bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimates of mortality attributable to influenza and RSV in the United States during 1997–2009 by influenza type or subtype, age, cause of death, and risk status
Authors: Matias Gonçalo , Taylor Robert , Haguinet François , Schuck‐Paim Cynthia , Lustig Roger , Shinde Vivek
Published: June 2014

Background

Influenza and respiratory syncytial virus (RSV) cause substantial mortality from respiratory and other causes in the USA, especially among people aged 65 and older.

Objectives

We estimated the influenza‐attributable mortality and RSV‐attributable mortality in the USA, stratified by age and risk status, using outcome definitions with different sensitivity and specificity.

Methods

Influenza‐ and RSV‐associated mortality was assessed from October 1997–March 2009 using multiple linear regression modeling on data obtained from designated government repositories.

Results

The main outcomes and measures included mortality outcome definitions—pneumonia and influenza, respiratory broad, and cardiorespiratory disease. A seasonal average of 10 682 (2287–16 363), 19 100 (4862–29 245), and 28 169 (6797–42 316) deaths was attributed to influenza for pneumonia and influenza, respiratory broad, and cardiorespiratory outcome definitions, respectively. Corresponding values for RSV were 6211 (4584–8169), 11 300 (8546–14 244), and 17 199 (13 384–21 891), respectively. A/H3N2 accounted for seasonal average of 71% influenza‐attributable deaths; influenza B accounted for most (51–95%) deaths during four seasons. Approximately 70% influenza‐attributable deaths occurred in individuals ≥75 years, with increasing mortality for influenza A/H3N2 and B, but not A/H1N1. In children aged 0–4 years, an average of 97 deaths was attributed to influenza (A/H3N2 = 49, B = 33, A/H1N1 = 15) and 165 to respiratory broad outcome definition (RSV). Influenza‐attributable mortality was 2·94‐fold higher in high‐risk individuals.

Conclusions

Influenza‐attributable mortality was highest in older and high‐risk individuals and mortality in children was higher than reported in passive Centers for Disease Control and Prevention surveillance. Influenza B‐attributable mortality was higher than A in four of 12 seasons. Our estimates represent an updated assessment of influenza‐attributable mortality in the USA.
Death from 1918 pandemic influenza during the First World War: a perspective from personal and anecdotal evidence
Authors: Wever Peter C. , van Bergen Leo
Published: June 2014

The Meuse‐Argonne offensive, a decisive battle during the First World War, is the largest frontline commitment in American military history involving 1·2 million U.S. troops. With over 26 000 deaths among American soldiers, the offensive is considered “America's deadliest battle”. The Meuse‐Argonne offensive coincided with the highly fatal second wave of the influenza pandemic in 1918. In Europe and in U.S. Army training camps, 1918 pandemic influenza killed around 45 000 American soldiers making it questionable which battle should be regarded “America's deadliest”. The origin of the influenza pandemic has been inextricably linked with the men who occupied the military camps and trenches during the First World War. The disease had a profound impact, both for the military apparatus and for the individual soldier. It struck all the armies and might have claimed toward 100 000 fatalities among soldiers overall during the conflict while rendering millions ineffective. Yet, it remains unclear whether 1918 pandemic influenza had an impact on the course of the First World War. Still, even until this day, virological and bacteriological analysis of preserved archived remains of soldiers that succumbed to 1918 pandemic influenza has important implications for preparedness for future pandemics. These aspects are reviewed here in a context of citations, images, and documents illustrating the tragic events of 1918.
Evaluation of vacuum‐assisted closure in patients with wound complications following tumour surgery
Authors: Mermerkaya Ugur , Bekmez Senol , Alkan Erkan , Ayvaz Mehmet , Tokgozoglu Mazhar
Published: June 2014

Covering the reconstructed area with a healthy soft‐tissue envelope is a major challenge after limb‐sparing surgery in patients with malignant bone and soft‐tissue tumours. Negative pressure wound therapy (NPWT) of open wounds hastens healing and minimises the requirement for complex reconstructive soft‐tissue surgery. The aim of this study was to investigate the effectiveness and safety of NPWT in bone and soft‐tissue malignant tumour patients with postoperative wound complications. Between January 2006 and November 2009, at a single institution, 13 patients with malignant bone and soft‐tissue tumours who had undergone wide resection were retrospectively analysed. NPWT was performed in all patients to temporarily close the soft‐tissue defects. After obtaining the culture negativity and normal infection markers, definitive soft‐tissue reconstruction was performed to close the wound with primary suturisation in two patients, split thickness grafts in four patients, full thickness grafts in two patients, rotational flaps in three patients and free flaps in two patients. Mean duration of hospitalisation was 20 (range 8–48) days and mean follow‐up period was 57·3 (range 50–74) months. There was no tumour recurrence or skip metastasis in the follow‐up period. In addition, there was no periprosthetic infection or complication associated with NPWT. In conclusion, NPWT therapy seems to be a safe and effective option in the management of local wound problems and secondary surgical site infections after musculoskeletal tumour surgery.
Density‐dependent effects on nesting success of temperate‐breeding Canada geese
Authors: Lebeuf Anik Pannetier , Giroux Jean‐François
Published: June 2014

Density‐dependent effects on reproduction can arise through variation in habitat quality or increased competition and interference among neighbours. Negative effects have been found in avian populations and these have been mainly attributed to food limitations. In this study, we investigated whether density‐dependent effects could result from either heterogeneity in habitat suitability, interference among neighbours, or predation. To test these hypotheses, we collected data over eight years in a growing population of temperate‐nesting Canada geeseBranta canadensis maxima. We compared different parameters of nesting success of geese between two sites characterized by different nest densities and looked at the effects of nest proximity on these parameters within each site. At the landscape level, we found density‐dependent effects due to variation in habitat quality associated with predation probabilities and flooding events. At a finer scale, nesting success declined with proximity to neighbours, probably due to increased aggressive interactions among pairs. However, complete clutch predation showed both positive and negative density‐dependence, due to differences in predator community at each site. We concluded that density‐dependent effects reduced nesting success of Canada geese through both heterogeneity in habitat safety and agonistic interference between neighbours but that density‐dependent effects could also be positive in some instances.
Causation in evidence‐based medicine: in reply to Strand and Parkkinen
Authors: Kerry Roger , Eriksen Thor E. , Noer Lie Svein A. , Mumford Stephen , Anjum Rani L.
Published: June 2014

Strand and Parkkinen criticize our dispositional account of causation in evidence‐based medicine for failing to provide a proper epistemology of causal knowledge. In particular, they claim that we do not explain how causal inferences should be drawn. In response, we point out that dispositionalism does indeed have an account of the epistemology of causation, including counterfactual dependence, intervention, prediction and clinical decision. Furthermore, we argue that this is an epistemology that fits better with the known fallibility of even our best‐informed predictions. Predictions are made on the basis that causes dispose or tend towards their effects, rather than guarantee them. The ontology of causation remains a valuable study for, among other reasons, it tells us that powers do not always combine additively. This counts against the monocausality that is tested by randomized controlled trials.
Multi‐day recurrences of intimate partner violence and alcohol intake across dynamic patterns of violence
Authors: Katerndahl David , Burge Sandra , Ferrer Robert , Becho Johanna , Wood Robert
Published: June 2014

Rationale, aims and objectives

Consistent links exist between male alcohol intake and male‐perpetrated intimate partner violence (IPV) as well as female alcohol intake and female‐perpetrated IPV. However, the nature of the relationship remains unclear. This study attempted to identify unique alcohol–violence patterns within three different types of relationship dynamics to better understand the alcohol–violence relationship and its role in violence dynamics.

Method

Two hundred women in abusive relationships were recruited from six primary care clinics. Subjects completed daily assessments of their relationship using interactive verbal response via telephone for 12 weeks. Dynamic patterns (periodic, chaotic, random) were determined by positive versus negative Lyapunov exponents and measures of correlation dimension saturation. To identify recurrent day‐to‐day activities, we used orbital decomposition (based on symbolic dynamics).

Results

Periodic dynamics included daily reports with mutual abuse and alcohol intake while random dynamics included a variety of patterns, especially those involving unequal mutual abuse. Unique strings for each dynamic pattern were examined. Periodic dynamics involved heavy alcohol intake by the husband or mutual moderate‐severe violence. Random dynamics uniquely involved mutual verbal abuse with husband's alcohol intake on same or different days as well as husband‐perpetrated moderate‐severe violence with or without husband‐perpetrated minor violence. Chaotic dynamics uniquely involved combinations from wife‐perpetrated minor violence alone to combinations of husband's heavy alcohol intake (with or without husband‐perpetrated minor violence), mutual verbal abuse, and husband‐perpetrated verbal abuse (with or without husband's heavy alcohol intake).

Conclusion

Recurrent 4‐day patterns were observed. Each dynamic pattern was characterized by recurrent strings unique to that pattern.
Evaluation of Experimental Coating to Improve the Zirconia‐Veneering Ceramic Bond Strength
Authors: Matani Jay D. , Kheur Mohit , Jambhekar Shantanu Subhashchandra , Bhargava Parag , Londhe Aditya
Published: June 2014

Purpose

To evaluate the shear bond strength (SBS) between zirconia and veneering ceramic following different surface treatments of zirconia. The efficacy of an experimental zirconia coating to improve the bond strength was also evaluated.

Materials and Methods

Zirconia strips were fabricated and were divided into four groups as per their surface treatment: polished (control), airborne‐particle abrasion, laser irradiation, and application of the experimental coating. The surface roughness and the residual monoclinic content were evaluated before and after the respective surface treatments. A scanning electron microscope (SEM) analysis of the experimental surfaces was performed. All specimens were subjected to shear force in a universal testing machine. The SBS values were analyzed with one‐way ANOVA followed by Bonferroni post hoc for groupwise comparisons. The fractured specimens were examined to observe the failure mode.

Results

The SBS (29.17 MPa) and roughness values (0.80) of the experimental coating group were the highest among the groups. The residual monoclinic content was minimal (0.32) when compared to the remaining test groups. SEM analysis revealed a homogenous surface well adhered to an undamaged zirconia base. The other test groups showed destruction of the zirconia surface. The analysis of failure following bond strength testing showed entirely cohesive failures in the veneering ceramic in all study groups.

Conclusion

The experimental zirconia surface coating is a simple technique to increase the microroughness of the zirconia surface, and thereby improve the SBS to the veneering ceramic. It results in the least monoclinic content and produces no structural damage to the zirconia substructure.
Influence of Matrix Attachment Installation Load on Movement and Resultant Forces in Implant Overdentures
Authors: Goto Takaharu , Nagao Kan , Ishida Yuichi , Tomotake Yoritoki , Ichikawa Tetsuo
Published: June 2014

Purpose

This in vitro study investigated the effect of attachment installation conditions on the load transfer and denture movements of implant overdentures, and aims to clarify the differences among the three types of attachments, namely ball, Locator, and magnet attachments.

Materials and Methods

Three types of attachments, namely ball, Locator, and magnetic attachments were used. An acrylic resin mandibular edentulous model with two implants placed in the bilateral canine regions and removable overdenture were prepared. The two implants and bilateral molar ridges were connected to three‐axis load‐cell transducers, and a universal testing machine was used to apply a 50 N vertical force to each site of the occlusal table in the first molar region. The denture movement was measured using a G2 motion sensor. Three installation conditions, namely, the application of 0, 50, and 100 N loads were used to install each attachment on the denture base. The load transfer and denture movement were then evaluated.

Results

The resultant force decreased with increasing installation load for all attachments. In particular, the resultant force on implants on the loading side of the Locator attachment significantly decreased when the installation load was increased from 0 to 50 N, and that for magnetic attachment significantly decreased when the installation load was increased from 50 to 100 N. For the residual ridges on the loading side, the direction of the forces for all attachments changed to downward with increasing installation load. Furthermore, the yaw Euler angle increased with increasing installation load for the magnetic attachment.

Conclusions

Subject to the limitations of this study, the use of any installation load greater than 0 N is recommended for the installation of ball and Locator attachments on a denture base. Regarding magnetic attachments, our results also recommend installation on a denture base using any installation load greater than 0 N, and suggest that the resultant force acting on the implant can be decreased by increasing the installation load; however, a large installation load of 100 N should be avoided when installing the attachment on the denture base to avoid increasing the denture movement.
Influence of Implant Angulation on the Fracture Resistance of Zirconia Abutments
Authors: Thulasidas Shreedevi , Givan Daniel A. , Lemons Jack E. , O'Neal Sandra Jean , Ramp Lance C. , Liu Perng‐Ru
Published: June 2014

Purpose

To investigate the effects of abutment design to correct for implant angulation and aging on the fracture resistance of zirconia abutments. Greater understanding of the fracture strength of the zirconia abutments under various clinical conditions may lead to improvement of clinical protocols and possibly limit potential failures of implant prosthetics.

Materials and Methods

Test specimens consisted of an implant‐zirconia abutment‐zirconia crown assembly with implant apex positioned at 0°, 20° to the facial (20F), and 20° to the lingual (20L) with respect to a constant crown contour. To keep the abutment design as the only variable, CAD/CAM technology was used to generate monolithic zirconia crowns identical both in external and internal dimensions and marginal contours to precisely fit all the abutments in an identical fashion. The monolithic zirconia abutments were designed to fit the constant crown contours and the internal connection of the implant at the three angulations. The customized abutments for the three implant angulations varied in emergence profile, screw hole location, and material thickness around the screw hole. Half the specimens from each group were subjected to steam autoclaving and thermocycling to simulate aging of the restorations in vivo. To mimic the off‐axis loading of the central incisor, the specimens were loaded at the recommended cephalometric interincisal relationship of 135° between the long axis of the crown supported by the implant and the Instron force applicator simulating the mandibular incisor. The force applicator was positioned 2 mm from the incisal edge and loaded at a 1 mm/min crosshead speed. Data were evaluated by 2‐way ANOVA (α = 0.05) and Tukey's HSD.

Results

The 20F group had the highest fracture values followed by the 0° group, and the 20L group had the lowest fracture values. Aging did not yield any significant difference in fracture force magnitudes.

Conclusion

Within the limitations of this study, tilting the implant apex to the lingual significantly reduced the fracture strength of angle‐corrected zirconia abutments. Accordingly, while the angle between the occlusal force application and the long axis of the implant decreases, the resistance (force) to fracture decreases.
Marked Testosterone Deficiency-Related Symptoms May be Associated to Higher Metabolic Risk in Men with Low Testosterone Levels
Authors: García-Cruz Eduard , Leibar-Tamayo Asier , Romero-Otero Javier , Asiaín Ignacio , Carrión Albert , Castañeda Roberto , Mateu Laura , Luque Pilar , Cardeñosa Oscar , Alcaraz Antonio
Published: June 2014

Introduction

Testosterone deficiency syndrome (TDS) is usually suspected on the basis of signs/symptoms. However, some men with low testosterone levels (low T) are asymptomatic or present mild, unnoticed symptoms. Would they have the same cardiovascular risk as symptomatic men?

Aims

This study aims to assess the relationship between presence/severity of low T-related symptoms and the likelihood of metabolic syndrome (MetS).

Methods

Data were taken from a multicenter, cross-sectional study conducted in Spain among men visiting men's healthcare offices aged ≥45 with low T (total T <8 nmol/L or <12 nmol/L and calculated free T <250 nmol/L). Only subjects whose MetS components and symptoms had been assessed were selected. Data available included anthropometrics, toxic habits, comorbidities, and total testosterone (TT) levels.

Main Outcome Measures

MetS was defined using the harmonized definition. Erectile dysfunction was classified using the International Index of Erectile Function questionnaire. The Ageing Male Symptoms (AMS) scale assessed symptoms. Symptom severity was classified as “none/mild” and “moderate/severe.” Bivariate and multivariate logistic regression analyses were performed to calculate the effect of moderate/severe symptoms on the odds ratio (OR) for MetS.

Results

Mean age (SD) was 61.2 (8.1) years. Erectile dysfunction (ED), AMS, and MetS prevalence were 97.4%, 94.9%, and 69.6%. Prevalence of MetS was higher in men with moderate/severe symptoms vs. men with no/mild ones (75.3% vs. 57.9%, P < 0.001). Age and prevalence of TT <8 nmol/L, moderate/severe ED, and obesity were significantly higher in men with moderate/severe symptoms. Multivariate analysis showed that besides obesity and moderate/severe ED, moderate/severe symptoms increased the likelihood of MetS. This effect disappeared in men with severe ED and in the nonobese. Three symptoms showed relationship with MetS after adjusting for all confounding factors.

Conclusion

Severity of TDS symptoms may indicate higher cardiovascular risk in men with low T.
Association of sleep‐disordered breathing with decreased cognitive function among patients with dementia
Authors: Aoki Kiyoaki , Matsuo Masahiro , Takahashi Masahiro , Murakami Junichi , Aoki Yasusuke , Aoki Naosuke , Mizumoto Hirotaka , Namikawa Ayako , Hara Hiroko , Miyagawa Masaharu , Kadotani Hiroshi , Yamada Naoto
Published: June 2014

Sleep is known to be essential for proper cognitive functioning. Sleep disturbance, especially respiratory disturbance during sleep, is a risk factor for the development of dementia. However, it is not known whether hypopnoea during sleep is related to severity of cognitive function in patients already diagnosed with dementia. Considering the high prevalence of sleep problems in aged people, it is important to determine if hypopnoea during sleep contributes to dementia. In addition, it would be desirable to develop a feasible method for objectively evaluating sleep in patients with dementia. For this purpose, a simple sleep recorder that employs single or dual bioparameter recording, which is defined as a type‐4 portable monitor, is suitable. In this study, a type‐4 sleep recorder was used to evaluate respiratory function during sleep in 111 patients with dementia, and data suggesting a possible relationship with cognitive function levels were examined. Multivariate logistic regression was used to investigate the association of severity of dementia with sleep‐disordered breathing, age, diabetes, dyslipidaemia and hypertension. It was found that the respiratory disturbance index was associated with severity of cognitive dysfunction in our subjects. Furthermore, patients younger than 80 years were more susceptible to lower cognitive function associated with sleep‐disordered breathing than patients 80 years old or over, because an increase in the respiratory disturbance index was associated with deteriorated cognitive function only in the former age group. These results suggest that proper treatment of sleep apnea is important for the preservation of cognitive function, especially in patients with early‐stage dementia.
No Major Impact of Skin Aging on the Response of Skin Blood Flow to a Submaximal Local Thermal Stimulus
Authors: Vionnet Julien , Calero‐Romero Irene , Heim Abigaël , Rotaru Corina , Engelberger Rolf Peter , Dischl Benoît , Noël Bernard , Liaudet Lucas , Waeber Bernard , Feihl François
Published: June 2014

Objective

This study was undertaken to investigate how aging affects dermal microvascular reactivity in skin areas differentially exposed to sunlight, and therefore to different degrees of photoaging.

Methods

We assessed, in young (18–30 years, n = 13) and aged males (≥60 years, n = 13), the thigh, forearm, and forehead's skin vasodilatory response to local heating (LTH) with a LDI. In each subject and at each location, local Tskin was brought from 34°C (baseline) to 39 or 41°C for 30 minutes, to effect submaximal vasodilation, with maximal vasodilation then elicited by further heating to 44°C.

Results

The CVCs evaluated at baseline and after maximal vasodilation (CVCmax) were higher in the forehead than in the two other anatomical locations. On all locations, CVCmax decreased with age but less markedly in the forehead compared to the two other locations. When expressed in % of CVCmax, the plateau increase of CVCs in response to submaximal temperatures (39 and 41°C) did not vary with age, and minimally so with location.

Conclusion

Skin aging, whether intrinsic or combined with photoaging, reduces the maximal vasodilatory capacity of the dermal microcirculation, but not its reactivity to local heating.
Addressing ethnic disparity in asthma trials
Authors: Radhakrishna Naghmeh , Hew Mark
Published: June 2014

See article, page 842
Obesity, COPD, NIV and reverse epidemiology
Authors: O'Donoghue Fergal J. , Howard Mark E.
Published: June 2014

See article, page 857
Streptococcus pneumoniae antigen in urine: Diagnostic usefulness and impact on outcome of bacteraemic pneumococcal pneumonia in a large series of adult patients
Authors: Zalacain Rafael , Capelastegui Alberto , Ruiz Luis Alberto , Bilbao Amaia , Gomez Ainhoa , Uranga Ane , España Pedro P.
Published: June 2014

Background and objective

Urinary pneumococcal antigen detection provides good results in the diagnosis of pneumococcal pneumonia but has rarely been used in bacteraemic pneumococcal pneumonia and it is not known whether it is associated with outcome in this type of pneumonia. Our objectives were to assess the usefulness of an immunochromatographic technique for detecting the pneumococcal antigen in urine in a large prospective study of patients with bacteraemic pneumococcal pneumonia and explore any potential association with outcomes.

Methods

This study, carried out over 8 years, included all adult immunocompetent patients admitted for bacteraemic pneumococcal pneumonia. An immunochromatographic test for the Streptococcus pneumoniae antigen in urine was performed in the first 24 h. The sensitivity of test was assessed and patients were divided into two groups according to test results to explore differences on admission and during the course of the illness using logistic regression models.

Results

Of the 350 patients with bacteraemic pneumococcal pneumonia included, 261 (74.6%) were positive for the antigen. Patient characteristics were very similar on admission and differences in severity (Pneumonia Severity Index) were not statistically significant. In the adjusted analysis, antigen‐positive patients had a higher risk of intensive care unit admission, treatment failure and adverse outcome.

Conclusions

The sensitivity of the immunochromatographic urinary antigen test was 74.6% and positive results were associated with poorer clinical outcome. We therefore recommend systematic use of this test when pneumonia is diagnosed in the emergency department.
A Time‐Dependent Risk Assessment for Broken Compact Fluorescent Lamps
Authors: Clear Robert , Rubinstein Francis
Published: June 2014

Environmental Protection Agency (EPA) ambient air quality guidelines are meant to limit long‐term exposures of toxins to safe levels. Unfortunately, there is little guidance for what constitutes a safe level from a one‐time (or very infrequent) short exposure(s). In the case of mercury, a review of the derivation of the EPA ambient air quality standard shows that it implicitly assumes a tissue burden model. The time dependence of the tissue burden is commonly described in terms of a half‐life, a modeling assumption that presumes that the decline in the tissue burden after a single exposure can be approximately described as an exponential decay. In this article, we use a simple exponential tissue burden model to derive a time‐dependent no observable adverse effect level (NOAEL) for mercury concentrations in air. The model predicts that tissue body burden will asymptotically approach the EPA air quality level for long exposure times, and reach workplace standard levels for exposures of a few hours. The model was used along with data on mercury levels from experimental work done by the Maine Department of Environmental Protection to evaluate the risks from a broken compact fluorescent lamp in a residential setting. Mercury levels approached the NOAEL only when the debris was left in an almost sealed room. Normal common‐sense cleaning measures: removal of debris to an outside area, and ventilation of the room for several minutes, reduced exposures to less than 1% of the NOAEL.
Outcomes of Arteriovenous Grafts Following Simultaneous Thrombectomy and Stent Graft Placement Across the Venous Anastomosis
Authors: Nassar George M. , Suki Dima , Rhee Edward , Khan Abdul Jabbar , Nguyen Binh , Achkar Katafan
Published: June 2014

Arteriovenous grafts (AVGs) suffer from high thrombosis rates. It is not known whether placement of stent grafts at the venous anastomosis (VA) of thrombosed AVGs would impact future thrombosis. This is a retrospective study evaluating a group of AVGs that underwent endovascular thrombectomy with placement of a stent graft at their VA. The study period was a minimum of 1 year or until kidney transplantation or death. Primary and secondary AVG patency rates were obtained using Kaplan–Meier survival estimates. Demographic parameters were analyzed using Cox multivariate analysis. The effect of early vs. late first thrombosis was also studied. Sixty‐six patients were included in the study. Of these, 53 (80%) experienced ≥1 thrombotic event during the study period. Thrombosis led to AVG loss in 26 (39%). The primary patency was 47%, 35%, and 21% at 3, 6, and 12 months, respectively. The assisted primary patency was 50%, 38%, and 25% at 3, 6, and 12 months, respectively. The secondary patency rate was 85%, 76%, and 72% at 3, 6, and 12 months, respectively. Thus, poor primary patency rates were observed despite stent graft placement at the VA. In addition, early thrombosis following stent graft placement was associated with worse AVG outcomes.
The changing face of the HIV epidemic in sub‐Saharan Africa
Authors: Mutevedzi Portia C. , Newell Marie‐Louise
Published: June 2014

The widespread roll‐out of antiretroviral therapy (ART) has substantially changed the face of human immunodeficiency virus (HIV). Timely initiation of ART in HIV‐infected individuals dramatically reduces mortality and improves employment rates to levels prior to HIV infection. Recent findings from several studies have shown that ART reduces HIV transmission risk even with modest ART coverage of the HIV‐infected population and imperfect ART adherence. While condoms are highly effective in the prevention of HIV acquisition, they are compromised by low and inconsistent usage; male medical circumcision substantially reduces HIV transmission but uptake remains relatively low; ART during pregnancy, delivery and breastfeeding can virtually eliminate mother‐to‐child transmission but implementation is challenging, especially in resource‐limited settings. The current HIV prevention recommendations focus on a combination of preventions approach, including ART as treatment or pre‐ or post‐exposure prophylaxis together with condoms, circumcision and sexual behaviour modification. Improved survival in HIV‐infected individuals and reduced HIV transmission risk is beginning to result in limited HIV incidence decline at population level and substantial increases in HIV prevalence. However, achievements in HIV treatment and prevention are threatened by the challenges of lifelong adherence to preventive and therapeutic methods and by the ageing of the HIV‐infected cohorts potentially complicating HIV management. Although current thinking suggests prevention of HIV transmission through early detection of infection immediately followed by ART could eventually result in elimination of the HIV epidemic, controversies remain as to whether we can treat our way out of the HIV epidemic.
Reproducibility of nuclear morphometry parameters from cytologic smears of canine cutaneous mast cell tumors—intra‐ and interobserver variability
Authors: Barbosa Daniella de F.L. , Paraventi Mariana D. , Strefezzi Ricardo de F.
Published: June 2014

Background

Qualitative and/or semiquantitative histopathologic grading has been the method of choice to predict the biologic behavior of mast cell tumors (MCT). Recently, computer‐assisted nuclear morphometric analysis of histologic or cytologic specimens has been shown to correlate with histopathologic grading ofMCT. However, it is still not clear what the reproducibility and variability of these computer‐assisted measurements are.

Objectives

The objective of this study was to estimate the intra‐ and interobserver variability in computer‐assisted morphometric analysis of nuclear parameters in fine‐needle cytologic smears of canine cutaneousMCT.

Materials and Methods

Measurements were performed by 2 observers with basic training on the recognition of neoplastic cells and operating the image analysis software. The analyses were performed twice at 6 months apart.

Results

No significant effects were detected for observer, time, and the interaction observer–time.

Conclusions

Nuclear morphometric analysis of mast cell tumors using cytologic smears is a reproducible method for grading ofMCT.
Thermodynamic assessment and experimental verification of reactive ion etching of magnetic metal elements
Authors: Kim Taeseung , Chen Jack Kun-Chieh , Chang Jane P.
Published: June 2014

A thermodynamic analysis of etch chemistries for Co, Fe, and Ni using a combination of hydrogen, oxygen, and halogen gases suggested that a single etchant does not work at 300 K; however, a sequential exposure to multiple etchants results in sufficiently high partial pressure of the reaction products for the process to be considered viable. This sequential dose utilized the two reactions, a surface halogenation followed by the secondary etchant exposure. (MX2 (c) + 3Y →MY(g) + 2XY(g), where M = Co, Fe, Ni; X = F, Cl, Br; Y = O, H) The volatilization reaction induced by sequential plasma exposure changed the equilibrium point, increasing the partial pressure of the etch product. Amongst all combinations, Cl2 or Br2 plasmas followed by H2 plasma were the most effective. From both the gas phase diagnostics and surface composition analysis, H2 plasma alone could not etch metallic Co, Fe, and Ni films but alternating doses of Cl2 and H2 plasmas resulted in more effective removal of chlorinated metals and increased the overall etch rate.
Two-particle quantum interference in tunnel-coupled optical tweezers
Authors: Kaufman A. M. , Lester B. J. , Reynolds C. M. , Wall M. L. , Foss-Feig M. , Hazzard K. R. A. , Rey A. M. , Regal C. A.
Published: June 2014

Bosons of a feather flit together

Bosons are a type of particle that likes to congregate. This property has a major effect on the behavior of identical bosons. Kaufman
et al.
demonstrated quantum interference of two bosonic Rb atoms placed in two neighboring quantum wells (see the Perspective by Thompson and Lukin). They prepared the atoms in exactly the same state so that there would be no way to tell them apart except for which well each atom was in. They then monitored the probability of the two atoms still being in separate wells. At certain times, the probability had a characteristic dip signifying that the bosons preferred to be in the same well.

Science
, this issue p.
306
; see also p.
272
Oceanic mass transport by mesoscale eddies
Authors: Zhang Zhengguang , Wang Wei , Qiu Bo
Published: June 2014

Spinning up ocean circulation discretely

Ocean eddies with diameters of tens to hundreds of kilometers are an important component of water transport on a global scale. Averaged over periods of many years, ocean circulation is regular and coherent enough to have been described as a conveyor belt. However, over shorter time scales, irregular, discrete events cause significant amounts of water movement—termed mesoscale eddies. Zhang
et al.
combined data from thousands of autonomous observational devices called ARGO floats with satellite data. The mesoscale eddies moved around as much ocean water as wind or deepwater currents.

Science
, this issue p.
322
Complete Genome Sequence of Chikungunya Virus Isolated in the Philippines
Authors: Kawashima Kent D. , Suarez Lady-Anne C. , Labayo Hannah Karen M. , Liles Veni R. , Salvoza Noel C. , Klinzing David C. , Daroy Maria Luisa G. , Matias Ronald R. , Natividad Filipinas F.
Published: June 2014

Chikungunya virus is an alphavirus of the
Togaviridae
family, which causes a febrile illness with arthralgia in humans. We report here on the complete genome sequence of chikungunya virus strain CHIKV-13-112A isolated from a patient in the Philippines who was suspected to have dengue virus. Phylogenetic analysis revealed that the strain is of the Asian genotype.
Draft Genome Sequence of
trh
+
Vibrio parahaemolyticus VP-49, Isolated from Seafood Harvested along the Mangalore Coast, India
Authors: Kumar Ballamoole Krishna , Deekshit Vijaya Kumar , Rai Praveen , Gurtler Volker , Karunasagar Iddya , Karunasagar Indrani
Published: June 2014

Vibrio parahaemolyticus
is a seafood-borne pathogen autochthonous to the marine and estuarine ecosystem, which is responsible for gastroenteritis due to the consumption of contaminated raw seafood. Here, we report the draft genome sequence of
V. parahaemolyticus
VP-49, isolated from seafood, to identify the different virulence attributes and to study the mechanisms that enhance its environmental fitness.
Draft Genome Sequence of Moraxella bovoculi Strain 237
T
(ATCC BAA-1259
T
) Isolated from a Calf with Infectious Bovine Keratoconjunctivitis
Authors: Calcutt Michael J. , Foecking Mark F. , Martin Neal T. , Mhlanga-Mutangadura Tendai , Reilly Thomas J.
Published: June 2014

Moraxella bovoculi
is a recently identified species, recovered from the bovine eye, which is under investigation as an etiological agent of infectious bovine keratoconjunctivitis. A draft genome sequence of the
Moraxella bovoculi
type strain 237
T
has been determined to identify features that may be important during host colonization.
Genome Sequence of the Neurotoxigenic Clostridium butyricum Strain 5521
Authors: Hassan Karl A. , Elbourne Liam D. H. , Tetu Sasha G. , Johnson Eric A. , Paulsen Ian T.
Published: June 2014

Clostridium
strains from six phylogenetic groups,
C. botulinum
groups I to IV,
C. baratii
, and
C. butyricum
, display the capacity to produce botulinum neurotoxin. Here, we present the genome sequence of a
C. butyricum
isolate, the neurotoxigenic strain 5521, which encodes the type E botulinum neurotoxin.
Trigger Point-Related Sympathetic Nerve Activity in Chronic Sciatic Leg Pain: A Case Study
Authors: Skorupska Elżbieta , Rychlik Michał , Pawelec Wiktoria , Bednarek Agata , Samborski Włodzimierz
Published: June 2014

Sciatica has classically been associated with irritation of the sciatic nerve by the vertebral disc and consequent inflammation. Some authors suggest that active trigger points in the gluteus minimus muscle can refer pain in similar way to sciatica. Trigger point diagnosis is based on Travel and Simons criteria, but referred pain and twitch response are significant confirmatory signs of the diagnostic criteria. Although vasoconstriction in the area of a latent trigger point has been demonstrated, the vasomotor reaction of active trigger points has not been examined. We report the case of a 22-year-old Caucasian European man who presented with a 3-year history of chronic sciatic-type leg pain. In the third year of symptoms, coexistent myofascial pain syndrome was diagnosed. Acupuncture needle stimulation of active trigger points under infrared thermovisual camera showed a sudden short-term vasodilatation (an autonomic phenomenon) in the area of referred pain. The vasodilatation spread from 0.2 to 171.9 cm2 and then gradually decreased. After needling, increases in average and maximum skin temperature were seen as follows: for the thigh, changes were +2.6°C (average) and +3.6°C (maximum); for the calf, changes were +0.9°C (average) and +1.4°C (maximum). It is not yet known whether the vasodilatation observed was evoked exclusively by dry needling of active trigger points. The complex condition of the patient suggests that other variables might have influenced the infrared thermovision camera results. We suggest that it is important to check if vasodilatation in the area of referred pain occurs in all patients with active trigger points.
Domperidone-induced dystonia: a rare and troublesome complication
Authors: Dhakal Om Prakash , Dhakal Mona , Bhandari Dhurba
Published: June 2014

Domperidone is a commonly prescribed antiemetic drug but its side effects are rarely seen. Extrapyramidal side effects are a very rare complication of the drug occurring in 1/10 000 population. They usually occur in infants and very young children due to a poorly developed blood–brain barrier. We report a case of acute dystonia in a 13-year-old boy induced by domperidone. The boy was treated for viral fever and was started on domperidone 30 mg/day, sustained release form (0.7 mg/kg/day), for persistent vomiting along with other supportive treatment. On the fourth day of treatment, although the fever and vomiting subsided, the child developed oromandibular dystonia despite giving the drug in the recommended dose. Fortunately, drug-induced dystonias are a reversible condition and the child improved in 7–8 days after discontinuation of the drug. There was no recurrence at 1 month follow-up. Usually, dystonic reactions do not threaten life but are troublesome and life altering, so judicious use of the drug is advised.
Challenging behaviour in a patient with schizophrenia and a 1q21.1 duplication
Authors: Gulati Gautam , Behrman Sophie , Khosla Vivek , Murphy Valerie
Published: June 2014

We report the case of a 42-year-old man with a 22-year history of schizophrenia, necessitating frequent detentions under the Mental Health Act for relapses in his mental state and challenging behaviour which has also brought him into contact with the law. His illness has proven resistant to treatment with conventional strategies and he developed serious priapism with clozapine. His challenging behaviour, some of which is not felt to be associated with schizophrenia, complicates any discharge planning from his current detention. Based on a history of childhood cardiac disease, and mildly atypical facies, a genetic screen was requested which showed a 1q21.1 duplication, likely causal in his schizophrenic illness. A review of proteins coded by the locus of the duplication did not reveal any specific targets for pharmacotherapy.
Atypical presentation of perforated peptic ulcer disease in a 12-year-old boy
Authors: Mbarushimana Simon , Morris-Stiff Gareth , Thomas George
Published: June 2014

A 12-year-old boy was referred to the surgical unit with 4 h history of severe lower abdominal pain and bilious vomiting. No other symptoms were reported and there was no significant medical or family history. Examination revealed tenderness in the lower abdomen, in particular the left iliac fossa. His white cell count was elevated at 19.6×109/L, with a predominant neutrophilia of 15.8×109/L and a C reactive protein of <0.3 mg/L. An abdominal X-ray revealed intraperitoneal gas and a chest X-ray identified free air under both hemidiaphragms. Subsequent diagnostic laparoscopy identified a perforated duodenal ulcer that was repaired by means of an omental patch. The case illustrates that although uncommon, alternate diagnoses must be borne in mind in children presenting with lower abdominal pain and diagnostic laparoscopy is a useful tool in children with visceral perforation as it avoids treatment delays and exposure to excess radiation.
Sniffing out a hidden cause of breathlessness
Authors: Nanzer Alexandra Marie , Janssen John , Hind Matthew
Published: June 2014

A 78-year-old man presented with severe exertional dyspnoea. He suffered from mild chronic obstructive pulmonary disease, congestive cardiac failure and seropositive myasthaenia gravis. Clinical examination of his chest and heart were unremarkable but he had speech dyspnoea and was unable to count to 20 in a single breath. Consecutive sniff nasal inspiratory measurements (SNIP) fell from 55 to 33 cm H2O and forced vital capacity (FVC) fell from 3.4 to 2.4 L. A diagnosis of myasthenic crisis was carried out and treatment with non-invasive ventilation, intravenous immunoglobulis and high-dose oral prednisolone was initiated. The patient responded well and was discharged following a short period of rehabilitation. A high index of suspicion and a careful clinical examination with the help of two simple bedside tests, FVC and SNIP, allowed correct and timely treatment of his condition.
A specific exercise strategy reduced the need for surgery in subacromial pain patients
Authors: Hallgren Hanna C Björnsson , Holmgren Theresa , Öberg Birgitta , Johansson Kajsa , Adolfsson Lars E
Published: June 2014

Background and purpose

A programme based on eccentric exercises for treating subacromial pain was in a previous study found effective at 3-month follow-up. The purposes of the present study were to investigate whether the results were maintained after 1 year and whether the baseline Constant-Murley score, rotator cuff status and radiological findings influenced the outcome.

Patients and methods

97 patients on the waiting list for arthroscopic subacromial decompression had been randomised to a specific exercise programme or unspecific exercises (controls). After 3 months of exercises, the patients were asked whether they still wanted surgery and this option was available until a 1-year follow-up. 1 year after inclusion or 1 year after surgery, the number of patients who decided to have surgery in each group was compared. The choice of surgery was related to the baseline Constant-Murley score, ultrasound and radiographs taken at inclusion.

Results

All patients had improved significantly (p<0.0001) in the Constant-Murley score at the 1-year follow-up. Significantly more patients in the control group decided to have surgery (63%) than those in the specific exercise group (24%; p<0.0001). Patients who decided to have surgery had a significantly lower baseline Constant-Murley score and more often a full-thickness tear. Patients with partial tears did not differ from those with intact tendons.

Interpretation

The positive short-term results of specific exercises were maintained after 1 year, and this exercise strategy reduces the need for surgery. Full-thickness tear and a low baseline Constant-Murley score appear to be a predictive marker for a less good outcome.

Trial registration number

Clinical trialsNCT01037673.
Parents’ perspectives on safety in neonatal intensive care: a mixed-methods study
Authors: Lyndon Audrey , Jacobson Carrie H , Fagan Kelly M , Wisner Kirsten , Franck Linda S
Published: June 2014

Background & objectives

Little is known about how parents think about neonatal intensive care unit (NICU) safety. Due to their physiologic immaturity and small size, infants in NICUs are especially vulnerable to injury from their medical care. Campaigns are underway to integrate patients and family members into patient safety. This study aimed to describe how parents of infants in the NICU conceptualise patient safety and what kinds of concerns they have about safety.

Methods

This mixed-methods study employed questionnaires, interviews and observation with parents of infant patients in an academic medical centre NICU. Measures included parent stress, family-centredness and types of safety concerns.

Results

46 parents completed questionnaires and 14 of these parents also participated in 10 interviews (including 4 couple interviews). Infants had a range of medical and surgical problems, including prematurity, congenital diaphragmatic hernia and congenital cardiac disease. Parents were positive about their infants’ care and had low levels of concern about the safety of procedures. Parents reporting more stress had more concerns. We identified three overlapping domains in parents' conceptualisations of safety in the NICU, including physical, developmental and emotional safety. Parents demonstrated sophisticated understanding of how environmental, treatment and personnel factors could potentially influence their infants’ developmental and emotional health.

Conclusions

Parents have safety concerns that cannot be addressed solely by reducing errors in the NICU. Parent engagement strategies that respect parents as partners in safety and address how clinical treatment articulates with physical, developmental and emotional safety domains may result in safety improvements.