bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlating data from different sensors to increase the positive predictive value of alarms: an empiric assessment
Authors: Bitan Yuval , O’Connor Michael F
Published: May 2013

Objectives: Alarm fatigue from high false alarm rate is a well described phenomenon in the intensive care unit (ICU). Progress to further reduce false alarms must employ a new strategy. Highly sensitive alarms invariably have a very high false alarm rate. Clinically useful alarms have a high Positive-Predictive Value. Our goal is to demonstrate one approach to suppressing false alarms using an algorithm that correlates information across sensors and replicates the ways that human evaluators discriminate artifact from real signal.

Methods: After obtaining IRB approval and waiver of informed consent, a set of definitions, (hypovolemia, left ventricular shock, tamponade, hemodynamically significant ventricular tachycardia, and hemodynamically significant supraventricular tachycardia), were installed in the monitors in a 10 bed cardiothoracic ICU and evaluated over an 85 day study period. The logic of the algorithms was intended to replicate the logic of practitioners, and correlated information across sensors in a way similar to that used by practitioners. The performance of the alarms was evaluated via a daily interview with the ICU attending and review of the tracings recorded over the previous 24 hours in the monitor. True alarms and false alarms were identified by an expert clinician, and the performance of the algorithms evaluated using the standard definitions of sensitivity, specificity, positive predictive value, and negative predictive value.

Results: Between 1 and 221 instances of defined events occurred over the duration of the study, and the positive predictive value of the definitions varied between 4.1% and 84%.

Conclusions: Correlation of information across alarms can suppress artifact, increase the positive predictive value of alarms, and can employ more sophisticated definitions of alarm events than present single-sensor based systems.
Student feedback about the use of literature excerpts in Sparshanam, a Medical Humanities module
Authors: Shankar P Ravi , Singh Kundan K , Dhakal Ajaya , Shakya Arati , Piryani Rano M
Published: May 2013

Medical humanities (MH) modules have been conducted for first year students at KIST Medical College, Lalitpur, Nepal for the last four years. Literature excerpts are widely used in MH programs in developed nations. In Nepal English language literature excerpts had been used previously in two modules. Problems noted were difficulty in comprehending the excerpts and relating them to the Nepalese scenario. The MH module for the 2011 intake was conducted from December 2011 to March 2012. The present study was conducted in the third week of March to obtain student perceptions about use of literature excerpts and suggestions for further improvement using a questionnaire. Literature excerpts used in the module dealt with Nepal and health-related topics. Sixty-eight of the 80 students (85%) participated in the study. The majority were male, self-financing and from urban areas. Respondents felt the excerpts introduced them to different aspects of the medical profession, prepared them for future practice, and underscored the importance of understanding the patients’ feelings. The literature excerpts with which they could identify the most and the least were noted. There were no differences in median enjoyment and effectiveness scores of the literature excerpts according to subgroups of respondents. The suggested benefits of using literature in medical education were similar to those reported previously. Most respondents were able to appreciate the English language excerpts. They felt that Nepali language excerpts and those by Nepali writers could also be included. The findings would be of interest to educators in other developing nations introducing MH modules.
Kyasanur forest disease virus: viremia and challenge studies in monkeys with evidence of cross-protection by Langat virus infection
Authors: Shah Keerti V , Dandawate Chandu N , Bhatt Pravin N
Published: May 2013

Kyasanur Forest Disease Virus (KFDV), discovered in 1957, is a member of the tick-borne encephalitis virus (TBEV) complex. Diseases caused by members of the TBEV complex occur in many parts of the world. KFDV produces a hemorrhagic fever in humans in South India and fatal illnesses in both species of monkeys in the area, the black faced langur (Presbytis entellus) and the bonnet macaque (Macaca radiata). Experimental infection of the langur and the bonnet macaque with early mouse passage KFDV strain P9605 resulted in a viremia of up to 11 days duration, peak viremia titers as high as 109, and death in 82 = 100% of the animals. Prolonged passage of the KFDV strain P9605 in monkey kidney tissue culture resulted in a markedly reduced virulence of the virus for both species; peak viremia titers in monkeys decreased by 2.5 to 4.0 log LD 50 (p= 0.001), and the mortality decreased to 10% (p= 0.001). In challenge experiments, monkeys previously infected with tissue-culture-adapted KFDV, or with the related Langat virus from Malaysia, were fully protected against virulent KFDV. These studies in non-human primates lend support to the idea that a live virus vaccine from a member of the TBEV complex may be broadly protective against infections by other members of the TBEV complex.
Student feedback about the use of role plays in Sparshanam, a medical humanities module
Authors: Shankar P Ravi , Piryani Rano M , Singh Kundan K , Karki Bal Man S
Published: May 2013

Background:At KIST Medical College, Lalitpur, Nepal, a Medical Humanities module for first year medical students has been conducted. Role plays are used to explore social, medical and sexual issues in the Nepalese context. The present study obtained student feedback about the role plays used in the module, the difficulties faced, and obtained suggestions for further improvement.

Method:The module was conducted from January to August 2011 using a total of 15 role plays. Student feedback was obtained using a semi-structured questionnaire. Informal discussions were held and a questionnaire was circulated among the first year students who had participated in the module.

Results:Ninety-eight of the 100 students in the module participated in the study. The overall opinion regarding the role plays was positive. Students stated role plays helped to make module objectives concrete and interesting, made students identify with the problem being investigated and improved communication skills. Role plays were designed to address important health issues in Nepal and prepare students for addressing these issues in future practice. A lack of sufficient time for preparing the role plays and initial problems with group dynamics were mentioned by the respondents during the study.

Conclusions:Student feedback about the use of role plays during the module was positive. Role plays helped in making module objectives more concrete and interesting, improved communication skills and addressed important health issues in Nepal. Role plays are not resource intensive and can be considered for use in medical schools in developing nations.
Neuronal activity-regulated gene transcription: how are distant synaptic signals conveyed to the nucleus?
Authors: Matamales Miriam
Published: May 2013

Synaptic activity can trigger gene expression programs that are required for the stable change of neuronal properties, a process that is essential for learning and memory. Currently, it is still unclear how the stimulation of dendritic synapses can be coupled to transcription in the nucleus in a timely way given that large distances can separate these two cellular compartments. Although several mechanisms have been proposed to explain long distance communication between synapses and the nucleus, the possible co-existence of these models and their relevance in physiological conditions remain elusive. One model suggests that synaptic activation triggers the translocation to the nucleus of certain transcription regulators localised at postsynaptic sites that function as synapto-nuclear messengers. Alternatively, it has been hypothesised that synaptic activity initiates propagating regenerative intracellular calcium waves that spread through dendrites into the nucleus where nuclear transcription machinery is thereby regulated. It has also been postulated that membrane depolarisation of voltage-gated calcium channels on the somatic membrane is sufficient to increase intracellular calcium concentration and activate transcription without the need for transported signals from distant synapses. Here I provide a critical overview of the suggested mechanisms for coupling synaptic stimulation to transcription, the underlying assumptions behind them and their plausible physiological significance.
Implementing a successful journal club in an anesthesiology residency program
Authors: Pitner Nathaniel D , Fox Chris A , Riess Matthias L
Published: May 2013

Journal clubs are an integral element of residency training. We report the successful implementation of a monthly structured journal club in our anesthesia residency program. Based on resident surveys before and one year after its start, the journal club led to a significantly higher confidence in how to critically appraise literature and present a manuscript. The journal club also improved the residents' ability to search the literature and their statistical knowledge, skills that are essential in the practice of evidence-based medicine. We describe key features that may aid other training programs in organizing a stimulating an educational and sustainable journal club.
Moving beyond Type I and Type II neuron types
Authors: Skinner Frances K
Published: May 2013

In 1948, Hodgkin delineated different classes of axonal firing.  This has been mathematically translated allowing insight and understanding to emerge.  As such, the terminology of ‘Type I’ and ‘Type II’ neurons is commonplace in the Neuroscience literature today.  Theoretical insights have helped us realize that, for example, network synchronization depends on whether neurons are Type I or Type II.  Mathematical models are precise with analyses (considering Type I/II aspects), but experimentally, the distinction can be less clear.  On the other hand, experiments are becoming more sophisticated in terms of distinguishing and manipulating particular cell types but are limited in terms of being able to consider network aspects simultaneously.   Although there is much work going on mathematically and experimentally, in my opinion it is becoming common that models are either superficially linked with experiment or not described in enough detail to appreciate the biological context.  Overall, we all suffer in terms of impeding our understanding of brain networks and applying our understanding to neurological disease.  I suggest that more modelers become familiar with experimental details and that more experimentalists appreciate modeling assumptions. In other words, we need to move beyond our comfort zones.
Correlation between miRNA-targeting-specific promotermethylation and miRNA regulation of target genes
Authors: Taguchi Y-h
Published: May 2013

BackgroundmiRNA regulation of target genes and promoter methylation were known to be the primary mechanisms underlying the epigenetic regulation of gene expression. However, how these two processes cooperatively regulate gene expression has not been extensively studied.

MethodsGene expression and promoter methylation profiles of 271 distinct human cell lines were obtained from gene expression omnibus. P-values that describe both miRNA-targeting-specific promoter methylation and miRNA regulation of target genes were computed with the MiRaGE method proposed recently by the author.

ResultsWe found that promoter methylation was miRNA-targeting-specific. In other words, changes in promoter methylation were associated with miRNA binding at target genes. It was also found that miRNA-targeting-specific promoter hypomethylation was related to miRNA regulation; the genes with miRNA-targeting-specific promoter hypomethylation were downregulated during cell senescence and upregulated during cellulardierentiation. Promoter hypomethylation was especially enhanced for genes targeted by miR-548 miRNAs, which are non-conserved, and primate-specific miRNAs that are typically expressed at lower levels than the frequently investigated conserved miRNAs.

ConclusionsIt was found that promoter methylation was affected by miRNA targeting. Furthermore, miRNA-targeting-specific promoter hypomethylation was suggested to facilitate gene regulation by miRNAs that are not strongly expressed (e.g., miR-548 miRNAs).
Association of spirochetal infection with Morgellons disease
Authors: Middelveen Marianne J , Burugu Divya , Poruri Akhila , Burke Jennie , Mayne Peter J , Sapi Eva , Kahn Douglas G , Stricker Raphael B
Published: May 2013

Morgellons disease (MD) is an emerging multisystem illness characterized by skin lesions with unusual filaments embedded in or projecting from epithelial tissue. Filament formation results from abnormal keratin and collagen expression by epithelial-based keratinocytes and fibroblasts. Recent research comparing MD to bovine digital dermatitis, an animal infectious disease with similar skin features, provided clues that spirochetal infection could play an important role in the human disease as it does in the animal illness. Based on histological staining, immunofluorescent staining, electron microscopic imaging and polymerase chain reaction, we report the detection of Borrelia spirochetes in dermatological tissue of  four randomly-selected MD patients. The association of MD with spirochetal infection provides evidence that this infection may be a significant factor in the illness and refutes claims that MD lesions are self-inflicted and that people suffering from this disorder are delusional. Molecular characterization of the Borrelia spirochetes found in MD patients is warranted.
The stabilizing effects of genetic diversity on predator-prey dynamics
Authors: Steiner Christopher F , Masse Jordan
Published: May 2013

Heterogeneity among prey in their susceptibility to predation is a potentially important stabilizer of predator-prey interactions, reducing the magnitude of population oscillations and enhancing total prey population abundance. When microevolutionary responses of prey populations occur at time scales comparable to population dynamics, adaptive responses in prey defense can, in theory, stabilize predator-prey dynamics and reduce top-down effects on prey abundance. While experiments have tested these predictions, less explored are the consequences of the evolution of prey phenotypes that can persist in both vulnerable and invulnerable classes. We tested this experimentally using a laboratory aquatic system composed of the rotifer Brachionus calyciflorus as a predator and the prey Synura petersenii, a colony-forming alga that exhibits genetic variation in its propensity to form colonies and colony size (larger colonies are a defense against predators). Prey populations of either low initial genetic diversity and low adaptive capacity or high initial genetic diversity and high adaptive capacity were crossed with predator presence and absence. Dynamics measured over the last 127 days of the 167-day experiment revealed no effects of initial prey genetic diversity on the average abundance or temporal variability of predator populations. However, genetic diversity and predator presence/absence interactively affected prey population abundance and stability; diversity of prey had no effects in the absence of predators but stabilized dynamics and increased total prey abundance in the presence of predators. The size structure of the genetically diverse prey populations diverged from single strain populations in the presence of predators, showing increases in colony size and in the relative abundance of cells found in colonies. Our work sheds light on the adaptive value of colony formation and supports the general view that genetic diversity and intraspecific trait variation of prey can play a vital role in the short-term dynamics and stability of planktonic predator-prey systems.
The Perinatal Adverse events and Special Trends in Cognitive Trajectory (PLASTICITY) - pre-protocol for a prospective longitudinal follow-up cohort study
Authors: Hokkanen Laura , Launes Jyrki , Michelsson Katarina
Published: May 2013

Prospective follow-up studies on long term effects of pre- and perinatal adverse conditions in adulthood are rare. We will continue to follow the prospective cohort of initially 1196 subjects with predefined at-delivery risk factors out of 22,359 consecutive deliveries during 1971-74 at a single maternity hospital. The risk cohort and 93 controls have been followed up with a comprehensive clinical program at 5, 9, and 16 years of age and by questionnaire at the age of 30 years. Major medical events known to affect the development and growth of the brain, or cognitive functions and personality have been documented. Here we present a pre-protocol for the project, which we will call PLASTICITY, whose aim is to follow consenting subjects and controls into mid-adulthood and beyond, and to explore how the neonatal risk factors modulate neurodevelopmental and neurodegenerative processes such as learning disabilities, ADHD, aging, early onset mild cognitive impairment and even dementia. Our first focus is on the neurological and cognitive outcomes at age 40 years, using detailed neurological, neuropsychological, neuroimaging, genetic, blood chemistry and registry based methods. Results will be expected to offer information on the risk of neurological, psychiatric, metabolic and other medical consequences as well as the need for health and social services at the brink of middle age, when new degenerative phenomena are known to emerge. The evaluation at age 40 years will serve as a baseline for later aging studies. We welcome all comments and suggestions, which we will apply in finalizing details and inviting collaboration.
Cocaine self-administration in mice with forebrain knock-down of trpc5 ion channels
Authors: Pomrenze Matthew B , Baratta Michael V , Rasmus Kristin C , Cadle Brian A , Nakamura Shinya , Birnbaumer Lutz , Cooper Donald C
Published: May 2013

Canonical transient receptor potential (TRPC) channels are a family of non-selective cation channels that play a crucial role in modulating neuronal excitability due to their involvement in intracellular Ca2+ regulation and dendritic growth. TRPC5 channels a) are one of the two most prevalent TRPC channels in the adult rodent brain; b) are densely expressed in deep layer pyramidal neurons of the prefrontal cortex (PFC); and c) modulate neuronal persistent activity necessary for working memory and attention. In order to evaluate the causal role of TRPC5 in motivation/reward-related behaviors, conditional forebrain TRPC5 knock-down (trpc5-KD) mice were generated and trained to nose-poke for intravenous cocaine. Here we present a data set containing the first 6 days of saline or cocaine self-administration in wild type (WT) and trpc5-KD mice. In addition, we also present a data set showing the dose-response to cocaine after both groups had achieved similar levels of cocaine self-administration. Compared to WT mice, trpc5-KD mice exhibited an apparent increase in self-administration on the first day of cocaine testing without prior operant training. There were no apparent differences between WT and trpc5-KD mice for saline responding on the first day of training. Both groups showed similar dose-response sensitivity to cocaine after several days of achieving similar levels of cocaine intake.
The rise of testicular germ cell tumours: the search for causes, risk factors and novel therapeutic targets
Authors: McIver Skye C , Roman Shaun D , Nixon Brett , Loveland Kate L , McLaughlin Eileen A
Published: May 2013

Since the beginning of the 20th century there has been a decline in the reproductive vitality of men within the Western world. The declining sperm quantity and quality has been associated with increased overt disorders of sexual development including hypospadias, undescended testes and type II testicular germ cell tumours (TGCTs). The increase in TGCTs cannot be accounted for by genetic changes in the population. Therefore exposure to environmental toxicants appears to be a major contributor to the aetiology of TGCTs and men with a genetic predisposition are particularly vulnerable. In particular, Type II TGCTs have been identified to arise from a precursor lesion Carcinomain situ(CIS), identified as a dysfunctional gonocyte; however, the exact triggers for CIS development are currently unknown. Therefore the transition from gonocytes into spermatogonia is key to those studying TGCTs. Recently we have identified seven miRNA molecules (including members of the miR-290 family and miR-136, 463* and 743a) to be significantly changed over this transition period. These miRNA molecules are predicted to have targets within the CXCR4, PTEN, DHH, RAC and PDGF pathways, all of which have important roles in germ cell migration, proliferation and homing to the spermatogonial stem cell niche. Given the plethora of potential targets affected by each miRNA molecule, subtle changes in miRNA expression could have significant consequences e.g. tumourigenesis. The role of non-traditional oncogenes and tumour suppressors such as miRNA in TGCT is highlighted by the fact that the majority of these tumours express wild type p53, a pivotal tumour suppressor usually inactivated in cancer. While treatment of TGCTs is highly successful, the impact of these treatments on fertility means that identification of exact triggers, earlier diagnosis and alternate treatments are essential. This review examines the genetic factors and possible triggers of type II TGCT to highlight target areas for potential new treatments.
Glycine-extended gastrin enhances somatostatin release from cultured rabbit fundic D-cells
Authors: Beales Ian LP
Published: May 2013

The role of the peptide hormone gastrin in stimulating gastric acid secretion is well established. Mature amidated gastrin is processed from larger peptide precursor forms. Increasingly these processing intermediates, such as glycine-extended gastrin (G-Gly) and progastrin, have been shown to have biological activities of their own, often separate and complementary to gastrin. Although G-Gly is synthesized and secreted by gastric antral G-cells, the physiological functions of this putative mediator are unclear. Gastrin and cholecystokinin (CCK) stimulate the secretion of somatostatin from gastric D-cells as part of the feedback control of gastric acid. In this study the effect of G-Gly and gastrin on the release of somatostatin from rabbit fundic D-cells was examined. D-cells were obtained by collagenase-EDTA digestion and elutriation and cultured for 48 hours. With a 2 hour exposure to the peptides, gastrin but not G-Gly stimulated somatostatin release. Treatment of D-cells for 24 hours with gastrin or G-Gly individually, significantly enhanced subsequent basal as well as CCK- and GLP-1-stimulated somatostatin release. Twenty four hours exposure to gastrin combined with G-Gly synergistically enhanced basal and agonist-stimulated somatostatin release and cellular somatostatin content. Gastrin and G-Gly may be important in the longer term regulation of D-cell function.
The Focal Adhesion Analysis Server: a web tool for analyzing focal adhesion dynamics
Authors: Berginski Matthew E , Gomez Shawn M
Published: May 2013

The Focal Adhesion Analysis Server (FAAS) is a web-based implementation of a set of computer vision algorithms designed to quantify the behavior of focal adhesions in cells imaged in 2D cultures. The input consists of one or more images of a labeled focal adhesion protein. The outputs of the system include a range of static and dynamic measurements for the adhesions present in each image as well as how these properties change over time. The user is able to adjust several parameters important for proper focal adhesion identification. This system provides a straightforward tool for the global, unbiased assessment of focal adhesion behavior common in optical microscopy studies. The webserver is available at: http://faas.bme.unc.edu/.
High efficiency generalized transduction in Escherichia coli O157:H7
Authors: Marinus Martin G , Poteete Anthony R
Published: May 2013

Genetic manipulation in enterohemorrhagicE. coliO157:H7 is currently restricted to recombineering, a method that utilizes the recombination system of bacteriophage lambda, to introduce gene replacements and base changesinter aliainto the genome. Bacteriophage 933W is a prophage inE. coliO157:H7 strain EDL933, which encodes the genes (stx2AB) for the production of Shiga toxin which is the basis for the potentially fatal Hemolytic Uremic Syndrome in infected humans. We replaced thestx2ABgenes with a kanamycin cassette using recombineering. After induction of the prophage by ultra-violet light, we found that bacteriophage lysates were capable of transducing to wildtype, point mutations in the lactose, arabinose and maltose genes. The lysates could also transduce tetracycline resistant cassettes. Bacteriophage 933W is also efficient at transducing markers inE. coliK-12. Co-transduction experiments indicated that the maximal amount of transferred DNA was likely the size of the bacteriophage genome, 61 kB. All tested transductants, in bothE. coliK-12 and O157:H7, were kanamycin-sensitive indicating that the transducing particles contained host DNA.
Players and Purists: Networking Strategies and Agency of Service Professionals
Authors: Bensaou Ben M. , Galunic Charles , Jonczyk-Sédès Claudia
Published: May 2013

Social capital research has established the performance advantages of networking. However, we know surprisingly little about the strategies individuals employ when networking and, in particular, the underlying agency mechanisms involved. Network analysis tends to presume structural determinism and ignore issues of endogeneity rather than explore how actors draw on schemas, beliefs, and values in developing their networks. This empirical paper induces three networking strategies of newly promoted service professionals operating within two firms (AuditCo and ConsultCo) over a 16-month period. Using a grounded theory building approach, we first establish a set of core categories that capture networking behavior. We then conduct a cluster analysis revealing three distinct networking configurations or strategies: Devoted Players, Purists, and Selective Players. We also reveal the distinct agency involved in each profile and investigate the extent to which these networking strategies correlate with variables that shed light on issues of endogeneity and deepen our understanding of the strategies (including network structure and socialization progress in the players’ new jobs).
Status and the True Believer: The Impact of Psychological Contracts on Social Status Attributions of Friendship and Influence
Authors: Bingham John B. , Oldroyd James B. , Thompson Jeffery A. , Bednar Jeffrey S. , Bunderson J. Stuart
Published: May 2013

This article examines how the fulfillment of obligations viewed as essential to an individual’s relationship with his or her employer (i.e., the psychological contract) affects attributions of friendship and influence within the organization. Drawing on social exchange theory and self-categorization theory, we hypothesize that individuals who fulfill relational obligations will receive more friendship nominations from others in the organization, whereas individuals who fulfill ideological obligations will receive more influence nominations. In contrast, we hypothesize that those who fulfill transactional obligations will receive fewer friendship and influence nominations. We also predict that individuals who hold similar beliefs about their relationship with the organization will be more likely to nominate similar coworkers as friends or as influential in the organization, and that ideological contract similarity may provide a more compelling rationale for influence nomination than transactional or relational contract similarity. We tested our framework in two samples and find support for these general hypotheses. Our findings suggest that positions of status and influence in ideologically oriented organizations may accrue to “true believers,” i.e., those whose contracts with the organization are construed in ideological terms. Accordingly, this study has important implications for research on psychological contracts and social influence.
Out of Sight, Out of Mind? Evidence of Perceptual Factors in the Multiple-Category Discount
Authors: Leung Ming D. , Sharkey Amanda J.
Published: May 2013

Extant work shows that market actors who span multiple social categories tend to be devalued relative to their more specialized peers. Scholars typically explain this pattern of results with one of two arguments. Some contend that perceptual factors—namely, the difficulties that buyers have in making sense of category spanners—contribute to the observed pattern of devaluation. Others argue that the penalty for category-spanning stems from the fact that those who do not focus their efforts narrowly tend to offer products that are of lower quality. Because these two mechanisms often co-occur, it has been difficult to provide definitive evidence of the perceptually driven component of the multiple-category penalty. We employ a natural experiment on a peer-to-peer crowd-funding website to address this gap. Difference-in-difference analyses on matched samples show that category spanning is perceived negatively and can result in devaluation, even in the absence of underlying quality differences. This result supports the argument that perceptual issues contribute to the penalty for category spanning.
Pharmacist-Physician Collaboration for Diabetes Care: The Diabetes Initiative Program
Authors: Farland Michelle Zingone , Byrd Debbie C , McFarland M Shawn , Thomas Jeremy , Franks Andrea S , George Christa M , Gross Benjamin N , Guirguis Alexander B , Suda Katie J
Published: May 2013

BACKGROUND:

Multiple complications can arise secondary to poor control of glucose, blood pressure, and cholesterol in a patient with diabetes.

OBJECTIVE:

To evaluate the effect of a pharmacist-physician collaboration on attainment of diabetes-related measures of control.

METHODS:

This was a prospective, multicenter, cohort study. Patients were enrolled from 7 practice sites throughout Tennessee if they had been diagnosed with type 2 diabetes, were aged 18 years or older with a life expectancy greater than 1 year, and were English speaking. Pregnant women were excluded. Patients were followed for 12 months following enrollment by informed consent. The pharmacist-physician collaboration method was established prior to study initiation. Primary outcomes included hemoglobin A1c (A1C), number of patients with A1C less than 7%, and percentage of patients with A1C greater than 9%.

RESULTS:

Of the 206 patients enrolled, the mean age was 59.73 years, and most were male (59.71%) and white (66.02%). The A1C was reduced by an average of 1.16% (p < 0.0001). The proportion of patients with A1C less than 7% increased from 12.75% at baseline to 36.76% at study conclusion (p = 0.0002). The proportion of patients with A1C greater than 9% decreased from 34.15% to 16.50%, (p < 0.0001).

CONCLUSIONS:

Pharmacist-physician collaborative management at multiple practice locations and types of setting (eg, private, academic, Veterans Affairs medical center) has a positive impact on glycemic control and diabetes-related health maintenance. This was accomplished without increasing the total number of antihyperglycemic agents prescribed and without an increase in patient-reported episodes of hypoglycemia.
The S.S. Mongolia Incident
Authors: Poblete Joanna
Published: May 2013

On December 23, 1910, the S.S. Mongolia arrived at the Port of Honolulu with 119 Filipinos aboard. The treatment of these passengers resulted in vigorous debates about Filipino labor mobility that impacted U.S.-Philippine relations, Hawaiian business needs, and health policies, as well as continental U.S. labor and sugar interests. From January through April 1911, officials in Washington, D.C., and the Philippines worked hard to stem fears about the health of Filipinos and maintain both the flow of these workers to Hawai‘i and the U.S.-Philippine political-legal relationship. Despite extensive regional protests, the acquisition of labor for sugar plantations and the preservation of U.S.-Philippine colonial ties ended up prevailing over nativist fears about the health and growing numbers of Filipinos in the United States.
Increased plasma β-hydroxybutyrate levels during the fasting test in patients with endogenous hyperinsulinaemic hypoglycaemia
Authors: Buffet Alexandre , Vezzosi Delphine , Maiza Jean Christophe , Grunenwald Solange , Bennet Antoine , Caron Philippe
Published: May 2013

Objective

The objective of the present study was to determine whether a plasma β-hydroxybutyrate (BOHB) level >2700 μmol/l during the 72-h fasting test is sufficient to rule out the diagnosis of endogenous hyperinsulinaemic hypoglycaemia (EHH).

Research design and methods

We retrospectively studied BOHB levels in 39 patients with EHH who had undergone a 72-h fasting test to make the diagnosis of EHH, and we compared EHH patients with BOHB levels >2700 μmol/l (group 1), EHH patients with BOHB levels <2700 μmol/l (group 2) and 59 controls (median glycaemia: 3.2 mmol/l and median BOHB: 6095 μmol/l).

Results

During a 72-h fasting test, nine patients (group 1) had BOHB levels >2700 μmol/l (median 6140 and range 2957–7824) and 30 patients (group 2) had BOHB levels <2700 μmol/l (median 542 and range 0–2607). In group 1, four patients had undergone partial pancreatectomy previously and were evaluated for the recurrence of hypoglycaemia, whereas none of the group 2 patients had been operated. The duration of the fasting test was longer in group 1 than in group 2 (P<0.0001), and at the end of the fasting test, plasma glucose concentrations were not significantly different (P=0.0617), but insulin (P=0.004), C-peptide (P=0.0015) and proinsulin (P=0.0038) levels were significantly lower in group 1 patients than in group 2 patients, suggesting lower insulin secretion and/or impaired glycaemic counter-regulation.

Conclusion

During a fasting test, a BOHB level >2700 μmol/l is observed in some EHH patients, suggesting that BOHB levels cannot rule out the recurrence of EHH, in particular, after partial pancreatectomy.
The role of transient dynamics in stochastic population growth for nine perennial plants
Authors: Ellis Martha M. , Crone Elizabeth E.
Published: May 2013

Most populations exist in variable environments. Two sets of theory have been developed to address this variability. Stochastic dynamics focus on variation in population growth rates based on random differences in vital rates such as growth, survival, and reproduction. Transient dynamics focus on short‐term, deterministic responses to changes in the stage distribution of individuals. These processes are related: demographic variation shifts stage structures, producing transient responses, which then contribute to the overall variability of population growth rate. The relative contributions of vital rates vs. transient responses to stochastic dynamics, and the implications for transient analyses, are unclear. This study explores the role of transient responses in stochastic dynamics of nine perennial plant species. Across the species, transient responses contributed more on average to variability in annual population growth rates than did variation in vital rates alone. Transient potential of an average matrix was indicative of the contribution of transient dynamics, although these metrics varied greatly across years. Transient responses were often in the opposite direction as demographic variation, suggesting that transient dynamics may at times have a buffering effect on populations. Overall, transient dynamics had an important role in modulating environmental variation, with implications for both processes in understanding stochastic dynamics.
Solid‐phase organic matter reduction regulates anaerobic decomposition in bog soil
Authors: Keller Jason K. , Takagi Kimberly K.
Published: May 2013

Peatlands store globally significant amounts of carbon and are important sources of the greenhouse gas methane (CH4) to the atmosphere. However, for reasons which are not well understood, many peatland soils produce smaller amounts of CH4 than theoretically predicted, and carbon dioxide (CO2) produced during anaerobic decomposition in peatland soils cannot be accounted for by commonly measured microbial processes. Here we show that the reduction of solid‐phase organic matter (i.e., humic substances) suppresses CH4 production in a bog soil and can be responsible for 33–61% of the total carbon mineralization in this soil. These results demonstrate that the reduction of organic matter is a key component of anaerobic decomposition in peatlands, and is at least partially responsible for their low CH4 production. Thus, organic matter reduction may be a key regulator of how peatlands respond to ongoing global change.
Differences in Peri‐Implant Microflora Between Fully and Partially Edentulous Patients: A Systematic Review
Authors: de Waal Yvonne C. , Winkel Edwin G. , Meijer Henny J. , Raghoebar Gerry M. , van Winkelhoff Arie J.
Published: May 2013

Background: The current evidence suggests that the oral microflora differs between individuals who are fully edentulous (FES) and those who are partially edentulous (PES). It is unknown whether this leads to differences in peri‐implant microflora when implants are installed. The aim of the study is to compare the submucosal peri‐implant microflora between FES and PES.

Methods: A systematic review was conducted. The MEDLINE, Embase, and Cochrane databases were searched for publications up to September 1, 2012. To reduce methodologic variations, only studies reporting in the same article about the submucosal peri‐implant microflora of FES and PES were selected.

Results: Eleven publications describing 10 studies were selected. Because of numerous differences among the selected studies, no meta‐analysis could be performed. Six of 10 studies showed a significant difference in the composition of the submucosal peri‐implant microflora in healthy and peri‐implant mucositis conditions between FES and PES, with the latter showing a potentially more pathogenic composition. However, microbiologic results were not unanimous among the studies.

Conclusions: In healthy and peri‐implant mucositis conditions, PES harbor a potentially more pathogenic peri‐implant microflora than FES. The current data are insufficient for a clear conclusion regarding peri‐implantitis cases. Overall, because of the lack of a meta‐analysis, the variability in microbiologic outcomes and the limited number of studies available, the current evidence seems not to be robust.
Validation of Antibiotic Efficacy on In Vitro Subgingival Biofilms
Authors: Belibasakis Georgios N. , Thurnheer Thomas
Published: May 2013

Background: Systemic antibiotics are often used as adjunctive treatment modalities for periodontal diseases. Testing of antimicrobial efficacy can be relevant only if the bacteria are in the form of biofilms rather than the planktonic state, and at concentrations of physiologic relevance, i.e., reachable in the periodontal pocket. The aim of the present study is to test the antimicrobial efficacy of five common antibiotic schemes at physiologically relevant concentrations on a multispecies in vitro biofilm model.

Methods: A 10‐species in vitro subgingival biofilm model was exposed to metronidazole (15 μg/mL), amoxicillin (15 μg/mL), metronidazole and amoxicillin in combination, doxycycline (2 μg/mL), and azithromycin (10 μg/mL) over 24 hours. Species‐specific bacterial numbers were determined by culture on selective agar media or by epifluorescence microscopy.

Results: Metronidazole alone did not affect biofilm composition. Total bacterial counts were significantly reduced by doxycycline, azithromycin, and amoxicillin alone or in combination with metronidazole, albeit by less than 1 log. On the species‐specific level, these regimens significantly reduced the numbers of Streptococcus anginosus, Porphyromonas gingivalis, and Fusobacterium nucleatum, as well as Campylobacter rectus (except for amoxicillin alone). The strongest effects were displayed by the combination of amoxicillin and metronidazole.

Conclusion: Antibiotics at concentrations detectable in gingival crevicular fluid do not dramatically reduce total bacterial loads in this in vitro biofilm model, but cause species‐specific reductions, which may disrupt the biofilm unity.
A concept for planning and management of on-site and centralised municipal wastewater treatment systems, a case study in Bangkok, Thailand. II: Scenario-based pollutant load analysis
Authors: Tsuzuki Yoshiaki , Koottatep Thammarat , Sinsupan Thitiphon , Jiawkok Supattra , Wongburana Chira , Wattanachira Suraphong , Sarathai Yuttachai
Published: May 2013

Scenario-based pollutant load analysis was conducted to develop a part of a concept for planning and management of wastewater treatment systems (WWTSs) under the mixture conditions of centralised and on-site WWTSs. Pollutant discharge indicators and pollutant removal efficiency functions were applied from another paper in the series, which were developed based on the existing conditions in urban and peri-urban areas of Bangkok, Thailand. Two scenarios were developed to describe development directions of the mixture conditions. Scenario 1 involves keeping the on-site wastewater treatment plants (WWTPs) within the areas of centralised WWTSs. Scenario 2 is dividing the centralised and on-site WWTS areas. Comparison of the smallest values of total pollutant discharge per capita (PDCtotal) between Scenarios 1 and 2 showed that the smallest PDCtotal in Scenario 1 was smaller than that in Scenario 2 for biological oxygen demand, chemical oxygen demand and total phosphorus whereas the smallest PDCtotal in Scenario 2 was smaller than that in Scenario 1 for total nitrogen, total coliforms and faecal coliforms. The results suggest that the mixture conditions could be a possible reason for smaller pollutant concentrations at centralised WWTPs. Quantitative scenario-based estimation of PDCtotal is useful and a prerequisite in planning and management of WWTSs.
Phosphorus release mechanisms during digestion of EBPR sludge under anaerobic, anoxic and aerobic conditions
Authors: Bi Dongsu , Guo Xiaopin , Chen Donghui
Published: May 2013

Three laboratory-scale digesters were operated in parallel under anaerobic, anoxic and aerobic conditions to reveal the release mechanisms of phosphorus when digesting enhanced biological phosphorus removal (EBPR) sludge. The variation rates of the parameters associated with phosphorus release were calculated and compared with that of a typical EBPR anaerobic process. The results show that both phosphorus-accumulating organisms (PAOs) and denitrifying phosphorus-accumulating organisms (DPAOs) played important roles in the phosphorus release during the digestion processes. Under anaerobic conditions, the PAOs hydrolyzed internal polyphosphorus (poly-P) into PO43−-P concurrent with synthesis of polyhydroxyalkanoates (PHA). Under anoxic or aerobic conditions, PAOs and/or DPAOs assimilated part of the PO43−-P from the digestive liquid using nitrate or oxygen as terminal electron acceptors. Nevertheless, the biological activities of PAOs under anaerobic conditions and DPAOs under anoxic conditions were limited. Moreover, it was the biomass hydrolysis degree that determined the phosphorus release capacity of the sludge, regardless of whether anaerobic, anoxic or aerobic conditions were adopted. Assuming that nitrate was the sole electron acceptor during anoxic digestion of EBPR biomass, the relationship between the consumption of nitrate and uptake of PO43−-P associated with the denitrifying phosphorus removal (DPR) can be expressed as ΔP = 0.11 × ΔN.
Combined risk prediction in the water environment based on an MS–AR model and Copula theory
Authors: Jun-yi Niu , Hu Huang , Na Chen
Published: May 2013

Making a quantitative prediction on the combined risk of the water body is helpful for the objective evaluation of the water environment system's state of health, and also has important results for the water environment system's safety management. In this paper, the Markov status switching theory (Markov Switching, MS), Monte Carlo method (Monte Carlo, MC) and Copula theory were used together, to establish a method for the water environment system's combined risk assessment. This method firstly using MS theory established the water quality time series' autoregression model (MS–AR); then the MS–AR model and MC method were used to carry out random simulation on the water quality time series; finally, multi-dimensional joint distribution among random simulation results were established by Copula function, and this distribution utilized to make a quantitative analysis of the water environment system's combined risk. By means of the above combined risk analysis model, the combined risk prediction and correlation analysis of the water quality of the Guohe River bridge section were carried out. The results showed that the total phosphorus (TP) and 5-day biochemical oxygen demand (BOD5) had an important effect on the Guohe River water environment's state of health, and there was a strong positive correlation between TP and BOD5.
Influence of initial pesticide concentrations in water on chlorpyrifos toxicity and removal by Iris pseudacorus
Authors: Wang Qinghai , Yang Juan , Li Cui , Xiao Bo , Que Xiaoe
Published: May 2013

For understanding the influence of initial concentrations of pesticides in the water body on removal efficiency of the contaminant by aquatic plants, one hydroponics experiment was used to investigate the influence of initial concentration (1–16 mg L−1) on toxicity and chlorpyrifos removal potential of Iris pseudacorus for 20 days under greenhouse conditions. An increased sensitivity to and reduced removal rate for chlorpyrifos were observed with increasing chlorpyrifos concentration. The relative growth rate (RGR) of I. pseudacorus was significantly inhibited in the presence of 4, 8 and 16 mg L−1 chlorpyrifos, and a negative relationship was also found between RGR and initial pesticide concentration. The half-life of chlorpyrifos was shortened in the hydroponic system with plants, indicating that I. pseudacorus accelerated chlorpyrifos removal from water. But the contribution of the plant to chlorpyrifos removal in the hydroponic phytoremediation system decreased with the increase of initial concentration of chlorpyrifos. The results also indicated that I. pseudacorus can efficiently eliminate chlorpyrifos and may ultimately serve as phytoremediation agents in the natural water body.