bluuebunny/crossref_metadata_2025 huggingface dataset:
Mean cost of a first combination antiretroviral therapy in HIV-infected patients in France, and determinants of expensive drugs prescription
Authors: Colombie V , Pugliese-Wehrlen S , Deuffic-Burban S , Cuzin L , Pugliese P , Katlama C , Poizot-Martin I , Raffi F , Cabie A , Dellamonica P , Yazdanpanah Y , Dat'Aids
Published: April 2013

To estimate the cost of the first combination antiretroviral drug therapy (cART) in HIV-infected patients and to determine factors associated with expensive prescriptions, 1698 patients starting cART between September 2002 and September 2007 were selected from the Dat'AIDS cohort. A multivariate linear regression model was used to assess associations between the cost of first cART and patient characteristics, clinical centre and cART adequacy. At cART initiation, the median age was 39 years, median CD4 count was 223 cells/mm3, median viral load (VL) was 5.2 log copies/mL and 18.3% presented with AIDS. cART was concordant with the French guidelines in 88.7%. The mean cost of cART varied from €26.69/day/person in 2002-2003 to €32.23 in 2006-2007 ( P < 0.0001), cost was associated with previous AIDS diagnosis (€31.83/day/person) versus (29.49; P < 0.0001), baseline VL > 5 log copies/mL (€30.99/day/person) versus (28.33; P < 0.0001) and centre. cART regimen not concordant with guidelines were more expensive (€38.31/day/person) versus (29.07; P < 0.0001). After adjusting for the year of initiation, the previous AIDS diagnosis, VL and recommended cART regimen, differences were still found between centres (from €27.81/day/person) to (33.12; P < 0.0001). Cost should be considered when choosing a first cART regimen, especially when considering clinically equivalent regimens.
Spatial analysis of primary and secondary syphilis incidence in China, 2004-2010
Authors: Yin F , Feng Z , Li X
Published: April 2013

China has recently experienced an increase in the incidence of syphilis. Effective spatial monitoring of syphilis incidence is important for successful implementation of control and prevention programmes. This study monitored county-level primary and secondary (P&S) syphilis incidence rates for all of mainland China by examining spatial patterns. Exploratory spatial data analysis (ESDA) methods were used to characterize the spatial distribution pattern of syphilis cases. During the seven-year study period, the average annual P&S syphilis incidence was 8.82 cases per 100,000 people. Using Empirical Bayes smoothed rates, the local Moran test identified many areas of high syphilis risk (all P values ≤0.01). The number of high-risk counties increased from 73 counties in 2004 to 134 counties in 2010. An eastern coastal cluster of high-risk counties persisted throughout 2004-2010. ESDA methods can assist public health officials in identifying high-risk areas. Allocating more resources to high-risk areas could more effectively reduce syphilis incidence.
Hypogonadism among HIV-infected men in Thailand
Authors: Sunchatawirul K , Tantiwongse K , Chathaisong P , Thongyen S , Chumpathat N , Manosuthi W
Published: April 2013

This study assessed prevalence and associated factors of hypogonadism among 491 HIV-infected Thai men who visited the HIV outpatient clinic. All participants were interviewed and data were collected from medical records, including demographic and HIV-related illness characteristics. They also completed questionnaires relevant to hypogonadal symptoms, sexual function and depression. All participants’ blood samples were obtained to check for total testosterone, sex hormone-binding globulin (SHBG) and albumin levels, and free testosterone (cFT) was calculated. Hypogonadism was diagnosed if a cFT level of <0.225 nmol/L was detected. The median age of the participants was 37 years old (ranging from 34 to 44 years old). HIV infection was diagnosed for a median of 77 (47-99) months. Eight of 491 participants (2%) had hypertension and 1 % had diabetes mellitus (DM). Fourteen (3%) used methadone and 23% had SHBG level over 70 nmol/L. Of the 491 participants, 123 (25%) men were diagnosed with hypogonadism. The univariate analyses indicated that DM, hypertension, methadone use, SHBG level >70 nmol/L group and lack of antiretroviral therapy were associated with hypogonadism. In multivariate analysis, a SHBG level >70 nmol/L was the only factor that was significantly associated with hypogonadism (odds ratio [OR] = 1.922, P = 0.007).
Sexually transmitted infections among HIV-infected heavy drinkers in St Petersburg, Russia
Authors: Pace C A , Lioznov D , Cheng D M , Wakeman S E , Raj A , Walley A Y , Coleman S M , Bridden C , Krupitsky E , Samet J H
Published: April 2013

The objective of this study was to estimate the prevalence and identify correlates of four sexually transmitted infections (STIs) among HIV-infected Russians reporting heavy alcohol use and recent unprotected sex, we conducted a cross-sectional analysis of baseline data from the HERMITAGE study. The primary outcome was any current STI, based on urine tests for Neisseria gonorrhoeae, Chlamydia trachomatis and Trichomonas vaginalis and serological testing for infection with Treponema pallidum. Data on potential demographic and behavioural predictors of STI were obtained from surveys administered at study entry. Of 682 participants, 12.8% (95% confidence interval [CI] 10.3, 15.3) tested positive for at least one STI. In a multivariable model adjusted for gender, age and marital status, only sex trade involvement over the last three months was significantly associated with an increased odds of STI (adjusted odds ratio [AOR] 2.00, 95% CI 1.13, 3.55). Given that STIs were common in this HIV-infected cohort, and that few patient characteristics predicted STI, the current practice of screening HIV-infected Russians for syphilis alone merits reevaluation.
Depression and dietary intake in a cohort of HIV-positive clients in Sydney
Authors: Purnomo J , Jeganathan S , Begley K , Houtzager L
Published: April 2013

This cross-sectional study aimed to compare dietary intake in people living with HIV (PLHIV) experiencing symptoms of depression with those not reporting depression. The Centre for Epidemiologic Studies Depression Scale (CES-D10) was used to classify the risk of depression. Dietary nutrient intake was determined using the diet history and food frequency questionnaire. Depressed ( n = 21) compared with non-depressed ( n = 37) subjects had significantly lower mean intake of fibre (16.1 versus 25.4 g/day), vitamin A (801.5 versus 1524.8 mg/day), magnesium (299.8 versus 380.0 mg/day) and folate (264.8 versus 402.9 μg/day). The proportion of subjects achieving the recommended intake of these nutrients, with the exception of folate was also found to be lower in the depressed group compared with non-depressed group. The study found that depressive symptomatology in PLHIV was associated with poorer dietary nutrient intake. A multidisciplinary model of care that includes a nutrition assessment is recommended for the management of PLHIV with depression to reduce the risk of associated nutritional problems.
HIV testing rate in the top end of the Northern Territory of Australia: room for improvement
Authors: Mattison G , Krause V , Su J Y , Broadfoot J , Ryder N
Published: April 2013

The Northern Territory of Australia has an exceptionally high prevalence of sexually transmitted infections (STIs), particularly in remote areas. In contrast there are few notified cases of HIV at present. This study describes HIV testing rates in both primary care and sexual health clinics in the Top End region. In 2010, medical records were reviewed for a random sample of patients from a sexual health clinic and three remote primary care clinics. Among sexual health clinic patients 51.4% overall, and 59.7% of those with an STI, were tested for HIV. In people diagnosed with an STI in remote primary care clinics 19.1 % were tested for HIV. HIV testing rates in the Top End of the Northern Territory do not meet the standard of national and international guidelines, with implications both for the early initiation of therapy and the accuracy of surveillance in a region with very high rates of STIs.
The uptake of HIV and syphilis testing in a nurse-delivered service during Gay Pride events
Authors: Manavi K , Williams G , Newton R
Published: April 2013

Novel HIV testing strategies may improve the uptake of the test. The aim of the present study was to investigate the uptake of HIV testing during Birmingham Pride events in 2009 and 2010. The project was a collaboration between Whittall Street Clinic and Healthy Gay Life. This was a nurse-delivered service that was offered for nine hours each day during the events (total of 36 hours in two years). The OraSure™ assay for HIV and syphilis testing was used. A total of 405 men visited our marquee during the 2009 ( n = 201) and 2010 ( n = 204) events. A total of 398 (98%) men accepted HIV testing during the events in 2009 and 2010. Six men (1.5%) were HIV-positive, an incidence of 37.7 cases per 10,000 persons perday. The uptake of syphilis testing was similarly high; 390 (96%) individuals agreed to be tested and one (0.5%) patient was diagnosed with syphilis. The uptake of HIV testing during the Pride event was high. Pride events provide a unique opportunity for testing undiagnosed HIV-infected patients. HIV testing should be provided in other cities during Pride events.
Local and systemic adverse effects of imiquimod therapy for external anogenital warts in men: report of three cases
Authors: Rosenblatt A , De Campos Guidi H G
Published: April 2013

Imiquimod is a topical immune response modifier used to treat anogenital warts. Although considered a safe drug, mild to moderate local and systemic side-effects may occasionally occur. We report three cases of local and systemic adverse effects related to imiquimod, including one case that mimicked meningitis, which promptly resolved with drug cessation.
South-west regional patient satisfaction survey
Authors: Challenor R , Metters L
Published: April 2013

A validated patient satisfaction survey for use with sexual health clinic attendees was used in 12 genitourinary (GU) medicine/sexual health clinics throughout the south-west region (UK). The questionnaire covers aspects of pre-appointment, performance of healthcare professionals, facilities and privacy, communication with respect, information on leaving and overall experience. Data from the 12 clinics are presented with mean performance scores and 95% confidence intervals (95% CI), as well as the experience of implementing the project across a region. There was a high level of satisfaction with overall quality of care: 86-100% rated the quality of care as either excellent or very good. Where clinics have performed below the 95% CI, it provides an opportunity to share good practice from the best performing clinics and to look at one's own processes and discuss as teams whether changes could be made that might improve outcomes. Other clinics might find it useful to use this questionnaire to look at their own performance and compare with these data. As medical re-validation for professional practice approaches, all doctors need to demonstrate that they have participated in collecting quality improvement data and implementing changes to service delivery; these data might provide a starting point.
Kaposi's sarcoma in pregnancy after initiation of highly active antiretroviral therapy: a manifestation of immune reconstitution syndrome
Authors: Adeyemo A , Wood C , Govind A
Published: April 2013

A case of Kaposi's sarcoma (KS) presenting as an immune reconstitution inflammatory syndrome in pregnancy with conservative management is reported. Successful outcomes for mother and baby were achieved. HIV was diagnosed at antenatal booking and highly active antiretroviral therapy commenced at 20 weeks. Multiple lymphadenopathies developed two months later. Excision biopsy of a node confirmed KS. In the absence of advanced disease, she was managed conservatively until delivery. The placenta showed no evidence of KS or human herpes virus 8 (HHV-8). The baby had negative HIV and HHV-8 polymerase chain reaction tests at zero, six and 12 weeks of life. Six months postpartum, the KS had regressed and HHV-8 viral load was undetectable.
What is the role of a full physical examination in the management of asymptomatic patients with late syphilis?
Authors: Dabis R , Radcliffe K
Published: April 2013

According to the British Association for Sexual Health and HIV guidelines, a full physical examination is recommended in patients with possible late syphilis. The aim of this audit was to review all cases of late syphilis diagnosed at our centre since 1994 to see if a full cardiovascular and neurological examination was documented and also to see what a full examination contributed to the management of asymptomatic patients. Of the 480 medical notes audited, 295 patients were asymptomatic of whom 288 (98%) had normal physical examinations; the rest were either not documented, declined or defaulted follow-up. Seven asymptomatic patients had positive clinical findings but these did not lead to a diagnosis of cardiovascular or neurological syphilis.

This audit has shown that performing a physical examination in asymptomatic patients added no benefit in diagnosing complications of late syphilis; it would appear that the physical examination did not alter the management.
Understanding Harris’ understanding of CEA: Is cost effective resource allocation undone?
Authors: Edlin Richard , McCabe Christopher , Round Jeff , Wright Judy , Claxton Karl , Sculpher Mark , Cookson Richard
Published: April 2013

We summarise and evaluate Harris’ criticisms of cost-effectiveness analysis (CEA) and the alternative processes he commends to health care decision makers. In contrast to CEA, Harris’ asserts that individuals have a right to life-saving treatment that cannot be denied on the basis of their capacity to benefit. We conclude that, whilst Harris’ work has challenged the proponents of CEA and quality-adjusted life years to be explicit about the method's indirect discriminatory characteristics, his arguments ignore important questions about what ‘lives saved’ mean. Harris also attempts to avoid opportunity cost by advocating the same chance of treatment for every person desiring treatment. Using a simple example, we illustrate that an ‘equal chances’ lottery is not in the interest of any patient, as it reduces the chance of treatment for all patients by leaving some of the health budget unspent.
Patients’ experiences of health and social care in long-term neurological conditions in England: A cross-sectional survey
Authors: Peters Michele , Fitzpatrick Ray , Doll Helen , Playford E Diane , Jenkinson Crispin
Published: April 2013

Objectives:

To investigate patients’ experiences of health and social care services in long-term neurological conditions in England.

Method:

Cross-sectional survey of 5209 patient members of the Motor Neurone Disease Association (MND, n = 890), Multiple Sclerosis Society (MS, n = 2345) or Parkinson's UK (PD, n = 1974). A questionnaire on patient experiences of health and social care was completed by 2563 (49%) (505 MND, 1157 MS and 901 PD).

Results:

A mixed picture of experiences of health and social care in MND, MS or PD was found with few problems reported for some aspects of services such as obtaining information about medication (n = 117, 6.1%). In contrast, problems with planning and integration of care were reported frequently, with 78.0% of patients not having a care plan and 61.9% reporting that services do not collaborate well in planning care. Other problems included delays with diagnosis, information about medication side effects, and management of conditions whilst in hospital. Significant differences between the three conditions were found for most aspects of care, with MND patients generally reporting fewer problems. The findings highlight which areas of health and social care need to be improved and monitored. While a larger sample size was obtained than in other studies, possible limitations include the sampling frame and the 49% response rate.

Conclusion:

Planning and integration of care are key areas that require improvement.
Impact of cost of medicines for chronic conditions on low income households in Australia
Authors: Kemp Anna , Preen David B , Glover John , Semmens James , Roughead Elizabeth E
Published: April 2013

Objectives:

To determine the cost of medicines for selected chronic illnesses and the proportion of discretionary income this would potentially displace for households with different pharmaceutical subsidy entitlements and incomes.

Methods:

We analysed household income and expenditure data for 9,774 households participating in two Australian surveys in 2009-10. The amount of ‘discretionary’ income available to households after basic living and health care expenditure was modelled for households with high pharmaceutical subsidies: pensioner and non-pensioner concessional (social security entitlements); and households with general pharmaceutical subsidies and low, middle or high incomes. We calculated the proportion of discretionary income that would be needed for medicines if one household member had diabetes or acute coronary syndrome, or if one member also had two co-existing illnesses (gastro-oesophageal reflux disease and depression, or asthma and osteoarthritis).

Results:

Pensioner and low income households had little discretionary income after basic living and health care expenditure (AUD$92 and $164/week, respectively). Medicines for the specified illnesses ranged from $11-$42/month for high subsidy households and $34-$186/month for low subsidy households. Costs reduced substantially once patients reached the annual pharmaceutical cap (safety net), prior to which medicine costs would displace the equivalent of 1%-10% of discretionary income for most household types. However, low income households would have to forego the equivalent of between 5%-26% of their discretionary income for between 7 and 9 months of the year before receiving additional subsidies.

Conclusions:

Prescription medicines for chronic conditions pose a substantial financial burden to many households, particularly those with low incomes and general pharmaceutical subsidies. Policies are needed to minimize the cost burden of prescription medicines, particularly for low-income working households.
The traveller, miner, cleaner and conductor: Idealized roles of the qualitative interviewer
Authors: Buetow Stephen
Published: April 2013

Qualitative researchers commonly receive simplistic advice on pitfalls to avoid when conducting interviews. The pitfalls include saying too much and saying too little, yet their cogency depends on the role of the qualitative interviewer. This paper distinguishes between the roles of the miner, traveller, cleaner, and conductor. These roles are ‘ideal types’ that construct, as problematic or not, the use of contested interviewing practices such as ‘leading’ and assigning meaning to informant responses. The paper emphasizes how the ‘cleaner’ attempts to enable informants to interpret their own ubiquitous metaphors and symbolic language. However, acknowledging that in reality the qualitative interviewer may play all three idealized roles (miner, traveller, cleaner), the interviewer as conductor can orchestrate different roles as potential ‘conversational partners’.
Contrasting Beliefs About Screening for Mental Disorders Among Uk Military Personnel Returning from Deployment to Afghanistan
Authors: Keeling M , Knight T , Sharp D , Fertout M , Greenberg N , Chesnokov M , Rona R J
Published: April 2013

Objective

The objective of the study was to elicit beliefs and experiences of the value of a screening programme for mental illness among UK military personnel.

Method

Three months after returning from Afghanistan 21 army personnel participated in a qualitative study about mental health screening. One-to-one interviews were conducted and recorded. Data-driven thematic analysis was used. Researchers identified master themes represented by extracts of text from the 21 complete transcripts.

Results

Participants made positive remarks on the advantages of screening. Noted barriers to seeking help included: unwillingness to receive advice, a wish to deal with any problems themselves and a belief that military personnel should be strong enough to cope with any difficulties. Participants believed that overcoming barriers to participating in screening and seeking help would be best achieved by making screening compulsory.

Conclusions

Although respondents were positive about a screening programme for mental illness, the barriers to seeking help for mental illness appear deep rooted and reinforced by the value ascribed to hardiness.
Interval Cancers in Nasopharyngeal Carcinoma Screening: Comparing Two Screening Intervals after a Negative Initial Screening Result
Authors: Chen Feng , Huang Qi-Hong , Fang Fang , Liu Zhi-Wei , Liu Ke , Xie Shang-Hang , Liu Qing , Hong Ming-Huang , Liao Zhen-Er , Ye Wei-Min , Zeng Yi-Xin , Cao Su-Mei
Published: April 2013

Objectives

To examine the optimal screening interval among the individuals who received a negative Epstein-Barr virus immunoglobulin A antibodies against viral capsid antigen (VCA-IgA) serum test result and who comprised the majority of the population screened for nasopharyngeal carcinoma (NPC).

Methods

Screening was performed in Sihui, Guangdong, China, offering a repeated screening for participants with an initial negative test either after 4-5 years in one centre (short interval centre), or 9-10 years in another (long interval centre). The characteristics and incidence rates (IRs) of interval NPCs (defined as cases diagnosed outside the screening protocol while within the screening interval) were compared between these two centres. Standard incidence ratios (SIRs) were also calculated using the general Sihui population as the reference.

Results

Seven interval NPCs were detected in the short interval centre (IR: 17.8/10 5 person-years) and 20 in the long interval centre (IR: 20.8/10 5 person-years during the first four years and 43.5/10 5 person-years during the remaining years). The SIR in the short interval centre was 0.43 (95% confidence interval [CI]: 0.17-0.89); SIR in the long interval centre was 0.47 (95% CI: 0.17-1.02) during the first four years and 0.90 (95% CI: 0.49-1.51) during the remaining years. No aggressive interval NPC was observed in the short interval centre; four were identified in the long interval centre.

Conclusions

The incidence of NPC, especially aggressive NPC, was low during the first few years after a negative screening; the incidence increased to the general population level afterwards. A screening interval of 4-5 years may therefore be more suitable than 9–10 years after a negative VCA-IgA test in NPC screening.
Cervical Screening Uptake, Political Interest and Voter Turnout: A Population-Based Survey of Women in England
Authors: Macedo Ana , Waller Jo , Patnick Julietta , Marlow Laura
Published: April 2013

Objectives

To examine the relationship between cervical screening uptake and political engagement, and to test whether political engagement and voting behaviour mediate the association between age and cervical screening uptake

Setting

A population-based survey of women in England in 2010.

Methods

Women aged 26-64 took part in home-based computer-assisted interviews ( n = 890). Women were classified as ‘up to date’ or ‘overdue/never been screened’ for cervical screening.

Results

Most women (81%) were up-to-date with screening; 19% were overdue. Age and marital status were associated with screening status. Women who were not registered to vote, had not voted in previous general elections, and those who showed less interest in elections and lower intention to engage in political activities were more likely to be overdue for screening. In multivariate analyses (adjusting for all significant measures) ‘being on the electoral register’ was the only significant independent predictor of screening status. ‘Being on the electoral register’ was also the only measure of voting behaviour that mediated the association between age and screening status.

Conclusion

We found limited evidence for the hypothesis that falling attendance for cervical screening could be associated with a broader phenomenon of disillusionment as indexed by reported voting behaviour and other measures of political engagement. Alternative explanations should be considered in order to better understand falling cervical screening uptake, particularly among younger women.
The Jade Goody Effect: Whose Cervical Screening Decisions Were Influenced by Her Story?
Authors: Marlow Laura Av , Sangha Amrit , Patnick Julietta , Waller Jo
Published: April 2013

Objectives

In 2009 more women attended cervical screening in England and Wales than in the previous year. Described as the ‘Jade Goody Effect’ this was attributed to the death from cervical cancer of a UK celebrity. The present study aimed to establish which sociodemographic characteristics were associated with being influenced by Jade Goody's story.

Methods

Data were collected as part of a Taylor Nelson Sofres (TNS) omnibus survey using random location sampling. Women in England aged 26-64 years were asked to report whether they felt Jade Goody's story had influenced their decisions about cervical screening over the 18 months between her death and the time of the survey.

Results

Data from 890 participants was included in analysis. Over a third of women felt Goody's story had influenced their decisions about cervical screening (40%). Younger women (aged 26-35 years) were more likely to have been influenced by Goody's story than older women (56-64 year olds). There was also evidence of socioeconomic variation with women from lower socioeconomic class groups and those with fewer educational qualifications more likely to say they had been influenced by Goody's story.

Conclusions

The ‘Jade Goody Effect’, as acknowledged by women themselves, was more pronounced among young women and influenced screening decisions more markedly among those from lower socioeconomic backgrounds. Narrative communication may be an effective way to encourage attendance at cervical cancer screening and reach groups of the population that are difficult to reach using traditional intervention methods.
Identification of purple sea urchin telomerase RNA using a next-generation sequencing based approach
Authors: Li Yang , Podlevsky Joshua D. , Marz Manja , Qi Xiaodong , Hoffmann Steve , Stadler Peter F. , Chen Julian J.-L.
Published: April 2013

Telomerase is a ribonucleoprotein (RNP) enzyme essential for telomere maintenance and chromosome stability. While the catalytic telomerase reverse transcriptase (TERT) protein is well conserved across eukaryotes, telomerase RNA (TR) is extensively divergent in size, sequence, and structure. This diversity prohibits TR identification from many important organisms. Here we report a novel approach for TR discovery that combines in vitro TR enrichment from total RNA, next-generation sequencing, and a computational screening pipeline. With this approach, we have successfully identified TR from Strongylocentrotus purpuratus (purple sea urchin) from the phylum Echinodermata. Reconstitution of activity in vitro confirmed that this RNA is an integral component of sea urchin telomerase. Comparative phylogenetic analysis against vertebrate TR sequences revealed that the purple sea urchin TR contains vertebrate-like template-pseudoknot and H/ACA domains. While lacking a vertebrate-like CR4/5 domain, sea urchin TR has a unique central domain critical for telomerase activity. This is the first TR identified from the previously unexplored invertebrate clade and provides the first glimpse of TR evolution in the deuterostome lineage. Moreover, our TR discovery approach is a significant step toward the comprehensive understanding of telomerase RNP evolution.
Rhythm and meaning: "Rhythmical deviations" as italics
Authors: Tarlinskaja Marina
Published: April 2013

English iambic pentameter allows rhythmical deviations that occupy three (seldom four, more often two) adjacent metrical positions. These deviations, though metrical, are noticed by the listener or reader. Starting from the first quarter of the 16th century, poets (Surrey) have used rhythmical deviations to emphasize ("italicize") semantically important segments in the line. Such rhythmical deviations have become part of the English poetic traditions. It has turned out that rhythmical deviations used to italicize meaning are filled with recurring rhythmical and grammatical structures and repeated lexicon. M. L. Gasparov used a special term to denote the recurring rhythmicalgrammatical structures: "clichés"; while calling clichés incorporating recurrent lexicon "formulas". I have discovered that formulas are part of the English poetic tradition: the same formulas recur in poetic texts of the 16th–20th cc. They are not plagiarisms, allusions or reminiscences; they are a common basket of goods that belong to all English poets, used by all and owned by none. The recurrent deviations usually occur on metrical positions "weak-strong-weak-strong" and as a rule contain a monosyllabic (rarely – disyllabic) verbpredicate followed by a monosyllabic grammatical word (e.g. an article), an adjectiveattribute and a noun – a direct object to the verb. The recurring lexicon includes verbs of motion, particularly verbs of fast, aggressive motion, an action directed downwards or causing an injury or death, and recurring nouns referring to moving objects or agents (hands, arms, wings; spear, sword). I term such recurring formulas "rhythmical italics".
Quasi-trochees in Nabokov's prose
Authors: Utgof Grigori
Published: April 2013

Summing up the ideas expressed in the most influential articles on the semantic halo of the Russian trochaic pentameter, scholars tend to avoid one particularly tricky question: how many units – and what kind of units – are needed to detect extra layers of meaning in a particular text? While the article of Kiril Taranovsky "О взаимоотношении стихотворного ритма и тематики" had implied that the source of these meanings (e.g. the dynamic theme of the journey) should be sought in a line starting from the 3- to 4-syllable structure, incorporating a verb of motion and an anapestic anacrusis (Выхожу [verb of motion, last syllable stressed] один я на дорогу), later research objected to this principle as an oversimplification. At the same time two later contributions on the subject (Kirill Vishnevsky's "Экспрессивный ореол пятистопного хорея" and Mikhail Gasparov's "The semantic halo of the Russian trochaic pentameter: Thirty years of the problem") proposed the idea of operating with whole texts as potential sources of meanings, thus calling into question a micro-level approach to the origin of the phenomenon. In my article I propose an empirical model that makes it possible to evaluate some limitations of both practices: I concentrate on some quasi-trochaic pentameters culled from the prose text of Подвиг (Glory) by Vladimir Nabokov (Sirin), and examine these quasi-verse incidents in the framework of both approaches.
Moving from Access to Use of the Information Infrastructure: A Multilevel Sociotechnical Framework
Authors: Racherla Pradeep , Mandviwalla Munir
Published: April 2013

Universal access (UA) to the Internet and the associated information infrastructure has become an important economic and societal goal. However, UA initiatives tend to focus on issues such as physical access and geographical ubiquity, and they measure adoption through penetration rates. In this paper, we apply an interpretive case study approach to analyze the Philadelphia wireless initiative to provide insights into the nature of UA and extend this concept to also consider universal use (UU). UU is important because simply providing access does not guarantee use. UU is presented as a conceptual goal that starts with the challenge of physical access, but which necessarily also leads to considerations of use. The results show that the human and technological elements underlying individual access and use are deeply embedded within various institutional elements and collectives that enable but also constrain meaningful use. We integrate our findings into a multilevel framework that shows how access and use are influenced by both micro and macro factors. This framework provides new insights into the study of the information infrastructure, digital divide, and public policy.
Research Note—The Impact of Intellectual Property Rights Enforcement on Open Source Software Project Success
Authors: Wen Wen , Forman Chris , Graham Stuart J. H.
Published: April 2013

We investigate how intellectual property rights (IPR) enforcement against developers and users of open source software (OSS) affects the success of related OSS projects. We hypothesize that when an IPR enforcement action is filed, user interest and developer activity will be negatively affected in two types of related OSS projects—those that display technology overlap with the OSS application in dispute and business projects that are specific to the disputed OSS platform. We examine two widely publicized lawsuits—SCO v. IBM and FireStar/DataTern v. Red Hat—using data from SourceForge.net. Our difference-in-difference estimates show that in the months following the filing of SCO v. IBM, OSS projects that exhibit high technology overlap with the disputed OSS experienced a 15% greater decline in user interest and 45% less developer activity than projects in the control group; OSS projects that are intended for business and specific to the disputed OSS platform had a 34% greater decline in user interest and 86% less developer activity than the control group. We find similar results following the filing of FireStar/DataTern v. Red Hat. Our results are also robust to a variety of robustness checks, including a falsification exercise and subsample analyses.
A Graph Patrol Problem with Random Attack Times
Authors: Lin Kyle Y. , Atkinson Michael P. , Chung Timothy H. , Glazebrook Kevin D.
Published: April 2013

This paper presents a patrol problem, where a patroller traverses a graph through edges to detect potential attacks at nodes. To design a patrol policy, the patroller needs to take into account not only the graph structure, but also the different attack time distributions, as well as different costs incurred due to successful attacks, at different nodes. We consider both random attackers and strategic attackers. A random attacker chooses which node to attack according to a probability distribution known to the patroller. A strategic attacker plays a two-person zero-sum game with the patroller. For each case, we give an exact linear program to compute the optimal solution. Because the linear programs quickly become computationally intractable as the problem size grows, we develop index-based heuristics. In the random-attacker case, our heuristic is optimal when there are two nodes, and in a suitably chosen asymptotic regime. In the strategic-attacker case, our heuristic is optimal when there are two nodes if the attack times are deterministic taking integer values. In our numerical experiments, our heuristic typically achieves within 1% of optimality with computation time orders of magnitude less than what is required to compute the optimal policy.
A Review of the Use of Angiotensin Receptor Blockers for the Prevention of Cardiovascular Events in Patients with Essential Hypertension Without Compelling Indications
Authors: Zaiken Kathy , Hudd Timothy R , Cheng Judy WM
Published: April 2013

OBJECTIVE

To review the role of angiotensin receptor blockers (ARBs) for the prevention of cardiovascular events in patients with essential hypertension without other compelling indications.

DATA SOURCES

Peer-reviewed clinical trials, review articles, and relevant treatment guidelines were identified from MEDLINE and Current Content database (both 1966-November 15, 2012) using the search terms angiotensin receptor blockers (ARBs), azilsartan, candesartan, eprosartan, irbesartan, losartan, olmesartan, telmisartan, valsartan, hypertension, myocardial infarction, stroke, heart failure, and cardiovascular outcomes. Results were limited to human trials published in English. Citations from articles were also reviewed for additional references.

STUDY SELECTION AND DATA EXTRACTION

The focus was on clinical trials evaluating cardiovascular end points of ARBs used in patients with essential hypertension without compelling indications.

DATA SYNTHESIS

Data supporting the use of ARBs for reducing cardiovascular events in patients with essential hypertension without compelling indications are inconsistent. To date, only candesartan and losartan have shown a significant reduction in cardiovascular morbidity within this sizable subgroup of patients. In the Study on Cognition and Prognosis in the Elderly (SCOPE) trial, candesartan showed a 27.8% reduction in nonfatal stroke versus placebo (95% CI 1.3–47.2; p = 0.04). Moreover, losartan demonstrated a decrease in all cardiovascular events compared to atenolol in the Cardiovascular Morbidity and Mortality in the Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) study (RR 0.87; 95% CI 0.77–0.98; p = 0.021).

CONCLUSIONS

Data supporting the use of ARBs for reducing cardiovascular events in patients with essential hypertension without compelling indications are limited and inconclusive. More studies are needed before ARBs can be routinely recommended as first-line therapy for hypertension management in patients without other compelling indications.
Azilsartan Medoxomil/Chlorthalidone: A New Fixed-Dose Combination Antihypertensive
Authors: Pierini Danielle , Anderson Katherine Vogel
Published: April 2013

OBJECTIVE

To evaluate the efficacy, safety, and clinical utility of the combination product azilsartan medoxomil/chlorthalidone for the treatment of hypertension.

DATA SOURCES

Articles indexed in PubMed through December 2012 were identified using the MeSH terms azilsartan and chlorthalidone, Edarbyclor, TAK-490, and Edarbi. Additional information was gathered from references cited in the identified publications, the package insert, and from a review of the ClinicalTrials.gov registry.

STUDY SELECTION AND DATA EXTRACTION

English-language articles, including clinical trials and reviews involving azilsartan medoxomil/chlorthalidone or each component individually for the treatment of hypertension were reviewed.

DATA SYNTHESIS

The antihypertensive combination tablet azilsartan medoxomil/chlorthalidone is the first to combine an inhibitor of the renin-angiotensin-aldosterone system with chlorthalidone, a thiazide-type diuretic. In 4 randomized controlled trials (3 published to date), azilsartan medoxomil/chlorthalidone 40 mg/12.5 mg and 40 mg/25 mg reduced blood pressure (BP) significantly more than comparators did, including an approximately 5-mm Hg greater BP reduction than olmesartan medoxomil/hydrochlorothiazide 40 mg/25 mg and azilsartan medoxomil/hydrochlorothiazide. Reductions in 24-hour ambulatory BP and clinic BP were observed, and a greater proportion of patients achieved BP targets while receiving azilsartan medoxomil/chlorthalidone. Azilsartan medoxomil/chlorthalidone was generally well tolerated, with minor, transient increases in serum creatinine and without a significant effect on potassium homeostasis. No studies have directly examined cardiovascular morbidity and mortality benefits associated with this combination.

CONCLUSIONS

The combination of azilsartan medoxomil/chlorthalidone has demonstrated safety and efficacy in lowering BP in hypertensive patients to a greater degree than olmesartan medoxomil/hydrochlorothiazide and azilsartan medoxomil/hydrochlorothiazide. As a fixed-dose combination tablet, it offers several clinical advantages.
Impact of Medication Therapy Management on Underserved, Primarily Hispanic Patients with Diabetes
Authors: Congdon Heather B , Dowling Thomas C , Cheng Iliana , Truong Hoai-An
Published: April 2013

BACKGROUND

Diabetes-related complications are more pronounced in Hispanic patients versus patients of other ethnicities. It is documented that medication therapy management (MTM) can improve diabetes outcomes; however, data regarding Hispanic patients are limited.

OBJECTIVE

To evaluate the impact of MTM on hemoglobin A1c (A1C), blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C) in underserved, primarily Hispanic patients who use a safety-net clinic as their medical home.

METHODS

A retrospective, observational study of uninsured, primarily Hispanic patients with diabetes who received MTM from October 2009 through March 2011. Patients were stratified into 2 cohorts: A1C less than 9% and A1C greater than or equal to 9%. Patients were also stratified by frequency of MTM visits and insulin use, regardless of A1C. A chart review was conducted to evaluate diabetes-related outcomes pre- and postimplementation of MTM. The primary study outcome was reduction of A1C. Secondary outcomes included reduction of BP and LDL-C and reduction of A1C based on MTM visit frequency or insulin use.

RESULTS

Sixty-four patients with at least 1 MTM visit and pre- and postimplementation A1C data were included. In the cohort with A1C greater than or equal to 9%, mean (SD) A1C values decreased from 10.9% (1.4%) to 8.8% (1.5%) versus the cohort with A1C less than 9%, whose A1C changed minimally, from 7.2% (0.9%) to 7.4% (1.4%). Regardless of their A1C, patients who were using insulin at baseline had a change in A1C of −0.8% (1.5%) versus −0.1% (1.6%) in those who were not using insulin at baseline (p = 0.04); patients who participated in multiple MTM visits had a significant reduction in A1C, from 9% to 8.3% (95% CI −1.26 to −0.03; p = 0.02) compared with patients participating in only 1 MTM visit.

CONCLUSIONS

Pharmacist-provided MTM can significantly improve diabetes control in uninsured, primarily Hispanic patients with poorly controlled diabetes and in those who are using insulin. Multiple MTM visits also yielded significant A1C reductions.
Pharmacokinetics of Doripenem in Infected Patients Treated Within and Outside the Intensive Care Unit
Authors: Bhalodi Amira A , Keel Rebecca A , Quintiliani Richard , Lodise Thomas P , Nicolau David P , Kuti Joseph L
Published: April 2013

BACKGROUND

Doripenem often is used in the intensive care unit (ICU) to treat serious infections. However, pharmacokinetics in this population often are altered by various physiologic changes. Current pharmacokinetic data in critically ill patients receiving doripenem are limited.

OBJECTIVE

To determine the pharmacokinetics of doripenem in patients treated in the ICU versus outside the ICU.

METHODS

A total of 3–4 serum samples were collected from 25 infected patients receiving doripenem. A 2-compartment model was fit to serum pharmacokinetic data with nonparametric adaptive grid with adaptive γ. In the structural pharmacokinetic model, clearance (Cl) was made proportional to creatinine clearance (CrCl) and an intercept term. Bayesian pharmacokinetic parameters were compared between the 2 populations. A 5000-patient Monte Carlo simulation was performed for various CrCl ranges. The probability of pharmacodynamic target attainment was calculated over a range of minimum inhibitory concentrations (MICs), assuming a target of 35% of the dosing interval that unbound drug concentrations remain above the MIC.

RESULTS

Mean (range) age, body mass index, and CrCl were 61 (31–90) years, 31.2 (15.1–55.5) kg/m2, and 86 (15–221) mL/min, respectively. After the Bayesian step, r2, bias, and precision were 0.97, 0.04, and 1.44 μg/mL, respectively. Mean (SD) parameters for ICU (n = 13) and non-ICU (n = 12) patients were not significantly different (p > 0.05): volume of central compartment (17.3 [11.2] vs 18.5 [11.7] L), Cl (10.1 [10.2] vs 15.5 [16.9] L/h), k12 (4.7 [4.7] vs 4.7 [4.8] h−1), and k21 (7.1 [5.5] vs 5.7 [5.3] h−1), respectively. Optimal target attainments were obtained for patients with normal renal function up to MICs of 2 μg/mL with a dose of 500 mg every 8 hours as 1-hour and 4-hour infusions.

CONCLUSIONS

Doripenem pharmacokinetics were similar between ICU and non-ICU patients in this population. Optimal dosing regimens should be selected based on underlying renal function and suspected MIC of the infecting pathogen.
Spontaneous Subcapsular Splenic Hematoma Associated with Filgrastim in a Patient Undergoing Allogeneic Hematopoietic Stem Cell Transplantation
Authors: Ganetsky Alex , Kucharczuk Colleen , Percio Sarah Del , Frey Noelle , Gill Saar
Published: April 2013

OBJECTIVE

To report the development of a spontaneous subcapsular splenic hematoma following filgrastim administration in a patient undergoing an allogeneic hematopoietic stem cell transplant.

CASE SUMMARY

A 60-year-old female with myelodysplastic syndrome was admitted for a reduced-intensity allogeneic hematopoietic stem cell transplant from an unrelated donor. She received filgrastim 5 μg/kg starting on day 1 to accelerate neutrophil recovery. On day 5, she began reporting severe left chest-wall pain. Contrast-enhanced computed tomography of the abdomen/pelvis revealed a spontaneous subcapsular splenic hematoma. Upon discontinuation of filgrastim, the pain fully resolved. The patient was subsequently rechallenged with filgrastim, which led to recurrence of the left-sided chest-wall pain. Filgrastim was discontinued and the patient reported resolution of the pain.

DISCUSSION

Filgrastim has been associated with splenic hematoma and splenic rupture, predominantly in healthy donors undergoing mobilization of peripheral blood stem cells. Although splenic rupture attributed to filgrastim in a patient undergoing allogeneic hematopoietic stem cell transplantation has been reported, to our knowledge, this is the first case report to establish causality. Using the Naranjo probability scale, an objective causality assessment revealed that the adverse drug event was highly probable.

CONCLUSIONS

Although filgrastim-induced splenomegaly, splenic hematomas, and splenic rupture are rare, clinicians working in the bone marrow transplant setting should be cognizant of the potential of growth factors to cause these adverse events.
Optimization of Supercritical Fluid Extraction of Antioxidant Compounds from Venezuelan Rosemary Leaves
Authors: Caldera Gabriela , Figueroa Yalitza , Vargas Maritza , Santos Diego T. , Marquina-Chidsey Germania
Published: April 2013

The extraction of the antioxidant compounds from rosemary can be achieved by means of various processes, such as hydrodistillation, soxhlet extraction, microwave-accelerated hydrodistillation (MAHD) and supercritical fluid extraction (SFE). The aim of our study was to optimize SFE variables such as extraction pressure, extraction temperature and static extraction time for the maximum extraction of carnosol and carnosic acid from Venezuelan rosemary (Rosmarinus officinalis L.) leaves by using 23 full factorial and Box-Behnken designs and Response Surface Methodology (RSM). The chemical characterization of the supercritical fluid extracts was achieved by high-performance liquid chromatography (HPLC), and the antioxidant activity was determined by the peroxide index assay. For the extraction of carnosol, the variables of extraction temperature and static extraction time were statistically significant, and for the extraction of carnosic acid, only the extraction temperature-static extraction time interaction was significant. At a fixed pressure, the highest extraction of carnosol and carnosic acid were achieved when the operational extraction conditions of extraction temperature and static extraction time were set at 48°C for 69 min and 64°C for 57 min, respectively. SFE extracts presented higher antioxidant activities than commercial and soxhlet extracts, and pure dibutyl hidroxytoluene (BHT). Since the carnosic acid/carnosol ratios presented in our SFE extracts are higher than those from other countries, possibly it would be expected that higher antioxidant activity values would be obtained for the Venezuelan extracts.