bluuebunny/crossref_metadata_2025 huggingface dataset:
Single-walled carbon nanotube/(Pb, Zn)-phosphate glass heterostructure: an optical sensor and efficient photocurrent converter
Authors: Balaji Sathravada , Bose Saptasree , Debnath Radhaballabh
Published: July 2012

A light-sensitive heterostructure composite of single-walled carbon nanotubes (SWCNTs) and (Pb, Zn)-phosphate glass is synthesized and its spectroscopic and optoelectronic properties are studied. Absorption spectrum of SWCNTs in the composite is quite different from that of its film, which is consistent with our earlier observations that SWCNTs in such a composite suffer stress-induced conformational deformations and band structure modulation. UV/Vis light-induced electron spin resonance (LIESR) spectrum of the composite shows large enhancement of the signal due to the conduction electrons of the SWCNTs and concomitant appearance of a new signal in the lower field region with g = 2.45 and peak-to-peak half width ΔH
pp = 9.0 mT, which is attributable to the lead hole (Pb3+). A phenomenon of creation of charge separation in the system due to the light-induced Pb3+ holes formation by releasing electrons from the interstitial Pb2+-sites and capture of those photo-generated electrons by the SWCNTs in the system, is thus observed. Similar LISER experiments using separately only UV (230–400 nm) and only Vis-light (>400 nm) demonstrate that the composite has good response to the UV and near visible light. Photoconduction studies, on the other hand, indicate that the SWCNTs, which exist in the system with a quasimetallic band structure, act as an efficient medium of transport for these charge carriers. The material thus shows the prospect of being used as a solar photocurrent converter.
Modelling electroluminescence in insulating polymers under ac stress: effect of voltage offset and pre-stressing
Authors: Baudoin F , Mills D H , Lewin P L , Le Roy S , Teyssedre G , Laurent C , Clain S
Published: July 2012

Ac electroluminescence (EL) in polyethylene films is well documented on experimental grounds but a detailed model encompassing injection and transport is still to be strengthened. In particular, different papers report that the EL under ac sinusoidal voltage for both divergent and uniform field configurations is independent of a superimposed dc voltage offset, which is confirmed by our own measurements. Based on modelling, we show that the dc offset voltage induces a transient behaviour of the ac EL; where the symmetry between the EL peaks occurring during each half cycle of the ac voltage is broken but the same steady state is reached for any value of dc offset. The transient duration is short relative to the timescale of a typical EL measurement explaining why it has not been reported experimentally. It depends on the injection level, charge mobility and recombination efficiency. The model also explains the dependence of ac EL on the presence of homo-space charge near the electrodes.
Determination of plasma stability using resonant field amplification in JET
Authors: Gryaznevich M.P. , Liu Y.Q. , Hender T.C. , Howell D.F. , Beurskens M. , Chapman I.T. , Challis C.D. , Joffrin E. , Koslowski H.R. , Buratti P. , Solano E.
Published: July 2012

Resonant field amplification (RFA) has been systematically measured on JET, using active MHD spectroscopy to probe plasma stability at high and low beta, and compared with theoretical predictions. RFA has been measured as a plasma response to externally applied fields. At high beta, RFA has been used to identify the ideal no-wall beta limit. It was found experimentally and explained theoretically that the beta limit strongly depends on the current density and q profiles, and in particular on the q
min value, and the current density profile near the plasma edge. At low beta, RFA has been observed and analysed in detail during edge-localized mode (ELM)-free periods prior to the first ELM either after L–H transition or after long ELM-free periods during a pulse. These observations confirm that the measured increase in the RFA in some cases (e.g. at low beta) may not be connected with the no-wall beta limit associated with the RWM, but may reflect a proximity to other stability thresholds. Reduction in RFA is observed during an outer mode for the first time. The first results on n = 2 probing on JET are presented.
Heterogeneity of Fusarium Head Blight of Wheat: Multi-scale Distributions and Temporal Variation in Relation to Environment
Authors: Kriss Alissa B. , Madden Laurence V. , Paul Pierce A. , Xu Xiangming
Published: July 2012

Fusarium head blight (FHB) is a serious disease of wheat, which is highly variable at several spatial and temporal scales. Different statistical approaches were used to either quantify or partially explain this heterogeneity. First, a generalized linear mixed model was fitted to hierarchical survey data for the incidence of FHB in Ohio. Estimated variance terms indicated large and significant spatial heterogeneity among counties and among fields within counties, with substantially lower variation among sites within fields. Second, window-pane analysis was used to investigate the effects of environment on the inter-annual variation in FHB in four United States (US) states and the spatio-temporal variation across three European countries. Moisture- or wetness-related variables (e.g., average daily relative humidity) were positively associated with FHB intensity for multiple window lengths and starting times, especially for the last 2 months of the growing season. Third, cross-spectral analysis was used to determine whether there was coherency between variation in FHB in Ohio and global climatic patterns. There were significant coherencies at one or more inter-annual time scales (i.e., periods), with peaks in FHB following lows in the climate index (a reflection of a La Niña event) by about 1 year.

Accepted for publication 27 April 2012. Published 23 July 2012.
First Report of Vinca minor Co-infected with Puccinia vincae and Golovinomyces orontii in Texas
Authors: Woodward J. E. , Vandiver M. R. , Ong K. L. , McBride S. A.
Published: July 2012

Vinca spp. are commonly planted in gardens and landscapes as a groundcover. In May 2009, diseased periwinkle (Vinca minor L.) plants were obtained from an established residential landscape in Muleshoe, TX. Both Golovinomyces orontii (Castagne) V.P. Heluta and Puccinia vincae were identified as pathogens in the samples. Whereas both G. orontii and P. vincae have been reported on Vinca minor in the United States, this is the first report of each in Texas.

Accepted for publication 24 May 2012. Published 24 July 2012.
Unravelling hair follicle–adipocyte communication
Authors: Schmidt Barbara , Horsley Valerie
Published: July 2012

Here, we explore the established and potential roles for intradermal adipose tissue in communication with hair follicle biology. The hair follicle delves deep into the rich dermal macroenvironment as it grows to maturity where it is surrounded by large lipid‐filled adipocytes. Intradermal adipocytes regenerate with faster kinetics than other adipose tissue depots and in parallel with the hair cycle, suggesting an interplay exists between hair follicle cells and adipocytes. While adipocytes have well‐established roles in metabolism and energy storage, until recently, they were overlooked as niche cells that provide important growth signals to neighbouring skin cells. We discuss recent data supporting adipocytes as niche cells for the skin and skin pathologies that may be related to alterations in skin adipose tissue defects.
Multiple clonal MLL fusions in a patient receiving CHOP‐based chemotherapy
Authors: Shih Shyh‐Jen , Fass Joseph , Buffalo Vincent , Lin Dawei , Singh Sheetal P. , Diaz Manuel O. , Vaughan Andrew T.
Published: July 2012

MLL rearrangements were analysed in the blood of a patient receiving chemotherapy for diffuse large B‐cell lymphoma using inverse polymerase chain reaction targeting exon 12, parallel sequencing and a custom algorithm design. Of thirteen MLL rearrangements detected, five were capable of generating MLL fusion genes, including MLL‐MLLT3, the most common fusion in acute myeloid leukaemia (AML). Other fusions, all previously clinically unobserved, included MLL‐NKD1, a fusion to the negative regulator of Wnt/β‐catenin signaling, a pathway linked to leukaemic cell proliferation. The majority of the fusions exhibited clonal persistence from before treatment until 6 months post‐chemotherapy, suggesting the fusions may confer a survival advantage to the mutant clone. MLL breakpoints were partly clustered at a specific location, indicating commonality in the process of their formation. Further, the same MLL breakpoint location exhibited a 50–100‐fold increase in C to T transitions, consistent with attack by activation‐induced cytidine deaminase (AICDA). As is also observed in AML and acute lymphoblastic leukaemia, in this single patient setting, MLL is capable of interacting with multiple fusion partners. This finding defines a discrete site of MLL susceptibility to fragmentation, linked to possible deregulation of AICDA function.
Development of an outcome measurement system for service planning for children and youth with special needs
Authors: Kertoy M. K. , Russell D. J. , Rosenbaum P. , Jaffer S. , Law M. , McCauley D. , Gorter J. W.
Published: July 2012

Aim

This study described the process used in developing an outcome measurement framework for system planning to improve services for children and youth with special needs and their families in a Canadian province. The study reports the results of several parent‐completed measures, which would be useful in service planning as well as the acceptability and utility of these measures for use by families and service centres.

Methods/results

Development of a theoretical framework, consultation with key stakeholders, testing the utility of selected outcome measures and initial dissemination of results were critical elements in the successful development of an outcome system. Consultation with stakeholders confirmed use of the International Classification of Functioning, Disability and Health and the child‐within‐family‐within community model as theoretical frameworks while building valuable partnerships and identifying potential barriers to implementation. Pilot testing showed three outcome measures were feasible for families to complete and the measures provided information about services for children that was valuable to families as well as service providers. Gaps in service delivery were identified and the need for better communication between service providers and communities to facilitate integrated services was highlighted.

Conclusion

The findings from this study can be used to implement an outcome measurement system for children with special needs and may serve as a resource for international researchers who are working to develop valid tools as well as outcome systems that are useful for system planning.
Reliability and validity of a new instrument to measure tolerance of everyday risk for children
Authors: Hill A. , Bundy A. C.
Published: July 2012

Background

A modicum of everyday risk provides opportunities for children to extend the limits of their competence. However, increasingly negative perceptions of risk have led to risk‐averse behaviours in adults, including severely restricting children's play. The degree to which risk in play is tolerated by adults impacts on the lives and experiences of children. However, no measure of adult tolerance to everyday risk exists. The purpose of this study was to develop a valid and reliable instrument examining adults’ tolerances of risk during children's play.

Methods

A 31‐item survey of risk tolerance was developed based on a Norwegian model of risky play; 100 parents and teachers of children aged 3 to 13 years completed the instrument. Data were subjected toRasch analysis. Psychometric properties of the data were examined.

Results

Iterative analyses produced an instrument with goodness of fit statistics in the acceptable range, a logical item hierarchy, person separation index >2 and reliability index of 0.87. There was a strong positive relationship between participants’ self‐perceived risk tolerance and scores on the instrument, and between the age of the child and scores on the instrument.

Conclusions

TheTolerance ofRisk inPlayScale (TRiPS) yields valid and reliable data for measuring the success of interventions to change adults’ everyday risk beliefs, and for exploring the impact of adults’ risk tolerance on children's play and development.
The recruitment process of the Barents Sea capelin (Mallotus villosus) stock, 2001–2003
Authors: WIEDMANN MAGNUS AUNE , PEDERSEN OLE‐PETTER , NILSSEN EINAR MAGNUS
Published: July 2012

Oceanographic and predation processes are important modulators of fish larvae survival and mortality. This study addresses the hypothesis that immature Norwegian spring‐spawning herring (Clupea harengus), when abundant in the Barents Sea, determine the capelin reproduction success through consumption of Barents Sea capelin (Mallotus villosus) larvae. Combining a hydrodynamic model and particle‐tracking individual‐based model, a realistic spatio‐temporal overlap between capelin larvae and predatory immature herring was modelled for the summer seasons of 2001–2003. Capelin larvae originating from western spawning grounds became widely dispersed during the summer season, whereas those originating from eastern spawning grounds experienced a rapid drift into the southeastern Barents Sea. Herring caused a 3% mortality of the capelin larvae population in 2001 and a 16% mortality in 2003, but the effect of predation from herring on capelin larvae was negligible in 2002. Despite a strong capelin larvae cohort and a virtual absence of predatory herring, the recruitment from the capelin 2002 year class was relatively poor from a long‐term perspective. We show that the choice of capelin spawning grounds has a major impact on the subsequent capelin larvae drift patterns, constituting an important modulator of the capelin larvae survival. Variation in drift patterns during the summer season is likely to expose the capelin larvae to a wide range of hazards, including predation from young cod, sandeel and other predators. Such alternative predators might thus have contributed to the poor capelin recruitment during 2001–2003, leading to the collapse of the capelin stock in the subsequent years.
Analysis of Foxo1‐regulated genes using Foxo1‐deficient pancreatic β cells
Authors: Miyazaki Satsuki , Minamida Rie , Furuyama Tatsuo , Tashiro Fumi , Yamato Eiji , Inagaki Shinobu , Miyazaki Jun‐ichi
Published: July 2012

Several reports have suggested that Foxo1, a key regulator in differentiation, growth and metabolism, is involved in pancreatic β‐cell function. However, detailed analyses have been hampered by a lack of Foxo1‐deficient β cells. To elucidate Foxo1's function in β cells, we produced a β‐cell line with inducible Foxo1 deletion. We generated a conditional knockout mouse line, in which Cre recombinase deletes the Foxo1 gene. We then established a β‐cell line from an insulinoma induced in this knockout mouse by the β‐cell‐specific expression of simian virus 40 T antigen. In this cell line, designated MIN6‐Foxo1flox/flox, adenovirus‐mediated Cre expression ablates the Foxo1 gene, generating MIN6‐Foxo1‐KO cells. Using these knockout and floxed cell lines, we found that Foxo1 ablation enhanced the glucose‐stimulated insulin secretion (GSIS) at high glucose concentrations and enhanced β‐cell proliferation. We also conducted DNA microarray analyses of MIN6‐Foxo1‐KO cells infected with either an adenovirus vector expressing a constitutively active FOXO1 or a control vector and identified several Foxo1‐regulated genes, including some known to be related to β‐cell function. These cells should be useful for further studies on Foxo1's roles in β‐cells and may lead to novel strategies for treating the impaired insulin secretion in type 2 diabetes mellitus.
Condition‐dependent natal dispersal in a large herbivore: heavier animals show a greater propensity to disperse and travel further
Authors: Debeffe Lucie , Morellet Nicolas , Cargnelutti Bruno , Lourtet Bruno , Bon Richard , Gaillard Jean‐Michel , Mark Hewison A. J.
Published: July 2012

Natal dispersal is defined as the movement between the natal range and the site of first breeding and is one of the most important processes in population dynamics. The choice an individual makes between dispersal and philopatry may be condition dependent, influenced by either phenotypic attributes and/or environmental factors.

Interindividual variability in dispersal tactics has profound consequences for population dynamics, particularly with respect to metapopulation maintenance. A better understanding of the mechanisms underlying this variability is thus of primary interest.

We investigated the ranging behaviour of 60 juvenileEuropean roe deer,Capreolus capreolus, monitored withGPScollars for 1 year prior to their first reproduction, from 2003 to 2010 inSouth‐WestFrance. Dispersal occurs across a spatial continuum so that dividing individuals into two categories (dispersers vs. philopatric) may lead to information loss. Therefore, to investigate condition‐dependent dispersal more accurately, we developed an individual‐based measure of dispersal distance, which took into account interindividual variation in ranging behaviour. We assessed the influence of body mass, the degree of habitat heterogeneity and sex on dispersal initiation date, dispersal propensity and distance.

The overall population dispersal rate was 0·34, with a mean ± SDlinear distance between natal and post‐dispersal home ranges of 12·3 ± 10·5 km. Dispersal distances followed a classical leptokurtic distribution. We found no sex bias in either dispersal rate or distance. Forest animals dispersed less than those living in more heterogeneous habitats. Heavier individuals dispersed with a higher probability, earlier and further than lighter individuals. Our individual‐based standardised dispersal distance increased linearly with body mass, with some suggestion of a body mass threshold of 14 kg under which no individual dispersed.

Natal dispersal in roe deer was thus dependent on both phenotypic attributes and environmental context. Our results suggest that population connectivity can be altered by a change in average body condition and is likely higher in the rich and heterogeneous habitats typical of modern day agricultural landscapes.
APN telephone follow up to low‐income first time mothers
Authors: Hannan Jean
Published: July 2012

Aims and objectives.  To examine the effects of a low cost advanced practice nurse telephone intervention for 2 months postbirth in low‐income first time mothers with healthy full term infants.

Background.  Currently women with non‐complicated, healthy full term newborn deliveries receive little to no routine postpartum support. This is problematic if mothers are first time mothers, poor, have problems accessing health care, have language barriers and sparse social support.

Design.  A two group randomised clinical trial. This study was conducted in an inner city South Florida county hospital.

Methods.  A control group (n = 69) received routine hospital discharge care. An intervention group (n = 70) received routine hospital discharge care plus APN follow up telephone calls for week 8 postdischarge. Comparison of outcomes included maternal health (stress, social support, physical health), infant health (routine medical visits, immunisations, weight gain), morbidity (urgent care visits, emergency room visits, re‐hospitalisations), and health care charges (urgent care visits, emergency room visits, re‐hospitalisations). Data were analysed using descriptive statistics and two‐sample t‐tests.

Results.  Intervention group mothers had significantly lower perceived stress, significantly greater perceived maternal health and social support; infants had healthier weight gain, fewer emergency room visits; significantly lower total health care charges ($14,333 vs. $70,834) compared to controls.

Conclusion.  Study results indicate that APN follow up telephone calls to low‐income first time mothers with healthy full term infants is an effective, safe, low cost, easy to apply intervention that improved mothers’ and infants’ health outcomes and reduced healthcare charges.

Relevance to clinical practice.  APNs are uniquely positioned to conduct follow up interventions aimed at providing continuity of care including APN telephone follow up. This is imperative for vulnerable populations especially during times of major budget cuts that affect health care services.
Adequacy of early enteral nutrition in adult patients in the intensive care unit
Authors: Kim Hyunjung , Stotts Nancy A , Froelicher Erika S , Engler Marguerite M , Porter Carol , Kwak Heejeong
Published: July 2012

Aims and objectives.  To evaluate the adequacy of energy and protein intake of patients in a Korean intensive care unit in the first four days after initiation of enteral feeding and to investigate the factors that had impact on adequate intake.

Background.  Underfeeding is a common problem for patients hospitalised in the intensive care unit and is associated with severe negative consequences, including increased morbidity and mortality.

Design.  A prospective, cohort study was conducted in a medical intensive care unit of a university hospital in Korea.

Methods.  A total of 34 adult patients who had a primary medical diagnosis and who had received bolus enteral nutrition for the first four days after initiation of enteral nutrition were enrolled in this study. The data on prescription and intake of energy and protein, feeding method and feeding interruption were recorded during the first four days after enteral feeding initiation. Underfeeding was defined as the intake <90% of required energy and protein.

Results.  Most patients (62%) received insufficient energy, although some (29%) received adequate energy. More than half of patients (56%) had insufficient protein intake during the first four days after enteral feeding was initiated. Logistic regression analysis showed that the factors associated with underfeeding of energy were early initiation of enteral nutrition, under‐prescription of energy and prolonged interruption of prescribed enteral nutrition.

Conclusion.  Underfeeding is frequent in Korean critically ill patients owing to early initiation, under‐prescription and prolonged interruption of enteral feeding.

Relevance to clinical practice.  Interventions need to be developed and tested that address early initiation, under‐prescription and prolonged interruption of enteral nutrition. Findings from this study are important as they form the foundation for the development of evidence‐based care that is badly needed to eliminate underfeeding in this large vulnerable Korean intensive care unit population.
Caring for people with chronic disease: is ‘muddling through’ the best way to handle the multiple complexities?
Authors: Sturmberg Joachim P.
Published: July 2012

It is stated everywhere that chronic care poses one of the biggest challenges for the future of medicine. Critical analysis however suggests that these statements are oversimplistic and based on limited, and at times, spurious assumptions. This paper highlights some basic realities: epidemiology shows that at any time, 80% of people experience ‘good enough health’, and that only 0.8% require tertiary medical care; most people with chronic conditions experience a stable illness trajectory; ‘true’ multi‐morbidity is a pattern of advanced age; ageing and the physiological decline of our organ systems is a slow and steady process starting at the age of 30; and, as our health declines in a variety of patterns with disease and ageing, our psycho‐socio‐semiotic care needs increase dramatically. I argue that managing the complexities associated with chronic disease care successfully requires an equally complex management approach, ‘muddling through’, defined by Lindblom as making decisions based on successive limited comparisons. Our patients – rightly – expect that we make these decisions in their best interest. Individual health care professionals and health care policy makers firmly need to put the patient at the centre of the health care system.
Estimating measurement error when annualizing health care costs
Authors: Linden Ariel , Samuels Steven J.
Published: July 2012

Objective

Health insurers routinely annualize members’ health care costs for reporting, predicting high cost cases and evaluating health management programmes. Annualization is the practice of extrapolating to a yearly cost from less than a year of data. In this paper, we systematically estimate the measurement error inherent in this approach.

Study design

The paper uses a retrospective observational study using longitudinal claims data from three types of insured populations: Medicare managed care, public employees and a self‐insured employer.

Methods

The unit of analysis was a block ‘year’ consisting of 12 consecutive months of cost data for any individual member. These blocks were constructed recursively allowing use of all available data that an individual could contribute. We tested the accuracy of the annualized costs by calculating the absolute error (AE) representing the difference, in dollars, between the actual annual costs and the predicted annual costs, and the absolute percentage error (APE) which is the absolute error divided by the actual 12‐month costs.

Results

Under the best case scenario (when 11 months of data were used to annualize costs), the mean AE ranged from approximately $2700 for the Medicare population to about $400 for the two working‐aged populations; and the mean APE ranged from 9.6% to 11.0% in the three populations. Accuracy diminished systematically with fewer months of available data.

Conclusions

Due to the largely unpredictable nature of monthly costs, annualization can produce substantial measurement error. Given the importance of cost metrics for decision making, we offer several alternative approaches that insurers should consider to improve measurement accuracy.
Are health professionals’ perceptions of patient safety related to figures on safety incidents?
Authors: Martijn Lucie , Harmsen Mirjam , Gaal Sander , Mettes Dirk , van Dulmen Simone , Wensing Michel
Published: July 2012

Objective

The study aims to explore whether health care professionals’ perceptions of patient safety in their practice were associated with the number of patient safety incidents identified in patient records.

Setting

Seventy primary care practices of general practice, general dental practice, midwifery practices and allied health care practices were used in the study.

Methods

A retrospective audit of 50 patient records was performed to identify patient safety incidents in each of the practices and a survey among health professionals to identify their perceptions of patient safety.

Results

All health professions felt that ‘communication breakdowns inside the practice’ as well as ‘communication breakdowns outside the practice’ and ‘reporting of patient safety concerns’ were a threat to patient safety in their work setting. We found little association between the perceptions of health professionals and the number of safety incidents. The only item with a significant relation to a higher number of safety incidents referred to the perception of ‘communication problems outside the practice’ as a threat to patient safety.

Conclusions

This study indicates that the assessment of professionals’ perceptions may be complementary to observed safety incidents, but not linked to an objective measure of patient safety.
Dietary practices in glutaric aciduria type 1 over 16 years
Authors: Gokmen‐Ozel H. , MacDonald A. , Daly A. , Ashmore C. , Preece M. A. , Hendriksz C. , Vijay S. , Chakrapani A.
Published: July 2012

How to cite this article
 Gokmen‐Ozel H., MacDonald A., Daly A., Ashmore C., Preece M.A., Hendriksz C., Vijay S. & Chakrapani A. (2012) Dietary practices in glutaric aciduria type 1 over 16 years. J Hum Nutr Diet.

Background:  In glutaric aciduria type 1 (GA1), dietary treatment with emergency management (EM) is essential to prevent encephalopathic crisis (EC). In the present study, dietary practices were examined in a single UK centre without access to newborn screening.

Methods:  Twenty GA1 patients (11 males, median age: 10.2 years, range 2.2–24.1 years) were evaluated. Nine presented without EC (median diagnosis age: 1.1 years, range 4 days to 8 years) and 11 with EC (median diagnosis age 10 months, range 6 months to 1.7 years). Dietary treatment, neurological outcome, anthropometry and biochemical/haematological markers were assessed.

Results:  Diet treatment varied according to age of diagnosis and symptom severity. Four of six pre‐encephalopathic children diagnosed before 2 years of age were treated with carnitine, protein restriction (medium l.2 g kg day−1) and lysine‐free/low tryptophan protein substitute (PS) (medium dose: 1.6 g kg day−1). EM consisted of natural protein cessation and glucose polymer with PS delivered via an enteral feeding tube. Older children (>3 years) without EC were given carnitine and protein restriction, and seven of nine EC patients had PS via an enteral feeding tube. Clinical deterioration occurred in two patients without EC; one taking PS and protein restriction (with a second untreatable pathology) and one after protein restriction only. In patients presenting with EC, four died and one had some improvement in movement, with the rest remaining stable but with severe disability. Patients taking PS had better nutritional markers [serum vitamin B12 (P < 0.001), albumin (P < 0.001), haemoglobin (P < 0.001) and essential plasma amino acids].

Conclusions:  Early diagnosis of GA1 before EC is essential because PS and protein restriction with meticulous EM prevents EC. PS also improves nutritional status irrespective of clinical condition.
Reliability and utility of the Behaviour Support Plan Quality Evaluation tool (BSP‐QEII) for auditing and quality development in services for adults with intellectual disability and challenging behaviour
Authors: McVilly K. , Webber L. , Paris M. , Sharp G.
Published: July 2012

Background  Having an objective means of evaluating the quality of behaviour support plans (BSPs) could assist service providers and statutory authorities to monitor and improve the quality of support provided to people with intellectual disability (ID) who exhibit challenging behaviour. The Behaviour Support Plan Quality Evaluation Guide II (BSP‐QEII) was developed to monitor and assess BSPs prepared by teachers to support children with disability in the school system. This study investigated the application of the BSP‐QEII to the assessment of BSPs for adults with ID in community support services.

Method  The inter‐rater reliability of the BSP‐QEII was assessed. The utility of the BPS‐QEII was then investigated with reference to a time series study of matched pairs of BSPs, developed for the same clients over a period of approximately 3 years. Differences in plan quality measured across a number of service and systemic variables were also investigated.

Results  The BSP‐QEII was found to have good inter‐rater reliability and good utility for audit purposes. It was able to discriminate changes in plan quality over time. Differences in plan quality were also evident across different service types, where specialist staff had or had not been involved, and in some instances where a statutory format for the plan had or had not been used. There were no differences between plans developed by government and community sector agencies, nor were there any regional differences across the jurisdiction.

Conclusions  The BSP‐QEII could usefully be adopted as an audit tool for measuring the quality of BSPs for adults with ID. In addition to being used for research and administrative auditing, the principles underpinning the BSP‐QEII could also be useful to guide policy and educational activities for staff in community based services for adults with ID.
Association of suppressor of cytokine signalling 3 polymorphisms with insulin resistance in patients with chronic hepatitis C
Authors: Zheng Y.‐Y. , Wang L.‐F. , Fan X.‐H. , Wu C.‐H. , Huo N. , Lu H.‐Y. , Xu X.‐Y. , Wei L.
Published: July 2012

Suppressor of cytokine signalling 3 is thought to be associated with insulin resistance in patients with chronic hepatitis C. We evaluated the role of suppressor of cytokine signalling 3 polymorphisms in determining insulin resistance in patients with chronic hepatitis C. Two hundred and ninety untreated hepatitis C virus‐infected patients without diabetes and cirrhosis were genotyped for the SNPs rs4969168, rs4969170 and rs12952093 of suppressor of cytokine signalling 3 using the TaqMan Genotyping Assay. We found that the rs4969170 AA genotype and rs4969170 A allele frequency were significantly more common in the insulin‐resistant group than the non‐insulin‐resistant group (89.5% vs 76.1%, OR = 2.693, 95% CI: 1.221‐5.939, P = 0.012 and 94.8% vs 88.0%, OR = 2.463, 95% CI: 1.151–5.271, P = 0.017, respectively). Haplotype G‐C was likely associated with non‐insulin resistance (adjusted P = 0.011). Multiple logistic regression analysis indicates that the independent risk factors for insulin resistance are the SNP rs4969170 AA genotype (OR = 3.005, 95% CI: 1.194–7.560, P = 0.019), HCV genotype 1 (OR = 2.524, 95% CI: 1.099–5.794, P = 0.029) and BMI (OR = 0.514, 95% CI: 0.265–0.999, P = 0.05).
Stochasticity of TOL plasmid catabolic promoters sets a bimodal expression regime in Pseudomonas putida mt‐2 exposed to m‐xylene
Authors: Silva‐Rocha Rafael , de Lorenzo Víctor
Published: July 2012

The expression dynamics of the catabolic promoters of the TOL plasmid pWW0 has been examined in single cells of Pseudomonas putida mt‐2 exposed to m‐xylene. To this end, we employed an á la carte bi‐cistronic gfp–lacZ reporter system for generating monocopy transcriptional fusions to each of the four promoters (Pr, Ps, Pu and Pm) of the regulatory network. Whereas expression of xylR (the master regulatory gene of the TOL system) behaved in a unimodal fashion, the activation of Pu and Pm displayed a high degree of stochasticity. This event resulted in a time‐dependent shift in the bacterial population between two induction states without intermediate expression levels. Bimodality of the Pm promoter for the lower TOL pathway was largely due to the propagation of the Ps output throughout the network, which caused stochastic overproduction of the second regulator of the system, XylS. Surprisingly, activation of Pm by the form of XylS that was bound to the pathway intermediate 3‐methylbenzoate was relatively minor. These stochastic phenomena in response to m‐xylene disappeared in the stationary phase. Taken together, the data suggests that genetically homogeneous populations of P. putida mt‐2 employ a strategy of phenotypic variation (metabolic bet‐hedging) when confronted with mixtures of nutrients.
Regulation of archaella expression by the FHA and von Willebrand domain‐containing proteins ArnA and ArnB in Sulfolobus acidocaldarius
Authors: Reimann Julia , Lassak Kerstin , Khadouma Sunia , Ettema Thijs J. G. , Yang Nuan , Driessen Arnold J. M. , Klingl Andreas , Albers Sonja‐Verena
Published: July 2012

The ability of microorganisms to sense and respond to sudden changes in their environment is often based on regulatory systems comprising reversible protein phosphorylation. The archaellum (former: archaeal flagellum) is used for motility in Archaea and therefore functionally analogous to the bacterial flagellum. In contrast with archaellum‐mediated movement in certain members of the Euryarchaeota, this process, including its regulation, remains poorly studied in crenarchaeal organisms like Sulfolobus species. Recently, it was shown in Sulfolobus acidocaldarius that tryptone limiting conditions led to the induction of archaella expression and assembly. Here we have identified two proteins, the FHA domain‐containing protein ArnA and the vWA domain‐containing protein ArnB that are involved in regulating archaella expression in S. acidocaldarius. Both proteins are phosphorylated by protein kinases in vitro and interact strongly in vivo. Phenotypic analyses revealed that these two proteins are repressors of archaella expression. These results represent the first step in understanding the networks that underlie regulation of cellular motility in Crenarchaeota and emphasize the importance of protein phosphorylation in the regulation of cellular processes in the Archaea.
The impact of antiretroviral therapy on adult mortality in rural Tanzania
Authors: Marston Milly , Michael Denna , Wringe Alison , Isingo Raphael , Clark Benjamin D. , Jonas Aswile , Mngara Julius , Kalongoji Samweli , Mbaga Joyce , Changalucha John , Todd Jim , Zaba Basia , Urassa Mark
Published: July 2012

Objective  To describe the impact of antiretroviral therapy (ART) on mortality rates among adults participating in an HIV community cohort study in north‐west Tanzania.

Methods  Serological and demographic surveillance rounds have been undertaken in a population of approximately 30 000 people since 1994. Free HIV care including ART has been available since 2005. Event history analysis was used to compare mortality rates among HIV‐negative and HIV‐positive adults in the 5‐year period before and after the introduction of ART. Crude and adjusted hazard ratios were calculated using exponential regression models. Interaction between time period and HIV status was assessed to investigate whether there was a non‐linear relationship between these two variables.

Results  Male and female mortality patterns varied over the pre‐ and post‐ART period. In women, the crude death rate fell for both HIV negatives and HIV positives hazard rate ratio (HRR = 0.71; 95%CI 0.51–0.99 and HRR = 0.68; 95%CI: 0.46–0.99, respectively). For men, the mortality among the HIV negatives increased (HRR = 1.47; 95%CI: 1.06–2.03) while the decline in mortality among the HIV positives (HRR = 0.77; 95%CI 0.52–1.13) was not statistically significant. The largest decrease in HIV‐positive mortality over the two periods was among the 30‐ to 44‐year‐old age group for women and among the 45‐ to 59‐year‐old age group for men.

Conclusion  There has been a modest effect on mortality in the study population following the introduction of free ART 5 years ago. Improving access to treatment and placing greater focus on retaining individuals on treatment are essential if the full potential of treatment for reducing HIV‐related mortality is to be realised.
Using age‐specific mortality of HIV infected persons to predict Anti‐Retroviral Treatment need: a comparative analysis of data from five African population‐based cohort studies
Authors: Żaba Basia , Kasamba Ivan , Floyd Sian , Isingo Raphael , Herbst Kobus , Bärnighausen Till , Gregson Simon , Nyamukapa Constance , Kayuni Ndoliwe , Todd Jim , Marston Milly , Wringe Alison
Published: July 2012

Objectives  To present a simple method for estimating population‐level anti‐retroviral therapy (ART) need that does not rely on knowledge of past HIV incidence.

Methods  A new approach to estimating ART need is developed based on calculating age‐specific proportions of HIV‐infected adults expected to die within a fixed number of years in the absence of treatment. Mortality data for HIV‐infected adults in the pre‐treatment era from five African HIV cohort studies were combined to construct a life table, starting at age 15, smoothed with a Weibull model. Assuming that ART should be made available to anyone expected to die within 3 years, conditional 3‐year survival probabilities were computed to represent proportions needing ART. The build‐up of ART need in a successful programme continuously recruiting infected adults into treatment as they age to within 3 years of expected death was represented by annually extending the conditional survival range.

Results  The Weibull model: survival probability in the infected state from age 15 = exp(−0.0073 × (age − 15)1.69) fitted the pooled age‐specific mortality data very closely. Initial treatment need for infected persons increased rapidly with age, from 15% at age 20–24 to 32% at age 40–44 and 42% at age 60–64. Overall need in the treatment of naïve population was 24%, doubling within 5 years in a programme continually recruiting patients entering the high‐risk period for dying.

Conclusion  A reasonable projection of treatment need in an ART naive population can be made based on the age and gender profile of HIV‐infected people.
Determinants of low birthweight, small‐for‐gestational‐age and preterm birth in Lombok, Indonesia: analyses of the birthweight cohort of the SUMMIT trial
Authors: Sebayang Susy K. , Dibley Michael J. , Kelly Patrick J. , Shankar Anita V. , Shankar Anuraj H. ,   on behalf of the SUMMIT Study Group
Published: July 2012

Objective  To examine the determinants of low birthweight (LBW), small‐for‐gestation (SGA) and preterm births in Lombok, Indonesia, an area of high infant mortality.

Methods  Data from The Supplementation with Multiple Micronutrient Intervention Trial (SUMMIT), a double‐blind cluster‐randomised controlled trial, were analysed. The odds ratio of factors known to be associated with LBW, SGA and preterm birth was assessed and adjusted for the cluster design of the trial using hierarchical logistic regression. Determinants included constitutional, demographic and psychosocial factors, toxic exposure, maternal nutrition and obstetric history and maternal morbidity during and prior to pregnancy. Population attributable risks of modifiable determinants were calculated.

Results  A cohort of 14 040 singleton births was available for analysis of LBW, with 13 498 observations for preterm births and 13 461 for SGA births. Determinants of LBW and SGA were similar and included infant’s sex, woman’s education, season at birth, mothers’ residence, household wealth, maternal mid‐upper arm circumference (MUAC), height and a composite variable of birth order and pregnancy interval. Socioeconomic indicators were also related to preterm births and included mother’s education, residence and household wealth, while nutritional‐related factors including low MUAC and birth order and interval were associated with preterm birth but not maternal height. Nausea was protective of preterm birth, while diarrhoea was associated with higher odds of preterm birth. Oedema during pregnancy was protective of SGA but associated with higher odds of preterm delivery. Around 33%, 13% and 13% of the determinants of LBW, SGA and preterm births were preventable.

Conclusion  Women’s education, maternal nutrition and household wealth and family planning are key factors to improving birth outcomes.
Hygiene and sanitation practices amongst residents of three long‐term refugee camps in Thailand, Ethiopia and Kenya
Authors: Biran Adam , Schmidt Wolf‐Peter , Zeleke Lemlem , Emukule Haron , Khay Hla , Parker Julian , Peprah Dorothy
Published: July 2012

Objective  To further the understanding of sanitation and hygiene in long‐term camp populations.

Methods  Data were collected by structured observation of handwashing (126 households), a questionnaire on sanitation, hygiene and household characteristics (1089 households) and discussions with mothers. Random walk algorithms were used to select households for observation and survey. Respondents for qualitative methods were a convenience sample.

Results  Across all key handwash occasions [excluding events with no handwash (n = 275)], soap was used for 30% of handwashes. After latrine use, both hands were washed with soap on 20% of occasions observed. Availability of soap in households differed across sites and mirrored the extent to which it was distributed free of charge. Qualitative data suggested lack of free soap as a barrier to ‘safe’ handwashing. Laundry was the priority for soap. In Ethiopia and Kenya, open defecation was practised by a significant minority and was more prevalent amongst households of rural origin. In Ethiopia, open defecation was significantly more prevalent amongst women.

Conclusions  Despite continuing hygiene education, rates of ‘safe’ handwashing are sub‐optimal. Soap scarcity in some households and the prioritisation of laundry are barriers to safe practice. Heterogeneity with respect to education and place of origin may need to be taken into account in the design of improved interventions.
Contraceptive use among HIV‐positive women in Quang Ninh province, Vietnam
Authors: Chi Bui Kim , Gammeltoft Tine , Hanh Nguyen Thi Thuy , Rasch Vibeke
Published: July 2012

Objective  To investigate contraceptive use among HIV‐positive women in Ha long city and Cam Pha town of Quang Ninh, a Northern province of Vietnam.

Methods  Cross‐sectional questionnaire study among HIV‐positive women identified through the district HIV/AIDS register. Information on socioeconomic characteristics and contraceptive use before and after HIV diagnosis was obtained through structured questionnaires. Chi‐square testing was used to assess whether the included women differed from the target population in terms of age. Crude Odds ratios (ORs) were calculated to show the association between contraceptive use and the women’s socioeconomic characteristics. Logistic regression analyses were applied to adjust for possible confounding. The women’s contraceptive use before HIV testing and after HIV testing was described and compared by Chi‐square testing, and the association between post‐test counselling and the women’s use of condom was assessed by ORs.

Results  Of the 351 participants, 63% stated they had used contraception before HIV diagnosis and 89% stated they had used contraception after HIV diagnosis. Forty six per cent of the women had been using either the pill or an intrauterine device (IUD) before the diagnosis whereas the same applied for only 8% of the women after diagnosis. Thirty‐nine per cent stated they had been using condom before HIV diagnosis whereas 87% stated condom use after HIV diagnosis. Condom use was more common among women who had received post‐test counselling (OR 3.03, 95% CI 1.03–8.90).

Conclusions  A change of contraceptive methods from IUD and oral contraception before HIV diagnosis to condom use after HIV diagnosis was observed. The women’s use of condoms after HIV diagnosis was associated with having received post‐test counselling.
Practicing medicine without borders: tele‐consultations and tele‐mentoring for improving paediatric care in a conflict setting in Somalia?
Authors: Zachariah R. , Bienvenue B. , Ayada L. , Manzi M. , Maalim A. , Engy E. , Jemmy J. P. , Ibrahim Said A. , Hassan A. , Abdulrahaman F. , Abdulrahman O. , Bseiso J. , Amin H. , Michalski D. , Oberreit J. , Draguez B. , Stokes C. , Reid T. , Harries A. D.
Published: July 2012

Objectives  In a district hospital in conflict‐torn Somalia, we assessed (i) the impact of introducing telemedicine on the quality of paediatric care, and (ii) the added value as perceived by local clinicians.

Methods  A ‘real‐time’ audio‐visual exchange of information on paediatric cases (Audiosoft Technologies, Quebec, Canada) took place between clinicians in Somalia and a paediatrician in Nairobi. The study involved a retrospective analysis of programme data, and a perception study among the local clinicians.

Results  Of 3920 paediatric admissions, 346 (9%) were referred for telemedicine. In 222 (64%) children, a significant change was made to initial case management, while in 88 (25%), a life‐threatening condition was detected that had been initially missed. There was a progressive improvement in the capacity of clinicians to manage complicated cases as demonstrated by a significant linear decrease in changes to initial case management for meningitis and convulsions (92–29%, P = 0.001), lower respiratory tract infection (75–45%, P = 0.02) and complicated malnutrition (86–40%, P = 0.002). Adverse outcomes (deaths and lost to follow‐up) fell from 7.6% in 2010 (without telemedicine) to 5.4% in 2011 with telemedicine (30% reduction, odds ratio 0.70, 95% CI: 0.57–0.88, P = −0.001). The number needed to be treated through telemedicine to prevent one adverse outcome was 45. All seven clinicians involved with telemedicine rated it to be of high added value.

Conclusion  The introduction of telemedicine significantly improved quality of paediatric care in a remote conflict setting and was of high added value to distant clinicians.