bluuebunny/crossref_metadata_2025 huggingface dataset:
FURTHER INVESTIGATION OF A STRABISMUS MODEL
Authors: D. A. KAULT MB BS, Bsc  , D. J. STARK fraco, frcs (Edin)  , K. P. STARK be, bec, phd, fie Aust
Published: December 2009

Computer models of strabismus have been available for about ten years. Such models are computer programs which perform a set of calculations based on an interpretation of the oculomotor system as a system of two spheres each with six adjustable springs. The effects of pathology and surgery can be simulated by altering the parameters of the springs. However, such models have not yet met with wide practical acceptance.

One reason for this lack of interest is that previous investigators have neglected to apply strabismus models to concomitant strabismus. In this paper the application of a strabismus model to concomitant strabismus is demonstrated and data are generated which should be clinically useful.

Another reason for lack of acceptance of comuter models results from the expectation that they may be unreliable because of biological variability, the model developed here is tested for its sensitivity to a wide range of biological variations and proves to be very robust. Therefore, information on concomitant squint surgery given by the model should be applicable to most patients.
DIFFERENTIATION AND ASSESSMENT OF CORNEAL ENDOTHELIAL CHANGES ASSOCIATED WITH DISEASES OF THE ANTERIOR SEGMENT OF THE EYE
Authors: ANNE M. V. BROOKS md, fraco, fracs, fracp  , GLENYS GRANT aiap, mbpa  , W. E. GlLLlES fraco, fracs, frcs (Edin)
Published: December 2009

Recent work has shown changes in the corneal endothelium accompanying corneal epithelial disease and anterior uveitis. It is important to differentiate these acute changes from other changes such as guttatae or corneal pigment deposition and to assess the magnitude of their effect upon the corneal endothelium.

We have used specular microscopy to study changes in the corneal endothelium and Descemet's membrane and to study deposits on the back of the corneal endothelium and correlate them with changes in the endothelium by the use of conventional specular microscopy and by relief images which give a three dimensional view of the area concerned. This has particularly been applied to the conditions of superficial punctate keratopathy, keratoconjunctivitis sicca, corneal abrasions and exposure keratopathy, iritis and cyclitis, pseudoexfoliation of the lens capsule, anterior sement pigment dispersal syndrome, bullous keratopathy as well as corneal guttatae and pigment granuis on the posterior cornea. freendothelial lesions have been distinguished from endothelial and retrocorneal lesions by this technique aiding elucidation of the state of the endothelium.

The changes which we noted occurred either at the level of Descemet's membrane (including formation of small rounded dark blebs less than one cell in diameter, larger blebs one to three cells in diameter, and guttatae, usually larger than the foregoing and sometimes very numerous), or at the level of the posterior endothelial surface (including small shiny nodular deposits, often numerous. due to pigment granules, and keratitic precipitates and inflammatory debris, the former usually large and the latter smaller, more irregular and somethimes very numeroug

The differentiation and assessment of these various changes are discussed.
A novel dialysing seton: short‐term biocompatibility
Authors: Richardson Peter , Walker Louise N. , Cooper Richard L. , Ben‐Nun Joshua
Published: December 2009

A novel dialysing seton made from haemodialysis tubes was implanted into eleven rabbit eyes to establish its biocompatibility. The animals were observed for up to 67 days after implantation. The cannulae were well tolerated clinically. Tissue obtained at seven different time periods was studied by light and electron microscopy and showed only a mild inflammatory reaction of the same grade as or less than that surrounding nylon sutures used to close the scleral trapdoors. The eye containing the seton had consistently lower intraocular pressure compared to the sham‐operated fellow eye for up to 24 days. This effect declined over the ensuing five weeks.
Restoring the function of the failed bleb
Authors: Gillies W. E. , Brooks Anne M. V.
Published: December 2009

Failure of the filtering bleb after trabeculectomy with a gonioscopically patent drainage cleft is likely to be due to: encapsulation of the bleb; flattening of the bleb; or cystoid bleb.

Encapsulated blebs and flattened blebs are usually associated with a high intraocular pressure (IOP) while cystoid blebs are not, but corneal ulceration due to the prominent cystoid bleb may make revision of the bleb necessary. If the IOP is raised it is best to proceed quickly to needling of the bleb using 5‐fluorouracil. Sixteen patients underwent needling of the bleb, eight with encapsulated, six flattened and two cystoid blebs. Chronic open‐angle glaucoma (10 cases) was the commonest glaucoma. Twelve patients obtained satisfactory control of IOP with mean pre‐needling IOP for encapsulated blebs of 32 mmHg (4.27 kPa), flattened blebs 36 mmHg (4.8 kPa) and cystoid blebs 16mmHg (2.13 kPa), while post‐needling IOP for encapsulated blebs was 12 mmHg (1.6kPa), flattened blebs 13 mmHg (1.73 kPa) and cystoid blebs 12 mmHg (1.6 kPa). Mean follow‐up for encapsulated blebs was 15, flattened blebs 11 and for cystoid blebs nine months. Mean time between trabeculectomy and needling was: for encapsulated blebs 16 days; flattened blebs 24 days; and cystoid blebs 19 months.
Prospective randomized comparison of endobutton versus cross‐pin femoral fixation in hamstring anterior cruciate ligament reconstruction with 2‐year follow‐up
Authors: Price Rohan , Stoney James , Brown Graeme
Published: December 2009

Background:  To determine if there is a different clinical outcome after TransFix versus endobutton femoral fixation in hamstring anterior cruciate ligament (ACL) reconstruction.

Methods:  Twenty‐nine patients were randomized into either Endobutton (Smith & Nephew, Andover, MA, USA) (n= 13) or TransFix (Arthrex, Naples, FL, USA) (n= 16) femoral fixation in hamstring ACL reconstruction. The distal fixation was with a bioabsorbable interference screw. The evaluation methods were clinical history and examination, KT1000 arthrometry for laxity as well as the International Knee Documentation Committee (IKDC) scores over a 2‐year time frame.

Results:  There were no significant differences between the study groups preoperatively. For the 2‐year follow‐up, 11 patients in the Endobutton group and 13 patients in the TransFix group were available (greater than 80%). No statistical differences between the two groups were found at the 1‐ or 2‐year follow‐up examinations. At the 2‐year follow‐up, 72.7% of the Endobutton and 84.6% of the TransFix group patients were in the IKDC A or B categories. Additional procedures postoperatively occurred more frequently in the TransFix group.

Conclusions:  There were no significant differences in the results for either technique of femoral fixation.

Level of Evidence:  Level I.
Delays in discharge of vascular surgical patients: a prospective audit
Authors: Edirimanne Senarath , Roake Justin A. , Lewis David R.
Published: December 2009

Aim:  To quantify delays in discharge for vascular surgical patients and identify causes of such delays.

Methods:  A prospective audit of delays in discharge of vascular surgical admissions over a 6‐month period was performed. Expected date and time of discharge was compared with actual date and time of discharge. Day‐case patients, patients who died during admission and patients not under the direct care of the vascular team were excluded.

Results:  There were 99 elective and 51 acute admissions accounting for 729 hospital bed days. The median (range) age was 72 years (21–92) and 94% of patients were living independently in the community. Forty‐seven percent of patients were discharged on the planned day and time, 21% on the planned day but at a later‐than‐predicted time and 32% were delayed by more than 1 day. Delays identified in this audit accounted for 135 bed days. Fifteen percent of delays were due to causes that can be improved by internal organization (e.g. delayed paperwork). The majority of the delays (85%) were due to external factors such as lack of rehabilitation beds or lack of placement facilities in nursing homes. Elderly patients and acute admissions were more likely to have long delays in discharge.

Conclusion:  Delays in discharge of vascular surgical patients use a lot of acute surgical bed days. Strategies to prevent delays in discharge should include not only improving internal organization and early identification and referral of patients who require rehabilitation/placement but also increased funding for such essential non‐acute services.
Nothing to sneeze at! A study into intra‐operative contamination
Authors: Graham David , Parkinson Benjamin , Evans Meghan , Keijzers Gerben , Derrington Petra
Published: December 2009

Purpose:  We performed a prospective study of sneezes from orthopaedic registrars to assess the potential for intra‐operative contamination from a masked surgeon, and to determine if head position can alter the potential for contamination.

Type of Study:  Prospective controlled trial.

Methods:  Four orthopaedic registrars from the Gold Coast Hospital each inhaled pepper to precipitate a sneeze. Cultures were taken with and without standard Smith & Nephew™ surgical masks, in positions directly in front and to the sides of a masked registrar. The process was repeated three times for each registrar. A control plate was left exposed to the atmosphere. A control plate and sneeze plate was cultured on blood agar. Three masks were subsequently swabbed to exclude contamination from the masks.

Results:  2/24 (8.33%) of the side with mask cultures returned significant bacterial growths. Also, 1/12 (8.33%) of the front with mask cultures returned significant growths. In addition, 9/12 (75%) of the direct sneezes resulted in significant bacterial counts. The control plate failed to return any growth. Subsequent culture of the exterior of three surgical masks failed to yield significant growth. There was a statistically significant odds ratio of 0.03 comparing the front and side group with the unmasked direct group. There was no statistically significant difference comparing front and side sneeze growth.

Conclusions:  While the use of surgical face masks significantly reduces bacterial counts following a sneeze, it fails to eliminate the potential for surgical field contamination completely. The fact that significant bacterial counts can be returned from direct culture through a mask and to the sides of a mask suggests that head position is irrelevant and contamination is possible in any direction. It is, therefore, suggested that, if possible, a sneezing surgeon distances himself/herself as much as possible from the sterile field. We also recommend following a sneeze; surgeons should re‐gown and glove, given the risk of contamination of the sterile field.

Level of evidence:  Level II.
Management of chronic obstructive pulmonary disease in Australia after the publication of national guidelines
Authors: Ta M. , George J.
Published: December 2009

Background: Information on the management of chronic obstructive pulmonary disease (COPD) in Australia, especially the extent of adherence to the COPD‐X Plan, is sparse.

Aim: To evaluate COPD patient adherence to treatment recommendations and healthcare provider adherence to the COPD‐X Plan.

Methods: Cross‐sectional study of patients admitted to a secondary care hospital with an acute exacerbation of COPD over a 6‐month period. Data were collected from patient interviews and medical notes.

Results: Participants (n= 45) aged 72 ± 11.5 years (mean ± SD) had a mean FEV1 % predicted 52.2 ± 18.7. At the time 11 (24.4%) patients continued to smoke; 25 (55.6%) had never participated in a pulmonary rehabilitation programme; and 23 (51.1%) self‐reported poor adherence to some COPD medications. Inhaler technique was deemed suboptimal in 25 (55.6%) patients. Only 11 (24.4%) patients had received any instructions from their doctor regarding management of exacerbations. The use of medications not supported by the COPD‐X guidelines were: long‐term prednisolone (11, 24.4%) and prophylactic antibiotics (3, 6.7%).

Conclusion: Management of COPD in Australia by both patients and providers remains suboptimal despite the publication and wide dissemination of the COPD‐X Plan, suggesting the need to intensify both patient and provider education in COPD management.
Study of compliance with a clinical pathway for suspected pulmonary embolism
Authors: Ng B. J. H. , Lindstrom S.
Published: December 2009

Background/Aims: Clinical pathways to guide the investigation of suspected pulmonary embolism have been increasingly adopted by emergency departments worldwide. This study evaluated the compliance with a clinical pathway that combines risk assessment (Wells score) with d‐dimer, ventilation–perfusion scanning or computed tomographic pulmonary angiography (CTPA). The aims of this study were to identify factors that contribute to compliance and to assess patient outcomes and resource utilization.

Methods: Repeated retrospective chart reviews of 239 patients who underwent investigation for pulmonary embolism through our emergency department extracted patient demographics, pathway parameters and patient outcomes. A phone interview at 3‐month follow up was carried out.

Results: Incidence of pulmonary embolism was 8.4% (n= 20). Compliance to the clinical pathway occurred in 120 subjects (50.2%). Non‐compliance occurred in 71 subjects (29.7%). Forty‐eight subjects (20.1%) underwent risk assessments, but subsequent diagnostic tests did not conform to the stated pathway (partial compliance). Compliance was poor in subjects assessed by non‐emergency department doctors (χ2= 27.95, P≤ 0.001). Compliance occurred less in pregnant subjects (χ2= 7.27, P= 0.007) and those with chronic respiratory disease (χ2= 5.31, P= 0.021). Subjects in the compliant group were less likely to undergo CTPA (odds ratio 2.07 (1.16–3.70), P= 0.012).

Conclusions: Compliance with this clinical pathway allowed emergency department doctors in an Australian university teaching hospital to complete diagnostic testing for suspected pulmonary embolism appropriately unless non‐emergency department doctors became involved. Compliance with this pathway altered the distribution of diagnostic tests performed with less reliance on CTPA, but was not associated with better patient outcomes.
The bosentan patient registry: long‐term survival in pulmonary arterial hypertension
Authors: Keogh A. , Strange G. , McNeil K. , Williams T. J. , Gabbay E. , Proudman S. , Weintraub R. G. , Wlodarczyk J. , Dalton B.
Published: December 2009

Background/Aims: The Bosentan Patient Registry (BPR) was a prospective, multicentre, Australian registry funded by Actelion Pharmaceuticals. The primary aim of the registry was to collect survival data in patients with pulmonary arterial hypertension (PAH) treated with bosentan.

Methods: The BPR was initiated in 15 specialized PAH centres. All patients on or starting bosentan were invited to enrol. Treating physicians notified the registry if patients discontinued bosentan, because of either a change in therapy, transplantation, intervention or death. Survival data were validated against the Australian Institute of Health and Welfare National Death Index.

Results: Between 2004 and 2007, a total of 528 patients (mean age 59 ± 17 years) were enrolled representing 69% of patients either previously taking or initiated on bosentan during that time. The BPR population was generally older with more advanced functional deficit than patients enrolled in randomized, placebo‐controlled trials. Aetiology was idiopathic (iPAH) in 58% and connective tissue disease related (scleroderma (SSc)‐PAH) in 42%. For iPAH patients, World Health Organisation functional classes II, III and IV at enrolment was 8.2%, 66.4% and 20.5%, and for the SSc‐PAH cohort, 3.2%, 75.8% and 17.9% respectively. The observed annual mortality was 11.8% in patients with iPAH and 16.6% in patients SSc‐PAH.

Conclusion: This large Australian registry provides ‘real life’ information on the characteristics and management of PAH in clinical practice. Treatment with bosentan improved survival outcomes in both iPAH and SSc‐PAH compared with historical controls. Age, disease severity and aetiology were critical factors in determining clinical outcomes.
Hospital doctors' attitudes towards older people
Authors: Leung S. , LoGiudice D. , Schwarz J. , Brand C.
Published: December 2009

Background: Ageism among health professionals is increasingly recognized, but few studies investigated hospital doctors' attitudes towards older people. The aims of this study were to investigate hospital doctors' attitudes towards older people and to determine whether factors, which were identified in studies on other health professionals, influence hospital doctors' attitudes.

Methods: Hospital doctors who worked in General Medicine or Aged Care units in two tertiary public hospitals in metropolitan Victoria, Australia, in 2008 were surveyed with Fraboni's Scale of Ageism (FSA), a validated instrument used to investigate attitudes towards older people. Demographic data from participants were collected.

Results: Of the 235 questionnaires distributed, 122 were returned (overall response rate 51.9%). Response rate was highest among consultants (80.4%), followed by registrars (64.1%) and lowest among interns and residents (35.2%). The mean FSA score attained by the respondents was 61.5 (SD 11.0), representing a point between a neutral and a positive disposition. Doctors' characteristics that were associated with more positive attitudes towards older people included age of 30 years or older (P < 0.001), female gender (P= 0.003), more senior in position (P < 0.001), postgraduate years of 10 or more (P < 0.001), previous working experience in Aged Care (P < 0.001), interest in Aged Care (P < 0.001) and more frequent social contacts with healthy older people (P < 0.001).

Conclusion: Hospital doctors of different demographic features and background characteristics display different attitudes towards older people. These findings can be used to inform future development of undergraduate and postgraduate medical curricula and form a basis for future studies on the effectiveness of these interventions in improving doctors' attitudes.
Maternal host plant effects on aphid performance: contrasts between a generalist and a specialist species on Brussels sprout cultivars
Authors: Tariq Muhammad , Wright Denis J. , Staley Joanna T.
Published: December 2009

The performance of the second generation (G2) of alates and apterae of a generalist, Myzus persicae, and a specialist, Brevicoryne brassicae, aphid species reared on Chinese cabbage or cabbage was evaluated on five cultivars of Brussels sprout.

Aphid performance was influenced both by the type of host on which the parent aphid had been reared and by the host on which it was feeding when reproducing.

The fecundity of the G2 of alates of both aphid species reared on Chinese cabbage differed significantly between all the cultivars of Brussels sprout and, on average, was 25% higher than those reared on cabbage. These differences were also apparent for the intrinsic rate of increase of B. brassicae but not for M. persicae.

There was a trend for the G2 of alates from Chinese cabbage to have greater fecundity compared with aphids from cabbage. These differences were significant for the fecundity of the G2 of alates of both aphid species on Brussels sprout cultivars Fillbasket (30% higher), Red Delicious (35% higher) and Winter Harvest (25% higher) than those reared on cabbage.

The intrinsic rate of increase for the G2 of alates of B. brassicae from Chinese cabbage was significantly different on all Brussels sprout cultivars tested. The intrinsic rate of increase differed significantly between aphids reared on either Chinese cabbage or cabbage on cultivars Oliver and Darkmar‐21 (M. persicae) and Red Delicious and Winter Harvest (B. brassicae). The cv. Oliver appeared to be the most consistently good host; Red Delicious was the poorest host overall.
Global warming affects phenology and voltinism of Lobesia botrana in Spain
Authors: Martín‐Vertedor Daniel , Ferrero‐García Juan J. , Torres‐Vila Luis M.
Published: December 2009

Climate change is promoting alterations of a very diverse nature in the life cycle of an array of insect species, including changes in phenology and voltinism. In Spain, there is observational evidence that the moth Lobesia botrana Den. & Schiff. (Lep.: Tortricidae), a key vine pest that is usually trivoltine in Mediterranean latitudes, tends to advance spring emergence, displaying a partial fourth additional flight, a fact that is potentially attributable to global warming.

To verify this hypothesis, local temperatures were correlated with L. botrana phenology in six vine‐growing areas of southwestern Spain during the last two decades (1984–2006) by exploiting the database of flight curves obtained with sexual pheromone traps. The dates of second and third flight peaks of the moth were calculated for each area and year and then correlated with both time (years) and local temperatures.

The results obtained demonstrated a noteworthy trend towards local warming (as a result of global warming) in the last two decades, with mean increases in annual and spring temperatures of 0.9 and 3.0°C, respectively. Therefore, L. botrana phenology has significantly advanced by more than 12 days. Moreover, the phenological advance contributed to increased moth voltinism in 2006 by promoting a complete fourth additional flight, a fact that has never been reported previously to our knowledge in the Iberian Peninsula.

The potential impact of an earlier phenology and increased voltinism in L. botrana is discussed from an agro‐ecological perspective.
Crenarchaeota affiliated with group 1.1b are prevalent in coastal mineral soils of the Ross Sea region of Antarctica
Authors: Ayton J. , Aislabie J. , Barker G. M. , Saul D. , Turner S.
Published: December 2009

The objective of this study was to examine the presence and diversity of Archaea within mineral and ornithogenic soils from 12 locations across the Ross Sea region. Archaea were not abundant but DNA sufficient for producing 16S rRNA gene clone libraries was extracted from 18 of 51 soil samples, from four locations. A total of 1452 clones were analysed by restriction fragment length polymorphism and assigned to 43 operational taxonomic units from which representatives were sequenced. Archaea were primarily restricted to coastal mineral soils which showed a predominance of Crenarchaeota belonging to group 1.1b (> 99% of clones). These clones were assigned to six clusters (A through F), based on shared identity to sequences in the GenBank database. Ordination indicated that soil chemistry and water content determined archaeal community structure. This is the first comprehensive study of the archaeal community in Antarctic soils and as such provides a reference point for further investigation of microbial function in this environment.
An α‐amylase is a novel receptor for Bacillus thuringiensis ssp. israelensis Cry4Ba and Cry11Aa toxins in the malaria vector mosquito Anopheles albimanus (Diptera: Culicidae)
Authors: Fernandez‐Luna Maria Teresa , Lanz‐Mendoza Humberto , Gill Sarjeet S. , Bravo Alejandra , Soberon Mario , Miranda‐Rios Juan
Published: December 2009

Bacillus thuringiensis ssp. israelensis (Bti) produces four Cry toxins (Cry4Aa, Cry4Ba, Cry10Aa and Cry11Aa), and two Cyt proteins (Cyt1Aa and Cyt2Ba), toxic to mosquito‐larvae of the genus Aedes, Anopheles and Culex, important human disease vectors that transmit dengue virus, malaria and filarial parasites respectively. Previous work showed that Bti is highly toxic to Anopheles albimanus, the main vector for transmission of malaria in Mexico. In this work, we analysed the toxicity of isolated Cry proteins of Bti and identified an An. albimanus midgut protein as a putative Cry4Ba and Cry11Aa receptor molecule. Biossays showed that Cry4Ba and Cry11Aa of Bti are toxic to An. albimanus larvae. Ligand blot assays indicated that a 70 kDa glycosylphosphatidylinositol‐anchored protein present in midgut brush border membrane vesicles of An. albimanus interacts with Cry4Ba and Cry11Aa toxins. This protein was identified as an α‐amylase by mass spectrometry and enzymatic activity assays. The cDNA that codes for the α‐amylase was cloned by means of 5′‐ and 3′‐RACE experiments. Recombinant α‐amylase expressed in Escherichia coli specifically binds Cry4Ba and Cry11Aa toxins.
Phenotypic and genomic diversity of Lactobacillus plantarum strains isolated from various environmental niches
Authors: Siezen Roland J. , Tzeneva Vesela A. , Castioni Anna , Wels Michiel , Phan Hoa T. K. , Rademaker Jan L. W. , Starrenburg Marjo J. C. , Kleerebezem Michiel , Molenaar Douwe , Van Hylckama Vlieg Johan E. T.
Published: December 2009

Lactobacillus plantarum is a ubiquitous microorganism that is able to colonize several ecological niches, including vegetables, meat, dairy substrates and the gastro‐intestinal tract. An extensive phenotypic and genomic diversity analysis was conducted to elucidate the molecular basis of the high flexibility and versatility of this species. First, 185 isolates from diverse environments were phenotypically characterized by evaluating their fermentation and growth characteristics. Strains clustered largely together within their particular food niche, but human fecal isolates were scattered throughout the food clusters, suggesting that they originate from the food eaten by the individuals. Based on distinct phenotypic profiles, 24 strains were selected and, together with a further 18 strains from an earlier low‐resolution study, their genomic diversity was evaluated by comparative genome hybridization against the reference genome of L. plantarum WCFS1. Over 2000 genes were identified that constitute the core genome of the L. plantarum species, including 121 unique L. plantarum‐marker genes that have not been found in other lactic acid bacteria. Over 50 genes unique for the reference strain WCFS1 were identified that were absent in the other L. plantarum strains. Strains of the L. plantarum subspecies argentoratensis were found to lack a common set of 24 genes, organized in seven gene clusters/operons, supporting their classification as a separate subspecies. The results provide a detailed view on phenotypic and genomic diversity of L. plantarum and lead to a better comprehension of niche adaptation and functionality of the organism.
The Road to Understanding Maps
Authors: Liben Lynn S.
Published: December 2009

Children and even some adults struggle to understand and use maps. In the symbolic realm, users must appreciate that the marks on a surface stand for environments and must understand how to interpret individual symbols. In the spatial realm, users must understand how representational space is used to depict environmental space. To do so, they must understand the consequences of cartographic decisions about the map's viewing distance, viewing angle, viewing azimuth, and geometric projection. Research identifies age-linked progressions in symbolic and spatial map understanding that are linked to normative representational and spatial development, and reveals striking individual differences. Current work focuses on identifying experiences associated with better map understanding. New technologies for acquiring, manipulating, analyzing, and displaying geo-referenced data challenge users and researchers alike.
Property Derivatives for Managing European Real‐Estate Risk
Authors: Fabozzi Frank J. , Shiller Robert J. , Tunaru Radu S.
Published: December 2009

Although property markets represent a large proportion of total wealth in developed countries, the real‐estate derivatives markets are still lagging behind in volume of trading and liquidity. Over the last few years there has been increased activity in developing derivative instruments that can be utilised by asset managers. In this paper, we discuss the problems encountered when using property derivatives for managing European real‐estate risk. We also consider a special class of structured interest rate swaps that have embedded real‐estate risk and propose a more efficient way to tailor these swaps.
Use of a prescription‐based measure of antiretroviral therapy adherence to predict viral rebound in HIV‐infected individuals with viral suppression
Authors: Cambiano V , Lampe FC , Rodger AJ , Smith CJ , Geretti AM , Lodwick RK , Holloway J , Johnson M , Phillips AN
Published: December 2009

Objective

The aim of the study was to assess whether a simple, routinely available measure of antiretroviral therapy (ART) adherence predicts viral rebound at the next HIV viral load (VL) measurement in virally suppressed patients.

Methods

The analysis was performed on the Royal Free HIV Cohort, London, UK. Each ‘drug coverage–viral load episode’ (DCVL episode) was defined as a 6‐month period immediately prior to a VL ≤50 HIV‐1 RNA copies/mL (time‐zero), during which the patient had been continuously on HAART, with all measured VLs ≤50 copies/mL. The next VL after time‐zero was used to assess whether VL rebound (defined as >200 copies/mL) had occurred. Drug coverage, our measure of adherence, was calculated as the proportion of days in the 6‐month period covered by a valid prescription for at least three antiretroviral drugs.

Results

A total of 376 (2.4%) VL rebounds occurred in 15 660 DCVL episodes among 1632 patients. Drug coverage was 100% for 32% of episodes, 95–99% for 16% of episodes and ≤60% for 10% of episodes. The risk ratio of rebound associated with a 10% increase in drug coverage, adjusted for potential confounding variables, was 0.93 (95% confidence interval 0.88–0.98).

Conclusions

Antiretroviral drug coverage assessed at the time of VL measurement in patients with undetectable VL is potentially clinically useful for predicting VL rebound at the next VL measurement.
Pitfalls in measuring high‐density lipoprotein cholesterol concentrations in HIV‐infected patients
Authors: Aragonès G , Beltrán R , Rull A , Marsillach J , Rodríguez F , Alí SB , Fernández‐Sender L , Camps J , Joven J , Alonso‐Villaverde C
Published: December 2009

Objectives

HIV infection and its treatment are associated with dyslipidaemia and increased risk of cardiovascular disease. Accurate high‐density lipoprotein (HDL) cholesterol values are necessary for the management of these abnormalities, but current methods have not been properly assessed in these patients. The aim of this study was to assess in HIV‐infected patients the consistency and accuracy of a synthetic polymer/detergent homogeneous assay used to measure HDL cholesterol concentrations and to evaluate the impact of storage.

Methods

HDL cholesterol was measured using a synthetic polymer/detergent homogeneous method in samples from HIV‐infected patients and healthy subjects for each of the storage regimens: baseline, after 1 week at 4 °C, and after 12 months at −80 °C. The ultracentrifugation and precipitation assays were used for comparison.

Results

Three out of every 20 samples from HIV‐infected patients had discrepant HDL cholesterol values with respect to the ultracentrifugation method. Overestimation was associated with high C‐reactive protein concentrations and underestimation with plasma γ‐globulin concentrations, an effect that was amplified by any of the storage conditions tested.

Conclusions

Caution is needed when using the synthetic polymer/detergent homogeneous method for direct measurement of HDL cholesterol concentrations in HIV‐infected patients. This assay is of limited use in clinical trials in which frozen samples are analysed.
Determinants of late HIV diagnosis among different transmission groups in Finland from 1985 to 2005
Authors: Kivelä PS , Krol A , Salminen MO , Ristola MA
Published: December 2009

Objectives

To study determinants of late HIV diagnosis in a low‐HIV‐prevalence (<0.1%) country where HIV spread among men who have sex with men (MSM) and heterosexuals in the 1980s, and among injecting drug users (IDUs) in the late 1990s.

Methods

Newly diagnosed HIV cases referred to the Helsinki University Central Hospital between 1985 and 2005 were reviewed to identify determinants of late HIV diagnosis, defined as diagnosis when the first CD4 count was <200 cells/μL, or when AIDS occurred within 3 months of HIV diagnosis. Determinants of late diagnosis were analysed using multivariate logistic regression.

Results

Among 934 HIV cases, 211 (23%) were diagnosed late. In the first 4‐year interval of each sub‐epidemic (1985–1989 for MSM and heterosexuals, 1998–2001 for IDUs), rates of late HIV diagnosis were 13%, 18% and 6%, respectively, but increased thereafter to 29%, 27% and 37%. Late diagnosis was associated with non‐Finnish ethnicity, older age, male gender, lack of earlier HIV testing, diagnosis at health care settings and later stage of the sub‐epidemic.

Conclusions

The lower rate of late diagnosis in the first 4‐year interval of each HIV sub‐epidemic suggests that the early stages of the HIV epidemic in Finland were detected early. This factor may have contributed to the low prevalence of HIV infection in Finland. The stage and age of the epidemic should be taken into account when interpreting the data on late HIV diagnosis, especially in cross‐country comparisons.
A family with autosomal dominant leukodystrophy linked to 5q23.2–q23.3 without lamin B1 mutations
Authors: Brussino A. , Vaula G. , Cagnoli C. , Panza E. , Seri M. , Di Gregorio E. , Scappaticci S. , Camanini S. , Daniele D. , Bradac G. B. , Pinessi L. , Cavalieri S. , Grosso E. , Migone N. , Brusco A.
Published: December 2009

Background and purpose:  Duplications of lamin B1 (LMNB1) at 5q23 are implicated in adult‐onset autosomal dominant leukodystrophy (ADLD) having been described in six families with diverse ethnic background but with a homogeneous phenotype. In a large Italian family, we recently identified a variant form of ADLD characterized clinically by absence of the autonomic dysfunction at onset described in ADLD and, on MRI, by milder cerebellar involvement with sparing of hemispheric white matter. Aim of this study was to investigate the genetic basis of this variant form of ADLD.

Methods:  We carried out a genome‐wide linkage analysis using microsatellite markers, and the genes in the candidate region were screened for point mutations. LMNB1 was also screened for deletions/duplications by real‐time PCR, multiplex ligation‐dependent probe amplification and Southern blot.

Results:  We mapped the variant ADLD locus to 5q23.2–q23.3, a genomic region containing 11 genes including LMNB1. Neither gene copy‐number defects nor point mutations in the LMNB1 gene were found. We also excluded point mutations in the coding exons of the other ten genes in the candidate region. However, expression of lamin B1 evaluated in lymphoblastoid cells was higher in patients than in healthy controls, and was similar to the lamin B1 expression levels found in a patient with LMNB1 duplication.

Conclusions:  This observation suggests that a mutation in an LMNB1 regulatory sequence underlies the variant ADLD phenotype. Thus, adult forms of ADLD linked to 5q23 appear to be more heterogeneous clinically and genetically than previously thought.
Global cities in Global Commodity Chains: exploring the role of Mexico City in the geography of global economic governance
Authors: PARNREITER CHRISTOF
Published: December 2009

In this article I assert that global cities are critical nodes in Global Commodity Chains because it is from them that producer services are provided. I explore forward linkages of producer service firms in Mexico City, showing that there are important service flows to companies responsible for the globalization of the ‘Mexican’ economy. Based on this finding I also indicate reasons why Mexico City is ‘on the map’ of global cities and of Global Commodity Chains. I argue that both access to local knowledge and close contact to clients are key factors. A third issue dealt with is the position of Mexico City in the geography of governance of commodity chains. The analysis suggests that it is useful to break up global city functions into the management of the world economy and into its command and control, because Mexico City is certainly a place for the former, while the scope of influence exercised from the city is rather limited.
Cities, material flows and the geography of spatial interaction: urban places in the system of chains
Authors: HESSE MARKUS
Published: December 2009

The emerging discourses on world cities and Global Commodity Chains are valuable spatial frameworks for conceptualizing globalization and its spatial consequences. However, both discourses have one thing in common: they neglect the territorial and thus physical dimension of global flows. Hence, in this article I take the perspective of material flows to reconnect the discourses on cities and chains. I aim to clarify the role of urban places and their ability to attract, manage and redirect flows in such networks. I do so by re‐examining classical concepts of spatial interaction and reorganization in human geography, with particular reference to centrality and intermediacy. The case of seaports and port cities is further explored to demonstrate the concrete conflicts and opportunities that arise with chain developments and insertion. To determine the relative position of places with regard to global chains and flows, Sheppard's concept of ‘positionality’ is discussed.
Intra‐firm and extra‐firm linkages in the knowledge economy: the case of the emerging mega‐city region of Munich
Authors: LÜTHI STEFAN , THIERSTEIN ALAIN , GOEBEL VIKTOR
Published: December 2009

With the aim of identifying emerging patterns of spatial development and the driving forces behind the associated process, in this article we draw together two threads of interlinked phenomena. First, we look at how multi‐location firms from the knowledge economy develop their intra‐firm networks internationally. Second, we establish the partners with which these firms have working relationships along individual chains of value, and in which these extra‐firm linkages are located. We start from a conceptual background that combines the location behaviour of firms with a value chain approach. We analyse the two main pillars of the knowledge economy – advanced producer services (APS) and high‐tech firms. A case study carried out in the greater Munich area provides the empirical basis and draws on quantitative and qualitative research methods. The results provide evidence that the greater Munich area can be regarded simultaneously as a hierarchically organized polycentric mega‐city region and high‐grade localized system of value chains.
Regulation of stargazin synaptic trafficking by C‐terminal PDZ ligand phosphorylation in bidirectional synaptic plasticity
Authors: Stein Emma L. A. , Chetkovich Dane M.
Published: December 2009

J. Neurochem. (2010) 10.1111/j.1471‐4159.2009.06529.x

Stargazin is a transmembrane α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic acid (AMPA) receptor regulatory protein that controls the surface and synaptic expression of AMPA‐type glutamate receptors (AMPARs). Synaptic anchoring of AMPARs is influenced by the interaction between stargazin’s C‐terminal post‐synaptic density‐95 (PSD‐95)/discs large/zona occludens‐1 (PDZ) ligand and the synaptic scaffolding protein PSD‐95. Phosphorylation of the stargazin PDZ ligand by protein kinase A (PKA) disrupts stargazin’s interaction with PSD‐95, but whether this phosphorylation plays a role in activity‐dependent regulation of stargazin/AMPAR synaptic trafficking is unknown. Here, we show that stargazin is phosphorylated within the PDZ ligand at threonine residue 321 (T321) by mitogen‐activated protein kinases (MAPKs) as well as PKA. By expressing constructs that selectively block T321 phosphorylation by either PKA or MAPKs, we show that stargazin T321 phosphorylation is required for activity‐dependent changes in stargazin synaptic clustering in dissociated rat hippocampal neuron cultures. Specifically, we find that mutations that block stargazin T321 phosphorylation by PKA prevent activity‐dependent increases in stargazin synaptic clustering, whereas a point mutant that blocks MAPK phosphorylation of T321 prevents activity‐dependent decreases in stargazin synaptic clustering. Taken together, our studies implicate phosphorylation of stargazin T321 by PKA and MAPKs in bidirectional control of stargazin/AMPAR synaptic clustering during synaptic plasticity.
‘Multiple action fixed combination. Present or future?’
Authors: García‐Donaire José Antonio , Ruilope Luis Miguel
Published: December 2009

Cardiovascular disease (CVD) is the most common cause of death in Western countries and will continue to be so in upcoming years. A close correlation has been demonstrated among CVD, stroke, ischemic heart disease, renal failure and a number of modifiable risk factors. As cardiovascular (CV) risk factors commonly co‐exist, high‐risk patients with hypertension, obesity and diabetes may well benefit from a multiple action combination of CV agents with synergistic efficacy. Control of blood pressure (BP) and the other CV risk factors is still far from the optimal rates and achievement of internationally accepted goals must be imperative. The benefits of achieving these goals, including significant reductions in CV morbidity and mortality, are well documented. Thus, a rigorous effort to improve BP goal attainment is required. Most of the patients will need two or more antihypertensives to achieve BP goal. Administering of two drugs in a single‐dose formulation substantially improves patient compliance compared with separate agent administration. Fixed‐dose combination therapy can offer potential advantages over individual agents, including increased efficacy, reduced incidence of adverse effects, lower healthcare costs and improved patient compliance through the use of a single medication administered once daily. Currently available fixed‐dose agents include several combinations with complementary pharmacodynamic activity. Last, the polypill includes several CV acting agents that affects various CV risk factors and offers encouraging results, although more data are needed to strengthen the polypill concept, its efficacy and safety.
Multiparametric sensitivity analysis of the additive model in data envelopment analysis
Authors: Singh Sanjeet
Published: December 2009

In this paper, we study multiparametric sensitivity analysis of the additive model in data envelopment analysis using the concept of maximum volume in the tolerance region. We construct critical regions for simultaneous and independent perturbations in all inputs/outputs of an efficient decision making unit. Necessary and sufficient conditions are derived to classify the perturbation parameters as “focal” and “nonfocal.” Nonfocal parameters can have unlimited variations because of their low sensitivity in practice and these parameters can be deleted from the final analysis. For focal parameters a maximum volume region is characterized. Theoretical results are illustrated with the help of a numerical example.
Farming system performance and water use efficiency in the Tunisian semi‐arid region: data envelopment analysis approach
Authors: Chemak Fraj , Boussemart Jean‐Philippe , Jacquet Florence
Published: December 2009

Understanding farming strategies and identifying the parameters controlling production technologies are the fundamental elements required to modify the consumption of the irrigated sector without compromising production objectives. In this regard, the objective of this investigation is to analyse the performance of irrigated farms in the region of Sidi Bouzid, Tunisia. Firstly, farm surveys were carried out in both public and private irrigated areas. Secondly, an analysis of the production system within these farms showed an appropriate technology process. Moreover, the application of the data envelopment analysis approach allowed the measurement of technical and allocative efficiency. The comparison between both production systems, based on public and private resources, revealed that more important resources were wasted under the private than under the public water management system. Thus, the surface wells creation strategy, as a second resource for irrigation, was found to be against the sustainable use of an already overexploited groundwater. However, such strategy is justified when analysing allocative efficiency scores. Indeed, the profitability of the activity, based on the use of wells for irrigation, appears to be much higher than the one based on public resources.
Adaptive beam search lookahead algorithms for the circular packing problem
Authors: Akeb Hakim , Hifi Mhand , M'Hallah Rym
Published: December 2009

This paper addresses the circular packing problem (CPP), which consists in packing n circles Ci, each of known radius ri, i∈N={1, …, n}, into the smallest containing circle C. The objective is to determine the radius r of C as well as the coordinates (xi, yi) of the center of Ci, i∈N. CPP is solved using two adaptive algorithms that adopt a binary search to determine r, and a beam search to check the feasibility of packing n circles into C when the radius is fixed at r. A node of level ℓ, ℓ=1, …, n, of the beam search tree corresponds to a partial packing of ℓ circles of N into C. The potential of each node of the tree is assessed using a lookahead strategy that, starting with the partial packing of the current node, assigns each unpacked circle to its maximum hole degree position. The beam search stops either when the lookahead strategy identifies a feasible packing or when it has fathomed all nodes. The computational tests on a set of benchmark instances show the effectiveness of the proposed adaptive algorithms.
Much ado about money and how to spend it! Analysing 40 years of annulment cases against the European Union Commission
Authors: BAUER MICHAEL W. , HARTLAPP MIRIAM
Published: December 2009

This article analyses four decades of annulment cases against the European Commission brought before the European Court of Justice by dissatisfied Member States. Annulment cases are interpreted as incidents of a struggle between Member State governments and the Commission about policy decisions. Studying annulment cases for the first time in comparative perspective, three important patterns of variation are identified: with respect to the evolution of annulment cases over time, as regards the Member States as plaintiffs and in view of policy fields. Subsequently the data are interpreted on the basis of structure, agency and policy field specific explanatory mechanisms. Leaving the aggregate level, the two policy areas that account for more than 80 per cent of annulments are analysed: EU agriculture and competition policy. In the vast majority of cases, the dominant rationale behind annulments is not national objections to the supranational exercise of delegated powers per se or in specific policies (as most structural theories would expect) but to the way the Commission uses these competences to restrict how national governments may allocate European or national funding.