bluuebunny/crossref_metadata_2025 huggingface dataset:
The Pharmacists’ Role in Patient–Provider Pain Management Treatment Agreements
Authors: Craig David S.
Published: July 2012

With the increased focus on improving patients’ pain control and upward trends in opioid overdose and deaths, health care professionals have become increasingly interested in reducing their professional risks and improving the safety of their patients receiving chronic opioids. These fears can often be further exacerbated by media attention of deaths from opioid misuse or unintentional overdose and physician prosecution for ‘overprescribing’ of controlled substances, including opioids. This article discusses the role pharmacists can play in patient-provider agreements, and highlights the potential risks associated with chronic opioid therapy. In addition, it describes the important differences between abuse, addiction, physical dependence, and tolerance. Sample informed consent for chronic opioid therapy and patient-provider agreements are included.
‘Whisky gloss’: The alcohol industry, devolution and policy communities in Scotland
Authors: Holden Chris , Hawkins Benjamin
Published: July 2012

Debates on devolution in the UK have been concerned both with the extent to which this has led to policy divergence and with whether devolved institutions have facilitated a more open policy style, which allows easier access to policy makers for a greater range of actors. Further questions have been raised about the extent to which devolution has strengthened territorial boundaries, making it difficult for interest groups to circumvent devolved institutions. Drawing on a series of interviews with a range of policy actors, we investigate the impact of the minority Scottish National Party (SNP) government in Scotland between 2007 and 2011 on alcohol policy and the alcohol policy community, with specific reference to debates about the introduction of minimum unit pricing (MUP). We show that the Scottish policy style did allow extensive access to policy makers, but that the election of the SNP government disrupted the formerly prevailing equilibrium within the Scottish alcohol policy community. The industry was unable to escape the implications of a change in Scottish law for its interests, but industry arguments that MUP is contrary to European Union law indicate that there is still some scope for venue shopping.
Low-level environmental exposure to lead and renal adverse effects: A cross-sectional study in the population of children bordering the Mbeubeuss landfill near Dakar, Senegal
Authors: Cabral M , Dieme D , Verdin A , Garçon G , Fall M , Bouhsina S , Dewaele D , Cazier F , Tall-Dia A , Diouf A , Shirali P
Published: July 2012

This study deals with the health effects within a child population, neighbouring a landfill. After detecting metals in soil and air samples collected in the surroundings of the landfill and in a control site, we have studied: (i) levels of lead (Pb) and exposure biomarkers in blood and urine, (ii) oxidative stress biomarkers and (iii) renal injury by applying a set of early effect biomarkers. Levels of Pb were higher in the exposed site (i.e. 1129 mg/kg and 640 ng/m3 in soil and air samples, respectively) versus those in the control site (i.e. 14.3 mg/kg and 9.3 ng/m3 in soil and air samples, respectively). Pb impregnation and levels of delta-aminolevulinic acid in urine were influenced by the living site that shows the prevailingly alarming situation in the Mbeubeuss landfill. Malondialdehyde changes indicated Pb-induced excessive production of reactive oxygen species. Lactate dehydrogenase activities and proteinuria were found to be higher in the children living in the exposed site. These evidences may reveal the usefulness of these two effect biomarkers to monitor the kidney injury entailed by relatively low-environmental exposure to Pb. Overall, these results show that the Mbeubeuss landfill constitutes a real source of environmental and health risk, be it living or working on site, of the surrounding population, predominantly for children.
Evaluating treatment effect within a multivariate stochastic ordering framework: Nonparametric combination methodology applied to a study on multiple sclerosis
Authors: Brombin Chiara , Di Serio Clelia
Published: July 2012

Multiple sclerosis is an autoimmune complex disease that affects the central nervous system. It has a multitude of symptoms that are observed in different people in many different ways. At this time, there is no definite cure for multiple sclerosis. However, therapies that slow the progression of disability, controlling symptoms and helping patients to maintain a normal quality of life, are available. We will focus on relapsing–remitting multiple sclerosis patients treated with interferons or glatiramer acetate. These treatments have been shown to be effective, but their relative effectiveness has not been well established yet. To assess the superiority of a treatment, instead of classical parametric methods, we propose a statistical approach within the permutation setting and the nonparametric combination of dependent permutation tests. In this framework, we may easily handle with hypothesis testing problems for multivariate monotonic stochastic ordering. This approach has been motivated by the analysis of a large observational Italian multicentre study on multiple sclerosis, with several continuous and categorical outcomes measured at multiple time points.
Front page or “buried” beneath the fold? Media coverage of carbon capture and storage
Authors: Boyd Amanda D. , Paveglio Travis B.
Published: July 2012

Media can affect public views and opinions on science, policy and risk issues. This is especially true of a controversial emerging technology that is relatively unknown. The study presented here employs a media content analysis of carbon capture and storage (CCS), one potential strategy to reduce greenhouse gas emissions. The authors analyzed all mentions of CCS in two leading Canadian national newspapers and two major western regional newspapers from the first article that discussed CCS in 2004 to the end of 2009 (825 articles). An in-depth content analysis was conducted to examine factors relating to risk from CCS, how the technology was portrayed and if coverage was negatively or positively biased. We conclude by discussing the possible impact of media coverage on support or opposition to CCS adoption.
Conducting Go-Along Interviews to Understand Context and Promote Health
Authors: Garcia Carolyn M. , Eisenberg Marla E. , Frerich Ellen A. , Lechner Kate E. , Lust Katherine
Published: July 2012

Go-along interviewing is an innovative approach to obtaining contextualized perspectives by conducting mobile interviews in which the participant acts as a navigational guide of the real or virtual space within which he or she lives. In this study, we used go-along interviews to obtain college students’ contextualized perceptions of sexual health resources. Seventy-eight undergraduate students showed and described the resources on and near five campuses in a Midwestern state. In this article, we focus on the methodology of go-along interviews. The go-along, a relatively new methodology in health research, is a format in which participants take an active role in shaping the interview, and it facilitates identification of resources that might be overlooked using traditional interview formats. The go-along methodology is promising for researchers wanting to ground health-promotion efforts in the context of environmental or community-based strengths and needs.
Common Perceptions of Parents Requesting Personal Exemption From Vaccination
Authors: Luthy Karlen E. , Beckstrand Renea L. , Meyers Carly J. H.
Published: July 2012

School nurses, as vaccination advocates, need to be aware of parents’ common concerns regarding vaccines, so the nurse can develop strategies to communicate with parents. The purpose of this cross-sectional, descriptive study was to identify common reasons parents in Utah seek exempting rather than vaccinating their children. Data were collected from a convenience sample of 801 parents responding to a 16-item questionnaire about why they exempted their children from receiving vaccinations. The most commonly reported reason for seeking a personal exemption included vaccines conflicting with philosophical beliefs. Parents exempting from one vaccine most commonly exempted the hepatitis series. Most parents communicated their vaccine concerns with their health care provider prior to seeking exemption. The majority of exempting parents did not use the Internet when researching vaccines even though they had Internet access. Considering the common vaccine-related perceptions of parents may be helpful when developing strategies to overcome these barriers to vaccination.
Stable Cystatin C Serum Levels Confirm Normal Renal Function in Patients With Dronedarone-Associated Increase in Serum Creatinine
Authors: Duncker David , Oswald Hanno , Gardiwal Ajmal , Lüsebrink Ulrich , König Thorben , Schreyer Hendrik , Klein Gunnar
Published: July 2012

Dronedarone is a new antiarrhythmic drug for patients with nonpermanent atrial fibrillation (AF). A relatively consistent finding in all trials studying dronedarone was a moderate but significant elevation of serum creatinine. Since dronedarone competes for the same organic cation transporter in the distal renal tubule with creatinine, serum creatinine and its derived estimated glomerular filtration rate might not reflect true renal function in patients on dronedarone. We therefore investigated alternative markers for renal function in these patients. We prospectively included 20 patients with nonpermanent AF in whom dronedarone 400 mg twice daily was started. Patients had normal renal function and serum creatinine; serum cystatin C and creatinine clearance were measured before treatment and 10 and 90 days after treatment started. Mean serum creatinine level for all 20 patients at baseline (day 0) was 84.55 ± 12.14 and 87.8 ± 17.59 µmol/L on day 10. This slight increase in all patients was not significant. Patients were now divided into the predefined groups of “increased creatinine” (increase in serum creatinine level > 1 standard deviation) and “not increased creatinine.” Patients with increased creatinine levels (n = 5) showed a significant elevation of serum creatinine levels from day 0 to day 10 (82.4 ± 9.18 to 104.4 ± 12.74 µmol/L; P = .003), whereas change in serum creatinine levels in the not increased creatinine group (n = 15) was not significant. Serum cystatin C levels remained stable in both of these groups (increased creatinine group: 0.76 ± 0.08 to 0.78 ± 0.08 mg/L; P = .65; not increased creatinine group: 0.77 ± 0.108 to 0.77 ± 0.107 mg/L; P = .906). In conclusion, cystatin C represents an easily available and reliable biomarker for estimation of true renal function in patients on dronedarone treatment.
Association Between Story Recall and Other Language Abilities in Schoolchildren With ADHD
Authors: Papaeliou Christina F. , Maniadaki Katerina , Kakouros Efthymios
Published: July 2012

Objective: The present study aimed to investigate the effect of working memory, vocabulary, and grammar on narrative comprehension in children with ADHD. Method: Participants were 25 schoolchildren with ADHD and 25 typically developing (TD) children matched for chronological age and performance IQ. Children were assessed with the Wechsler Intelligence Scale for Children-Third Edition (WISC-III), a verbal IQ test, and a story recall task. Results: It was shown that children with ADHD recall less information from the stories than did TD children, while they are less sensitive to the importance of the information they recall. Moreover, it was found that children with ADHD experience problems in answering factual questions. Further analysis revealed that deficiencies in narrative comprehension may be accounted for by problems in working memory. Conclusion: The discussion focuses on the role of working memory in narrative comprehension and the implications of these findings for intervention approaches.
Do ADHD Children With and Without Child Behavior Checklist–Dysregulation Profile Have Different Clinical Characteristics, Cognitive Features, and Treatment Outcomes?
Authors: Peyre Hugo , Speranza Mario , Cortese Samuele , Wohl Mathias , Purper-Ouakil Diane
Published: July 2012

Objective: The Child Behavior Checklist–Dysregulation Profile (CBCL-DP), characterized by elevated scores on the “Attention Problems,” “Aggressive Behavior,” and “Anxious/Depressed” scales in the CBCL, has been associated with later severe psychopathology. In a sample of children with ADHD, this study sought to further explore the clinical characteristics, the response to methylphenidate medication, and the cognitive features of ADHD children with CBCL-DP. Method: The sample consisted of 173 ADHD outpatients (age = 10.9 ± 2.81) assessed using symptom severity scales, personality questionnaires (Emotionality Activity Sociability [EAS] and Junior Temperament and Character Inventory [JTCI]), and neuropsychological tests. A subsample of 136 participants was reassessed after optimal adjustment of methylphenidate dosage.Results and Conclusion: Variables that were independently associated with CBCL-DP were clinical severity (ADHD Rating Scale [ADHD-RS]), internalized disorders, high emotionality (EAS), and low self-directedness (JTCI). CBCL-DP was associated neither with poorer response to methylphenidate nor with more side effects. There were no differences in cognitive performances between participants with and without CBCL-DP.
Do Symptoms of ADHD at Ages 7 and 10 Predict Academic Outcome at Age 16 in the General Population?
Authors: Holmberg Kirsten , Bölte Sven
Published: July 2012

Objective: To examine the value of the Conners 10-item scale to predict academic outcomes at age 16 years in schoolchildren aged 7 and 10 years. Method: A cohort study of N = 544 children in a municipality of Stockholm County was conducted. Using the parent and teacher version of the Conners 10-item scale, 7- and 10-year-olds were screened for ADHD symptoms and followed-up for school outcome at age 16 years. Results: The best predictors for school outcome at age 16 years were the Conners items, “child failing to finish tasks” and “being inattentive, easily distracted,” with a high specificity (90%-97%) but low sensitivity (18%-39%). Conclusion: This study indicates a considerable association between certain symptoms of inattentiveness in young schoolchildren and academic underachievement at age 16 years. Screening for one to two symptoms of inattention in schoolchildren identifies 30% to 40% of participants at risk for later poor school attainment.
Explaining coalition-bargaining outcomes
Authors: Schermann Katrin , Ennser-Jedenastik Laurenz
Published: July 2012

Most analyses of policy outcomes from coalition-bargaining have hitherto been conducted within a spatial framework that requires the aggregation of coalition policy into a small number of point estimates. Such an approach, however, is limited in terms of the level of specificity at which it can operate. This article therefore draws on the methodology from the pledge fulfilment literature in order to provide a more in-depth examination of coalition-bargaining outcomes. We are thus able to take advantage of the fact that contemporary coalition agreements provide a wealth of detailed information on the government’s prospective course of policy action. Based on a quantitative text analysis of election manifestos, a dataset of over 1,000 election pledges is used to test a number of hypotheses on the adoption of policies in Austrian coalition agreements between 2002 and 2008. The multivariate models yield strong support for the hypotheses and suggest that the methodological approach has the potential to enhance our understanding of coalition-bargaining.
A brief motivational intervention for heavy alcohol use in dental practice settings: Rationale and development
Authors: Neff James Alan , Walters Scott T , Braitman Abby L , Kelley Michelle L , Paulson James F , Brickhouse Tegwyn H , Gunsolley John C , Darby Michele L , Lemaster Margaret F , Vandersluis J. Patrick , Walsh Margaret M
Published: July 2012

Although brief alcohol interventions have proven effective in a variety of health care settings, the present article describes the development of the first brief intervention for heavy drinkers in dental practice. Elements of motivational interviewing and personalized normative feedback were incorporated in a 3- to 5-minute intervention delivered by dental hygienists. The intervention is guided by a one-page feedback report providing personalized normative feedback regarding the patient’s current oral health practices, their drinking in comparison to others, and oral cancer risk associated with current smoking and drinking. Future publications will present data regarding intervention effectiveness from an ongoing randomized trial.
Finite element simulation of the behaviours of laminated armour systems against blast wave and projectile dynamic impacts
Authors: Tan Ping
Published: July 2012

For investigating the blast wave and fragment/projectile protective performance of laminated armour systems, backed with, or without, air spacers, two-dimensional finite element models were developed using the commercial finite element software Autodyn. In this investigation, four differently shaped projectiles, including flat-faced cylindrical projectile, blunt cylindrical projectile, ogive-nose projectile and spherical projectile, were considered. The blast load was simplified as a triangular pulse. For validating the present models, a comparison of the present numerical results with the analytical and expermental results available in literature was conducted. A good agreement between them was noted. Subsequently, a parametric study was conducted to examine the effects of the key parameters on the dynamic responses of an armour systems against blast wave or projectile impact. The results indicated that the residual (or exit) velocity of projectile, the rear surface deflection of the armour system against a projectile impact and the peak value of the pressure measured in a water body simultant are dependent on the armour component property and configuration. Under the assumption that the components of laminated armour systems are perfectly bonded together and remain so on impact, the results showed that the inclusion of an air spacer onto the rear surface of the armour system may play an important role in reducing the peak pressure, residual (or exit) velocity of the projectile and the rear surface deflection of the armour system.
Leg Ulcer as a Complication of a Posttraumatic Tibial Arteriovenous Fistula Treated by Endovascular Approach With Stent-Graft Placement
Authors: Rabellino Martín , Shinzato Sergio , Aragón-Sánchez Javier , Peralta Oscar , Marenchino Ricardo , García-Mónaco Ricardo
Published: July 2012

Endovascular treatment of posttraumatic arteriovenous fistulae (AVFs) in the lower extremities by means of covered stent-grafts is widely accepted, and many cases have been reported in the iliac-femoral region. However, few reports exist on the treatment of infrapopliteal AVFs, with or without a pseudoaneurysm, using this method. The authors present this case report dealing with a patient who had undergone a tibial and peroneal open fracture in his left limb 34 years ago. He developed a leg ulcer as a consequence of AVF between the tibialis posterior artery and vein, which resulted in venous insufficiency, which was treated by the endovascular approach with the placement of a stent-graft. Total healing was achieved over a period of 3 months. Angio-CT was performed, showing stent-graft patency 6 months after the endovascular procedure.
Combination of Negative Pressure Wound Therapy and Hyalomatrix Application for Soft Tissue Defect of the Great Toe
Authors: Coban Yusuf Kenan
Published: July 2012

Soft tissue defect of the hallux can be particularly difficult to manage because of the absence of local muscle tissue for coverage. The author presents his experience of a combination therapy for severe posttraumatic soft tissue defect of the hallux in a young patient.
Strategies for solidarity education at Catholic schools in Chile: Approximations and descriptions from the perspectives of school principals
Authors: López Alejandra Isabel Santana , Mary Natalia Hernández
Published: July 2012

This research project sought to learn how solidarity education is manifested in Chilean Catholic schools, considering the perspectives of school principals, programme directors and pastoral teams.

Eleven Chilean schools were studied and the information gathering techniques applied included: a questionnaire, semi-structured individual interviews and group interviews. The grounded theory model was used to analyse the data. The results describe contexts of emerging solidarity education strategies and one perceives a variety of degrees of effort, bi-directional fields of action and traditional attitudes associated with charity. There is an overall sense of solidarity-in-transition, ranging from welfare-oriented action to promotional activities, channelled through training processes. Strengths, weaknesses, challenges and the need for outside support for the schools are highlighted in order to assure effectiveness and sustainability for the programmes.
Patients’ experiences of surgical site infection
Authors: Tanner Judith , Padley Wendy , Davey Susan , Murphy Katherine , Brown Brian
Published: July 2012

The qualitative experience of having a surgical site infection (SSI) is often overlooked. The aim of this study was to present a description of how SSIs affect the lives of patients and their families. Seventeen former patients from three hospitals in England were interviewed to explore their experience of having an SSI. The interview data was transcribed and analysed into the following themes – horror stories, physical effects, psychological effects, effect on families, feelings of relief, not blaming the hospital, and lack of support after discharge. Numerous articles describe SSIs as being ‘distressing’ for patients. This study reveals the extent of the distress, with patients describing feeling ‘utter despair’ and ‘wanting to die’. These symptoms continued for months after patients had been discharged from hospital.
Subnetwork-based analysis of chronic lymphocytic leukemia identifies pathways that associate with disease progression
Authors: Chuang Han-Yu , Rassenti Laura , Salcedo Michelle , Licon Kate , Kohlmann Alexander , Haferlach Torsten , Foà Robin , Ideker Trey , Kipps Thomas J.
Published: July 2012

The clinical course of patients with chronic lymphocytic leukemia (CLL) is heterogeneous. Several prognostic factors have been identified that can stratify patients into groups that differ in their relative tendency for disease progression and/or survival. Here, we pursued a subnetwork-based analysis of gene expression profiles to discriminate between groups of patients with disparate risks for CLL progression. From an initial cohort of 130 patients, we identified 38 prognostic subnetworks that could predict the relative risk for disease progression requiring therapy from the time of sample collection, more accurately than established markers. The prognostic power of these subnetworks then was validated on 2 other cohorts of patients. We noted reduced divergence in gene expression between leukemia cells of CLL patients classified at diagnosis with aggressive versus indolent disease over time. The predictive subnetworks vary in levels of expression over time but exhibit increased similarity at later time points before therapy, suggesting that degenerate pathways apparently converge into common pathways that are associated with disease progression. As such, these results have implications for understanding cancer evolution and for the development of novel treatment strategies for patients with CLL.
How I treat plasma cell leukemia
Authors: van de Donk Niels W. C. J. , Lokhorst Henk M. , Anderson Kenneth C. , Richardson Paul G.
Published: July 2012

Primary plasma cell leukemia (pPCL) is a rare and aggressive plasma cell proliferative disorder with a very poor prognosis and with distinct biologic, clinical, and laboratory features. Compared with multiple myeloma, pPCL presents more often with extramedullary involvement, anemia, thrombocytopenia, hypercalcemia, elevated serum β2-microglobulin and lactate dehydrogenase levels, as well as impaired renal function. Many of the genetic aberrations observed in newly diagnosed pPCL are typically found in advanced multiple myeloma. These cytogenetic abnormalities and mutations lead to increased proliferation, enhanced inhibition of apoptosis, escape from immune surveillance, and independence from the BM microenvironment, with changes in expression of adhesion molecules or chemokine receptors. The outcome of pPCL has improved with the introduction of autologous stem cell transplantation and combination approaches with novel agents, including bortezomib and immunomodulatory drugs, such as lenalidomide. In this review, we provide an overview of currently available therapeutic options with recommendations of how these treatment modalities can best be used to improve outcome for plasma cell leukemia patients.
Tissue factor–positive neutrophils bind to injured endothelial wall and initiate thrombus formation
Authors: Darbousset Roxane , Thomas Grace M. , Mezouar Soraya , Frère Corinne , Bonier Rénaté , Mackman Nigel , Renné Thomas , Dignat-George Françoise , Dubois Christophe , Panicot-Dubois Laurence
Published: July 2012

For a long time, blood coagulation and innate immunity have been viewed as interrelated responses. Recently, the presence of leukocytes at the sites of vessel injury has been described. Here we analyzed interaction of neutrophils, monocytes, and platelets in thrombus formation after a laser-induced injury in vivo. Neutrophils immediately adhered to injured vessels, preceding platelets, by binding to the activated endothelium via leukocyte function antigen-1–ICAM-1 interactions. Monocytes rolled on a thrombus 3 to 5 minutes postinjury. The kinetics of thrombus formation and fibrin generation were drastically reduced in low tissue factor (TF) mice whereas the absence of factor XII had no effect. In vitro, TF was detected in neutrophils. In vivo, the inhibition of neutrophil binding to the vessel wall reduced the presence of TF and diminished the generation of fibrin and platelet accumulation. Injection of wild-type neutrophils into low TF mice partially restored the activation of the blood coagulation cascade and accumulation of platelets. Our results show that the interaction of neutrophils with endothelial cells is a critical step preceding platelet accumulation for initiating arterial thrombosis in injured vessels. Targeting neutrophils interacting with endothelial cells may constitute an efficient strategy to reduce thrombosis.
Oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly
Authors: Almirall Jordi , Rofes Laia , Serra-Prat Mateu , Icart Roser , Palomera Elisabet , Arreola Viridiana , Clavé Pere
Published: July 2012

The aim of this study was to explore whether oropharyngeal dysphagia is a risk factor for community-acquired pneumonia (CAP) in the elderly and to assess the physiology of deglutition of patients with pneumonia.

In the case–control study, 36 elderly patients (aged ≥70 years) hospitalised with pneumonia were matched by age and sex with two independently living controls. All subjects were given the volume–viscosity swallow test to identify signs of oropharyngeal dysphagia. In the pathophysiological study, all cases and 10 healthy elderly subjects were examined using videofluoroscopy.

Prevalence of oropharyngeal dysphagia in the case–control study was 91.7% in cases and 40.3% in controls (p<0.001). Adjusting for functionality and comorbidities, dysphagia showed an independent effect on pneumonia (OR 11.9, 95% CI 3.03–46.9). Among cases in the pathophysiological study, 16.7% showed safe swallow, 30.6% high penetrations, 36.1% severe penetrations and 16.7% silent aspirations during videofluoroscopy, while in the healthy elderly subjects these percentages were 80%, 20%, 0% and 0%, respectively (p<0.001). A delay in closure of the laryngeal vestibule (0.414±0.029 sversus0.200±0.059 s, p<0.01) was the main mechanism of impaired airway protection.

In elderly subjects, oropharyngeal dysphagia is strongly associated with CAP, independently of functionality and comorbidities. Elderly patients with pneumonia presented a severe impairment of swallow and airway protection mechanisms. We recommend universal screening of dysphagia in older persons with pneumonia.
Effect of urbanisation on the relationship between total serum IgE and asthma
Authors: Checkley William , Robinson Colin L. , Baumann Lauren M. , Romero Karina , Combe Juan M. , Gilman Robert H. , Wise Robert A. , Hamilton Robert G. , Gonzalvez Guillermo , Cama Vitaliano , Hansel Nadia N. ,   the PURA study investigators
Published: July 2012

It is unclear if the relationship of total serum IgE with asthma varies with degree of urbanisation. We hypothesised that the relationship of total serum IgE to asthma is more pronounced in an urbanversusa rural environment.

We enrolled 1441 children aged 13–15 years in a peri-urban shanty town in Lima, Peru (n=725) and 23 villages in rural Tumbes, Peru (n=716). We asked participants about asthma and allergy symptoms, environmental exposures and sociodemographics; and performed spirometry, and exhaled nitric oxide and allergy skin testing. We obtained blood for total serum IgE in 1143 (79%) participants.

Geometric means for total serum IgE were higher in LimaversusTumbes (262versus192 kU·L−1; p<0.001). The odds of asthma increased by factors of 1.6 (95% CI 1.3–2.0)versus1.4 (95% CI 0.9–2.1) per log unit increase in total serum IgE in LimaversusTumbes, respectively. Atopy was an effect modifier of the relationship of total serum IgE on asthma. Among atopics and non-atopics, the odds of asthma increased by a factor of 2.0 (95% CI 1.5–2.7) and 1.0 (95% CI 0.7–1.4) per log unit increase in total serum IgE, respectively.

Total serum IgE was associated with atopic asthma but not with non-atopic asthma. Urbanisation did not appear to be an effect modifier of this relationship.
Radial probe EBUSversusCT-guided needle biopsy for evaluation of peripheral pulmonary lesions: an economic analysis
Authors: Steinfort Daniel P. , Liew Danny , Irving Louis B.
Published: July 2012

Selection of the optimal procedure for minimally invasive diagnosis of peripheral pulmonary lesions (PPLs) may be based on clinical factors; however, selection of diagnostic strategy may also be influenced by cost. Economic analysis of minimally invasive diagnosis of PPL has not been performed previously.

Decision-tree analysis was applied to compare downstream costs of endobronchial ultrasound-guided transbronchial lung biopsy (EBUS-TBLB) with computed tomography-guided percutaneous needle biopsy (CT-PNB). Calculations were based on real costs derived from patient data. Sensitivity analyses and probabilistic sensitivity analysis were undertaken to identify the more cost-beneficial approach for varying input parameter values. Cost-effectiveness calculations were based on estimated disutility, according to the wait-trade-off technique.

For base-case analysis, initial evaluation with CT-PNB was cost-beneficial (AU$2,724versusEBUS-TBLB AU$2,748). The variable which exerted the most influence on cost-benefit outcomes was the cost of managing complications. CT-PNB remained the more cost-effective procedure at base-case parameters, although thresholds were identified during sensitivity analysis where EBUS-TBLB became more cost-effective.

The costs of EBUS-TBLB and CT-PNB to evaluate PPL appear to be equivalent, but specific clinical-radiologic factors known to influence procedural outcomes will influence cost-benefit outcomes. Further evaluation of patient preferences and their influence on cost-effectiveness are required.
The role of bronchodilator treatment in the prevention of exacerbations of COPD
Authors: Wedzicha Jadwiga A. , Decramer Marc , Seemungal Terence A.R.
Published: July 2012

Exacerbations of chronic obstructive pulmonary disease (COPD) are natural events in the progression of the disease, and are characterised by acute worsening of symptoms, especially dyspnoea. These heterogeneous events follow increased airway inflammation, often due to infection, and lead to decreased airflow and increased lung hyperinflation relative to stable COPD. Although exacerbation frequency generally increases as COPD progresses, some patients experience frequent exacerbations (≥2 per year) independently of disease severity. Exacerbations, especially frequent exacerbations, are associated with impaired health-related quality of life, reduced physical activity and poor disease prognosis.

The cornerstone of pharmacotherapy for stable COPD is long-acting bronchodilators, including the long-acting β2-agonists (LABAs) and long-acting anti-muscarinic agents (LAMAs) alone or combined with inhaled corticosteroids (ICS). While ICS treatment can potentially reduce the risk of exacerbations, clinical studies have demonstrated the efficacy of LABAs and LAMAs in reducing COPD symptoms, primarily by reducing lung hyperinflation secondary to reduced airway resistance. Sustained reduction in lung hyperinflation may in turn lessen dyspnoea during an exacerbation. Indeed, recent studies suggest that bronchodilators may also reduce the incidence of, or prevent, exacerbations.

Using data from recent studies, this review explores the evidence and possible mechanisms through which bronchodilators may prevent exacerbations.
Use of continuous positive airway pressure reduces airway reactivity in adults with asthma
Authors: Busk Michael , Busk Nancy , Puntenney Paula , Hutchins Janet , Yu Zhangsheng , Gunst Susan J. , Tepper Robert S.
Published: July 2012

Asthma is characterised by airway hyperreactivity, which is primarily treated with β-adrenergic bronchodilators and anti-inflammatory agents. However, mechanical strain during breathing is an important modulator of airway responsiveness and we have previously demonstrated in animal models that continuous positive airway pressure (CPAP) resulted in lowerin vivoairway reactivity. We now evaluated whether using nocturnal CPAP decreased airway reactivity in clinically-stable adults with asthma.

Adults with stable asthma and normal spirometry used nocturnal CPAP (8–10 cmH2O) or sham treatment (0–2 cmH2O) for 7 days. Spirometry and bronchial challenges were obtained before and after treatment. The primary outcome was the provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 s (PC20).

The CPAP group (n=16) had a significant decrease in airway reactivity (change in (Δ)logPC200.406, p<0.0017) while the sham group (n=9) had no significant change in airway reactivity (ΔlogPC200.003, p=0.9850). There was a significant difference in the change in airway reactivity for the CPAPversusthe sham group (ΔlogPC200.41, p<0.043).

Our findings indicate that chronic mechanical strain of the lungs produced using nocturnal CPAP for 7 days reduced airway reactivity in clinically stable asthmatics. Future studies of longer duration are required to determine whether CPAP can also decrease asthma symptoms and/or medication usage.
Membrane damage and repair in primary monocytes exposed to human β-defensin-3
Authors: Lioi Anthony B , Reyes Rodriguez Angel L , Funderburg Nicholas T , Feng Zhimin , Weinberg Aaron , Sieg Scott F
Published: July 2012

Human beta defensin-3 damages cell membranes of monocytes, potentially affecting these cellsˈ survival and activity at inflammation sites.

Interactions of AMPs with plasma membranes of primary human immune cells are poorly characterized. Analysis of PI exclusion as a measure of membrane integrity indicated that hBD-3 caused membrane perturbations in monocytes but not T or B cells at concentrations typically used to kill bacteria or to induce activation of APCs. Bleb-like structures were observed in monocytes exposed to hBD-3. These cells also increased surface expression of LAMP1, a membrane repair marker after exposure to hBD-3. Furthermore, cell death was enhanced by adding an inhibitor of membrane repair. Removal of cholesterol from membranes resulted in greater susceptibility of cells to hBD-3, but cholesterol content was not different between the cell types, as assessed by filipin staining. Freshly isolated monocytes expressed higher levels of the negatively charged phospholipid, PS, on their outer leaflet compared with B or T cells. Preincubation of monocytes with molecules that bind PS protected these cells from hBD-3-induced membrane damage, suggesting that outer-membrane PS expression can at least partially explain monocyte susceptibility to hBD-3. The potential for membrane disruption caused by AMPs should be evaluated in various cell types when considering these molecules for therapeutic applications in humans.
Cigarette smoking as a risk factor for other substance misuse: 10-year study of individuals with and without attention-deficit hyperactivity disorder
Authors: Biederman Joseph , Petty Carter R. , Hammerness Paul , Batchelder Holly , Faraone Stephen V.
Published: July 2012

Background

We previously documented that cigarette smoking is a risk factor for subsequent alcohol and drug misuse and dependence in adolescent girls with attention-deficit hyperactivity disorder (ADHD).

Aims

To revisit this hypothesis with a large longitudinal sample of both genders followed up for 10 years into young adulthood.

Method

We used data from two identically designed, longitudinal, case–control family studies of boys and girls with and without ADHD ascertained from psychiatric and paediatric sources. We studied 165 individuals with ADHD and 374 controls followed up longitudinally and masked for 10 years. We assessed ADHD, smoking and substance use status using structured diagnostic interviews. We tested the association between cigarette smoking and subsequent substance use outcomes using Cox proportional hazard regression models.

Results

Youth with ADHD who smoked cigarettes (n= 27) were significantly more likely to subsequently develop drug misuse and dependence compared with youth with ADHD who did not smoke (n= 138,P<0.05).

Conclusions

These results confirm that cigarette smoking increases the risk for subsequent drug and alcohol use disorders among individuals with ADHD. These findings have important public health implications, and underscore the already pressing need to prevent smoking in children with ADHD.
Ethnic density as a buffer for psychotic experiences: findings
from a national survey (EMPIRIC)
Authors: Das-Munshi Jayati , Bécares Laia , Boydell Jane E. , Dewey Michael E. , Morgan Craig , Stansfeld Stephen A. , Prince Martin J.
Published: July 2012

Background

Aetiological mechanisms underlying ethnic density associations with
psychosis remain unclear.

Aims

To assess potential mechanisms underlying the observation that minority
ethnic groups experience an increased risk of psychosis when living in
neighbourhoods of lower own-group density.

Method

Multilevel analysis of nationally representative community-level data
(from the Ethnic Minorities Psychiatric Illness Rates in the Community
survey), which included the main minority ethnic groups living in
England, and a White British group. Structured instruments assessed
discrimination, chronic strains and social support. The Psychosis
Screening Questionnaire ascertained psychotic experiences.

Results

For every ten percentage point reduction in own-group density, the
relative odds of reporting psychotic experiences increased 1.07 times
(95% CI 1.01–1.14, P = 0.03 (trend)) for the total
minority ethnic sample. In general, people living in areas of lower
own-group density experienced greater social adversity that was in turn
associated with reporting psychotic experiences.

Conclusions

People resident in neighbourhoods of higher own-group density experience
‘buffering’ effects from the social risk factors for psychosis.
Adsorption of Toluene on Alkali Metal Ion-Exchanged ZSM-5 and β-Zeolites under Humid Conditions
Authors: Takamitsu Yasuyuki , Ariga Ko , Yoshida Satoshi , Ogawa Hiroshi , Sano Tsuneji
Published: July 2012

Alkali metal ion-exchanged ZSM-5 and β-zeolites were tested as hydrocarbon traps for reducing cold-start emissions. The hydrocarbon trap performances were investigated by temperature-programmed desorption employing toluene as a probe molecule both in the presence and absence of water. Toluene adsorption was significantly inhibited in the presence of water. The extent of this inhibitory effect was strongly dependent on the nature of the alkali metal cation. The Cs cation was the most effective in suppressing the inhibition. The suppression of the inhibition is likely due to an enhancement of the interaction between the toluene molecules and zeolite-framework oxygens bearing high negative charge. Having investigated hydrocarbon trap performances of alkali metal ion-exchanged Y and mordenite zeolites as well as ZSM-5 and β, it was concluded that both the type of alkali metal cation employed and the Si/Al ratio of zeolite were the major factors that affected the hydrocarbon trap performance rather than the nature of framework structure of zeolite. On the other hand, the durability was influenced by the type of framework structure used. The stability decreased in the order: Cs/ZSM-5 > Cs/β > Cs/Y ≈ Cs/mordenite. The adsorption capacity of Cs/ZSM-5 was preserved even after thermal treatment at 900 °C.
Numerical Investigations on Wind Flow over Complex Terrain
Authors: Ramechecandane S. , Gravdahl Arne Reidar
Published: July 2012

A comparison of three two-equation turbulence models namely the standard k-ε model, Renormalized Group Theory (RNG) k-ε model and the k-ω model of Wilcox for flow over three different types of topographies have been presented in this paper. The present work is also an attempt to propose best practices for simulating atmospheric boundary layer (ABL) flows over complex terrain. Numerical investigations are performed for three different topographies: (i) cosine Hill (ii) Bolund Hill and (iii) Askervein Hill. The commercial CFD solver PHOENICS and the wind farm design tool WindSim V-5.1.0 are used for solving the Reynolds Averaged Navier Stokes (RANS) equations with the turbulence closure. The profiles of velocity and turbulent kinetic energy obtained using the various turbulence models are compared with available experimental data. The numerical results clearly show the superiority of the k-ω model of Wilcox over the standard k-ε model and the RNG k-ε model for ABL flows. Though the velocity profiles obtained using all three models are alike there exists a significant variation in the turbulent kinetic energy profiles for the cases considered in this investigation. The models perform very well when the terrain orography is quite complex, except for the predictions on the leeward side of the Hill where the elliptic effects are more pronounced.
Resonances and Aerodynamic Damping of a Vertical Axis Wind Turbine
Authors: Ottermo Fredric , Bernhoff Hans
Published: July 2012

The dynamics of a straight-bladed vertical axis wind turbine is investigated with respect to oscillations due to the elasticity of struts and shaft connecting to the hub. In particular, for the three-bladed turbine, a concept is proposed for dimensioning the turbine to maximize the size of the resonance free rpm range for operation. The effect of aerodynamic damping on the struts is also considered. The damping of these types of oscillations for a typical turbine is found to be good.
Novel Scheme for Improving the Performance of a Wind Driven Doubly Fed Induction Generator during Grid Fault
Authors: Mossa Mahmoud A. , Mohamed Yehia S.
Published: July 2012

Enhancement of fault ride-through (FRT) capability and subsequent improvement of rotor speed stability of wind farms equipped with doubly fed induction generator (DFIG) is the objective of this paper. The objective is achieved by employing a novel FRT scheme with suitable control strategy. The proposed FRT scheme, which is connected between the rotor circuit and dc link capacitor in parallel with Rotor Side Converter, consists of an uncontrolled rectifier, two sets of IGBT switches, a diode and an inductor. In this scheme, the input mechanical energy of the wind turbine during grid fault is stored and utilized at the moment of fault clearance, instead of being dissipated in the resistors of the crowbar circuit as in the existing FRT schemes. Consequently, torque balance between the electrical and mechanical quantities is achieved and hence the rotor speed deviation and electromagnetic torque fluctuations are reduced. This results in reduced reactive power requirement and rapid reestablishment of terminal voltage on fault clearance. Furthermore, the stored electromagnetic energy in the inductor is transferred into the dc link capacitor on fault clearance and hence the grid side converter is relieved from charging the dc link capacitor, which is very crucial at this moment, and this converter can be utilized to its full capacity for rapid restoration of terminal voltage and normal operation of DFIG. Extensive simulation study carried out employing MATLAB/SIMULINK software vividly demonstrates the potential capabilities of the proposed scheme in enhancing the performance of DFIG based wind farms to fault ride-through.
Delivery of a Robust a Frequency Response Service from Wind Farms for the Great Britain Transmission System
Authors: Horne Jonathan M
Published: July 2012

Frequency stability refers to the ability of a synchronous a.c. power system to remain in operation following an imbalance between generation and load [1]. With excess generation the frequency will increase, and conversely, with a deficit of generation the frequency will fall. When either happens either all or a selection of plant must increase or decrease output automatically and rapidly to make up for the short fall or excess in power. This ancillary service is known as frequency response. Failure to do this correctly could result in system frequency exceeding permitted limits and automatic disconnection of customers, or in the worst case, system blackout. As the volume of wind turbine generation continues to increase exponentially, particularly in wind rich island countries such as Great Britain and Ireland, there comes a point where the synchronous generation must operate at reduced output or even be disconnected. Services which were once provided by this displaced synchronous generation must logically be taken up by other plant, with the obvious target being the replacement wind generation [2, 3]. Frequency response is one of these key services, particularly in smaller island networks with highly variable system frequency. Wind plant is ideally placed during windy days to provide a high frequency response service (reducing in output when frequency is high), with the remaining connected synchronous generation operating at low load to provide the required low frequency response. However, there are several factors which must be considered before wind plant can provide a robust, reliable and repeatable service to help in maintaining frequency stability in a grid. The major factors are discussed in this paper, together with presentation of a technique for providing frequency response from wind plant. This technique has been adopted by several wind turbine manufacturers, and has been, or is in the process of being implemented in a number of onshore and offshore wind farms in Great Britain.