bluuebunny/crossref_metadata_2025 huggingface dataset:
Prescribing of potentially inappropriate medications among the elderly population in an ambulatory care setting in a Saudi military hospital: Trend and cost
Authors: Al‐Omar Hussain A , Al‐Sultan Mohammed S , Abu‐Auda Hisham S
Published: October 2012

Aim:  To explore the prevalence of potentially inappropriate medication (PIM) use in the elderly, to identify the trends and the patterns of prescribing such medication, and to calculate the associated direct medication cost of such practice in a Saudi hospital.

Methods:  This was a retrospective cross‐sectional study of patients who were aged 65 years or older on at least one PIM. The source of our data was outpatient pharmacy prescription records at Riyadh Military Hospital (RMH) for 2002, 2003 and 2004. Beers' explicit criteria for PIM was used to identify these medications.

Results:  A total of 20 521 PIM were identified. The prevalence of PIM for 2002, 2003 and 2004 was 2.5%, 2.3% and 2.1%, respectively. A total of 43.6% of the patients had filled a prescription of one PIM, 18% filled two PIM and 38.4% filled three or more PIM. Digoxin accounted for 23.7% of these PIM. The most commonly prescribed medications were cardiovascular medications at 26.7%. The total direct cost that was associated with inappropriate prescribing was 518 314 Saudi Riyals (US$138 217) during the study period.

Conclusion:  PIM prescribing in RMH was less compared with what was published in the literature in other countries. It was unclear whether these results reflect the level of elderly healthcare services provided to RMH patients or because of underreporting. Drug utilization review programs, medical education, recruiting physicians and clinical pharmacists who are specialized in geriatrics, finding safer medications or integration of computer software to detect such medications during prescriptions entry can improve the medical services provided to the elderly. Geriatr Gerontol Int 2013; 13: 616–621.
The early effects of stavudine compared with tenofovir on adipocyte gene expression, mitochondrial DNA copy number and metabolic parameters in South African HIV‐infected patients: a randomized trial
Authors: Menezes CN , Duarte R , Dickens C , Dix‐Peek T , Van Amsterdam D , John M‐A , Ive P , Maskew M , MacPhail P , Fox MP , Raal F , Sanne I , Crowther NJ
Published: October 2012

Objectives

Stavudine is being phased out because of its mitochondrial toxicity and tenofovir (TDF) is recommended as part of first‐line highly active antiretroviral therapy (HAART) in South Africa. A prospective, open‐label, randomized controlled trial comparing standard‐ and low‐dose stavudine with TDF was performed to assess early differences in adipocyte mtDNA copy number, gene expression and metabolic parameters in Black South African HIV‐infected patients.

Methods

Sixty patients were randomized 1:1:1 to either standard‐dose (30–40 mg) or low‐dose (20–30 mg) stavudine or TDF (300 mg) each combined with lamivudine and efavirenz. Subcutaneous fat biopsies were obtained at weeks 0 and 4. Adipocyte mtDNA copies/cell and gene expression were measured using quantitative polymerase chain reaction (qPCR). Markers of inflammation and lipid and glucose metabolism were also assessed.

Results

A 29% and 32% decrease in the mean mtDNA copies/cell was noted in the standard‐dose (P < 0.05) and low‐dose stavudine (P < 0.005) arms, respectively, when compared with TDF at 4 weeks. Nuclear respiratory factor‐1 (NRF1) and mitochondrial cytochrome B (MTCYB) gene expression levels were affected by stavudine, with a significantly (P < 0.05) greater fall in expression observed with the standard, but not the low dose compared with TDF. No significant differences were observed in markers of inflammation and lipid and glucose metabolism.

Conclusions

These results demonstrate early mitochondrial depletion among Black South African patients receiving low and standard doses of stavudine, with preservation of gene expression levels, except for NRF1 and MTCYB, when compared with patients on TDF.
East Asian welfare model refocus? A case study on economic support for the elderly living alone in Taiwan
Authors: Li William D.H.
Published: October 2012

This article argues that the concept of the East Asian welfare regime can be further developed by examining the changing role of the family in welfare provision. Beginning with a brief literature review of the East Asian welfare model, the family has been regarded as the main welfare provider among East Asian societies. Nevertheless, from a policy‐centred perspective, the oversimplified picture of the East Asian welfare model does not reveal how families actually perform in welfare provision or how the dynamic change in the welfare mix for vulnerable groups under the welfare regime has been accommodated. This article presents a case study and shows that while most elderly people in Taiwan still live with their children, who are also their main means of support, a significant number of them are living alone and that much of the economic support they used to receive from nongovernmental organisation now comes from the state.
Clay record of climate change since the mid‐Pleistocene in Jiujiang, south China
Authors: Hong Hanlie , Gu Yangsheng , Yin Ke , Wang Chaowen , Li Zhaohui
Published: October 2012

To obtain a better understanding of climate change in south China in the Quaternary, a clay mineralogical study was undertaken on the red earth profile at Jiujiang, using X‐ray diffraction (XRD) and particle‐size distribution analysis methods. The XRD results showed that the clay minerals of the Jiujiang red earth were mainly mixed‐layer illite–smectite (I/S), illite, kaolinite and vermiculite, with trace amounts of mixed‐layer kaolinite–smectite (K/S). Changes in clay mineral composition displayed a trend of three‐stage evolution. The higher mixed‐layer I/S clays and kaolinite contents in the lower portion suggest extremely warm and humid climates over the period c. 700 to c. 350 ka ago. A gradual decrease in I/S clays and kaolinite reveals a gradual climate change from warm/humid to cool/dry during the period c. 350 to c. 130 ka ago. The higher illite and vermiculite contents indicate a relatively cool and dry climate during the period since c. 130 ka ago. The particle‐size distribution pattern of the upper section was similar to that of the Xiashu loess, while that of the middle to lower section was similar to those of fluvially reworked red earth. A rapid increase in the abundance of large grain‐size components at 2.6 m depth indicates an intensification of the winter monsoon and a cool and dry climate during the period, in good agreement with results from the clay mineral composition and homogeneous structure. The red earth sequences in south China could probably be used to test the response of tropical to subtropical regions to global climate changes.
Picture‐Based Memory Impairment Screen for Dementia
Authors: Verghese Joe , Noone Mohan L. , Johnson Beena , Ambrose Anne F. , Wang Cuiling , Buschke Herman , Pradeep Vayyattu G. , Abdul Salam Kizhakkaniyakath , Shaji Kunnukatil S. , Mathuranath Pavagada S.
Published: October 2012

Objectives

To develop and validate a picture‐based memory impairment screen (PMIS) for the detection of dementia.

Design

Cross‐sectional.

Setting

Outpatient clinics, Baby Memorial Hospital, Kozhikode city in the southern Indian state of Kerala.

Participants

Three hundred four community‐residing adults aged 55 to 94 with a mean education level of 8 years; 65 were diagnosed with dementia.

Measurements

PMIS: a culture‐fair picture‐based cognitive screen designed to be administered by nonspecialists. Diagnostic accuracy estimates (sensitivity, specificity, positive and negative predictive power) of PMIS cut‐scores in detecting dementia (range 0–8).

Results

PMIS scores were worse in participants with dementia (1.5) than in controls (7.7, P < .001). At the optimal cut‐score of 5, PMIS had a sensitivity of 95.4% (95% confidence interval (CI) = 90.3–100.0%) and a specificity of 99.2% (95% CI = 98.0–100.0%) for detecting dementia. In the 167 participants with <10 years of education, PMIS scores of five or less had a sensitivity of 97.8% (95% CI = 93.6–100.0%) and specificity of 99.2% (95% CI = 97.6–100.0%). The PMIS had better specificity than the Mini‐Mental State Examination in detecting dementia, especially in older adults with low education.

Conclusion

The PMIS is a brief and reliable screen for dementia in elderly populations with variable literacy rates.
The Protective Effects of Executive Functions and Episodic Memory on Gait Speed Decline in Aging Defined in The Context of Cognitive Reserve
Authors: Holtzer Roee , Wang Cuiling , Lipton Richard , Verghese Joe
Published: October 2012

Objectives

To evaluate whether levels of cognitive reserve (CR), as measured using the Wechsler Adult Intelligence Scale (WAIS)‐III vocabulary test, moderated longitudinal associations between cognitive functions and decline in gait speed in a community‐based cohort of older adults without dementia, specifically, whether the protective effect of executive function (EF) and episodic memory against decline in gait speed would be greater in individuals with higher CR.

Design

Longitudinal (median number of repeated annual gait speed measures, 3; maximum number of visits, 7).

Setting

General community.

Participants

Seven hundred thirty‐one community‐residing individuals aged 70 and older without dementia were followed longitudinally with cognitive and gait evaluations at baseline and at annual visits.

Measurements

Decline in gait speed (cm/s) served as the primary outcome. The Free and Cued Selective Reminding Test (FCSRT) was used to assess episodic memory. The Digit Symbol Substitution Test (DSST) was used to assess attention and EF. The vocabulary test served as a marker for CR.

Results

Linear mixed effects model showed that gait speed declined over the follow‐up period (P < .001). The significant three‐way interactions of time by DSST by vocabulary (P = .01) and time by FCSRT by vocabulary (P = .02) revealed that levels of CR moderated the longitudinal associations between EF and episodic memory and gait speed decline.

Conclusion

The protective effects of EF and episodic memory against gait speed decline in aging are greater in individuals with higher CR.
“Is Jaffna Tamil the Best?” Producing “Legitimate” Language in a Multilingual Sri Lankan School
Authors: Davis Christina P.
Published: October 2012

Drawing on research in the Tamil‐medium stream of a multilingual Buddhist National school in Kandy, Sri Lanka, this article explores how teachers engage with, negotiate, and contest sociolinguistic hierarchies. Since the colonial period, Jaffna Tamils have maintained a hierarchy over other Tamil‐speaking groups (Up‐country Tamils and Muslims) in education, with Jaffna Tamil legitimized in the national curriculum. However, as a result of demographic and institutional shifts related to the outbreak of the Civil War in 1983, these hierarchies are shifting. In the first part of the article, I explore teachers' explicit discussions and debates about language that occurred in my presence. In the second part, I show are these ideologies are enacted in difference contexts of practice, including subject‐area classrooms, language classrooms, and oratorical performances. I argue that incongruities within and between teachers' metadiscourses and practices reveal subtle dynamics in the configuration of social hierarchies. [multilingual education, social inequality, language ideologies, metadiscourse, Tamil]
Words to Make you Laugh?: Performing the Public in Guadeloupean Comedy Sketches
Authors: Managan Kathe
Published: October 2012

Guadeloupean comedy sketches in Kréyòl, live and on DVD, feature stock characters taken from the city streets, rum shops and small neighborhoods of the island. Through their depictions, actors in Kréyòl comedy sketches position different Guadeloupean “types” into an imagined social landscape that spans the island, the Caribbean and the mainland, including much of the social complexity of the island. This paper considers how creole comedy constructs a particular vision of the Guadeloupean public. In this overseas department of France, artists dedicate a considerable amount of time and energy to imagining and reclaiming what it means to be Guadeloupean. I explore how comedy sketches elaborate and circulate social and linguistic stereotypes and how Kréyòl comedy offers commentary and presents stances on Guadeloupean society and the issues the community faces, such as high unemployment, assimilation into France and the impacts of globalization. [publics, comedy, performance, Guadeloupe, stereotypes]
Men's management of urinary incontinence in daily living: implications for practice
Authors: McKenzie Shona , St John Winsome , Wallis Marianne , Griffiths Susan
Published: October 2012

Many men develop urinary incontinence following prostate disease or surgery. Men with urinary incontinence use strategies to manage urinary incontinence in their daily lives, often with minimal assistance from health professionals. Much of the available information and advice offered to men about daily‐living management of urinary incontinence have been adapted from information relating to management difficulties experienced by women. This study explored strategies used by community‐dwelling men to manage urinary incontinence in their daily lives. Men with self‐reported urinary incontinence were recruited from clinical and non‐clinical settings. A researcher‐developed survey was used to identify type, severity and duration of urinary incontinence, and the strategies men used to manage urinary incontinence in daily living. Sixty‐one items, grouped according to functional strategies, asked how often each strategy was used to manage urinary incontinence. A response rate of 66% was achieved with 103 men completing a survey. The findings of this study can be used by urology nurses to ensure continence education for men with urinary incontinence addresses areas that are of most importance, as well addressing their specific needs.
Retracted: Efficacy and Adverse Effects of (R)‐9‐(2‐phosphonylmethoxypropyl)‐2,6‐diaminopurine in Feline Immunodeficiency Virus‐Infected Cats
Authors: Justa N. , Weber K. , Klein D. , Mueller R.S. , Sauter‐Louis C. , Hartmann K.
Published: October 2012

Background

(R)‐9‐(2‐phosphonylmethoxypropyl)‐2,6‐diaminopurine (PMPDAP) is active against feline immunodeficiency virus (FIV) in vitro, and is less toxic than other acyclic nucleoside phosphonates. Its efficacy in naturally infected cats has not been evaluated in large controlled studies.

Hypothesis/Objectives

PMPDAPis effective in naturallyFIV‐infected cats with minimal adverse effects.

Animals

Forty‐five privately owned cats naturally infected withFIV.

Methods

Prospective, randomized, placebo‐controlled, double‐blinded clinical study. Cats were randomly assigned to be treated withPMPDAP(25 mg/kg) daily,PMPDAP3 times a week, or placebo for a period of 6 weeks.

Results

Administration ofPMPDAPtoFIV‐infected cats did not lead to detectable improvements in clinical, virological, or immunological variables. Proviral load (FIVcopies/106cells) did not change significantly during treatment (placebo group: from 9505 ± 10119 to 8564 ± 8615;PMPDAP3 times a week: from 4818 ± 4426 to 5041 ± 6197;PMPDAPdaily: from 3525 ± 5038 to 3167 ± 5824). There was a significant decrease of red blood cell counts (×1012/L) (from 8.91 ± 1.82 to 7.34 ± 1.79 in cats treated 3 times per week (P < .001), and from 8.96 ± 1.13 to 6.01 ± 1.36 in cats treated daily (P < .001)), as well as of packed cell volume, and hemoglobin in both groups receivingPMPDAP.

Conclusions and Clinical Importance

Administration ofPMPDAPwas not associated with significant improvements in clinical, immunological, or virological parameters, but treatment was associated with adverse effects, mainly anemia. Thus,PMPDAP, as administered in this study, cannot be recommended for treatment ofFIV‐infected cats.
Thermal Acclimation of Respiration and Photosynthesis in the Marine Macroalga Gracilaria lemaneiformis (Gracilariales, Rhodophyta)
Authors: Zou Dinghui , Gao Kunshan
Published: October 2012

The responses of respiration and photosynthesis to temperature fluctuations in marine macroalgae have the potential to significantly affect coastal carbon fluxes and sequestration. In this study, the marine red macroalga Gracilaria lemaneiformis was cultured at three different temperatures (12, 19, and 26°C) and at high‐ and low‐nitrogen (N) availability, to investigate the acclimation potential of respiration and photosynthesis to temperature change. Measurements of respiratory and photosynthetic rates were made at five temperatures (7°C–33°C). An instantaneous change in temperature resulted in a change in the rates of respiration and photosynthesis, and the temperature sensitivities (i.e., the Q10 value) for both the metabolic processes were lower in 26°C‐grown algae than 12°C‐ or 19°C‐grown algae. Both respiration and photosynthesis acclimated to long‐term changes in temperature, irrespective of the N availability under which the algae were grown; respiration displayed strong acclimation, whereas photosynthesis only exhibited a partial acclimation response to changing growth temperatures. The ratio of respiration to gross photosynthesis was higher in 12°C‐grown algae, but displayed little difference between the algae grown at 19°C and 26°C. We propose that it is unlikely that respiration in G. lemaneiformis would increase significantly with global warming, although photosynthesis would increase at moderately elevated temperatures.
Screening for autoantibodies in chronic hepatitis C patients has no effect on treatment initiation or outcome
Authors: Mauss S. , Berger F. , Schober A. , Moog G. , Heyne R. , John C. , Pape S. , Hueppe D. , Pfeiffer‐Vornkahl H. , Alshuth U.
Published: October 2012

Autoantibodies in hepatitis C virus–infected patients may indicate autoimmune hepatitis or other immune‐mediated diseases. This may impact safety and efficacy of interferon‐based therapy of chronic hepatitis C. We investigated the association between a positive test result for a variety of autoantibodies and the initiation and efficacy of therapy for chronic hepatitis C. We analysed an observational cohort of 24 306 patients for an association between autoantibodies and treatment outcome. 8241 patients were tested simultaneously for antinuclear antibodies (ANA), liver kidney microsomal antibodies (LKM), smooth muscle antibodies (SMA) and antimitochondrial antibodies (AMA). Matched‐pair analysis was performed matching one autoantibody‐positive patient to three controls. Control patients had negative tests for all four antibodies. Analyses were performed for patients with a single positive autoantibody test and for patients with multiple positive autoantibody tests. A positive test result for ANA, LKM, SMA or AMA did not affect the physician's decision to initiate therapy with pegylated interferon and ribavirin. In addition, a positive test for one or multiple autoantibodies did not adversely affect sustained virologic response. There was no difference in fibrosis stage or alanine transaminase at baseline or during therapy irrespective of antibody status. Thyroid dysfunction was more frequent in patients with positive LKM antibodies (P = 0.004). Initiation of therapy for chronic hepatitis C and outcome were not affected by the presence of ANA, LKM, SMA or AMA. Routine testing of these autoantibodies seems not warranted. Determination of autoantibodies should be guided by individualized clinical decisions.
Factors associated with successful decrease and discontinuation of antegrade continence enemas (ACE) in children with defecation disorders: a study evaluating the effect of ACE on colon motility
Authors: Rodriguez L. , Nurko S. , Flores A.
Published: October 2012

Background  Antegrade continence enemas (ACE) have been used in the treatment of defecation disorders in children; little is known on their effect on colon motility and the utility of the colon manometry (CM) predicting long‐term ACE outcomes.

Methods  Retrospective review of children with constipation undergoing CM before and after ACE to evaluate CM changes and their utility on predicting ACE outcome.

Key Results  A total of 40 patients (mean age 8.8 SD 3 years and 53% female patients) were included; 39 of 40 responded to the ACE. Of these 39, 14 (36%) were dependent and 25 (64%) had decreased it (11 of those or 28% discontinued it). On repeat CM we found a significant increase in the fasting (P < 0.01) and postprandial (P = 0.03) motility index, number of bisacodyl‐induced high amplitude propagating contractions (HAPCs) (P = 0.03), and total HAPCs (P = 0.02). Gastrocolonic response to a meal, propagation and normalization of HAPCs improved in 28%, 58%, and 33%, respectively, with CM normalizing in 33% of patients. The baseline CM did not predict ACE outcome. The presence of normal HAPCs on the repeat CM was associated with ACE decrease. Progression and normalization of HAPCs (P = 0.01 and 0.02, respectively) and CM normalization (P = 0.01) on repeat CM were individually associated with ACE decrease. No CM change was associated with ACE discontinuation. Multivariate analysis showed that older age and HAPC normalization on CM predict ACE decrease and older age is the only predictor for ACE discontinuation.

Conclusions & Inferences  Colon motility improves after ACE and the changes on the repeat CM may assist in predicting ACE outcome.
Drosophila S2 Cells Secrete Wingless on Exosome‐Like Vesicles but the Wingless Gradient Forms Independently of Exosomes
Authors: Beckett Karen , Monier Solange , Palmer Lucy , Alexandre Cyrille , Green Hannah , Bonneil Eric , Raposo Graca , Thibault Pierre , Borgne Roland Le , Vincent Jean‐Paul
Published: October 2012

Wingless acts as a morphogen in Drosophila wing discs, where it specifies cell fates and controls growth several cell diameters away from its site of expression. Thus, despite being acylated and membrane associated, Wingless spreads in the extracellular space. Recent studies have focussed on identifying the route that Wingless follows in the secretory pathway and determining how it is packaged for release. We have found that, in medium conditioned by Wingless‐expressing Drosophila S2 cells, Wingless is present on exosome‐like vesicles and that this fraction activates signal transduction. Proteomic analysis shows that Wingless‐containing exosome‐like structures contain many Drosophila proteins that are homologous to mammalian exosome proteins. In addition, Evi, a multipass transmembrane protein, is also present on exosome‐like vesicles. Using these exosome markers and a cell‐based RNAi assay, we found that the small GTPase Rab11 contributes significantly to exosome production. This finding allows us to conclude from in vivo Rab11 knockdown experiments, that exosomes are unlikely to contribute to Wingless secretion and gradient formation in wing discs. Consistent with this conclusion, extracellularly tagged Evi expressed from a Bacterial Artificial Chromosome is not released from imaginal disc Wingless‐expressing cells.
Numerical Analysis of Specific Absorption Rate and Heat Transfer in Human Head Subjected to Mobile Phone Radiation: Effects of User Age and Radiated Power
Authors: Wessapan Teerapot , Rattanadecho Phadungsak
Published: October 2012

The human head is one of the most sensitive parts of the human entire body when exposed to electromagnetic radiation. This electromagnetic radiation interacts with the human head and may lead to detrimental effects on human health. However, the resulting thermophysiologic response of the human head is not well understood. In order to gain insight into the phenomena occurring within the human head with temperature distribution induced by electromagnetic field, a detailed knowledge of absorbed power distribution as well as temperature distribution is necessary. This study presents a numerical analysis of specific absorption rate and heat transfer in the heterogeneous human head model exposed to mobile phone radiation. In the heterogeneous human head model, the effects of user age and radiated power on distributions of specific absorption rate and temperature profile within the human head are systematically investigated. This study focuses attention on organs in the human head in order to investigate the effects of mobile phone radiation on the human head. The specific absorption rate and the temperature distribution obtained by numerical solution of electromagnetic wave propagation and unsteady bioheat transfer equation in various tissues in the human head during exposure to mobile phone radiation are presented.
Effect of Inclination Angle and Flow Rate on the Heat Transfer During Bottom Jet Cooling of a Steel Plate
Authors: Chester Noel L. , Wells Mary A. , Prodanovic Vladan
Published: October 2012

The heat transfer that occurs during bottom water jet impingement on a hot steel plate has been investigated in terms of the effect inclination angle and flow rate. This research was carried out to develop quantitative knowledge of the heat transfer, which occurs on the runout table, a crucial component in the hot rolling production of advanced high strength steels. Industrially produced hot-rolled steel samples were instrumented with numerous subsurface thermocouples installed close to the quench surface. The experimental measurements were used in conjunction with an inverse heat conduction (IHC) model to quantify boiling characteristics as well as heat extraction histories for the different nozzle inclination angles and flow rates. It was found that, as nozzle inclination angle increased, the degree of asymmetry of the cooled region on the surface of the sample was increased and the overall rate of heat extraction decreased. The angle of inclination had a significant effect on overall heat extraction; a vertical nozzle was the most efficient from a perspective of heat transfer under the nozzle. As expected, as flow rates increased, the amount of heat energy extracted increased for all the conditions studied, regardless of the nozzle inclination.
Analysis of Entropy Generation During Mixed Convective Heat Transfer of Nanofluids Past a Square Cylinder in Vertically Upward Flow
Authors: Sarkar Sandip , Ganguly Suvankar , Dalal Amaresh
Published: October 2012

The present work demonstrates entropy generation due to laminar mixed convection of water-based nanofluid past a square cylinder in vertically upward flow. Streamline upwind Petrov–Galerkin (SUPG) based finite element method is used for numerical simulation. Nanosized copper (Cu) and alumina (Al2O3) particles suspended in water are used with Prandtl number (Pr) = 6.2. The range of nanoparticle volume fractions considered is 0–20%. Computations are carried out at a representative Reynolds number (Re) of 100 with Richardson number (Ri) range −0.5 < Ri < 0.5, both values inclusive. For both the nanofluids (Al2O3–water and Cu–water nanofluids), total entropy generation decreases with increasing nanoparticle volume fractions. It is found that for the present case of mixed convection flows with nanofluids, thermal irreversibility is much higher than that of frictional irreversibility. The Bejan number decreases with increasing nanoparticle volume fractions.
Recognition of the Different Structural Forms of the Capsid Protein Determines the Outcome following Infection with Porcine Circovirus Type 2
Authors: Trible Benjamin R. , Suddith Andrew W. , Kerrigan Maureen A. , Cino-Ozuna Ada G. , Hesse Richard A. , Rowland Raymond R. R.
Published: October 2012

Porcine circovirus type 2 (PCV2) capsid protein (CP) is the only protein necessary for the formation of the virion capsid, and recombinant CP spontaneously forms virus-like particles (VLPs). Located within a single CP subunit is an immunodominant epitope consisting of residues 169 to 180 [CP(169–180)], which is exposed on the surface of the subunit, but, in the structural context of the VLP, the epitope is buried and inaccessible to antibody. High levels of anti-CP(169–180) activity are associated with porcine circovirus-associated disease (PCVAD). The purpose of this study was to investigate the role of the immune response to monomer CP in the development of PCVAD. The approach was to immunize pigs with CP monomer, followed by challenge with PCV2 and porcine reproductive and respiratory syndrome virus (PRRSV). To maintain the CP immunogen as a stable monomer, CP(43–233) was fused to ubiquitin (Ub-CP). Size exclusion chromatography showed that Ub-CP was present as a single 33-kDa protein. Pigs immunized with Ub-CP developed a strong antibody response to PCV2, including antibodies against CP(169–180). However, only low levels of virus neutralizing activity were detected, and viremia levels were similar to those of nonimmunized pigs. As a positive control, immunization with baculovirus-expressed CP (Bac-CP) resulted in high levels of virus neutralizing activity, small amounts of anti-CP(169–180) activity, and the absence of viremia in pigs following virus challenge. The data support the role of CP(169–180) as an immunological decoy and illustrate the importance of the structural form of the CP immunogen in determining the outcome following infection.
Narrative synthesis of health service accreditation literature
Authors: Hinchcliff Reece , Greenfield David , Moldovan Max , Westbrook Johanna Irene , Pawsey Marjorie , Mumford Virginia , Braithwaite Jeffrey
Published: October 2012

Aims

To systematically identify and synthesise health service accreditation literature.

Methods

A systematic identification and narrative synthesis of health service accreditation literature published prior to 2012 were conducted. The search identified 122 empirical studies that examined either the processes or impacts of accreditation programmes. Study components were recorded, including: dates of publication; research settings; levels of study evidence and quality using established rating frameworks; and key results. A content analysis was conducted to determine the frequency of key themes and subthemes examined in the literature and identify knowledge-gaps requiring research attention.

Results

The majority of studies (n=67) were published since 2006, occurred in the USA (n=60) and focused on acute care (n=79). Two thematic categories, that is, ‘organisational impacts’ and ‘relationship to quality measures’, were addressed 60 or more times in the literature. ‘Financial impacts’, ‘consumer or patient satisfaction’ and ‘survey and surveyor issues’ were each examined fewer than 15 times. The literature is limited in terms of the level of evidence and quality of studies, but highlights potential relationships among accreditation programmes, high quality organisational processes and safe clinical care.

Conclusions

Due to the limitations of the literature, it is not prudent to make strong claims about the effectiveness of health service accreditation. Nonetheless, several critical issues and knowledge-gaps were identified that may help stimulate and inform discussion among healthcare stakeholders. Ongoing effort is required to build upon the accreditation evidence-base by using high quality experimental study designs to examine the processes, effectiveness and financial value of accreditation programmes and their critical components in different healthcare domains.
Personalised performance feedback reduces narcotic prescription errors in a NICU
Authors: Sullivan Kevin M , Suh Sanghee , Monk Heather , Chuo John
Published: October 2012

Objective

Neonates are at high risk for significant morbidity and mortality from medication prescribing errors. Despite general awareness of these risks, mistakes continue to happen. Alerts in computerised physician order entry intended to help prescribers avoid errors have not been effective enough. This improvement project delivered feedback of prescribing errors to prescribers in the neonatal intensive care unit (NICU), and measured the impact on medication error frequency.

Methods

A front-line multidisciplinary team doing multiple Plan Do Study Act cycles developed a system to communicate prescribing errors directly to providers every 2 weeks in the NICU. The primary outcome measure was number of days between medication prescribing errors with particular focus on antibiotic and narcotic errors.

Results

A T-control chart showed that the number of days between narcotic prescribing errors rose from 3.94 to 22.63 days after the intervention, an 83% improvement. No effect in the number of days between antibiotic prescribing errors during the same period was found.

Conclusions

An effective system to communicate mistakes can reduce some types of prescribing errors.
Characteristics of femur fractures in ambulatory young children
Authors: Capra Louise , Levin Alex V , Howard Andrew , Shouldice Michelle
Published: October 2012

Objectives

To determine and identify the characteristics and circumstances of femur fractures in ambulatory young children.

Design and setting

Retrospective review of 203 ambulatory children, between 1 and 5 years old, presenting with femur fractures to an urban paediatric hospital over a 10-year period. χ2And Student's t test were employed for statistical analysis.

Results

The mean age was 36.6 months, with 155 (76.2%) being male. The most frequent mechanism of injury was fall from a height (n=62, 30.5%). The highest number of injuries occurred in 2–3-year-olds. The most common history in 1–2-year-olds was stumbling on/over something causing a fall. For 4–5 year olds it was road traffic accidents. Other additional physical findings were infrequent (14.3%) and not suspicious of inflicted injury. Child protective services concluded three of the cases to be likely non-accidental, and four cases were inconclusive but requiring close follow-up. Of these seven children, six occurred in 1–2-year-olds. No distinguishing feature was noted in fracture type or location.

Conclusions

Femur fractures can occur with low velocity injury whether from a short fall or twisting/stumbling injury in young healthy ambulatory children.
Pointers and pitfalls of mycophenolate-associated colitis
Authors: Lee Stephen , de Boer W Bastiaan , Subramaniam Kavitha , Kumarasinghe M Priyanthi
Published: October 2012

Aims

Mycophenolate-associated colitis has been previously reported to show patterns of colonic mucosal injury mimicking a host of conditions, including graft-versus-host disease, ischaemia and inflammatory bowel disease (IBD). The aim of this study is to characterise, semiquantitatively, pathological changes of mycophenolate mofetil (MMF) mucosal injury.

Methods

Seven transplant patients receiving MMF who underwent colonoscopic examination and biopsy were identified retrospectively over a 2-year period. Multiple histologic parameters, including architectural distortion, cryptitis, stromal active inflammation, individual damaged crypts (IDC) and crypt apoptotic figures were evaluated in the biopsies semiquantitatively. Where biopsy site was identified, the parameters were assessed separately in biopsies from right and left colon.

Results

All cases showed mixed patterns of mucosal injury. All seven cases showed focal architectural distortion (in 58% of fragments per case), focal cryptitis (mean 3.0 foci per case), increased crypt apoptosis (mean 26.5/100 crypts) and IDC (mean 3.0 foci). Focal changes resembling acute self-limited colitis were noted in three cases. Possible proximal accentuation of some changes was noted with right side biopsies tending to show greater crypt apoptotic activity and more foci of architectural distortion. Three cases showed dual pathology (two with cytomegalovirus (CMV) infection and one with IBD).

Conclusions

Although a wide spectrum of changes may be seen in MMF-associated colitis, important microscopic clues include a mixed pattern of injury (typically a combination of crypt apoptosis, isolated crypt damage and architectural distortion), and possible proximal accentuation of pathologic changes. The need for clinical correlation and follow-up is emphasised by the occurrence of dual pathology in patients treated with MMF.
Point of Care INR testing devices: performance of the Roche CoaguChek XS and XS Plus in the UK NEQAS BC external quality assessment programme for healthcare professionals: four years’ experience
Authors: Kitchen Dianne Patricia , Kitchen Steven , Jennings Ian , Woods Timothy AL , Fitzmaurice David A , Murray Ellen T , Walker Isobel D
Published: October 2012

Background

Vitamin K antagonists have been used for many decades and have been traditionally monitored by the measurement of the International Normalised Ratio (INR) in the laboratory. Introduction of Point of Care (POC) testing devices to measure INR has resulted in many tests being undertaken in primary care. External Quality Assessment (EQA) of these POC devices is recommended to ensure accuracy and reliability of INR results outside a laboratory setting.

Aim

To assess the quality of INR results for users of two POC devices (CoaguChek XS and CoaguChek XS Plus) over a four-year period.

Methods

Four surveys (two samples) were sent in each 12-month period. The median INR value of each sample was calculated and the percentage deviation from this median determined. Any results greater than 15% from the median were considered to be outside consensus which indicated a possible problem within the testing system.

Results

Variability of INR results in this UK National External Quality Assessment Scheme (NEQAS) programme was comparable to that in the UK NEQAS EQA programme for laboratory INR testing. Occurrence of persistent problems was lower in the POC programme than the laboratory programme.

Conclusions

Utilisation of an EQA programme for POC devices in primary care is feasible and necessary. Our data suggest for those health professionals using EQA, the reliability and accuracy of INR testing matches the quality of laboratory testing.
TENSORIAL NSI AND UNPARTICLE PHYSICS IN NEUTRINO SCATTERING
Authors: BARRANCO J. , BOLAÑOS A. , GARCÉS E. A. , MIRANDA O. G. , RASHBA T. I.
Published: October 2012

We have analyzed the electron antineutrino scattering off electrons and the electron antineutrino–nuclei coherent scattering in order to obtain constraints on tensorial couplings. We have studied the formalism of nonstandard interactions (NSI) as well as the case of unparticle physics. For our analysis we have focused on the recent TEXONO collaboration results and we have obtained current constraints to possible electron antineutrino–electron tensorial couplings in both new physics formalisms. The possibility of measuring electron antineutrino–nucleus coherent scattering for the first time and its potential to further constrain electron antineutrino–quark tensorial couplings is also discussed.
Growth and Band Gap Control of Corundum-Structured α-(AlGa)2O3 Thin Films on Sapphire by Spray-Assisted Mist Chemical Vapor Deposition
Authors: Ito Hiroshi , Kaneko Kentaro , Fujita Shizuo
Published: October 2012

Following the previous achievement of highly crystalline α-Ga2O3 thin films on c-plane sapphire, the growth of corundum-structured α-(Al
x
Ga1-x
)2O3 was examined aiming at the future application of α-(Al
x
Ga1-x
)2O3/Ga2O3 heterostructures to power devices and other functional devices. The results show the control of x and band gap up to 0.81 and 7.8 eV, respectively, maintaining the dominant corundum structure. The transmission electron microscope observation suggested the formation of the crystallographically good interface of α-(Al
x
Ga1-x
)2O3/Ga2O3 without the severe generation of threading dislocation lines from the interface.
Carrier Concentration Effect of Cu-Doped ZnO Films for Room Temperature Ferromagnetism
Authors: Ai Zhiwei , Wu Hao , Lin Ying , Zhou Zhongpo , Wang Sheng , Liu Chang
Published: October 2012

Recent reports on the observation of room temperature ferromagnetism in Cu doped ZnO have been highly regarded by the scientific community. There are several contradicting reports where some authors have confirmed the occurrence of ferromagnetism in ZnO while others have ruled it out. Even in studies where room temperature ferromagnetism is reported, the effect of carrier type with the ferromagnetic properties is still unclear. To study this problem, the observation of room temperature ferromagnetism in Cu-doped (5%) single crystalline ZnO films grown on Si substrates was observed. ZnO films were prepared by pulsed laser deposition. Hall measurements showed that the Zn0.95Cu0.05O film was n-type with carrier density around 4.3×1017cm-3. This film exhibits room-temperature ferromagnetism with a saturation magnetization of 0.31 µB/Cu atom. The predominant valence state of the doped Cu atoms is monovalent. When additional electrons were introduced into the films, the ferromagnetism was weaken and vanished. Our results confirm that the p-type nature of the film is not essential for realizing ferromagnetic characteristics, if only the concentration of n-type carriers were not very high.
Energy-Filtered Secondary-Electron Imaging for Nanoscale Dopant Mapping by Applying a Reverse Bias Voltage
Authors: Tsurumi Daisuke , Hamada Kotaro , Kawasaki Yuji
Published: October 2012

We observed the dopant contrast of an InP structure with magnifications as high as 250,000 by simultaneously applying secondary electron energy-filtering and a reverse bias voltage. The detection modes without energy-filtering and without a bias voltage did not generate a clear contrast. This was because the reverse bias increased the contrast and relatively decreased the sensitivity to the contamination layer while the energy-filtering reduced the influence of the contamination layer, even at a high magnification. This method can be widely used for semiconductor devices and enables practical nanoscale dopant mapping with a high data acquisition rate, and is therefore expected to greatly assist in extending the frontiers of the semiconductor industry.
Zona occludens-2 protects against podocyte dysfunction induced by ADR in mice
Authors: Bautista-García Pablo , Reyes José L. , Martín Dolores , Namorado María C. , Chavez-Munguía Bibiana , Soria-Castro Elizabeth , Huber Otmar , González-Mariscal Lorenza
Published: October 2012

Zona occludens-2 (ZO-2) is a protein present at the tight junction and nucleus of epithelial cells. ZO-2 represses the transcription of genes regulated by the Wnt/β-catenin pathway. This pathway plays a critical role in podocyte injury and proteinuria. Here, we analyze whether the overexpression of ZO-2 in the glomerulus, by hydrodynamics transfection, prevents podocyte injury mediated by the Wnt/β-catenin pathway in the mouse model of adriamycin (ADR) nephrosis. By immunofluorescence and immunogold electron microscopy, we show that ZO-2 is present in mice glomerulus, not at the slit diaphragms where nephrin concentrates, but in the cytoplasm and at processes of podocytes. Our results indicate that in the glomeruli of mice treated with ADR, ZO-2 overexpression increases the amount of phosphorylated β-catenin, inhibits the expression of the transcription factor snail, prevents nephrin and podocalyxin loss, reduces podocyte effacement and massive fusions, restrains proteinuria, and supports urea and creatinine clearance. These results suggest that ZO-2 could be a new target for the regulation of hyperactive Wnt/β-catenin signaling in proteinuric kidney diseases.
Klotho protects against mouse renal fibrosis by inhibiting Wnt signaling
Authors: Satoh Minoru , Nagasu Hajime , Morita Yoshitaka , Yamaguchi Terry P. , Kanwar Yashpal S. , Kashihara Naoki
Published: October 2012

Augmented Wnt signaling has been implicated in many fibrotic diseases including obstructive nephropathy. Soluble form Klotho has been reported to function as a secreted Wnt antagonist. In this study, we tested whether Klotho protein could reduce renal fibrosis by inhibition of Wnt signaling. Transgenic mice that overexpressed Klotho, wild-type mice, and Klotho hetero mutant mice underwent unilateral ureteral obstruction (UUO). In some Klotho hetero mutant mice, Klotho-encoding plasmid was transferred into the skeletal muscle by electroporation. UUO induced activation of Wnt signaling in wild-type but less in Klotho transgenic mice. Enhanced tubulointerstitial fibrosis in wild-type mice was also attenuated in Klotho transgenic mice. In contrast, Wnt signaling and concomitant tubulointerstitial fibrosis were further augmented in Klotho hetero mutant mice after UUO compared with wild-type mice. In Klotho-encoding plasmid-transfected Klotho hetero mutant mice, however, Wnt signaling was markedly reduced accompanied by a decrease in extracellular matrix deposition after UUO. In vitro studies showed that stimulation of Wnt3a induced prolonged cell cycle arrest at G2/M phase, with a resultant increase in production of fibrogenic cytokines. Cotreatment with Klotho bypassed the G2/M arrest and reduced fibrogenic cytokine production. In conclusion, Klotho is a critical negative regulator of Wnt signaling and a suppressor of renal fibrosis in the obstructed kidney model.
Reovirus: A Targeted Therapeutic—Progress And Potential
Authors: Maitra Radhashree , Ghalib Mohammad H. , Goel Sanjay
Published: October 2012

Medical therapy of patients with malignancy requires a paradigm shift through development of new drugs with a good safety record and novel mechanisms of activity. While there is no dearth of such molecules, one particular agent, “reovirus” is promising by its ability to target cancer cells with aberrant signaling pathways. This double-stranded RNA virus has been therapeutically formulated and has rapidly progressed from preclinical validation of anticancer activity to a phase III registration study in platinum refractory metastatic squamous cell carcinoma of the head and neck. During this process, reovirus has shown safety both as a single agent when administered intratumorally and intravenously, as well as in combination therapy, with multiple chemotherapeutics such as gemcitabine, carboplatin/paclitaxel, and docetaxel; and similarly with radiation. The scientific rationale for its development as an anticancer agent stems from the fact that it preferentially replicates in and induces lyses of cells with an activated Kras pathway. As documented in many previous studies, the initial observation of greater tropism in Kras-compromised situation might certainly not be the sole and possibly not even the predominant reason for enhanced virulence. All the same, scientists have emphasized on Kras optimistically due to its high prevalence in various types of cancers. Incidence of Kras mutation has been found to be highest in pancreatic cancer (85%–90%) followed by colorectal (35–45%) and lung (25–30%). Reovirus, in fact has the potential not only as a therapy but also as a tool to unravel the aberrant cellular pathway leading to carcinogenicity. Mol Cancer Res; 10(12); 1514–25. ©2012 AACR.