bluuebunny/crossref_metadata_2025 huggingface dataset:
National Institutes of Health Stroke Scale (NIHSS) as An Early Predictor of Poststroke Dysphagia
Authors: Jeyaseelan Rebecca D. , Vargo Mary M. , Chae John
Published: January 2015

Background

Despite the availability of multiple comprehensive screening methods to detect dysphagia during acute stroke care, consensus is lacking as to the best practice. Our previous study demonstrated favorable sensitivity of the Functional Independence Measure (FIM) compared with a bedside 3‐sip test. However, the FIM is challenging to administer during acute stroke care. The National Institutes of Health Stroke Scale (NIHSS) is administered routinely in the emergency department.

Objective

To evaluate the utility of the NIHSS as a predictor of clinically relevant poststroke dysphagia compared with FIM data in the same cohort.

Design

Retrospective analysis.

Setting

Academic medical center.

Patients

Individuals with acute stroke who were admitted for acute care and later transferred to acute rehabilitation within the same institution.

Methods

Clinically relevant dysphagia was defined as aspiration on modified barium swallow or laryngeal penetration on modified barium swallow requiring diet change, or aspiration pneumonia. NIHSS and FIM scores were compiled for all patients.

Main Outcome Measurements

Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for NIHSS and FIM. Sensitivity and specificity of different values of NIHSS and FIM were analyzed via receiver operator characteristic curves.

Results

Of 290 patients admitted to acute stroke rehabilitation, 88 (30%) manifested clinically relevant dysphagia during their rehabilitation stay. Sensitivity analyses suggested cut‐off values for the NIHSS and the FIM of >9 and <55, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value for the NIHSS were 75%, 62%, 46%, and 85%, respectively. For the FIM, these parameters were 80%, 72%, 55%, and 92%, respectively.

Conclusions

The NIHSS >9 and FIM <55 are moderately predictive of clinically relevant dysphagia. Although the NIHSS clinical test characteristics are not as favorable as the FIM, NIHSS appears to be more sensitive than some other reported methods such as a 3‐sip water test. Further study into development of paradigms that incorporate NIHSS into initial assessment of dysphagia risk may be appropriate.
Skillslabtraining an Pflegeschulen
Authors: Staudinger Claudia
Published: January 2015

„Was wir wollen, wissen wir: starke junge Menschen, ihrer Selbst sicher, ausgestattet mit Vertrauen in ihre Möglichkeiten und Mut zu Neuem. Gerne sollen sie lernen und Lust am Entdecken haben: für ein ganzes Leben …“ (Thurn, Leiterin der Bielefelder Laborschule, in der Frankfurter Rundschau vom 1.9.2003, zit. in Keuchel, 2005)
Pflegearbeit in der Psychoonkologie
Authors: Dautel Anja
Published: January 2015

Die Psychoonkologie ist ein eigenes Arbeitsgebiet im onkologischen Kontext mit dem Ziel, die Krankheitsverarbeitung von onkologischen Patientinnen und Patienten zu unterstützen, Nebenwirkungen und Begleiterscheinungen von Diagnostik und Therapie zu lindern und die Lebensqualität zu verbessern. Dies geschieht unter anderem auch durch die Stärkung der sozialen Ressourcen der Betroffenen und ihrer Angehörigen.
DFT Study on Thermodynamic Parameters of CO2 Absorption into Aqueous Solution of Aliphatic Amines
Authors: Hajmalek Monireh , Aghaie Hossein , Zare Karim , Aghaie Mehran
Published: January 2015

Using density functional theory (DFT), the thermodynamic parameters of the CO2 absorption into the aqueous solution of the aliphatic amines including some alkylamines, alkanolamines, diamines and a type of aminoamide were calculated. The geometry optimization and the calculation of vibrational frequencies in the gas phase were performed at the B3LYP/6-311++G(d,p) level of theory. Moreover, the standard solvation free energies of the studied species were computed upon the solution phase optimized geometries through the latest continuum solvation model (SMD/IEF-PCM) at the HF/6-31G(d) level of theory. With this approach, two important properties of the CO2 absorption into the aqueous solutions of the studied amines were evaluated: the acid dissociation constant (pKa) of the parent amines and the standard enthalpy change (δHabs⦵) related to the CO2 absorption process. A roughly linear relationship was observed between pKa and δHabs⦵. This finding suggests that a raise in the basicity of an amine leads to an increase in the heat released in CO2 absorption and consequently in the required energy for the regeneration of amine.
Oxidative Dehydrogenation of Alkanes using Oxygen-Permeable Membrane Reactor
Authors: Yan Rui-qiang , Liu Wei , Song Chun-lin
Published: January 2015

The oxidative dehydrogenation (ODH) reactions of ethane and propane were investigated in a catalytic membrane reactor, incorporating oxygen-permeable membranes based upon La2Ni0.9V0.1 O4+δ or Ba0.5Sr0.5Co0.8Fe0.2O3−δ As a compromise between the occurrence of a measureable oxygen flux and excessive homogenous gas phase reactions, the measurements were conducted at an intermediate temperature, either at 550 or 650 °C. The results show the dominating role of the oxygen flux across the membrane and available sites at the membrane surface in primary activation of the alkane and, hence, in achieving high alkane conversions. The experimental data of ODH of propane and ethane on both membrane materials can be reconciled on the basis of Mars-van Krevelen mechanism, in which the alkane reacts with lattice oxygen on the membrane surface to produce the corresponding olefin. It is further demonstrated that the oxygen concentration in the gas phase and on the membrane surface is crucial for determining the olefin selectivity.
Adsorption of Microcystin onto Polymer Covered Gold Chips by Quartz Crystal Microbalance-Dissipation Detection
Authors: Zheng Bin , Bi Jian-hong , Dong Hua-ze , Zhu Jin-miao , Liang Hao-jun
Published: January 2015

Different functional polystyrenes were synthesized and the adsorptions of microcystin-LR onto those resins were monitored by quartz crystal microbalance-dissipation. Both adsorption pH and surface properties had a considerable effect on the adsorption amount, while adsorption temperature was less significant. Ammonium polystyrene would be a better candidate for microcystin-LR adsorption at neutral pH conditions.
Effector Vγ9Vδ2 T cells dominate the human fetal γδ T-cell repertoire
Authors: Dimova Tanya , Brouwer Margreet , Gosselin Françoise , Tassignon Joël , Leo Oberdan , Donner Catherine , Marchant Arnaud , Vermijlen David
Published: January 2015

Significance

Despite their enormous potential for diversity (in excess of 1015theoretical receptor specificities), the human γδ T-cell repertoire is dominated by a specific subset expressing the T-cell receptor containing the γ-chain variable region 9 and the δ-chain variable region 2 (Vγ9Vδ2) known to react to a set of pathogen-derived small molecules (phosphoantigens). Overrepresentation of this restricted set of γδ T cells in adults has been thought to reflect an antigen-specific selection process resulting from postnatal exposure to pathogens. However, we demonstrate here that restricted Vγ9Vδ2 cells with preprogrammed effector function represent the predominant γδ T-cell subset circulating in human fetal blood. This observation suggests that, despite developing in a sterile environment, the human fetal γδ T cell repertoire is enriched for pathogen-reactive T cells well before pathogen exposure.
Methane emissions from natural gas infrastructure and use in the urban region of Boston, Massachusetts
Authors: McKain Kathryn , Down Adrian , Raciti Steve M. , Budney John , Hutyra Lucy R. , Floerchinger Cody , Herndon Scott C. , Nehrkorn Thomas , Zahniser Mark S. , Jackson Robert B. , Phillips Nathan , Wofsy Steven C.
Published: January 2015

Significance

Most recent analyses of the environmental impact of natural gas have focused on production, with very sparse information on emissions from distribution and end use. This study quantifies the full seasonal cycle of methane emissions and the fractional contribution of natural gas for the urbanized region centered on Boston. Emissions from natural gas are found to be two to three times larger than predicted by existing inventory methodologies and industry reports. Our findings suggest that natural-gas–consuming regions may be larger sources of methane to the atmosphere than is currently estimated and represent areas of significant resource loss.
Inositol pyrophosphates promote tumor growth and metastasis by antagonizing liver kinase B1
Authors: Rao Feng , Xu Jing , Fu Chenglai , Cha Jiyoung Y. , Gadalla Moataz M. , Xu Risheng , Barrow James C. , Snyder Solomon H.
Published: January 2015

Significance

Inositol pyrophosphates are messenger molecules incorporating the energetic pyrophosphate bond. Although they have been implicated in diverse biologic processes, their physiologic functions remain enigmatic. We show that the catalytic activity of inositol hexakisphosphate kinase 2 (IP6K2), one of the principal enzymes generating the inositol pyrophosphate IP7 (5-diphosphoinositolpentakisphosphate), mediates cancer cell migration and tumor metastasis both in cell culture and intact mice. In this process, IP6K2 diminishes cell–cell adhesion, enabling cells to invade the intercellular matrix. Drugs that inhibit IP6K2 may be beneficial in cancer therapy.
“Why not love our language and our culture?” National rights and citizenship in Khrushchev's Soviet Union
Authors: Goff Krista A.
Published: January 2015

This paper highlights campaigns for national rights among two non-titular communities in the Soviet Union and places them in local historical contexts. Drawing on archival sources and oral history interviews, the author not only delves into the campaigns themselves, but also explores broader debates about the nature of Khrushchev's Thaw and Soviet citizenship, which was far from an empty concept in the Khrushchev era. Petitioners invoked discourses that indicate both an awareness of national rights and an expectation of the state's obligation to protect them. Oral history interviews with surviving petitioners and community members support the notion that petition language can serve as a reflection of how petitioners viewed their place in Soviet society and interpreted the Soviet citizen contract.
Securing the nuclear nation
Authors: Brown Kate
Published: January 2015

In 1946, in the Southern Urals, construction of the Union of Soviet Socialist Republics first plutonium plant fell to the GULAG-Narodnyi Komissariat Vnutrennikh Del (NKVD). The chief officers in charge of the program – Lavrentii Beria, Sergei Kruglov, and Ivan Tkachenko – had been pivotal figures in the deportation and political and ethnic cleansing of territories retaken from Axis forces during WWII. These men were charged with building a nuclear weapons complex to defend the Soviet Union from the American nuclear monopoly. In part thanks to the criminalization and deportation of ethnic minorities, Gulag territories grew crowded with foreign nationals and ethnic minorities in the postwar years. The NKVD generals were appalled to find that masses of forced laborers employed at the plutonium construction site were members of enemy nations. Beria issued orders to cleanse the ranks of foreign enemies, but construction managers could not spare a single healthy body as they raced to complete their deadlines. To solve this problem, they created two zones: an interior, affluent zone for plutonium workers made up almost exclusively of Russians; and anterior zones of prisoners, soldiers, ex-cons, and local farmers, many of whom were non-Russian. The selective quality of Soviet “nuclearity” meant that many people who were exposed to the plant's secret plutonium disasters were ethnic minorities, people whose exposures went unrecorded or under-recorded because of their invisibility and low social value.
“Illiberal Spaces:” Uzbekistan's extraterritorial security practices and the spatial politics of contemporary authoritarianism
Authors: Lewis David
Published: January 2015

Research on comparative authoritarianism has tended to neglect spatial approaches to the politics of non-democratic states. This article argues that spatial theory offers a useful framework for exploring extraterritorial security practices designed to counter political opposition among migrant and exile communities. A case study of Uzbekistan explores how the state responded to the perceived security threats posed by rapidly growing communities of labor migrants and the activities of many political and religious activists in exile. The security services developed a network of extraterritorial intelligence and security mechanisms – including surveillance, detention, interrogation and forced returns – to pre-empt or respond to any perceived threats to the regime emanating from abroad. These security practices extended the state in complex ways beyond its borders, resulting in new “state spaces” that reproduced elements of domestic repression in other jurisdictions. The article suggests that such extraterritorial practices are typical of contemporary authoritarian regimes, as such states seek to manage the spatial challenges produced by mass global migration, international financial flows, and transnational processes of knowledge production.
3USS: a web server for detecting alternative 3′UTRs from RNA-seq experiments
Authors: Le Pera Loredana , Mazzapioda Mariagiovanna , Tramontano Anna
Published: January 2015

Summary: Protein-coding genes with multiple alternative polyadenylation sites can generate mRNA 3′UTR sequences of different lengths, thereby causing the loss or gain of regulatory elements, which can affect stability, localization and translation efficiency. 3USS is a web-server developed with the aim of giving experimentalists the possibility to automatically identify alternative 3 ′ UTRs (shorter or longer with respect to a reference transcriptome), an option that is not available in standard RNA-seq data analysis procedures. The tool reports as putative novel the 3 ′ UTRs not annotated in available databases. Furthermore, if data from two related samples are uploaded, common and specific alternative 3 ′ UTRs are identified and reported by the server.

Availability and implementation: 3USS is freely available at http://www.biocomputing.it/3uss_server

Contact:  anna.tramontano@uniroma1.it

Supplementary information:  Supplementary data are available at Bioinformatics online.
Effects of Temperature on the Transmission of West Nile Virus by Culex tarsalis (Diptera: Culicidae)
Authors: Reisen William K. , Fang Ying , Martinez Vincent M.
Published: January 2015

Culex tarsalis Coquillett females were infected with the NY99 strain of West Nile virus (family Flaviviridae, genus Flavivirus, WNV) and then incubated under constant temperatures of 10–30°C. At selected time intervals, transmission was attempted using an in vitro capillary tube assay. The median time from imbibing an infectious bloodmeal until infected females transmitted WNV (median extrinsic incubation period, EIP50) was estimated by probit analysis. By regressing the EIP rate (inverse of EIP50) as a function of temperature from 14 to 30°C, the EIP was estimated to require 109 degree-days (DD) and the point of zero virus development (x-intercept) was estimated to be 14.3°C. The resulting degree-day model showed that the NY99 WNV strain responded to temperature differently than a lineage II strain of WNV from South Africa and approximated our previous estimates for St. Louis encephalitis virus (family Flaviviridae, genus Flavivirus, SLEV). The invading NY99 WNV strain therefore required warm temperatures for efficient transmission. The time for completion of the EIP was estimated monthly from temperatures recorded at Coachella Valley, Los Angeles, and Kern County, California, during the 2004 epidemic year and related to the duration of the Cx. tarsalis gonotrophic cycle and measures of WNV activity. Enzootic WNV activity commenced after temperatures increased, the duration of the EIP decreased, and virus potentially was transmitted in two or less gonotrophic cycles. Temperatures in the United States during the epidemic summers of 2002–2004 indicated that WNV dispersal and resulting epicenters were linked closely to above-average summer temperatures.
An Avian Contribution to the Presence of Ixodes pacificus (Acari: Ixodidae) and Borrelia burgdorferi on the Sutter Buttes of California
Authors: Wright Stan A. , Lemenager Debbie A. , Tucker James R. , Armijos M. Veronica , Yamamoto Sheryl A.
Published: January 2015

Birds from 45 species were sampled during three spring seasons from an isolated canyon on the Sutter Buttes in California for the presence of subadult stages of Ixodes pacificus Cooley & Kohls, and for infection with Borrelia burgdorferi Johnson, Schmid, Hyde, Steigerwalt & Brenner. These birds were found to have an infestation prevalence of 45%, a density of 1.7 ticks per bird, and an intensity of 3.8 ticks per infested bird. There was a significant difference in the I. pacificus infestations between canopy and ground-dwelling birds. Birds also demonstrated an overall infection with B. burgdorferi of 6.4% with significant difference between bird species. Amplification and subsequent sequencing of the 23s-5s rRNA intergenic spacer region of the Borrelia genome from one bird, a hermit thrush, Catharus guttatus (Nuttall), showed that the infection in this bird was caused by B. burgdorferi sensu stricto; the first such finding in a bird from the far west. Our results suggest that birds play a role in the distribution and maintenance of I. pacificus, and possibly of B. burgdorferi, at the Sutter Buttes, CA.
Armigeres subalbatus (Diptera: Culicidae) Prophenoloxidase III Is Required for Mosquito Cuticle Formation: Ultrastructural Study on dsRNA-Knockdown Mosquitoes
Authors: Tsao I. Y. , Christensen B. M. , Chen C. C.
Published: January 2015

We previously suggested that Armigeres subalbatus (Coquillett) prophenoloxidase III (As-pro-PO III) might be associated with morphogenesis of larvae and pupae. Because PO and its activation system are present in the insect cuticle, and cuticle formation is a major event during pupal morphogenesis, we used ultrastructural analysis to examine the effects of As-pro-PO III knockdown on the formation of pupal and adult cuticle. Inoculation of As-pro-PO III dsRNA resulted in the incomplete formation of nascent pupal endocuticle and pharate adult cuticle, i.e., significantly fewer cuticular lamellae were deposited, the helicoidal pattern of chitin microfibrils was disorganized, and numerous electron-lucent spaces were present in the cuticular protein matrix. Similar disruptions were observed in the cuticle of adults derived from As-pro-PO III dsRNA-inoculated pupae. It has long been suggested that the quinines, generated by PO-catalyzed oxidation reactions, function as cross-linking agents; therefore, it seems reasonable to suggest that the loss of As-pro-PO III-mediated protein-protein linkages causes morphological abnormalities in the protein matrix. Our findings suggest that As-pro-PO III plays a role in cuticle formation in mosquitoes, a novel function for phenol-oxidizing enzymes.
Population Genetic Structure of the German Cockroach (Blattodea: Blattellidae) in Apartment Buildings
Authors: Crissman Jonathan R. , Booth Warren , Santangelo Richard G. , Mukha Dmitry V. , Vargo Edward L. , Schal Coby
Published: January 2015

The German cockroach, Blattella germanica (L.) (Blattodea: Blattellidae), is a major residential pest with the potential to vector various pathogens and produce and disseminate household allergens. Understanding population genetic structure and differentiation of this important pest is critical to efforts to eradicate infestations, yet little is known in this regard. Using highly polymorphic microsatellite markers, we investigated patterns of genetic diversity and differentiation within and among 18 apartments from six apartment complexes located in Raleigh, NC. No departure from panmixia was found between rooms within apartments, indicating that active dispersal resulting in gene flow may occur among rooms within apartment units. Alternatively, aggregations within apartments may exist in relative isolation under a metapopulation framework, derived from a recent, common source. Thus, in the event of population control practices leading to incomplete cockroach eradication within an apartment, recolonization of shelters and rooms is likely to occur from a genetically similar aggregation. A pattern of isolation-by-distance across the six apartment complexes indicated that dispersal was more common within complexes than among them, and F statistics suggested greater genetic similarity between apartments in a single building than between separate buildings of an apartment complex. Similarly, neighbor-joining tree and Bayesian clustering analyses were able to cluster only those apartments that were within a single building, indicating higher dispersal with associated gene flow within buildings than between them. The lack of any broader connectivity, as indicated by significant FST and G-tests suggests that human-mediated dispersal of B. germanica between buildings of an apartment complex or between complexes occurs infrequently enough to have negligible effects on gene flow.
Deep Mitochondrial DNA Lineage Divergences Within Alberta Populations of Dermacentor albipictus (Acari: Ixodidae) Do Not Indicate Distinct Species
Authors: Leo Sarah S. T. , Pybus Margo J. , Sperling Felix A. H.
Published: January 2015

The winter tick Dermacentor albipictus (Packard) has a single-host life cycle that allows it to reach severe infestation levels on ungulates, particularly moose. Genotypic variation within these and related ticks has been a source of taxonomic confusion, although the continuity in their morphology and life history has generally been interpreted as indicating the existence of a single species. To further investigate this variation, we sequenced regions of two mitochondrial DNA (mtDNA) genes (COI and 16S rDNA), two nuclear genes (lysozyme and ITS-2), and two bacterial markers from Francisella-like endosymbionts found in these ticks (eubacterial mtDNA 16S rRNA and a homolog of Francisella tularensis [Dorofe’ev] 17-kDa lipoprotein). We sampled 42 D. albipictus individuals from whitetail and mule deer culled from three populations in east-central Alberta, as well as four D. albipictus and two Dermacentor variabilis (Say) from other locations. We then compared DNA sequence variation between the genes and related this to variation in the morphology of spiracle plates. Both mtDNA regions indicated two deeply diverged lineages (mean difference of 7.1% for COI and 4.5% for 16S) that would normally be considered diagnostic of distinct species in DNA barcoding studies. However, very little divergence was revealed by nuclear gene sequences, bacterial endosymbionts, and morphometric analyses, and any variation that did occur in these markers was not congruent with mtDNA divergences. We conclude that the sampled populations in Alberta represent a single species, D. albipictus, and reiterate the importance of integrative approaches in species delimitation.
Repellency to Stomoxys calcitrans (Diptera: Muscidae) of Plant Essential Oils Alone or in Combination With Calophyllum inophyllum Nut Oil
Authors: Hieu Tran Trung , Kim Soon-Il , Lee Sang-Guei , Ahn Young-Joon
Published: January 2015

The repellency to female Stomoxys calcitrans (L.) (Diptera: Muscidae) of 21 essential oils (EOs) alone or in combination with Calophyllum inophyllum L. (Clusiaceae) nut oil (tamanu oil) was examined using an exposed human hand bioassay. Results were compared with those of commonly used repellent N,N-diethyl-3-methylbenzamide (DEET). In tests with six human male volunteers at a dose of 0.5 mg/cm2, patchouli (protection time [PT], 3.67 h) was the most effective EO but less active than DEET (4.47 h), as judged by the PT to first bite. Very strong repellency also was produced by clove bud, lovage root, and clove leaf EOs (PT, 3.50–3.25 h), whereas strong repellency was obtained from thyme white EO (2.12 h). Thyme red, oregano, and geranium EOs exhibited moderate repellency (PT, 1.24–1.11 h). At 0.25 mg/cm2, protection time of clove bud, clove leaf, and lovage root EOs (PT, ≈1 h) was shorter than that of DEET (2.17 h). An increase in the protection time was produced by binary mixtures (PT, 2.68–2.04 h) of five EOs (clove bud, clove leaf, thyme white, patchouli, and savory) and tamanu oil (0.25:2.0 mg/cm2) compared with that of either the constituted essential oil or tamanu oil alone (PT, 0.56 h). The protection time of these binary mixtures was comparable with that of DEET. With the exception of savory EO, the other EOs, tamanu oil, and binary mixtures did not induce any adverse effects on the human volunteers at 0.5 mg/cm2. Thus, binary mixtures of essential oils and tamanu oil described merit further study as potential repellents for protection from humans and domestic animals from biting and nuisance caused by S. calcitrans.
Detection of West Nile Virus RNA in Mosquitoes and Identification of Mosquito Blood Meals Collected at Alligator Farms in Louisiana
Authors: Unlu Isik , Kramer Wayne L. , Roy Alma F. , Foil Lane D.
Published: January 2015

Since 2001, alligator farms in the United States have sustained substantial economic losses because of West Nile virus (WNV) outbreaks in American alligators (Alligator mississippiensis). Once an initial infection is introduced into captive alligators, WNV can spread among animals by contaminative transmission. Some outbreaks have been linked to feeding on infected meat or the introduction of infected hatchlings, but the initial source of WNV infection has been uncertain in other outbreaks. We conducted a study to identify species composition and presence of WNV in mosquito populations associated with alligator farms in Louisiana. A second objective of this study was to identify the origin of mosquito blood meals collected at commercial alligator farms. Mosquitoes were collected from 2004 to 2006, using Centers for Disease Control light traps, gravid traps, backpack aspirators, and resting boxes. We collected a total of 58,975 mosquitoes representing 24 species. WNV was detected in 41 pools of females from 11 mosquito species: Anopheles crucians, Anopheles quadrimaculatus, Coquillettidia perturbans, Culex coronator, Culex erraticus, Culex nigripalpus, Culex quinquefasciatus, Mansonia titillans, Aedes sollicitans, Psorophora columbiae, and Uranotaenia lowii. The blood meal origins of 213 field-collected mosquitoes were identified based on cytochrome B sequence identity. Alligator blood was detected in 21 mosquitoes representing six species of mosquitoes, including Cx. quinquefasciatus and Cx. nigripalpus. Our results showed that mosquitoes of species that are known to be competent vectors of WNV fed regularly on captive alligators. Therefore, mosquitoes probably are important in the role of transmission of WNV at alligator farms.
Formulations of Deet, Picaridin, and IR3535 Applied to Skin Repel Nymphs of the Lone Star Tick (Acari: Ixodidae) for 12 Hours
Authors: Carroll J. F. , Benante J. P. , Kramer M. , Lohmeyer K. H. , Lawrence K.
Published: January 2015

The efficacies of a 20% 1-methyl-propyl-2-(hydroxyethyl)-1-piperidinecarboxylate (picaridin) spray, 20% 3-(N-acetyl-N-butyl)aminopropionic acid ethyl ester (IR3535) spray, 20% picaridin lotion, 10% IR3535 lotion, and 33% N,N-diethyl-3-methylbenzamide (deet) cream in repelling nymphal lone star ticks, Amblyomma americanum (L.), were determined at 2-h intervals over 12 h using human subjects. A repellent formulation was applied in a 5-cm-wide band encircling a volunteer’s lower leg. For each challenge, 70 host-seeking nymphs were released on each volunteer’s ankle, and tick locations were recorded 10 min after the ticks were released. Ticks that crawled entirely across the repellent band were considered not repelled. For all formulations and time points, significantly fewer (all P < 0.0001) A. americanum nymphs crossed the treatment bands on the volunteers’ ankles than crossed the corresponding area on the untreated control legs. Formulations containing ≥20% active ingredient were highly effective, with <10% of the ticks crossing through the treatment bands for any challenge during the 12 h. At least 40% of ticks exposed to any formulation for any challenge fell or crawled off the volunteers. There was no difference in effectiveness between the 20% spray and 20% lotion formulations of picaridin. The 10% IR3535 lotion was significantly less effective than the formulations with higher concentrations of repellent. In the formulations tested, deet, picaridin, and IR3535 provided lasting protection against A. americanum.
Use of a Ventricular Septal Defect Occluder for Apical Closure in Transapical Aortic Valve Replacement
Authors: Ferrari Enrico , Locca Didier , Berdajs Denis , Marcucci Carlo , Gronchi Fabrizio , Lavanchy Jerome , Prêtre René , Tozzi Piergiorgio
Published: January 2015

During transapical transcatheter aortic valve replacement (TA-TAVR), the apical closure remains a challenge for the surgeon, having the risk for ventricular tear and massive bleeding. Apical closure devices are already under clinical evaluation, but only a few can lead to a full percutaneous TA-TAVR. We describe the successful use of a 9-mm myocardial occluder (ventricular septal defect occluder) that was used to seal the apex after a standard TA-TAVR (using the Sapien XT 23-mm transcatheter valve and the Ascendra + delivery system). The placement of the nonmodified myocardial occluder was performed through the Ascendra + delivery system, with a very small amount of blood loss and an acceptable sealing of the apical tear. This approach is feasible and represents a further step toward true-percutaneous transapical heart valve procedures. Modified apical occluders are under evaluation in animal models.
The Role of Computed Tomography Angiography in Patients Undergoing Evaluation for Minimally Invasive Cardiac Surgery: An Early Program Experience
Authors: Youssef Samuel J. , Millan Juan A. , Youssef Gabriel M. , Earnheart Amanda , Lehr Eric J. , Barnhart Glenn R.
Published: January 2015

Objective

An increasing number of patients are undergoing surgical procedures using minimally invasive cardiac surgery (MICS). These techniques use conventional or retrograde arterial perfusion with direct aortic cross-clamping or endoballoon occlusion. Precise knowledge of the arterial tree is required to avoid complications and to plan for the operation. We examined the role of computed tomography angiography (CTA) in evaluating patients for MICS.

Methods

We reviewed all consecutive candidates undergoing CTA during preoperative evaluation for MICS aortic, mitral, tricuspid, Maze, atrial septal defect, or myxoma procedures between February 2008 and May 2010. The CTA findings of patients excluded from MICS were compared against those successfully undergoing MICS.

Results

One hundred eleven MICS candidates underwent preoperative CTA. Thirty-five (32%) had single or multiple CTA findings precluding MICS and underwent sternotomy. Seventy-six (68%) had favorable CTA findings and underwent MICS. The MICS group had a mean age of 62 years, with 29 women (39%); the non-MICS group had a mean age of 68 years, with 17 women (48%). Of the patients excluded from MICS, two (6%) had diminished or absent lower extremity pulses. All MICS patients (except for aortic) had successful use of the endoballoon. There were no perfusion or peripheral vascular complications. There was one stroke, one lymphocele, and one death (chronic obstructive pulmonary disease exacerbation).

Conclusions

Computed tomography angiography is of fundamental importance in evaluating patients for MICS. It can identify calcified regions that make for threatening catheter passage with subsequent retrograde arterial perfusion. Abnormalities of the arterial tree are identified. The use of CTA-guided patient selection can thus avoid major perioperative complications.
A comparison of a formal triage scoring system and a quick-look triage approach
Authors: Betz Martin , Stempien James , Wilde Alan , Bryce Rhonda
Published: January 2015

Background

Emergency Department (ED) triage systems have become increasingly comprehensive over time, requiring ever more resources such as nursing time and computer support. There are very few studies that have looked at whether this increased complexity results in improved performance.

Objectives

This study looked at one aspect of performance, comparing reliability of triage nurses’ (TNs) triage scores utilizing a simple quick-look method with a commonly used, resource-intense, five-level triage system.

Methods

This observational study of TNs was carried out in two urban tertiary-care hospital EDs, in real time, assessing patients arriving consecutively. Immediately upon patients’ arrival, TNs were asked to assign triage scores based simply on their observation of the patient and the chief complaint. The patient was then triaged in the department’s usual way, utilizing a computer-assisted five-level triage system [Canadian Triage and Acuity Scale (CTAS)]. Agreement between scores was quantified. κ scores were calculated, and weighted by the CTAS score.

Results

A total of 496 triage assessments were included. Percent agreement between the quick-look method and the standard CTAS method was 84.5%. κ scores were moderately high. Fourteen patients (2.6%), ultimately classified as CTAS 1 or 2, initially received lower scores from TNs using the quick-look method. No comparison of validity was assessed.

Conclusion

TNs assigning triage scores to ED patients on arrival, using only chief complaint and observation, were statistically comparable to scores assigned utilizing a resource-intense, comprehensive triage system, but clinically significant discrepancies were identified.
Ethically justified treatment limitations in emergency situations
Authors: Tirkkonen Joonas , Olkkola Klaus T. , Tenhunen Jyrki , Hoppu Sanna
Published: January 2015

Objective

Medical emergency teams (METs) implement do not attempt cardiopulmonary resuscitation (DNACPR) orders and other limitations of medical treatment (LOMTs) in hospitals regularly. However, METs operate in emergency situations with limited or no patient information at the scene. We aimed to study the medical ethics of LOMTs implemented in in-hospital emergency situations.

Methods

This was a prospective observational study with retrospect case-note analysis conducted in a single Finnish university hospital over 16 months. Data were collected according to the Utstein-style scientific statement.

Results

There were 774 reviews on 640 patients without preceding LOMT. During the reviews MET assigned LOMTs (including 55 DNACPR orders) for a group of 59 patients who were older (median 77 vs. 68 years; P<0.001) and had higher cumulative comorbidity (median Charlson comorbidity index 2 vs. 1; P=0.001) compared with patients without LOMTs (no-LOMT). Most reviews (71%) leading to new LOMTs occurred during on-call time. In the majority of LOMT cases at least two physicians (86%) and the patient/relatives (76%) were involved in the decision-making. All but one (98%) of the LOMT reviews were documented in the electronic patient records and included clearly described rationale for the LOMT. The median durations of the MET reviews (31 vs. 31 min, P=0.9) were comparable in the two groups. Age alone was never recorded as a reason for LOMT.

Conclusion

LOMTs were implemented in a decent and ethically justified manner in emergency situations following the code of conduct recommended by guidelines, even though MET operated under highly suboptimal circumstances for end-of-life care planning.
The RING Finger Ubiquitin E3 Ligase SDIR1 Targets SDIR1-INTERACTING PROTEIN1 for Degradation to Modulate the Salt Stress Response and ABA Signaling inArabidopsis
Authors: Zhang Huawei , Cui Feng , Wu Yaorong , Lou Lijuan , Liu Lijing , Tian Miaomiao , Ning Yuese , Shu Kai , Tang Sanyuan , Xie Qi
Published: January 2015

The plant hormone abscisic acid (ABA) regulates many aspects of plant development and the stress response. The intracellular E3 ligase SDIR1 (SALT- AND DROUGHT-INDUCED REALLY INTERESTING NEW GENE FINGER1) plays a key role in ABA signaling, regulating ABA-related seed germination and the stress response. In this study, we found that SDIR1 is localized on the endoplasmic reticulum membrane in Arabidopsis thaliana. Using cell biology, molecular biology, and biochemistry approaches, we demonstrated that SDIR1 interacts with and ubiquitinates its substrate, SDIRIP1 (SDIR1-INTERACTING PROTEIN1), to modulate SDIRIP1 stability through the 26S proteasome pathway. SDIRIP1 acts genetically downstream of SDIR1 in ABA and salt stress signaling. In detail, SDIRIP1 selectively regulates the expression of the downstream basic region/leucine zipper motif transcription factor gene ABA-INSENSITIVE5, rather than ABA-RESPONSIVE ELEMENTS BINDING FACTOR3 (ABF3) or ABF4, to regulate ABA-mediated seed germination and the plant salt response. Overall, the SDIR1/SDIRIP1 complex plays a vital role in ABA signaling through the ubiquitination pathway.
Is Biggest Best? A Comparative Analysis of the Financial Viability of the Brisbane City Council
Authors: Sinnewe Elisabeth , Kortt Michael A. , Dollery Brian
Published: January 2015

Structural reform through forced mergers has been a dominant feature of Australian local government for decades. Advocates of compulsory consolidation contend that larger municipalities perform better across a wide range of attributes, including financial sustainability. Although empirical scholars of local government have invested considerable effort into investigating these claims, no one has yet examined the performance of Brisbane City Council against other local authorities, despite the fact that it is by far the largest council in Australia. This paper seeks to remedy this neglect by comparing Brisbane with Sydney City Council, an average of six southeast Queensland councils and an average of 10 metropolitan New South Wales councils against four measures of financial performance over the period 2008–2011.
Assessing the utility of whole genome amplified DNA for next‐generation molecular ecology
Authors: Blair Christopher , Campbell C. Ryan , Yoder Anne D.
Published: January 2015

DNA quantity can be a hindrance in ecological and evolutionary research programmes due to a range of factors including endangered status of target organisms, available tissue type, and the impact of field conditions on preservation methods. A potential solution to low‐quantity DNA lies in whole genome amplification (WGA) techniques that can substantially increase DNA yield. To date, few studies have rigorously examined sequence bias that might result from WGA and next‐generation sequencing of nonmodel taxa. To address this knowledge deficit, we use multiple displacement amplification (MDA) and double‐digest RAD sequencing on the grey mouse lemur (Microcebus murinus) to quantify bias in genome coverage and SNP calls when compared to raw genomic DNA (gDNA). We focus our efforts in providing baseline estimates of potential bias by following manufacturer's recommendations for starting DNA quantities (>100 ng). Our results are strongly suggestive that MDA enrichment does not introduce systematic bias to genome characterization. SNP calling between samples when genotyping both de‐novo and with a reference genome are highly congruent (>98%) when specifying a minimum threshold of 20X stack depth to call genotypes. Relative genome coverage is also similar between MDA and gDNA, and allelic dropout is not observed. SNP concordance varies based on coverage threshold, with 95% concordance reached at ~12X coverage genotyping de‐novo and ~7X coverage genotyping with the reference genome. These results suggest that MDA may be a suitable solution for next‐generation molecular ecological studies when DNA quantity would otherwise be a limiting factor.
Long‐term mortality, remission, criminality and psychiatric comorbidity of heroin dependence: 11‐year findings from the Australian Treatment Outcome Study
Authors: Teesson Maree , Marel Christina , Darke Shane , Ross Joanne , Slade Tim , Burns Lucy , Lynskey Michael , Memedovic Sonja , White Joanne , Mills Katherine L.
Published: January 2015

Aims

To determine the long‐term mortality, remission, criminality and psychiatric comorbidity during 11 years among heroin‐dependent Australians.

Design

Longitudinal cohort study.

Setting

Sydney, Australia.

Participants

A total of 615 participants were recruited and completed baseline interviews between 2001 and 2002. Participants completed follow‐up interviews at 3, 12, 24 and 36 months post‐baseline, and again at 11 years post‐baseline; 431 (70.1%) of the original 615 participants completed the 11‐year follow‐up.

Measurements

Participants were administered the Australian Treatment Outcome Study (ATOS) structured interview, addressing demographics, treatment history, drug use, heroin overdose, criminality, health and mental health at all interviews. Overall, 96.1% of the cohort completed at least one follow‐up interview.

Findings

At 11 years, 63 participants (10.2%) were deceased. The proportion of participants who reported using heroin in the preceding month decreased significantly from baseline (98.7%) to 36‐month follow‐up (34.0%; odds ratio = 0.01; 95% confidence interval = 0.00, 0.01) with further reductions evident between 36 months and 11 years (24.8%). However, one in four continued to use heroin at 11 years, and close to one‐half (46.6%) were in current treatment. The reduction in current heroin use was accompanied by reductions in risk‐taking, crime and injection‐related health problems, and improvements in general physical and mental health. The relationship with treatment exposure was varied. Major depression was associated consistently with poorer outcome.

Conclusions

In an 11‐year follow‐up of patients undergoing treatment for heroin dependence, 10.2% had died and almost half were still in treatment; the proportion still using heroin fell to a quarter, with major depression being a significant predictor of continued use.
Ultrasonography and C‐reactive protein can predict the outcomes of voiding cystography after the first urinary tract infection
Authors: Kido Jun , Yoshida Fuminori , Sakaguchi Katsuya , Ueno Yasushi , Yanai Masaaki
Published: January 2015

Aim

This study evaluated whether sex, clinical variables, laboratory variables or ultrasonography predicted the presence of vesicoureteric reflux during the first episode of urinary tract infection in paediatric patients. We also aimed to define the criteria that indicated the need for voiding cystography testing.

Methods

We used voiding cystography to investigate 200 patients who experienced their first urinary tract infection at our institution between 2004 and 2013 and retrospectively analysed the data by reviewing their medical records.

Results

Sex (p = 0.001), peak blood C‐reactive protein levels (p < 0.001), the duration of fever after antibiotic administration (p = 0.007) and the ultrasonography findings grade (p < 0.001) were significantly different between patients with and without vesicoureteric reflux. Grade IV–V ultrasonography findings and C‐reactive protein levels of ≥80 mg/L predicted vesicoureteric reflux with a sensitivity, specificity and odds ratio of 47.8%, 87.8% and 6.59 (95% confidence interval = 3.26–13.33), respectively (p < 0.001).

Conclusion

Voiding cystography should be performed for patients with C‐reactive protein levels of ≥80 mg/L and grade IV–V ultrasonography findings, but is not necessary in patients with C‐reactive protein levels of <80 mg/L and grade I–III ultrasonography findings.
Decompressing posthaemorrhagic ventricular dilatation significantly improves regional cerebral oxygen saturation in preterm infants
Authors: Norooz F , Urlesberger B , Giordano V , Klebermasz‐Schrehof K , Weninger M , Berger A , Olischar M
Published: January 2015

Aim

This study aimed to delineate the impact of posthaemorrhagic ventricular dilatation (PHVD) on regional cerebral oxygen saturation (rcSO2) in preterm infants before and after ventricular decompression using near‐infrared spectroscopy (NIRS).

Methods

rcSO2 values were recorded, fractional tissue oxygen extraction (FTOE) was calculated, cerebral ultrasound scans were performed, and resistive indices and ventricular width were collected before and after decompression. Where possible, amplitude‐integrated electroencephalography (aEEG) and visual evoked potentials (VEPs) were recorded before and after decompression.

Results

We included nine preterm infants: nine with cranial ultrasound scan data, eight with NIRS data, seven with aEEG data and four with VEPs. The resistive index was stable and remained unchanged after decompression in all patients. Before decompression, the mean rcSO2 value was 42.6 ± 12.9% and increased to 55 ± 12.2% after decompression. With increasing ventricular width, FTOE showed a mean value of 0.51 ± 0.05 and decreased to a mean of 0.39 ± 0.12 after decompression. Amplitude‐integrated electroencephalography showed a more continuous pattern, and VEPs showed delayed latencies in all patients before intervention, improving afterwards.

Conclusion

Near‐infrared spectroscopy may be of additional clinical value in progressive PHVD to determine the optimal time point for ventricular decompression.
Adverse drug reactions in special populations – the elderly
Authors: Davies E. A. , O'Mahony M. S.
Published: January 2015

The International Conference on Harmonization considers older people a ‘special population’, as they differ from younger adults in terms of comorbidity, polypharmacy, pharmacokinetics and greater vulnerability to adverse drug reactions (ADRs). Medical practice is often based on single disease guidelines derived from clinical trials that have not included frail older people or those with multiple morbidities. This presents a challenge caring for older people, as drug doses in trials may not be achievable in real world patients and risks of ADRs are underestimated in clinical trial populations. The majority of ADRs in older people are Type A, potentially avoidable and associated with commonly prescribed medications. Several ADRs are particularly associated with major adverse consequences in the elderly and their reduction is therefore a clinical priority. Falls are strongly associated with benzodiazepines, neuroleptics, antidepressants and antihypertensives. There is good evidence for medication review as part of a multifactorial intervention to reduce falls risk in community dwelling elderly. Multiple medications also contribute to delirium, another multifactorial syndrome resulting in excess mortality particularly in frail older people. Clostridium difficile associated with use of broad spectrum antibiotics mainly affects frail older people and results in prolonged hospital stay with substantial morbidity and mortality. Antipsychotics increase the risk of stroke by more than three‐fold in patients with dementia. Inappropriate prescribing can be reduced by adherence to prescribing guidelines, suitable monitoring and regular medication review. Given the heterogeneity within the older population, providing individualized care is pivotal to preventing ADRs.