bluuebunny/crossref_metadata_2025 huggingface dataset:
Determination of the relationship between adequacy of dialysis and quality of life and self‐care agency
Authors: Kalender Nurten , Tosun Nuran
Published: July 2013

Aim and objectives

To investigate the relationship between the dialysis adequacy and the quality of life and self‐care agency.

Background

Haemodialysis (HD), which is the leading treatment option for chronic renal failure (CRF), leads to significant changes in the life of the patient. These changes affecting almost all the dimensions of life also negatively affect the quality of life and self‐care agency.

Design

Descriptive study.

Methods

The research was conducted with a total of 112 patients who had been admitted to two private dialysis centres between May 2009 and September 2010, who met the research criteria. The Data Collection Form for the Socio‐demographic and Medical Characteristics, the Biochemical and Medical Parameters Form to determine the adequacy of dialysis, the SF‐36 Quality of Life Scale and the Self‐Care Agency Scale were used in the research.

Results

A significant relationship was found between Kt/V, one of the parameters used for the assessment of dialysis adequacy, and the emotional role scores of the SF‐36 Quality of Life Scale and between the URR level and physical functioning (r = +0·192, p = 0·045) and emotional role scores (r = +0·284, p = 0·003). No significant relationship could be found between the self‐care agency and the evaluated parameters.

Conclusions

Kt/V and URR, which have an effect on dialysis adequacy, may affect the quality of life. Our results are similar to those of previous studies, which showed that Kt/V and URR affect the quality of life.

Relevance to clinical practice

It was recommended to regularly control the parameters used for the assessment of dialysis adequacy and to evaluate their effects on the quality of life, to determine the most affected quality of life subparameters and to address these problems and solve them.
Clients with chronic conditions: community nurse role in a multidisciplinary team
Authors: Wilkes Lesley , Cioffi Jane , Cummings Joanne , Warne Bronwyn , Harrison Kathleen
Published: July 2013

Aims and objectives

To define and validate the role of the community nurse in a multidisciplinary team caring for clients with chronic and complex needs.

Background

A key factor in optimising care for clients with chronic and complex conditions in the community is the use of multidisciplinary teams. A team approach is more effective as it enables better integration of services. The role of the community nurse in the multidisciplinary team has as yet not been delineated.

Design

A modified Delphi technique was used in this study.

Methods

A group of 17 volunteer registered nurses who were experienced in the care of clients with chronic conditions and complex care needs in the community formed a panel of experts. Experts were emailed a series of three questionnaires.

Results

Main findings show that the role of the community nurse in a multidisciplinary team for clients with chronic conditions has six main domains – advocate, supporter, coordinator, educator, team member and assessor.

Conclusion

A consensus on the role of the community nurse in the multidisciplinary team is described. The six key role domains reaffirm the generic role of the nurse and the validation of the role clarifies and reinforces the centrality of the community nurse in the team. Further refinement of the community nurse role is indicated to increase comprehensiveness of role descriptors particularly for the role domain, advocate.

Relevance to clinical practice

Community nurses working in multidisciplinary teams caring for clients with chronic conditions can define their role as a team member. The working relationship of the community nurse with other health professionals in the multidisciplinary team as a key approach to more integrated care for clients and carers enables the use of this approach to be better understood by all team members. With this increased understanding, community nurses are in a position to build stronger and more effective care teams.
Patients’ lived seclusion experience in acute psychiatric hospital in the United States: a qualitative study
Authors: Ezeobele I. E. , Malecha A. T. , Mock A. , Mackey‐Godine A. , Hughes M.
Published: July 2013

Accessible summary

The findings revealed that the patients perceived seclusion as an intervention that is punitive and a means used by the staff to exert control.

Patients perceived that staff incitements and lack of communication skills led to their being secluded.

The findings provided recommendations and strategies for seclusion reduction that were based on the patients’ first‐hand seclusion experiences.

This phenomenological study used Husserlian's philosophy to explore and describe the lived experiences of psychiatric patients who were secluded at a free‐standing acute care hospital located in South‐western United States (US). The study is crucial because very few studies have been conducted in this area in the US. The study examined a purposive sample of 20 patients, 3 days post‐seclusion. Data were generated through face‐to‐face, semi‐structured interviews incorporating open‐ended questions and probes to facilitate discussion until saturation was reached. Interviews were transcribed verbatim and data analysed using Colaizzi's seven steps method. Results were described according to the themes and subthemes identified. Findings uncovered four themes: (1) alone in the world; (2) staff exert power and control; (3) resentment towards staff; and (4) time for meditation. The findings from this study illuminated the views surrounding patients’ seclusion experience. It provided first‐hand information on the patients’ seclusion experience that might be helpful to the mental health professionals in the seclusion reduction process.
Three faces of justice: Competing ethical paradigms in forensic psychiatry
Authors: Adshead Gwen
Published: July 2013

Respect for justice has traditionally been an essential principle of health care ethics. However, many bioethical accounts of justice focus only on distributive justice, and how resources for health care should be allocated. In this article, I will argue that the practice of forensic mental health care requires clinicians to engage with justice in three additional and different ways: justice as liberty and fairness; retributive justice and protection of the vulnerable; and justice as the promotion of virtue. I will argue that British forensic psychiatry favours retributive and protective justice; in contrast to a libertarian approach to forensic practice in the United States. I discuss how respect for justice as support for virtue complements therapeutic work with offenders, which aims at the development of pro‐social character. I will conclude that without respect for justice as virtue, there is a danger that clinical forensic psychiatry risks doing harm to patients and bringing the profession into disrepute.
Radiologic response to transcatheter hepatic arterial chemoembolization and clinical outcomes in patients with hepatocellular carcinoma
Authors: Kim Chang Joon , Kim Hong Joo , Park Jung Ho , Park Dong Il , Cho Yong Kyun , Sohn Chong Il , Jeon Woo Kyu , Kim Byung Ik , Kim Min‐Ji
Published: July 2013

Background & Aims

The current study analysed the association between radiologic tumour response and survival times of patients with hepatocellular carcinoma (HCC) who were treated with transcatheter hepatic arterial chemoembolization (TACE).

Methods

Among 493 consecutive patients presenting to our institution between July 2002 and June 2010 with radiologically (n = 398) or histologically (n = 95) confirmed HCC, 368 patients who met inclusion criteria, underwent TACE and had confirmed survival data were retrospectively reviewed. The radiologic response was assessed using RECIST 1.1, EASL and mRECIST criteria at 1 month after the initial TACE.

Results

By univariate analysis, higher Child–Turcotte–Pugh (CTP) score, bilobar and multifocal distribution of tumours, larger tumour size (>5 cm), higher serum alpha‐foetoprotein (AFP) level (>200 ng/ml), no subsequent radiofrequency ablation, advanced ECOG, UNOS and BCLC staging, absence of complete necrosis and non‐responder (SD or PD) in RECIST 1.1, EASL and mRECIST response assessment were significantly associated with shorter overall survival times. By Cox proportional hazards model, advanced age, presence of ascites, higher MELD score, advanced BCLC staging, absence of complete necrosis and non‐responder by RECIST 1.1, EASL and mRECIST criteria were independent and significant prognosticators for overall survival times in patients with HCC who underwent TACE. By time‐dependent ROC curve analysis, mRECIST response criteria showed greatest accuracy in predicting survival (AUROC = 0.8676), followed by EASL (AUROC = 0.8471) and RECIST 1.1 (AUROC = 0.7986).

Conclusion

mRECIST and EASL criteria for assessing radiologic response 1 month after initial TACE more consistently predict the differences in overall survival between responders and non‐responders than conventional RECIST 1.1 criteria.
In Defense of Anti‐Archimedean Moral Realism: A Response to Recent Critics
Authors: Clipsham Patrick
Published: July 2013

RonaldDworkin famously argued that many putatively nonmoral metaethical theories can only be understood as being internal to the moral domain. If correct, this position, referred to as anti‐archimedeanism, has profound implications for the methodology of metaethics. This is particularly true for skeptical metaethical theories. This article defends a version of anti‐archimedeanism that is true to the spirit rather than the letter ofDworkin's original thesis from several recent objections. First, it addressesKennethEhrenberg's recent attempt to demonstrate how certain metaethical theories can be understood in a morally neutral manner. It then discussesCharlesPigden's claim thatDworkin begs the question against error theorists and nihilists by assuming a conceptual space that error theorists and nihilists would reject. It concludes that the anti‐archimedean methodology originally proposed byDworkin is defensible, and can be used to support a robust form of moral realism.
Epistemic Responsibility and Critical Thinking
Authors: Vaidya Anand Jayprakash
Published: July 2013

Should we always engage in critical thinking about issues of public policy, such as health care, gun control, and LGBT rights? Michael Huemer (2005) has argued for the claim that in some cases it is not epistemically responsible to engage in critical thinking on these issues. His argument is based on a reliabilist conception of the value of critical thinking. This article analyzes Huemer's argument against the epistemic responsibility of critical thinking by engaging it critically. It presents an alternative account of the value of critical thinking that is tied to the notion of forming and deploying a critical identity. And it develops an account of our epistemic responsibility to engage in critical thinking that is not dependent on reliability considerations alone. The primary purpose of the article is to provide critical thinking students, or those that wish to reflect on the value of critical thinking, with an opportunity to think metacritically about critical thinking by examining an argument that engages the question of whether it is epistemically responsible for one to engage in critical thinking.
Woronin bodies, their impact on stress resistance and virulence of the pathogenic mould Aspergillus fumigatus and their anchoring at the septal pore of filamentous Ascomycota
Authors: Beck Julia , Echtenacher Bernd , Ebel Frank
Published: July 2013

Hyphae of filamentous Ascomycota consist of compartments that are connected via septal pores. To avoid a dramatic loss of cellular content after wounding, fungi developed mechanisms to occlude their septal pores. In most Pezizomycotina, so‐called Woronin bodies are anchored in proximity to the pore. This is a prominent example for precise spatial positioning of organelles, but so far the underlying molecular organization has remained largely unknown. Using the pathogenic mould Aspergillus fumigatus, we provide evidence that Woronin bodies are important for stress resistance and virulence. Furthermore the molecular machinery anchoring them at the septum is described. Namely, we have identified Lah as the tethering protein and provide evidence that the Woronin body protein HexA binds to the septal pore in a Lah‐dependent manner. Moreover, we demonstrate that a striking poly‐histidine motif targets HexA to the septal cell wall. Thus, the axis HexA‐Lah is an excellent candidate for the tether linking Woronin bodies to the septum. This model applies to A. fumigatus, but most likely also to the vast majority of the Pezizomycotina. Our findings shed light on the evolution of Woronin body anchoring and provide a basis for the development of novel strategies to combat fungal pathogens like A. fumigatus.
Intrinsicality and Grounding
Authors: Marshall Dan
Published: July 2013

A number of philosophers have recently claimed that intrinsicality can be analysed in terms of the metaphysical notion of grounding. Since grounding is a hyperintensional notion, accounts of intrinsicality in terms of grounding, unlike most other accounts, promise to be able to discriminate between necessarily coextensive properties that differ in whether they are intrinsic. They therefore promise to be compatible with popular metaphysical theories that posit necessary entities and necessary connections between wholly distinct entities, on which it is plausible that there are such properties. This paper argues that this promise is illusory. It is not possible to give an analysis of intrinsicality in terms of grounding that is consistent with these theories. Given an adequate analysis should be compatible with these theories, it follows that it is not possible to analyse intrinsicality in terms of grounding.
Characterization of resistance mechanisms activated by Trichoderma harzianum T39 and benzothiadiazole to downy mildew in different grapevine cultivars
Authors: Banani H. , Roatti B. , Ezzahi B. , Giovannini O. , Gessler G. , Pertot I. , Perazzolli M.
Published: July 2013

Downy mildew, caused by Plasmopara viticola, is one of the most destructive diseases of grapevine and is controlled with intense application of chemical fungicides. Treatment with Trichoderma harzianum T39 (T39) or benzothiadiazole‐7‐carbothioic acid S‐methyl ester (BTH) has been previously shown to activate grapevine resistance to downy mildew and reduce disease symptoms in the Pinot noir cultivar. However, enhancement of plant resistance can be affected by several factors, including plant genotype. In order to further extend the use of resistance inducers against downy mildew, the physiological and molecular properties of T39‐ and BTH‐activated resistance in different cultivars of table and wine grapes were characterized under greenhouse conditions. T39 treatment reduced downy mildew symptoms, but the degree of efficacy differed significantly among grapevine cultivars. However, efficacy of BTH‐activated resistance was consistently high in the different cultivars. Expression profiles of defence‐related genes differed among cultivars in response to resistance inducers and to pathogen inoculation. T39 treatment enhanced the expression of defence‐related genes in the responsive cultivars, before and after P. viticola inoculation. A positive correlation between the efficacy of T39 and the expression level of defence‐related genes was found in Primitivo and Pinot noir plants, while different genes or more complex processes were probably activated in Sugraone and Negroamaro. The data reported here suggest that the use of a responsive cultivar is particularly important to maximize the efficacy of resistance inducers and new natural inducers should be explored for the less responsive cultivars.
Incidence, Risk Factors, and Consequences of Amniotic Fluid Embolism
Authors: Kramer Michael S. , Abenhaim Haim , Dahhou Mourad , Rouleau Jocelyn , Berg Cynthia
Published: July 2013

Background

Amniotic fluid embolism (AFE) is a rare but serious cause of maternal mortality whose aetiology remains obscure. Previous population‐based studies have reported associations with labour induction and caesarean delivery.

Methods

We updated a previous analysis based on the US Nationwide Inpatient Sample from 1999 to 2008. We adapted a diagnostic validation algorithm to minimise false‐positive diagnoses, along with statistical methods that account for the stratified random sampling design.

Results

Of the 8 571 209 deliveries recorded in the database, 276 met our case definition of AFE, of which 62 (22.9% of the 274 with known vital status) were fatal. Significant associations with AFE were observed for medical induction {adjusted odds ratio [aOR] = 1.7 [95% confidence interval (CI) 1.2, 2.5]}, caesarean delivery [aOR = 15.0; 95% CI 9.4, 23.9], instrumental vaginal delivery [aOR = 6.6; 95% CI 4.0, 11.1], and cervical/uterine trauma [aOR = 7.4; 95% CI 3.6, 14.9]. AFE was associated with increases in risk of stillbirth, hysterectomy, maternal death, and prolonged maternal length of delivery hospital stay.

Conclusions

AFE remains an extremely serious obstetric complication with high risks of maternal and fetal mortality. The increased risks of AFE associated with labour induction and caesarean delivery have implications for elective use of these interventions.
What's Religious about the Iliad?
Authors: Kitts Margo
Published: July 2013

The disconnection between contemporary understandings and ancient experiences of “religion,” “theology,” and the “supernatural” has plagued attempts to understand Homeric imagination for more than a century. The chasm might be measured by judgments that the theomachy of Iliad 20 and 21, for instance, must be “bad art,” “black comedy,” or represents a “comic agon” imitative of Near Eastern creation stories. In other words, it is not to be taken seriously. This paper defends religious sensibilities in the Iliad. It summarizes the problems of uncovering these sensibilities with an ear toward some basic issues in hermeneutics: the difficulties posed by the poem's diachronic development, conceivably over centuries, but more importantly difficulties internal to the poem, such as fickle Muses and the world they open for us. Finally, the tools of poetic extension and catachresis help to grasp the poem's sophistication in its representations of divine violence.
Distribution-free Prediction Bands for Non-parametric Regression
Authors: Lei Jing , Wasserman Larry
Published: July 2013

We study distribution-free, non-parametric prediction bands with a focus on their finite sample behaviour. First we investigate and develop different notions of finite sample coverage guarantees. Then we give a new prediction band by combining the idea of ‘conformal prediction’ with non-parametric conditional density estimation. The proposed estimator, called COPS (conformal optimized prediction set), always has a finite sample guarantee. Under regularity conditions the estimator converges to an oracle band at a minimax optimal rate. A fast approximation algorithm and a data-driven method for selecting the bandwidth are developed. The method is illustrated in simulated and real data examples.
Model Selection Principles in Misspecified Models
Authors: Lv Jinchi , Liu Jun S.
Published: July 2013

Model selection is of fundamental importance to high dimensional modelling featured in many contemporary applications. Classical principles of model selection include the Bayesian principle and the Kullback–Leibler divergence principle, which lead to the Bayesian information criterion and Akaike information criterion respectively, when models are correctly specified. Yet model misspecification is unavoidable in practice. We derive novel asymptotic expansions of the two well-known principles in misspecified generalized linear models, which give the generalized Bayesian information criterion and generalized Akaike information criterion. A specific form of prior probabilities motivated by the Kullback–Leibler divergence principle leads to the generalized Bayesian information criterion with prior probability, GBICp, which can be naturally decomposed as the sum of the negative maximum quasi-log-likelihood, a penalty on model dimensionality, and a penalty on model misspecification directly. Numerical studies demonstrate the advantage of the new methods for model selection in both correctly specified and misspecified models.
Confidence Intervals for Low Dimensional Parameters in High Dimensional Linear Models
Authors: Zhang Cun-Hui , Zhang Stephanie S.
Published: July 2013

The purpose of this paper is to propose methodologies for statistical inference of low dimensional parameters with high dimensional data. We focus on constructing confidence intervals for individual coefficients and linear combinations of several of them in a linear regression model, although our ideas are applicable in a much broader context. The theoretical results that are presented provide sufficient conditions for the asymptotic normality of the proposed estimators along with a consistent estimator for their finite dimensional covariance matrices. These sufficient conditions allow the number of variables to exceed the sample size and the presence of many small non-zero coefficients. Our methods and theory apply to interval estimation of a preconceived regression coefficient or contrast as well as simultaneous interval estimation of many regression coefficients. Moreover, the method proposed turns the regression data into an approximate Gaussian sequence of point estimators of individual regression coefficients, which can be used to select variables after proper thresholding. The simulation results that are presented demonstrate the accuracy of the coverage probability of the confidence intervals proposed as well as other desirable properties, strongly supporting the theoretical results.
Semiparametric Inference for Data with A Continuous Outcome from A Two-Phase Probability-Dependent Sampling Scheme
Authors: Zhou Haibo , Xu Wangli , Zeng Donglin , Cai Jianwen
Published: July 2013

Multiphased designs and biased sampling designs are two of the well-recognized approaches to enhance study efficiency. We propose a new and cost-effective sampling design, the two-phase probability-dependent sampling design, for studies with a continuous outcome. This design will enable investigators to make efficient use of resources by targeting more informative subjects for sampling. We develop a new semiparametric empirical likelihood inference method to take advantage of data obtained through a probability-dependent sampling design. Simulation study results indicate that the sampling scheme proposed, coupled with the proposed estimator, is more efficient and more powerful than the existing outcome-dependent sampling design and the simple random sampling design with the same sample size. We illustrate the method proposed with a real data set from an environmental epidemiologic study.
Modification of the Armijo line search to satisfy the convergence properties of HS method
Authors: Belloufi Mohammed , Benzine Rachid , Yamina Laskri
Published: July 2013

The Hestenes-Stiefel (HS) conjugate gradient algorithm is a useful tool of unconstrainednumerical optimization, which has good numerical performance but no global convergence result under traditional line searches. This paper proposes a line search technique that guarantee the globalconvergence of the Hestenes-Stiefel (HS) conjugate gradient method. Numerical tests are presented tovalidate the diï¬€erent approaches.
Analysis and Synthesis of Spool Valves With Arbitrary Metering Area Variation
Authors: Gillella Pradeep , Sun Zongxuan
Published: July 2013

This paper presents a systematic method for analyzing and designing the notches on the spool of a flow control valve to influence the area-schedule, i.e., relationship between the spool position and the metering area. The motivation for such a flow control valve comes from a novel hydraulic actuator intended for camless valve actuation in internal combustion engines. The proposed actuator has a unique hydromechanical internal feedback system in which the motion of the flow regulator's spool is directly coupled to the motion of the actuator. Lack of direct control of the spool position necessitates the appropriate modification of the spool design in order to control the variation of the effective area across the valve. The design modifications required to realize the desired area-schedules are first discussed. A systematic procedure which combines computational fluid dynamics (CFD) analysis and geometry based analysis is then developed to characterize the variation of the effective area for various spool designs. It is shown that the mean area available for the fluid flow through the entire notch serves as a better approximation of the metering characteristics when compared to the traditional approach of using the minimum area. The proposed analysis procedure is validated with experimental data from a prototype spool valve. The fast turn around time of the proposed analysis technique is then used to develop an automated procedure to design the 3D features (notches) on the spool required to realize any specified area-schedule.
A Control-Oriented Model for Dynamics From Fuel Injection Profile to Intake Gas Conditions in Diesel Engines
Authors: Yan Fengjun , Wang Junmin
Published: July 2013

Fuel injection profile variations play a critical role in advanced combustion mode control for diesel engines and also possess control authorities on engine in-cylinder conditions (ICCs). In order to systematically utilize the active fueling control, in conjunction with air-path control, for transient operations of advanced multimode combustion diesel engines, this paper presents a physics-based, control-oriented model that describes the inherent dynamics from fuel injection profile variations to the intake gas conditions. To show the effectiveness of the developed control-oriented model, comparisons were made with the simulation results from a high-fidelity GT-Power computational engine model as well as the experimental data acquired on a medium-duty diesel engine during transient operations.
Nanomechanical and Wear Behavior of Microtextured Carbide-Coated CoCrMo Alloy Surfaces
Authors: Ettienne-Modeste Geriel A. , Topoleski L. D. Timmie
Published: July 2013

The nanomechanical properties of a CoCrMo medical implant alloy and a novel microtextured carbide-coated CoCrMo alloy (MTCC) surface—hardness and elastic modulus—were examined using nanoindentation. The MTCC surfaces may be a successful alternative bearing material for artificial joints. Understanding the nanomechanical, material properties, and surface morphology of the MTCC–CoCrMo surface are important for designing wear resistant artificial joints. The microtextured carbide surfaces were created using a microwave plasma-assisted chemical vapor deposition reaction (MPCVD). Nanomechanical properties, volumetric wear properties, and surface morphology were measured and used to determine the performance of the conventional CoCrMo alloy and MTCC surfaces (processed for either 2 or 4 h) in static environments and under severe wear conditions. The hardness, elastic modulus, and surface parameters of the 4-h MTCC surfaces were always greater than the 2-h MTCC and CoCrMo alloy surfaces. The nanomechanical properties changed for the CoCrMo alloy and 2-h and 4-h MTCC surfaces after, in contrast to before, wear testing. This indicates that the wear mechanisms affect the nanomechanical results. Overall, the 4-h MTCC surfaces had greater wear resistance than the 2-h MTCC or CoCrMo alloy surfaces.
XiAP-ping Castration-Resistant Prostate Cancer
Authors: Voora Deepak
Published: July 2013

The XAF1-XIAP pathway provides a mechanistic link and a path for personalized prostate cancer therapy.
A Comprehensive, Model-Based Review of Vaccine and Repeat Infection Trials for Filariasis
Authors: Morris C. Paul , Evans Holly , Larsen Sasha E. , Mitre Edward
Published: July 2013

Filarial worms cause highly morbid diseases such as elephantiasis and river blindness. Since the 1940s, researchers have conducted vaccine trials in 27 different animal models of filariasis. Although no vaccine trial in a permissive model of filariasis has provided sterilizing immunity, great strides have been made toward developing vaccines that could block transmission, decrease pathological sequelae, or decrease susceptibility to infection. In this review, we have organized, to the best of our ability, all published filaria vaccine trials and reviewed them in the context of the animal models used. Additionally, we provide information on the life cycle, disease phenotype, concomitant immunity, and natural immunity during primary and secondary infections for 24 different filaria models.
Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis
Authors: Nguyen Chinh , Barker Bridget Marie , Hoover Susan , Nix David E. , Ampel Neil M. , Frelinger Jeffrey A. , Orbach Marc J. , Galgiani John N.
Published: July 2013

Coccidioidomycosis is the endemic mycosis caused by the fungal pathogens
Coccidioides immitis
and
C. posadasii
. This review is a summary of the recent advances that have been made in the understanding of this pathogen, including its mycology, genetics, and niche in the environment. Updates on the epidemiology of the organism emphasize that it is a continuing, significant problem in areas of endemicity. For a variety of reasons, the number of reported coccidioidal infections has increased dramatically over the past decade. While continual improvements in the fields of organ transplantation and management of autoimmune disorders and patients with HIV have led to dilemmas with concurrent infection with coccidioidomycosis, they have also led to advances in the understanding of the human immune response to infection. There have been some advances in therapeutics with the increased use of newer azoles. Lastly, there is an overview of the ongoing search for a preventative vaccine.
Non-M Variants of Human Immunodeficiency Virus Type 1
Authors: Mourez Thomas , Simon François , Plantier Jean-Christophe
Published: July 2013

The AIDS pandemic that started in the early 1980s is due to human immunodeficiency virus type 1 (HIV-1) group M (HIV-M), but apart from this major group, many divergent variants have been described (HIV-1 groups N, O, and P and HIV-2). The four HIV-1 groups arose from independent cross-species transmission of the simian immunodeficiency viruses (SIVs) SIVcpz, infecting chimpanzees, and SIVgor, infecting gorillas. This, together with human adaptation, accounts for their genomic, phylogenetic, and virological specificities. Nevertheless, the natural course of non-M HIV infection seems similar to that of HIV-M. The virological monitoring of infected patients is now possible with commercial kits, but their therapeutic management remains complex. All non-M variants were principally described for patients linked to Cameroon, where HIV-O accounts for 1% of all HIV infections; only 15 cases of HIV-N infection and 2 HIV-P infections have been reported. Despite improvements in our knowledge, many fascinating questions remain concerning the origin, genetic evolution, and slow spread of these variants. Other variants may already exist or may arise in the future, calling for close surveillance. This review provides a comprehensive, up-to-date summary of the current knowledge on these pathogens, including the historical background of their discovery; the latest advances in the comprehension of their origin and spread; and clinical, therapeutic, and laboratory aspects that may be useful for the management and the treatment of patients infected with these divergent viruses.
Diagnosis of Clostridium difficile Infection: an Ongoing Conundrum for Clinicians and for Clinical Laboratories
Authors: Carey-Ann Burnham D. , Carroll Karen C.
Published: July 2013

Clostridium difficile
is a formidable nosocomial and community-acquired pathogen, causing clinical presentations ranging from asymptomatic colonization to self-limiting diarrhea to toxic megacolon and fulminant colitis. Since the early 2000s, the incidence of
C. difficile
disease has increased dramatically, and this is thought to be due to the emergence of new strain types. For many years, the mainstay of
C. difficile
disease diagnosis was enzyme immunoassays for detection of the
C. difficile
toxin(s), although it is now generally accepted that these assays lack sensitivity. A number of molecular assays are commercially available for the detection of
C. difficile
. This review covers the history and biology of
C. difficile
and provides an in-depth discussion of the laboratory methods used for the diagnosis of
C. difficile
infection (CDI). In addition, strain typing methods for
C. difficile
and the evolving epidemiology of colonization and infection with this organism are discussed. Finally, considerations for diagnosing
C. difficile
disease in special patient populations, such as children, oncology patients, transplant patients, and patients with inflammatory bowel disease, are described. As detection of
C. difficile
in clinical specimens does not always equate with disease, the diagnosis of
C. difficile
infection continues to be a challenge for both laboratories and clinicians.
Pasteurella multocida: from Zoonosis to Cellular Microbiology
Authors: Wilson Brenda A. , Ho Mengfei
Published: July 2013

In a world where most emerging and reemerging infectious diseases are zoonotic in nature and our contacts with both domestic and wild animals abound, there is growing awareness of the potential for human acquisition of animal diseases. Like otherPasteurellaceae,Pasteurellaspecies are highly prevalent among animal populations, where they are often found as part of the normal microbiota of the oral, nasopharyngeal, and upper respiratory tracts. ManyPasteurellaspecies are opportunistic pathogens that can cause endemic disease and are associated increasingly with epizootic outbreaks. Zoonotic transmission to humans usually occurs through animal bites or contact with nasal secretions, withP. multocidabeing the most prevalent isolate observed in human infections. Here we review recent comparative genomics and molecular pathogenesis studies that have advanced our understanding of the multiple virulence mechanisms employed byPasteurellaspecies to establish acute and chronic infections. We also summarize efforts being explored to enhance our ability to rapidly and accurately identify and distinguish among clinical isolates and to control pasteurellosis by improved development of new vaccines and treatment regimens.
Antianaerobic Antimicrobials: Spectrum and Susceptibility Testing
Authors: Brook Itzhak , Wexler Hannah M. , Goldstein Ellie J. C.
Published: July 2013

Susceptibility testing of anaerobic bacteria recovered from selected cases can influence the choice of antimicrobial therapy. The Clinical and Laboratory Standards Institute (CLSI) has standardized many laboratory procedures, including anaerobic susceptibility testing (AST), and has published documents for AST. The standardization of testing methods by the CLSI allows comparisons of resistance trends among various laboratories. Susceptibility testing should be performed on organisms recovered from sterile body sites, those that are isolated in pure culture, or those that are clinically important and have variable or unique susceptibility patterns. Organisms that should be considered for individual isolate testing include highly virulent pathogens for which susceptibility cannot be predicted, such asBacteroides,Prevotella,Fusobacterium, andClostridiumspp.;Bilophila wadsworthia; andSutterella wadsworthensis. This review describes the current methods for AST in research and reference laboratories. These methods include the use of agar dilution, broth microdilution, Etest, and the spiral gradient endpoint system. The antimicrobials potentially effective against anaerobic bacteria include beta-lactams, combinations of beta-lactams and beta-lactamase inhibitors, metronidazole, chloramphenicol, clindamycin, macrolides, tetracyclines, and fluoroquinolones. The spectrum of efficacy, antimicrobial resistance mechanisms, and resistance patterns against these agents are described.
Staphylococcal and Streptococcal Superantigen Exotoxins
Authors: Spaulding Adam R. , Salgado-Pabón Wilmara , Kohler Petra L. , Horswill Alexander R. , Leung Donald Y. M. , Schlievert Patrick M.
Published: July 2013

This review begins with a discussion of the large family ofStaphylococcus aureusand beta-hemolytic streptococcal pyrogenic toxin T lymphocyte superantigens from structural and immunobiological perspectives. With this as background, the review then discusses the major known and possible human disease associations with superantigens, including associations with toxic shock syndromes, atopic dermatitis, pneumonia, infective endocarditis, and autoimmune sequelae to streptococcal illnesses. Finally, the review addresses current and possible novel strategies to prevent superantigen production and passive and active immunization strategies.
Low positivity rate after systematic screening forTrichomonas vaginalisin three patient cohorts from general practitioners, STI clinic and a national population-based chlamydia screening study
Authors: Geelen Tanja H , Hoebe Christian J P A , Dirks Anne , Dukers-Muijrers Nicole H T M , van Bergen Jan E A M , Wolffs Petra F G
Published: July 2013

Objective

The goal of this multi-cohort study is to investigate the positivity rate ofTrichomonas vaginalis(TV) among three distinct Dutch patient populations and its relation withChlamydia trachomatis(CT) positivity. Few studies have been performed in Europe where TV positivity rate seems to be low. Additionally, the majority of earlier studies have focused on high risk or specific populations.

Methods

A random selection of men and women from a national population-based chlamydia screening, attendees of a sexually transmitted infections (STI) clinic and a non-selected population from general practitioners (GPs) were systematically screened for TV and CT using PCR. The associations among TV and CT co-infection, age and gender were studied.

Results

A total of 2079 individuals were studied. A TV positivity rate of 1.5% was observed in the medium risk GP cohort followed by 0.7% in the low risk population-based cohort and 0.6% in the high risk STI clinic. TV was found in 0.7% of CT positives and a similar 1.1% among CT negatives. All TV positive individuals in this study were women.

Conclusions

The positivity rate of TV was low (<2%) and comparable in all three populations studied. We found no association between TV and CT infection.
AN IDENTIFICATION APPROACH OF TECHNICALLY EFFICIENT CATEGORY FOR CONTROLLABLE, CATEGORICAL FACTORS IN PRODUCTION AND AN APPLICATION TO A PRODUCTION PROCESS
Authors: SONG SEUNG-MIN , KIM TAEHO , KIM JAE-GON , KANG JANGHA
Published: July 2013

This paper suggests a new DEA-based approach to the identification of the efficient category value for controllable categorical factors when controllable categorical factors are involved in the DMU's production process. Though the main objective of this approach is to identify the efficient category value for nonhierarchical categorical factors, it can also be employed to identify the efficient category value for hierarchical categorical factors without any large adjustment. This new approach is applied to an empirical data from an Agricultural Resource Management Survey for soybean production in Pennsylvania. The result of the empirical application illustrates how our approach leads us to the efficient category value of categorical factors by using both radial measure and nonradial measure. Moreover, it shows us the existence of substantial heterogeneity in the use of categorical factors and the opportunity of improvement in DMUs' selection of category value for categorical factors.
FLOW SHOP SCHEDULING WITH REINFORCEMENT LEARNING
Authors: ZHANG ZHICONG , WANG WEIPING , ZHONG SHOUYAN , HU KAISHUN
Published: July 2013

Reinforcement learning (RL) is a state or action value based machine learning method which solves large-scale multi-stage decision problems such as Markov Decision Process (MDP) and Semi-Markov Decision Process (SMDP) problems. We minimize the makespan of flow shop scheduling problems with an RL algorithm. We convert flow shop scheduling problems into SMDPs by constructing elaborate state features, actions and the reward function. Minimizing the accumulated reward is equivalent to minimizing the schedule objective function. We apply on-line TD(λ) algorithm with linear gradient-descent function approximation to solve the SMDPs. To examine the performance of the proposed RL algorithm, computational experiments are conducted on benchmarking problems in comparison with other scheduling methods. The experimental results support the efficiency of the proposed algorithm and illustrate that the RL approach is a promising computational approach for flow shop scheduling problems worthy of further investigation.
ILLUMINATION, SCALE AND ROTATION INVARIANT ALGORITHM FOR VISION-BASED UAV NAVIGATION
Authors: DAWADEE AAKASH , CHAHL JAVAAN , NANDAGOPAL D(NANDA) , NEDIC ZORICA
Published: July 2013

Navigation has been a major challenge for the successful operation of an autonomous aircraft. Although success has been achieved using active methods such as radar, sonar, lidar and the global positioning system (GPS), such methods are not always suitable due to their susceptibility to jamming and outages. Vision, as a passive navigation method, is considered as an excellent alternative; however, the development of vision-based autonomous systems for outdoor environments has proven difficult. For flying systems, this is compounded by the additional challenges posed by environmental and atmospheric conditions. In this paper, we present a novel passive vision-based algorithm which is invariant to illumination, scale and rotation. We use a three stage landmark recognition algorithm and an algorithm for waypoint matching. Our algorithms have been tested in both synthetic and real-world outdoor environments demonstrating overall good performance. We further compare our feature matching method with the speed-up robust features (SURF) method with results demonstrating that our method outperforms the SURF method in feature matching as well as computational cost.
CLINICAL OUTCOME AND COST COMPARISON OF CARPAL TUNNEL WOUND CLOSURE WITH MONOCRYL® AND ETHILON®: A PROSPECTIVE STUDY
Authors: Dosani Anis , Khan Sameer K. , Gray Sheila , Joseph Steve , Whittaker Ian A.
Published: July 2013

This prospective non-randomised two-cohort study compares the use of an absorbable suture (Poliglecrapone [Monocryl]: Group A) and a non-absorbable suture (Polyamide [Ethilon]: Group B) in wound closure after elective carpal tunnel decompression. The primary outcome was scar cosmesis as assessed by the Stonybrook Scar Evaluation Scale (SBSES); the financial cost of wound closure was compared as a secondary outocome. All fifty patients completed follow-up. At six weeks, there was no significant difference in the two groups regarding scar tenderness (p = 0.5), although residual swelling was more evident in the absorbable group (p = 0.2). The mean SBSES score at six weeks was 4.72 in Group A, and 4.8 in Group B (p = 0.3). The unit cost per closed wound of Monocryl was three times than Ethilon (p < 0.05). Ethilon is thus cost-effective without compromising the cosmetic outcome, and we recommend using this as the preferred suture for closure of carpal tunnel wounds.
CONSERVATIVE TREATMENT OF FRACTURES OF THE PROXIMAL PHALANX: AN OPTION EVEN FOR UNSTABLE FRACTURE PATTERNS
Authors: Held Michael , Jordaan Pieter , Laubscher Maritz , Singer Martin , Solomons Michael
Published: July 2013

Purpose: The purpose of the study was to assess the efficacy of the conservative management of proximal phalangeal fractures in a dorsal plaster slab.

Methods: Twenty-three consecutive patients with extra-articular proximal phalangeal fractures were included in this prospective study. Fourteen patients (62%) presented with fractures considered unstable. The fractures were reduced and the position was held with a dorsal plaster slab for three weeks. The patients were followed up for an average of seven weeks (range 2 to 45) after the injury. Range of motion of the finger and radiological evidence of union, non-union or malunion was documented after removal of the plaster.

Results: Ninety-one percent of fractures maintained an acceptable reduction. All cases measured less than 15° of angulation. On average 1,1 mm of shortening was measured. In two (9%) cases the reduction was not accepted on follow up assessment and the fractures were managed surgically.

Conclusion: Most extra-articular proximal phalanx fractures can be managed conservatively with acceptable results.
ISOLATED ABDUCTOR DIGITI MINIMI PALSY — AN UNUSUAL CASE OF GUYON'S CANAL COMPRESSION
Authors: Kumar Kannan , Thirkannad Sunil
Published: July 2013

We present a case of isolated Abductor Digiti Minimi (ADM) palsy caused by an anomalous branch from the ulnar artery. Electrophysiology suggested selective involvement of the motor branch to the ADM in the Guyon's canal. Surgical exploration revealed an anomalous branch of the ulnar artery causing a pincer effect on the nerve to the ADM. Division and ligation of this branch effectively decompressed the nerve and the patient recovered satisfactorily. This report highlights the need to consider vascular aberrations as a differential diagnosis for ulnar neuropathy in Guyon's canal.
BILATERAL THUMB METACARPOPHALANGEAL JOINT FUSIONS FOR SEVERE HYPEREXTENSION DEFORMITIES IN CONJUNCTION WITH CARPOMETACARPAL JOINT RECONSTRUCTIONS
Authors: Tsang Cynthia , Hunter Alistair R. , Sorene Elliot D.
Published: July 2013

Background: Hyperextension of the first metacarpophalangeal (MCP) joint and adduction of the first web space of the hand are features of advanced stages of carpometacarpal (CMC) joint arthrosis. Restoration of mechanical efficiency in such patients requires stabilization of both the CMC and MCP joints. This study describes a patient with bilateral secondary hyperextension of the MCP joint greater than 50° who displayed good functional outcome following staged bilateral MCP joint arthrodesis with simultaneous CMC joint reconstruction.

Case Report: Excision of trapezium, formation of a Weilby sling utilising flexor carpi radialis, and insertion of a Swanson's prosthesis forms the basis of CMC joint reconstruction. Fusion of the MCP joint involved placement of longitudinal K-wires and tension band wiring. The patient underwent an initial right-sided procedure in 2008 and subsequently elected for the same procedure on the contralateral side 26 months later. Good functional improvement was achieved with a pre and postoperative DASH score of 49 and 8 respectively. Follow-up and radiological imaging at 34 months from her initial surgery confirmed good positions of the prostheses and solid MCP joint fusions. The patient developed postoperative interphalangeal joint pain, which responded to steroid injection.

Discussion: There is currently limited evidence available addressing the management of severe hyperextension deformity greater than 50° of the MCP joint in the presence of CMC joint arthrosis. Staged bilateral fusion of the MCP joint and simultaneous CMC joint reconstruction in this case illustrates good, reproducible functional results and patient satisfaction with reduced postoperative return to function.