bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypertonic Saline is More Effective Than Normal Saline in Seasonal Allergic Rhinitis in Children
Authors: Marchisio P. , Varricchio A. , Baggi E. , Bianchini S. , Capasso M.E. , Torretta S. , Capaccio P. , Gasparini C. , Patria F. , Esposito S. , Principi N.
Published: January 2017

Allergic rhinitis (AR) is a very common childhood disease that is associated with a significant reduction in the patients' quality of life. Its treatment combines educating the patients and their parents, immunotherapy and drug administration. However, even the best approach does not relieve the symptoms of a number of patients. Alternative therapies are particularly needed for children because the fear of adverse events frequently reduces parental compliance to the prescribed drugs, and immunotherapy is less easy to administer than in adults. In this prospective investigator-blinded study we evaluated whether children, with a documented history of seasonal grass pollen-related AR, benefit from nasal irrigation by assessing the effects on nasal signs and symptoms, on middle ear effusion and on adenoidal hypertrophy. We randomized children aged 5 to 9 years (median age 82 months) to normal saline or hypertonic saline (a 2.7% sodium chloride solution), administered twice-daily using a disposable 20 ml syringe, or no treatment. Nasal symptoms (rhinorrhea, itching, sneezing, nasal obstruction), swelling of turbinates, adenoid hypertrophy or middle ear effusion were assessed at baseline and after 4 weeks of treatment. Two hundred and twenty children (normal saline: 80; hypertonic saline: 80; no treatment: 60) completed the study. After four weeks, all the considered items were significantly reduced in the group receiving hypertonic saline (P <0.0001), whereas in the group receiving normal saline only rhinorrhea (P = 0.0002) and sneezing (P = 0.002) were significantly reduced. There was no significant change in any of the items in the control group. The duration of oral antihistamines was significantly lower in the children receiving hypertonic saline than in those treated with normal saline or in controls. No adverse events were reported and parental satisfaction and compliance with the procedure were globally very good, regardless of the solution used. Using our procedure, hypertonic saline is effective, inexpensive, safe, well tolerated and easily accepted by children with seasonal grass pollen-related AR and their parents. Our data suggest that nasal irrigation with hypertonic saline might be included in the wide spectrum of therapies recommended for grass-pollen AR.
Haemophagocytic Syndrome Associated with Mucormycosis Infection
Authors: Arena V. , De-Giorgio F. , Pennacchia I. , Manna R. , Vetrugno G. , Stigliano E. , Milic N. , Gasbarrini G. , Abenavoli L.
Published: January 2017

Several clinical forms of mucormycosis are recognized. The tendency of mucoraceous zygomycetes to invade the blood vessels often produces a disseminated infection. A case of a disseminated mucormycosis complicated by a haemophagocytic syndrome (HS) in a 32-year-old Caucasian male is reported in this article. Few cases of infection-associated HS (IAHS), involving infections caused by fungi, have been reported. In all the recorded cases, the fungal infection coexists with malignant lymphoma, immunodeficiency and a long-term steroid therapy for renal transplant or Crohn's disease. This is the second described case of the HS due to mucormycosis.
Surgical Debridement Plus Topical Cyclosporine a in the Treatment and Vernal Shield Ulcers
Authors: Caputo R. , Pucci N. , Mori F. , De Libero C. , Di Grande L. , Bacci G.M.
Published: January 2017

Vernal Keratoconjunctivitis (VKC) is a severe chronic bilateral inflammation of the ocular surface characterized by seasonal exacerbations. Long-term prognosis is generally good; however, 6% develop sequelae responsible for permanent visual impairment. Corneal involvement is almost always present, consisting of punctate keratitis, shield ulcers (3–11%) and late corneal neovascularization. In recent years, topical cyclosporine A preparations at 2% in oil or at 1% in polyvinyl alcohol, have been successfully proposed for long term VKC treatments. It has been previously proven that medical treatment is not always sufficient, especially when it is employed to treat shield ulcer plaques. In such conditions, surgery may be effective for avoiding long term complications such as amblyopia, strabismus, infections and corneal perforation. In this paper, we show the efficacy of surgical debridement by means of simple scraping associated with topical cyclosporine treatment for the management of vernal shield ulcers complicated with plaques.
Neutrophils as Effectors of Host Defense and Host Damage. Physiopathology and Perspectives of Pharmacological Manipulation
Authors: Sacchetti C. , Dallegri F. , Patrone F.
Published: January 2017

Although neutrophils (neutrophilic polymorphonuclear leukocytes, PMNs) provide a principal means of host defense against bacteria and fungi, they can also promote host tissue injury in several non infectious diseases (1). The intervention of PMNs in the pathogenesis of gouty arthritis, rheumatoid arthritis, autoantibody -and immunecomplex-mediated glomerulo-nephritis has been well documented. Moreover, a relevant role of PMNs in tissue injury is now more than suggestive in an increasing number of disease states, including immune vasculitis, ulcerative colitis, chronic obstructive pulmonary disease, adult acute respiratory distress syndrome. At present, the same toxic potential of PMNs is generally thought to be equally responsible for both the microorganism killing and the tissue injury in the aforementioned disorders (1, 2, 3). This fact, coupled with the incomplete knowledge of the events underlying the PMN responses and the PMN-mediated tissue injury, makes rational therapeutic approaches untimely at least as far as the dangerous effects of PMNs are concerned.
The American Economic Review at 100: A Summary of the Journal'S Most Frequent Contributing Authors and Institutions
Authors: Heck Jean L. , Zaleski Peter A.
Published: January 2017

The American Economic Review (AER) celebrates it 100th anniversary during 2011. During this century of contributions to economic thought, the elite group of most frequent contributing authors and academic institutions revealed in this study represent major participants in the unparalleled role that the AER has played in the world of scholarly published research. These contributing authors and academic institutions are most deserving of our admiration.
Not All Micro-Loans Were Created Equal: The Effect of Supply Chain Location on Micro-Lending
Authors: Cooke Aaron
Published: January 2017

The positive effects of micro-loans on the impoverished has become veritable gospel to economic development professionals. Pioneered by Muhammed Yunus in the 1970s, the concept of making small loans to groups of poor entrepreneurs has become a mainstream tool of development and poverty reduction agents around the globe. However, little research has been done at this time into the microeconomic mechanics of small scale finance, especially the different outcomes of the loan depending on what sector of the economy the debtor is engaged in. A simulation designed to pursue further understanding of this subject, and conducted in partnership with Opportunity International, a micro-finance NGO, and the Westmont Investment Club, reveals whether different outcomes of a micro-loan were caused by a debtor's location in the production chain.
Barter and Business Cycles: Further Empirical Evidence
Authors: Marvasti Akbar , Smyth David J.
Published: January 2017

Rising interest in barter due to the current world-wide recession has motivated a re-examination of macroeconomic determinants of barter in the U.S. economy, particularly its correlation with the business cycle. This critical evaluation, using the International Reciprocal Trade Association data, addresses, among other issues, whether firm size affect the behavior of firms during business cycles. Here, we deal with replacement of the missing observations by filling them with forecasts using the Box-Jenkins ARMA and Kalman filter methods before performing the unit root and cointegration tests. Although the ECM estimates for various measures of business cycles are occasionally inconsistent, overall the inventory measures and capacity utilization results suggest that barter transactions are counter-cyclical regardless of the firm size. Additionally, we find that barter rises with inflationary trend, dissemination of access to computer technology, tax rates and tax laws requiring disclosure of barter transactions.
Toward An Econometric Model of Guzman'S Theory of Customary International Law
Authors: Luby Ryan
Published: January 2017

The United States' recent incursions into both Iraq and Afghanistan have resituated debates concerning the validity and effectiveness of customary international law (CIL). On the one hand, scholars such as Goldsmith and Bradley argue that CIL is neither valid nor effective. Recently, Guzman formulated a response to such arguments as those proposed by Goldsmith and Bradley (1997). In a lucid critique of Goldsmith's argument, Guzman categorizes such arguments as “doctrinal” (2006). Instead, Guzman proposes a game theoretic model that seeks to quantify “reputation” in order to ascertain a given norm's status as CIL. The following paper proposes an econometric model in order to operationalize Guzman's theory of CIL. Indeed, looking at a politically and economically diverse group of five countries between the years of 1960 and 2008, the analysis herein suggests a more nuanced conception of CIL than the absolutist position of Goldsmith.
Toward an Historical Anthropology of the ‘Ethical State’: Articulations among Gender, Class and Education in an Irish Parish, 1860–1910
Authors: Cohen Marilyn
Published: January 2017

The cultural formation of citizens and the hegemony of the ‘ethical state’ in England emerged in the mid-nineteenth century, a period when capitalist social relations were consolidating, operating through the processes of bourgeois institutional differentiation and the regulation of culture and social space from above. This paper employs the methods of historical ethnography to address the historical vertities of these cultural processes in colonial Ireland. It focuses on one institution—education—in one north of Ireland parish to explore how class and gender mediated the process and experience of the institutional separation of education in the second half of the nineteenth century. The rigid ‘culture of control’ orchestrating gender roles and material survival in working-class households framed distinctions in the attainment of schooled knowledges and created divergent uses and functions for such knowledge in the broader social context.
The Dynamics of Political Economy in Ireland: The Case of Asylum Seekers and the Right to Work
Authors: Loyal Steven , Staunton Ciarán
Published: January 2017

This paper is partly the outcome of research that was conducted on behalf of the Irish Refugee Council between January and July 2000.' The research was prompted by the Irish Government's decision to allow the right to work to asylum seekers who had made their applications for asylum in Ireland 12 months prior to 27 July 1999. It incorporated both qualitative and quantitative techniques and included a sample of 37 asylum seekers who had received the right to work. Due to in-built research requirements, the research report focused entirely upon concrete social policy recommendations towards creating a viable, democratic, rights-based and equality focused environment within which to address the employment and social needs of Asylum Seekers. Sociopolitical analysis was therefore not the primary focus of the research. However, a re-evaluation of the findings allowed such sociopolitical themes to be subsequently explored in this article.
Globalisation and its Discontents
Authors: Allen Kieran
Published: January 2017

The emergence of an anti-globalisation movement which seeks to project a common interest between workers and social movements against neo-liberalism, represents a challenge for sociological theory. The most direct challenge is to the ‘court sociology’ of Beck and Giddens who now act as advisors to political elites. They have conceptualised globalisation as primarily an abstract cultural process which calls for ‘inevitable’ flexible changes among the dominated. One theorist who rose to the challenge of the anti-globalisation movement was Pierre Bourdieu. His later writings re-legitimised a discourse of resistance. But his explanation of neo-liberalism in terms of subjective changes among the state nobility has underplayed the economic changes in late capitalism that gave rise to the phase of globalisation.
Inequalities in Preparation for University Entrance: An Examination of the Educational Histories of Entrants to University College, Cork
Authors: Dowling Teresa
Published: January 2017

Because of differences between and within second-level schools in the length of the curriculum offered to pupils, and because of the differing usage of extra tutoring outside of schools by pupils themselves, entrants to universities show considerable diversity in the quantity of second-level schooling they have received. This paper analyses first-year students in University College, Cork, in 1989 to examine this diversity and its links with social class and with patterns of faculty enrolment within the university. It concludes that inequalities in the quantity of second-level schooling received parallel other inequalities in the Irish education system and so intensify the inegalitarian nature of that system.
Screening for Straights: Aspects of Entrance Policy at a Gay Disco
Authors: McVeigh Andrea
Published: January 2017

The gay disco has an important function within the gay community. It is a place where lesbians and gay men can meet and socialise with other members of the gay community, in a fairly closed environment that offers seclusion and shelter from the outside (mainly heterosexual) world. This paper examines the way in which potential patrons of a gay disco, that is, those who were not known as regular patrons to the doorman and bouncers, were screened in an attempt to determine sexual identity, to ensure that as few heterosexuals as possible were allowed entrance into the club.
Drumcree: A Struggle for Recognition
Authors: Mulholland Peter
Published: January 2017

This paper attempts to explain what motivates the Catholic community in Portadown in their opposition to routing Orange Parades through their neighbourhoods. It argues that the parades issue cannot be fully explained in terms of a conflict over two equal but opposing sets of rights, or as a localised manifestation of a power struggle between the two ethno-national communities in Northern Ireland. Rather, it is best understood as a struggle against the sectarianism that governs relations between the two communities, and which Catholics experience as a violation of their dignity and rights. This violation effectively maintains their subordinate status by undermining their self-confidence, self-esteem and self-respect. This, in turn, diminishes their ability and willingness to participate in and to benefit from the socioeconomic and cultural life of one of the most prosperous provincial towns in the north of Ireland.
Topical Review: Cortical Malformation and Pediatric Epilepsy: A Molecular Genetic Approach
Authors: Mochida Ganeshwaran H.
Published: January 2017

Genetic malformations of the cerebral cortex are important causes of neurologic morbidity in children because they are often associated with developmental delay, motor disturbances (cerebral palsy), and epilepsy. Primary autosomal recessive microcephaly is a cortical malformation with a low incidence of epilepsy. One of its causative genes, ASPM, might play an important role in regulating proliferation of neuronal progenitor cells. Mutations in ASPM do not seem to affect later stages of cortical development, such as neuronal migration, and this might be responsible for the low epileptogenicity of this malformation. ASPM might also have played an important role in the evolutionary expansion of the human brain. Bilateral frontoparietal polymicrogyria, on the other hand, is a highly epileptogenic malformation. Its causative gene, GPR56 , is also expressed in the neurogenic regions of the cortex, but its primary function might be in the determination of cell fate and/or cortical patterning. Further studies of these genes will likely lead to a better understanding of human brain development and epilepsy. ( J Child Neurol 2005;20:300—303).
Topical Review: Activated Remodeling and N-Methyl-D-Aspartate (NMDA) Receptors in Cortical Dysplasia
Authors: Yamanouchi Hideo
Published: January 2017

Cortical dysplasia is now recognized as one of the major etiologies causing intractable epilepsy in childhood. Dysplastic cortex displays cortical dyslamination, which is often associated with dysmorphic large neurons and less frequently with balloon cells. The dysmorphic large neurons are commonly located in the subcortical white matter and cerebral cortex, with enlarged nuclei with a single prominent nucleolus and showing aberrant cytoskeletal changes. I have shown that dysmorphic large neurons have several immature types of cytoskeletal proteins, such as the low-molecular-weight form of microtubule-associated protein 2 (MAP2) and MAP1B, which are involved in the outgrowth and modeling of neuronal processes in the immature brain. I have also reported that dysmorphic large neurons also have enhanced gene expression of growth-associated protein GAP43, which is a phosphoprotein enriched at presynaptic nerve terminals and is thought to be involved in axonal outgrowth and plasticity in synaptic connections. Finally, I have shown that the N-methyl-D-aspartate acid (NMDA) receptor R1 gene is up-regulated in the dysmorphic large neurons and nearly normal-sized neurons located in the dysplastic cortex. This evidence suggests that growth of neuronal processes and activated excitatory synaptic remodeling exist in the epileptic conditions of cortical dysplasia. ( J Child Neurol 2005;20:303—307).
Topical Review: Schizencephaly: Clinical Spectrum, Epilepsy, and Pathogenesis
Authors: Granata Tiziana , Freri Elena , Caccia Claudio , Setola Veronica , Taroni Franco , Battaglia Giorgio
Published: January 2017

After almost 60 years since the original description, we have reviewed the results of the more recent studies on schizencephaly in an attempt to delineate its imaging and clinical spectra of presentation and to point out the still unsettled controversies on its pathogenesis. The clinical picture is mainly based on the presence of motor deficits and mental retardation, but the severity of the clinical picture is extremely variable, mainly related to the size and location of the clefts and to the presence of associated cerebral malformations. By contrast, the outcome of epilepsy, which is present in about half of the cases and drug resistant in a third, is not strictly related to the severity of the malformation. Some clinical and functional magnetic resonance imaging studies have suggested that, beside the features of the anatomic damage, the functional reorganization of a malformed and unaffected cortex is most likely crucial in determining the clinical outcome. Review of the genetic studies and the more recent personal data suggests that the role of the EMX2 gene in schizencephaly, if any, is restricted to a minority of cases, leaving the etiopathogenesis of this brain malformation still a matter of study and debate. ( J Child Neurol 2005;20:313—318).
Clinical Application of Experimental Cortical Dysplasia in Rats
Authors: Tanaka Tatsuya , Tsuda Hiroshige , Hashizume Kiyotaka , Sakurai Juro , Hodozuka Akira , Nakai Hirofumi
Published: January 2017

This report details clinical and experimental studies of focal cortical dysplasia. The first part deals with 14 surgical cases of children with intractable epilepsy. At surgery, intraoperative electrocorticography was performed to localize the epileptic foci under neuroleptanalgesia. Thirteen patients showed epileptiform discharges on this preresection electrocorticography. All foci in noneloquent areas were resected. Patients who had undergone total lesionectomy with complete focus resection showed the most favorable postoperative results. However, the positive correlation between the intraoperative electrocorticographic findings and the pathologic classification of cortical dysplasia was not found in the present study. Nine patients have been seizure free with reduced medication and two patients have achieved worthwhile improvement. We conclude that intraoperative electrocorticography can improve the surgical outcome for intractable epilepsy by localizing epileptic foci for resection. The second part describes a kainic acid—induced experimental model of focal cortical dysplasia, which demonstrated not only the epileptic properties of the dysplasia but also the perilesional epileptogenicity. The findings supported the surgical results for the patients with focal cortical dysplasia. ( J Child Neurol 2005;20:351—356).
Dynamic Statistical Parametric Mapping for Analyzing the Magnetoencephalographic Epileptiform Activity in Patients With Epilepsy
Authors: Shiraishi Hideaki , Stufflebeam Steven M. , Knake Susanne , Ahlfors Seppo P. , Sudo Akira , Asahina Naoko , Egawa Kiyoshi , Hatanaka Keisaku , Kohsaka Shinobu , Saitoh Shinji , Grant P. Ellen , Dale Anders M. , Halgren Eric
Published: January 2017

Our current purpose is to evaluate the applicability of dynamic statistical parametric mapping, a novel method for localizing epileptiform activity recorded with magnetoencephalography in patients with epilepsy. We report four pediatric patients with focal epilepsies. Magnetoencephalographic data were collected with a 306-channel whole-head helmet-shaped sensor array. We calculated equivalent current dipoles and dynamic statistical parametric mapping movies of the interictal epileptiform discharges that were based in the minimum-L2 norm estimate, minimizing the square sum of the dipole element amplitudes. The dynamic statistical parametric mapping analysis of interictal epileptiform discharges can demonstrate the rapid change and propagation of interical epileptiform discharges. According to these findings, specific epileptogenic lesion—focal cortical dysplasia could be found and patients could be operated on successfully. The presurgical analysis of interictal epileptiform discharges using dynamic statistical parametric mapping seems to be promising in patients with a possible underlying focal cortical dysplasia and might help to guide the placement of invasive electrodes. ( J Child Neurol 2005;20:363—369).
Cellular interaction influenced by surface modification strategies of gelatin-based nanoparticles
Authors: Tse Wai Hei , Gyenis Laszlo , Litchfield David W , Zhang Jin
Published: January 2017

Theranostic applications of gelatin nanospheres require two major components, a method of detection and good biocompatibility. We characterized the response of UTA-6 human osteosarcoma cells to the introduction of functionalized 90 bloom-based gelatin nanospheres (158 ± 49 nm) modified with three elements in different order: (a) hybridization with cadmium-based quantum dots for optical detection, (b) bioconjugation with anti-human IgG FAB (anti-IgG) for cell targeting, with/without (c) capping with polyethylene glycol on the surface for enhanced biocompatibility. A one-pot process is developed for incorporating quantum dots and antibody with gelatin nanospheres. Path A of modifying gelatin nanospheres with quantum dots first followed by anti-IgG resulted in a significantly greater cellular viability than Path B with anti-IgG first followed by quantum dots. Capping with polyethylene glycol as the final step in modification yielded significantly opposing results with decreases in Path A and increases in Path B. Three-dimensional z-stacking fluorescent images of hybrid gelatin nanospheres with anti-IgG is observed to have an increase in cellular association. The observed results suggest the modification order for building hybrid nanospheres may have an impact on cellular response.
Cyclic Antidepressant Poisoning: A Review and Case Report
Authors: Cohen Henry , Hoffman Robert S. , Howland Mary Ann
Published: January 2017

Although newer cyclic antidepressants have been introduced over the past several years, the tricyclic antidepressants (TCAs) continue to be the leading cause of morbidity from drug overdose in the United States. Overdose features depend on the particular cyclic antidepressant ingested and its pharmacological properties, and can include CNS depression, cardiac arrhythmias, hypotension, seizures, and anticholinergic symptomatology. Life-threatening symptomatology almost always begins within 2 hours, and certainly within 6 hours, after arrival to the emergency department. Plasma TCA levels are unreliable predictors of TCA toxicity and are not recommended. An ECG with a prolonged QRS complex more than 100 msec seems to be the best indicator of serious sequelae with TCAs. Management consists of stabilization of vital signs, gastrointestinal decontamination, intravenous sodium bicarbonate, and supportive care. Agents once thought to be useful for the treatment of cardiac dysrhythmias and seizures such as phenytoin and physostigmine should be avoided. The future of TCA antibody fragments in the treatment of TCA overdose seems promising. Newer and, to some degree, safer antidepressants in overdose have recently been introduced, and they include fluoxetine, trazodone, and sertraline. Amoxapine, bupropion, and maprotiline seem to be as toxic as the TCAs. A significant interaction between cyclic antidepressants and monoamine-oxidase inhibitors exists. Management includes supportive care and basic poison management. Prevention of poisoning seems to be the most logical and effective method of maintaining patient safety. TCAs should be avoided in children younger than 6 years old. All adults with suicidal ideations should receive no more than a 1-week supply (about 1 g) of drug. Finally consideration should be given to using one of the newer, safer antidepressants in all patients with suicidal ideations.
Limitations of Secondary Data for Strategic Marketing in Rural Areas
Authors: Borders T. F. , Rohrer J. E. , Vaughn T. E.
Published: January 2017

Market research is an important element of the strategic marketing process. By understanding the healthcare needs of a market area, hospital and health system managers can set priorities for new services and allocate resources appropriately. The process of market research often begins with an evaluation of health status and socioeconomic indicators collected from secondary sources. Unfortunately, indicators that have been recommended in the literature may not be feasible for use in rural markets because of their lack of statistical precision or inability to differentiate healthcare service needs. This study evaluated the statistical precision and variability of 79 secondary health status and socioeconomic measures reported at the county level in Iowa, USA, a largely rural state. Our findings suggest that many readily available health status and socioeconomic indicators do not discriminate need among rural health care markets. Only six health status and two socioeconomic indicators met our statistical precision and variability criteria. These findings have important implications for managers planning health services in rural localities. Managers of rural health systems may need to employ alternative market research methods, such as analysis of claims-based utilization rates or community health surveys.
Primary Care Groups and Trusts: Stages in a Process of Organizational Evolution
Authors: Smith J.
Published: January 2017

In this paper, the origins and early experiences of the new national network of primary care groups (PCGs) in the NHS are explored, emphasizing that they represent the latest stage in an evolutionary process in the development of primary care organizations. Using Greiner's five stages of organizational growth, an analysis is made of the development of PCGs and the future primary care trusts (PCTs). The author asserts that, having grown through creativity in the pre-1997 NHS, primary care organizations in the ‘New NHS’ are experiencing growth through direction, with a much greater degree of central control and management being brought to bear on PCGs. The likely future shape of PCGs and PCTs is then described, drawing on the analysis of PCGs within Greiner's framework for organizational growth. The paper concludes by setting out guidelines for managers and clinicians charged with the responsibility of developing PCGs and PCTs, based on the premise that these new organizational forms are not an end in themselves, but a stage in the organizational development of primary care in the NHS.
Evaluation of the Information and Support Services in the Voluntary Sector Using a New P–C–P Attributes Model
Authors: Philip G. , Stewart J.
Published: January 2017

This paper describes the development and use of a modified SERVQUAL research instrument for measuring the service quality of voluntary organizations from the perspective of their ‘customers’. A series of focus group meetings were run with providers and users of the services to identify the appropriate dimensions of service quality. These were structured meetings led by the researchers addressing set questions in a group setting. The meeting enabled the identification of six different dimensions of service quality which neatly mapped on to the pivotal–core–peripheral (P–C–P attributes model [Philip and Hazlett, 1997]), which was developed after extensive research of existing models such as SERVQUAL. These dimensions were used to develop a questionnaire to assess service quality within the voluntary sector. The questionnaire was distributed to 2005 service users, representing eight voluntary organizations from across Northern Ireland. The research resulted in the development of a methodology and research instrument suitable for measuring service quality in the voluntary sector.
Women and HIV—Revisited Ten Years on
Authors: Shah Rimi , Bradbeer Caroline
Published: January 2017

This article compares how women and their relationship to HIV has changed since the original publication of this article in 1990. The number of women infected with HIV has continued to rise, but, in contrast, there have been few changes in their management. We review transmission risks and manifestations of the infection, and also discuss the issues faced by women with HIV.
Rectal Gonorrhoea in Homosexual Men: Source of Infection
Authors: McMillan A , Young H , Moyes A
Published: January 2017

The objective of this retrospective study was to determine the possible source of infection in homosexual men with rectal gonorrhoea: the probable source of rectal gonorrhoea was identified in 46/155 cases. Although the urethra was the site of infection in 33 (72%) of these contacts, only pharyngeal gonorrhoea was identified in 9 (20%) men. In 25/26 cases, there was concordance in the auxo/serotypes of Neisseria gonorrhoeae between contacts with urethral gonorrhoea and the index men with rectal gonorrhoea. Eleven out of 12 pharyngeal isolates were of the same auxo/serotype as the index cases. This study supports the hypothesis that rectal gonorrhoea in homosexual men can be acquired from the oropharynx. Because infection at this site is an independent risk factor for acquisition of HIV, screening for rectal and pharyngeal gonorrhoea should be offered to men who have sex with men, even when there is no history of unprotected receptive anal intercourse.
Sexually Transmitted Infections and Use of Sexual Health Services among Young Australian Women: Women's Health Australia Study
Authors: Schofield Margot J , Minichiello Victor , Mishra Gita D , Plummer David , Savage Jan
Published: January 2017

Our objective was to examine associations between self-reported sexually transmitted infections (STIs) and sociodemographic, lifestyle, health status, health service use and quality of life factors among young Australian women; and their use of family planning and sexual health clinics and associations with health, demographic and psychosocial factors.

The study sample comprised 14,762 women aged 18–23 years who participated in the mailed baseline survey for the Australian Longitudinal Study on Women's Health, conducted in 1996. The main outcome measures are self report of ever being diagnosed by a doctor with an STI, including chlamydia, genital herpes, genital warts or other STIs, and use of family planning and sexual health clinics.

The self-reported incidence of STI was 1.7% for chlamydia, 1.1% genital herpes, 3.1% genital warts, and 2.1% other STIs. There was a large number of demographic, health behaviour, psychosocial and health service use factors significantly and independently associated with reports of having had each STI. Factors independently associated with use of family planning clinic included unemployment, current smoking, having had a Pap smear less than 2 years ago, not having ancillary health insurance, having consulted a hospital doctor and having higher stress and life events score. Factors independently associated with use of a sexual health clinic included younger age, lower occupation status, being a current or ex-smoker, being a binge drinker, having had a Pap smear, having consulted a hospital doctor, having poorer mental health and having higher life events score.

This study reports interesting correlates of having an STI among young Australian women aged 18–23. The longitudinal nature of this study provides the opportunity to explore the long-term health and gynaecological outcomes of having STIs during young adulthood.
HIV Infection in Sexually Transmissible Disease Practice in Sydney: The Effects of Legislation, Public Education and Changing Clinical Spectrum
Authors: Donovan Basil , Finlayson Robert J , Mutimer Kieran , Price Ross , Robertson Mark , Nelson Megan , Slade Margaret , Reece Ian , Nogare Joanne dalle
Published: January 2017

The experience with human immunodeficiency virus (HIV) infection of a private inner-city sexually transmissible diseases (STD) clinic in Sydney was quantified. Between February 1984 and March 1988, 2073 of the Clinic's patients were tested for antibodies to HIV on 5095 occasions. Of those tested, 538 (26%) were positive for antibodies to HIV: 532 (98.9%) of the seropositives had practised male homosexual intercourse. This is the highest reported seroprevalence of HIV for any primary care service in Australia. Those individuals seropositive because of other risk behaviours were detected by voluntary contact tracing rather than by screening. Female prostitution was not found to be a risk factor for HIV. In general, rates of first HIV antibody tests were adversely affected by threatening legislation, and temporarily stimulated (among lower-risk persons) by a national television campaign.

These data suggest that much of the counselling, detection and management of HIV infection in Australia is occurring in private practice, and that STD services (private and public) are at the forefront of the HIV epidemic. This has implications for disease surveillance and control, health services planning and medical education.
Efficacy of Combined Metronidazole and Triple Tetracycline Therapy in the Treatment of Non-Gonococcal Urethritis
Authors: Woolley P D , Kinghorn G R , Talbot M D , Duerden B I
Published: January 2017

In a double-blind placebo-controlled trial using triple tetracycline (Deteclo, Lederle) 300 mg twice daily for two weeks in conjunction with metronidazole (Flagyl, May & Baker) 400 mg or matching placebo twice daily for seven days, it was shown that the addition of anti-anaerobic therapy did not significantly affect the number of cases of persistent urethritis or the relapse rate of patients with non-gonococcal urethritis (NGU).
Serological Evidence for Human Immunodeficiency Virus Type 2 in East Africa
Authors: Constantine N T , Sheba M Fathi , Fox E , Woody J N , Abbatte E A
Published: January 2017

Infection by human immunodeficiency virus type 2 (HIV-2) has not previously been described in North or East Africa. We examined over 1200 sera of high-risk individuals from three North/East African countries for antibodies to HIV-2. Results indicated that 17 were repeatedly reactive by ELISA; 4 were confirmed by Western blot. Of the 4 confirmed, 2 produced strong reactions to the envelope antigens of HIV-2 but not of HIV-1. One of these subjects was a foreigner from Senegal who was tested while in Egypt and one was a Djiboutian prostitute who was infected presumably prior to October 1987. We conclude that HIV-2 has been introduced into this region and that specific testing of selected individuals for HIV-2 is warranted.
Evaluation of the Amount of Nonoxynol Available in Condoms for the Inhibition of Hiv Using a Method Based on HPLC
Authors: Trap R , Trap B , Petersen C S
Published: January 2017

A method is described for detection of nonoxynol in condoms, based on methanol-water extraction followed by reverse-phase high-performance liquid chromatography. Using this method, we found that approximately 50% of the nonionic surfactant lubricant nonoxynol migrated into elastomers (rubber latex), resulting in a concentration of nonoxynol insufficient to inhibit human immunodeficiency virus (HIV) (<0.05%). In order to minimize the risk of sexual transmission of HIV, and to ensure spermicidal effect and optimal rubber properties, the concentration of nonoxynol in condoms, therefore, should either be increased, or nonoxynol should be packed separately. Further studies are needed to clarify and determine the solubility and migration of nonoxynols into elastomers.
Setting up a Support Service for Male Prostitutes in London
Authors: Tomlinson D R , Hillman R J , Harris J R W
Published: January 2017

Estimating the number of male prostitutes working at any given time is fraught with difficulties. We suggest that perhaps around 600–700 men were selling sex in London in 1989. We report some preliminary observations gained during the setting up of a specific service for male prostitutes. Of 32 male prostitutes seen, 26 worked as rent-boys, 4 worked through agencies and 2 worked independently from home. Forty-one per cent had evidence of at least one sexually transmissible disease and 3 of 16 men tested (19%) were human immunodeficiency virus (HIV) positive.
Inpatient Health Care Utilization for Patients With HIV and AIDS in the Edinburgh City Hospital
Authors: Brettle R P , Willcocks L , Cowan F M , Richardson A M
Published: January 2017

A retrospective analysis of HIV-positive patients admitted to the City Hospital, Edinburgh by 31st December 1992, 7 years after the inception of the HIV clinic, revealed that 373 patients, 72% of them injection drug users (IDUs), had required 2069 admissions (5.5/admitted patient, 3.3/clinic patient or 0.5/clinic patient/year) and had utilized 21934 bed days (59 bed days/admitted patient, 35 days/clinic patient or 5 bed days/clinic patient/year).

The average length of stay (ALOS) was significantly longer for AIDS than HIV (non-AIDS) admissions (14.0 vs 9.5, P < 0.0001) as it was for admissions with a CD200 diagnosis (a CD4 count below 200 cells per mm3 on two consecutive occasions) compared to those without (12.1 vs 10.0 days, P = 0.004). There was no gender effect on ALOS but there was a significant effect of risk activity; homo/bisexuals had a significantly longer ALOS than drug users ( P < 0.0001). Homo/bisexual patients with AIDS or a CD200 diagnosis had longer ALOS than drug users (15.7 vs 13 days and 15.8 vs 10.8). By 1992 each member of the clinic was on average utilizing one admission per year and 11.6 bed days per year. The number of admissions in that year for patients without a CD200 or AIDS diagnosis was however low (0.5 and 0.75 admissions/patient/year) compared to patients with an AIDS or CD200 diagnosis (2.6 and 1.6 admissions/patient/year).

The annual number of occupied bed days/living patient was greatest for those with AIDS (60 vs 5 days) or with a CD200 diagnosis (23.5 vs 4.1 days). Females with AIDS used more annual bed days than males (64.2 vs 52.7 days) but not if analysed by CD200 diagnosis (22.0 vs 24.1). As far as risk activity was concerned drug users used more bed days per year than homo/bisexuals with AIDS (60 vs 52 days) or without AIDS (5.4 vs 4.4 days). However homo/bisexuals used more bed days than drug users with a CD200 diagnosis (39.8 vs 20.4 days) or without (7.0 vs 4.2 days) a CD200 diagnosis.

Thus in Edinburgh, both clinical and immunological staging, were predictive of resource utilization. Gender, however, was not predictive and the effect of risk activity was complex possibly because of differing socio-economic status. The extra hospital resources for drug use related HIV appears to be in the form of more frequent admissions at all stages of HIV disease rather than in an increased ALOS per admission.
Management of STDs and Cost of Treatment in Primary Health Care Centres in Pikine, Senegal
Authors: van der Veen F H , Ndoye I , Guindo S , Deschampheleire I , Fransen L
Published: January 2017

We studied the current management of STD-related syndromes by urban health facilities in Pikine (Senegal) in 252 consecutive patients presenting with STD-related complaints, to assess the cost and effectiveness of services and to estimate the potential benefit by introducing management protocols. Most common presenting complaints for women were vaginal discharge and low abdominal pain, reported for 122 (82.9%) and 22 (15.0%) of 147 female patients. Urethral discharge and genital ulceration were reported for 80 (76.2%) and for 17 (16.2%) of 105 male patients. The average cost was 4.01 ECU (1 European Currency Unit = 1.2 US$=334 Franc CFA) for male patients (ranging from 0.57 to 25.70 ECU) and 12.75 ECU for female patients (ranging from 0.57 to 37.60 ECU). Only 20 of 80 patients with urethral discharge (25%) received effective treatment. Effectiveness was not related to cost of therapy or qualification of staff. Utilization of management protocols improves the quality and accessibility of care for STD, by potentially doubling effectiveness and reducing the costs for patients to 12% of the current level.
Self Sampling as Part of Screening for Sexually Transmitted Diseases in Clinic Attenders. A Preliminary Study
Authors: Markos A R , Wade A A H , Walzman M , Shahmanesh M
Published: January 2017

Self sampling of the secretions of the female genital tract for microbiological investigations for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis was assessed in female attenders of the genitourinary medicine clinic in Coventry and Warwickshire Hospital. The purpose of the study was to evaluate the possibility of offering this method of investigation to workers in the sex industry, who are reluctant to attend GUM Clinics. This Pilot Study aimed at assessing the feasibility and acceptability of self sampling of the secretions of the lower genital tract by female patients and its reliability in the detection of sexually transmitted infections. The analysis of the data from 75 participants, indicated that 7 infections were detected on patient sampling as compared to 11 on samples taken by a physician.

Self sampling may prove a valuable alternative for the sex industry workers who are reluctant to attend GUM clinics.
Prevalence of Neurosyphilis at Government Rajaji Hospital, Madurai, India
Authors: Ganesh R , Stanley A , Ganesh Nalini , Venkatram M K , Alagappan R
Published: January 2017

Forty patients (34 males and 6 females) with neurological complaints/manifestations and with a past history of multiple sexual partners attending the Government Rajaji Hospital, Madurai, India between April 1992 and October 1992 were investigated for neurosyphilis. Metabolic disorders, hypertension, ischaemic heart disease, arrhythmias and trauma were excluded. Seven males (17.5%) were found to have neurosyphilis. The youngest was 26 years old and the oldest was 47. All were married and of low socioeconomic background. Meningovascular syphilis was the predominant presentation (6:1). Associated cardiovascular involvement was noticed in one of the cases. There was no associated HIV infection in these cases. The incidence is higher than previous reports from this centre.
Preventing Pelvic Infection after Abortion
Authors: Stevenson M M , Radcliffe K W
Published: January 2017

Pelvic infection is the commonest complication of legal abortion. The presence of lower genital tract infections increases the risk of complications, and women requesting abortion are at significant risk of harbouring sexually transmitted diseases (STD). Prophylactic antibiotic treatment can decrease the rate of post-abortal sepsis, but the optimum regime is unclear. In particular, patients with Chlamydia trachomatis infection, and bacterial vaginosis would appear to be at increased risk, and detection and treatment of these conditions can lower this risk. The opportunity to screen and treat for STD presents itself in this setting, allowing patients and their sexual contacts to benefit, with a decrease in the infected pool in the community.
Intralesional Interferon for the Treatment of Recalcitrant Molluscum Contagiosum in HIV Antibody Positive Individuals—A Preliminary Report
Authors: Nelson Mark R , Chard Susan , Barton Simon E
Published: January 2017

Molluscum contagiosum is common in HIV disease and available therapies have a poor success rate and require frequent clinic visits. Interferon α has been used to treat recalcitrant condylomata acuminata and this study was undertaken to assess the use of this treatment in unresponsive molluscum contagiosum. A total of 30 molluscum contagiosum were injected with one megaunit of interferon α weekly for 4 weeks; 11 molluscum contagiosum completely cleared and 18 reduced in size by over 50%. Molluscum less than 0.5 cm in diameter, and those in patients without AIDS were more likely to respond. No surrounding lesions changed in size.
Power Stations as Chemical Plants — Could Power Become the Byproduct?
Authors: Mahi P.
Published: January 2017

The need of power stations to act as integrated chemical plants is a new departure for the electricity supply industry. The need to control pollutants from power generation plants while at the same time utilising waste products to generate income from the sale of valuable by products is a potential prospect.

The technology already exists at commercial scale to treat high sulphur fuels in conventional power stations or coal gasification plants to produce elemental sulphur, sulphuric acid or gypsum as saleable products. Future prospects may involve the utilisation of carbon dioxide either as received gas or its conversion to useful compounds. The coal ashes also provide a potential feed material to recover aluminium oxide and supply the existing smelters with an indigenous raw material.

In this paper, an attempt is made to examine the potential of power stations to become chemical plants; to identify both the nature and quantities of the chemicals which could be produced and to assess whether the chemical industry is able to absorb these products and provide a firm market base.