bluuebunny/crossref_metadata_2025 huggingface dataset:
Genomics of bleeding disorders
Authors: Goodeve A. C. , Pavlova A. , Oldenburg J.
Published: April 2014

Molecular genetic tools are widely applied in inherited bleeding disorders. New genes involved in haemorrhagic disorders have been identified by genome wide linkage analysis on families with a specific phenotype. LMNA1 or MCFD in combined FV/FVIII‐deficiency and VKORC1 in vitamin K coagulation factor deficiency type 2 are two examples. Identification of the causative gene mutation has become standard for most bleeding disorders. Knowledge of the causative mutation allows genetic counselling in affected families and most importantly adds to the pathophysiological understanding of phenotypes. Haemophilia A represents a model as the F8 gene mutation predicts the risk of developing an inhibitor and more recently also the bleeding phenotype. In this review novel genetic diagnostic strategies for bleeding disorders are outlined and inhibitor formation is presented as an example for clinical relevant phenotype/genotype correlation studies.
Prophylaxis in real life scenarios
Authors: Fischer K. , Konkle B. , Broderick C. , Kessler C. M.
Published: April 2014

Prophylaxis has become the standard mantra of care for those individuals with severe haemophilia A and B. Primary prophylaxis is advocated to prevent the occurrence of symptomatic acute spontaneous haemarthroses and to preserve joint structure and function. Typically, twice or thrice weekly infusions of factor VIII or IX concentrates are integral to this treatment approach. Secondary prophylaxis is initiated after the relentless cycle of progressive joint damage has been triggered by prior haemarthroses and is intended to preserve existing joint health by preventing additional spontaneous bleeding events. Event‐driven prophylaxis involves the administration of clotting factor concentrates to prevent acute traumatic bleeds, which are anticipated to occur in association with surgical or physical trauma. This regimen enhances the effectiveness of primary or secondary prophylaxis protocols or on‐demand approaches to replacement therapy. Besides the marked reduction in the so‐called annual bleed rate, prophylaxis regimens frequently increase personal self‐confidence to embark on a more active and physical lifestyle; however, in reality, prophylaxis must be individualized in accordance with bleeding phenotypes, with the unique pharmacokinetic profile of administered replacement clotting factor concentrates, with the specific clinical scenario, and with the degree of intensity anticipated for any physical activity. The introduction of extended half‐life replacement products will also influence how these prophylaxis regimens will be accomplished. The following scenarios will discuss how prophylaxis regimens can be implemented to protect the individual from developing spontaneous and activity‐induced acute bleeding complications and to maintain an improved quality of life.
Assessment of outcomes
Authors: Blanchette V. S. , O’Mahony B. , McJames L. , Mahlangu J. N.
Published: April 2014

Effective healthcare delivery necessitates evaluation of the effect of interventions in the form of outcome assessment. Treatment effect includes measurement of how the patient feels, functions and survives following healthcare interventions. In haemophilia, which is a rare bleeding disorder, outcome assessment was characterized by a lack of validated outcome measurement tools and the challenges of hemophilia study design to collect outcome data. The aim of this communication is to share current thinking and, through practical examples, provide a state of the art practice in the assessment of hemophilia outcomes from a healthcare provider, patient/family and funder perspective. This discussion is timely and particularly relevant to the care of people with hemophilia on the eve of a number of novel hemophilia treatment products which are about to be licensed for use, specifically the long‐acting factor VIII and factor IX concentrates. The first section by Dr Blanchet gives an overview of the tools currently available for assessment of structure/function, patient activities and patient participation in hemophilia healthcare delivery, pointing out the challenge of developing new tools and appropriate validation of currently available tools. The second section by Mr Brian O'Mahony emphasizes the essential collaboration and partnership between healthcare providers and people with hemophilia in collating the outcome data. In the third and final section, Mr Leigh McJames, gives a funder's perspective of the desirable outcomes of hemophilia care.
Primary haemostasis: newer insights
Authors: Berndt M. C. , Metharom P. , Andrews R. K.
Published: April 2014

At the same time as biophysical and omics approaches are drilling deeper into the molecular details of platelets and other blood cells, as well as their receptors and mechanisms of regulation, there is also an increasing awareness of the functional overlap between human vascular systems. Together, these studies are redefining the intricate networks linking haemostasis and thrombosis with inflammation, infectious disease, cancer/metastasis and other vascular pathophysiology. The focus of this state‐of‐the‐art review is some of the newer advances relevant to primary haemostasis. Of particular interest, platelet‐specific primary adhesion‐signalling receptors and associated activation pathways control platelet function in flowing blood and provide molecular links to other systems. Platelet glycoprotein (GP)Ibα of the GPIb‐IX‐V complex and GPVI not only initiate platelet aggregation and thrombus formation by primary interactions with von Willebrand factor and collagen, respectively, but are also involved in coagulation, leucocyte engagement, bacterial or viral interactions, and are relevant as potential risk markers in a range of human diseases. Understanding these systems in unprecedented detail promises significant advances in evaluation of individual risk, in new diagnostic or therapeutic possibilities and in monitoring the response to drugs or other treatment.
Haemophilia care – beyond the treatment guidelines
Authors: Srivastava A.
Published: April 2014

Care for people with haemophilia (PWH) has improved much over the last two decades leading to near normal lives for those receiving early regular prophylaxis with clotting factor concentrates (CFC). Yet, there are significant limitations of those practices. In the absence of a well‐defined optimal prophylaxis protocol, there are wide variations in practices with a two to threefold difference in doses. In those parts of the world where there are constraints on the availability of CFC, episodic replacement remains the norm for most patients even though it is evident that this does not change the natural history of the disease over a wide range of doses. Suitable prophylactic protocols therefore need to be developed wherever possible at these doses. Finally, there are only limited data on long‐term outcomes in haemophilia from anywhere in the world. The practice of documenting specific outcomes as part of the regular evaluation of PWH needs to be established and the appropriate instruments used to assess them. Definitions of clinical events and endpoints of interventions in clinical studies are being developed to help such data collection. The correlations between different replacement therapy protocols and specific outcomes will help define what is best at different dose levels. Such data will allow better health planning and treatment choices throughout the world.
Headache in Children With Chiari I Malformation
Authors: Toldo Irene , Tangari Marta , Mardari Rodica , Perissinotto Egle , Sartori Stefano , Gatta Michela , Calderone Milena , Battistella Pier Antonio
Published: April 2014

Background

Headache is the most common symptom of Chiari 1 malformation, a condition characterized by the herniation of cerebellar tonsils through the foramen magnum. However, the headache pattern of cases with Chiari 1 malformations is not well defined in the literature, especially in children.

Objective

The aim of this retrospective chart review was to evaluate the frequency and the characteristics of headache in children with Chiari 1 malformation at initial evaluation and during follow up.

Methods

Forty‐five cases with tonsillar ectopia were selected among 9947 cases under 18 years of age who underwent neuroimaging between 2002 and 2010. A semistructured clinical interview (mean follow‐up: 5.2 years) was conducted. Headache was classified according to the second edition of the International Classification of Headache Disorders.

Results

Possible associations between clinical picture, in particular headache pattern, but also other signs and symptoms attributable to Chiari 1 malformation, and the extent of tonsillar ectopia were found for 3 different groups: those with borderline (<5 mm, N = 12), mild (5‐9 mm, N = 27), and severe tonsillar ectopia (≥10 mm, N = 6), respectively. Twenty‐four out of 33 (73%) cases with Chiari 1 malformation complained of headache, and 9/33 (27%) of those patients (5 with mild and 4 with severe tonsillar ectopia) reported headache attributed to Chiari 1 malformation.

Conclusions

In our studied pediatric population, the most common symptom for cases diagnosed with Chiari 1 malformation was headache, and headache attributed to Chiari 1 malformation was the most common headache pattern in patients with Chiari 1 malformation. The presence of headache attributed to Chiari 1 malformation along with 3 other signs or symptoms of Chiari 1 malformation were highly predictive of severe tonsillar ectopia.
How General Practitioners Treat Migraine in Children – Evaluation of a Headache Guideline
Authors: de Coo Ilse F. , de Jong Gosse , Zielman Ronald , van den Berg Jan S.P.
Published: April 2014

Background

Migraine is a common illness in children associated with a negative impact on the quality of life. In the Netherlands, treatment of migraine is commonly performed by general practitioners (GPs). The migraine guideline of the Dutch College of General Practitioners recommends inactivity and acetaminophen in patients with migraine who are younger than 18 years of age.

Objective

The aim of our study was to evaluate the pharmacological treatment of migraine in children by GPs before referral to the hospital. Our objective was to answer the following questions. First, are GPs inclined to prescribe medication not listed in the Dutch College of General Practitioners Guideline? Second, which clinical characteristics are associated with the use of medication not listed in this guideline?

Methods

In this retrospective cross‐sectional study, prescribed medication and migraine characteristics were investigated in Dutch migraine patients (age <18 years), using hospital records and a paper‐and‐pencil questionnaire.

Results

A total of 223 children were included. Medications not listed in the guideline were used in 41.3% of the patients before referral. In children younger than 12 years, the use of medication not listed in the guideline was associated with an older age, when compared with children who were treated according to the guideline. In the group of patients older than 11 years, the use of medication not listed in the guideline was associated with a longer history of migraine and a longer duration of the migraine attacks.

Conclusions

Medications not listed in the GPs guideline were used in a large portion of the patients younger than 18 years with migraine who were referred to secondary care.
Medication Overuse Headache: Self‐Perceived and Actual Knowledge Among Pharmacy Staff
Authors: Hedenrud Tove , Babic Naida , Jonsson Pernilla
Published: April 2014

Objective

The aim of this study was to investigate knowledge about medication overuse headache (MOH) among pharmacy staff.

Background

MOH is a public health problem both in Sweden and in many other countries. Persons with MOH have limited contact with health care, and medications used are to large extent over‐the‐counter (OTC) medications. Therefore, pharmacists have an important role in, eg, advising these individuals about their medication use. Little is, however, known about the actual level of knowledge about MOH among pharmacy staff, which determines the quality of their advice to MOH sufferers.

Methods

A total of 326 questionnaires were distributed to 44 pharmacies in Gothenburg, Sweden. The questionnaire included background questions, questions about advice on headache treatment, source of knowledge about MOH, and questions on self‐perceived and actual knowledge on MOH.

Results

The response rate was 70%. A majority of the pharmacy staff (90.6%) considered themselves to have knowledge about MOH to some or a greater extent. Almost half had learned about MOH through their university/vocational education. Only 8.6% knew that all 5 headache medications listed in the questionnaire can cause development of MOH, but 40% responded correctly on which treatment advice one can give a person with MOH. Actual knowledge on treatment advice differed significantly between groups of self‐perceived knowledge.

Conclusion

The knowledge on MOH is insufficient among pharmacy staff, but with the proper knowledge, pharmacy staff is well positioned to effect both primary and secondary prevention of MOH. We suggest not only increasing educational efforts about MOH within pharmacy programs but also continuing education at the pharmacies for all staff. Further, it is also important to increase knowledge among pharmacy customers.
CAM in the Real World: You May Practice Evidence‐Based Medicine, But Your Patients Don't
Authors: Cowan Robert P.
Published: April 2014

Background

Complementary and Alternative Medicine (CAM) approaches are widely used among individuals suffering from headache. The medical literature has focused on the evidence base for such use and has largely ignored the fact that these approaches are in wide use despite that evidence base.

Discussion

This article focuses on the uses of CAM by patients and suggests strategies for understanding and addressing this use without referring back to the evidence base. The rationale for this discussion pivots on the observation that patients are already using these approaches, and for many there are anecdotal and historical bases for use which patients find persuasive in the absence of scientific evidence.

Conclusion

Until such time as the body of scientific literature adequately addresses non‐conventional approaches, physicians must acknowledge and understand, as best as possible, CAM approaches which are in common use by patients. This is illustrated with a case study and examples from practice. This article does not review the evidence base for various CAM practices as this has been done well elsewhere.
‘Today and more than ever, I FEEL LIKE A RESEARCHER’: successful online learning collaborations between librarians and a Graduate School
Authors: Newall Elizabeth , Gratton Christine , Maltby Jane
Published: April 2014

This article describes the development and delivery of an online module at the University of Nottingham on the literature review process. In particular, it discusses how academic librarians collaborated with researcher developers at the Graduate School at the University to deliver a highly successful online learning experience for students. The article provides an overview of the course, a discussion on the experiences of both the tutors and participants involved, concentrating specifically on those in Medicine and Health Sciences. Details about future international collaborations and development of the course are also provided.
Duration of injury correlates with necrosis in caerulein‐induced experimental acute pancreatitis: implications for pathophysiology
Authors: Jacob Tony G. , Raghav Rahul , Kumar Ajay , Garg Pramod K. , Roy Tara S.
Published: April 2014

Pancreatic acinar cell necrosis is indicative of severe pancreatitis and the degree of necrosis is an index of its outcome. We studied whether the dose and duration of injury correlates with severity, particularly in terms of necrosis, in caerulein‐induced acute pancreatitis (AP) in Swiss albino mice. In addition to control group 1 (G1), groups 2 and 3 received four injections of caerulein every hour but were sacrificed at five hours (G2) and nine hours (G3) respectively, and group 4 received eight injections and was sacrificed at nine hours (G4). The severity of pancreatitis was assessed histopathologically and biochemically. The histopathological scores of pancreatitis in groups 3 and 4 were significantly higher than in groups 1 and 2 (4 vs. 1, 4 vs. 2, 3 vs. 1, 3 vs. 2; P < 0.05). TUNEL‐positive apoptotic cells were significantly higher in groups 2 and 3 compared with groups 1 and 4 (P < 0.05). Necrosis was significantly more in group 4 than other groups (37.49% (4.68) vs. 19.97% (1.60) in G2; 20.36% (1.56) in G3; P = 0.006 for G 2 vs. 4 and P = 0.019 for G 3 vs. 4). Electron microscopy revealed numerous autophagosomes in groups 2 and 3 and mitochondrial damage and necrosis in group 4. The pancreatic and pulmonary myeloperoxidase activity in group 4 was significantly higher than that in the other groups (P < 0.01). Hence, severity of pancreatitis is a function of the dose of injurious agent, while inflammation is both dose and duration dependent, which may also explain the wide spectrum of severity of AP seen in clinical practice.
HLA‐A, HLA‐B and HLA‐DRB1 allele and haplotype diversity among volunteer bone marrow donors from Croatia
Authors: Grubic Z. , Burek Kamenaric M. , Mikulic M. , Stingl Jankovic K. , Maskalan M. , Zunec R.
Published: April 2014

The determination of human leucocyte antigen (HLA)‐A, HLA‐B and HLA‐DRB1 alleles in the routine procedure of a volunteer hematopoietic stem cell (HSC) donor's registration in the Croatian Bone Marrow Donor Registry (CBMDR) is performed to enhance the odds of finding a suitable HLA compatible donor for patients in need of a HSC transplantation worldwide. However, besides its original purpose, it also provides valuable information about the HLA polymorphism among Croats. The aim of the present study was to analyse the HLA allele and haplotype frequencies in a sample of 4000 donors from CBMDR. The distribution of HLA‐A, HLA‐B and HLA‐DRB1 alleles did not demonstrate significant differences from the data reported for other European populations. The higher frequency of B*40:02 allele in comparison with B*40:01 and DRB1*11:04 in comparison with DRB1*11:01 is interesting because it represents a difference in comparison with the Western and Northern European populations which are a main source of donors for Croatian patients. The haplotype frequencies show a greater variation and difference in comparison with data from other registries and populations; however, due to a lack of high‐resolution haplotype data, comparison was possible only with a very limited number of other populations.
A promoter polymorphism (rs3806798) of interleukin‐15 gene is associated with chronic hepatitis B virus infection in the Chinese Han population
Authors: Zhang X. , Sun X. H. , Li M. , Zhou Z. H. , Gao Y. Q.
Published: April 2014

This study aimed to investigate the association between the polymorphisms of IL‐15 gene and susceptibility to chronic hepatitis B virus (HBV) infection in the Chinese Han population. A total of 234 patients with chronic HBV infection and 150 age‐ and sex‐matched healthy controls in the Chinese population were enrolled in this case–control study. Genotyping of ten single nucleotide polymorphisms (SNPs) in the IL‐15 gene was carried out via Sequenom MassARRAY system. The association analysis demonstrated that SNP rs3806798 (A/T) had a significant difference in the distribution between patients and healthy controls (P = 0.033). Moreover, a significantly increased risk of HBV infection was found to be associated with IL‐15 rs3806798 A allele among male patients and HBeAg‐negative patients, compared with IL‐15 rs3806798 T allele (P = 0.003; P = 0.046, respectively). Furthermore, haplotype analysis revealed that haplotype ATAGG (rs3806798, rs12508866, rs1519551, rs6819823 and rs2857261, respectively) in block 1 was significantly associated with HBV infection (P = 0.022). In conclusion, we found an association between IL‐15 rs3806798 and the risk of chronic HBV infection in a sample of Chinese Han population.
External quality assessment of patient HLA‐B*57:01 testing prior to abacavir prescription
Authors: Darke C. , Corbin S. A.
Published: April 2014

Hypersensitivity reactions to the drug abacavir are strongly associated with possession of HLA‐B*57:01. Hence, patients with HIV/AIDS who may be prescribed abacavir should be tested for this HLA allele and the drug withheld from those that possess B*57:01. The UK National External Quality Assessment Service for Histocompatibility and Immunogenetics has operated a scheme for B*57:01 testing since 2008 which, in 2013, involved 47 participants from 12 countries. A total of 24 B*57:01‐positive, 2 B*57:03‐positive and 22 B*57‐negative blood samples (including 2 B*58 samples) were distributed to between 28 and 47 laboratories each year over 6 years. Participants, who were unaware of the samples' HLA types, tested and reported on their B*57/B*57:01 status. A total of 1868 reports were assessed over the 6 years. Of the 880 reports on B*57:01 samples, 93.4% were correctly assigned as B*57:01, 2.8% were assigned as groups of B*57 alleles including B*57:01, and 3.3% were reported as B*57 positive only. Over the 6 years, there were four (0.46%) false B*57:01 negative reports. All the B*57:03‐positive and B*57‐negative samples, involving 72 and 916 assignments, respectively, were essentially reported as B*57:01 negative. Thus, there were no false B57:01 positive assignments. The reporting of B*57:01 status over the last 3 years of the scheme was 99.8% sensitive and 100% specific. Over the last year, it was 100% sensitive and 100% specific.
The Norwegian version of the Severe Respiratory Insufficiency Questionnaire
Authors: Markussen Heidi , Lehmann Sverre , Nilsen Roy M , Natvig Gerd K
Published: April 2014

The aims of this study were to translate and adapt the Severe Respiratory Insufficiency (SRI) questionnaire into Norwegians and to test its reliability and validity.Data were collected from a cross‐sectional survey and were linked to the Norwegian Registry of patients receiving long‐term mechanical ventilation (LTMV). Of 193 potential participants, 127 responded to the SRI questionnaire. Reliability as measured with Cronbach's α varied between 0.68 and 0.88 for the subscales and was 0.94 for SRI‐sum score. Construct validity was obtained with high correlations between subscales in SF‐36 and SRI. The SRI questionnaire discriminated well between universally accepted clinical differences among categories of patients receiving LTMV by significant dissimilarities in SRI‐sum score and SRI subscales. The Norwegian version of SRI has well‐documented psychometric properties regarding reliability and validity. It might be used in clinical practice and in international studies for assessing health‐related quality of life in patients receiving LTMV.
Insufficient interleukin‐12 signalling favours differentiation of human CD4+ and CD8+ T cells into GATA‐3+ and GATA‐3+ T‐bet+ subsets in humanized mice
Authors: Billerbeck Eva , Labitt Rachael N. , Vega Kevin , Frias‐Staheli Natalia , Dorner Marcus , Xiao Jing W. , Rice Charles M. , Ploss Alexander
Published: April 2014

Differentiation of CD4+ T cells into type 1 or type 2 subsets is mediated by the expression of the opposing lineage defining transcription factors T‐bet and GATA‐3. However, the existence of GATA‐3+ T‐bet+ CD4+ T cells in mice suggests functional plasticity of these subsets. Little is known about type 1 and type 2 plasticity of human T‐cell subsets in vivo. Here, we show that in the xenogeneic environment of humanized mice, which lacks a functional immune‐regulatory network, human CD4+ and, notably, CD8+ T cells preferentially differentiate into interleukin (IL)‐4+ GATA‐3+ and IL‐4+ interferon‐γ+ GATA‐3+ T‐bet+ subsets. Treatment with recombinant human IL‐12 or expansion of IL‐12‐producing human dendritic cells in vivo reverted this phenotype and led to the down‐regulation of GATA‐3 expression. These changes also correlated with improved antiviral immune responses in humanized mice. In conclusion, our study shows the capacity of human CD4+ and CD8+ T cells for stable co‐expression of GATA‐3 and T‐bet in humanized mice and reveals a critical role for IL‐12 in regulating this phenotype.
Wogonin prevents lipopolysaccharide‐induced acute lung injury and inflammation in mice via peroxisome proliferator‐activated receptor gamma‐mediated attenuation of the nuclear factor‐kappaB pathway
Authors: Yao Jing , Pan Di , Zhao Yue , Zhao Li , Sun Jie , Wang Yu , You Qi‐Dong , Xi Tao , Guo Qing‐Long , Lu Na
Published: April 2014

Acute lung injury (ALI) from a variety of clinical disorders, characterized by diffuse inflammation, is a cause of acute respiratory failure that develops in patients of all ages. Previous studies reported that wogonin, a flavonoid‐like chemical compound which was found in Scutellaria baicalensis, has anti‐inflammatory effects in several inflammation models, but not in ALI. Here, the in vivo protective effect of wogonin in the amelioration of lipopolysaccharide (LPS) ‐induced lung injury and inflammation was assessed. In addition, the in vitro effects and mechanisms of wogonin were studied in the mouse macrophage cell lines Ana‐1 and RAW264.7. In vivo results indicated that wogonin attenuated LPS‐induced histological alterations. Peripheral blood leucocytes decreased in the LPS‐induced group, which was ameliorated by wogonin. In addition, wogonin inhibited the production of several inflammatory cytokines, including tumour necrosis factor‐α, interleukin‐1β (IL‐1β) and IL‐6, in the bronchoalveolar lavage fluid and lung tissues after LPS challenge, while the peroxisome proliferator‐activated receptor γ (PPARγ) inhibitor GW9662 reversed these effects. In vitro results indicated that wogonin significantly decreased the secretion of IL‐6, IL‐1β and tumour necrosis factor‐α in Ana‐1 and RAW264.7 cells, which was suppressed by transfection of PPARγ small interfering RNA and GW9662 treatment. Moreover, wogonin activated PPARγ, induced PPARγ‐mediated attenuation of the nuclear translocation and the DNA‐binding activity of nuclear factor‐κB in vivo and in vitro. In conclusion, all of these results showed that wogonin may serve as a promising agent for the attenuation of ALI‐associated inflammation and pathology by regulating the PPARγ‐involved nuclear factor‐κB pathway.
Mycobacterium indicus pranii and Mycobacterium bovis BCG lead to differential macrophage activation in Toll‐like receptor‐dependent manner
Authors: Kumar Pawan , Tyagi Rohit , Das Gobardhan , Bhaskar Sangeeta
Published: April 2014

Mycobacterium indicus pranii (MIP) is an atypical mycobacterial species possessing strong immunomodulatory properties. It is a potent vaccine candidate against tuberculosis, promotes Th1 immune response and protects mice from tumours. In previous studies, we demonstrated higher protective efficacy of MIP against experimental tuberculosis as compared with bacillus Calmette–Guérin (BCG). Since macrophages play an important role in the pathology of mycobacterial diseases and cancer, in the present study, we evaluated the MIP in live and killed form for macrophage activation potential, compared it with BCG and investigated the underlying mechanisms. High levels of tumour necrosis factor‐α, interleukin‐12p40 (IL‐12p40), IL‐6 and nitric oxide were produced by MIP‐stimulated macrophages as compared with BCG‐stimulated macrophages. Prominent up‐regulation of co‐stimulatory molecules CD40, CD80 and CD86 was also observed in response to MIP. Loss of response in MyD88‐deficient macrophages showed that both MIP and BCG activate the macrophages in a MyD88‐dependent manner. MyD88 signalling pathway culminates in nuclear factor‐κB/activator protein‐1 (NF‐κB/AP‐1) activation and higher activation of NF‐κB/AP‐1 was observed in response to MIP. With the help of pharmacological inhibitors and Toll‐like receptor (TLR) ‐deficient macrophages, we observed the role of TLR2, TLR4 and intracellular TLRs in MIP‐mediated macrophage activation. Stimulation of HEK293 cells expressing TLR2 in homodimeric or heterodimeric form showed that MIP has a distinctly higher level of TLR2 agonist activity compared with BCG. Further experiments suggested that TLR2 ligands are well exposed in MIP whereas they are obscured in BCG. Our findings establish the higher macrophage activation potential of MIP compared with BCG and delineate the underlying mechanism.
Jordanian women's dissatisfaction with childbirth care
Authors: Mohammad K.I. , Alafi K.K. , Mohammad A.I. , Gamble J. , Creedy D.
Published: April 2014

Background

Dissatisfaction with childbirth care can have a negative impact on a woman's health and well‐being, as well as her relationships with her infant.

Aim

To investigate the prevalence and associated factors of dissatisfaction with intrapartum care by Jordanian women.

Method

A descriptive cross‐sectional study was used. Participants (n = 320) who were 7 weeks post‐partum were recruited from five maternal and child health centres in Irbid city in northern Jordan. Participants provided personal and obstetric information, and completed the Satisfaction with Childbirth Care Scale.

Results

The majority of women (75.6%) were dissatisfied with their intrapartum care. Dissatisfaction was associated with the attendance of unknown and unwanted persons during childbirth, experiencing labour as more painful than expected, and perceptions of inadequate help from healthcare providers to manage pain during labour.

Limitations

Findings are limited to Jordanian women accessing public sector perinatal health services.

Conclusion

The high percentage of women reporting dissatisfaction with intrapartum care in this study is of concern. Women's perception of pain and expectations of staff during labour and birth need to be addressed through education and improved communication by staff.

Implications for Nursing and Health Policy

Development of national evidence‐based policies and quality assurance systems would help reduce the rate of obstetric interventions and give greater emphasis to respect for women's preferences during labour and birth.
Choosing union representation: the role of attitudes and emotions
Authors: Eaton Adrienne E. , Rogers Sean E. , Chang Tracy F. H. , Voos Paula B.
Published: April 2014

In theUnitedStates, most unions are recognised by a majority vote of employees through union representation elections administered by the government. Most empirical studies of individual voting behaviour during union representation elections use a rational choice model. Recently, however, some have posited that voting is often influenced by emotions. We evaluate competing hypotheses about the determinants of union voting behaviour by using data collected from a 2010 representation election atDeltaAirLines, aUS‐based company. In addition to the older rational choice framework, multiple regression results provide support for an emotional choice model. Positive feelings toward the employer are statistically significantly related to voting ‘no’ in a representation election, while positive feelings toward the union are related to a ‘yes’ vote. Effect sizes for the emotion variables were generally larger than those for the rational choice variables, suggesting that emotions may play a key role in representation election outcomes.
Effects of Land Use and Climate Change on Stream Temperature I: Daily Flow and Stream Temperature Projections
Authors: Daraio Joseph A. , Bales Jerad D.
Published: April 2014

Freshwater mussels (order Unionida) are a highly imperiled group of organisms that are at risk from rising stream temperatures (T). There is a need to understand the potential effects of land use (LU) and climate change (CC) on stream T and have a measure of uncertainty. We used available downscaled climate projections and LU change simulations to simulate the potential effects on average daily stream T from 2020 to 2060. Monte Carlo simulations were run, and a novel technique to analyze results was used to assess changes in hydrologic and stream T response. Simulations of daily mean T were used as input to our stochastic hourly T model. CC effects were on average two orders of magnitude greater than LU impacts on mean daily stream T. LU change affected stream T primarily in headwater streams, on average up to 2.1°C over short durations, and projected CC affected stream T, on average 2.1‐3.3°C by 2060. Daily mean flow and T ratios from Monte Carlo simulations indicated greater variance in the response of streamflow (up to 55%) to LU change than in the response of stream T (up to 9%), and greater variance in headwater stream segments compared to higher order stream segments for both streamflow and T response. Simulations indicated that combined effects of climate and LU change were not additive, suggesting a complex interaction and that forecasting long‐term stream T response requires simulating CC and LU change simultaneously.
The Atmosphere can be a Source of Certain Water Soluble Volatile Organic Compounds in Urban Streams
Authors: Kenner Scott J. , Bender David A. , Pankow James F. , Zogorski John S.
Published: April 2014

Surface water and air volatile organic compound (VOC) data from 10 U.S. Geological Survey monitoring sites were used to evaluate the potential for direct transport of VOCs from the atmosphere to urban streams. Analytical results of 87 VOC compounds were screened by evaluating the occurrence and detection levels in both water and air, and equilibrium concentrations in water (Cws) based on the measured air concentrations. Four compounds (acetone, methyl tertiary butyl ether, toluene, and m‐ & p‐xylene) were detected in more than 20% of water samples, in more than 10% of air samples, and more than 10% of detections in air were greater than long‐term method detection levels (LTMDL) in water. Benzene was detected in more than 20% of water samples and in more than 10% of air samples. Two percent of benzene detections in air were greater than one‐half the LTMDL in water. Six compounds (chloroform, p‐isopropyltoluene, methylene chloride, perchloroethene, 1,1,1‐trichloroethane, and trichloroethene) were detected in more than 20% of water samples and in more than 10% of air samples. Five VOCs, toluene, m‐ & p‐xylene, methyl tert‐butyl ether (MTBE), acetone, and benzene were identified as having sufficiently high concentrations in the atmosphere to be a source to urban streams. MTBE, acetone, and benzene exhibited behavior that was consistent with equilibrium concentrations in the atmosphere.
Automation of a Hydrodynamic Model of the Delaware Estuary for Rapid Water Quality Simulations of Pollutant Releases
Authors: Yagecic John , Suk Namsoo
Published: April 2014

To facilitate the rapid simulation of accidental pollution releases, the Delaware River Basin Commission has developed applications which completely automate data retrieval and processing for the development of a hydrodynamic model input file, as well as running the model. Overnight, every night, the applications retrieve from the internet multiple datasets for constructing freshwater inflow and tidal boundary time series. The hydrodynamic model is run automatically, using the recently written model input file. When no release has occurred, the hydrodynamic output file is not used and is simply overwritten on the following evening, from the updated hydrodynamic model run. Automating the hydrodynamic model portion of the simulation dramatically reduces the time required to simulate the transport of an accidental release to the Delaware Estuary.
Aortic to Brachial Pulse Pressure Amplification as Functional Marker and Predictor of Renal Function Loss in Chronic Kidney Disease
Authors: Wassertheurer Siegfried , Burkhardt Klaus , Heemann Uwe , Baumann Marcus
Published: April 2014

Pulse pressure amplification (PPA) reflects large artery function. Its contribution in chronic kidney disease (CKD) remains uncertain. The authors assessed PPA in CKD progression in patients with CKD stage 2 to 4 (n=128) and 89 controls (follow‐up: 42 months). PPA was reduced in CKD patients as compared with control patients and associated with decline in renal function. Sixteen renal endpoints, defined by 50% loss of renal function or start of renal replacement therapy, were detected. In Cox regression analysis, PPA, estimated glomerular filtration rate, and proteinuria predicted renal endpoints. Patients with CKD stage 4 and low PPA had the highest risk for developing renal endpoints (unadjusted 8.1; 2.4–27.7 and adjusted for age and proteinuria 5.6; 1.5–21.9, log‐rank P<.001). Taken together, PPA is reduced in CKD and is associated with declining renal function. In addition, low PPA predicts renal endpoints in severe CKD. Furthermore, this study emphasizes the role of systolic blood pressure as a major determinant of PPA.
Blood Pressure Variability in Children With Primary vs Secondary Hypertension
Authors: Leisman Daniel , Meyers Melissa , Schnall Jeremy , Chorny Nataliya , Frank Rachel , Infante Lulette , Sethna Christine B.
Published: April 2014

Increased blood pressure variability (BPV) is correlated with adverse cardiovascular (CV) events in adults. However, there has been limited research on its effect in the pediatric population. Additionally, BPV differences between primary and secondary hypertension (HTN) are not known. Children with primary and secondary HTN underwent 24‐hour ambulatory blood pressure monitoring and echocardiography studies. BPV measures of standard deviation (SD), average real variability (ARV), and range were calculated for the 24‐hour, daytime, and nighttime periods. Seventy‐four patients (median age, 13.5 years; 74% boys) were examined, 40 of whom had primary HTN. Body mass index z score and age were independent predictors of systolic ARV (R2=0.14) and SD (R2=0.39). There were no statistically significant differences in overall or wake period BPV measures between secondary or primary HTN groups, but sleep period diastolic SD was significantly greater in the secondary HTN group (9.26±3.8 vs 7.1±2.8, P=.039). On multiple regression analysis, secondary HTN was associated with increased sleep period diastolic SD (P=.025). No metrics of BPV in the overall, wake, and sleep periods were found to be significantly associated with left ventricular hypertrophy (LVH). The results of this study do not show a strong relationship between overall or wake BPV with primary vs secondary HTN, but the association of secondary HTN with sleep period diastolic BPV deserves further exploration. Contrary to expectation, the findings of this study failed to indicate a relationship between BPV and LVH for all patients as well for primary hypertensive and secondary hypertensive patients.
Toxicity of Carum copticum essential oil‐loaded nanogel against Sitophilus granarius and Tribolium confusum
Authors: Ziaee M. , Moharramipour S. , Mohsenifar A.
Published: April 2014

Myristic acid–chitosan (MA‐chitosan) nanogels were synthesized with the technique of self‐assembly and loaded with Carum copticum (L.) essential oil. Scanning electron microscopy (SEM) study indicated nanogels with smooth surfaces and near spherical appearance, and according to transmission electron microscopy (TEM) image, core–shell stricter of nanogels was reported. Subsequently, fumigant toxicity of C. copticum oil and oil‐loaded nanogels was assessed against Sitophilus granarius (L.) and Tribolium confusum Jacquelin du Val. Adults were exposed to different concentrations of the oil and oil‐loaded nanogels at 27 ± 1°C and 55 ± 5% r.h. in continuous darkness. The mortality was counted after 3, 6, 10, 24 and 48 h of exposure. Mortality increased with increasing concentration levels. Fumigant toxicity of oil‐loaded nanogels was significantly more than the oil even after 48 h. According to the findings, oil‐loaded nanogels were 8.9‐ and 3.7‐fold more toxic than the oil against S. granarius and T. confusum, respectively. The persistence of oil and oil‐loaded nanogels was also investigated over period of time. Oil‐loaded nanogels lost the insecticidal effectiveness after 21 days post‐application for S. granarius and 33 days in the case of T. confusum, while the efficacy of oil decreased in the early days of application. Chemical composition of C. copticum essential oil was measured, and six components were identified. Thymol, ρ‐cymene and γ‐terpinolene were the major components of the oil. The essential oil‐loaded nanogels may have potential to be used as an alternative to synthetic insecticides for stored products protection. However, more research is necessary to improve the findings.
Development of a standardized protein immunomarking protocol for insect mark–capture dispersal research
Authors: Hagler J. R. , Naranjo S. E. , Machtley S. A. , Blackmer F.
Published: April 2014

A field study was conducted to test the marking efficiency of broadcast spray applications of protein marks on stationary (represented by cadavers) and free‐roaming lady beetles Hippodamia convergens Guérin‐Méneville that were strategically placed in blooming alfalfa plots. The marks tested included three different concentrations of egg albumin from chicken egg white, casein from bovine milk and trypsin inhibitor from soy milk. The cadaver and free‐roaming beetle treatments served to measure the acquisition and retention of each protein treatment regime by direct contact with the spray solution and by residual contact with protein‐marked residue on alfalfa, respectively. In addition, the vertical distribution of marking efficacy was determined by sampling alfalfa plant tissue and beetle cadavers that were located on the upper and lower portion of the plant canopy. The data indicated that the backpack spray apparatus was very effective at uniformly administering the various protein marks, regardless of the concentration, throughout the entire plant canopy. Also, the free‐roaming beetles readily self‐marked by contact exposure to protein‐treated plants. We also identified concentrations of each protein type that will mark about 90% of the resident beetle population. Moreover, if a mark–capture‐type study only requires two unique protein marks, we determined that concentrations of 25% for egg white and 100% for bovine milk could be used to mark 98% of the population. Our results provide a significant step towards standardizing protein immunomarking protocols for insect mark–capture dispersal research. In addition, we identify several areas of research that are needed to further standardize the protein mark–capture procedure.
Promoting self‐management and adherence with strength and balance training for older people with long‐term conditions: a mixed‐methods study
Authors: Robinson Lisa , Newton Julia L. , Jones Diana , Dawson Pamela
Published: April 2014

Rationale, aims and objectives

In the context of an ageing population, increasing numbers of older people with long‐term conditions are presenting to secondary health care facilities in the United Kingdom having experienced a fall or fall‐related injury. Despite such observations, falls and long‐term conditions have traditionally been regarded as entirely separate entities. The purpose of this study was to explore the process of behaviour change in a small sample of older people with the fall‐associated chronic liver disease primary biliary cirrhosis (PBC) receiving either a standard or an enhanced programme of strength and balance training (SBT).

Methods

A qualitatively driven mixed‐methods approach was employed that juxtaposed semi‐structured interviews with graphical representations of patient‐reported outcome measures collected during the course of an experimental case series in nine older people with the fall‐associated chronic liver disease PBC.

Results

Participants receiving both the standard and enhanced intervention completed the programme of SBT as instructed throughout the course of the case series. However, only the enhanced intervention, which focused on self‐determination and self‐management support, was associated with continued active participation on completion of the programme.

Conclusions

Longer, but not necessarily more intensive, periods of clinical intervention are necessary to support individuals at risk of falling to move through the incremental stages of behaviour change. Effective self‐management support should focus on the development of a wide range of strategies and behaviours to empower older people with long‐term conditions develop an ongoing active commitment to SBT.
Cost‐effectiveness of early detection of atrial fibrillation via remote control of implanted devices
Authors: Lorenzoni Giulia , Folino Franco , Soriani Nicola , Iliceto Sabino , Gregori Dario
Published: April 2014

Rationale, aims and objectives

Atrial fibrillation (AF) is an independent risk factor for stroke, and its incidence is high in patients implanted with pacemakers (PMs) and implantable cardioverter defibrillators (ICDs). The aim of our study is to evaluate the potential benefit of remote control (RC) on the incidence of stroke related to AF in patients with new‐onset AF implanted with PMs and ICDs and to evaluate the impact of RC on the consumption of medical resources.

Method

The study consisted of two cohorts of patients: group AMB (patients attending ambulatory care clinics from August to October 2013) and group RC (patients followed remotely). All detected cases of new‐onset AF were confirmed by the electrogram stored in the device's memory or by standard electrocardiogram recording. Monte Carlo simulations were performed in order to evaluate the potential risk reduction of stroke related to AF. The costs were estimated from the perspectives of the hospital, the patients and the National Health Service.

Result

We enrolled 223 patients in group RC and 359 in group AMB. We detected 20 new‐onset cases of AF, and the median time to AF detection was 2 days in the RC and 78 days in the ambulatory care clinic control. Management of patients was more efficient with RC, with an average savings in direct costs of €40.88 per year per patient. Through the use of Monte Carlo simulations, we showed that the early detection of new‐onset AF may provide a relative risk reduction of 94.3% for stroke in PM‐implanted patients older than 55 years.

Conclusion

RC potentially provides a risk reduction for stroke because it allows an early detection of new‐onset AF. Moreover, it is also a cost‐saving means of follow‐up.
Using LCA‐based Decomposition Analysis to Study the Multidimensional Contribution of Technological Innovation to Environmental Pressures
Authors: Font Vivanco David , Kemp René , van der Voet Ester , Heijungs Reinout
Published: April 2014

This article presents a general framework for macroenvironmental assessment, combining life cycle assessment (LCA) with the IPAT equation, and explores its combination with decomposition analysis to assess the multidimensional contribution of technological innovation to environmental pressures. This approach is illustrated with a case study in which carbon dioxide (CO2) and nitrogen oxides (NOx) air emissions from diesel passenger cars in Europe during the period 1990–2005 are first decomposed using index decomposition analysis into technology, consumption activity, and population growth effects. By a second decomposition, the contribution of a specific innovation (diesel engine) is calculated on the basis of the technology and consumption activity effects, through a technological comparison with a relevant alternative and the calculation of the rebound effect, respectively. The empirical analysis for diesel passenger cars highlights the discrepancies between the micro (LCA) and macro (IPAT‐LCA) analytical approaches. Thus, whereas diesel engines present a relatively less‐pollutant environmental product profile than their gasoline counterparts, total CO2and NOxemissions would have increased partly as a consequence of their introduction, mainly driven by the increase in travel demand caused by the induced direct price rebound effect from fuel savings and fuel price differences. The counterintuitive result shows the need for such an analysis.