bluuebunny/crossref_metadata_2025 huggingface dataset:
Natural‐source d‐α‐tocopheryl acetate inhibits oxidant stress and modulates atopic asthma in humans in vivo
Authors: Hoskins Aimee , Roberts Jackson L. , Milne Ginger , Choi Leena , Dworski Ryszard
Published: March 2012

Background

Asthma is associated with oxidant stress and diminished antioxidant defenses. Yet, the mechanistic role of oxidant stress and antioxidant supplementation in human asthmatics remains uncertain. We determined the effect of high doses of the antioxidant natural‐source d‐α‐tocopheryl acetate for 16 weeks on allergen‐induced airway oxidant stress, inflammation, and bronchial responsiveness to methacholine and allergen in atopic asthmatics in vivo.

Methods

Thirty‐three mild atopic asthmatics underwent bronchoscopy with baseline bronchoalveolar lavage and segmental allergen challenge. The allergen‐challenged airway was lavaged 24 h later. At least 3 weeks later, patients underwent inhaled challenges with methacholine and specific allergen. Volunteers took 1500 IU of natural‐source d‐α‐tocopheryl acetate daily for at least 16 weeks. At the end of the treatment, the two bronchoscopies and inhaled methacholine and allergen challenges were repeated. F2‐isoprostanes, specific markers of oxidant stress, and selected Th1 and Th2 cytokines were analyzed in the lavage fluid.

Results

Following supplementation of natural‐source d‐α‐tocopheryl acetate, plasma concentrations of α‐tocopherol increased and γ‐tocopherol decreased. Both baseline and allergen‐induced F2‐isoprostanes significantly decreased, providing biochemical evidence for an antioxidant effect. Natural‐source d‐α‐tocopheryl acetate reduced allergen‐provoked concentrations of interleukin 3 and interleukin 4 and augmented levels of interleukin 12 in bronchoalveolar lavage fluid. Natural‐source d‐α‐tocopheryl acetate improved airway responsiveness to methacholine but did not alter airway reactivity to specific allergen.

Conclusions

Inhibition of oxidant stress by natural‐source d‐α‐tocopheryl acetate modulates allergic inflammation and airway hyperresponsiveness in human atopic asthmatics in vivo. These results need to be confirmed by a randomized placebo‐controlled trial.
Cow’s milk and ovalbumin‐specific IgG and IgA in children with eczema: low β‐lactoglobulin‐specific IgG4 levels are associated with cow’s milk allergy
Authors: Savilahti Emma M. , Viljanen Mirva , Kuitunen Mikael , Savilahti Erkki
Published: March 2012

To cite this article: Savilahti EM, Viljanen M, Kuitunen M, Savilahti E. Cow’s milk and ovalbumin‐specific IgG and IgA in children with eczema: low β‐lactoglobulin‐specific IgG4 levels are associated with cow’s milk allergy. Pediatric Allergy Immunology 2012: 23: 590–596.

Tolerance to allergens may partly depend on allergen‐specific IgG and IgG subclasses and IgA antibodies. We investigated whether specific IgG and IgG subclasses and IgA antibodies to β‐lactoglobulin, α‐casein, and ovalbumin differed between infants who had verified cow’s milk allergy (CMA) and infants with cow’s milk (CM)‐associated eczema, but negative CM oral challenge. The study population comprised 95 infants with clinical eczema that was by history associated with the consumption of CM. After an elimination period, a double‐blind, placebo‐controlled (DBPC) CM oral challenge confirmed CMA in 45 infants. Skin prick tests (SPT) were performed with CM and hen’s egg. Serum levels of IgE antibodies to CM and hen’s egg were measured with UniCAP (Phadia, Uppsala, Sweden), and levels of IgA, IgG, IgG1, and IgG4 antibodies to β‐lactoglobulin, α‐casein, and ovalbumin were measured with enzyme‐linked immunosorbent assay. We observed that infants with CMA had lower IgG4 levels to β‐lactoglobulin than infants with negative DBPC CM challenge (p = 0.004). Positive CM SPT was associated with lower IgG4 levels to α‐casein (p = 0.04). The relation of CM IgE to β‐lactoglobulin and α‐casein IgG4 was higher in CMA than in infants with negative challenge (p < 0.002 and 0.0001). Positive egg SPT was associated with elevated levels of specific IgG to ovalbumin, β‐lactoglobulin, and α‐casein as well as IgA to α‐casein (p < 0.04). Our study thus shows that low β‐lactoglobulin‐specific serum IgG4 levels may differentiate eczematous infants with CMA from infants who have eczema with only suspected association with CM.
Effect of lactose on gut microbiota and metabolome of infants with cow’s milk allergy
Authors: Francavilla Ruggiero , Calasso Maria , Calace Laura , Siragusa Sonya , Ndagijimana Maurice , Vernocchi Pamela , Brunetti Luigia , Mancino Giuseppe , Tedeschi Giuseppe , Guerzoni Elisabetta , Indrio Flavia , Laghi Luca , Miniello Vito L. , Gobbetti Marco , De Angelis Maria
Published: March 2012

To cite this article: Francavilla R, Calasso M, Calace L, Siragusa S, Ndagijimana M, Vernocchi P, Brunetti L, Mancino G, Tedeschi G, Guerzoni E, Indrio F, Laghi L, Miniello VL, Gobbetti M, De Angelis M. Effect of lactose on gut microbiota and metabolome of infants with cow’s milk allergy. Pediatric Allergy Immunology 2012: 23: 420–427.

Allergic infants have an unusual gastrointestinal microbiota with low numbers of Bifidobacterium/Lactobacilli and high levels of Clostridium, staphylococci and Escherichia coli. Hydrolyzed formula used to treat these infants is deprived of lactose that instead may influence the gut microbial composition. The aim of the present study is to investigate the influence of lactose on the composition of the gut microbiota and metabolome of infants with cow’s milk allergy. Infants prospectively enrolled received an extensively hydrolyzed formula with no lactose for 2 months followed by an identical lactose‐containing formula for an additional 2 months. Healthy, age‐gender‐matched infants were used as controls. The following determinations were performed before and after the introduction of lactose in the diet: enumeration of cells present in the feces using FISH, counts of viable bacterial cells and gas‐chromatography mass spectrometry/solid‐phase microextraction analysis. The addition of lactose to the diet significantly increases the counts of Bifidobacteria and lactic acid bacteria (p < 0.01), decreases that of Bacteroides/clostridia (p < 0.05) reaching counts found in healthy controls; lactose significantly increases the concentration of total short‐chain fatty acids (p < 0.05). The addition of lactose to an extensively hydrolyzed formula is able to positively modulate the composition of gut microbiota by increasing the total fecal counts of Lactobacillus/Bifidobacteria and decreasing that of Bacteroides/Clostridia. The positive effect is completed by the increase of median concentration of short chain fatty acids, especially for acetic and butyric acids demonstrated by the metabolomic analysis.
Do clinical pathways enhance access to evidence‐based acute myocardial infarction treatment in rural emergency departments?
Authors: Kinsman Leigh D. , Rotter Thomas , Willis Jon , Snow Pamela C. , Buykx Penny , Humphreys John S.
Published: March 2012

Objective:  The objective of this study is to measure the impact of a five‐step implementation process for an acute myocardial infarction (AMI) clinical pathway (CPW) on thrombolytic administration in rural emergency departments.

Design:  Cluster randomised controlled trial.

Setting:  Six rural Victorian emergency departments participated.

Intervention:  The five‐step CPW implementation process comprised (i) engaging clinicians; (ii) CPW development; (iii) reminders; (iv) education; and (v) audit and feedback.

Main outcome measures:  The impact of the intervention was assessed by measuring the proportion of eligible AMI patients receiving a thrombolytic and time to thrombolysis and electrocardiogram.

Results:  Nine hundred and fifteen medical records were audited, producing a final sample of 108 patients eligible for thrombolysis. There was no significant difference between intervention and control groups for median door‐to‐needle time (29 mins versus 29 mins; P = 0.632), proportion of those eligible receiving a thrombolytic (78% versus 84%; P = 0.739), median time to electrocardiogram (7 mins versus 6 mins; P = 0.669) and other outcome measures. Results showed superior outcome measures than other published studies.

Conclusions:  The lack of impact of the implementation process for a chest pain CPW on thrombolytic delivery or time to electrocardiogram in these rural hospitals can be explained by a ceiling effect in outcome measures but was also compromised by the small sample. Results suggest that quality of AMI treatment in rural emergency departments (EDs) is high and does not contribute to the worse mortality rate reported for AMIs in rural areas.
Differences between patients' expectations and satisfaction with nursing care in a private hospital in Jordan
Authors: Abdel Maqsood Amal Samir , Oweis Arwa I , Hasna Fadia Shawqi
Published: March 2012

Abdel Maqsood AS, Oweis AI, Hasna FS. International Journal of Nursing Practice 2012; 18: 140–146

Differences between patients' expectations and satisfaction with nursing care in a private hospital in Jordan

A descriptive correlation study was conducted to describe the differences between patient expectations and satisfaction with nursing care, and to determine the relationships among patient's satisfaction with nursing care and selected sociodemographic variables. A convenience sample of 250 patients with different medical, surgical and gynaecologic diagnoses was recruited to participate in the study, which was carried out at a private hospital in Amman. Two research instruments and a sociodemographic data form were used for data collection: The Patient Expectations Questionnaire and Patient Satisfaction with Nursing Care Quality Questionnaire. The results indicated that patients were more satisfied with technical and ethical aspects of nursing care whereas they were less satisfied with nursing care during the night shift as well as with professional information provided by the nurses. The difference between patients' expectations and satisfaction was statistically significant. Patients' opinions regarding their expectations and their satisfaction with nursing care can be considered as an important opportunity for nurses to plan and implement appropriate strategies that improve the quality of nursing care.
Which is the best method to estimate the actual ureteral length in patients undergoing ureteral stent placement?
Authors: Kawahara Takashi , Ito Hiroki , Terao Hideyuki , Yoshida Minoru , Ogawa Takehiko , Uemura Hiroji , Kubota Yoshinobu , Matsuzaki Junichi
Published: March 2012

Objectives:  To define the best modality for estimating ureteral length in patients undergoing ureteral stent placement.

Methods:  This study enrolled 151 patients (169 ureters) undergoing stent insertion. In all of them, an intravenous urography and non‐contrast computed tomography were carried out. The actual ureteral length was determined by direct measurement using a 5‐Fr ureteral catheter. A multivariate analysis evaluated the association between the ureteral length and each of the following parameters: body height, body surface area, ureteral trace by intravenous urography, linear distance (liner distance 1) from the ureteropelvic junction to the ureterovesical junction by intravenous urography, linear distance (liner distance 2) from the mid kidney to the ureterovesical junction by intravenous urography, and the distance from the level of the renal vein to the ureterovesical junction by axial computed tomography (axial computed tomography distance).

Results:  The mean actual ureteral length was 23.2 cm (median 24 cm, range 16–29 cm). The Spearman correlation coefficients for body height, body surface area, ureteral trace, liner distance 1, liner distance 2 and axial computed tomography distance were 0.3126, 0.3076, 0.4541, 0.5230, 0.4796 and 0.6168, respectively. Axial computed tomography distance showed the best correlation with the actual ureteral length.

Conclusion:  The axial computed tomography distance as calculated by the axial computed tomography can more reliably predict the actual ureteral length than other parameters. Further studies are required to show the best method for estimating the actual ureteral length in patients undergoing ureteral stent placement.
Suppressive effect of pregnant serum on murine dendritic cell function
Authors: Bozorgmehr Mahmood , Zarnani Amir Hassan , Nikoo Shohreh , Moazzeni Seyed Mohammad
Published: March 2012

Aim:  Tolerance to the semi‐allogenic fetal graft by the maternal immune system is a medical enigma. Many aspects of immunoregulation at the feto–maternal interface have been clarified, but systemic effects of pregnancy on the immune system are still elusive. The present study was undertaken to determine whether mid‐pregnancy mouse serum has an inhibitory effect on dendritic cells (DC) function.

Material and Methods:  Mid‐gestational sera were obtained from allogenic pregnant Balb/c mice (Balb/c × C57BL/6) on days 9–11 of gestation. Splenic DC were purified from Balb/c mice, and treated with mid‐pregnancy mouse serum. Antigen pulsed DC were injected into mice palms. After 5 days, draining lymph nodes were removed, cultured in the presence of cognate antigen, and proliferation of responding cells was measured by 3H‐thymidin incorporation. Interleukin (IL)‐10 and interferon‐gamma (IFN‐γ) production by stimulated lymph node antigen‐specific cells was also measured in culture supernatants using sandwich ELISA.

Results:  Treatment of DC with pregnant mouse serum markedly blocked their ability to induce antigen‐specific lymphocyte proliferation and IFN‐γ and IL‐10 production by primed lymph node cells in comparison with non‐pregnant serum‐treated DC.

Conclusion:  Pregnant mouse serum has an inhibitory effect on DC capacity to induce antigen‐specific proliferation and cytokine secretion by lymph node cells. The suppressive effects of pregnant serum on DC could be considered as one of the mechanisms responsible for the systemic immunomodulation observed during pregnancy.
Factors affecting medical and nursing staff reporting of child abuse
Authors: Ben Natan M. , Faour C. , Naamhah S. , Grinberg K. , Klein‐Kremer A.
Published: March 2012

BEN NATAN M., FAOUR C., NAAMHAH S., GRINBERG K. & KLEIN‐KREMER A. (2012) Factors affecting medical and nursing staff reporting of child abuse. International Nursing Review59, 331–337

Aim:  The purpose of the current research was to examine whether the theory of planned behaviour (TPB) succeeds in predicting nursing and medical staff reporting of suspected child abuse.

Background:  Despite the rising incidence of child abuse in Israel, medical and nursing staff reports of suspected child abuse remain low.

Methods:  This descriptive, correlational, cross‐sectional study was based on TPB. The Child Abuse Report Intention Scale questionnaire was administered to 143 nurses and 42 doctors who work with children in various departments of a central Israeli hospital and in a large affiliated community‐based clinic. Descriptive, correlational and linear regression statistics were calculated.

Results:  Objection to child abuse, views of professional responsibility on this issue, degree of self‐control and subjective beliefs, affect reporting of suspected child abuse. Differences in reporting are evident between doctors and nurses and also between medical and nursing staff from the Arab and Jewish sectors. Doctors report more than nurses and Jewish staff members report more than their Arab colleagues. Medical and nursing staff's number of own children has a direct effect on their inclination to report child abuse.

Conclusions:  The TPB model succeeds in partly predicting medical and nursing staff reporting of suspected child abuse. This model can serve as a basis for intervention plans aimed at developing medical and nursing simulations of coping with conflict issues involving child abuse in an attempt to eradicate and treat inadequate reporting.
Protester or non‐protester: a binary state? On the use (and non‐use) of latent class models to analyse protesting in economic valuation*
Authors: Meyerhoff Jürgen , Bartczak Anna , Liebe Ulf
Published: March 2012

In the analysis of stated preferences studies, it is often assumed that protesting is a discretely measured item only occurring among those who are not willing to pay. However, various studies have recently shown that protest beliefs are as well held by respondents who state a positive willingness to pay (WTP). Using latent class (LC) models, we investigate the extent of heterogeneity with respect to protest beliefs among all respondents of two contingent valuation studies. The advantage of LC models is that classes of individuals are endogenously identified and no selection bias is introduced by ad hoc definitions of protesters. Further we investigate whether it is possible to identify a class of non‐protesters. Finding a group of pure non‐protesters could indicate how strongly stated WTP in the whole sample is affected by protest beliefs. For both samples, we find a class with strong protest beliefs but no pure non‐protest class. Overall, our results suggest that LC models might not be the first choice to determine unbiased WTP measures, but they provide valuable insights into the degree of protesting expressed by different groups and corresponding determinants of group membership.
The Democratic Worth of Celebrity Politics in an Era of Late Modernity
Authors: Wheeler Mark
Published: March 2012

In a seminal article published in 2004, John Street argued that celebrity politics has provided a greater expression for the enhancement of democratic behaviour. Consequently, this analysis builds on Street's thesis to consider the worth of celebrity politics in an era of late modernity. To this end, it employs Henrik Bang's and John Keane's constructs of Everyday Makers and Monitory Democracy, which have emphasised the importance of ‘involvement’, ‘voice’ and ‘output’ in terms of representation, to provide an ideological framework to capture the value of celebrity politics. Subsequently, it may be argued that Barack Obama utilised a form of ‘liquid’ celebrity in his 2008 US presidential campaign to reconnect with a disenfranchised electorate. However, this article will critically assess these types of celebrity politics to contend that aggregated forms of ‘input’ drawn from celebrity activism may more truly affect political outcomes.
Investigating the Economic Determinants of the UK Gender Equality Policy Agenda
Authors: Annesley Claire , Gains Francesca
Published: March 2012

Promoting certain kinds of gender equality—such as promoting and supporting female participation in paid work or male engagement with unpaid care work—is costly. Yet, there has been little examination in gender and policy research of the economic determinants of gendered policy change. In this article we investigate, using graphs and descriptive analysis derived from three data sets, whether the agenda-setting possibilities of feminist policy actors pushing for redistributive gender policy are constrained by economic conditions. Our hypotheses are that it is easier to get costly gender equality policies on the agenda, first, when the economy is growing and, second, when advocates utilise an economic case to frame their arguments. We find that gender equality policy agendas in the UK appear to follow periods of positive economic performance and that economic framing of gender equality policy is essential.
Improving Democracy and Accountability in Ghana: The Importance of Parliamentary Oversight Tools
Authors: STAPENHURST RICK , PELIZZO RICCARDO
Published: March 2012

In this research note, we examine the nature of, and influences on, parliamentary oversight in Ghana. We find that while macro‐institutions are important when examining good governance and legislative effectiveness, meso‐level institutions (such as oversight tools) are more important than previously acknowledged. We also detect a positive relationship between an increase in legislative oversight facilities and the reputation of parliament and its members, the legitimacy of democracy and political institutions, and the success in curbing corruption. And finally, we confirm that the successful functioning of institutions depends on the presence or absence of specific contextual factors. In the case of Ghana, these factors are a relatively low level of partisanship at the committee level, parliament's ability to find alternative sources of information, and the demand for good governance.
Substance use and sexual risk behaviour among HIV‐positive men who have sex with men in specialized out‐patient clinics
Authors: Dirks H , Esser S , Borgmann R , Wolter M , Fischer E , Potthoff A , Jablonka R , Schadendorf D , Brockmeyer N , Scherbaum N
Published: March 2012

Objectives

Unprotected sexual intercourse between men who have sex with men (MSM) is the most common route of HIV infection in Germany. Approximately 70% of newly infected people are MSM. Substance use is a determinant of sexual risk behaviour in the general population, but also in the MSM subpopulation. There are only a few studies, from the USA, on the correlation between substance use and sexual risk behaviour in HIV‐infected MSM in specialized care.

Methods

In a German sample of 445 HIV‐infected MSM treated in specialized out‐patient clinics, the influence of substance use on sexual risk behaviour was investigated. Information was obtained from subjects using self‐report questionnaires and a structured interview.

Results

Recreational drug use was common. The prevalences of cannabis addiction (4.5%), harmful use of cannabis (4.3%) and harmful use of dissociative anaesthetics (0.4%) were higher than in the general German male population. A substantial proportion of patients reported unprotected insertive (32.9%) and receptive (34.6%) anal intercourse during the last 12 months. Use of cannabis, amyl nitrite, dissociative anaesthetics, cocaine, amphetamines and erectile dysfunction medication was significantly correlated with unprotected sexual contacts. Substance use in the context of sexual activity significantly increased sexual risk behaviour.

Conclusions

Substance use, especially in the context of sexual activity, should be taken into account when developing new prevention and intervention programmes aimed at reducing sexual risk behaviour in HIV‐infected MSM currently in specialized care.
Estimation of International Migration in Post‐Soviet Republics
Authors: Makaryan Shushanik
Published: March 2012

When annual migration data lack reliability, scholars apply alternative methods for estimating international migration. Yet, researchers note that alternative approaches have primarily been tested on developed countries, rather than developing countries that usually have dramatic migration shifts. I close this research gap. I use the example of 15 former Soviet republics to demonstrate several conclusions. First, I show that such alternative approaches as immigration‐by‐origin data of receiving countries do not result in reliable and valid estimates of post‐Soviet migration, given the large variation that exists in how former Soviet republics define “migrant”. Second, I demonstrate that population censuses, while a more superior alternative, fail to capture temporary migrants. In developing countries, the international emigration is mainly due to temporary (undocumented labour) migration. Third, I suggest that scholars and policy‐makers should apply household surveys as a possible alternative. However, while this method seems promising, given the limited use of household surveys in migration measurement in the post‐Soviet republics, future research by both scholars and applied researchers should explore the advantages and limitations of household surveys as an alternative source for estimation of migration. Finally, I outline methodological guidelines that researchers and scholars can advance on migration issues in the post‐Soviet region.
An examination of materialism, conspicuous consumption and gender differences
Authors: Segal Brenda , Podoshen Jeffrey S.
Published: March 2012

This paper examines gender differences in terms of materialism, conspicuous consumption, brand loyalty and impulse buying. We build our hypotheses based on both existing marketing and consumption literature with an additional integration of historical and gender studies literature in order to further augment the study of materialism and its related variables. Our study used survey data from 1180 Americans living in four northeastern states. Results show that significant differences between the genders were found in terms of materialism, conspicuous consumption and impulse buying. No significant difference was found in terms of brand loyalty.
Effects of Vulture Declines on Facultative Scavengers and Potential Implications for Mammalian Disease Transmission
Authors: OGADA D. L. , TORCHIN M. E. , KINNAIRD M. F. , EZENWA V. O.
Published: March 2012

Abstract:  Vultures (Accipitridae and Cathartidae) are the only known obligate scavengers. They feed on rotting carcasses and are the most threatened avian functional group in the world. Possible effects of vulture declines include longer persistence of carcasses and increasing abundance of and contact between facultative scavengers at these carcasses. These changes could increase rates of transmission of infectious diseases, with carcasses serving as hubs of infection. To evaluate these possibilities, we conducted a series of observations and experimental tests of the effects of vulture extirpation on decomposition rates of livestock carcasses and mammalian scavengers in Kenya. We examined whether the absence of vultures changed carcass decomposition time, number of mammalian scavengers visiting carcasses, time spent by mammals at carcasses, and potential for disease transmission at carcasses (measured by changes in intraspecific contact rates). In the absence of vultures, mean carcass decomposition rates nearly tripled. Furthermore, the mean number of mammals at carcasses increased 3‐fold (from 1.5 to 4.4 individuals/carcass), and the average time spent by mammals at carcasses increased almost 3‐fold (from 55 min to 143 min). There was a nearly 3‐fold increase in the mean number of contacts between mammalian scavengers at carcasses without vultures. These results highlight the role of vultures in carcass decomposition and level of contact among mammalian scavengers. In combination, our findings lead us to hypothesize that changes in vulture abundance may affect patterns of disease transmission among mammalian carnivores.
MORPHOLOGICAL AND PHYSIOLOGICAL EFFECTS IN PROBOSCIA ALATA (BACILLARIOPHYCEAE) GROWN UNDER DIFFERENT LIGHT AND CO2 CONDITIONS OF THE MODERN SOUTHERN OCEAN1
Authors: Hoogstraten Astrid , Timmermans Klaas R. , de Baar Hein J. W.
Published: March 2012

The combined effects of different light and aqueous CO2 conditions were assessed for the Southern Ocean diatom Proboscia alata (Brightwell) Sundström in laboratory experiments. Selected culture conditions (light and CO2(aq)) were representative for the natural ranges in the modern Southern Ocean. Light conditions were 40 (low) and 240 (high) μmol photons · m−2 · s−1. The three CO2(aq) conditions ranged from 8 to 34 μmol · kg−1 CO2(aq) (equivalent to a pCO2 from 137 to 598 μatm, respectively). Clear morphological changes were induced by these different CO2(aq) conditions. Cells in low [CO2(aq)] formed spirals, while many cells in high [CO2(aq)] disintegrated. Cell size and volume were significantly affected by the different CO2(aq) concentrations. Increasing CO2(aq) concentrations led to an increase in particulate organic carbon concentrations per cell in the high light cultures, with exactly the opposite happening in the low light cultures. However, other parameters measured were not influenced by the range of CO2(aq) treatments. This included growth rates, chlorophyll a concentration and photosynthetic yield (FV/FM). Different light treatments had a large effect on nutrient uptake. High light conditions caused an increased nutrient uptake rate compared to cells grown in low light conditions. Light and CO2 conditions co‐determined in various ways the response of P. alata to changing environmental conditions. Overall P. alata appeared to be well adapted to the natural variability in light availability and CO2(aq) concentration of the modern Southern Ocean. Nevertheless, our results showed that P. alata is susceptible to future changes in inorganic carbon concentrations in the Southern Ocean.
Use of Kiosks and Patient Understanding of Opt‐out and Opt‐in Consent for Routine Rapid Human Immunodeficiency Virus Screening in the Emergency Department
Authors: Haukoos Jason S. , Hopkins Emily , Bender Brooke , Al‐Tayyib Alia , Long Jeremy , Harvey Jeffrey , Irby Jessica , Bakes Katherine ,   for the Denver Emergency Department HIV Testing Research Consortium
Published: March 2012

ACADEMIC EMERGENCY MEDICINE 2012; 19:287–293 © 2012 by the Society for Academic Emergency Medicine

Objectives:  The objective was to evaluate patient acceptance and understanding of nontargeted opt‐out and opt‐in rapid human immunodeficiency virus (HIV) screening using computerized kiosks in the emergency department (ED).

Methods:  This study was a prospective quasi‐experiment in an urban hospital with an annual ED and urgent care census of 120,000 visits. During medical screening, patients 13 years and older were offered rapid HIV screening using kiosks and opt‐out consent (October 2009) or opt‐in consent (December 2009). Random time blocks were used to administer structured surveys to evaluate patient understanding of the testing process.

Results:  During the opt‐out phase, 6,602 were offered testing, and of these 3,993 (61%) did not opt‐out and 886 (13%) completed screening. During the opt‐in phase, 5,781 were offered testing, and of these 930 (16%) opted‐in and 389 (7%) completed screening (absolute difference = 6%, 95% confidence interval [CI] = 5% to 8%). During the opt‐out phase, 330 patients completed the survey. Of these, 201 (61%) did not opt‐out, but 108 (54%, 95% CI = 47% to 61%) responded that they had not been informed about an HIV test. Of the 84 patients who had been informed, 32 (38%, 95% CI = 28% to 49%) responded that they had not agreed to an HIV test. During the opt‐in phase, 416 completed the survey. Of these, 80 (19%) agreed to testing and two (3%, 95% CI = 0.3% to 9%) responded that they had not been informed about an HIV test. Of the 74 patients who had been informed, only two (3%, 95% CI = 0.3% to 9%) responded that they had not agreed to an HIV test.

Conclusions:  Computerized kiosks can be successfully used to perform nontargeted rapid HIV screening in EDs. However, when using this approach, patient understanding of opt‐in consent is significantly better than opt‐out consent.
Optimizing Clinical Operations as Part of a Global Emergency Medicine Initiative in Kumasi, Ghana: Application of Lean Manufacturing Principals to Low‐resource Health Systems
Authors: Carter Patrick M. , Desmond Jeffery S. , Akanbobnaab Christopher , Oteng Rockefeller A. , Rominski Sarah D. , Barsan William G. , Cunningham Rebecca M.
Published: March 2012

Background:  Although many global health programs focus on providing clinical care or medical education, improving clinical operations can have a significant effect on patient care delivery, especially in developing health systems without high‐level operations management. Lean manufacturing techniques have been effective in decreasing emergency department (ED) length of stay, patient waiting times, numbers of patients leaving without being seen, and door‐to‐balloon times for ST‐elevation myocardial infarction in developed health systems, but use of Lean in low to middle income countries with developing emergency medicine (EM) systems has not been well characterized.

Objectives:  To describe the application of Lean manufacturing techniques to improve clinical operations at Komfo Anokye Teaching Hospital (KATH) in Ghana and to identify key lessons learned to aid future global EM initiatives.

Methods:  A 3‐week Lean improvement program focused on the hospital admissions process at KATH was completed by a 14‐person team in six stages: problem definition, scope of project planning, value stream mapping, root cause analysis, future state planning, and implementation planning.

Results:  The authors identified eight lessons learned during our use of Lean to optimize the operations of an ED in a global health setting: 1) the Lean process aided in building a partnership with Ghanaian colleagues; 2) obtaining and maintaining senior institutional support is necessary and challenging; 3) addressing power differences among the team to obtain feedback from all team members is critical to successful Lean analysis; 4) choosing a manageable initial project is critical to influence long‐term Lean use in a new environment; 5) data intensive Lean tools can be adapted and are effective in a less resourced health system; 6) several Lean tools focused on team problem‐solving techniques worked well in a low‐resource system without modification; 7) using Lean highlighted that important changes do not require an influx of resources; and 8) despite different levels of resources, root causes of system inefficiencies are often similar across health care systems, but require unique solutions appropriate to the clinical setting.

Conclusions:  Lean manufacturing techniques can be successfully adapted for use in developing health systems. Lessons learned from this Lean project will aid future introduction of advanced operations management techniques in low‐ to middle‐income countries.
Alcohol prevention in Swedish antenatal care: effectiveness and perceptions of the Risk Drinking project counseling model
Authors: NILSEN PER , SKAGERSTRÖM JANNA , RAHMQVIST MIKAEL , HULTGREN EVA , BLOMBERG MARIE
Published: March 2012

Objective. To compare an earlier Swedish antenatal care counseling routine concerning alcohol consumption with an expanded model in terms of effectiveness in achieving abstinence in pregnancy. A further objective was to assess the women's perceptions of the alcohol counseling. Design. Cohort study. Setting. Antenatal care center in a provincial Swedish university town. Population. Women who received alcohol counseling; 1533 in cohort 1 (routine counseling) and 1476 in cohort 2 (expanded model). Approximately 93% of all pregnant women in Linköping are registered at this center. Methods. Data were collected by means of an anonymous questionnaire. Thirteen questions in the questionnaire were analysed for this study. Main outcome measures. Replies from three questions concerning pre‐pregnancy drinking and three questions on drinking during pregnancy. Results. The response rate was 60% for cohort 1 and 64% for cohort 2. Perceptions of the advice from the antenatal care center were generally favorable. Similar proportions of women, approximately 6%, in both cohorts drank at least once during the pregnancy (after pregnancy recognition). There were four predictors for drinking during pregnancy: older age; having previously given birth to a child; frequency of pre‐pregnancy drinking; and perceiving the message from antenatal care as “small amounts of alcohol during pregnancy don't matter.”Conclusions. An expanded counseling model implemented in Swedish antenatal care did not reduce the proportion of women who continued drinking during pregnancy in comparison with a previous counseling model, although the advice provided in the new model was perceived more favorably.
Restless legs syndrome during and after pregnancy and its relation to snoring
Authors: SARBERG MARIA , JOSEFSSON ANN , WIRÉHN ANN‐BRITT , SVANBORG EVA
Published: March 2012

Objective. To study development of restless legs syndrome (RLS) during and after pregnancy, and whether RLS is related to snoring or other pregnancy‐related symptoms. Design. Prospective study. Setting. Antenatal care clinics in the catchment area of Linköping university hospital, Sweden. Population. Five hundred consecutively recruited pregnant women. Methods. Sleep disturbances, including symptoms of RLS and snoring, were assessed with questionnaires in each trimester. A complementary questionnaire was sent three years after delivery to women experiencing symptoms of RLS during pregnancy. Main outcome measures. Symptoms of RLS in relation to snoring in each trimester. Results. Symptoms of RLS were reported by 17.0% of the women in the first trimester, by 27.1% in the second trimester and by 29.6% in the third trimester. Snoring in the first trimester was correlated to increased prevalence of RLS in all three trimesters (p= 0.003, 0.017 and 0.044 in the first, second and third trimester, respectively). No correlation was found between RLS and anemia, parity or body mass index. Among the women who experienced RLS, 31% still had symptoms three years after delivery. Fifty‐eight per cent of those whose symptoms had disappeared stated that this happened within one month after delivery. Conclusions. Symptoms of RLS progressed most between the first and second trimester. Women who snored in the first or second trimester of pregnancy had a higher prevalence of RLS in the third trimester, which indicates that snoring in early pregnancy might predict RLS later. Symptoms of RLS disappear quite soon after delivery, but about one‐third of women with RLS during pregnancy may still have symptoms three years after childbirth.
Niche conservatism and the differences in species richness at the transition of tropical and subtropical climates in South America
Authors: Giehl Eduardo L. Hettwer , Jarenkow João André
Published: March 2012

Although detected long ago, latitudinal disparity in species richness lacks a consensus regarding its underlying mechanisms. We evaluated whether the main predictions derived from the tropical niche conservatism hypothesis help to explain differences regarding species richness and turnover of species and lineages between forests located in tropical and subtropical climates. If tropical niches are retained, we predict that only a subset of tropical lineages disperses and establishes outside the tropics; tip‐level phylogenetic clustering increases outside the tropics; and the climatic variation drives species richness indirectly via constraints to the distribution of lineages. We compiled 58 checklists along tropical and subtropical sites of riparian forests in southeastern South America. We tested the frequency of niches shifts for species and lineages and the abundance of taxa in each climate. Next, we checked the likelihood of pathways linking climatic and spatial predictors directly with species richness and via phylogenetic clustering estimates. Several lineages only occurred in the tropics, and the number of species and lineages that occurred in both climates was lower than expected by chance. Conversely, few lineages were exclusively subtropical and diversified in the subtropics. Phylogenetic clustering increased in subtropical sites and was correlated with decreasing species richness. An interaction between mean temperature of coldest quarter and precipitation seasonality explained most variation in species richness via increases in phylogenetic clustering. These results support an important contribution of climatic niche conservatism to explain richness disparities between tropics and subtropics, mainly because of the inability of most lineages to colonize the subtropics, which is very likely related to cold intolerance. Since niche conservatism likely drives most of the variation in tree species richness in the region, it provides a mechanistic interpretation of the observed patterns, thus fostering the understanding of richness disparities between these tropical and subtropical tree communities.
Regulation of NF‐κB by ubiquitination and degradation of the IκBs
Authors: Kanarek Naama , Ben‐Neriah Yinon
Published: March 2012

Summary:  The nuclear factor‐κB (NF‐κB) signaling pathway is a busy ground for the action of the ubiquitin–proteasome system; many of the signaling steps are coordinated by protein ubiquitination. The end point of this pathway is to induce transcription, and to this end, there is a need to overcome a major obstacle, a set of inhibitors (IκBs) that bind NF‐κB and prohibit either the nuclear entry or the DNA binding of the transcription factor. Two major signaling steps are required for the elimination of the inhibitors: activation of the IκB kinase (IKK) and degradation of the phosphorylated inhibitors. IKK activation and IκB degradation involve different ubiquitination modes; the latter is mediated by a specific E3 ubiquitin ligase SCFβ‐TrCP. The F‐box component of this E3, β‐TrCP, recognizes the IκB degron formed following phosphorylation by IKK and thus couples IκB phosphorylation to ubiquitination. SCFβ‐TrCP‐mediated IκB ubiquitination and degradation is a very efficient process, often resulting in complete degradation of the key inhibitor IκBα within a few minutes of cell stimulation. In vivo ablation of β‐TrCP results in accumulation of all the IκBs and complete NF‐κB inhibition. As many details of IκB‐β‐TrCP interaction have been worked out, the development of β‐TrCP inhibitors might be a feasible therapeutic approach for NF‐κB‐associated human disease. However, we may still need to advance our understanding of the mechanism of IκB degradation as well as of the diverse functions of β‐TrCP in vivo.
NF‐κB and the link between inflammation and cancer
Authors: DiDonato Joseph A. , Mercurio Frank , Karin Michael
Published: March 2012

Summary:  The nuclear factor‐κB (NF‐κB) transcription factor family has been considered the central mediator of the inflammatory process and a key participant in innate and adaptive immune responses. Coincident with the molecular cloning of NF‐κB/RelA and identification of its kinship to the v‐Rel oncogene, it was anticipated that NF‐κB itself would be involved in cancer development. Oncogenic activating mutations in NF‐κB genes are rare and have been identified only in some lymphoid malignancies, while most NF‐κB activating mutations in lymphoid malignancies occur in upstream signaling components that feed into NF‐κB. NF‐κB activation is also prevalent in carcinomas, in which NF‐κB activation is mainly driven by inflammatory cytokines within the tumor microenvironment. Importantly, however, in all malignancies, NF‐κB acts in a cell type‐specific manner: activating survival genes within cancer cells and inflammation‐promoting genes in components of the tumor microenvironment. Yet, the complex biological functions of NF‐κB have made its therapeutic targeting a challenge.
It takes two to tango: IκBs, the multifunctional partners of NF‐κB
Authors: Hinz Michael , Arslan Seda Çöl , Scheidereit Claus
Published: March 2012

Summary:  The inhibitory IκB proteins have been discovered as fundamental regulators of the inducible transcription factor nuclear factor‐κB (NF‐κB). As a generally excepted model, stimulus‐dependent destruction of inhibitory IκBs and processing of precursor molecules, both promoted by components of the signal integrating IκB kinase complex, are the key events for the release of various NF‐κB/Rel dimers and subsequent transcriptional activation. Intense research of more than 20 years provides evidence that the extending family of IκBs act not simply as reversible inhibitors of NF‐κB activation but rather as a complex regulatory module, which assures feedback regulation of the NF‐κB system and either can inhibit or promote transcriptional activity in a stimulus‐dependent manner. Thus, IκB and NF‐κB/Rel family proteins establish a complex interrelationship that allows modulated NF‐κB‐dependent transcription, tailored to the physiological environment.
Post‐transcriptional regulatory networks play a key role in noise reduction that is conserved from micro‐organisms to mammals
Authors: Joshi Anagha , Beck Yvonne , Michoel Tom
Published: March 2012

RNA‐binding proteins (RBPs) are core regulators of mRNA transcript stability and translation in prokaryotes and eukaryotes alike. Genome‐wide studies in yeast have shown intriguing relationships between the expression dynamics of RBPs, the structure of post‐transcriptional regulatory networks of RBP–mRNA binding interactions and noise reduction in post‐transcriptionally regulated expression profiles. In the present study, we assembled and compared the genomic properties of RBPs and integrated transcriptional and post‐transcriptional regulatory networks in four species: Escherichia coli, yeast, mouse and human. We found that RBPs are consistently regulated to have minimal levels of protein noise, that known noise‐buffering network motifs are enriched in the integrated networks and that post‐transcriptional feedback loops act as regulators of other regulators. These results support a general model where RBPs are the key regulators of stochastic noise‐buffering in numerous downstream cellular processes. The currently available datasets do not allow clarification of whether post‐transcriptional regulation by RBPs and by noncoding RNAs plays a similar or distinct role, although we found evidence that specific combinations of transcription factors, RBPs and micro‐RNAs jointly regulate known disease pathways in humans, suggesting complementarity rather than redundancy between both modes of post‐transcriptional regulation.
British Perceptions of Ottoman Judicial Reform in the Late Nineteenth Century: Some Preliminary Insights
Authors: Rubin Avi
Published: March 2012

In the second half of the nineteenth century, the Ottomans founded a new court system, the Nizamiye courts, as part of an empire-wide ambitious project of judicial and administrative reform, which involved legal transplantation from the French model. The institutional evolution of these courts was completed with elaborate legislation introduced in 1879. This article explores British consular and diplomatic accounts dispatched in the immediate aftermath of the 1879 reforms in an attempt to assess the value of these reports for understanding the passage of Ottoman law to modernity. Comparison of British accounts with relevant Ottoman sources and recent research reveals that British consuls and diplomats produced distorted representations of Ottoman judicial reform, exhibiting lack of faith in the effectiveness of these reforms. Misrepresentation resulted from ignorance about the nature of reformed Ottoman law, prejudice, and concerns about the effect of these reforms on the ability of British consuls to interfere with Ottoman court proceedings.
Systemic toxoplasmosis in captive flying‐foxes
Authors: Sangster CR , Gordon AN , Hayes D
Published: March 2012

Systemic toxoplasmosis caused by Toxoplasma gondii was diagnosed in two juvenile, captive flying‐foxes (Pteropus conspicillatus and P. scapulatus), which died following respiratory distress. One animal displayed clinical signs suggestive of neurological disease. This is the first report of this disease in megachiropteran bats and adds to the list of differential diagnoses for both systemic and neurological disease in these animals. The role of captivity in the exposure and development of the disease is discussed.
Nigropallidal encephalomalacia in horses grazing Rhaponticum repens (creeping knapweed)
Authors: Elliott CRB , McCowan CI
Published: March 2012

Nigropallidal encephalomalacia was diagnosed in two horses in northern Victoria that had a history of long‐term pasture access to a dense growth of Rhaponticum repens. The region in which the affected horses lived had received well above average rainfall for several months preceding the poisoning. Affected horses had sudden onset of subcutaneous oedema of the head, impaired prehension and mastication, dullness, lethargy and repeated chewing‐like jaw movements. Diagnosis was confirmed at necropsy, with characteristic malacic lesions in the substantia nigra and globus pallidus of the brain. This is the first documented case of nigropallidal encephalomalacia in Australian horses associated with R. repens.