bluuebunny/crossref_metadata_2025 huggingface dataset:
A Clinical Rule (Sex, Contralateral Occlusion, Age, and Restenosis) to Select Patients for Stenting Versus Carotid Endarterectomy
Authors: Touzé Emmanuel , Trinquart Ludovic , Felgueiras Rui , Rerkasem Kittipan , Bonati Leo H. , Meliksetyan Gayané , Ringleb Peter A. , Mas Jean-Louis , Brown Martin M. , Rothwell Peter M.
Published: October 2013

Background and Purpose—

Compared with carotid endarterectomy (CEA), carotid angioplasty and stenting (CAS) is associated with a higher risk of procedural stroke or death especially in patients with symptomatic stenosis. However, after the perioperative period, risk is similar with both treatments, suggesting that CAS could be an acceptable option in selected patients.

Methods—

We performed systematic reviews of observational studies of procedural risks of CEA or CAS and extracted data on 9 predefined risk factors (age, contralateral carotid occlusion, coronary artery disease, diabetes mellitus, sex, hypertension, peripheral artery disease, and type and side of stenosis). We calculated pooled relative risks of procedural stroke or death. Factors with differential effects on risk of CAS versus CEA were identified by interaction tests and used to derive a rule. The rule was tested using individual patient data from randomized trials of CAS versus CEA from the Carotid Stenting Trialists’ Collaboration (CSTC).

Results—

We identified 170 studies. The effects of sex, contralateral occlusion, age, and restenosis (SCAR) on the procedural risk of stroke or death differed. Patients with contralateral occlusion or restenosis and women <75 years were at relatively low risk for CAS (SCAR negative), with all others being high risk (SCAR positive). Among the 3049 patients in the CSTC validation, 694 (23%) patients were SCAR negative. The pooled RR of procedural stroke and death with CAS versus CEA was 0.93 (0.49–1.77;
P
=0.83) in SCAR-negative and 2.41 (1.68–3.45;
P
<0.0001) in SCAR-positive patients (
P
[interaction]=0.05).

Conclusions—

The SCAR rule is potentially useful to identify patients in whom CAS has a similar risk of perioperative stroke or death to CEA.
Stroke Awareness Among Inpatient Nursing Staff at an Academic Medical Center
Authors: Adelman Eric E. , Meurer William J. , Nance Dorinda K. , Kocan Mary Jo , Maddox Kate E. , Morgenstern Lewis B. , Skolarus Lesli E.
Published: October 2013

Background and Purpose—

Because 10% of strokes occur in hospitalized patients, we sought to evaluate stroke knowledge and predictors of stroke knowledge among inpatient and emergency department nursing staff.

Methods—

Nursing staff completed an online stroke survey. The survey queried outcome expectations (the importance of rapid stroke identification), self-efficacy in recognizing stroke, and stroke knowledge (to name 3 stroke warning signs or symptoms). Adequate stroke knowledge was defined as the ability to name ≥2 stroke warning signs. Logistic regression was used to identify the association between stroke symptom knowledge and staff characteristics (education, clinical experience, and nursing unit), stroke self-efficacy, and outcome expectations.

Results—

A total of 875 respondents (84% response rate) completed the survey and most of the respondents were nurses. More than 85% of respondents correctly reported ≥2 stroke warning signs or symptoms. Greater self-efficacy in identifying stroke symptoms (odds ratio, 1.13; 95% confidence interval, 1.01–1.27) and higher ratings for the importance of rapid identification of stroke symptoms (odds ratio, 1.23; 95% confidence interval, 1.002–1.51) were associated with stroke knowledge. Clinical experience, educational experience, nursing unit, and personal knowledge of a stroke patient were not associated with stroke knowledge.

Conclusions—

Stroke outcome expectations and self-efficacy are associated with stroke knowledge and should be included in nursing education about stroke.
Cost of Spontaneous Intracerebral Hemorrhage in Canada During 1 Decade
Authors: Specogna Adrian V. , Patten Scott B. , Turin Tanvir C. , Hill Michael D.
Published: October 2013

Background and Purpose—

Spontaneous intracerebral hemorrhage (ICH) is widely considered to be the most devastating form of stroke in North America. Currently there is no clear understanding of the cost of treatment in Canada and thus no way of understanding how to manage ICH spending in this country.

Methods—

We used a cohort study design to report and to examine the cost of ICH hospital care in a Canadian health center during 1 decade. Economic, treatment, and patients data were obtained from clinical and administrative sources.

Results—

Analyses were performed using 987 consecutive patients with ICH from 1999 to 2008. The total inflation-adjusted cost of care was highly variable (median cost per discharge, $10 544.45 and $363.54 [min] to $265 470.43 [max] United States Dollars). Total cost did not change significantly during the decade. Patients age (cost change per year older, −$114.06 and −$189.01 to −$38.78) and in-hospital mortality (cost change for death, −$5092.84 and −$6270.65 to −$3697.09) were significantly associated with lower cost, whereas Charlson Comorbidity Index (cost change for ≥1, $5726.27 and $3965.36 to $7755.45), having surgery (cost change for surgery, $25 499.78 and $20 813.95 to $30 933.06), and admission National Institutes of Health Stroke Scale (cost change for ≥15 points, $7800.20 and $1637.78 to $17 026.38) were significantly associated with higher cost.

Conclusions—

To our knowledge, this is the most thorough published study to date to report and to examine predictors of ICH treatment costs in Canada. This study provides evidence that it may be reasonable to consider patients age, probability of death, level of comorbidity, need for surgery, and baseline ICH severity when forecasting health spending.
A new species of Munidopsis (Anomura, Galatheoidea, Munidopsidae) from the Gulf of California, western Mexico
Authors: Hendrickx Michel E. , Ayón-Parente Manuel
Published: October 2013

A new species ofMunidopsisWhiteaves, 1784 is described from the SW Gulf of California, western Mexico. The new species differs from all other known species ofMunidopsisof the East Pacific by the presence of numerous antero-posteriorly compressed processes on the carapace, many of which are truncate and with crenulated anterior margin, by its oval-shaped carapace, wider in its posterior half, and by the short, subrectangular, narrow rostrum with an upturned distal portion. It also differs from the East Pacific species and other species ofMunidopsisby the densely pitted carapace and appendages.
A Forty-Year Search for a Single-Negotiating Text: Rio+20 as a Post-Agreement Negotiation
Authors: Wagner Lynn M.
Published: October 2013

Abstract

This article elaborates on the place of the United Nations Conference on Sustainable Development (UNCSD, also known as Rio+20) in a forty-year trajectory of international sustainable development negotiations, particularly through the processes placed in motion during the 1992 Rio Earth Summit event. The negotiation of the final UNCSD document also can be evaluated in its own right, and the article examines this process in the second section, keeping in mind the negotiating system in which the talks took place. The final section focuses on the process as a post-agreement negotiation and considers the role of the twenty-year milestone negotiations in shaping the sustainable development regime. The article explores in particular the role that consensus negotiated agreements have played as the regime’s decision-making procedure, and how this procedure has faltered as the complexity – including the number of issues, actors and obligations incorporated into the regime – has increased. Two elements from the Rio+20 outcome – a “take-it-or-change-it” facilitation approach of the Brazilian hosts and the adoption of a process to create “sustainable development goals” as a different means to focus international expectations – are presented as new directions for decision making in the regime’s next rounds of regime governance and regime adjustment negotiations.
Nuclear Politics of Denial: South Africa and the Additional Protocol
Authors: Pretorius Joelien
Published: October 2013

Abstract

South Africa was one of the first states to conclude an Additional Protocol with the International Atomic Energy Agency (IAEA) in 2002, allowing the IAEA greater right of access to safeguard nuclear activities and material. In light of this, some observers in the arms control community find it odd that South Africa’s representatives at the Nuclear Suppliers Group (NSG) would be the main objectors to making the conclusion of an Additional Protocol a precondition for states wishing to import uranium enrichment and reprocessing technology (classified as sensitive nuclear technology and material). The South African objection should be viewed as only the most recent in a series of objections to measures that may seem obviously in line with nuclear non-proliferation. This emerging pattern in South Africa’s nuclear diplomacy and, more specifically, the objection to the Additional Protocol condition are related to its membership in the Non-Aligned Movement (NAM) and can be investigated through the lens of a politics of denial. Denial is the act of saying “no”, but it is also in psychological parlance the unconscious thought process manifesting a refusal to acknowledge the existence of certain unpleasant aspects of external reality. It will be argued that South Africa’s opposition to the Additional Protocol condition can be explained in the context of two instances of denial: (i) a perceived denial by the nuclear haves of what the Nuclear Non-Proliferation Treaty codifies as an inalienable right to peaceful nuclear technology – something that South Africa is cautious to be complicit in; and (ii) the nuclear weapon states’ denial (the psychological meaning) of the unpleasant reality of a hypocritical nuclear order – something that South Africa wants to expose or at least something with which to engage to limit the effects for itself and other NAM members. The politics of denial does not yield to a pragmatist/utopian dichotomy in the nuclear realm, but instead reveals the dialectic nature of realism and idealism in nuclear politics, especially as reflected in South Africa’s nuclear diplomacy.
The Social Life of Illegal Drug Users in Prison: A Comparative Perspective
Authors: Oleinik Anton
Published: October 2013

Different degrees of criminalization of illegal drug use influence the overall composition of prison populations across countries. Individuals convicted of illegal drug-related crimes represent a significant part of the prison population in Kazakhstan, Russia and Ukraine. These convicts are not a part of the traditional criminal milieu, but a product of the perception of certain acts as crimes in particular contexts (e.g., an increasing social distance, the state’s control over potentially dangerous groups, etc.). The experience of incarceration might cause important changes in their life after release. The idea that prison contributes to the interiorization of criminal norms rather than preventing deviant behavior in the future seems especially fruitful in regard to illegal drug users. Elements of prison subculture are described on the basis of an empirical research conducted in 1996-2003 in Russian prisons (N = 769 (49 of these were convicted in relation to illegal drugs) in 2000-2001; and N = 214 (24) in 2003). The social organization of everyday life of inmates convicted of drug-related offences in Russia, Kazakhstan (N = 396 (76) in 2001) and Ukraine (N = 208 (26) in 2003) is compared with that of other convicts to test the hypothesis about the lack of significant differences between the two groups.
Observed Atmospheric Response to Cold Season Sea Ice Variability in the Arctic
Authors: Frankignoul Claude , Sennéchael Nathalie , Cauchy Pierre
Published: October 2013

The relation between weekly Arctic sea ice concentrations (SICs) from December to April and sea level pressure (SLP) during 1979–2007 is investigated using maximum covariance analysis (MCA). In the North Atlantic sector, the interaction between the North Atlantic Oscillation (NAO) and a SIC seesaw between the Labrador Sea and the Greenland–Barents Sea dominates. The NAO drives the seesaw and in return the seesaw precedes a midwinter/spring NAO-like signal of the opposite polarity but with a strengthened northern lobe, thus acting as a negative feedback, with maximum squared covariance at a lag of 6 weeks. Statistical significance decreases when SLP is considered in the whole Northern Hemisphere but it increases when North Pacific SIC is included in the analysis. The maximum squared covariance then occurs after 8 weeks, resembling a combination of the NAO response to the Atlantic SIC seesaw and the Aleutian–Icelandic low seesaw-like response to in-phase SIC changes in the Bering and Okhotsk Seas, which is found to lag the North Pacific SIC. Adding SST anomalies to the SIC anomalies in the MCA leads to a loss of significance when the MCA is limited to the North Atlantic sector and a slight degradation in the Pacific and hemispheric cases, suggesting that SIC is the driver of the midwinter/spring atmospheric signal. However, North Pacific cold season SST anomalies also precede a NAO/Arctic Oscillation (AO)-like SLP signal after a shorter delay of 3–4 weeks.
Dynamical Effects of Aerosol Perturbations on Simulated Idealized Squall Lines
Authors: Lebo Zachary J. , Morrison Hugh
Published: October 2013

The dynamical effects of increased aerosol loading on the strength and structure of numerically simulated squall lines are explored. Results are explained in the context of Rotunno–Klemp–Weisman (RKW) theory. Changes in aerosol loading lead to changes in raindrop size and number that ultimately affect the strength of the cold pool via changes in evaporation. Thus, the balance between cold pool and low-level wind shear–induced vorticities can be changed by an aerosol perturbation. Simulations covering a wide range of low-level wind shears are performed to study the sensitivity to aerosols in different environments and provide more general conclusions. Simulations with relatively weak low-level environmental wind shear (0.0024 s−1) have a relatively strong cold pool circulation compared to the environmental shear. An increase in aerosol loading leads to a weakening of the cold pool and, hence, a more optimal balance between the cold pool– and environmental shear–induced circulations according to RKW theory. Consequently, there is an increase in the convective mass flux of nearly 20% in polluted conditions relative to pristine. This strengthening coincides with more upright convective updrafts and a significant increase (nearly 20%) in cumulative precipitation. An increase in aerosol loading in a strong wind shear environment (0.0064 s−1) leads to less optimal storms and a suppression of the convective mass flux and precipitation. This occurs because the cold pool circulation is weak relative to the environmental shear when the shear is strong, and further weakening of the cold pool with high aerosol loading leads to an even less optimal storm structure (i.e., convective updrafts begin to tilt downshear).
Partisan Personality
Authors: Sweetser Kaye D.
Published: October 2013

Focusing on the psychological underpinnings of partisanship, this study asks whether there is a difference in the personality profile for self-described Democrats and Republicans. Using a survey of young voters ( N = 610), psychological measures such as the Big Five personality dimensions and locus of control were measured in conjunction with standard political interest variables such as political cynicism and political information efficacy. The results indicate supporters for the two major parties are wired differently, in line with previous findings about ideology. Democrats were driven by an external locus of control and Republicans by an internal locus. This research finds self-identified Independents as truly being somewhere in between.
Are Nasopharyngeal Cultures Useful in Diagnosis of Acute Bacterial Sinusitis in Children?
Authors: Shaikh Nader , Hoberman Alejandro , Colborn D. Kathleen , Kearney Diana H. , Jeong Jong H. , Kurs-Lasky Marcia , Barbadora Karen A. , Bowen A’Delbert , Flom Lynda L. , Wald Ellen R.
Published: October 2013

The diagnosis of acute bacterial sinusitis can be challenging because symptoms of acute sinusitis and an upper respiratory tract infection (URI) overlap. A rapid test, if accurate in differentiating sinusitis from URI, could be helpful in the diagnostic process. We examined the utility of nasopharyngeal cultures in identifying the subgroup of children with a clinical diagnosis of acute sinusitis who are least likely to benefit from antimicrobial therapy (those with completely normal sinus radiographs). Nasopharyngeal swabs were collected from 204 children meeting a priori clinical criteria for acute sinusitis. All children had sinus X-rays at the time of diagnosis. To determine if negative nasopharyngeal culture results could reliably identify the subgroup of children with normal radiographs, we calculated negative predictive values and negative likelihood ratios. Absence of pathogens in the nasopharynx was not helpful in identifying this low-risk subgroup.
Individualization: A double-edged sword: Welfare, the experience of social risks and the need for social insurance in the Netherlands
Authors: Achterberg Peter , Raven Judith , van der Veen Romke
Published: October 2013

For various reasons the process of individualization has always been supposed to be linked to a decline in welfare state support. Because of individualization, it is commonly argued people appreciate collectively organized welfare less and less. This article studies whether individualists really support the welfare state less than collectivists. In order to examine this, the authors use data collected in 2006 in the Netherlands. Distinguishing between two types of individualism, the study finds that people who are structurally disembedded from their institutional environment – the structural individualists – do not indeed support the welfare state. Moreover, for these structural individualists, the socioeconomic risks they run and their actual class position do not translate into support for the welfare state. Contrary to this, the study finds that people who can be classified as cultural individualists – those who emphasize individuality – are more supportive of the welfare state. For these cultural individualists it is also found that their socioeconomic position and interests influence the way they think about the welfare state. Cultural individualists hence are more supportive of the welfare state, and especially so for those in weak socioeconomic positions.
Politeness Strategies in Imagined Conversation Openers About Eldercare
Authors: Pitts Margaret J. , Fowler Craig , Fisher Carla L. , Smith Stephanie A.
Published: October 2013

In the United States, many adult children and their aging parents reach the point when it is necessary to address future care needs of the parent. Given that the prevailing culture values independence over interdependence, discussing future care needs can be face threatening. Therefore, an examination of how adult children approach such conversations and manage face needs is an important first step toward understanding what makes these conversations effective and supportive. We use politeness theory to illuminate ways in which adult children incorporate facework in imagined messages (“openers”) to initiate a conversation with their aging parent about eldercare. Openers were thematically coded for politeness strategies and messages. Imagined openers featured complex “strings” of positive and negative politeness strategies. Implications are addressed.
A parent-based book-reading intervention for disadvantaged children with language difficulties
Authors: Colmar Susan Hilary
Published: October 2013

Children with delayed language skills, who were from a socio-economic area defined as disadvantaged, made significant improvements in language skills after their parents were trained in easily learned strategies, enabling them to make simple changes in the way they interacted with their children. The 36 children, mean age five years, were allocated into three groups: an Experimental group and a Control group, where all the children had language delays and/or difficulties, and a second Control group of children whose language was measured within the average range. Parents of children in the Experimental group were trained and asked to implement the strategies. The intervention strategies used during book reading and during everyday conversations included: pausing and encouraging the child to talk more on their chosen topic, over a four-month period. Using an ANCOVA on difference scores with children’s pre-intervention language scores for each variable as the covariate, significant results were obtained at post testing. Further, large effect sizes were measured using Cohen’s d. In addition, a Student–Newman–Keuls test on difference scores confirmed that the significant changes were obtained for the Experimental group, as predicted.
Cytotoxic effect of 4-hydroxytamoxifen conjugate material on human Schwann cells: Synthesis and characterization
Authors: Escobar Ivirico Jorge L , Beaumont Marco , García Cruz Dunia M , Gómez-Pinedo Ulises A , Pradas Manuel M
Published: October 2013

In this study, the toxicity of 4-hydroxytamoxifen (4-OHT) on human Schwann cells (HSCs) was evaluated. Substantial alterations in the cell morphology and viability were observed at 4-OHT concentrations higher than 3 µg/mL. Therefore, we designed and synthesized a drug–polymer conjugate, based on N-(2-hydroxypropyl)methacrylamide (HPMA) and ethyl acrylate (EA) for delivering 4-OHT to the target tissue without the detrimental consequences of the systemic therapy currently used. The macromer carrier of 4-OHT (MATX), with a functionalization degree of 80%, was synthesized in two steps and verified by 1H-NMR and matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectroscopy. MATX was conjugated to the poly(HPMA-co-EA) copolymer network via radical polymerization. The influence of MATX on the physical, chemical, and mechanical properties of poly(HPMA-co-EA-co-MATX) with a ratio of 69/29/2 wt% was compared to those of poly(HPMA-co-EA) networks with a similar feed mixture. The in vitro release of 4-OHT within 1 month was 6 wt% of the total amount of drug linked to the copolymer backbone.
Preparation and characterization of new polyimide films containing zeolite L and/or silica
Authors: Hamciuc Elena , Hamciuc Corneliu , Musteata Valentina Elena , Kalvachev Yuri , Wolinska-Grabczyk Aleksandra
Published: October 2013

New polyimide (PI) films containing zeolite L and/or silica, having a thickness of tens of micrometers, were prepared using a PI matrix with pendant carboxylic groups. The influence of various ratios of inorganic filler on thermal stability, dielectric behavior, and gas transport properties of the films was studied with respect to their structure. The surface morphology was investigated by scanning electron microscopy. The films were flexible, tough, and showed good thermal properties with a glass transition temperature in the range of 187–218°C. The dielectric spectroscopy revealed γ and β subglass transitions having the corresponding relaxation activation energy in the range of 44.7–51.4 kJ mol−1 and 65.1–121.6 kJ mol−1, respectively. At temperatures above 200°C, a conductivity relaxation process was evidenced. Gas permeation tests using small molecules (O2, N2 and CO2), at 6 atm and 30°C, indicated that the PI films containing higher amount of zeolite showed the highest permeability for all gases.
Social Dynamics in Rural Sri Lankan Hospitals
Authors: Senarathna Lalith , Hunter Cynthia , Dawson Andrew H. , Dibley Michael J.
Published: October 2013

Different hospitals produce different cultures—products of relationships between people of different staff categories and people from external community groups. These relationships demonstrate unique social dynamics in rural peripheral hospitals that form a major part of the health care system in Sri Lanka and other developing countries. Understanding the existing social dynamics might be useful when trying to implement new treatment guidelines that can involve behavior change. We aimed to explore the existing social dynamics in peripheral hospitals in rural Sri Lanka by examining the treatment related to cases of acute self-poisoning that is a common, highly interactive medical emergency. These hospitals demonstrate higher levels of community influence in treatment decisions and closer interactions between hospital staff. We argue that health care teamwork is effective in peripheral hospitals, resulting in benefits to all staff, who see these hospitals as better places to work and train, in contrast to a commonly held belief that such rural hospitals are disadvantaged and difficult places.
Approaches to Salivary Cortisol Collection and Analysis in Infants
Authors: Tryphonopoulos Panagiota D. , Letourneau Nicole , Azar Rima
Published: October 2013

Salivary cortisol is becoming more commonly utilized as a biologic marker of stress in observational studies and intervention research. However, its use with infants (12 months of age or younger) is less widespread and poses some special challenges to researchers. In order to decide on the most suitable collection procedure for salivary cortisol in infants, a number of criteria should be considered. This article will aid investigators interested in integrating salivary cortisol measurement into their research studies by presenting (1) an overview of the patterns of cortisol secretion in infancy including the development of diurnal rhythm and response to stress; (2) a comparison of the most commonly used approaches for collecting salivary cortisol samples in infants including cotton rope, syringe aspiration technique, filter paper, hydrocellulose microsponge, and the Salimetrics children’s swab; (3) a discussion of the factors contributing to heightened cortisol variability in infancy and how these can be limited; (4) analytical issues associated with cortisol measurement; and (5) examples of criteria to consider when choosing a saliva sampling method and lab for conducting assays.
Task-based learning and teaching in China: Secondary school teachers’ beliefs and practices
Authors: Zheng Xinmin , Borg Simon
Published: October 2013

While much has been written about task-based language teaching (TBLT), research examining teachers’ understandings of what TBLT means remains limited. This article explores the understandings of TBLT of three Chinese secondary school teachers of English and the implementation of TBLT in their lessons. Narrative accounts were constructed for each teacher using observational data from two lessons and two semi-structured interviews. These accounts illustrate how each teacher implemented the curriculum as well as the cognitive and contextual factors that shaped their decisions with specific reference to the use of tasks. One key finding is that TBLT was defined in a narrow manner and was strongly associated with communicative activities, especially oral work involving pair and group work. The study also shows that the two more experienced teachers introduced a stronger formal element of grammar into their lessons than recommended by the curriculum; and while all three teachers highlighted the challenges for them in using tasks (e.g. due to large classes), the youngest of the three displayed most commitment to the principles in the curriculum. The qualitative accounts we present here are empirically instructive in the way they extend our understandings of how teachers respond to innovative curricula and specifically to TBLT; these accounts also have concrete practical value: they are a source of material that can be used in teacher education contexts to encourage teachers to reflect on their own beliefs and practices in relation to TBLT.
First language attrition of constraints on wh-scrambling: Does the second language have an effect?
Authors: Gürel Ayşe
Published: October 2013

This paper examines the effects of English as a second language (L2) on Turkish as a first language (L1) in the domain of wh-scrambling, as formulated in the generative framework. Unlike English, Turkish allows wh-extractions out of islands under certain morphological conditions. The data come from 27 native Turkish speakers, who have immigrated to an English-speaking country at an adult age and used English as a dominant language. The results of an acceptability judgment task revealed the same tendencies in the attrition and monolingual control group towards rejection of certain grammatical wh-extractions. Thus, the findings implicate no L2 influence in L1 change.
Deeper, broader, longer transitional justice
Authors: Nickson Ray , Braithwaite John
Published: October 2013

Transitional justice has an expectation management problem. International law imposes a right to justice and an obligation to defeat impunity from crimes against humanity. Yet there has not been a war where a substantial proportion of criminals against humanity have been convicted. Nor is one likely. The theoretical solution considered in this paper is to broaden, deepen, and lengthen our conception of justice so that more survivors might be vindicated by some kind of justice, even if a partial kind of justice. We broaden justice with a more holistic, yet multidimensional conception of what justice means, so that, for example, restorative justice, Islamic justice and indigenous justice can be embraced among many alternatives to impunity. Deepening justice means deeper survivor and citizen opportunities to shape a more responsive justice and to shape remedies through participation. Lengthening justice means giving less priority to speedy trial and closure as transitional justice values. It might mean a permanent Truth and Reconciliation Commission that keeps its doors open to victims decades on.
Virologic and Immunologic Effectiveness at 48 Weeks of Darunavir–Ritonavir-Based Regimens in Treatment-Experienced Persons Living with HIV-1 Infection in Clinical Practice
Authors: Biscione Fernando Martín , Westin Mateus Rodrigues , Ribeiro Karina Mota , Estevam Denize Lotufo , Cardoso Sandra Wagner , Tenore Simone Barros , Neto Lauro Ferreira da Silva Pinto , Alencastro Paulo Ricardo , Suffert Theodoro Armando , de Moraes Mônica Jacques , Barbosa Alexandre Naime , Morejón Karen Mirna Loro , de Arruda Érico Antônio Gomes , Silveira Jussara María , Neto José Luiz Andrade , Greco Dirceu Bartolomeu , Tupinambás Unaí
Published: October 2013

Introduction:

Published data addressing the effectiveness of darunavir–ritonavir (DRV/r)-based therapy for multiexperienced patients in developing countries are scarce. This study evaluated the 48-week virologic and immunologic effectiveness of salvage therapy based on DRV/r for the treatment of multidrug-experienced HIV-1-infected adults in Brazil.

Materials and Methods:

A multicenter retrospective cohort study was carried out with multidrug-experienced adults who were on a failing antiretroviral therapy and started a DRV/r-based salvage therapy between 2008 and 2010. The primary effectiveness end point was the proportion of patients with virologic success (plasma HIV-1 RNA <50 copies/mL at week 48).

Results:

At 48 weeks, 73% of the patients had HIV-RNA <50 copies/mL and a mean increase of 108 CD4 cells/mm3. Higher baseline viral load, lower baseline CD4 count, younger age, and 3 or more DRV/r-associated resistance mutations were significantly predictive of virologic failure. Concomitant use of raltegravir was strongly associated with virologic success.

Conclusion:

The use of DRV/r-based regimens for salvage therapy is an effective strategy in the clinical care setting of a developing country.
Fungal genomes mining to discover novel sterol esterases and lipases as catalysts
Authors: Barriuso Jorge , Prieto Alicia , Martínez Maria Jesus
Published: October 2013

Background

Sterol esterases and lipases are enzymes able to efficiently catalyze synthesis and hydrolysis reactions of both sterol esters and triglycerides and due to their versatility could be widely used in different industrial applications. Lipases with this ability have been reported in the yeast Candida rugosa that secretes several extracellular enzymes with a high level of sequence identity, although different substrate specificity. This versatility has also been found in the sterol esterases from the ascomycetes Ophiostoma piceae and Melanocarpus albomyces.

Results

In this work we present an in silico search of new sterol esterase and lipase sequences from the genomes of environmental fungi. The strategy followed included identification and search of conserved domains from these versatile enzymes, phylogenetic studies, sequence analysis and 3D modeling of the selected candidates.

Conclusions

Six potential putative enzymes were selected and their kinetic properties and substrate selectivity are discussed on the basis of their similarity with previously characterized sterol esterases/lipases with known structures.
A novel type of N-acetylglutamate synthase is involved in the first step of arginine biosynthesis in Corynebacterium glutamicum
Authors: Petri Kathrin , Walter Frederik , Persicke Marcus , Rückert Christian , Kalinowski Jörn
Published: October 2013

Background

Arginine biosynthesis in Corynebacterium glutamicum consists of eight enzymatic steps, starting with acetylation of glutamate, catalysed by N-acetylglutamate synthase (NAGS). There are different kinds of known NAGSs, for example, “classical” ArgA, bifunctional ArgJ, ArgO, and S-NAGS. However, since C. glutamicum possesses a monofunctional ArgJ, which catalyses only the fifth step of the arginine biosynthesis pathway, glutamate must be acetylated by an as of yet unknown NAGS gene.

Results

Arginine biosynthesis was investigated by metabolome profiling using defined gene deletion mutants that were expected to accumulate corresponding intracellular metabolites. HPLC-ESI-qTOF analyses gave detailed insights into arginine metabolism by detecting six out of seven intermediates of arginine biosynthesis. Accumulation of N-acetylglutamate in all mutants was a further confirmation of the unknown NAGS activity. To elucidate the identity of this gene, a genomic library of C. glutamicum was created and used to complement an Escherichia coli ΔargA mutant. The plasmid identified, which allowed functional complementation, contained part of gene cg3035, which contains an acetyltransferase domain in its amino acid sequence. Deletion of cg3035 in the C. glutamicum genome led to a partial auxotrophy for arginine. Heterologous overexpression of the entire cg3035 gene verified its ability to complement the E. coli ΔargA mutant in vivo and homologous overexpression led to a significantly higher intracellular N-acetylglutamate pool. Enzyme assays confirmed the N-acetylglutamate synthase activity of Cg3035 in vitro. However, the amino acid sequence of Cg3035 revealed no similarities to members of known NAGS gene families.

Conclusions

The N-acetylglutamate synthase Cg3035 is able to catalyse the first step of arginine biosynthesis in C. glutamicum. It represents a novel class of NAGS genes apparently present only in bacteria of the suborder Corynebacterineae, comprising amongst others the genera Corynebacterium, Mycobacterium, and Nocardia. Therefore, the name C-NAGS (Corynebacterineae-type NAGS) is proposed for this new family.
Asymptomatic subjects with diabetes have a comparable risk of coronary artery disease to Non-diabetic subjects presenting chest pain: a 4-year community-based prospective study
Authors: Koo Bo Kyung , Kim Yun Gi , Park Kyong Soo , Moon Min Kyong
Published: October 2013

Background

Although diabetes mellitus is an important risk factor of coronary artery disease (CAD), routine screening for CAD is not recommended for asymptomatic diabetic patients. We assessed the impact of chest pain on CAD risk according to the presence or absence of diabetes mellitus.

Methods

We investigated the future CAD event rate in subjects with and without chest pain according to the presence or absence of diabetes in a prospective large-scale community-based study in Korea.

Results

Among 8,574 subjects (4,032 men and 4,542 women) without a history of CAD, 0.8% and 2.2% of non-diabetic and diabetic subjects, respectively, reported newly developed CAD events during 4 years of follow-up. Although the presence of chest pain at baseline was also significantly associated with an increased risk of CAD of more than 2-fold in both non-diabetic and diabetic subjects (P < 0.01), the risk of future CVD event in asymptomatic diabetic patients was not significantly different from that in non-diabetic subjects with chest pain (hazard ratio, 0.907; 95% confidence interval, 0.412 – 1.998).

Conclusions

The CAD event rate of asymptomatic subjects with diabetes was comparable to that of non-diabetic subjects reporting chest pain. Considering the high risk of CAD in asymptomatic diabetic patients, more clinical trials aimed at formulating strategies to screen asymptomatic diabetic subjects should be carried out.
A non-randomised controlled trial of the R&R2MHP cognitive skills program in high risk male offenders with severe mental illness
Authors: C-Y Yip Vivienne , Gudjonsson Gisli H , Perkins Derek , Doidge Amie , Hopkin Gareth , Young Susan
Published: October 2013

Background

The growing popularity of offending behavior programs has led to the interest of whether such programs are effective with mentally disordered offenders. This study aimed to evaluate the effectiveness of the Reasoning and Rehabilitation program adapted for offenders with severe mental illness (R&R2 MHP).

Methods

A sample of 59 adult high risk males detained in a high secure hospital completed questionnaires at baseline and post treatment to assess violent attitudes, anger, coping processes and social problem-solving. An informant measure of social and psychological functioning, including disruptive behavior, was completed by staff at the same time. The data of 30 patients who participated in the group condition were compared using intention to treat analysis with 29 controls who received treatment as usual.

Results

80% of group participants completed the program. In contrast to controls, significant medium-large treatment effects were found at outcome on self-reported measures of violent attitudes, social problem-solving and coping processes. Improvements were endorsed by informant ratings of disruptive behavior, social and psychological functioning.

Conclusions

The R&R2MHP had a comparatively low dropout rate and was effective in a sample of high risk mentally disordered offenders requiring detention in high security. Future research should use a randomized controlled design.

Trial registration

Current Controlled TrialsACTRN12613000216718.
Consumption of sweetened, dried cranberries may reduce urinary tract infection incidence in susceptible women – a modified observational study
Authors: Burleigh Alexandra E , Benck Susan M , McAchran Sarah E , Reed Jess D , Krueger Christian G , Hopkins Walter J
Published: October 2013

Background

Urinary tract infections (UTIs) are one of the most common bacterial infections, and over 50% of women will have a UTI during their lifetimes. Antibiotics are used for prophylaxis of recurrent UTIs but can lead to emergence of drug-resistant bacteria. Therefore, it is reasonable to investigate nutritional strategies for prevention of UTIs. Cranberry juices and supplements have been used for UTI prophylaxis, but with variable efficacy. Because dried cranberries may contain a different spectrum of polyphenolics than juice, consuming berries may or may not be more beneficial than juice in decreasing the incidence of UTIs in susceptible women. The primary objectives of this study were to determine if consumption of sweetened, dried cranberries (SDC) decreases recurrent UTIs and whether this intervention would alter the heterogeneity, virulence factor (VF) profiles, or numbers of intestinal E. coli.

Methods

Twenty women with recurrent UTIs were enrolled in the trial and consumed one serving of SDC daily for two weeks. Clinical efficacy was determined by two criteria, a decrease in the six-month UTI rates pre- and post-consumption and increased time until the first UTI since beginning the study. Strain heterogeneity and virulence factor profiles of intestinal E. coli isolated from rectal swabs were determined by DNA fingerprinting and muliplex PCR, respectively. The numbers of intestinal E. coli eluted from rectal swabs pre- and post-consumption were also quantified.

Results

Over one-half of the patients did not experience a UTI within six months of SDC consumption, and the mean UTI rate per six months decreased significantly. Kaplan-Meier analysis of infection incidence in women consuming SDC compared to patients in a previous control group showed a significant reduction in time until first UTI within six months. The heterogeneity, VF profiles, and prevalence of intestinal E. coli strains were not significantly different after cranberry consumption.

Conclusions

Results of this study indicate a beneficial effect from consuming SDC to reduce the number of UTIs in susceptible women. Because there were no changes in the heterogeneity or VF profiles of E. coli, additional studies are needed to determine the mechanism of action of SDC for reduction of UTIs.
Longitudinal associations between oral health impacts and quality of life among a national cohort of Thai adults
Authors: Yiengprugsawan Vasoontara , Somkotra Tewarit , Seubsman Sam-ang , Sleigh Adrian C
Published: October 2013

Background

There is limited evidence on the association between oral health and general health in middle-income countries. This study analysed data from 60,569 adult students enrolled at Sukhothai Thammathirat Open University and residing throughout Thailand who reported oral health impacts at the 2005 baseline and 2009 health status based on Short Form (SF-8) survey.

Findings

In 2005, 16.4% had difficulty chewing and/or swallowing, 13.4% reported difficulty speaking and/or discomfort with social interaction, and 10.8% of the cohort reported having pain associated with teeth or dentures. Cohort members reporting one or more oral health impacts in 2005 had lower SF-8 mean scores in 2009. In particular, monotonic dose–response gradients in 2005–2009 associations based on multivariate linear regression were found between an increase in number of oral impacts (0, 1, 2, 3) and a decline in SF-8 Physical Component Summary scores (adjusted means of 50.5, 49.2, 48.6, 47.9) as well as SF-8 Mental Component Summary scores (adjusted means of 43.2, 40.9, 40.3, 38.6) in younger cohort members. Similar dose response gradients were found in older cohort members.

Conclusions

We found strong association between oral health impacts and adverse health and quality of life among Thai adults. This finding confirms that oral health is one of the key determinants of population health.
The complete genome sequence of EC1-UPM, a novel N4-like bacteriophage that infects Escherichia coli O78:K80
Authors: Gan Han Ming , Sieo Chin Chin , Tang Shirley Gee Hoon , Omar Abdul Rahman , Ho Yin Wan
Published: October 2013

Background

Bacteriophage EC1-UPM is an N4-like bacteriophage which specifically infects Escherichia coli O78:K80, an avian pathogenic strain that causes colibacillosis in poultry. The complete genome sequence of bacteriophage EC1-UPM was analysed and compared with other closely related N4-like phage groups to assess their genetic similarities and differences.

Results

Bacteriophage EC1-UPM displays a very similar codon usage profile with its host and does not contain any tRNA gene. Comparative genomics analysis reveals close resemblance of bacteriophage EC1-UPM to three N4-like bacteriophages namely vB_EcoP_G7C, IME11 and KBNP21 with a total of 44 protein coding genes shared at 70% identity threshold. The genomic region coding for the tail fiber protein was found to be unique in bacteriophage EC1-UPM. Further annotation of the tail fiber protein using HHpred, a highly sensitive homology detection tool, reveals the presence of protein structure homologous to various polysaccharide processing proteins in its C-terminus. Leveraging on the availability of multiple N4-like bacteriophage genome sequences, the core genes of N4-like bacteriophages were identified and used to perform a multilocus phylogenetic analysis which enabled the construction of a phylogenetic tree with higher confidence than phylogenetic trees based on single genes.

Conclusion

We report for the first time the complete genome sequence of a N4-like bacteriophage which is lytic against avian pathogenic Escherichia coli O78:K80. A novel 928 amino acid residues tail fiber protein was identified in EC1-UPM which may be useful to further the understanding of phage-host specificity. Multilocus phylogenetic analysis using core genes of sequenced N4-like phages showed that the evolutionary relationship correlated well with the pattern of host specificity.
A comparative study of modified confirmatory techniques and additional immuno-based methods for non-conclusive autolytic Bovine spongiform encephalopathy cases
Authors: Sarasa Rocío , Becher Dietmar , Badiola Juan J , Monzón Marta
Published: October 2013

Background

In the framework of the Bovine Spongiform Encephalopathy (BSE) surveillance programme, samples with non-conclusive results using the OIE confirmatory techniques have been repeatedly found. It is therefore necessary to question the adequacy of the previously established consequences of this non-conclusive result: the danger of failing to detect potentially infected cattle or erroneous information that may affect the decision of culling or not of an entire bovine cohort. Moreover, there is a very real risk that the underreporting of cases may possibly lead to distortion of the BSE epidemiological information for a given country.

In this study, samples from bovine nervous tissue presenting non-conclusive results by conventional OIE techniques (Western blot and immunohistochemistry) were analyzed. Their common characteristic was a very advanced degree of autolysis. All techniques recommended by the OIE for BSE diagnosis were applied on all these samples in order to provide a comparative study. Specifically, immunohistochemistry, Western blotting, SAF detection by electron microscopy and mouse bioassay were compared. Besides, other non confirmatory techniques, confocal scanning microscopy and colloidal gold labelling of fibrils, were applied on these samples for confirming and improving the results.

Results

Immunocytochemistry showed immunostaining in agreement with the positive results finally provided by the other confirmatory techniques. These results corroborated the suitability of this technique which was previously developed to examine autolysed (liquified) brain samples. Transmission after inoculation of a transgenic murine model TgbovXV was successful in all inocula but not in all mice, perhaps due to the very scarce PrPsc concentration present in samples.

Electron microscopy, currently fallen into disuse, was demonstrated to be, not only capable to provide a final diagnosis despite the autolytic state of samples, but also to be a sensitive diagnostic alternative for resolving cases with low concentrations of PrPsc.

Conclusions

Demonstration of transmission of the disease even with low concentrations of PrPsc should reinforce that vigilance is required in interpreting results so that subtle changes do not go unnoticed. To maintain a continued supervision of the techniques which are applied in the routine diagnosis would prove essential for the ultimate eradication of the disease.