By 3D echocardiography, we identified two LV apex levels: (i) 3D Apex, defined as the last apical slice at which LV cavity was visible; (ii) 2D Apex, defined as the level where diameters are equal to those of apical LV short axis used for twist analysis in the same subject. The ratio between the distance of 2D Apex and 3D Apex from LV base was calculated and expressed as percentage (2D Apex/3D Apex).

Results

2D Apex/3D Apex was strongly related to the magnitude of twist and untwisting rate (r = 0·82, P<0·001; r = −0·46, P = 0·015, respectively). The only determinant of twist was 2D Apex/3D Apex (r2 = 0·68; r = 0·82; F ratio: 52·6, P<0·001); whereas untwisting rate was influenced by 2D Apex/3D Apex and age (r2 = 0·42; r = 0·65; F ratio: 7·7; P = 0·003 for 2D Apex/3D Apex; and P = 0·011 for age).

Conclusions

Left ventricular apical level acquisition, even when recorded in a standard manner, determines variability of twist mechanics measurements. Thus, current anatomical markers used to identify LV apex for twist analysis are not reliable and need different standardization. 3D echocardiography may help in such standardization.
Attenuation of contact hypersensitivity by cell‐permeable heat shock protein 70 in BALB/c mouse model
Authors: Park Jin Mo , Je Jeong Hwan , Wu Wen Hao , Jee Hyun Joong , Lee Sang‐Kyou , Lee Min‐Geol
Published: October 2012

In contact hypersensitivity (CHS), multiple cells, inflammatory mediators and cytokines are known to be involved in the regulation of the immune response. Previously, we revealed the reactive oxygen species generation by 2, 4, 6‐trinitrobenzene sulphonic acid (TNBS) in vivo, followed by heat shock protein 70 (Hsp70) carbonylation and the exogenous antioxidant role of cell‐permeable Hsp70. Here, we demonstrate the role of Hsp70 using cell‐permeable Hsp70 in the mouse CHS model. Pretreatment of cell‐permeable Hsp70: (i) suppressed ear swelling; (ii) down‐regulated phosphorylated p38, but up‐regulated phosphorylated extracellular signal‐regulated kinase; (iii) increased population of CD4+CD25+Foxp3+ T cells; (iv) decreased secretion of tumor necrosis factor‐α (TNF‐α), IL‐12, interferon‐γ and IL‐2 and (v) but up‐regulated IL‐4 and transforming growth factor beta (TGF‐β) in the lymph nodes. In conclusion, cell‐permeable Hsp70 attenuates CHS through modulation of MAPK pathway and regulation of Th1, Th2 and regulatory T cells.
Association between non‐atopic hand eczema and interleukin‐13 gene polymorphism in Taiwanese nursing population
Authors: Chen Yin‐Chun , Tu Hung‐Pin , Wu Ching‐Shuang , Ko Ying‐Chin , Yu Hsin‐Su , Lu Yi‐Wei , Li Wan‐Chen , Chen Gwo‐Shing , Lan Cheng‐Che E.
Published: October 2012

Chronic hand eczema is an important occupational skin disease with atopic dermatitis (AD) and wet work being the most important risk factors. This study was launched to analyse the potential association between AD‐related inflammation genes and development of non‐atopic hand eczema among nurses in University Hospital. Atopic eczema, non‐atopic hand dermatitis and control groups were identified. The association between occurrence of non‐atopic hand eczema and interleukin (IL)‐13, IL‐4 and IL‐5 gene variants was analysed. IL13 rs20541 A allele [assuming recessive model; odds ratio (OR) = 3.38, 95% CI: (1.63–7.00)] showed association with development of non‐atopic hand eczema. Additive score analyses showed combination of this gene variant with previously identified risk factors including certain SPINK5 polymorphism and more than 10 years of work experience conferred highest risk for development of non‐atopic hand eczema. As non‐atopic hand eczema made up significant portion of occupational skin diseases, further studies should be focused on this commonly encountered skin condition.
The Th2 cytokine, interleukin‐4, abrogates the cohesion of normal stratum corneum in mice: implications for pathogenesis of atopic dermatitis
Authors: Hatano Yutaka , Adachi Yasuko , Elias Peter M. , Crumrine Debra , Sakai Takashi , Kurahashi Rieko , Katagiri Kazumoto , Fujiwara Sakuhei
Published: October 2012

There is mounting evidence that Th2 cytokines adversely affect skin barrier functions and contribute to the pathogenesis of atopic dermatitis (AD). AD is also characterized by abnormal cohesion in the stratum corneum (SC). However, the contribution of Th2 cytokines to this abnormality remains unknown. This study examined the effects of IL‐4, a prototypic Th2 cytokine, on the cohesion of the SC. Structural and physiological assessments revealed that repeated intradermal injections of IL‐4 compromised the cohesion of the SC of normal hairless mice. Two potential mechanisms were explored to account for the altered cohesion. First, IL‐4 decreased the amount of corneodesmosomes and down‐regulated the expression of desmoglein 1, but not of corneodesmosin (CDSN) or loricrin expression, in murine skin and in cultured human keratinocytes (KC). IL‐4 did not affect the skin surface pH, and in situ zymography revealed no net change in total serine protease activity in the IL‐4‐treated SC. Yet, IL‐4 enhanced expression of kallikrein (KLK)7, while simultaneously down‐regulating KLK5 and KLK14. Finally, IL‐4 did not alter the expression of the lympho‐epithelial Kazal‐type inhibitor (LEKTI) in KC. This study suggests that IL‐4 abrogates the cohesion of SC primarily by reducing epidermal differentiation.
Influence of in vitro hemolysis on nucleated red blood cells and reticulocyte counts
Authors: Lippi G. , Pavesi F. , Cattabiani C. , Avanzini P. , Pipitone S.
Published: October 2012

Introduction

Nucleated red blood cells (NRBCs) and reticulocytes are early and important measures of red blood cells’ (RBCs) turnover, but little is known on how spurious hemolysis may affect the reliability of these parameters.

Materials and Methods

Ten EDTA‐anticoagulated samples were divided into three aliquots. The first was immediately tested, where;?>as the others (defined A and B) were mechanically hemolyzed by aspiration 5 and 10 times through a small‐gauge needle. RBC, NRBC, and reticulocyte counts were performed on Sysmex XE‐2100.

Results

An increasing amount of hemolysis was produced in hemolyzed aliquots A and B. The RBC and reticulocyte counts progressively decreased from the nonhemolyzed sample to hemolyzed aliquots ‘A’ and ‘B’. The NRBC count increased in 3 of the 10 samples and decreased in the remaining seven.

Conclusions

Hemolysis of venous blood samples may seriously jeopardize NRBC and reticulocyte counts.
Acute renal failure in cirrhotic patients with severe sepsis: Value of urinary interleukin‐18
Authors: Tsai Ming‐Hung , Chen Yung‐Chang , Yang Chih‐Wei , Jenq Chang‐Chi , Fang Ji‐Tseng , Lien Jau‐Min , Hung Cheng‐Chieh , Weng Hsu‐Huei , Wu Cheng‐Shyong , Peng Yun‐Shing , Shen Chien‐Heng , Tung Shui‐Yi , Tian Ya‐Chung
Published: October 2012

Background and Aim

Acute renal failure (ARF) is a common complication of liver cirrhosis and severe sepsis. Differentiating functional renal failure from acute tubular necrosis (ATN) has been difficult in this clinical setting. It has been shown that urinary interleukin 18 (IL‐18) can serve as a sensitive marker for ARF and ATN. This study was aimed to investigate the diagnostic and prognostic values of urinary IL‐18 in ARF associated with liver cirrhosis and severe sepsis.

Methods

We prospectively evaluated the relationship between urinary IL‐18 and clinical outcomes in 168 consecutive cirrhotic patients with severe sepsis.

Results

One hundred and eight patients (64.3%) developed ARF at admission to the intensive care unit. ARF was associated with higher urinary IL‐18 and impaired effective arterial volume. Renal failure was functional in 64 (59.2%), due to acute tubular necrosis (ATN) in 30 (27.7%), and mixed type in 14 (12.9%). Patients with ATN had significantly higher levels of urinary IL‐18, rates of vasopressor dependency, and hospital mortality than those with functional renal failure. By using the areas under receiver operating characteristic (AUROC) curve, urinary IL‐18 demonstrated an excellent discriminative power (AUROC 0.882) for diagnosing tubular injury in those with ARF. Meanwhile, hospital survivors had significantly lower urinary and serum IL‐18 levels, compared to non‐survivors. In multivariate analysis, urinary IL‐18, international normalized ratio, and mean arterial pressure were independent factors to predict hospital mortality.

Conclusions

Urinary IL‐18 can serve as a diagnostic and prognostic marker in cirrhotic patients with severe sepsis.
Australasian respiratory and emergency physicians do not use the pneumonia severity index in community‐acquired pneumonia
Authors: SERISIER DAVID J. , WILLIAMS SOPHIE , BOWLER SIMON D.
Published: October 2012

Background and objective:  The value of community‐acquired pneumonia (CAP) severity scoring tools is almost exclusively reliant upon regular and accurate application in clinical practice. Until recently, the Australasian Therapeutic Guidelines has recommended the use of the Pneumonia Severity Index (PSI) in spite of poor user‐friendliness.

Methods:  Electronic and postal survey of respiratory and emergency medicine physician and specialist registrar members of the Royal Australasian College was undertaken to assess the use of the PSI and the accuracy of its application to hypothetical clinical CAP scenarios. The confusion, urea, respiratory rate, blood pressure, age 65 or older (CURB‐65) score was also assessed as a simpler alternative.

Results:  Five hundred thirty‐six (228 respiratory, 308 emergency) responses were received. Only 12% of respiratory and 35% of emergency physicians reported using the PSI always or frequently. The majority were unable to accurately approximate PSI scores, with significantly fewer respiratory than emergency physicians recording accurate severity classes (11.8% vs 21%, OR 0.50, 95% CI: 0.37–0.68, P < 0.0001). In contrast, significantly more respiratory physicians were able to accurately calculate the CURB‐65 score (20.4% vs 15%, OR 1.45, 95% CI: 1.10–1.91, P = 0.006).

Conclusions:  Australasian specialist physicians primarily responsible for the acute management of CAP report infrequent use of the PSI and are unable to accurately apply its use to hypothetical scenarios. Furthermore, respiratory and emergency physicians contrasted distinctly in their use and application of the two commonest severity scoring systems—the recent recommendation of two further alternative scoring tools by Australian guidelines may add to this confusion. A simple, coordinated approach to pneumonia severity assessment across specialties in Australasia is needed.
Contribution of phage‐derived genomic islands to the virulence of facultative bacterial pathogens
Authors: Busby Ben , Kristensen David M. , Koonin Eugene V.
Published: October 2012

Facultative pathogens have extremely dynamic pan‐genomes, to a large extent derived from bacteriophages and other mobile elements. We developed a simple approach to identify phage‐derived genomic islands and apply it to show that pathogens from diverse bacterial genera are significantly enriched in clustered phage‐derived genes compared with related benign strains. These findings show that genome expansion by integration of prophages containing virulence factors is a major route of evolution of facultative bacterial pathogens.
RENAISSANCE OR REQUIEM: IS NUCLEAR ENERGY COST EFFECTIVE IN A POST‐FUKUSHIMA WORLD?
Authors: SCHWARZ PETER M. , COCHRAN JOSEPH A.
Published: October 2012

In the aftermath of Fukushima, decisions to slow or stop the future use of nuclear power have not been based on rational economic analysis. We find that there are cost‐effective technologies that would greatly mitigate future natural disasters. Even if the U.S. nuclear industry adopted new safety technologies and paid the full cost of insurance and borrowing, it is more efficient to continue to use existing nuclear plants than to replace them with new fossil fuel plants. However, new nuclear plant costs can exceed fossil fuel alternatives if the price of carbon emissions is below $118/ton. (JEL Q40, Q48, Q54)
Data‐Parallel Decompression of Triangle Mesh Topology
Authors: Meyer Quirin , Keinert Benjamin , Sußner Gerd , Stamminger Marc
Published: October 2012

We propose a lossless, single‐rate triangle mesh topology codec tailored for fast data‐parallel GPU decompression. Our compression scheme coherently orders generalized triangle strips in memory. To unpack generalized triangle strips efficiently, we propose a novel parallel and scalable algorithm. We order vertices coherently to further improve our compression scheme. We use a variable bit‐length code for additional compression benefits, for which we propose a scalable data‐parallel decompression algorithm. For a set of standard benchmark models, we obtain (min: 3.7, med: 4.6, max: 7.6) bits per triangle. Our CUDA decompression requires only about 15% of the time it takes to render the model even with a simple shader.
Synthetic Controllable Turbulence Using Robust Second Vorticity Confinement
Authors: He S , Lau R. W. H.
Published: October 2012

Capturing fine details of turbulence on a coarse grid is one of the main tasks in real‐time fluid simulation. Existing methods for doing this have various limitations. In this paper, we propose a new turbulence method that uses a refined second vorticity confinement method, referred to as robust second vorticity confinement, and a synthesis scheme to create highly turbulent effects from coarse grid. The new technique is sufficiently stable to efficiently produce highly turbulent flows, while allowing intuitive control of vortical structures. Second vorticity confinement captures and defines the vortical features of turbulence on a coarse grid. However, due to the stability problem, it cannot be used to produce highly turbulent flows. In this work, we propose a robust formulation to improve the stability problem by making the positive diffusion term to vary with helicity adaptively. In addition, we also employ our new method to procedurally synthesize the high‐resolution flow fields. As shown in our results, this approach produces stable high‐resolution turbulence very efficiently.
Security‐level classification for confidential documents by using adaptive neuro‐fuzzy inference systems
Authors: Alparslan Erdem , Karahoca Adem , Bahşi Hayretdin
Published: October 2012

The security‐level detection of a confidential document is a vital task for organizations to protect their confidential information. Diverse classification rules and techniques are being applied by human experts. Increasing number of confidential information in organizations is making difficult to classify all the documents carefully with human effort. The recommended frameworks in this study classify the internal documents of TUBITAK UEKAE (National Research Institute of Electronics and Cryptology of Turkey) by using classification algorithms naïve Bayes, support vector machines (SVMs) and adaptive neuro‐fuzzy inference systems (ANFISs). A hybrid approach involving support vector classifiers and adaptive neuro‐fuzzy classifiers exposes the most successful accuracy rates of expert system classification. This study also states preprocessing tasks required for document classification with natural language processing. To represent term–document relations, a recommended metric TF‐IDF was chosen to construct a weight matrix. Agglutinative nature of Turkish documents is handled by Turkish stemming algorithms. At the end of the article, some experimental results and success metrics are projected with accuracy rates and receiver operating characteristic (ROC) curves.
Move for Change Part II: a European survey evaluating the impact of the EPDA Charter for people with Parkinson's disease
Authors: Stocchi F. , Bloem B. R.
Published: October 2012

Background and purpose

The Move for Change campaign is a three‐part series of pan‐European surveys designed by the European Parkinson's Disease Association (EPDA) to assess the impact that the EPDA Charter for People with Parkinson's disease (PD) has had since its launch in 1997. Here, we report results from the second survey, focusing on the third right of the Charter; that is, ‘all patients have the right to have access to support services’. Although the level of evidence for different support services varies, it is important to ensure that patients can access services with clinically proven benefits.

Methods

This survey comprised nine questions administered online via the EPDA and PD organization Web sites. Accessibility of support services was defined as ‘services/medication/multidisciplinary healthcare professionals, etc. being available and on hand to patients when required’.

Results

Neurologists and general practitioners (GPs) received highest accessibility results (90.0 and 87.0% of respondents, respectively), with moderate results for physiotherapists (68.0%) and PD organizations (72.0%) and lower results for PD specialist nurses (26.0%), occupational therapists (23.0%), and counselors (27.0%). Support provided by neurologists and PD specialists was considered to be ‘very helpful’ by 59.0 and 55.7%, respectively, whilst only 31.8% of respondents gave such favorable ratings to GPs. Funding of services was variable across Europe.

Conclusions

These data demonstrate the challenges faced by PD patients in accessing the adequate care and support required throughout the course of their disease. These findings can assist healthcare professionals and policymakers in improving access to support services for patients and their families across Europe.
Characteristics and natural course of neonatal and infantile gastrointestinal milk allergy and the efficacy of oral immunotherapy
Authors: Arakawa H. , Yagi H. , Koyama H. , Nakajima N. , Takizawa T.
Published: October 2012

The characteristics and natural course of gastrointestinal (GI) allergies, which mainly affect infants and young children, are not fully determined. We investigated the nature of neonatal and infantile GI allergies and the efficacy of slow oral immunotherapy in patients with persistent symptoms. We observed 12 patients (five boys, seven girls) aged at first presentation from 0 days to 8 months after birth. Detailed interviews, peripheral blood eosinophil counts, antigen‐specific IgE antibody levels, antigen‐specific lymphocyte stimulation tests (LSTs), stool occult blood eosinophil counts and skin tests were performed in combination with milk elimination tests. Five patients underwent an intestinal mucosal biopsy. Provocation testing was used to assess tolerance acquisition. The only clinical symptom in six patients was bloody stool, while vomiting, fever, poor weight gain or hepatic dysfunction developed in six patients. Milk‐specific LSTs were positive in 10 of 11 cases tested. Lower GI endoscopy showed large numbers of infiltrating eosinophils in four of five patients with an intestinal mucosal biopsy. Provocation tests to confirm tolerance acquisition were performed in three patients. Interestingly, one patient suffered IgE‐mediated GI anaphylaxis during the provocation test. One patient had a sustained high LST index, and elimination of dairy milk products was continued. At 4 years of age, she underwent an oral challenge test. On ingestion of 5 mL of milk, she exhibited fever, loose stool, poor appearance and increased white blood cell counts, which was considered a positive provocation test. Therefore, slow oral immunotherapy was started using 1/20 of the threshold dose, with fat intake at least four times per week. This was steadily increased by 20% over 2 weeks without inducing symptoms. The characteristics of neonatal and infantile GI allergies are diverse, and they generally remit spontaneously. However, patients who do not develop tolerance may be suitable choices for oral immunotherapy.
Sublingual immunotherapy for Japanese cedar pollinosis: current status in Japan
Authors: Gotoh M. , Okubo K.
Published: October 2012

Immunotherapy is not generally used in Japan and very few medical institutions perform it. For radical treatment, immunotherapy should be selected. However, subcutaneous immunotherapy has not yet gained acceptance. Japanese cedar pollinosis is a seasonal allergic rhinitis that is indigenous to Japan and occurs with a nationwide mean prevalence of 25%. Clinical research on sublingual immunotherapy for Japanese cedar pollinosis has made progress and it should come into practical use within 2–3 years. If sublingual immunotherapy becomes practical, it should provide a new treatment option for Japanese cedar pollinosis.
The Impact of Illness on Retirement Finances
Authors: KELLY SIMON J. , PERCIVAL RICHARD , SCHOFIELD DEBORAH J. , SHRESTHA RUPENDRA N. , CALLANDER EMILY J. , PASSEY MEGAN E.
Published: October 2012

Early retirement due to illness reduces financial capacity over the long term. Using a microsimulation model called Health&WealthMOD, it was found that for Australians aged 45–64, those out of the labour force due to ill health would accumulate a significantly lower amount of savings by age 65 than what they could have accumulated if they had no chronic condition and remained in the labour force. They will also have access to an annuity, which provides as little as $40 per year. This is a concern as self‐reliance is seen to be a key strategy of government to offset the financial burden of ageing populations and to raise living standards of older persons.
Role of Pain Medications, Consultants, and Other Services in Improved Pain Control of Elderly Adults with Cancer in Geriatric Evaluation and Management Units
Authors: Nipp Ryan , Sloane Richard , Rao Arati V. , Schmader Kenneth E. , Cohen Harvey J.
Published: October 2012

Objectives

To determine whether pain medication use and inpatient consultations and services were associated with significantly better pain control.

Design

Secondary data analysis from a randomized two‐by‐two factorial trial. Hospitalized, frail individuals aged 65 and older were randomized to receive care in a geriatric inpatient unit, a geriatric outpatient clinic, both, or neither.

Setting

Eleven Veterans Affairs Medical Centers.

Participants

Ninety‐nine individuals with a diagnosis of cancer, excluding nonmelanoma skin cancer; 44 received geriatric evaluation and management unit (GEMU) care and 55 usual care.

Measurements

Pain medications were measured at baseline and discharge; consultations and other services were quantified for the entire admission.

Results

Participants receiving GEMU care had a significantly higher number of consultations than those in usual care. Participants in GEMU care received psychiatry, endocrinology, and psychology consultations 12.7% (P = .004), 9.1% (P = .04), and 21.8% (P = .05) times more, respectively, and occupational and physical therapy 27.3% (P = .004) and 18.2% (P = .04) more, respectively. There were no significant differences in pain medication use between intervention and usual care.

Conclusion

Significantly greater use of psychology, psychiatry, physical and occupational therapy in the GEMU participants may have improved the effectiveness of pain management in individuals in inpatient GEMUs. Although analgesic use was not significantly different between the GEMU and usual care groups, small sample size may have limited the ability to detect these differences.
Self‐Help Treatment for Insomnia Symptoms Associated with Chronic Conditions in Older Adults: A Randomized Controlled Trial
Authors: Morgan Kevin , Gregory Pamela , Tomeny Maureen , David Beverley M. , Gascoigne Claire
Published: October 2012

Objectives

To evaluate the effectiveness of a self‐help cognitive behavioral intervention in improving sleep quality in older adults reporting insomnia symptoms associated with chronic disease.

Design

A pragmatic two‐arm randomized controlled trial comparing supported self‐help with treatment as usual (TAU).

Setting

Primary care.

Participants

One hundred ninety‐three self‐referred individuals aged 55 to 87 with long‐term conditions and chronic insomnia symptoms (as defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition).

Intervention

Self‐help participants received six consecutive booklets, at weekly intervals, providing structured advice on important components of cognitive behavioral therapy for insomnia (CBT‐I, including self‐monitoring, sleep restriction, stimulus control procedures, and cognitive strategies), plus access to a telephone helpline. Control group participants received a single sheet of advice detailing standard sleep hygiene measures.

Measurements

The primary outcome was sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI). Secondary outcomes were the Insomnia Severity Index (ISI), the subjective sleep efficiency index, and the Fatigue Severity Scale.

Results

In the self‐help group, sleep outcomes showed significant improvements after treatment (PSQI, P < .001; ISI, P < .001; sleep efficiency, P < .001) and at 3‐month (PSQI, P = .002; ISI, P = .006; sleep efficiency, P = .001) and 6‐month (PSQI, P = .003; ISI, P = .003; sleep efficiency, P = .001) follow‐up. Effect sizes were moderate (range of adjusted Cohen d = 0.51–0.75). Treatment had no effect on levels of daytime fatigue. Most treated participants (73%) said they would recommend the self‐help program to others.

Conclusion

Self‐help CBT‐I offers a practical first‐line response to individual reporting insomnia symptoms associated with chronic disease in primary care settings. In these individuals, symptoms of daytime fatigue may be more closely associated with disease processes than with sleep quality.
Resistance of a subset of red blood cells to clearance by antibodies in a mouse model of incompatible transfusion
Authors: Liepkalns Justine S. , Cadwell Chantel M. , Stowell Sean R. , Hod Eldad A. , Spitalnik Steven L. , Zimring James C.
Published: October 2012

Background

Alloimmunization to antigens on transfused red blood cells (RBCs) represents a major barrier to chronic transfusion. In extreme cases of multiple alloimmunization, clinicians may be faced with the decision of transfusing incompatible RBCs or risking death from lack of transfusion. The disastrous results of hemolytic transfusion reactions are well understood, and major pathways of clearance have been described. However, well described but poorly understood is the survival of a subset of incompatible donor RBCs during hemolysis, despite antibody binding.

Study Design And Methods

We utilize a tractable murine model of incompatible transfusion in which RBCs from transgenic donor mice expressing human glycophorin A (hGPA) are transfused into recipients passively immunized with anti‐hGPA.

Results

As in humans, the majority of RBCs are cleared but a subset of incompatible donor RBCs persist in circulation, despite being bound by antibodies. Data contained herein reject the hypothesis that lack of clearance is due to insufficient antibody or overwhelming of phagocytic machinery; rather, we establish that surviving RBCs represent a distinct population resistant to clearance.

Conclusions

These studies demonstrate that surviving RBCs during incompatible transfusion can represent a population that is resistant to clearance.
Revisions of the Fish Invasiveness Screening Kit (FISK) for its Application in Warmer Climatic Zones, with Particular Reference to Peninsular Florida
Authors: Lawson Larry L. , Hill Jeffrey E. , Vilizzi Lorenzo , Hardin Scott , Copp Gordon H.
Published: October 2012

The initial version (v1) of the Fish Invasiveness Scoring Kit (FISK) was adapted from the Weed Risk Assessment of Pheloung, Williams, and Halloy to assess the potential invasiveness of nonnative freshwater fishes in the United Kingdom. Published applications of FISK v1 have been primarily in temperate‐zone countries (Belgium, Belarus, and Japan), so the specificity of this screening tool to that climatic zone was not noted until attempts were made to apply it in peninsular Florida. To remedy this shortcoming, the questions and guidance notes of FISK v1 were reviewed and revised to improve clarity and extend its applicability to broader climatic regions, resulting in changes to 36 of the 49 questions. In addition, upgrades were made to the software architecture of FISK to improve overall computational speed as well as graphical user interface flexibility and friendliness. We demonstrate the process of screening a fish species using FISK v2 in a realistic management scenario by assessing the Barcoo grunter Scortum barcoo (Terapontidae), a species whose management concerns are related to its potential use for aquaponics in Florida. The FISK v2 screening of Barcoo grunter placed the species into the lower range of medium risk (score = 5), suggesting it is a permissible species for use in Florida under current nonnative species regulations. Screening of the Barcoo grunter illustrates the usefulness of FISK v2 as a proactive tool serving to inform risk management decisions, but the low level of confidence associated with the assessment highlighted a dearth of critical information on this species.
Predictors of suboptimal and crash initiation of dialysis at two tertiary care centers
Authors: Chiu Kenrry , Alam Ahsan , Iqbal Sameena
Published: October 2012

Many end‐stage renal disease patients do not have an optimal start to dialysis. Many patients have suboptimal initiation, while others “crash” start on dialysis without prior care from a nephrologist. We examined factors associated with suboptimal or crash starts. We conducted a retrospective cohort study of 377 incident dialysis patients at two tertiary care centers from January 2006 to April 2011. Logistic regression was used to identify factors associated with suboptimal and crash starts to dialysis. Out of 377 patients, 102 (27%) had optimal starts, 221 (59%) had suboptimal starts, and 54 (14%) had crash starts. Three hundred thirty‐four patients (89%) began with hemodialysis, while 11% started with peritoneal dialysis. Factors independently associated with a suboptimal start as opposed to an optimal start included nephrology care more than 12 months prior to initiation of dialysis (odds ratio [OR], 0.26; 95% confidence interval [CI], 0.12–0.58), Charlson Comorbidity Index (OR, 1.25 per 1 point; 95% CI, 1.09–1.43), and age (OR, 1.02 per 1 year; 95% CI, 1.00–1.04). In comparison, diabetic nephropathy (OR, 0.25; 95% CI, 0.12–0.54), a history of pulmonary edema within 6 months prior to initiation of dialysis (OR, 3.70; 95% CI, 1.77–7.75), and a diagnosis of chronic obstructive lung disease (OR, 0.07; 95% CI, 0.01–0.52) were independently associated with a crash start. There was a low incidence of optimal dialysis starts in our tertiary care dialysis population. Our study highlights that suboptimal and crash start patients are distinct populations. Modifying factors that predict nonoptimal dialysis starts will need to consider these distinctions.
De novo HBV infection in a Mayo Clinic hemodialysis population: Economic impact of reduced HBV testing and a call for changes in current US CDC guidelines on HBV testing protocols
Authors: Onuigbo Macaulay A. C. , Onuigbo Nnonyelum T. C.
Published: October 2012

Hemodialysis (HD) exposes end‐stage renal disease patients to significantly higher risks for Hepatitis B Virus (HBV) infection, a major public health scourge. Therefore, current US CDC guidelines, last revised in 2001, call for monthly HbsAg tests. The charge to Medicare per HbsAg test is $100. In an economic analysis, we hypothesized that in the new environment of Medicare Fee Bundling, this is unwise and wasteful if de novo HBV infection rate among HD patients is <1%. We determined de novo HBV infection rate among a Mayo Clinic HD cohort, July 2000–July 2010. A retrospective analysis of all relevant medical records of the cohort was completed to identify de novo HBV infection. Nine hundred sixty‐five HD patients were analyzed. One case of de novo HBV infection was identified in a 54‐year old known IV drug user, a previous Hepatitis C carrier. This translates to a de novo HBV case incidence rate of 0.1%. De novo HBV infection among HD patients in the US, 2000–2010, is only 0.1%. In the early 1970s, rates were as high as 30%. We recommend 3‐monthly HbsAg testing, but to continue current monthly testing for IV drug users and other high‐risk groups. Huge cost savings would result, without any compromise of quality outcomes. With over 500,000 HD patients, this represents a mind‐boggling $40 billion savings in Medicare charges over 10 years. The US CDC should revise these outdated guidelines, last revised in 2001, to fall in line with current clinical realities on the ground.
Decompensated high‐output congestive heart failure in a patient with AVF and the role of right heart catheterization: A case study
Authors: Malhotra Kunal , Dhawan Vibhu , Dalal Pranav , Ariyamuthu Venkatesh , Bichu Prasad , Botdorf Joshua , Khanna Ramesh
Published: October 2012

A 70‐year‐old Caucasian male presented 8 months postcadaveric renal transplant with slowly progressive shortness of breath, abdominal distention, and cough for a duration of a few days. Thorough evaluation found him to have severe pulmonary hypertension (PH) on echocardiogram with decompensated high‐output congestive heart failure. A right heart catheterization was done, which confirmed elevated right‐sided pressures and high cardiac output. The mean pulmonary artery pressure, on a Swan–Ganz catheter, improved from 37 to 30 mmHg on partial manual occlusion of his still functioning hemodialysis arteriovenous fistula. Subsequently, the patient underwent ligation of the fistula and this led to gradual improvement in his symptoms. Follow‐up right heart catheterization and echocardiogram showed marked improvement and normalization of right heart pressures. We recommend that patients with arteriovenous fistula should undergo close monitoring for development of early signs and symptoms of congestive heart failure and screening for PH by echocardiography post‐kidney transplant. Right heart catheterization should be considered if screening is positive. Risk and benefit of fistula closure should be weighed in face of reduced survival from PH in dialysis patients and closure should be considered in post‐transplant patients.
Improving Interunit Transitions of Care Between Emergency Physicians and Hospital Medicine Physicians: A Conceptual Approach
Authors: Beach Christopher , Cheung Dickson S. , Apker Julie , Horwitz Leora I. , Howell Eric E. , O’Leary Kevin J. , Patterson Emily S. , Schuur Jeremiah D. , Wears Robert , Williams Mark
Published: October 2012

ACADEMIC EMERGENCY MEDICINE 2012; 19:1188–1195 © 2012 by the Society for Academic Emergency Medicine

Patient care transitions across specialties involve more complexity than those within the same specialty, yet the unique social and technical features remain underexplored. Further, little consensus exists among researchers and practitioners about strategies to improve interspecialty communication. This concept article addresses these gaps by focusing on the hand‐off process between emergency and hospital medicine physicians. Sensitivity to cultural and operational differences and a common set of expectations pertaining to hand‐off content will more effectively prepare the next provider to act safely and efficiently when caring for the patient. Through a consensus decision‐making process of experienced and published authorities in health care transitions, including physicians in both specialties as well as in communication studies, the authors propose content and style principles clinicians may use to improve transition communication. With representation from both community and academic settings, similarities and differences between emergency medicine and internal medicine are highlighted to heighten appreciation of the values, attitudes, and goals of each specialty, particularly pertaining to communication. The authors also examine different communication media, social and cultural behaviors, and tools that practitioners use to share patient care information. Quality measures are proposed within the structure, process, and outcome framework for institutions seeking to evaluate and monitor improvement strategies in hand‐off performance. Validation studies to determine if these suggested improvements in transition communication will result in improved patient outcomes will be necessary. By exploring the dynamics of transition communication between specialties and suggesting best practices, the authors hope to strengthen hand‐off skills and contribute to improved continuity of care.
Localization of c‐MYB in differentiated cells during postnatal molar and alveolar bone development
Authors: Lungova Vlasta , Buchtova Marcela , Janeckova Eva , Tucker Abigail S. , Knopfova Lucia , Smarda Jan , Matalova Eva
Published: October 2012

The MYB family of transcription activators has been associated with a high proliferation rate and an undifferentiated state of cells in a number of tissues. Recently emerging data suggest that these molecules may also play a role in differentiation. In this study, the pattern of expression of c‐MYB was followed during postnatal stages of mouse molar odontogenesis using immunohistochemistry on serial sections. Along with an abundance of the c‐MYB protein in proliferating zones, we confirmed the presence of this protein in differentiated ameloblasts, odontoblasts, and osteoblasts. In addition, c‐MYB was also found in cementoblasts and alveolar fibroblasts. These findings suggest integration of c‐MYB into regulatory networks during hard‐tissue differentiation and mineralization.
Efficacy and Safety of Once-Daily Tadalafil in Men with Erectile Dysfunction Who Reported No Successful Intercourse Attempts at Baseline
Authors: Shabsigh Ridwan , Seftel Allen D. , Kim Edward D. , Ni Xiao , Burns Patrick R.
Published: October 2012

Introduction

Tadalafil is efficacious and well tolerated for erectile dysfunction (ED), but effects in men with “complete ED” are unclear.

Aim

To investigate effects of once-daily tadalafil in men with no successful intercourse attempts at baseline.

Methods

Through a post hoc, pooled-data analysis of four randomized, double-blind trials on the effects of tadalafil 2.5 or 5 mg (vs. placebo) in men with ED, we evaluated efficacy and safety in subjects with 0 “yes” responses to Sexual Encounter Profile question 3 (SEP3) during an initial 4-week treatment-free run-in period.

Main Outcome Measures

Changes from baseline in the SEP diary and the International Index of Erectile Function-erectile function (IIEF-EF) domain were subjected to analysis of covariance models.

Results

Five hundred ninety-five subjects with no successful attempts at baseline were included in the analysis. The mean (±standard deviation) age was 58.2 ± 10.7 years; and most subjects had ED for ≥1 year (95.0%). ED was severe in 61.5% and moderate in 26.4%. Approximately 45% had diabetes mellitus or hypertension. After 12 weeks, the mean per-patient SEP3 percentage increased from 0% to 32.4% with tadalafil 2.5 mg and to 46.4% with tadalafil 5 mg (each P < 0.001 vs. placebo). Corresponding data for successful penetration (SEP2) were increases from 21.1% to 48.2% with tadalafil 2.5 mg and from 24.4% to 66.2% with 5 mg (each P < 0.001 vs. placebo). Mean IIEF-EF increased from 9.7 to 15.7 with tadalafil 2.5 mg and from 10.7 to 19.2 with 5 mg (each P < 0.001 vs. placebo). Tadalafil also significantly improved the intercourse-satisfaction and overall-satisfaction domains (vs. placebo). Both doses of tadalafil were generally well tolerated, with adverse event rates similar to placebo.

Conclusions

The posttreatment intercourse success rate was 32% and 46% for tadalafil 2.5 mg and 5 mg, respectively, in men with no successful intercourse attempts at baseline.
A Pilot Study of HIV/STI Risk Among Men Having Sex with Men Using Erectile Dysfunction Medications: Challenges and Opportunities for Sexual Medicine Physicians
Authors: Goltz Heather Honoré , Coon David W. , Catania Joseph A. , Latini David M.
Published: October 2012

Introduction

A growing literature suggests relationships between erectile dysfunction medications (EDM) and riskier sexual behavior among men who have sex with men (MSM). Questions remain concerning EDM use and related HIV/sexually transmitted infections (STI) risk among older MSM, particularly those 40 years and over, for whom EDM may be medically warranted.

Aim

This exploratory pilot study explores the relationship between EDM and risky sexual behavior in a convenience sample of MSM using EDM and attending historic sex-on-premises venues.

Methods

We examined anonymous surveys from 139 MSM. Bivariate relationships were examined. We then fit a multiple logistic regression model to determine predictors of engaging in unprotected anal intercourse (UAI) at last EDM, using variables identified as being significantly related to UAI in the bivariate analyses. Potential predictors entered the model in a stepwise fashion.

Main Outcome Measures

The primary outcome measure was engaging in UAI at last EDM use.

Results

MSM participating in the study ranged from 27 to 77 years and averaged 52.0 years (standard deviation = 10.73 years). These participants were primarily older MSM; fewer were younger MSM (12.12%), under age 40. Participants reporting UAI at last EDM use (N = 41) were significantly younger (P < 0.01). Men visiting bars within the last 6 months reported less UAI (P < 0.01). Both variables were independent predictors of UAI in the logistic regression model (P < 0.01).

Conclusion

Similar to reports from younger MSM, our findings suggest older MSM using EDM and reporting UAI are also recreational drug users. We include recommendations for urologists and other sexual medicine physicians treating MSM who may be at elevated risk for HIV/STI infection because of joint EDM and club drug use.
Two Unconventional Risk Factors for Major Adverse Cardiovascular Events in Subjects with Sexual Dysfunction: Low Education and Reported Partner’s Hypoactive Sexual Desire in Comparison with Conventional Risk Factors
Authors: Rastrelli Giulia , Corona Giovanni , Fisher Alessandra D. , Silverii Antonio , Mannucci Edoardo , Maggi Mario
Published: October 2012

Introduction

The classification of subjects as low or high cardiovascular (CV) risk is usually performed by risk engines, based upon multivariate prediction algorithms. However, their accuracy in predicting major adverse CV events (MACEs) is lower in high-risk populations as they take into account only conventional risk factors.

Aim

To evaluate the accuracy of Progetto Cuore risk engine in predicting MACE in subjects with erectile dysfunction (ED) and to test the role of unconventional CV risk factors, specifically identified for ED.

Methods

A consecutive series of 1,233 men (mean age 53.33 ± 9.08 years) attending our outpatient clinic for sexual dysfunction was longitudinally studied for a mean period of 4.4 ± 2.6 years.

Main Outcome Measure

Several clinical, biochemical, and instrumental parameters were evaluated. Subjects were classified as high or low risk, according to previously reported ED-specific risk factors.

Results

In the overall population, Progetto Cuore-predicted population survival was not significantly different from the observed one (P = 0.545). Accordingly, receiver operating characteristic (ROC) analysis shows that Progetto Cuore has an accuracy of 0.697 ± 0.037 (P < 0.001) in predicting MACE. Considering subjects at high risk according to ED-specific risk factors, the observed incidence of MACE was significantly higher than the expected for both low educated and patients reporting partner’s hypoactive sexual desire (HSD, both <0.05), but not for other described factors. The area under ROC curves of Progetto Cuore for MACE in subjects with low education and reported partner’s HSD were 0.659 ± 0.053 (P = 0.008) and 0.550 ± 0.076 (P = 0.570), respectively.

Conclusion

Overall, Progetto Cuore is a proper instrument for evaluating CV risk in ED subjects. However, in ED, other factors such as low education and partner’s HSD concur to risk profile. At variance with low education, Progetto Cuore is not accurate enough to predict MACE in subjects with partner’s HSD, suggesting that the latter effect is not mediated by conventional risk factors included in the algorithm.