bluuebunny/crossref_metadata_2025 huggingface dataset:
Mixed convective flow of a dusty fluid over a vertical stretching sheet with non‐uniform heat source/sink and radiation
Authors: Gireesha B.J. , Chamkha A.J. , Manjunatha S. , Bagewadi C.S.
Published: April 2013

Purpose

The purpose of this paper is to study the problem of two‐dimensional unsteady mixed convective flow a dusty fluid over a stretching sheet in the presence of thermal radiation and space‐dependent heat source/sink.

Design/methodology/approach

The equations governing the fluid flow and temperature fields for both the fluid and dust phases are reduced to coupled non‐linear ordinary differential equations by using a suitable set of similarity transformations. Numerical solutions of the resulting equations are obtained using the well known RKF45 method.

Findings

The numerical results are benchmarked with previously published studies and found to be in excellent agreement. Finally, the effects of the pertinent parameters which are of physical and engineering interest on the flow and heat transfer characteristics are presented graphically and in tabulated form.

Originality/value

The problem is relatively original as the dusty fluid works for this type of problem are lacking.
Designing appropriate valuation model for sustainable property tax system in developing countries
Authors: Babawale G.K.
Published: April 2013

Purpose

This study seeks to contrive a sustainable valuation model for developing countries: a model that reasonably combines simplicity with equity, cost effectiveness, transparency, and the peculiarities of the local market place for improved revenue yields.

Design/methodology/approach

The study draws from theory, experiences of other nations and international best practices to arrive at what should be the most appropriate tax base, valuation basis, valuation method, and the most expedient valuation approach for developing countries.

Findings

Using Lagos State, Nigeria to demonstrate the application of the contrived conceptual framework, the study, among others, recommended for her urban areas, a combination of modified mass appraisal technique, modified UK's “property banding” technique, and discrete valuation to reflect the diverse distribution of her property stock. Others include a ten‐yearly comprehensive revaluation and indexation for the annual or periodic adjustments during the intervening periods.

Social implications

Property tax remains, among known local taxes today, the most viable, stable, predictable, progressive, and veritable source of own revenue for a truly independent local government administration. However, while developed countries have been able to tap these potentials to a good advantage for both fiscal and non‐fiscal goals; it is regrettable that the experience of most developing countries has not been equally satisfactory. Inappropriate valuation process, among others, remains a component of the tax system that is misguided and surrounded with much misgiving; hence a revisit.

Originality/value

Given the peculiar characteristics of the property valuation environment of developing countries, the highly simplified but pragmatic valuation model proposed is expected to birth a sustainable property tax system anchored on equity, cost effectiveness, ease of administration, and enhanced valuation ratio, with potentials for improved compliance and tax revenue yields.
Factors influencing the implementation of clean energy interventions in low‐income urban communities in South Africa
Authors: Elizabeth Streeter Alida (Leandi) , de Jongh Derick
Published: April 2013

Purpose

This study aims to identify the key factors that influence the successful implementation of clean energy interventions in low‐income urban communities in South Africa.

Design/methodology/approach

The study took the form of three phases: an explorative, primary data‐gathering process through semi‐structured interviews where secondary data were made available by respondents in the form of official project reports; data analysis of the primary qualitative, explorative, semi‐structured interview data and the secondary documentary data obtained with consent; and identifying and describing the key factors which influence the implementation of clean energy interventions in low income‐urban communities.

Findings

The results indicated that although many important factors were identified throughout this research, the ultimate success of the implementation of clean energy interventions in these communities lies not only in the clean energy interventions themselves, but rather hinges on nine key factors: project planning and development; community participation; community employment; political buy‐in; communication and engagement; beneficiary criteria; installation and maintenance; project management; and technology and suppliers.

Originality/value

The findings from this study provide useful insights to all stakeholders involved in the development and implementation of clean energy interventions in low‐income urban communities.
Recurrent response to advanced lung adenocarcinoma with erlotinib developing leptomeningeal metastases during gefitinib therapy and two case reports
Authors: Xing Puyuan , Li Junling , Shi Yuankai , Zhang Xiangru
Published: April 2013

Background

Epidermal growth factor‐tyrosine kinase inhibitors (EGFR‐TKIs) are one of the effective medicines in advanced lung adenocarcinoma leptomeningeal metastasis (LM) treatment in recent years.

Methods

This paper reports two cases of advanced lung adenocarcinoma with exon‐EGFR19 mutation. LM occurred during gefitinib treatment with an extracranial condition under control. Later, erlotinib was adopted with a recurrent response.

Results

The progression free survival of both patients was over six months and their LM was under control for six and a half and nine months, respectively. LM may be sensitive on different levels to different EGFR‐TKIs.

Conclusion

Erlotinib can be used to replace gefitinib if intracranial tumor progress occurs during gefitinib treatment. However, our conclusion still needs to be proven by further clinical research.
Junior doctors' perceptions of their self‐efficacy in prescribing, their prescribing errors and the possible causes of errors
Authors: Ryan Cristín , Ross Sarah , Davey Peter , Duncan Eilidh M. , Fielding Shona , Francis Jill J. , Johnston Marie , Ker Jean , Lee Amanda Jane , MacLeod Mary Joan , Maxwell Simon , McKay Gerard , McLay James , Webb David J. , Bond Christine
Published: April 2013

Aims

The aim of the study was to explore and compare junior doctors' perceptions of their self‐efficacy in prescribing, their prescribing errors and the possible causes of those errors.

Methods

A cross‐sectional questionnaire study was distributed to foundation doctors throughout Scotland, based on Bandura's Social Cognitive Theory and Human Error Theory (HET).

Results

Five hundred and forty‐eight questionnaires were completed (35.0% of the national cohort). F1s estimated a higher daytime error rate [median 6.7 (IQR 2–12.4)] than F2s [4.0 IQR (0–10) (P = 0.002)], calculated based on the total number of medicines prescribed. The majority of self‐reported errors (250, 49.2%) resulted from unintentional actions. Interruptions and pressure from other staff were commonly cited causes of errors. F1s were more likely to report insufficient prescribing skills as a potential cause of error than F2s (P = 0.002). The prescribers did not believe that the outcomes of their errors were serious. F2s reported higher self‐efficacy scores than F1s in most aspects of prescribing (P < 0.001).

Conclusion

Foundation doctors were aware of their prescribing errors, yet were confident in their prescribing skills and apparently complacent about the potential consequences of prescribing errors. Error causation is multi‐factorial often due to environmental factors, but with lack of knowledge also contributing. Therefore interventions are needed at all levels, including environmental changes, improving knowledge, providing feedback and changing attitudes towards the role of prescribing as a major influence on patient outcome.
Is robotic‐assisted ventral mesh rectopexy superior to laparoscopic ventral mesh rectopexy in the management of obstructed defaecation?
Authors: Mantoo S. , Podevin J. , Regenet N. , Rigaud J. , Lehur P.‐A. , Meurette G.
Published: April 2013

Aim

Function, morbidity and recurrence of symptoms after robotic‐assisted ventral mesh rectopexy (RVMR) and laparoscopic ventral mesh rectopexy (LVMR) for pelvic floor disorders (PFDs) were compared.

Method

Forty‐four patients operated on for PFD with RVMR were compared with 74 of 144 patients who had had LVMR performed between 2008 and 2011. The groups were matched for age, body mass index, American Society of Anesthesiologists status and previous hysterectomy. The same surgical technique and type of mesh were used. Early postoperative morbidity and function [obstructed defaecation syndrome (ODS), incontinence scores (CCF) and sexual activity] were compared.

Results

Operation time was longer in RVMR compared with LVMR (191 ± 26 vs 163 ± 39 min; P = 0.0002). RVMR showed less blood loss (8 ± 34 vs 42 ± 88 ml; P = 0.012) and fewer early complications (2% vs 11%; P = 0.019). ODS and CCF scores improved in both groups. Patients after RVMR reported a better improvement in digitation, straining and satisfaction after defaecation. There was a statistically significant difference in the postoperative ODS score in favour of RVMR (P = 0.004). Sexually active patients in both groups reported a similar improvement. There was no difference in early recurrence (P = 0.692).

Conclusion

Although not a randomized comparison, this study shows that ventral mesh rectopexy performed by the robot was followed by better function then LVMR.
Factors associated with postoperative morbidity, reoperation and readmission rates after laparoscopic total abdominal colectomy for ulcerative colitis
Authors: Gu J. , Stocchi L. , Remzi F. , Kiran R. P.
Published: April 2013

Aim

The aim of this study was to evaluate factors affecting postoperative outcomes after laparoscopic total abdominal colectomy (TAC) with end ileostomy (EI) for ulcerative colitis (UC).

Method

Patients undergoing laparoscopic TAC/EI for severe UC/indeterminate colitis in our institution between 1998 and 2010 were retrospectively identified from a prospectively established database. Demographics, disease characteristics and perioperative outcomes were recorded. Associations between the 30‐day postoperative outcome and patient‐, disease‐ and treatment‐related variables were assessed using univariate and multivariate logistic regression models.

Results

Two hundred and four patients (105 men, median age 35.5 years) were identified. The conversion rate was 4.4%. Median blood loss and operation time were 100 ml and 185 min. Length of hospital stay was 5.8 ± 4.4 days. Overall postoperative morbidity, reoperation and readmission rates were 40, 7 and 17%, respectively Preoperative treatment with high steroid doses was significantly associated with postoperative morbidity on multivariate analysis (P = 0.011). Univariate analysis showed that lower preoperative body mass index (BMI), haemoglobin, serum albumin level and pancolitis were associated with reoperation, of which a lower BMI (P = 0.043) was also independently significant on multivariate analysis. No specific factor was significantly associated with readmission.

Conclusion

Preoperative clinical deterioration is associated with an adverse outcome after laparoscopic TAC for UC.
Parallel evolution of novelties: extremely long intromittent organs in the leaf beetle subfamily Criocerinae
Authors: Matsumura Yoko , Machida Ryuichiro , Wipfler Benjamin , Beutel Rolf G. , Yoshizawa Kazunori
Published: April 2013

Extreme elongation of a part of the intromittent organ, the flagellum, has occurred several times in Criocerinae (Chrysomelidae). These leaf beetles have acquired a specialized pocket to store the flagellum in the abdominal cavity, at the same time allowing a quick control of movements of this structure during copulation. We investigated the morphogenesis of the intromittent organs of species with and without a flagellum to discuss the evolutionary background of parallel evolution of novel structures. We found that the specialized pocket is formed by the invagination of an epidermal layer and a resultant rotation of the primary gonopore. Invaginationitselfis a well‐known phenomenon in morphogenetic processes, which leads us to hypothesize that the novelty is formed by co‐opting a previously acquired genetic system. A large open‐space is present within the intromittent organ during the entire morphogenesis in species without a flagellum, and the invagination in the species with a flagellum grows in the corresponding area. This means that there are no physical impediments for the growth of a large pocket. In addition the sites of muscular attachments in the species with a flagellum are also different from those without it. The differentiation of muscles is completed immediately before adult emergence, which means the muscles are adjustable during the entire morphogenesis in this group. Simple modifications probably based on a co‐option of previously acquired genetic systems, the potential space for adding a new element, and an adjustable factor in morphogenesis of the intromittent organ facilitate the parallel evolution of the extreme elongation.
Efficacy of cyclo‐oxygenase inhibition by two commercially available firocoxib products in horses
Authors: Barton M. H. , Paske E. , Norton N. , King D. , Giguère S. , Budsberg S.
Published: April 2013

Reasons for performing study

Two firocoxib preparations for oral use are approved for use in animals in many countries: a chewable canine tablet and an equine paste. In order to reduce costs, many veterinarians use the canine product in horses even though this is an off‐label use of the preparation.

Objective

To determine the relative efficacy of 2 commercially available firocoxib products to inhibit prostaglandin E2 (PGE2) synthesis after oral dosing in horses.

Study design

A crossover design using 8 adult horses (n = 4 for each preparation during each treatment period). Body weight range 532–614 kg.

Methods

Horses received 57 mg of the assigned firocoxib preparation orally once daily for 7 days, with a 14 day washout period between drug crossover. Ten healthy adult light breed horses were used as no‐treatment controls. During each treatment period, blood was taken before dosing on Days 0 and 7 and on Day 7 1 h after dosing for ex vivo lipopolysaccharide (LPS) stimulation to induce (PGE2) synthesis. Heparinised plasma was also collected on Day 7 immediately prior to and 1 h after dosing to determine plasma firocoxib concentrations.

Results

In the control group, there was no significant change in LPS‐induced PGE2 over time. In contrast, immediately prior to and 1 h after treatment on Day 7, the mean LPS‐induced PGE2 concentration decreased significantly compared to Day 0 values in all treated horses. There was no difference in PGE2 or plasma firocoxib concentrations between firocoxib treatment groups.

Conclusion

In this model, the canine chewable preparation of firocoxib was as effective as the equine paste formulation at reducing LPS‐induced PGE2 synthesis.

Potential relevance

The canine chewable preparation of firocoxib may be a suitable alternative to the paste formulation in horses for situations where extra‐label drug use can be legally justified.

The Summary is available in Chinese ‐ see Supporting information.
The architecture of Trypanosoma brucei tubulin‐binding cofactor B and implications for function
Authors: Fleming Jennifer R. , Morgan Rachel E. , Fyfe Paul K. , Kelly Sharon M. , Hunter William N.
Published: April 2013

Tubulin‐binding cofactor (TBC)‐B is implicated in the presentation of α‐tubulin ready to polymerize, and at the correct levels to form microtubules. Bioinformatics analyses, including secondary structure prediction, CD, and crystallography, were combined to characterize the molecular architecture of Trypanosoma brucei TBC‐B. An efficient recombinant expression system was prepared, material‐purified, and characterized by CD. Extensive crystallization screening, allied with the use of limited proteolysis, led to structures of the N‐terminal ubiquitin‐like and C‐terminal cytoskeleton‐associated protein with glycine‐rich segment domains at 2.35‐Å and 1.6‐Å resolution, respectively. These are compact globular domains that appear to be linked by a flexible segment. The ubiquitin‐like domain contains two lysines that are spatially conserved with residues known to participate in ubiquitinylation, and so may represent a module that, through covalent attachment, regulates the signalling and/or protein degradation associated with the control of microtubule assembly, catastrophe, or function. The TBC‐B C‐terminal cytoskeleton‐associated protein with glycine‐rich segment domain, a known tubulin‐binding structure, is the only such domain encoded by the T. brucei genome. Interestingly, in the crystal structure, the peptide‐binding groove of this domain forms intermolecular contacts with the C‐terminus of a symmetry‐related molecule, an association that may mimic interactions with the C‐terminus of α‐tubulin or other physiologically relevant partners. The interaction of TBC‐B with the α‐tubulin C‐terminus may, in particular, protect from post‐translational modifications, or simply assist in the shepherding of the protein into polymerization.
Nitrogen deposition and warming – effects on phytoplankton nutrient limitation in subarctic lakes
Authors: Bergström Ann‐Kristin , Faithfull Carolyn , Karlsson Daniel , Karlsson Jan
Published: April 2013

The aim of this study was to predict the combined effects of enhanced nitrogen (N) deposition and warming on phytoplankton development in high latitude and mountain lakes. Consequently, we assessed, in a series of enclosure experiments, how lake water nutrient stoichiometry and phytoplankton nutrient limitation varied over the growing season in 11 lakes situated along an altitudinal/climate gradient with low N‐deposition (<1 kg N ha−1 yr−1) in northern subarctic Sweden. Short‐term bioassay experiments with N‐ and P‐additions revealed that phytoplankton in high‐alpine lakes were more prone to P‐limitation, and with decreasing altitude became increasingly N‐ and NP‐colimited. Nutrient limitation was additionally most obvious in midsummer. There was also a strong positive correlation between phytoplankton growth and water temperature in the bioassays. Although excess nutrients were available in spring and autumn, on these occasions growth was likely constrained by low water temperatures. These results imply that enhanced N‐deposition over the Swedish mountain areas will, with the exception of high‐alpine lakes, enhance biomass and drive phytoplankton from N‐ to P‐limitation. However, if not accompanied by warming, N‐input from deposition will stimulate limited phytoplankton growth due to low water temperatures during large parts of the growing season. Direct effects of warming, allowing increased metabolic rates and an extension of the growing season, seem equally crucial to synergistically enhance phytoplankton development in these lakes.
A high blood level in the venous chamber and a wet‐stored dialyzer help to reduce exposure for microemboli during hemodialysis
Authors: Forsberg Ulf , Jonsson Per , Stegmayr Christofer , Jonsson Fredrik , Nilsson Bo , Nilsson Ekdahl Kristina , Stegmayr Bernd
Published: April 2013

During hemodialysis (HD), microemboli develop in the blood circuit of the apparatus. These microemboli can pass through the venous chamber and enter into the patient's circulation. The aim of this study was to investigate whether it is possible to reduce the risk for exposure of microemboli by altering of the treatment mode. Twenty patients on chronic HD were randomized to a prospective cross‐over study of three modes of HD: (a) a dry‐stored dialyzer (F8HPS, Fresenius, steam sterilized) with a low blood level in the venous chamber (DL), (b) the same dialyzer as above, but with a high level in the venous chamber (DH), and (c) a wet‐stored dialyzer (Rexeed, Asahi Kasei Medical, gamma sterilized) with a high blood level (WH). Microemboli measurements were obtained in a continuous fashion during 180 minutes of HD for all settings. A greater number of microemboli were detected during dialysis with the setting DL vs. WH (odds ratio [OR] 4.07, 95% confidence interval [CI] 4.03–4.11, P < 0.0001) and DH vs. WH (OR 1.18, 95% CI 1.17–1.19, P < 0.0001) and less for DH vs. DL (OR 0.290, 95% CI 0.288–0.293, P < 0.0001). These data indicate that emboli exposure was least when using WH, greater with DH, and most with DL. This study shows that using a high blood level in the venous chamber and wet‐stored dialyzers may reduce the number of microemboli.
Characterization of Magnesium‐Doped Hydroxyapatite Prepared by Sol‐Gel Process
Authors: Ziani Salima , Meski Samira , Khireddine Hafit
Published: April 2013

Pure and doped hydroxyapatite (HA) nanocrystalline powders (Ca10‐xMgx(PO4)6OH2) were synthesized using sol‐gel process. For this, calcium nitrate tetrahydrate, magnesium nitrate hexahydrate, and phosphorous pentoxide were used as precursors for Ca, Mg, and P, respectively. Calculated amounts of magnesium ions (Mg+2) especially from 0 to 10% (molar ratio) were incorporated as dopant into the calcium sol solution. The structure and morphology of the gels obtained after mixing the phosphorous and (calcium + magnesium) sol solution were different, and their condensations in time depend on the quantities of magnesium added. The several powders resulting from the gels dried and sintered at 500°C for 1 h were characterized by thermogravimetry (TG), Fourier transform infrared spectroscopy (FTIR), X‐ray diffraction (XRD), and inductively coupled plasma (ICP). Additionally, their agglomeration, morphology, and particle size were investigated using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The specific surface area of each sample was measured by the Brunauer–Emmett–Teller (BET) gas adsorption technique. The results of XRD, FTIR, and ICP values ranged between 0.45 and 2.11 mg/L indicated that the magnesium added in the calcium solution was incorporated in the lattice structure of HA so prepared, while those obtained by SEM and TEM confirmed the influence of Mg on their morphology (needle and irregular shape) and crystallite size, which is about 30–60 nm. The as‐prepared powders had a specific surface area ranged between 6.37 and 27.60 m2/g.
Predicting current and future spatial community patterns of plant functional traits
Authors: Dubuis Anne , Rossier Leila , Pottier Julien , Pellissier Loïc , Vittoz Pascal , Guisan Antoine
Published: April 2013

Community‐level patterns of functional traits relate to community assembly and ecosystem functioning. By modelling the changes of different indices describing such patterns – trait means, extremes and diversity in communities – as a function of abiotic gradients, we could understand their drivers and build projections of the impact of global change on the functional components of biodiversity. We used five plant functional traits (vegetative height, specific leaf area, leaf dry matter content, leaf nitrogen content and seed mass) and non‐woody vegetation plots to model several indices depicting community‐level patterns of functional traits from a set of abiotic environmental variables (topographic, climatic and edaphic) over contrasting environmental conditions in a mountainous landscape. We performed a variation partitioning analysis to assess the relative importance of these variables for predicting patterns of functional traits in communities, and projected the best models under several climate change scenarios to examine future potential changes in vegetation functional properties. Not all indices of trait patterns within communities could be modelled with the same level of accuracy: the models for mean and extreme values of functional traits provided substantially better predictive accuracy than the models calibrated for diversity indices. Topographic and climatic factors were more important predictors of functional trait patterns within communities than edaphic predictors. Overall, model projections forecast an increase in mean vegetation height and in mean specific leaf area following climate warming. This trend was important at mid elevation particularly between 1000 and 2000 m a.s.l. With this study we showed that topographic, climatic and edaphic variables can successfully model descriptors of community‐level patterns of plant functional traits such as mean and extreme trait values. However, which factors determine the diversity of functional traits in plant communities remains unclear and requires more investigations.
Effects of Nebivolol on Aortic Compliance in Patients With Diabetes and Maximal Renin Angiotensin System Blockade: The EFFORT Study
Authors: Briasoulis Alexandros , Oliva Raymond , Kalaitzidis Rigas , Flynn Colleen , Lazich Ivana , Schlaffer Carrie , Bakris George
Published: April 2013

The beneficial effects of nebivolol on arterial stiffness and endothelial dysfunction are well documented in untreated hypertensive patients and differ from nonvasodilatory β‐blockers. This study tests the hypothesis that the addition of nebivolol in predominantly African American patients with type 2 diabetes already receiving maximally tolerated doses of renin‐angiotensin system (RAS) blockers will further improve large artery compliance. Patients with type 2 diabetes and hypertension on maximal RAS blockade (n=70) were randomized to nebivolol or metoprolol succinate daily. Doses were titrated until systolic blood pressure (SBP) was <130 mm Hg. Radial artery applanation tonometry and pulse wave velocity (PWV) analysis were used to derive central aortic pressures and hemodynamic indices at repeated visits at intervals during a 6‐month period. Both metoprolol succinate and nebivolol groups demonstrated reductions in brachial SBP (−8.2±4.3 mm Hg [P=.01] and −7.8±3.7 [P=.002], respectively) and aortic DBP (−2.4±1.8 [P=.039] and −4.0±2.9 mm Hg [P=.013], respectively). Aortic SBP decreased in the nebivolol group only (125.3±8 to 121.6±8.2, P=.025). There were no between group differences in aortic SBP, DBP, augmentation index, or PWV reduction. A significant increase in hemoglobin A1c was observed only in the metoprolol group. In patients with well‐controlled type 2 diabetes and hypertension treated with maximally tolerated RAS blockade, nebivolol does not offer significant reductions in aortic BP over metoprolol succinate but maintains a stable metabolic profile.
Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases
Authors: Chapple Iain L. C. , Genco Robert ,   working group 2 of the joint EFP/AAP workshop
Published: April 2013

Background

Diabetes and periodontitis are complex chronic diseases with an established bidirectional relationship. There is long‐established evidence that hyperglycaemia in diabetes is associated with adverse periodontal outcomes. However, given the ubiquity of periodontal diseases and the emerging global diabetes epidemic, the complications of which contribute to significant morbidity and premature mortality, it is timely to review the role of periodontitis in diabetes.

Aims

To report the epidemiological evidence from cross‐sectional, prospective and intervention studies for the impact of periodontal disease on diabetes incidence, control and complications and to identify potential underpinning mechanisms.

Epidemiology

Over the last 20 years, consistent and robust evidence has emerged that severe periodontitis adversely affects glycaemic control in diabetes and glycaemia in non‐diabetes subjects. In diabetes patients, there is a direct and dose‐dependent relationship between periodontitis severity and diabetes complications. Emerging evidence supports an increased risk for diabetes onset in patients with severe periodontitis.

Biological mechanisms

Type 2 diabetes is preceded by systemic inflammation, leading to reduced pancreatic β‐cell function, apoptosis and insulin resistance. Increasing evidence supports elevated systemic inflammation (acute‐phase and oxidative stress biomarkers) resulting from the entry of periodontal organisms and their virulence factors into the circulation, providing biological plausibility for the effects of periodontitis on diabetes. AGE (Advanced Glycation Endproducts)–RAGE (Receptor for AGEs) interactions and oxidative‐stress‐mediated pathways provide plausible mechanistic links in the diabetes to periodontitis direction.

Interventions

Randomized controlled trials (RCTs) consistently demonstrate that mechanical periodontal therapy associates with approximately a 0.4% reduction in HbA1C at 3 months, a clinical impact equivalent to adding a second drug to a pharmacological regime for diabetes. RCTs are needed with larger numbers of subjects and longer term follow‐up, and if results are substantiated, adjunctive periodontal therapies subsequently need to be evaluated. There is no current evidence to support adjunctive use of antimicrobials for periodontal management of diabetes patients.

Guidelines

Given the current evidence, it is timely to provide guidelines for periodontal care in diabetes patients for medical and dental professionals and recommendations for patients/the public.
Infection and inflammatory mechanisms
Authors: Van Dyke Thomas E. , van Winkelhoff Arie Jan
Published: April 2013

This introductory article examines the potential mechanisms that may play a role in the associations between periodontitis and the systemic conditions being considered in the EFP/AAP Workshop in Segovia, Spain. Three basic mechanisms have been postulated to play a role in these interactions; metastatic infections, inflammation and inflammatory injury, and adaptive immunity. The potential role of each alone and together is considered in in vitro and animal studies and in human studies when available. This is not a systematic or critical review, but rather an overview of the field to set the stage for the critical reviews in each of the working groups.
The effectiveness of a specialised oral nutrition supplement on outcomes in patients with chronic wounds: a pragmatic randomised study
Authors: Bauer J. D. , Isenring E. , Waterhouse M.
Published: April 2013

Background

Nutrition supplements enriched with immune function enhancing nutrients have been developed to aid wound‐healing, although evidence regarding their effectiveness is limited and systematic reviews have lead to inconsistent recommendations. The present pragmatic, randomised, prospective open trial evaluated a wound‐specific oral nutrition supplement enriched with arginine, vitamin C and zinc compared to a standard supplement with respect to outcomes in patients with chronic wounds in an acute care setting.

Methods

Twenty‐four patients [11 males and 13 females; mean (SD) age: 67.8 (22.3) years] with chronic wounds (14 diabetic or venous ulcers; 10 pressure ulcers or chronic surgical wounds) were randomised to receive either a wound‐specific supplement (n = 12) or standard supplement (n = 12) for 4 weeks, with ongoing best wound and nutrition care for an additional 4 weeks. At baseline, and at 4 and 8 weeks, the rate of wound‐healing, nutritional status, protein and energy intake, quality of life and product satisfaction were measured. Linear mixed effects modelling with random intercepts and slopes were fitted to determine whether the wound‐specific nutritional supplement had any effect.

Results

There was a significant improvement in wound‐healing in patients receiving the standard nutrition supplement compared to a wound‐specific supplement (P = 0.044), although there was no effect on nutritional status, dietary intake, quality of life and patient satisfaction.

Conclusions

The results of the present study indicate that a standard oral nutrition supplement may be more effective at wound‐healing than a specialised wound supplement in this clinical setting.
Using the Life Course Paradigm to Explain Mechanisms That Link Family Disruptions to Compulsive Buying
Authors: BAKER ANDREW , MATHUR ANIL , FATT CHOONG KWAI , MOSCHIS GEORGE P. , RIGDON EDWARD E.
Published: April 2013

This research examines compulsive buying as an impulse‐control disorder, a form of maladaptive behavior believed to have its roots in early‐in‐life experiences of family adversities. Unlike previous research that has typically studied only the effects of family divorce on compulsive buying, this study examines the effects of disruptive family events within the broader multitheoretical life course framework. A sample of 327 young adults is used to test the hypothesized relationships derived from the main life course perspectives. The results show alternate paths leading to compulsive buying, beyond those uncovered in previous studies. By offering a broader overarching framework, the article shows how previous efforts to study compulsive buying can be improved, pointing to the value of the multitheoretical life course approach in understanding consumption phenomena.
Multidrug‐Resistant Organisms in Dialysis Patients
Authors: Calfee David P.
Published: April 2013

Multidrug‐resistant organisms (MDROs) have emerged as important causes of healthcare‐associated infections (HAIs), and these infections are associated with significant morbidity and mortality. Dialysis patients have been particularly affected by these pathogens, with colonization and infection rates often exceeding those seen in persons with other types of healthcare exposure. The infection control practices that are currently recommended for use in dialysis facilities and other healthcare settings have the potential to eliminate, or at least substantially reduce transmission of and infection with MDROs. Unfortunately, recent data suggest that these recommended practices are not consistently implemented. Additional efforts and research are needed to increase healthcare workers' awareness of and adherence to infection prevention measures, to develop new and more effective prevention strategies, and to determine cost‐effective approaches to MDRO prevention to optimize the safety and quality of care provided to dialysis patients.
Modeling and Analysis of a Combined Photovoltaic-Thermoelectric Power Generation System
Authors: Najafi Hamidreza , Woodbury Keith A.
Published: April 2013

In the present paper, the possibility of using thermoelectric power generator modules (TEGs) to convert the heat generated by the photovoltaic/thermal (PVT) collector into electricity is investigated. A comprehensive heat transfer model for the combined PVT-TEG system is developed via matlab and simulated under different conditions. The hot side of the TEG module is considered connected to the top of the air channel which is attached to the backside of the solar panel. Air flows through the channel and cools down the cold side of the TEG modules. The TEG modules convert the temperature gradient to electricity and generate extra power from the excess heat, which results in improving the overall performance of the system. The temperature profile within the system is determined. The total generated power by the combined PVT-TEG system under different levels of irradiation is evaluated and discussed and the efficiency of each subsystem is calculated. Moreover, the performance of the combined system on a typical summer day in the Tuscaloosa, AL climate is determined in order to show the potential of using the proposed system by using actual meteorological data. Finally, the optimal required number of TEG modules needed in order to achieve the highest overall output power by the system for fixed weather conditions is evaluated and discussed.
Po‐Poster ‐ 15: Conversion of kV‐CT Numbers to electron density of human tissues in vivo: Validation using megavoltage CT scanning on a tomotherapy machine
Authors: Prasad S , Kron T , Battista J , Kempe J
Published: April 2013

In radiotherapy planning, the calibration of CT number in terms of electron density (electrons per cm3) is essential for dose computations in heterogeneous tissue. For electron density of soft tissues with low atomic numbers (6 < Z < 8) and with kilovoltage (kV) CT number values below 100, the calibration curve is linear and well justified theoretically. For tissues with higher CT number values (> 100), empirical methods based on phantom experiments with bone‐substitute materials have been performed to produce an approximate bone calibration curve. This approach was first validated for in‐vivo tissues by plotting kV‐CT numbers against the electron density measured independently by Compton‐scatter imaging. With the advent of megavoltage (MV) CT scanning on tomotherapy machines, we now have a similar opportunity for the measurement of electron densities in vivo. In this work, we have scanned radiotherapy patients (N ∼ 30) using a kilovoltage CT scanner (Picker PQ5000, Marconi Medical Systems, Cleveland, Ohio) operated at 130 kVp and we repeated the studies using 3.5 MV X‐rays produced by a tomotherapy unit (TomoTherapy Inc.). Through manual identification of common anatomical features and sampling of homologous tissue regions, a calibration curve of kV‐CT number versus electron density was plotted. The curve, which includes 50 regional data points per patient, shows very good agreement with previously reported empirical equations. This study reaffirms that kV‐CT scanning, done at one fixed energy (e.g. 130 kVp), can be used for tissue electron densitometry in living soft tissues and bone.
Po‐Poster ‐ 34: Diffusion tensor imaging in the human calf muscle as a measure of the muscle disorder
Authors: Zaraiskaya T , Noseworthy M , Kumbhare D
Published: April 2013

The diffusion tensor imaging (DTI) is a method for the evaluation of water diffusion in organized tissues. In muscles the diffusion of water is expected to be anisotropic. It is hypothesized that diffusion is larger along muscle fibers compared to that across fibers. From a series of diffusion weighted images the diffusion tensor can be calculated. The obtained eigenvalues and eigenvectors of this tensor provide information about local muscle tissue anisotropy. The aim of this study was to determine whether DTI is a suitable method to characterize the extent of human calf muscle injuries such as tears, and the difference between immediate post‐exercise and at rest skeletal muscle. The data were collected using a GE‐3.0T shortbore scanner with a standard knee coil. Four subjects were investigated: one patient with chronic compartment syndrome affecting the posterior compartment of the calf, one patient with clinically apparent acute medial gastrocnemius tear, and two healthy volunteers. The diffusion anisotropy of water was characterized by the fractional anisotropy. The diffusion images demonstrate the anisotropy of the diffusion and the large contrast arising from the different orientations of the cells in the muscle tissue. The calculated eigenvalues of the diffusion tensor reflects the strong anisotropic character of the muscle tissue. The results of the fiber tractography method demonstrate disorder as expected for the muscle tear, while the healthy muscle shows the ordering in the fibers. As a conclusion, DTI and fibre tracking may be suitable techniques for analyzing skeletal muscle damage and evaluating lesion extent.
Multiplex Liquid Chromatography-Tandem Mass Spectrometry Assay for Simultaneous Therapeutic Drug Monitoring of Ribavirin, Boceprevir, and Telaprevir
Authors: Aouri Manel , Moradpour Darius , Cavassini Matthias , Mercier Thomas , Buclin Thierry , Csajka Chantal , Telenti Amalio , Rauch Andri , Decosterd Laurent A.
Published: April 2013

New directly acting antivirals (DAAs) that inhibit hepatitis C virus (HCV) replication are increasingly used for the treatment of chronic hepatitis C. A marked pharmacokinetic variability and a high potential for drug-drug interactions between DAAs and numerous drug classes have been identified. In addition, ribavirin (RBV), commonly associated with hemolytic anemia, often requires dose adjustment, advocating for therapeutic drug monitoring (TDM) in patients under combined antiviral therapy. However, an assay for the simultaneous analysis of RBV and DAAs constitutes an analytical challenge because of the large differences in polarity among these drugs, ranging from hydrophilic (RBV) to highly lipophilic (telaprevir [TVR]). Moreover, TVR is characterized by erratic behavior on standard octadecyl-based reversed-phase column chromatography and must be separated from VRT-127394, its inactive C-21 epimer metabolite. We have developed a convenient assay employing simple plasma protein precipitation, followed by high-performance liquid chromatography coupled to tandem mass spectrometry (HPLC-MS/MS) for the simultaneous determination of levels of RBV, boceprevir, and TVR, as well as its metabolite VRT-127394, in plasma. This new, simple, rapid, and robust HPLC-MS/MS assay offers an efficient method of real-time TDM aimed at maximizing efficacy while minimizing the toxicity of antiviral therapy.
How Does Colistin-Induced Nephropathy Develop and Can It Be Treated?
Authors: Ozkan Gulsum , Ulusoy Sukru , Orem Asım , Alkanat Mehmet , Mungan Sevdegül , Yulug Esin , Yucesan Fulya Balaban
Published: April 2013

Colistin is an old antibiotic used in the treatment of Gram-negative infections. It was once suspended because of its nephrotoxic effect but has since been reintroduced due to multidrug-resistant bacterial infections. The pathogenesis of colistin-associated nephropathy has not been clarified, and there is currently no effective therapeutic or prophylactic agent available. The aim of this study was to investigate the roles of caspase-associated apoptosis and caspase 1, calpain 1, inducible nitric oxide synthase (iNOS), and endothelial nitric oxide synthase (eNOS) expression in the pathogenesis of colistin-associated nephrotoxicity and the effect of grape seed proanthocyanidin extract (GSPE) in preventing it. Twenty-four rats were divided into three groups: control, colistin, and colistin plus GSPE (colistin+GSPE). Colistin-associated nephropathy was induced by the administration of 300,000 IU/kg of body weight/day colistin intraperitoneally for 7 days. The experiment was discontinued on the seventh day. Blood was collected for measurements of blood urea nitrogen (BUN) and creatinine levels. Histopathological examination of kidney tissue and caspase 1 and 3, iNOS, eNOS, terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling (TUNEL), and calpain 1 staining was also performed. Significant increases in BUN levels; creatinine levels; renal histopathological scores; and TUNEL, caspase 1 and 3, calpain 1, iNOS, and eNOS staining were observed for the colistin group compared to the control group. Significant decreases in BUN levels; creatinine levels; renal histopathological scores; and TUNEL, caspase 1 and 3, calpain 1, iNOS, and eNOS staining were observed in the colistin+GSPE group compared to the colistin group. Our study shows, for the first time in the literature, that caspase-mediated apoptosis, iNOS, caspase 1, and calpain 1 are involved in the pathogenesis of colistin-associated nephropathy. GSPE had a renoprotective effect, as shown by the lowered levels of these mediators.
Antimicrobial Activity of Ceftaroline Tested against Staphylococci with Reduced Susceptibility to Linezolid, Daptomycin, or Vancomycin from U.S. Hospitals, 2008 to 2011
Authors: Sader Helio S. , Flamm Robert K. , Jones Ronald N.
Published: April 2013

Vancomycin, linezolid, and daptomycin are very active against staphylococci, but isolates with decreased susceptibility to these antimicrobial agents are isolated sporadically. A total of 19,350
Staphylococcus aureus
isolates (51% methicillin resistant [MRSA]) and 3,270 coagulase-negative staphylococci (CoNS) were collected consecutively from 82 U.S. medical centers from January 2008 to December 2011 and tested for susceptibility against ceftaroline and comparator agents by the reference broth microdilution method. Among
S. aureus
strains, 14 isolates (0.07%) exhibited decreased susceptibility to linezolid (MIC, ≥8 μg/ml), 18 (0.09%) to daptomycin (MIC, ≥2 μg/ml), and 369 (1.9%) to vancomycin (MIC, ≥2 μg/ml; 368 isolates at 2 μg/ml and 1 at 4 μg/ml). Fifty-one (1.6%) CoNS were linezolid resistant (MIC, ≥8 μg/ml), and four (0.12%) were daptomycin nonsusceptible (MIC, ≥2 μg/ml). Ceftaroline was very active against
S. aureus
overall (MIC
50/90
, 0.5/1 μg/ml; 98.5% susceptible), including MRSA (MIC
50/90
, 0.5/1 μg/ml; 97.2% susceptible). All daptomycin-nonsusceptible and 85.7% of linezolid-resistant
S. aureus
isolates were susceptible to ceftaroline. Against
S. aureus
isolates with a vancomycin MIC of ≥2 μg/ml, 91.9, 96.2, and 98.9% were susceptible to ceftaroline, daptomycin, and linezolid, respectively. CoNS strains were susceptible to ceftaroline (MIC
50/90
, 0.25/0.5 μg/ml; 99.1% inhibited at ≤1 μg/ml), including methicillin-resistant (MIC
50/90
, 0.25/0.5 μg/ml), linezolid-resistant (MIC
50/90
, 0.5/0.5 μg/ml), and daptomycin-nonsusceptible (4 isolates; MIC range, 0.03 to 0.12 μg/ml) strains. In conclusion, ceftaroline demonstrated potent
in vitro
activity against staphylococci with reduced susceptibility to linezolid, daptomycin, or vancomycin, and it may represent a valuable treatment option for infections caused by these multidrug-resistant staphylococci.
Epsilon Toxin Is Essential for the Virulence of Clostridium perfringens Type D Infection in Sheep, Goats, and Mice
Authors: Garcia J. P. , Adams V. , Beingesser J. , Hughes M. L. , Poon R. , Lyras D. , Hill A. , McClane B. A. , Rood J. I. , Uzal F. A.
Published: April 2013

Clostridium perfringenstype D causes disease in sheep, goats, and other ruminants. Type D isolates produce, at minimum, alpha and epsilon (ETX) toxins, but some express up to five different toxins, raising questions about which toxins are necessary for the virulence of these bacteria. We evaluated the contribution of ETX toC. perfringenstype D pathogenicity in an intraduodenal challenge model in sheep, goats, and mice using a virulentC. perfringenstype D wild-type strain (WT), an isogenic ETX null mutant (etxmutant), and a strain where theetxmutation has been reversed (etxcomplemented). All sheep and goats, and most mice, challenged with the WT isolate developed acute clinical disease followed by death in most cases. Sheep developed various gross and/or histological changes that included edema of brain, lungs, and heart as well as hydropericardium. Goats developed various effects, including necrotizing colitis, pulmonary edema, and hydropericardium. No significant gross or histological abnormalities were observed in any mice infected with the WT strain. All sheep, goats, and mice challenged with the isogenicetxmutant remained clinically healthy for ≥24 h, and no gross or histological abnormalities were observed in those animals. Complementation ofetxknockout restored virulence; most goats, sheep, and mice receiving this complemented mutant developed clinical and pathological changes similar to those observed in WT-infected animals. These results indicate that ETX is necessary for type D isolates to induce disease, supporting a key role for this toxin in type D disease pathogenesis.