bluuebunny/crossref_metadata_2025 huggingface dataset:
A Population‐Based and Longitudinal Study of Sexual Behavior and Multidrug‐Resistant HIV Among Patients in Clinical Care
Authors: Kozal Michael J , Amico K Rivet , Chiarella Jennifer , Cornman Deborah , Fisher William , Fisher Jeffrey , Friedland Gerald
Published: October 2009

Background

Population‐based and longitudinal information regarding sexual risk behavior among patients with multidrug resistant (MDR) HIV and their sexual partners is of great public health and clinical importance.

Objective

To characterize the HIV sexual risk behaviors of patients with and without drug‐resistant HIV in the clinical care setting over time.

Measurements

393 HIV‐positive patients completed questionnaires of self‐reported sexual risk behaviors at approximate 6‐month intervals extending over 24 months. HIV viral load and genotypic drug resistance obtained during the same time points were matched to the behavioral data. Multidrug resistance was defined as having resistance to 2 or 3 antiretroviral (ARV) drug classes.

Results

In serial cross‐sectional analyses, 393 patients (44% female and 79% heterosexual) contributed 919 matched behavioral and virologic results over the 24 months of data collection. Of these, 250 patients (64%) reported having sex during at least 1 survey period resulting in greater than 10,000 sexual events with more than 1000 partners. Unprotected sexual behavior was reported by 45% of sexually active patients, resulting in 34% of all sex events that exposed 29% of all partners. Of these patients with unprotected sexual events, 31% had HIV drug resistance 11.6% with resistance to 2 classes of ARVs (2‐class), and 1.8% with 3‐class ARV resistance at the time of a sexual risk event. Close to 1000 or 28% of all unprotected sexual events involved resistant strains (11% of these with resistance to 2 classes and 0.2% with 3‐class resistance, exposing 20% of unprotected sexual partners to resistant HIV (8% to 2‐class and 0.6% to 3‐class resistance).

In longitudinal analysis among the 78 patients who reported a cumulative total of 12 months of sexual history and had resistance testing, 38% reported engaging in unprotected sexual behavior. There was substantial and complex variation in the distribution of unprotected sexual events and in the detection of resistance over time.

Conclusion

In this study of HIV sexual risk and resistance over time among HIV‐infected patients in clinical care, a substantial proportion engaged in unprotected sex and had drug‐resistant HIV, frequently exposing partners to 1‐ or 2‐class resistant HIV strains. However, relatively few exposures involved 3‐class resistance. The dynamics of sexual risk behavior and HIV drug resistance are complex and vary over time and urgently require both general and targeted interventions to reduce transmission of resistant HIV.
One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after study
Authors: Puskarich Michael A , Marchick Michael R , Kline Jeffrey A , Steuerwald Michael T , Jones Alan E
Published: October 2009

Introduction

Early structured resuscitation of severe sepsis has been suggested to improve short term mortality; however, no previous study has examined the long-term effect of this therapy. We sought to determine one year outcomes associated with implementation of early goal directed therapy (EGDT) in the emergency department (ED) care of sepsis.

Methods

We performed a longitudinal analysis of a prospective before and after study conducted at a large urban ED. Adult patients were enrolled if they had suspected infection, 2 or more systemic inflammatory response criteria, and either systolic blood pressure (SBP) <90 mmHg after a fluid bolus or lactate >4 mM. Exclusion criteria were: age <18 years, no aggressive care desired, or need for immediate surgery. Clinical and outcomes data were prospectively collected on consecutive eligible patients for 1 year before and 2 years after implementing EGDT. Patients in the pre-implementation phase received non-protocolized care at attending physician discretion. The primary outcome was mortality at one year.

Results

285 subjects, 79 in the pre- and 206 in the post-implementation phases, were enrolled. Compared to pre-implementation, post-implementation subjects had a significantly lower ED SBP (72 vs. 85 mm Hg, P < 0.001) and higher sequential organ failure assessment score (7 vs. 5, P = 0.0004). The primary outcome of 1 year mortality was observed in 39/79 (49%) pre-implementation subjects and 77/206 (37%) post-implementation subjects (difference 12%; P = 0.04).

Conclusions

Implementation of EGDT for the treatment of ED patients with severe sepsis and septic shock was associated with significantly lower mortality at one year.
Monocyte heterogeneity underlying phenotypic changes in monocytes according to SIV disease stage
Authors: Kim Woong-Ki , Sun Yue , Do Hien , Autissier Patrick , Halpern Elkan F , Piatak Michael , Lifson Jeffrey D , Burdo Tricia H , McGrath Michael S , Williams Kenneth
Published: October 2009

Expansion of two monocyte subpopulations expressing CD16 and their correlation with viral load are observed in this cross-sectional study of SIV-infected macaques.

Infection by HIV is associated with the expansion of monocytes expressing CD16 antigens, but the significance of this in HIV pathogenesis is largely unknown. In rhesus macaques, at least three subpopulations of blood monocytes were identified based on their expression of CD14 and CD16: CD14highCD16−, CD14highCD16low, and CD14lowCD16high. The phenotypes and functions of these subpopulations, including CD16+ monocytes, were investigated in normal, uninfected rhesus macaques and macaques that were infected with SIV or chimeric SHIV. To assess whether these different monocyte subpopulations expand or contract in AIDS pathogenesis, we conducted a cross-sectional study of 54 SIV- or SHIV-infected macaques and 48 uninfected controls. The absolute numbers of monocyte populations were examined in acutely infected animals, chronically infected animals with no detectable plasma virus RNA, chronically infected animals with detectable plasma virus RNA, and animals that died with AIDS. The absolute numbers of CD14highCD16low and CD14lowCD16high monocytes were elevated significantly in acutely infected animals and chronically infected animals with detectable plasma virus RNA compared with uninfected controls. Moreover, a significant, positive correlation was evident between the number of CD14highCD16low or CD14lowCD16high monocytes and plasma viral load in the infected cohort. These data show the dynamic changes of blood monocytes, most notably, CD14highCD16low monocytes during lentiviral infection, which are specific to disease stage.
Antigen-induced Erk1/2 activation regulates Ets-1-mediated sensitization of CD8+ T cells for IL-12 responses
Authors: Li Qingsheng , Eppolito Cheryl , Odunsi Kunle , Shrikant Protul A
Published: October 2009

The molecular basis of collaboration between instructions that program CD8+ T cells for long-term responses.

The presence of IL-12 during antigen stimulation instructs naive CD8+ T cells for long-term effector responses, but their mechanisms of collaboration are not understood completely. Herein, we report that CD8+ T cells (OT-I T cells) stimulated with antigen for a longer duration show enhanced sensitization to IL-12 as a result of Erk1/2-dependent, increased Ets-1 phosphorylation and subsequent increases in IL-12Rβ2 expression. Correspondingly, naive OT-I T cells stimulated by antigen for a longer duration in the presence of IL-12, irrespective of frequency of APCs, show robust effector maturation and mount long-term antigen-recall responses upon adoptive transfer. These results identify the role of antigen strength-dependent Erk1/2 activation for Ets-1-mediated collaboration with IL-12 in CD8+ T cells.
Immunopathogenesis of polymicrobial otitis media
Authors: Bakaletz Lauren O
Published: October 2009

The synergistic relationship between URT viruses and bacteria in OM pathogenesis is not fully understood, but overall is predicated on viral impairment of airway defenses.

OM, or inflammation of the middle ear, is a highly prevalent infection in children worldwide. OM is a multifactorial disease with multiple risk factors, including preceding or concurrent viral URT infection. Hence, OM is also a polymicrobial disease. The mechanisms by which viruses predispose to bacterial OM are replete; however, all are predicated on the general principle of compromise of primary host airway defenses. Thus, despite an as-yet incomplete understanding of the molecular mechanisms involved in bacterial superinfection of a virus-compromised respiratory tract, the URT viruses are known to induce histopathology of airway mucosal epithelium, up-regulate expression of eukaryotic receptors used for bacterial adherence, alter the biochemical and rheological properties of airway mucus, and affect innate and acquired host immune functions, among others. Although discussed here in the context of OM, during preceding or concurrent viral infection of the human respiratory tract, viral impairment of airway defenses and the resulting predisposition to subsequent bacterial coinfection are also known to be operational in the mid and lower airway as well.
Signaling through TLR7 enhances the immunosuppressive activity of murine CD4+CD25+ T regulatory cells
Authors: Forward Nicholas A , Furlong Suzanne J , Yang Yongjun , Lin Tong-Jun , Hoskin David W
Published: October 2009

In vitro and in vivo stimulation of the TLR7 signaling pathway of T regulatory cells causes increased IL-2 responsiveness and enhanced suppressor function.

Although signaling through certain TLRs is known to modulate the function of T lymphocytes, the effect of TLR7 stimulation on CD4+CD25+ Treg cell activity has not yet been elucidated. In this study, we show that mouse CD4+CD25+ Treg cells express TLR7 mRNA and protein. We therefore used the TLR7 agonists imiquimod, gardiquimod, and single-stranded poly(U) to show that TLR7 stimulation enhanced the ability of murine Treg cells to suppress anti-CD3/anti-CD28 mAb-coated bead-stimulated proliferation of syngeneic CD4+CD25– Tresp cells. In contrast, imiquimod failed to enhance the suppressor function of Treg cells from mice deficient in the MyD88 adaptor protein involved in TLR7 and other TLR signal transduction. Imiquimod increased murine Treg cell-mediated suppression of Tresp cell proliferation induced by anti-TCRβ mAb in the presence of syngeneic BMDCs, and Treg cells from gardiquimod-treated mice exhibited enhanced in vitro suppressor function. Moreover, levels of Tresp cell-secreted IL-2 and IFN-γ were reduced further in the presence of Treg cells plus imiquimod in comparison with Treg cells alone. In addition, imiquimod treatment increased CD25 expression by Treg cells and caused exogenous IL-2 to enhance Treg cell suppressor function. Furthermore, combined treatment with imiquimod and IL-2 increased Foxp3 expression by Treg cells. Collectively, these findings suggest that TLR7 signaling enhanced the suppressor function of Treg cells by sensitizing Treg cells to IL-2-induced activation. We speculate that TLR7-stimulated enhancement of Treg cell suppressor function may modulate host T cell responses against ssRNA viruses.
Clathrin-independent internalization of normal cellular prion protein in neuroblastoma cells is associated with the Arf6 pathway
Authors: Kang Young-Shin , Zhao Xiaohong , Lovaas Jenna , Eisenberg Evan , Greene Lois E.
Published: October 2009

To understand the role of clathrin-mediated endocytosis in the internalization of normal cellular prion protein (PrPc) in neuronal cells, N2a cells were depleted of clathrin by RNA interference. PrPc internalization via the constitutive endocytic pathway in the absence of Cu2+ and the stimulated pathway in the presence of Cu2+ were measured in both control and clathrin-depleted cells. Depletion of clathrin had almost no effect on the internalization of PrPc either in the presence or absence of Cu2+, in contrast to the marked reduction observed in transferrin uptake. By contrast, the internalization of PrPc was inhibited by the raft-disrupting drugs filipin and nystatin, and by the dominant-negative dynamin-1 mutant dynamin-1 K44A, both in the presence and absence of Cu2+. The internalized PrPc was found to colocalize with cargo that traffic in the Arf6 pathway and in large vacuoles in cells expressing the Arf6 dominant-active mutant. These results show that PrPc is internalized in a clathrin-independent pathway that is associated with Arf6.
HSCARG inhibits activation of NF-κB by interacting with IκB kinase-β
Authors: Gan Qini , Li Tingting , Hu Bin , Lian Min , Zheng Xiaofeng
Published: October 2009

HSCARG is a recently identified human NADPH sensor. Our previous studies have shown that HSCARG can affect NO production and cell viability, but the signal pathway mediated by this protein is unknown. Here, we show that HSCARG is involved in the NF-κB signaling pathway and find that HSCARG suppresses TNF- and IL1-induced NF-κB activation in a dose-dependent manner. Co-immunoprecipitation and immunofluorescence analyses demonstrate that HSCARG interacts and colocalizes with IKKβ. HSCARG inhibits the phosphorylation of IKKβ and further blocks the degradation of IκBα, the substrate of IKKβ, which retains NF-κB in the cytoplasm and suppresses its activity. In addition, our data indicate that IKKβ is required for HSCARG-inhibited NF-κB activation. Our findings delineate a pathway by which HSCARG negatively regulates NF-κB activation.
Reprogramming ofXistagainst the pluripotent state in fusion hybrids
Authors: Do Jeong Tae , Han Dong Wook , Gentile Luca , Sobek-Klocke Ingeborg , Wutz Anton , Schöler Hans R.
Published: October 2009

The fusion of somatic cells with pluripotent cells results in the generation of pluripotent hybrid cells. Because the `memory' of somatic cells seems to be erased during fusion-induced reprogramming, genetic reprogramming is thought to be a largely unidirectional process. Here we show that fusion-induced reprogramming, which brings about the formation of pluripotent hybrids, does not always follow a unidirectional route. Xist is a unique gene in that it is reprogrammed to the state of somatic cells in fusion-induced pluripotent hybrids. In hybrids formed from the cell fusion of embryonal carcinoma cells (ECCs) with male neural stem cells (mNSCs), the Xist gene was found to be reprogrammed to the somatic cell state, whereas the pluripotency-related and tissue-specific marker genes were reprogrammed to the pluripotent cell state. Specifically, Xist is not expressed in hybrids, because the `memory' of the somatic cell has been retained (i.e. mNSCs do not exhibit Xist expression) and that of the pluripotent cell erased (i.e. inactivation of the partially active Xist gene of ECCs, complete methylation of the Xist region). The latter phenomenon is induced by male, but not by female, NSCs.
Sensorless evaluation for a computer numerical control machine tool slide level using an empirical mode decomposition method
Authors: Zhou Y Q , Mei X S , Jiang G D , Sun N G , Tao T
Published: October 2009

Slide level has a lot of influence on computer numerical control (CNC) machine tool performance. The deterioration of slide level will result in torsional vibration of the feed-axis control system and lower CNC machine tool control precision. Hence, it is necessary to investigate evaluation technology for the slide level of CNC machine tools. In this article, a novel kind of sensorless evaluation method for machine tool slide level based on linear scale or motor encoder and AC servo motor current/output torque is proposed. To improve evaluation precision, a kind of filtering method based on empirical mode decomposition (EMD) technology is employed. The analysis results of the experiments show that it is simple, rapid, feasible, and reliable to use sensorless information for evaluating slide level based on the EMD method.
Transverse vibration of short carbon nanotubes using cylindrical shell and beam models
Authors: Ghorbanpourarani A , Mohammadimehr M , Arefmanesh A , Ghasemi A
Published: October 2009

The transverse vibrations of single- and double-walled carbon nanotubes are investigated under axial load by applying the Euler—Bernoulli and Timoshenko beam models and the Donnell shell model. It is concluded that the Euler—Bernoulli beam model and the Donnell shell model predictions have the lowest and highest accuracies, respectively. In order to predict the vibration behaviour of the carbon nanotube more accurately, the current classical models are modified using the non-local theory. The natural frequencies, amplitude coefficient, critical axial load, and strain are obtained for the simply supported boundary conditions.
Interstory drifts of multi-story buildings under random earthquake excitations
Authors: Gao W , Wang C , Zhang N
Published: October 2009

Interstory drifts of multi-story buildings with interval parameters subjected to stationary or non-stationary earthquake excitations are investigated. A multi-story building is modelled as a shear beam structure. The uncertainties of structural mass, stiffness, and damping are described by interval variables. Using the interval factor method, an interval structural parameter can be expressed as the product of its midpoint value and interval factor. Structural natural frequencies, power spectral density, and mean-square value of seismic random interstory drifts can then be expressed as the functions of interval factors of the structural parameters. The computational expressions for the lower bound, midpoint, upper bound, maximum width, and interval change ratio of the structural random interstory drifts are derived by means of the interval operations. The effects of the uncertainties of the structural parameters on the random responses of an eight-story building are investigated and discussed in detail.
Numerical investigation and validation of the optimization of a centrifugal compressor using a response surface method
Authors: Kim S , Park J , Ahn K , Baek J
Published: October 2009

In this article, an effective optimization performed by the authors, at the design mass flowrate, of a vaned centrifugal compressor using the response surface method is presented. The optimization process was carried out consecutively for the impeller and the diffuser. As a result of the optimization process, the efficiency and pressure ratio of the optimized model were found to be better than those of the original model because of some improvements in flow characteristics. Compared with the original model, dramatic changes in the pressure and entropy contours could be obtained in the optimized model. In order to determine the performance in the off-design operating conditions, an off-design analysis was carried out. Also, the numerical calculations in this optimization process are validated by the experimental results and show good agreement with the experimental results except under choking conditions.
Simulations of gas turbine performance: Influence of gas-behaviour modelling
Authors: Lee A S , Singh R , Probert S D
Published: October 2009

Several gas-turbine-behaviour simulation programs have been developed so far to predict gas turbines performances under design and off-design conditions. The focus of the present investigation is on addressing the effects of the different approaches to modelling the gases’ thermodynamic properties on the performance prediction of gas turbines, in particular that of the conventional and two-combustor engines.

Unfortunately, the use of various different models has resulted in variations in the predicted values for a gas turbine's performance under identical conditions. Also, in the comparison of the performance of the two-combustor engine with that of the conventional engine, the use of various different gas-properties models has shown different outcomes; for example, the predictions using the considered constant-specific-heat model have revealed that the two-combustor engine operates with a higher thermal efficiency compared with what is achievable using by the baseline (conventional) engine, whereas the predictions using the modified and improved specific-heat models have shown otherwise. Hence, depending on the applications, the selection of prediction methodology and its gas (thermodynamic) properties model might result in misleading findings.
Controllers with integral action: An experimental evaluation
Authors: Miranda M F , Takahashi R H C , Jota F G
Published: October 2009

This paper presents an experimental evaluation of two design methods for including integral action in
Role of jet core in splashing patterns of diesel jet impingement on a solid wall
Authors: Weclas M , Cypris J
Published: October 2009

Under certain conditions diesel jet wall impingement results in triangular (polygonal) splashing shapes. This process has been found to be almost independent of injection pressure, injection frequency or of the injection duration. The triangular splashing shapes are observed at a given transition time after diesel jet wall contact. This time depends on the distance from the wall and on the injection pressure (jet velocity). This triangular splashing process is dependent on the distance from the wall, and does not correspond to a typical hydraulic jump process. The wall jet created after jet impingement along the solid wall is not responsible for triangular splashing. The process investigated depends on the degree of the diesel jet development and is characterized by impingement of the jet core on the wall only. A hypothesis of a non-homogeneous jet core has been formulated and verified to explain triangular splashing regions.

For very small distances between nozzle and wall, the resulting splashing may be observed as a star-like three-jet structure. These jets, rebounding in three pre-dominating directions, will spread the preliminary circular splashing (just after wall contact of the primary jet), rendering the splashing geometry more and more triangular in shape until the transition time occurs.
Intestinal spirochetosis as a cause of chronic diarrhoea in patients with HIV infection: case report and review of the literature
Authors: Ena J , Simón-Aylón A , Pasquau F
Published: October 2009

We describe a 77-year-old patient with HIV infection suffering from chronic diarrhoea whose colonoscopy findings showed normal appearance mucosa and tissue samples revealed the presence of a dense layer of spirochetes attached to the apical cell membrane. A literature search from 1996 to April 2009 identified 19 additional cases of intestinal spirochetosis in patients with HIV infection. Analysis of cases showed that intestinal spirochetosis causes chronic diarrhoea in men who have sex with men (92% of patients with reported HIV infection risk factors) who are not severely immunosuppressed (70% with CD4 lymphocyte cells >200/μL). Colonoscopy examination often revealed normal appearance mucosa. Haematoxylin and eosin stain of biopsy samples showed the presence of spirochetes, but Warthin–Starry silver staining makes organisms easier to detect. Patients promptly responded to metronidazole or penicillin therapy. In summary, invasive intestinal spirochetosis should be considered in the differential diagnosis of patients with HIV infection and chronic diarrhoea.
Temporal Forecast Uncertainty for Ramp Events
Authors: Greaves Beatrice , Collins Jonathan , Parkes Jeremy , Tindal Andrew
Published: October 2009

As the penetration of wind energy continues to increase around the world, the impact of wind energy on the management of electrical grids is becoming increasingly evident. The challenge for the grid operator of integrating wind energy, or for the energy trader to maximise the market value of the energy, is toughest during periods of rapid change in wind farm production, or ramp events. These events are also tough to forecast accurately, and it is therefore essential to understand the uncertainty of forecasting such events.

To date the majority of work on the uncertainty of wind energy forecasts has been focused on the possible amplitude of wind production that might occur at a given time. However, there has been limited investigation into effectively defining the possible timing of significant wind energy events.

This paper aims to focus on methodologies for generating temporal forecast uncertainty for rapid changes in wind farm production. The first challenge is to define ramp events, secondly the forecast uncertainty needs to be calculated and finally this information needs to be presented clearly to the end user. This paper covers these three areas, with a focus on the method of calculating forecast uncertainty using multiple NWP inputs, statistical processing and adaptive algorithms.

The results are based on GH Forecaster services for both individual and portfolios of wind farms. The outcome of the investigation demonstrates that temporal forecast uncertainty can be calculated and clearly presented to indicate the likely timing and amplitude of wind energy ramp events.
Experimental Investigations on Sail Type Wind-Turbines
Authors: Ghosh Pronoy , Kamoji M.A. , Date A.W. , Prabhu S.V.
Published: October 2009

Horizontal and vertical axis type wind turbines using sails (instead of rigid blades) are experimentally investigated. Cretan type wind turbines are horizontal axis sail type wind turbines. The simple design, low cost and ease of construction of these turbines make them an attractive option for areas having low wind velocities. Coefficient of power and coefficient of torque for Cretan type rotor with 5 blades for a solidity ratio of 0.85 is studied. The type of the cloth used is polyester with porosity ranging between 75 to 300 μm. Experiments are conducted for Reynolds number of 1 × 105 and 1.2 × 105 and tip speed ratios ranging between 0 and 0.1. Influence of sail angle (5°, 15°, 25° and 30°) on the performance of the horizontal axis sail type wind turbines is investigated. Sail angle of 25° gives the maximum coefficient of power of 0.31 at a tip speed ratio of 0.71.

Sail Savonius wind turbines are investigated on the vertical wind turbine domain. The enhanced performance of Cretan type wind rotors using sails laid the foundation for studying the behavior of Savonius wind turbines with flexible blades. The sail Savonius rotor used in the study has a rotor diameter of 180 mm with an overlap ratio of 0.15. The type of cloth used is polyester with the porosity ranging between 75 to 300 μm. The performance characteristic curves are measured for Reynolds number of 9 × 104 and 1 × 105. The peak value of coefficient of power is around 0.05 at a tip speed ratio of 0.43 for a Reynolds number of 1 × 105.
Fast Prototype Blade Design
Authors: Hjort Søren , Dixon Kristian , Gineste Michael , Olsen Anders S.
Published: October 2009

One of the most obvious and promising solutions to bringing down cost of wind energy is continued improvement of energy output per structural load. For the blade designer this boils down to the task of designing a blade with a desired energy output and an optimized ratio of energy per load. Since the wind industry is not yet at a stage where all performance and loading aspects of new blade types can be determined with full certainty on a purely theoretical and analytical basis, manufacturing and testing of full-scale prototypes remains a fundamental cornerstone.

The paper presents a fast prototyping development platform. This platform enables complete blade layout optimization as well as nested optimizations of sub-component entities such as airfoils and laminate plans. Validation comes at various levels, both numerically from more advanced models that are not applicable for large scale optimization, and from physical tests, e.g. wind tunnel profile measurements. First, the detailed workflow of the fast prototyping development platform is laid out. Then a specific and recent example of a multi-MW blade design optimization is given, and finally the results are discussed and a path for process improvements is suggested.
Effects of Exposure to Loud Noise on Hearing on People of Calabar, Cross River State, Nigeria
Authors: Asuquo U.E. , Onuu M.U. , Asuquo A.U.
Published: October 2009

The effects of noise on hearing have been assessed among residents of Calabar, Cross River State, Nigeria, using subjective and objective measures. A 39-item questionnaire was used for the subjective measure. A sample size of 1000 persons in the high noise zones (noise level>80 dB(A)) was randomly selected and used as a study group while 1000 persons in the low noise zones (noise level<50dB(A)) were also randomly selected and used as the control group. Results on Pure Tone Audiometry (PTA) was used to assess the hearing acuity of the respondents and to determine if there was any effect of exposure to loud noise on the hearing of those in the high noise zones. Using a statistical analysis software (SAS), a probability value of 0.0001 (<0.05) and a calculated chi-square (χ2) value of 82.2509 (tabulated χ2=5.22) were obtained. Thus implying that exposure to loud noise does affect hearing of residents in the high noise zones.
On the Maximum Quadratic Assignment Problem
Authors: Nagarajan Viswanath , Sviridenko Maxim
Published: October 2009

Quadratic assignment is a basic problem in combinatorial optimization that generalizes several other problems such as traveling salesman, linear arrangement, dense k subgraph, and clustering with given sizes. The input to the quadratic assignment problem consists of two n × n symmetric nonnegative matrices [Formula: see text] and [Formula: see text]. Given matrices W, D, and a permutation [Formula: see text], the objective function is [Formula: see text]. In this paper, we study the maximum quadratic assignment problem, where the goal is to find a permutation π that maximizes [Formula: see text]. We give an [Formula: see text]-approximation algorithm, which is the first nontrivial approximation guarantee for this problem. The above guarantee also holds when the matrices W, D are asymmetric. An indication of the hardness of maximum quadratic assignment is that it contains as a special case the dense k subgraph problem, for which the best-known approximation ratio is [Formula: see text] (Feige et al. [Feige, U., G. Kortsarz, D. Peleg. 2001. The dense k-subgraph problem. Algorithmica 29(3) 410–421]).

When one of the matrices W, D satisfies triangle inequality, we obtain a [Formula: see text]-approximation algorithm. This improves over the previously best-known approximation guarantee of four (Arkin et al. [Arkin, E. M., R. Hassin, M. Sviridenko. 2001. Approximating the maximum quadratic assignment problem. Inform. Processing Lett. 77 13–16]) for this special case of maximum quadratic assignment.

The performance guarantee for maximum quadratic assignment with triangle inequality can be proved relative to an optimal solution of a natural linear programming relaxation that has been used earlier in branch-and-bound approaches (see, eg., Adams and Johnson [Adams, W. P., T. A. Johnson. 1994. Improved linear programming-based lower bounds for the quadratic assignment problem. DIMACS Ser. Discrete Math. Theoret. Comput. Sci. 16 43–77]). It can also be shown that this linear program (LP) has an integrality gap of [Formula: see text] for general maximum quadratic assignment.
Flow Cytometric Immunophenotyping and Minimal Residual Disease Analysis in Multiple Myeloma
Authors: Gupta Ritu , Bhaskar Archana , Kumar Lalit , Sharma Atul , Jain Paresh
Published: October 2009

Presence of normal plasma cells (PCs), hemodilution of bone marrow aspirate, and changes in the immunophenotype are important considerations in minimal residual disease (MRD) assessment in multiple myeloma (MM). We evaluated 124 subjects—107 with MM, 11 with Hodgkin lymphoma, and 6 allogeneic stem cell transplantation donors—for the immunophenotype of neoplastic, reactive, and normal PCs respectively. Of the patients with MM, 36 were evaluated for MRD and 23 for a change in immunophenotype after chemotherapy. The immunophenotype of normal and reactive PCs was similar and differed from that of neoplastic PCs with respect to CD19, CD45, CD56, CD52, CD20, and CD117. At least 2 antigens were aberrantly expressed in all cases and 3 in 90.7% of MM cases. A change in the immunoprofile of PCs was observed in 18 (78%) of 23 cases. By using flow cytometry, we detected MRD in all samples, and a neoplastic PC index (percentage of neoplastic PCs/total bone marrow PCs) of less than 30 could differentiate immunofixation (IFx)− from IFx+ samples (complete and partial responders, respectively).
Is the QuantiFERON-TB Blood Assay a Good Replacement for the Tuberculin Skin Test in Tuberculosis Screening?
Authors: Zhao Xiangrong , Mazlagic Damir , Flynn Ethan A. , Hernandez Helda , Abbott Charles L.
Published: October 2009

The QuantiFERON-TB Gold In-Tube method (QFT-GIT; Cellestis, Carnegie, Australia) is a recently US Food and Drug Administration–approved interferon-γ release assay (IGRA) for the detection of tuberculosis infection, which has been screened for by the tuberculin skin test (TST) for nearly a century. We report a pilot study comparing the QFT-GIT and TST results for screening health care workers (HCWs) at Berkshire Medical Center (BMC; Pittsfield, MA), the second hospital in Massachusetts to use QFT-GIT. For the study, 40 BMC HCWs, 20 TST+ and 20 TST−, were screened with the QFT-GIT test.

All 20 TST− subjects were also QFT-GIT−, while only 10 of 20 TST+ subjects were QFT-GIT+. The overall agreement between the QFT-GIT and TST results was 75% (κ = 0.5; 95% confidence interval, 0.268–0.732). The suboptimal agreement was partially due to a higher specificity of QFT-GIT. Confounding factors (eg, bacille Calmette-Guérin vaccination status and birthplace) are discussed, and literature regarding IGRAs and their comparison with TST is reviewed.
Immunophenotypic Variations in Mantle Cell Lymphoma
Authors: Gao Juehua , Peterson LoAnn , Nelson Beverly , Goolsby Charles , Chen Yi-Hua
Published: October 2009

Mantle cell lymphoma (MCL) expresses pan–B-cell antigens and is usually CD5+/CD10−/CD23−/FMC7+. In this study, we evaluated 52 patients with confirmed diagnoses of MCL and identified variant immunophenotypes in 21 patients (19/48 classical and 2/4 variant MCLs), including CD5− in 6 (12%) of 52, CD10+ in 4 (8%) of 50, CD23+ in 10 (21%) of 48, and FMC7− in 4 (11%) of 37 cases. Three cases showed variations in 2 antigens, including CD5−/CD23+, CD10+/FMC7−, and CD23+/FMC7−; they were all classical MCLs. One blastoid variant MCL was CD23+, and one was FMC7−. Evaluation for proliferation index by immunohistochemical analysis for Ki-67 demonstrated no significant difference between MCLs with variant immunophenotypes and MCLs with typical immunophenotypes. The high proliferation index (>60%) was exclusively seen in the blastoid and pleomorphic variants. Our results indicate that immunophenotypic variations are common in MCL, and recognizing the variability is important for accurate subclassification of B-cell lymphoma.
Time Trends in Fungal Infections as a Cause of Death in Hematopoietic Stem Cell Transplant Recipients
Authors: Alsharif Mariam , Cameron Stuart E. H. , Young Jo-Anne H. , Savik Kay , Henriksen Jonathan C. , Gulbahce H. Evin , Pambuccian Stefan E.
Published: October 2009

Infectious complications remain an important cause of death in hematopoietic stem cell transplant (HSCT) recipients. We undertook a 20-year (1988–2007) retrospective review of all autopsies performed on HSCT recipients in our institution, with emphasis on infections, especially fungal infections, as the cause of death. Of the 2,943 autopsies performed in our institution from 1988 to 2007, 395 (13.4%) involved HSCT recipients (117 pediatric; 278 adult). Of the patients, 298 had received allogeneic, 46 autologous, 41 umbilical cord blood, and 3 autologous plus allogeneic types, and 7 were unknown HSCT types. The most common causes of death were pulmonary complications, occurring in 247 (62.5%) of 395 cases. In 178 cases (45.1%), microorganisms (viral, bacterial, and/or fungal) were documented at autopsy in one or more organs and contributed to the cause of death. Fungal infections were found in 23.5% of cases, but their frequency as a cause of death decreased throughout this study, from 30.3% in the 1988–1992 period to 10.9% in the 2003–2007 period.
T-Cell Receptor Gene Rearrangement and CD30 Immunoreactivity in Traumatic Ulcerative Granuloma With Stromal Eosinophilia of the Oral Cavity
Authors: Salisbury Catherine L. , Budnick Steven D. , Li Shiyong
Published: October 2009

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is an ulcerative lesion of the oral mucosa with unknown pathogenesis. A few recent case reports have demonstrated molecular evidence of T-cell clonality in TUGSE and CD30 immunoreactivity in the large atypical mononuclear cells, raising the possibility that a TUGSE subset may represent the oral counterpart of primary cutaneous CD30+ T-cell lymphoproliferative disorders. We examined the immunoreactivity for CD30 and T-cell receptor (TCR) γ gene rearrangement in 37 TUGSE cases. Clonal TCR gene rearrangements were demonstrated in 7 (24%) of 29 cases with amplifiable DNA, and the morphologic features and CD30 immunoreactivity of these cases did not differ from those with polyclonal TCR gene rearrangements. Clinical follow-up was available for 5 of 7 TUGSE cases with clonal TCR gene rearrangement for an average period of 1.75 years after the initial biopsy or excision, and there was no evidence of local recurrence or development of systemic T-cell lymphoproliferative disorder. Without morphologic and/or clinical evidence of lymphoma, T-cell clonality and/or CD30 positivity in these lesions is not indicative of malignancy and should be interpreted with caution.
Does Advice from Pharmacy Staff Vary According to the Nonprescription Medicine Requested?
Authors: Kelly Fiona S , Williams Kylie A , Benrimoj Shalom I
Published: October 2009

Background:

Community pharmacy has long been advocated as an appropriate gateway of supply for nonprescription medicines and health-related advice. Consumers sometimes self-treat the symptoms of minor illness, yet there is conflicting evidence over their ability to do so properly. Emerging trends also suggest a variable approach to nonprescription medicine supply by pharmacy staff. Understanding of this is limited and more structured exploration is needed.

Objective:

To explore variation in pharmacy staff response to requests for nonprescription medicines from different legislative schedules through analysis of data collected using pseudo-patient methods.

Methods:

Consumers posed as pharmacy patrons (ie, pseudo-patients, simulated patients) and requested 1 of 3 specific nonprescription medicines by name. Two of these, ibuprofen and a branded cold and flu medication, could be sold by any pharmacy staff member (these were considered Pharmacy Medicine). The third, a combination analgesic containing paracetamol (acetaminophen), codeine, and doxylamine, required pharmacist involvement in the sale (considered Pharmacist Only Medicine). Pseudo-patient visits measured the service provided in each pharmacy by observing whether staff performed particular behaviors such as providing advice regarding the drugs.

Results:

Staff response was generally superior when pseudo-patients requested the combination analgesic that required pharmacist intervention. Medicine advice was provided verbally to 84.9% of pseudo-patients requesting this analgesic compared with 51.1% of those requesting the cold and flu medication. Similar trends were observed for other behaviors.

Conclusions:

Emerging patterns imply that pharmacy staff response may vary according to the medicine requested. It may be that pharmacists and their staff prioritize drugs or behaviors that they consider critically relevant as part of a risk management approach. This has possible implications for future scheduling policy. Further research using a range of scenarios would more fully explore the breadth of such behavior. This would aid identification of medicines that trigger professional intervention and inform development of targeted training programs.
Documentation Quality in Community Pharmacy: Completeness of Electronic Patient Records After Patients' First Visits
Authors: Floor-Schreudering Annemieke , De Smet Peter AGM , Buurma Henk , Egberts Antoine CG , Bouvy Marcel L
Published: October 2009

Background:

When patients visit a community pharmacy for the first time, the creation of an electronic patient record (EPR) with relevant and up-to-date data is a prerequisite for adequate medication surveillance and patient counseling.

Objective:

To investigate the level of completeness of documentation in the EPR after a patient's first visit to a Dutch community pharmacy.

Methods:

In each participating pharmacy, newly enlisted (<3 mo) patients to whom at least one medication had been dispensed were enrolled in this survey. For each patient who could be interviewed, pharmacy master students used a structured questionnaire to gather relevant, mandatory patient data (ie, basic characteristics, current drugs used, diseases, intolerabilities, specific conditions) and nonmandatory patient data (eg, diagnostic and monitoring data, personal experiences and habits, drug use problems) from the patient's EPR and from a structured telephone interview with the patient. Data retrieved from the patient's EPR were compared with data provided by the patient during the telephone interview.

Results:

Of 403 selected patients, 154 (38.2%) could be interviewed by telephone. Poor documentation of telephone numbers in the EPR was the main reason for nonresponse (134/249). Interviewers found that 67.7% of prescription drugs, 0% of over-the-counter drugs, 19.6% of diseases, 3.7% of intolerabilities, and none of the specific conditions reported by patients had been documented in the EPR. Nonmandatory data (personal experiences and habits, drug use problems) reported during the patient interview had not been documented in the EPR.

Conclusions:

The EPR after a patient's first visit to the community pharmacy is often incomplete. For new patients, the pharmacist should more proactively and systematically gather patient information, and all relevant information should be recorded, preferably in coded form, in the pharmacy information system to allow more adequate clinical risk management.
Effect of Drug Information Request Templates on Pharmacy Student Compliance with the Modified Systematic Approach to Answering Drug Information Questions
Authors: Lavsa Stacey M , Corman Shelby L , Verrico Margaret M , Pummer Tara L
Published: October 2009

Background:

The modified systematic approach to answering drug information questions is a technique used in drug information practice and in teaching pharmacy students to effectively provide drug information. Drug information request templates were developed to prompt students and other trainees to ask appropriate background questions and perform an effective search.

Objective:

An evaluation was conducted to determine whether use of drug information templates by fourth-year pharmacy students during their drug information experiential rotation improved compliance with the modified systematic approach.

Methods:

Fifty documented drug information requests, including 25 prior to template implementation (August 2005–August 2006) and 25 after template implementation (August 2007–August 2008), were randomly selected for evaluation. Each question was evaluated for completeness of background information obtained, categorization and identification of the ultimate question, completeness of references searched, and formulation of a concise response and an evidence-based recommendation.

Results:

Background information was complete in 16% of pre-template questions and 92% of post-template questions (p < 0.001). Eighty-four percent of pre-template questions and 96% of post-template questions were appropriately categorized (p = 0.349). The requestor's ultimate question was clearly identified in 68% of pre-template questions and 92% of post-template questions (p = 0.074). All necessary references were searched in 36% of pre-template questions and 88% of post-template questions (p < 0.001). A concise response was documented in 80% of pre-template questions and 92% of post-template questions (p = 0.417). In questions determined to require a specific recommendation among the pre-template (n = 20) and post-template groups (n = 14), a clear and evidence-based recommendation was described in 40% (p = 0.038) and 79% (p = 0.038), respectively.

Conclusions:

Use of drug information request templates improves students' compliance with the modified systematic approach, most notably in obtaining background information and searching necessary references including primary literature.
Teacher Involvement in the Development of Function-Based Behaviour Intervention Plans for Students With Challenging Behaviour
Authors: O'Neill Sue , Stephenson Jennifer
Published: October 2009

This article examines literature published since 1997 on functional behaviour assessment (FBA) and behaviour intervention plans (BIPs), involving school-based personnel, for children identified as having or being at risk of emotional/behavioural disorder (E/BD) in school settings. Of interest was the level of involvement of school-based personnel in the FBA and BIP processes, intervention efficacy, the social validity of assessment and intervention, and intervention treatment integrity. Results indicate that involvement of school-based personnel in all FBA processes and BIP design was not common practice. FBA-based BIPs were found to be effective in reducing problem behaviours targeted for change for the majority of student participants. Social validity and treatment integrity measures, when reported, were high. Issues of training and barriers to successful application are discussed.
Quenching a Desire for Power: The Role of Music Therapy for Adolescents With ADHD
Authors: McFerran Katrina
Published: October 2009

There is a growing body of literature that investigates the value of music therapy for people with emotional and behavioural disorders such as attention deficit disorder. These studies often focus on overt behavioural change as the indication of successful outcomes. The instrumental case study reported here challenges this focus and provides a description of music therapy for one young man that emphasises the importance of power in his experience. A grounded theory analysis of this single case reveals that both individual and small-group music therapy provided important opportunities for the young man to express himself and to control what he and others did. This example is intended to stimulate the contemplation of different understandings of the potential role for music therapy, with an emphasis on emotional needs and quality of life as the primary focus.
Visual Impairment in the Absence of Dystroglycan
Authors: Satz Jakob S. , Philp Alisdair R. , Nguyen Huy , Kusano Hajime , Lee Jane , Turk Rolf , Riker Megan J. , Hernández Jasmine , Weiss Robert M. , Anderson Michael G. , Mullins Robert F. , Moore Steven A. , Stone Edwin M. , Campbell Kevin P.
Published: October 2009

Ocular involvement in muscular dystrophy ranges from structural defects to abnormal electroretinograms. While the mechanisms underlying the abnormal retinal physiology in patients are not understood, it is thought that α-dystroglycan extracellular interactions are critical for normal visual function. Here we show that β-dystroglycan anchors dystrophin and the inward rectifying K+channel Kir4.1 at glial endfeet and that disruption of dystrophin and potassium channel clustering in dystroglycan mutant mice is associated with an attenuation of the electroretinogram b-wave. Glial-specific inactivation of dystroglycan or deletion of the cytoplasmic domain of β-dystroglycan was sufficient to attenuate the electroretinogram b-wave. Unexpectedly, deletion of the β-dystroglycan cytoplasmic domain did not disrupt the laminar structure of the retina. In contrast to the role of α-dystroglycan extracellular interactions during early development of the CNS, β-dystroglycan intracellular interactions are important for visual function but not the laminar development of the retina.