bluuebunny/crossref_metadata_2025 huggingface dataset:
A randomised controlled trial of active chronic otitis media comparing courses of eardrops versus one‐off topical treatments suitable for primary, secondary and tertiary healthcare settings
Authors: Loock J.W.
Published: July 2012

Clin. Otolaryngol. 2012, 37, 261–270

Objective:  Primary: to compare one‐off administration of boric acid powder with courses of 1% acetic acid and ciprofloxacin eardrops in treating active chronic otitis media. Secondary: to evaluate the effectiveness of Quadriderm® cream in resistant active chronic otitis media; and to document side effects of these treatments, especially hearing loss.

Study design:  Randomised controlled trial.

Setting:  Outpatient department of a tertiary ENT unit.

Participants:  Hundred and fifty‐nine patients over 6 years old with active chronic mucosal (without cholesteatoma) otitis media randomised to receive one of the three primary agents.

Method:  All techniques employed were suitable for primary healthcare givers as well as specialists. After confirming eligibility, patients were randomly allocated to treatment. All ears underwent toilet with irrigation using clean water, a syringe and ambient light, with or without dry mopping, until the perforation was visible. The randomised solution was flushed through the middle ear and eustachian tube using a ‘tragal pump’ technique: saline was used as the solution for flushing in the boric acid powder arm. Patients allocated topical ear medication were given a bottle of eardrops to administer (six drops twice daily, ‘pumped in’) until finished. Those allocated boric acid powder had the external ear canals filled as a one‐off treatment. Patients were followed up monthly thereafter.

Outcome measures:  Primary: Dry (inactive) middle ears as assessed by the doctor. Secondary: Patient assessment of success; microbiologic culture and sensitivity; audiologic changes because of treatment; complications of treatment; costs of therapies.

Results:  Ciprofloxacin eardrops and boric acid powder were statistically superior to 1% acetic acid eardrops in rendering active chronic otitis media inactive (73% dry ears for ciprofloxacin; 67% for boric acid powder; and 24% for acetic acid). There was no difference between the success rates of ciprofloxacin eardrops and boric acid powder. Quadriderm cream was effective in 85% of patients failing first‐line therapy. No agent caused significant complications and specifically no hearing loss.

Conclusions:  This study showed a single application of boric acid powder following external auditory canal irrigation until the perforation was visible to be as effective as the current best practice of topical quinolone eardrops in active chronic otitis media. Boric acid powder is inexpensive and does not require patient compliance. Boric acid powder is a viable, less costly alternative to topical antibiotic/steroid ear drops in the developing world for active chronic otitis media. Acetic acid eardrops 1% are ineffective. Quadriderm cream, given as a one‐off therapy, also appears to be effective.
Time‐course changes of muscle protein synthesis associated with obesity‐induced lipotoxicity
Authors: Masgrau Aurélie , Mishellany‐Dutour Anne , Murakami Hitoshi , Beaufrère Anne‐Marie , Walrand Stéphane , Giraudet Christophe , Migné Carole , Gerbaix Maude , Metz Lore , Courteix Daniel , Guillet Christelle , Boirie Yves
Published: July 2012

Key points

Prolonged obesity leads to ectopic lipid accumulation in non‐adipose tissues, particularly in skeletal muscles, inducing metabolic dysfunctions (reduced glucose uptake, mitochondria dysfunction, lipotoxicity).

Several studies in humans and rodents have shown that obesity induces a short‐term increase in fat‐free mass but a long‐term decrease in skeletal muscle mass.

We investigated the mechanisms potentially involved in muscle loss by measuring simultaneously protein synthesis and lipid infiltration in different types of skeletal muscles, during the development of obesity.

Our results show that protein synthesis rate in glycolytic muscles increased together with muscle mass during the early phase of obesity development, whereas it decreased later. Reduced protein synthesis rate was associated with a high lipid accumulation in glycolytic muscles.

These results suggest that lipid accumulation in muscles during prolonged obesity is deleterious for amino acid incorporation in skeletal muscle proteins, and thus indirectly for muscle mass.

Abstract  The object of the study was to investigate the sequential changes of protein synthesis in skeletal muscle during establishment of obesity, considering muscle typology. Adult Wistar rats were fed a standard diet for 16 weeks (C; n= 14), or a high‐fat, high‐sucrose diet for 16 (HF16; n= 14) or 24 weeks (HF24; n= 15). Body composition was measured using a dual‐energy X‐ray absorptiometry scanner. The fractional synthesis rates (FSRs) of muscle protein fractions were calculated in tibialis anterior (TA) and soleus muscles by incorporation of l‐13C‐valine in muscle protein. Muscle lipid and mitochondria contents were determined using histochemical analysis. Obesity occurred in an initial phase, from 1 to 16 weeks, with an increase in weight (P < 0.05), fat mass (P < 0.001), muscle mass (P < 0.001) and FSR in TA (actin: 5.3 ± 0.2 vs. 8.8 ± 0.5% day−1, C vs. HF16, P < 0.001) compared with standard diet. The second phase, from 16 to 24 weeks, was associated with a weight stabilization, a decrease in muscle mass (P < 0.05) and a decrease in FSR in TA (mitochondrial: 5.6 ± 0.2 vs. 4.2 ± 0.4% day−1, HF16 vs. HF24, P < 0.01) compared with HF16 group. Muscle lipid content was increased in TA in the second phase of obesity development (P < 0.001). Muscle mass, lipid infiltration and muscle protein synthesis were differently affected, depending on the stage of obesity development and muscle typology. Chronic lipid infiltration in glycolytic muscle is concomitant with a reduction of muscle protein synthesis, suggesting that muscle lipid infiltration in response to a high‐fat diet is deleterious for the incorporation of amino acid in skeletal muscle proteins.
Outbreak of Klebsiella pneumoniae Carbapenemase-2-Producing K. pneumoniae Sequence Type 11 in Taiwan in 2011
Authors: Lee Chun-Ming , Liao Chun-Hsing , Lee Wen-Sen , Liu Yung-Ching , Mu Jung-Jung , Lee Meng-Chih , Hsueh Po-Ren
Published: July 2012

From June to September 2011, a total of 305 ertapenem-nonsusceptible
Enterobacteriaceae
isolates (MICs of ertapenem ≥ 1 μg/ml) were collected from 11 hospitals in different parts of Taiwan. The MICs of 12 antimicrobial agents against these isolates were determined using the broth microdilution method, and genes for carbapenemases were detected using PCR. Genotypes of isolates possessing carbapenemase genes were identified by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing. The ertapenem-nonsusceptible
Enterobacteriaceae
isolates included
Klebsiella pneumoniae
(
n
= 219),
Escherichia coli
(
n
= 64),
Enterobacter cloacae
(
n
= 15), and other species (
n
= 7). Seven (2.3%) of the ertapenem-nonsusceptible
Enterobacteriaceae
isolates exhibited colistin MICs of >4 μg/ml, and 24 (7.9%) were not susceptible to tigecycline (MICs > 2 μg/ml). A total of 29 (9.5%) isolates carried genes encoding carbapenemases, namely,
K. pneumoniae
carbapenemase-2 (KPC-2) in 16 (7.3%) isolates of
K. pneumoniae
(KPC-2-KP) and IMP-8 in 5 (2.3%) isolates of
K. pneumoniae
, 5 (33.3%) isolates of
E. cloacae
, 1 isolate of
E. coli
, 1 isolate of
Klebsiella oxytoca
, and one isolate of
Citrobacter freundii
. The 16 KPC-2-KP isolates were isolated from patients at four different hospitals in northern Taiwan. All 16 of the KPC-2-KP isolates were susceptible to amikacin and colistin and had a similar pulsotype (pulsotype 1) and the same sequence type (sequence type 11). Infections due to KPC-2-KP mainly occurred in severely ill patients in the intensive care unit (
n
= 14, 88%). Four patients with infections due to KPC-2-KP died within 14 days of hospitalization. The findings are the first to demonstrate intrahospital and interhospital dissemination of KPC-2-KP in northern Taiwan.
Existence of Separate Domains in Lysin PlyG for Recognizing Bacillus anthracis Spores and Vegetative Cells
Authors: Yang Hang , Wang Dian-Bing , Dong Qiuhua , Zhang Zhiping , Cui Zongqiang , Deng Jiaoyu , Yu Junping , Zhang Xian-en , Wei Hongping
Published: July 2012

As a potential antimicrobial, the bacteriophage lysin PlyG has been reported to specifically recognize
Bacillus anthracis
vegetative cells only and to kill
B. anthracis
vegetative cells and its germinating spores. However, how PlyG interacts with
B. anthracis
spores remains unclear. Herein, a 60-amino-acid domain in PlyG (residues 106 to 165), located mainly in the previously identified catalytic domain, was found able to specifically recognize
B. anthracis
spores but not vegetative cells. The exosporium of the spores was found to be the most probable binding target of this domain. This is the first time that a lysin for spore-forming bacteria has been found to have separate domains to recognize spores and vegetative cells, which might help in understanding the coevolution of phages with spore-forming bacteria. Besides providing new biomarkers for developing better assays for identifying
B. anthracis
spores, the newly found domain may be helpful in developing PlyG as a preventive antibiotic to reduce the threat of anthrax in suspected exposures to
B. anthracis
spores.
Role of Heme Oxygenase-1 in Polymyxin B-Induced Nephrotoxicity in Rats
Authors: Dezoti Fonseca Cassiane , Watanabe Mirian , Vattimo Maria de Fátima Fernandes
Published: July 2012

Polymyxin B (PMB) is a cationic polypeptide antibiotic with activity against multidrug-resistant Gram-negative bacteria. PMB-induced nephrotoxicity consists of direct toxicity to the renal tubules and the release of reactive oxygen species (ROS) with oxidative damage. This study evaluated the nephroprotective effect of heme oxygenase-1 (HO-1) against PMB-induced nephrotoxicity in rats. Adult male Wistar rats, weighing 286 ± 12 g, were treated intraperitoneally once a day for 5 days with saline, hemin (HO-1 inducer; 10 mg/kg), zinc protoporphyrin (ZnPP) (HO-1 inhibitor; 50 μmol/kg, administered before PMB on day 5), PMB (4 mg/kg), PMB plus hemin, and PMB plus ZnPP. Renal function (creatinine clearance, Jaffe method), urinary peroxides (ferrous oxidation of xylenol orange version 2 [FOX-2]), urinary thiobarbituric acid-reactive substances (TBARS), renal tissue thiols, catalase activity, and renal tissue histology were analyzed. The results showed that PMB reduced creatinine clearance (
P
< 0.05), with an increase in urinary peroxides and TBARS. The PMB toxicity caused a reduction in catalase activity and thiols (
P
< 0.05). Hemin attenuated PMB nephrotoxicity by increasing the catalase antioxidant activity (
P
< 0.05). The combination of PMB and ZnPP incremented the fractional interstitial area of renal tissue (
P
< 0.05), and acute tubular necrosis in the cortex area was also observed. This is the first study demonstrating the protective effect of HO-1 against PMB-induced nephrotoxicity.
Topical Neutralization of Interleukin-17 during Experimental Pseudomonas aeruginosa Corneal Infection Promotes Bacterial Clearance and Reduces Pathology
Authors: Zaidi Tanweer S. , Zaidi Tauqeer , Pier Gerald B. , Priebe Gregory P.
Published: July 2012

The proinflammatory cytokine interleukin-17 (IL-17) is involved in neutrophilic tissue infiltration, contributing to both microbial clearance as well as inflammation-associated tissue damage. Its role during bacterial corneal infections is unknown. We hypothesized that IL-17 responses would be detrimental in this setting and tested the impact of IL-17 receptor deficiency or antibody-mediated neutralization of IL-17 in a murine model ofPseudomonas aeruginosaulcerative keratitis after scratch injury. We found that, compared with infected corneas from wild-type mice, those from IL-17 receptor (IL-17R)-deficient mice had significantly lower corneal pathology scores, neutrophil influx, and intracellular bacterial levels. Infected IL-17R-deficient corneas had low intercellular adhesion molecule 1 (ICAM-1) expression, and ICAM-1-deficient mice were similarly resistant to infection. Topical treatment with polyclonal antibodies to IL-17 resulted in significant reductions in corneal pathology and also lowered bacterial counts after infection with six different laboratory or clinicalP. aeruginosastrains, including both invasive and cytotoxic strains. Thus, neutralization of IL-17 duringP. aeruginosacorneal infection reduces neutrophil influx and pathology without compromising bacterial clearance and offers a promising new avenue for therapy of these potentially sight-threatening infections.
The K1K2 Region of Lys-Gingipain of Porphyromonas gingivalis Blocks Induction of HLA Expression by Gamma Interferon
Authors: Yun Peter L. , Li Nan , Collyer Charles A. , Hunter Neil
Published: July 2012

In the context of periodontal disease, cysteine proteinases or gingipains fromPorphyromonas gingivalishave been implicated in the hydrolysis of cytokines, including gamma interferon (IFN-γ). This cytokine plays a crucial role in host defenses, in part, by regulating expression of major histocompatibility complex molecules. Our recent analysis has identified three structurally defined modules, K1, K2, and K3, of the hemagglutinin region of the lysine gingipain Kgp. These three structurally homologous domains have a common β-sandwich topology that is similar to that found in a superfamily of adhesins and carbohydrate binding domains. The three Kgp hemagglutinin modules are distinguished by variation in some of the loops projecting from the β-sandwich core. Recombinant products corresponding to both single and multidomain regions as well as native Kgp bound IFN-γ with similar affinities. Among the adhesin domain constructs, only the K1K2 polypeptide inhibited the upregulation of HLA-1 expression in a human erythroleukemia (K562) line induced by both recombinant and native IFN-γ. The K1K2 polypeptide also inhibited HLA-DR expression induced by IFN-γ in human umbilical vein endothelial cells. These effects were competitively inhibited by coincubation with sodium or potassium chloride solution. The N-terminal residues of IFN-γ were implicated in mediating the effect of K1K2, while antibody binding to loop 1 of K2 blocked the action of K1K2. The findings indicate the potential significance of structurally defined Kgp adhesin modules in the inactivation of IFN-γ but also the potential of K1K2 in locating the target for the catalytic domain of Kgp.
Evolution and Virulence Contributions of the Autotransporter Proteins YapJ and YapK of Yersinia pestis CO92 and Their Homologs in Y. pseudotuberculosis IP32953
Authors: Lenz Jonathan D. , Temple Brenda R. S. , Miller Virginia L.
Published: July 2012

Yersinia pestis
, the causative agent of plague, evolved from the gastrointestinal pathogen
Yersinia pseudotuberculosis
. Both species have numerous type Va autotransporters, most of which appear to be highly conserved. In
Y. pestis
CO92, the autotransporter genes
yapK
and
yapJ
share a high level of sequence identity. By comparing
yapK
and
yapJ
to three homologous genes in
Y. pseudotuberculosis
IP32953 (YPTB0365, YPTB3285, and YPTB3286), we show that
yapK
is conserved in
Y. pseudotuberculosis
, while
yapJ
is unique to
Y. pestis
. All of these autotransporters exhibit >96% identity in the C terminus of the protein and identities ranging from 58 to 72% in their N termini. By extending this analysis to include homologous sequences from numerous
Y. pestis
and
Y. pseudotuberculosis
strains, we determined that these autotransporters cluster into a YapK (YPTB3285) class and a YapJ (YPTB3286) class. The YPTB3286-like gene of most
Y. pestis
strains appears to be inactivated, perhaps in favor of maintaining
yapJ
. Since autotransporters are important for virulence in many bacterial pathogens, including
Y. pestis
, any change in autotransporter content should be considered for its impact on virulence. Using established mouse models of
Y. pestis
infection, we demonstrated that despite the high level of sequence identity,
yapK
is distinct from
yapJ
in its contribution to disseminated
Y. pestis
infection. In addition, a mutant lacking both of these genes exhibits an additive attenuation, suggesting nonredundant roles for
yapJ
and
yapK
in systemic
Y. pestis
infection. However, the deletion of the homologous genes in
Y. pseudotuberculosis
does not seem to impact the virulence of this organism in orogastric or systemic infection models.
Symptomatic gastric sarcoidosis in a patient with pulmonary sarcoidosis in remission
Authors: Shkolnik Lauren E , Shin Reuben D , Brabeck David M , Rothman Richard D
Published: July 2012

Sarcoidosis is a multisystem, non-infectious, granulomatous disease of unknown cause, characterised by histological evidence of non-caseating granulomas. Gastrointestinal (GI) involvement is uncommon, reported in <1% of patients with the disease. Herein, we present a rare case of isolated gastric sarcoidosis in a patient with latent pulmonary sarcoidosis and unexplained manifestations of GI disease, illustrating that clinical disease expression is variable; may be organ-specific; and, known disease latency confined to one organ does not exclude the possibility of active disease in another organ system. In patients with organ-specific sarcoidosis, whether active or in remission, presenting with GI symptoms, the possibility of gastric sarcoidosis should be considered. Oesophagogastroduodenoscopy and biopsy, when indicated, should be considered for definitive diagnosis.
Cardiac tamponade due to umbilical venous catheter in the new born
Authors: Abdellatif Mohamed , Ahmed Ashfag , Alsenaidi Khalfan
Published: July 2012

With more and more extreme premature and very low-birth weight babies being resuscitated, umbilical central venous catheterisation is now being used more frequently in neonatal intensive care. The authors present a case of cardiac tamponade following umbilical venous catheterisation in a neonate, an uncommon, yet potentially fatal complication. The patient was diagnosed at the appropriate time by echocardiography and urgent pericardiocentesis proved lifesaving.
Oxylator and SCUBA dive regulators: useful utilities for in-water resuscitation
Authors: Winkler Bernd E , Froeba Gebhard , Koch Andreas , Kaehler Wataru , Muth Claus-Martin
Published: July 2012

Introduction

In water resuscitation has been reported to enhance the outcome of drowning victims. Mouth-to-mouth ventilation during swimming is challenging. Therefore, the efficacy of ventilation utilities was evaluated.

Methods

Ventilation was assessed with the Oxylator ventilator, as well as the consecutive self-contained underwater breathing apparatus (SCUBA) regulators using an anaesthetic test lung: Poseidon Cyklon 5000, Poseidon XStream, Apeks TX 100, Spiro Arctic, Scubapro Air2 and Buddy AutoAir.

Results

Oxylator, Apeks TX 100, Arctic and Buddy AutoAir delivered reliable peak pressures and tidal volumes. In contrast, the ventilation parameters remarkably depended on duration and depth of pressing the purge button in Poseidon Cyklon 5000, Poseidon XStream and Scubapro Air2. Critical peak pressures occurred during ventilation with all these three regulators.

Discussion

The use of Poseidon Cyklon 5000, Poseidon XStream and Scubapro Air2 regulators is consequently not recommended for in-water ventilation. With the limitation that the devices were tested with a test lung and not in a human field study, Apeks TX 100, Spiro Arctic and Buddy AutoAir might be used for emergency ventilation and probably ease in-water resuscitation for the dive buddy of the victim. Professional rescue divers could be equipped with the Oxylator and an oxygen tank to achieve an early onset of efficient in-water ventilation in drowning victims.
Triage vital signs do not correlate with serum lactate or base deficit, and are less predictive of operative intervention in penetrating trauma patients: a prospective cohort study
Authors: Caputo Nicholas , Fraser Robert , Paliga Andrew , Kanter Marc , Hosford Karlene , Madlinger Robert
Published: July 2012

Background

Triage vital signs are often used to help determine a trauma patient's haemodynamic status. Recent studies have demonstrated that these may not be very specific in determining major injury. The purpose of this study was to determine if there is any correlation between triage vital signs, base deficit (BD) and lactate, and to determine the odds of operative intervention in penetrating trauma patients.

Methods

A prospective observational cohort study was undertaken. Baseline vital signs, BD and lactate were recorded in all patients for whom the trauma team was activated. Pearson correlation and coefficient (ρ) were calculated. ORs were calculated.

Results

75 patients were enrolled. Pearson correlations and coefficients calculated for lactate to systolic blood pressure were: −0.052 (ρ=0.0011, 95% CI −0.225 to 0.228); lactate and HR: 0.23 (ρ=0.0166, 95% CI −0.211 to 0.242); lactate and RR: 0.23 (ρ=0.054, 95% CI −0.174 to 0.277). BD to systolic blood pressure were: 0.003 (ρ=0.00001, 95% CI −0.229 to 0.224); BD and HR: −0.19 (ρ=0.038, 95% CI −0.399 to 0.038); BD and RR: −0.019 (ρ=0.0004, 95% CI −0.244 to 0.208). Odds of operative intervention were greater in patients with abnormally high lactate, OR 4.17 (95% CI 1.57 to 11), but not for BD, OR 2.53 (95% CI 0.99 to 6.45), or any of the vital signs.

Conclusions

Triage vital signs have no correlation to lactate or BD levels in penetrating trauma patients. Odds of operative intervention are greater in patients with abnormally high serum lactate levels, but not in those with abnormal triage vital signs or BD.
Early Predictors of Survival to and After Heart Transplantation in Children With Dilated Cardiomyopathy
Authors: Pietra Biagio A. , Kantor Paul F. , Bartlett Heather L. , Chin Clifford , Canter Charles E. , Larsen Ranae L. , Edens R. Erik , Colan Steven D. , Towbin Jeffrey A. , Lipshultz Steven E. , Kirklin James K. , Naftel David C. , Hsu Daphne T.
Published: July 2012

Background—

The importance of clinical presentation and pretransplantation course on outcome in children with dilated cardiomyopathy listed for heart transplantation is not well defined.

Methods and Results—

The impact of age, duration of illness, sex, race, ventricular geometry, and diagnosis of myocarditis on outcome in 261 children with dilated cardiomyopathy enrolled in the Pediatric Cardiomyopathy Registry and Pediatric Heart Transplant Study was studied. End points included listing as United Network for Organ Sharing status 1, death while waiting, and death after transplantation. The median age at the time of diagnosis was 3.4 years, and the mean time from diagnosis to listing was 0.62±1.3 years. Risk factors associated with death while waiting were ventilator use and older age at listing in patients not mechanically ventilated (
P
=0.0006 and
P
=0.03, respectively). Shorter duration of illness (
P
=0.04) was associated with listing as United Network for Organ Sharing status 1. Death after transplantation was associated with myocarditis at presentation (
P
=0.009), nonwhite race (
P
<0.0001), and a lower left ventricular end-diastolic dimension
z
score at presentation (
P
=0.04). In the myocarditis group, 17% (4 of 23) died of acute rejection after transplantation.

Conclusions—

Mechanical ventilator use and older age at listing predicted death while waiting, whereas nonwhite race, smaller left ventricular dimension, and myocarditis were associated with death after transplantation. Although 97% of children with clinically or biopsy-diagnosed myocarditis at presentation survived to transplantation, they had significantly higher posttransplantation mortality compared with children without myocarditis, raising the possibility that preexisting viral infection or inflammation adversely affects graft survival.
Monthly Weather Forecasts in a Pest Forecasting Context: Downscaling, Recalibration, and Skill Improvement
Authors: Hirschi Martin , Spirig Christoph , Weigel Andreas P. , Calanca Pierluigi , Samietz Jörg , Rotach Mathias W.
Published: July 2012

Monthly weather forecasts (MOFCs) were shown to have skill in extratropical continental regions for lead times up to 3 weeks, in particular for temperature and if weekly averaged. This skill could be exploited in practical applications for implementations exhibiting some degree of memory or inertia toward meteorological drivers, potentially even for longer lead times. Many agricultural applications fall into these categories because of the temperature-dependent development of biological organisms, allowing simulations that are based on temperature sums. Most such agricultural models require local weather information at daily or even hourly temporal resolution, however, preventing direct use of the spatially and temporally aggregated information of MOFCs, which may furthermore be subject to significant biases. By the example of forecasting the timing of life-phase occurrences of the codling moth (Cydia pomonella), which is a major insect pest in apple orchards worldwide, the authors investigate the application of downscaled weekly temperature anomalies of MOFCs for use in an impact model requiring hourly input. The downscaling and postprocessing included the use of a daily weather generator and a resampling procedure for creating hourly weather series and the application of a recalibration technique to correct for the original underconfidence of the forecast occurrences of codling moth life phases. Results show a clear skill improvement of up to 3 days in root-mean-square error over the full forecast range when incorporating MOFCs as compared with deterministic benchmark forecasts using climatological information for predicting the timing of codling moth life phases.
Neutrophil to Lymphocyte Ratio Is Associated With the Severity of Coronary Artery Disease in Patients With ST-Segment Elevation Myocardial Infarction
Authors: Şahin Durmuş Yıldıray , Elbasan Zafer , Gür Mustafa , Yıldız Ali , Akpınar Onur , Icen Yahya Kemal , Turkoglu Caner , Tekin Kamuran , Kuloglu Osman , Çaylı Murat
Published: July 2012

We assessed the relationship between the severity of coronary artery disease assessed by SYNTAX score (SS) and neutrophil to lymphocyte ratio (N:L ratio) in patients with ST elevation myocardial infarction (STEMI). In total, 840 patients with STEMI in whom primary percutaneous coronary intervention was performed were prospectively included (622 male, 218 female; mean age 58.6 ± 12.4 years). Total and differential leukocyte counts and other biochemical markers were measured at admission. Patients were categorized into tertiles on the basis of SS. The N:L ratio of SShigh group was higher compared with SSlow and SSmid groups ( P < .001 for all). Multivariate regression analysis showed that N:L ratio (β = .277, P < .001), ejection fraction (β = −.086, P = .012), age (β = .104, P = .004), and diabetes (β = .152, P < .001) were the independent predictors for SS in patients with STEMI.
Ethnic School Segregation and Self-Esteem
Authors: Agirdag Orhan , Van Houtte Mieke , Van Avermaet Piet
Published: July 2012

The authors examine whether school segregation is related to pupils’ global self-esteem and whether this association is mediated by teacher–pupil relationships. Multilevel analyses based on a survey of 2,845 pupils (aged 10 to 12) in 68 primary schools in Belgian urban areas reveal that, for native-Belgian pupils, a higher proportion of immigrants at school is associated with increasing self-esteem. Initially no such association was found for immigrant pupils, as the effect of schools’ ethnic composition on their self-esteem was suppressed by teacher–pupil relationships. For both groups, experiences of supportive relationships with teachers were largely associated with self-esteem.
Effective Facets of a Field Experience That Contributed to Eight Preservice Teachers’ Developing Understandings About Culturally Responsive Teaching
Authors: Bennett Susan V.
Published: July 2012

I investigated eight preservice teachers’ understandings about culturally responsive pedagogy as they tutored children in writing from different ethnic, socioeconomic, cultural, and linguistic backgrounds in an afterschool program at a local community center. I utilized an embedded case study and chose constant comparison, within-case analysis and cross-case analysis. I recommend effective aspects of the field experience, which facilitated preservice teachers’ development of deeper understandings about culturally responsive pedagogy: one-on-one student teacher interaction and scaffolding critical reflection.
Early support visits by district nurses to cancer patients at home: A multi-perspective qualitative study
Authors: Griffiths Jane , Ewing Gail , Rogers Margaret
Published: July 2012

Background:

Many palliative cancer patients spend much of their last year at home. In the UK, district nurses make frequent support visits to patients and carers at this time, yet surprisingly little is known about their supportive role in palliative care. Current studies are limited to district nurses’ reports of practice, which offer limited insight into their content. Patients’ and carers’ views on district nurse support visits are largely unknown.

Aim:

To present findings of a multi-perspective study that explored how district nurse early support visits are both described and carried out.

Design:

Focus groups with district nurses to explore views on the purpose of early support visits. Observation of support visits to identify how they are conducted. Patient and carer interviews to elucidate and verify district nurse data.

Setting and participants:

Participants included 58 district nurses, 10 palliative care patients and nine carers from four Primary Care Trusts in contrasting urban and rural locations.

Results:

District nurses had difficulty articulating early support visits. Observations however revealed a complex role comprising extensive physical and practical assessments, practical interventions, information giving, liaison, facilitation and referral. Patients and carers confirmed that they felt valued, reassured and supported by district nurses.

Conclusions:

A multi-perspective approach provided new insights into district nurse support visits. Monitoring work described appears to have additional psycho-social benefits for patients and carers. The supportive role of district nurses needs to be clearly articulated and recognised so that colleagues, patients and carers access this valuable resource for palliative care patients.
Multi-scale simulations of fire growth on a sandwich composite structure
Authors: Marquis Damien M , Pavageau Michel , Guillaume Eric
Published: July 2012

A coupled pyrolysis/computational fluid dynamics model is used to investigate the fire contribution of glass fibre–reinforced polyester/balsa-cored sandwich composite structure in case of fire on board a ship. Prior to simulating real-scale scenarios, numerical simulations of experiments were performed on samples of the tested material of increasing size, for validation and evaluation purposes. The main idea was to assess gradually the ability of the model to reproduce the fire growth on our composite material faithfully. The numerical and experimental results are compared and discussed. Overall, the numerical results are in good agreement with the experimental data, encouraging simulations at real scale.
Math Growth Trajectories of Students With Disabilities
Authors: Wei Xin , Lenz Keith B. , Blackorby Jose
Published: July 2012

This study examined math growth trajectories by disability category, gender, race, and socioeconomic status using a nationally representative sample of students ages 7 to 17. The students represented 11 federal disability categories. Compared with the national norming sample, students in all 11 disability categories had lower math achievement levels and slower growth in elementary school. In secondary school, however, the math growth rate slowed down and was similar for all students. Among students with disabilities, those with speech or visual impairments had the highest math achievement, and those with multiple disabilities or intellectual disability had the lowest. Relative to students with learning disabilities on calculation, growth rates for students with autism were significantly slower and those for students with speech impairments decelerated significantly faster. For students with disabilities, gender, White–Black, and socioeconomic status math achievement gaps were significant and stable over time, whereas White–Hispanic math achievement gaps widened over time.
A Review of Teaching Sentence-Level Writing Skills to Students With Writing Difficulties and Learning Disabilities
Authors: Datchuk Shawn M. , Kubina Richard M.
Published: July 2012

Students with writing difficulties and learning disabilities struggle with many aspects of the writing process, including use of sentence-level skills. This literature review summarizes results from 19 published articles that used single-case or group-experimental and quasi-experimental designs to investigate effects of intervention on the sentence-level skills of handwriting, sentence construction, and grammar/usage. Results suggest struggling writers benefited from intervention, particularly in handwriting and sentence construction, and transferred acquired skills to more complex tasks such as sentence writing and extended composition. Also presented are the implications for research and practice.
Biomechanical influence of pin placement and elbow angle on joint distraction and hinge alignment for an arthrodiatasis elbow–pin–fixator construct
Authors: Lee Wei-Shiun , Lin Shang-Chih , Shih Kao-Shang , Chao Ching-Kong , Chen Yeung-Jen , Fan Chang-Yuan
Published: July 2012

Stiffness and contracture of the periarticular tissues are common complications of a post-traumatic elbow. Arthrodiatasis is a surgical technique that uses an external fixator for initial immobilization and subsequent distraction. The two prerequisites for an ideal arthrodiatasis are concentric distraction (avoiding bony contact) and hinge alignment (reducing internal stress). This study used the finite element (FE) method to clarify the relationship between these two prerequisites and the initial conditions (pin placement, elbow angle, and distraction mode). A total of 12 variations of the initial conditions were symmetrically arranged to evaluate their biomechanical influence on concentric distraction and hinge alignment. The humeroulnar surface was hypothesized to be ideally distracted orthogonal to the line joining the tips of the olecranon and the coronoid. The eccentric separation of the humeroulnar surfaces is a response to the non-orthogonality of the distracting force and joining line. Pin placement significantly affects the effective moment arm of the fixing pins to distract the bridged elbow. Both elbow angle and distraction mode directly alter the direction of the distracting force at the elbow center. In general, the hinges misalignment occurs in a direction opposite to the distraction-activated site. After joint distraction, the elastic deflection of the fixing pins inevitably makes both elbow and fixator hinges to misalign. This indicates that both joint distraction and hinge alignment are the interactive mechanisms. The humeroulnar separation is more concentric in the situation of the 120° humeral distraction by using stiffer pins with convergent placement. Even so, the eccentric displacement of the elbow hinge is a crucial consideration in the initial placement of the guiding pin to compensate for hinge misalignment.
Polycaprolactone–starch blends with corn-based coupling agent: physical properties and in vitro analysis
Authors: Nor Fethma M , Kurniawan Denni , Seo Young-Kwon , Park Jung-Keug , Lee Ho Yong , Lim Joong Yeon
Published: July 2012

In an attempt to improve properties of polycaprolcatone–starch blend, this study uses zein as coupling agent in preparing the blend through a single-step process. Zein, which has affinity to both polar and non-polar groups, is expected to improve miscibility between the blends’ constituents and its overall biocompatibility. Mechanical properties of the blend were tested and further characterizations (Fourier transform infrared spectroscopy, thermal properties) were performed to analyze the effect of zein as an addition to the blend’s physical properties. The blend’s biocompatibility was examined by indirect methods (contact angle and weight gain after immersion in simulated body fluid) and in vitro analysis. No significant effect on the blend’s strength and stiffness was caused by adding zein. Hydrophilicity and cell affinity were improved when zein was added. Zein did not perform as a coupling agent that improved miscibility between polycaprolactone and starch, but its addition improved the blend’s biocompatibility.
Limited benefit of hamstrings forces for the anterior cruciate ligament-deficient knee: an in vitro study
Authors: Elias John J , Kirkpatrick Marcus S , Stonestreet Matthew J , Shah Kushal S , Frampton Caroline E , Morscher Melanie A , Jones Kerwyn C
Published: July 2012

The hamstrings are considered stabilizers of the anterior cruciate ligament-deficient knee; however, anterior cruciate ligament injury primarily influences tibiofemoral kinematics near full extension, where the hamstrings have the least influence on kinematics. Ten knees were tested at multiple flexion angles in vitro to directly compare the influence of anterior cruciate ligament injury and hamstrings activation on tibiofemoral kinematics. Tibiofemoral kinematics were measured for three testing conditions: (1) anterior cruciate ligament intact, with forces applied through the quadriceps muscles (596 N), (2) anterior cruciate ligament cut, with forces applied through the quadriceps, and (3) anterior cruciate ligament cut, with forces applied through the quadriceps and hamstrings (200 N). Based on repeated measures comparisons performed at each flexion angle, cutting the anterior cruciate ligament significantly ( p < 0.05) increased tibial anterior translation, medial translation, and internal rotation at 0° and 15° of flexion by approximately 2.5 mm, 1 mm, and 2°, respectively. Internal rotation also increased significantly at 30°. With the anterior cruciate ligament cut, loading the hamstrings significantly decreased anterior translation, medial translation, and internal rotation at 45°, by approximately 2 mm, 2 mm, and 4°, respectively. Loading the hamstrings caused kinematic changes in the opposite direction of the anterior cruciate ligament injury, but the changes occurred at deeper flexion angles than those at which anterior cruciate ligament injury influenced tibiofemoral kinematics.
Design of multi-degrees-of-freedom dexterous modular arm instruments for minimally invasive surgery
Authors: Cepolina Francesco E , Zoppi Matteo
Published: July 2012

In robot-assisted minimally invasive laparoscopic surgery, dexterity has a high relevance. Ideally, the surgeon should feel like in open surgery with the robotic instrument able to perform all tool motions in a suitably wide workspace. The avoidance of the surrounding organs and the adaptation of the motion of the instrument to the space available in the patient should be carried out by the robot and should not interest the surgeon. The dexterity is improved by increasing the number of degrees of freedom available in the portion of the surgical instrument inside the patient. The trend has been to date to actuate the joints in the instrument using actuators located outside the patient and tendons or other transmissions to reach the joints. This approach presents intrinsic limitations that can be overcome only with a change of the architecture. The article presents a design of surgical arm made of modules joined together in a chain. Each module embeds its actuation and sensing. The arm architecture can be selected to be optimal for a specific patient and surgery. The major criticality of this architectural rethink is if small actuators could provide enough torque to move the chain and apply sufficient surgical forces. Preliminary experiments are presented proving that embedded actuation can be strong and powerful enough. The designs of a variety of modules are carefully described.
Meta-analysis using Dirichlet process
Authors: Muthukumarana Saman , Tiwari Ram C
Published: July 2012

This article develops a Bayesian approach for meta-analysis using the Dirichlet process. The key aspect of the Dirichlet process in meta-analysis is the ability to assess evidence of statistical heterogeneity or variation in the underlying effects across study while relaxing the distributional assumptions. We assume that the study effects are generated from a Dirichlet process. Under a Dirichlet process model, the study effects parameters have support on a discrete space and enable borrowing of information across studies while facilitating clustering among studies. We illustrate the proposed method by applying it to a dataset on the Program for International Student Assessment on 30 countries. Results from the data analysis, simulation studies, and the log pseudo-marginal likelihood model selection procedure indicate that the Dirichlet process model performs better than conventional alternative methods.
Meanings of Care by Bereaved Relatives of Homicide Victims in Dar es Salaam, Tanzania
Authors: Outwater Anne H. , Tarimo Edith A. M. , Miller June E. , Campbell Jacqueline C.
Published: July 2012

Purpose: The purpose was to describe the meanings of care, kutunza, for the deceased and the relatives of homicide victims. The secondary aim was to identify ways in which nurses could best console the families. Method: An ethnonursing method was employed. Relatives of homicide victims in Dar es Salaam, Tanzania, were interviewed at a mortuary, using an interview guide constructed with Leininger’s enablers as major elements. Content analysis was performed according to Leininger’s phases of ethnonursing analysis of qualitative data. Findings: Families of 30 homicide victims were studied. The mean age of the victims was 30.7 years, range 17 to 47 years. All victims, except 1, were male. The informants included 29 relatives and two close friends. The following four themes were identified: (a) providing basic needs, (b) paying attention as if one were kin, (c) consoling through gathering, and (d) caring for each other. Conclusions: Care is manifested by respectful attention to the preparation of the deceased and by providing an environment by which the community can gather to console the bereaved family. Implications for Nursing: Respectful preparation of the deceased’s body is essential. Nurses can provide emotional support to the families and find an area where the extended family can grieve and console each other.
Northern British Columbian Aboriginal Mothers
Authors: Johnston Suzanne , Boyle Joyceen S.
Published: July 2012

This interpretive ethnographic study describes the experiences of northern British Columbian Aboriginal mothers raising adolescents with fetal alcohol spectrum disorder (FASD) and provides an understanding of how the mothers interpreted and responded to their adolescents’ FASD. The all-encompassing theoretical perspectives of postcolonialism provided the conceptual guide for this study. This ontological stance facilitates discourse on the social and historical context of this research focused on northern British Columbian Aboriginal mothers. Using semistructured interviews and participant observation, eight participants were interviewed three times over a period of several months. Data were analyzed using an interpretive analysis to generate an overarching cultural theme, Mothering from the Margins. The theme conveyed how study participants understood FASD and how they were raising their adolescents within the social and historical context unique to postcolonial societies.
Prevalence of Migraine Headaches in the Romany Population in Spain
Authors: Jiménez-Sánchez Silvia , Fernández-de-las-Peñas César , Jiménez-García Rodrigo , Hernández-Barrera Valentín , Alonso-Blanco Cristina , Palacios-Ceña Domingo , Carrasco-Garrido Pilar
Published: July 2012

Purpose: To compare the prevalence of migraine headaches in the Romany population with the prevalence in the general Spanish population and to describe its association with demographic and clinical risk factors. Method: A cross-sectional study using data from the 2006 Spanish National Health Survey ( n = 16,079) and the National Health Survey in the Romany Population ( n = 993). Inclusion criteria were migraine headache diagnosed by a neurologist, suffered over the preceding 2 weeks that reduced work or leisure activity by half a day or more. Results: The prevalence of migraine in the Romany population (29.4%, 95% confidence interval [CI] = 26.48-32.53) was significantly higher than in the general Spanish population (12.52%, 95% CI = 11.85-13.22). Females (odds ratio [OR] = 1.56, 95% CI = 1.10-2.21), those ≤40 years old (OR = 4.17, 95% CI = 1.78-9.62), those sleeping ≤8 hours/day or less (OR = 1.85, 95% CI = 1.32-2.59), those with body mass index >30 kg/m2 (OR = 1.75, 95% CI = 1.15-2.65), those suffering from osteoarthritis (OR = 2.59, 95% CI = 1.54-4.36), and those suffering from allergy (OR = 1.69, CI = 1.05-2.71) were associated with higher incidence of migraines. Romanies with migraines reported worse self-perceived health status (OR = 2.11, 95% CI = 1.41-3.15) and higher incidence of depression (OR = 2.09 95% CI = 1.32-3.30) than those without. Discussion: Prevalence of migraines is greater in the Romany living in Spain than in the general Spanish population. Implication for practice: Public health systems should focus prevention campaigns specifically on this population and concentrate on those factors that are potentially modifiable.
Analysis of fatigue damage character of soils under impact load
Authors: Xue Xinhua , Ren Tinghong , Zhang Wohua
Published: July 2012

Hammers are most typical of impact machines and are widely used in the mechanical manufacture industry. It is important to predict the effects of the damage growth on the fatigue process of the hammer foundation especially when subjected to long-term repeated impact loading. Although there have been many articles about damage model of soils, few of them have studied the problem of soil failure under cyclic loading as the fatigue damage of soils failure. In this paper, a damage fatigue problem of a hammer foundation system considered with fatigue damage growth and vibration on the machine foundation due to the impact of hammer blows is discussed by numerical results using the concept of damage mechanics based on the interaction between hammer foundation and soil ground. It has been found that the influence of damage due to hammer blows on the responses of the ground soil near the foundation is significantly increased with damage development both in the hammer foundation and the surrounding soil. Therefore, in order to protect the environment from damage due to the blows of a hammer, the design for actively vibration absorbing control and damage control in the hammer foundation system needs to be taken into account.
Length of adjuvant imatinib therapy in GIST: Weighing benefits, side effects and costs
Authors: Dasanu Constantin A
Published: July 2012

A recent large randomized clinical trial showed a survival advantage with 36 vs 12 months of adjuvant imatinib in patients with resected gastrointestinal stromal tumors (GISTs). However, there was a higher therapy discontinuation rate with the longer duration of treatment. Preferences of individual GIST patients and the imatinib risk/benefit ratio should always be sought before employing this agent in adjuvant setting for longer than 12 months. A shorter duration of therapy may be preferred in patients with a limited life expectancy, serious cardiovascular co-morbidities, diminished compliance or poor adherence to oral therapy. Further study of underlying economic, psychosocial, and physical barriers of longer vs shorter duration of adjuvant therapy in this patient population is probably warranted.