bluuebunny/crossref_metadata_2025 huggingface dataset:
A randomized equivalence trial comparing the i‐gel and laryngeal mask airway Supreme in children
Authors: Jagannathan Narasimhan , Sommers Katherine , Sohn Lisa E. , Sawardekar Amod , Shah Ravi D. , Mukherji Isabella I , Miller Steven , Voronov Polina , Seraphin Sally
Published: November 2012

Background

The laryngeal mask airway Supreme (Supreme) is a new single‐use supraglottic device with gastric access capability now available in all sizes for children.

Objectives

To compare the i‐gel with the Supreme in children for routine airway maintenance.

Materials/Methods

One hundred and seventy children, aged 3 months to 11 years, 5–50 kg in weight, were randomly assigned to receive either the i‐gel or the Supreme. The primary outcome measured was airway leak pressure. Secondary outcomes included the following: ease and time for insertion, insertion success rate, fiberoptic grade of view, ease of gastric tube placement, number of airway manipulations, quality of airway during anesthetic maintenance, and complications.

Results

A total of 168 patients were assessed for the outcomes. The median (IQR [range]) airway leak pressure for the i‐gel was higher than with the Supreme, 20 (18–25 [9–40]) cm H2O vs 17 (14–22 [10–40]) cm H2O, respectively (P = 0.001). There were no differences in the time for device insertion, fiberoptic grade of view, quality of airway, and complications. Median (IQR[range]) time of successful insertion of a gastric tube was faster with the Supreme, 12 (9.2–14.3 [5.2–44.2]) s than with the i‐gel, 14 (11.9–19 [6.9–75]) s; P = 0.01. The number of airway manipulations during placement was higher with the i‐gel than with the laryngeal mask airway Supreme (12 vs 13 patients), P = 0.02.

Conclusions

In infants and children, when a single‐use supraglottic device with gastric access capabilities is required, the i‐gel demonstrated higher airway leak pressures and can be a useful alternative to the Supreme.
A novel intubation technique in bilateral cleft palate pediatric patients: hard gum shield–aided intubation
Authors: Mahmoud Ahmed Abdelaal Ahmed , Fouad Ahmed Zaghloul , Mansour Mohamed Ahmed , Kamal Ahmed Mostafa
Published: November 2012

Background

Cleft palate anesthesia is challenging due to difficult airway. Left paraglossal intubation moves resting point of laryngoscope laterally but associated with narrower laryngoscopic view and possible trauma, and we invented the use of hard gum shield as a bridge over defective palate to facilitate intubation with possible wider window and defective tissue protection.

Methods

Eighty bilateral cleft palate children, ASA physical status I–II aged 9 months to 6 years scheduled for plastic surgery had general anesthesia, were involved in prospective, controlled, randomized study, and were randomly divided by closed envelope method into two groups: group I (40 patients): intubated by hard gum shield–aided intubation and group II (40 patients): intubated by left paraglossal intubation. Both techniques compared as regards (i) intubation time; (ii) Cormack and Lehane score; (iii) need for external laryngeal manipulation; (iv) easiness of intubation: easy, modest, or difficult intubation; and (v) complications: desaturation and failed intubation.

Results

Intubation time was shorter in group I (28.47 ± 3.78 vs. 37.63 ± 6.64 s, P = 0.001). Cormack and Lehane score was better in group I (P = 0.003). Need for external laryngeal manipulation was less in group I (P = 0.015). Easiness of intubation was better in group I (P = 0.022). No difference was found in complications between groups.

Conclusion

Hard gum shield–aided intubation facilitated intubation more than left paraglossal in bilateral cleft palate children with shorter intubation time, better glottic view, easier intubation, less need for laryngeal manipulation than left paraglossal intubation with no difference in complications.
Starches—from current models to genetic engineering
Authors: Sonnewald Uwe , Kossmann Jens
Published: November 2012

As the world's second most abundant biopolymer, starch serves as food, feed and renewable resource for bioenergy production and other industrial applications. Unlike storage lipids, starch is stored in the form of semi‐crystalline granules, which are tissue‐ and species‐specific in number, shape and size. Over the last decades, most biosynthetic and degradative enzymes of starch metabolism have been identified in the model species Arabidopsis thaliana. Based on this, biotechnological applications have arisen that led to a number of transgenic crop plants with elevated starch content or improved starch quality. Irrespective of this great success, there are still numerous open questions including the regulation of starch metabolism, the initiation of granule formation, the regulation of granule shape and size and many more, which will be tackled over the next decades. Here, we briefly summarize current knowledge concerning starch metabolism and its regulation and biotechnological use.
Dose–response effect of exercise frequency on bone mineral density in post‐menopausal, osteopenic women
Authors: Kemmler W. , von Stengel S.
Published: November 2012

The purpose of this study was to determine the long‐term dose–response relationship of exercise frequency on areal bone mineral density (aBMD) in early post‐menopausal women with osteopenia. Based on the 12‐year results of the consequently supervised exercise group (EG) of the Erlangen Fitness and Osteoporosis Prevention Study, we retrospectively structured two exercise groups according to the overall exercise frequency. Changes in aBMD at lumbar spine and proximal femur as assessed by dual‐energy x‐ray absorptiometry technique were compared between a low‐frequency exercise group (LEF‐EG, n = 16) with 1.5–<2 sessions/week and a high‐frequency exercise group (HEF‐EG, n = 25) with ≥2–3.5 sessions/week. Changes in aBMD at the lumbar spine and proximal femur were significantly more favorable in the HEF‐EG compared with the LEF‐EG; lumbar spine: (mean value ± standard deviation) 1.1 ± 4.7% vs −4.1 ± 3.0%; P = 0.001, ES: d' = 1.26; total hip: −4.4 ± 3.9% vs −6.7 ± 3.5%, P = 0.045, ES: d' = 0.70). BMD results of the LEF‐EG did not significantly differ from the data of the non‐training control group (lumbar spine: −4.4 ± 5.2%, total hip: −6.9 ± 5.0%). Although this result might not be generalizable across all exercise types and cohorts, it indicates that to impact bone, an overall exercise frequency of at least 2 sessions/week may be crucial, even if exercise is applied with high intensity/impact.
Injuries and illnesses during the 2011 Paris European Athletics Indoor Championships
Authors: Edouard P. , Depiesse F. , Hertert P. , Branco P. , Alonso J.‐M.
Published: November 2012

This study aimed to record and analyse incidence and characteristics of injuries and illnesses incurred during the Indoor Athletics Championships. During the 2011 European Indoor Athletics Championships in Paris, incidence and characteristics of new injuries and illnesses were recorded prospectively by physicians and physiotherapists from national teams and local organizing committee in 631 registered athletes. Around 70% of athletes were covered by the medical teams (response rate: 84%). Thirty injuries, including eight time‐loss injuries, were reported, representing an incidence of 47.5 injuries and 29.4 time‐loss injuries per 1000 registered athletes. Injury and time‐loss injury risk were highest in heptathlon and hurdles. Three‐quarters of injuries affected the lower extremity. Thigh strain was the most common diagnosis (n = 7; 23%). Noncontact trauma (n = 9; 30%) was the predominant cause. A total of 18 illnesses were reported. Incidence of illnesses was 28.5 per 1000 registered athletes, with 17% resulting in time lost from sport. Upper respiratory tract infection was the most common diagnosis (n = 8; 44%) followed by upper respiratory tract allergy (n = 3; 17%) and gastroenteritis (n = 3; 17%). Injury and illness incidence and severity were lower during the 2011 European Indoor Athletics Championships than during outdoor championships, probably due to the shorter duration, the fewer number of events, and shorter sprint distances.
Antenatal monitoring of anti‐D and anti‐c: could titre scores determined by column agglutination technology replace continuous flow analyser quantification?
Authors: Bruce D. G. , Tinegate H. N. , Williams M. , Babb R. , Wells A. W.
Published: November 2012

Objective

To determine if column agglutination technology (CAT) for titration of anti‐D and anti‐c concentrations produces comparable results to those obtained by continuous flow analyser (CFA).

Background

Anti‐D and anti‐c are the two commonest antibodies that contribute to serious haemolytic disease of the foetus and neonate (HDFN). Current practice in the UK is to monitor these antibodies by CFA quantification, which is considered more reproducible and less subjective than manual titration by tube IAT (indirect antiglobulin test). CAT is widely used in transfusion laboratory practice and provides a more objective endpoint than tube technique.

Materials and methods

Antenatal samples were (i) quantified using CFA and (ii) titrated using CAT with the reaction strength recorded by a card reader and expressed as a titre score (TS).

Results

The TS rose in accordance with levels measured by quantification and was able to distinguish antibody levels above and below the threshold of clinical significance.

Conclusion

CAT titre scores provided a simple and reproducible method to monitor anti‐D and anti‐c levels. The method was sensitive to a wide range of antibody levels as determined by quantification. This technique may have the potential to replace CFA quantification by identifying those cases that require closer monitoring for potential HDFN.
Measures of general and central obesity and risk of type 2 diabetes in a Ghanaian population
Authors: Frank Laura K. , Heraclides Alexandros , Danquah Ina , Bedu‐Addo George , Mockenhaupt Frank P. , Schulze Matthias B.
Published: November 2012

Objective

The epidemic of obesity and type 2 diabetes is evident in sub‐Saharan Africa (SSA). However, their associations have hardly been examined in this region.

Methods

A hospital‐based case–control study in urban Ghana consisting of 1221 adults (542 cases and 679 controls) investigated the role of anthropometric parameters for diabetes. Logistic regression was used for analysis. The discriminative power and population‐specific cut‐off points for diabetes were identified by receiver operating characteristic curves.

Results

The strongest association with diabetes was observed for waist‐to‐hip ratio: age‐adjusted odds ratios per 1 standard deviation difference were 1.95 (95% confidence interval [CI]: 1.64–2.31) in women and 1.40 [1.01–1.94] in men. Also, among women, the odds of diabetes increased with higher waist circumference (1.35 [1.17–1.57]) and waist‐to‐height ratio (1.29 [1.12–1.50]). Among men, this was not discernible. Rather, hip circumference was inversely related (0.69 [0.50–0.95]). Body mass index was neither associated with diabetes in women (1.01 [0.88–1.15]) nor in men (0.74 [0.52–1.04]). Among both genders, waist‐to‐hip ratio showed the best discriminative ability for diabetes in this population and the optimal cut‐off points were ≥0.88 in women and ≥0.90 in men. Recommended cut‐off points for body mass index and waist circumference had a poor predictive ability.

Conclusion

Our findings suggest that measures of central rather than general obesity relate to type 2 diabetes in SSA. It remains to be verified from larger population‐based epidemiological studies whether anthropometric targets of obesity prevention in SSA differ from those in developed countries.
Optimal location of basin‐wide constructed washlands to reduce risk of flooding
Authors: Baek Chun Woo , Lee Jung Ho , Paik Kyungrock
Published: November 2012

A washland can effectively reduce peak flow of a high flow event at a certain location. A number of washlands located in a basin influence each other's hydrological function, and hence, their hydrological role should be evaluated from a river network perspective. Here, we present an approach to determine optimal locations of constructed washlands in a basin, considering their mutual effect. The problem is formulated as a multiobjective problem with maximizing peak flow reduction effect as one objective and minimizing the total volume of washlands, which is associated with cost, as another. By simplifying modelling algorithm for hydrological routing, we show that consideration of all possible cases is feasible for the situation of a typical basin. This approach guarantees global optimum and shows a full spectrum of Pareto front, which will help decision‐makers in problems of multiple objective functions. The proposed approach is demonstrated for the Anseong River basin.
Effect of extra polymeric substance removal on sludge reduction potential of Bacillus licheniformis at its optimised pH condition
Authors: Merrylin J. , Kaliappan S. , Kumar S. Adish , Yeom Ick Tae , Banu J. Rajesh
Published: November 2012

The effect of extracellular polymeric substances (EPSs) on the solubilisation of municipal wastewater sludge by protease‐secreting bacteria was investigated. The untreated sludge is an environmental menace, so sludge management techniques are introduced to treat and dispose sludge in a proper way. Sludge pretreatment is needed to increase the solubilisation and the efficiency of treatment methods. The present study deals with sludge solubilisation by bacterial enzymatic pretreatment. The EPS present in the sludge was removed by sodium hydroxide and formaldehyde to enhance solubilisation and increase the bacterial enzymatic activity. After the removal of EPS with different normalities of NaOH, there was about 11–18% sludge solubilisation and about 8–16% sludge reduction during bacterial pretreatment. Bacterial enzymatic pretreated sludge was further treated using aerobic digesters. From the results obtained in aerobic digestion, 0.06 N NaOH was chosen as the optimal concentration to remove EPSs.
Quality assessment of water receiving effluents from crude oil flow stations in Niger Delta, Nigeria
Authors: Nnaji C. C. , Agunwamba J. C.
Published: November 2012

Waterbodies receiving effluent from six crude oil flow stations in the Niger Delta area of Nigeria were assessed. A total of six hundred and forty‐five observations for 19 parameters were used to assess the quality of these waters using the Canadian water quality index. A high correlation was obtained between copper and ammonia (R = 0.9996, P < 0.01) on one hand, and dissolved oxygen and BOD (R = 0.786, P < 0.01) on the other. Of the six stations, only one can be classified to be in good conditon, two were in fair conditions, two were marginal, while one was of poor quality. The quality of waterbodies assessed depends more on the degree of violation of standards and the number of times standards were violated. Furthermore, the quality of these waterbodies are affected more by the hydroglogy and geology of the Niger Delta than any other factor.
The usefulness and limitations of the diabetic macaque model in evaluating long‐term porcine islet xenograft survival
Authors: Graham Melanie L. , Schuurman Henk‐Jan
Published: November 2012

Abstract:  Background:  Various groups have reported prolonged diabetes reversal and graft function after porcine islet transplantation into diabetic macaques using different experimental designs (macaque source, islet source, type of immunosuppression): subsequently, the International Xenotransplantation Association has published recommendations for entering a clinical trial. Our experiments showed limitations that affected consistent achievement of long‐term survival. We aimed to identify these limitations and underlying causes to emphasize the translational value of this highly relevant type 1 diabetic macaque model.

Methods:  We reviewed data from our institution and literature data on long‐term porcine islet xenograft survival in the diabetic macaque model, especially focusing on aspects of incomplete diabetes reversal relative to macaque normal values. This phenomenon was compared with diabetes reversal in an allo‐islet transplant model in macaques and with chronic insulin treatment of diabetic macaques, all with 180‐day follow‐up. This comparison enabled to identify potential model limitations and underlying causative factors.

Results:  Especially in the xenograft model, the achievement of long‐term graft survival revealed limitations including chronic, mild hyperglycemia and absence of body weight (BW) gain or even progressive BW loss. Metabolic incompatibilities in glycemic control (i.e., insulin kinetics) between the pig and macaque species underlie chronic, mild hyperglycemia. This phenomenon might not bear relevance for the pig‐to‐human species combination because the glycemic control in pigs and humans is similar and differs from that in nonhuman primates (NHP). Weight loss could be related to changes in the gastrointestinal tract related with local high exposure to orally administered immunosuppressants; these must be given at higher dose levels because of low bioavailability in macaques to achieve systemic exposure at therapeutic levels. This is aggravated by insufficient graft insulin production in proportion to the needs of macaques: this model limitation has no translational value to the pig‐to‐human setting. Nutritional deficits can result in incorrect interpretation of blood glucose levels and C‐peptide levels regarding graft function. Likewise, nutritional status alters physiologic responses, influencing susceptibility to infectious and noninfectious complications.

Conclusion:  The model‐induced confounding described interferes with accurate interpretation of safety and efficacy studies, which affects the translational value of pig‐to‐NHP islet cell transplant studies to the pig‐to‐human transplant condition.
Fast transit portal dosimetry using density‐scaled layer modeling of aSi‐based electronic portal imaging device and Monte Carlo method
Authors: Jung Jae Won , Kim Jong Oh , Yeo Inhwan Jason , Cho Young‐Bin , Kim Sun Mo , DiBiase Steven
Published: November 2012

Purpose:

Fast and accurate transit portal dosimetry was investigated by developing a density‐scaled layer model of electronic portal imaging device (EPID) and applying it to a clinical environment.

Methods:

The model was developed for fast Monte Carlo dose calculation. The model was validated through comparison with measurements of dose on EPID using first open beams of varying field sizes under a 20‐cm‐thick flat phantom. After this basic validation, the model was further tested by applying it to transit dosimetry and dose reconstruction that employed our predetermined dose‐response‐based algorithm developed earlier. The application employed clinical intensity‐modulated beams irradiated on a Rando phantom. The clinical beams were obtained through planning on pelvic regions of the Rando phantom simulating prostate and large pelvis intensity modulated radiation therapy. To enhance agreement between calculations and measurements of dose near penumbral regions, convolution conversion of acquired EPID images was alternatively used. In addition, thickness‐dependent image‐to‐dose calibration factors were generated through measurements of image and calculations of dose in EPID through flat phantoms of various thicknesses. The factors were used to convert acquired images in EPID into dose.

Results:

For open beam measurements, the model showed agreement with measurements in dose difference better than 2% across open fields. For tests with a Rando phantom, the transit dosimetry measurements were compared with forwardly calculated doses in EPID showing gamma pass rates between 90.8% and 98.8% given 4.5 mm distance‐to‐agreement (DTA) and 3% dose difference (DD) for all individual beams tried in this study. The reconstructed dose in the phantom was compared with forwardly calculated doses showing pass rates between 93.3% and 100% in isocentric perpendicular planes to the beam direction given 3 mm DTA and 3% DD for all beams. On isocentric axial planes, the pass rates varied between 95.8% and 99.9% for all individual beams and they were 98.2% and 99.9% for the composite beams of the small and large pelvis cases, respectively. Three‐dimensional gamma pass rates were 99.0% and 96.4% for the small and large pelvis cases, respectively.

Conclusions:

The layer model of EPID built for Monte Carlo calculations offered fast (less than 1 min) and accurate calculation for transit dosimety and dose reconstruction.
Five ways of deriving the equation of motion for rolling bodies
Authors: Højgaard Jensen Jens
Published: November 2012

The equation of motion for rolling bodies can be derived in several different ways. This paper shows that the equation of motion can be derived in five and only five ways without needing to know the normal and frictional forces acting at the point of contact. After enumerating these five ways, we examine two illustrative examples: an asymmetric disk rolling on a cylinder and a symmetric ball rolling on a turntable. We also discuss the educational benefits of including this topic when teaching mechanics.
Engaging the community through an undergraduate biomedical physics course
Authors: Van Ness G. R. , Widenhorn Ralf
Published: November 2012

We report on the development of an undergraduate biomedical physics course at Portland State University, motivated by both student interest and the desire of the university's Physics Department to provide an interdisciplinary intermediate-level physics course. The course was developed through the community engagement of physicians, clinical researchers, and basic science researchers. Class meetings were a combination of regular and guest lectures, hands-on exercises, web-based activities, class discussions, and a student poster information session for patrons at a local science museum. The course inspired students to engage in research projects in biomedical physics that enhance their understanding of science and education as well as benefit the learning of future students. Furthermore, this course offers an opportunity for traditionally underrepresented groups in physics courses, such as women, to gain additional exposure to physics.
A unique pure mechanical system revealing dipole repulsion
Authors: Ee June-Haak , Lee Jungil
Published: November 2012

We study multiple elastic collisions of a block and a ball against a rigid wall in one dimension. The complete trajectory of the block is solved as an analytic function of time. Near the turning point of the block the force carried by the ball is proportional to 1/x3, where x is the distance between the wall and the block, in the limit that the block is sufficiently heavier than the ball. This is a unique pure mechanical system that reveals dipole-like repulsion.
Direct Observation of Stalled Fork Restart via Fork Regression in the T4 Replication System
Authors: Manosas Maria , Perumal Senthil K. , Croquette Vincent , Benkovic Stephen J.
Published: November 2012

DNA Repair in Vitro

Accurate replication of the genome is critical to an organism's continued survival. Damaged DNA not repaired before the commencement of replication can cause the DNA replication fork to stall or collapse, which can result in mutation or recombination, with potentially serious consequences for cell and organism. Fork regression involving a so-called “chicken foot” structure (Holliday junction) is thought to provide one mechanism for dealing with unrepaired DNA damage during replication.

Manosas
et al.

(p.
1217
) analyzed the action of the T4 bacteriophage replisome and helicase UvsW on a stalled-fork mimic in vitro, using a magnetic trap. UvsW was able to switch migration directions, which was essential for remodeling the stalled fork. Together, UvsW and T4 holoenzyme were able to drive template switching and lesion bypass in vitro.
Three-Dimensional Structures Self-Assembled from DNA Bricks
Authors: Ke Yonggang , Ong Luvena L. , Shih William M. , Yin Peng
Published: November 2012

Building with DNA

One route for assembling three-dimensional (3D) DNA nanostructures is to start with a long natural DNA single strand and attach short strands, or “staples,” that cause the entire “origami” structure to fold into a desired shape.

Ke
et al.

(p.
1177
, see the cover; see the Perspective by

Gothelf

) present an alternative approach to 3D assembly that builds upon modular assembly of 2D DNA tiles. One hundred and two distinct shapes were created from four-domain, 32-nucleotide single-stranded DNAs that assembled like children's blocks; each block could bind to four neighboring blocks through specific pairing interactions. Computer design and stepwise assembly allowed assembly of hollow shapes with a variety of internal cavities.
iPSC Disease Modeling
Authors: Soldner Frank , Jaenisch Rudolf
Published: November 2012

Induced pluripotent stem cell technology has great potential to model human diseases, but faces many challenges.
Building the Human Brain
Authors: Machens Christian K.
Published: November 2012

A computational model of the human brain simulates complex behaviors.
Experts Agree Global Warming Is Melting the World Rapidly
Authors: Kerr Richard A.
Published: November 2012

A new analysis in this week's issue makes it clear that ice losses from Greenland and West Antarctica have been accelerating, showing that some ice sheets are disconcertingly sensitive to warming.
An Oil Gusher in the Offing, but Will It Be Enough?
Authors: Kerr Richard A.
Published: November 2012

Under the right conditions, a new report from the International Energy Agency says, world oil production could increase through 2035 and meet the world's growing demand for energy as oil.
Amid Europe's Food Fights, EFSA Keeps Its Eyes on the Evidence
Authors: Kupferschmidt Kai
Published: November 2012

Europe's food-safety watchdog, celebrating its 10th anniversary this month, wins praise for sticking to the science—even when Europeans prefer not to hear it.
Nipah Virus Envelope-Pseudotyped Lentiviruses Efficiently Target ephrinB2-Positive Stem Cell Populations
In Vitro
and Bypass the Liver Sink When Administered
In Vivo
Authors: Palomares Karina , Vigant Frederic , Van Handel Ben , Pernet Olivier , Chikere Kelechi , Hong Patrick , Sherman Sean P. , Patterson Michaela , An Dong Sung , Lowry William E. , Mikkola Hanna K. A. , Morizono Kouki , Pyle April D. , Lee Benhur
Published: November 2012

Sophisticated retargeting systems for lentiviral vectors have been developed in recent years. Most seek to suppress the viral envelope's natural tropism while modifying the receptor-binding domain such that its tropism is determined by the specificity of the engineered ligand-binding motif. Here we took advantage of the natural tropism of Nipah virus (NiV), whose attachment envelope glycoprotein has picomolar affinity for ephrinB2, a molecule proposed as a molecular marker of “stemness” (present on embryonic, hematopoietic, and neural stem cells) as well as being implicated in tumorigenesis of specific cancers. NiV entry requires both the fusion (F) and attachment (G) glycoproteins. Truncation of the NiV-F cytoplasmic tail (T5F) alone, combined with full-length NiV-G, resulted in optimal titers of NiV-pseudotyped particles (NiVpp) (∼10
6
IU/ml), even without ultracentrifugation. To further enhance the infectivity of NiVpp, we engineered a hyperfusogenic NiV-F protein lacking an N-linked glycosylation site (T5FΔN3). T5FΔN3/wt G particles exhibited enhanced infectivity on less permissive cell lines and efficiently targeted ephrinB2
+
cells even in a 1,000-fold excess of ephrinB2-negative cells, all without any loss of specificity, as entry was abrogated by soluble ephrinB2. NiVpp also transduced human embryonic, hematopoietic, and neural stem cell populations in an ephrinB2-dependent manner. Finally, intravenous administration of the luciferase reporter NiVpp-T5FΔN3/G to mice resulted in signals being detected in the spleen and lung but not in the liver. Bypassing the liver sink is a critical barrier for targeted gene therapy. The extraordinary specificity of NiV-G for ephrinB2 holds promise for targeting specific ephrinB2
+
populations
in vivo
or
in vitro
.
Ecology and Physics of Bacterial Chemotaxis in the Ocean
Authors: Stocker Roman , Seymour Justin R.
Published: November 2012

Intuitively, it may seem that from the perspective of an individual bacterium the ocean is a vast, dilute, and largely homogeneous environment. Microbial oceanographers have typically considered the ocean from this point of view. In reality, marine bacteria inhabit a chemical seascape that is highly heterogeneous down to the microscale, owing to ubiquitous nutrient patches, plumes, and gradients. Exudation and excretion of dissolved matter by larger organisms, lysis events, particles, animal surfaces, and fluxes from the sediment-water interface all contribute to create strong and pervasive heterogeneity, where chemotaxis may provide a significant fitness advantage to bacteria. The dynamic nature of the ocean imposes strong selective pressures on bacterial foraging strategies, and many marine bacteria indeed display adaptations that characterize their chemotactic motility as “high performance” compared to that of enteric model organisms. Fast swimming speeds, strongly directional responses, and effective turning and steering strategies ensure that marine bacteria can successfully use chemotaxis to very rapidly respond to chemical gradients in the ocean. These fast responses are advantageous in a broad range of ecological processes, including attaching to particles, exploiting particle plumes, retaining position close to phytoplankton cells, colonizing host animals, and hovering at a preferred height above the sediment-water interface. At larger scales, these responses can impact ocean biogeochemistry by increasing the rates of chemical transformation, influencing the flux of sinking material, and potentially altering the balance of biomass incorporation versus respiration. This review highlights the physical and ecological processes underpinning bacterial motility and chemotaxis in the ocean, describes the current state of knowledge of chemotaxis in marine bacteria, and summarizes our understanding of how these microscale dynamics scale up to affect ecosystem-scale processes in the sea.
Toxin-Antitoxin Genes of the Gram-Positive Pathogen Streptococcus pneumoniae: So Few and Yet So Many
Authors: Chan Wai Ting , Moreno-Córdoba Inma , Yeo Chew Chieng , Espinosa Manuel
Published: November 2012

Pneumococcal infections cause up to 2 million deaths annually and raise a large economic burden and thus constitute an important threat to mankind. Because of the increase in the antibiotic resistance ofStreptococcus pneumoniaeclinical isolates, there is an urgent need to find new antimicrobial approaches to triumph over pneumococcal infections. Toxin-antitoxin (TA) systems (TAS), which are present in most living bacteria but not in eukaryotes, have been proposed as an effective strategy to combat bacterial infections. Type II TAS comprise a stable toxin and a labile antitoxin that form an innocuous TA complex under normal conditions. Under stress conditions, TA synthesis will be triggered, resulting in the degradation of the labile antitoxin and the release of the toxin protein, which would poison the host cells. The three functional chromosomal TAS fromS. pneumoniaethat have been studied as well as their molecular characteristics are discussed in detail in this review. Furthermore, a meticulous bioinformatics search has been performed for 48 pneumococcal genomes that are found in public databases, and more putative TAS, homologous to well-characterized ones, have been revealed. Strikingly, several unusual putative TAS, in terms of components and genetic organizations previously not envisaged, have been discovered and are further discussed. Previously, we reported a novel finding in which a unique pneumococcal DNA signature, the BOX element, affected the regulation of the pneumococcalyefM-yoeBTAS. This BOX element has also been found in some of the other pneumococcal TAS. In this review, we also discuss possible relationships between some of the pneumococcal TAS with pathogenicity, competence, biofilm formation, persistence, and an interesting phenomenon called bistability.
High-grade myxofibrosarcoma presenting at the spermatic cord after radiotherapy for prostate cancer
Authors: Tearada Hiroshi , Nagata Masao , Mugiya Soichi , Ozono Seiichiro
Published: November 2012

A 72-year-old man with a history of prostate cancer presented 7 years postradiotherapy with a painless, egg-sized, rapidly growing nodule on the left groin at the radiation site. He underwent left high orchiectomy under a diagnosis of groin lymph node metastasis of prostate cancer. The tumour had penetrated deep into the internal inguinal ring and was resected as proximally as possible to the internal ring with a positive surgical margin. Macroscopically, the left testis was intact in the resected specimen. Immunohistochemical staining revealed that the tumour consisted of myxofibrosarcoma (MFS) with spindle cells; and was positive for vimentin, cytokeratin (AE1/AE3), MIB-1 and CD68, and negative for α-SMA, S-100, CD34 and myogenin. Thus, the tumour was diagnosed as high-grade MFS of the spermatic cord. Postoperative CT revealed a right renal tumour and adrenal tumour. Right radial nephrectomy was performed and the patient was doing well at 10-month follow-up.
A rare presentation of craniopharyngioma: delayed puberty
Authors: İnci Mehmet Fatih , Özkan Fuat , Bozkurt Selim , Demir Caner Feyzi
Published: November 2012

Craniopharyngiomas are the most frequently encountered suprasellar tumours in children. Owing to the slow growth rate of these tumours, they are often quite large before becoming symptomatic. They are more common among children and older adults (55–74 years). Depending upon the direction of growth and tumour size, craniopharyngiomas can affect the hypothalamus, pituitary stalk, optic nerves and chiasm and carotid arteries. Compression of these neural and vascular structures frequently precipitates endocrine disorders, visual loss and an increased intracranial pressure. Hypopituitarism leading to a delayed puberty is a rare presentation of craniopharyngioma. The diagnosis of craniopharyngioma is usually made with the classic radiological imaging features based on CT and MRI.
Unilateral surgical treatment for patients with midportion Achilles tendinopathy may result in bilateral recovery
Authors: Alfredson Håkan , Spang Christoph , Forsgren Sture
Published: November 2012

Background

Bilateral midportion Achilles tendinopathy/tendinosis is not unusual, and treatment of both sides is often carried out. Experiments in animals suggest of the potential involvement of central neuronal mechanisms in Achilles tendinosis.

Objectives

To evaluate the outcome of surgery for Achilles tendinopathy.

Methods

This observational study included 13 patients (7 men and 6 women, mean age 53 years) with a long duration (6–120 months) of chronic painful bilateral midportion Achilles tendinopathy. The most painful side at the time for investigation was selected to be operated on first. Treatment was ultrasound-guided and Doppler-guided scraping procedure outside the ventral part of the tendon under local anaesthetic. The patients started walking on the first day after surgery. Follow-ups were conducted and the primary outcome was pain by visual analogue scale. In an additional part of the study, specimens from Achilles and plantaris tendons in three patients with bilateral Achilles tendinosis were examined.

Results

Short-term follow-ups showed postoperative improvement on the non-operated side as well as the operated side in 11 of 13 patients. Final follow-up after 37 (mean) months showed significant pain relief and patient satisfaction on both sides for these 11 patients. In 2 of 13 patients operation on the other, initially non-operated side, was instituted due to persisting pain. Morphologically, it was found that there were similar morphological effects, and immunohistochemical patterns of enzyme involved in signal substance production, bilaterally.

Conclusion

Unilateral treatment with a scraping operation can have benefits contralaterally; the clinical implication is that unilateral surgery may be a logical first treatment in cases of bilateral Achilles tendinopathy.
Impact of universal health insurance coverage in Thailand on sales and market share of medicines for non-communicable diseases: an interrupted time series study
Authors: Garabedian Laura Faden , Ross-Degnan Dennis , Ratanawijitrasin Sauwakon , Stephens Peter , Wagner Anita Katharina
Published: November 2012

Objective

In 2001, Thailand implemented the Universal Coverage Scheme (UCS), a public insurance system that aimed to achieve universal access to healthcare, including essential medicines, and to influence primary care centres and hospitals to use resources efficiently, via capitated payment for outpatient services and other payment policies for inpatient care. Our objective was to evaluate the impact of the UCS on utilisation of medicines in Thailand for three non-communicable diseases: cancer, cardiovascular disease and diabetes.

Design

Interrupted time-series design, with a non-equivalent comparison group.

Setting

Thailand, 1998–2006.

Data

Quarterly purchases of medicines from hospital and retail pharmacies collected by IMS Health between 1998 and 2006.

Intervention

UCS implementation, April–October 2001.

Outcome measures

Total pharmaceutical sales volume and percent market share by licensing status and National Essential Medicine List status.

Results

The UCS was associated with long-term increases in sales of medicines for conditions that are typically treated in outpatient primary care settings, such as diabetes, high cholesterol and high blood pressure, but not for medicines for diseases that are typically treated in secondary or tertiary care settings, such as heart failure, arrhythmias and cancer. Although the majority of increases in sales were for essential medicines, there were also postpolicy increases in sales of non-essential medicines. Immediately following the reform, there was a significant shift in hospital sector market share by licensing status for most classes of medicines. Government-produced products often replaced branded generic or generic competitors.

Conclusions

Our results suggest that expanding health insurance coverage with a medicine benefit to the entire Thai population increased access to medicines in primary care. However, our study also suggests that the UCS may have had potentially undesirable effects. Evaluations of the long-term impacts of universal health coverage on medicine utilisation are urgently needed.
Computer templates in chronic disease management: ethnographic case study in general practice
Authors: Swinglehurst Deborah , Greenhalgh Trisha , Roberts Celia
Published: November 2012

Objective

To investigate how electronic templates shape, enable and constrain consultations about chronic diseases.

Design

Ethnographic case study, combining field notes, video-recording, screen capture with a microanalysis of talk, body language and data entry—an approach called linguistic ethnography.

Setting

Two general practices in England.

Participants and methods

Ethnographic observation of administrative areas and 36 nurse-led consultations was done. Twenty-four consultations were directly observed and 12 consultations were video-recorded alongside computer screen capture. Consultations were transcribed using conversation analysis conventions, with notes on body language and the electronic record. The analysis involved repeated rounds of viewing video, annotating field notes, transcription and microanalysis to identify themes. The data was interpreted using discourse analysis, with attention to the sociotechnical theory.

Results

Consultations centred explicitly or implicitly on evidence-based protocols inscribed in templates. Templates did not simply identify tasks for completion, but contributed to defining what chronic diseases were, how care was being delivered and what it meant to be a patient or professional in this context. Patients’ stories morphed into data bytes; the particular became generalised; the complex was made discrete, simple and manageable; and uncertainty became categorised and contained. Many consultations resembled bureaucratic encounters, primarily oriented to completing data fields. We identified a tension, sharpened by the template, between different framings of the patient—as ‘individual’ or as ‘one of a population’. Some clinicians overcame this tension, responding creatively to prompts within a dialogue constructed around the patient's narrative.

Conclusions

Despite their widespread implementation, little previous research has examined how templates are actually used in practice. Templates do not simply document the tasks of chronic disease management but profoundly change the nature of this work. Designed to assure standards of ‘quality’ care they contribute to bureaucratisation of care and may marginalise aspects of quality care which lie beyond their focus. Creative work is required to avoid privileging ‘institution-centred’ care over patient-centred care.
New species of Smittium and Stachylina and other trichomycetes in larval Diptera from streams in Nova Scotia, Canada 1This paper is dedicated to Jo-Ann Frost, one of the first students of these fungi in Nova Scotia, and to the numerous other undergraduates who have engaged with us in our studies of gut fungi, not only in the province, but wherever our studies have taken us.
Authors: White Merlin M. , Strongman D.B.
Published: November 2012

The guts of non-predaceous invertebrates in aquatic and moist terrestrial habitats are often colonized by an ecological group of microorganisms called trichomycetes. Taxonomically, these endobionts are currently a diverse, polyphyletic assemblage including both zygomycetous fungi as well as protistan species. Trichomycetes are worldwide in distribution and are from varied habitats, but the species inventory of gut fungi from hosts in Canada is far from complete. We summarize the findings from our earliest surveys (from 1997 to 2005) and collections of candidate dipteran hosts in Nova Scotia. Nine new species of gut fungi are added to the inventory list, including the following seven Smittium spp.: Smittium aggregatum, Smittium gronthidium, Smittium papillum, Smittium pavocaudatum, Smittium radiculans, Smittium sparsum, and Smittium verticillatum, and the following two Stachylina spp.: Stachylina brevicellaris and Stachylina subgrandis. Four of the other 13 Harpellales, Pennella digitata, Smittium megazygosporum, Stachylina penetralis, and Zancudomyces culisetae are reported for the first time in Atlantic Canada. Also recorded is Paramoebidium curvum, with many more specimens of this genus from various locations and hosts included as Paramoebidium spp. only. We suggest that future collections of Diptera, to further document and discover trichomycetes, are warranted across the varied host habitats that abound not only in eastern Canada but the rest of the country as well.
Cascading water: combining GIS and system analysis to maximize water reuse
Authors: Nesbit Susan , Stano Joseph , Atwater James W. , Casavant Tracy
Published: November 2012

This study presents a model designed to determine the feasibility of municipal scale water exchange aimed at reducing overall water and energy use. Water and energy balances are performed using a combination of process simulation and a geographic information system (GIS). Objective functions manipulate results from the balances to find optimal inter-company water reuse relationships that maximize the quantity of water reused, where water quality is adequate and the required pumping energy is minimized. Optimization results are presented as GIS maps that can be included as layers within existing municipal GIS maps.
Rhizosphere bacteria ofCostulariaspp. from ultramafic soils in New Caledonia: diversity, tolerance to extreme edaphic conditions, and role in plant growth and mineral nutrition
Authors: Gonin Mathieu , Gensous Simon , Lagrange Alexandre , Ducousso Marc , Amir Hamid , Jourand Philippe
Published: November 2012

Rhizosphere bacteria were isolated from Costularia spp., pioneer sedges from ultramafic soils in New Caledonia, which is a hotspot of biodiversity in the South Pacific. Genus identification, ability to tolerate edaphic constraints, and plant-growth-promoting (PGP) properties were analysed. We found that 105colony-forming units per gram of root were dominated by Proteobacteria (69%) and comprised 21 genera, including Burkholderia (28%), Curtobacterium (15%), Bradyrhizobium (9%), Sphingomonas (8%), Rhizobium (7%), and Bacillus (5%). High proportions of bacteria tolerated many elements of the extreme edaphic conditions: 82% tolerated 100 μmol·L–1chromium, 70% 1 mmol·L–1nickel, 63% 10 mmol·L–1manganese, 24% 1 mmol·L–1cobalt, and 42% an unbalanced calcium/magnesium ratio (1/16). These strains also exhibited multiple PGP properties, including the ability to produce ammonia (65%), indole-3-acetic acid (60%), siderophores (52%), and 1-aminocyclopropane-1-carboxylate (ACC) deaminase (39%); as well as the capacity to solubilize phosphates (19%). The best-performing strains were inoculated with Sorghum sp. grown on ultramafic substrate. Three strains significantly enhanced the shoot biomass by up to 33%. The most successful strains influenced plant nutrition through the mobilization of metals in roots and a reduction of metal transfer to shoots. These results suggest a key role of these bacteria in plant growth, nutrition, and adaptation to the ultramafic constraints.
Probabilistic characterization of roof panel uplift capacity under wind loading
Authors: He W.X. , Hong H.P.
Published: November 2012

The integrity of the roof system is important to the safety of inhabitants and prevents excessive damage to light-frame wood structures. The uplift capacity of fastened roof panels has been investigated using experimental tests and numerical models. Monotonically increasing uniform static pressure is often employed in experimental investigations and numerical modeling is carried out by assuming that the tributary area method is adequate and the fasteners can be modeled as linear elastic springs, even though the force–deformation relationship for nail withdrawal is nonlinear and uncertain. This study is aimed at assessing the statistical characteristics and modeling the uplift capacity for the roof panel under stochastic wind pressure by incorporating the uncertainty in nail withdrawal behaviour. The results show that the nonlinear behaviour of nail withdrawal needs to be considered to improve the accuracy of the estimated uplift capacity; the statistics and the probability model of the uplift capacity are affected by the degree of correlation of the fastener behaviour within the panel; and that nail spacing and missing nails influence the uplift capacity significantly.
Efficient induction of specific cytotoxic T lymphocytes against gastric adenocarcinoma by a survivin peptide
Authors: Gang Yi , Zhang Xiaoyin , He Yuanlong , Zheng Jianyong , Wu Kaichun , Ding Jie , Fan Daiming
Published: November 2012

Survivin has been demonstrated to be an excellent target for immunotherapy in several types of cancer, but little is known of the efficacy of survivin with gastric adenocarcinoma. In this study, a simple method was performed, and relatively high efficacy was shown upon inducing survivin-derived peptide-specific cytotoxic T lymphocytes (CTL) from peripheral blood mononuclear cells of healthy donors. The induced CTLs exhibited specific lysisagainstHLA-A2 matched tumor cells in vitro, and similar results were demonstrated in primary cell cultures isolated from patients with gastric adenocarcinoma. Up to 30% of randomly selected patients could potentially benefit from immunotherapy targeting survivin. These results suggested that this survivin epitope peptide could be a promising vaccine candidate for immunotherapy for patients with gastric adenocarcinoma.