bluuebunny/crossref_metadata_2025 huggingface dataset:
Intravenous Morphine Can Avoid Distressing Constipation Associated With Oral Morphine: A Retrospective Analysis of Our Experience in 11 Patients in the Palliative Care In-Patient Unit
Authors: Mazumdar Ashish , Mishra Seema , Bhatnagar Sushma , Gupta Deepak
Published: September 2008

Morphine is the preferred strong opioid analgesic. Most of the adverse effects, such as daytime drowsiness, dizziness, mental clouding, and effects on cognitive and psychomotor function or nausea and vomiting, usually resolve with time. The main continuing adverse effect of morphine is constipation, and prophylactic use of laxative is almost always required. We are presenting retrospective data of 11 patients admitted in our palliative care unit over the past 5 months for new (not yet received any opioid analgesic in any form) and severe cancer pain management. It was found that none of the patients was having constipation with intravenous morphine. This finding can be explained on the basis of differences in pharmacologic profiles, in affinity to opioid receptor, and a higher exposure of opioid-binding receptor in the GI tract after oral administration of morphine compared with intravenous morphine. This explanation was further affirmed as constipation and need for laxative was reported by 7 of the 11 patients when they were given the equi-analgesic oral doses of morphine. Thus, the route of administration seems to be responsible for the above finding; hence, further evaluation with prospective observation and data collection is being planned to look for external validity in a larger population catered by our palliative care unit.
Coalition Government and Political Communication
Authors: Martin Lanny W. , Vanberg Georg
Published: September 2008

One of the central challenges facing multiparty governments in parliamentary democracies is the need for coalition parties to communicate to their constituents that they have not strayed significantly from their electoral commitments when agreeing to policy compromises. We argue that one of the main ways parties attempt to make their case to constituents is through their behavior in legislative debate. Debate provides a unique opportunity—tied directly to the policy the government is implementing—to declare party positions on the coalition compromise. In an analysis of several hundred legislative speeches in two parliamentary democracies, we show that coalition parties communicate with constituents much more extensively on internally divisive issues, especially as the next parliamentary elections draw near. We also demonstrate contextual and institutional effects (including the impact of junior ministers) that complement emerging findings in the literature on coalition governance.
Uprooting Nebuchadnezzar's Tree
Authors: Clarke Michelle Tolman
Published: September 2008

However boldly Francis Bacon might praise Machiavelli, he nevertheless formulates a powerful critique of his mentor's views regarding the means and aims of empire. Oriented by a prudential and normative commitment to philanthropia, Bacon reassesses the role of glory in political affairs and rejects key elements of Machiavelli's imperial vision. By deploying inversions of three Machiavellian images associated with empire—King Solomon rather than King David, the lowly mustard seed rather than Nebuchadnezzar's tree, and Themistocles rather than Fabius Maximus—Bacon signals his rejection of an imperial model based on violent conquest, a centralized and hierarchical structure, and conservative social and political values. In its place, he erects a new imperial model dedicated in principle to humanity, prosperity, and cosmopolitanism.
Cabinet Collapses and Currency Crashes
Authors: Bernhard William , Leblang David
Published: September 2008

Asset market performance conditions the strategic context of cabinet terminations. In turn, information about cabinet terminations shapes how market actors evaluate the government's commitment to specific policies, affecting overall economic performance. To understand how the economy affects cabinet terminations, therefore, we must account for the endogeneity between cabinet outcomes and market performance. In this article, we model both cabinet terminations and speculative currency attacks. We argue that changes in the probability of different types of cabinet ends condition the probability that currency traders will sharply shift their assets out of a country. In turn, the probability of a speculative attack influences the probabilities of different types of cabinet ends—for instance, the higher the likelihood of speculative attack, the lower the chance of an early strategic election. We connect separate models of cabinet termination and speculative attacks using an instrumental-variables framework.
Governmental Politics and the Dynamics of Multiparty Competition
Authors: Laver Michael
Published: September 2008

The politics of coalition government is a phase in a never-ending dynamic process of multiparty political competition. Most models of coalition government are static and focus on the making or the breaking of governments, ignoring or at least holding constant all other aspects of party competition. Here, the author considers some issues that are raised by locating the politics of coalition government in a more dynamic setting.
Hierarchical fibre composite structure and micromechanical properties of phosphatic and calcitic brachiopod shell biomaterials — an overview
Authors: Schmahl W. W. , Griesshaber E. , Merkel C. , Kelm K. , Deuschle J. , Neuser R. D. , Göetz A. J. , Sehrbrock A. , Mader W.
Published: September 2008

Brachiopods are a phylum of shell-forming sessile marine invertebrates which have existed since the early Cambrian. Two very different biomaterial design strategies for their shells evolved early in their history. Both strategies use hybrid fibre composites, however, one is based on mineral fibres embedded in ~2 wt.% of organic biopolymer sheaths and the inorganic fibres are calcite single crystals. In the second strategy the fibres are biopolymers and are reinforced with Ca-phosphate nanoparticles to form a fibrous nanocomposite. Here the organic component (chitin) dominates. The Ca-phosphate nanoparticle-reinforcement strategy is not unlike that in vertebrate bone, however, the microscale structure is laminated with alternating laminae which have a different degree of mineralization.

The calcitic shells feature an outer compact layer of calcite micro- and nanoparticles protecting the inner fibrous layer from the outside. Transmission electron microscopy of the fibrous layer reveals intercrystalline and intracrystalline biopolymers. The calcitic shell material is stiff with nano-indentation E-moduli of 63±8 GPa and relatively hard (Vickers microhardness up to 400 HV 0.0005/10 and nanohardness 4±0.5 GPa). Compared to inorganic calcite the microhardness is doubled and the nanohardness increases by 60%. We attribute this increased hardness to intracrystalline biopolymers. The nano-indentation E-moduli of the chitinophosphatic shells range from 3 to 55 GPa as a result of the varying degree of mineralization between their laminae, and similarly their nanohardness varies between 0.1 and 3 GPa. For brachiopods burrowing inside the sediment, the alternation of non-mineralized laminae with thin, more strongly mineralized laminae provides abrasion-resistance, hardness and longitudinal stiffness while it preserves the flexibility provided by the organic component for bending movements.
Assessment of crystallographic influence on material properties of calcite brachiopods
Authors: Pérez-Huerta A. , Cusack M. , Zhu W.
Published: September 2008

Calcium carbonate biominerals are frequently analysed in materials science due to their abundance, diversity and unique material properties. Aragonite nacre is intensively studied, but less information is available about the material properties of biogenic calcite, despite its occurrence in a wide range of structures in different organisms. In particular, there is insufficient knowledge about how preferential crystallographic orientations influence these material properties. Here, we study the influence of crystallography on material properties in calcite semi-nacre and fibres of brachiopod shells using nanoindentation and electron backscatter diffraction (EBSD). The nano-indentation results show that calcite semi-nacre is a harder and stiffer (H ≈ 3—5 GPa; E = 50–85 GPa) biomineral structure than calcite fibres (H = 0.4—3 GPa; E = 30—60 GPa). The integration of EBSD to these studies has revealed a relationship between the crystallography and material properties at high spatial resolution for calcite semi-nacre. The presence of crystals with the c-axis perpendicular to the plane-of-view in longitudinal section increases hardness and stiffness. The present study determines how nano-indentation and EBSD can be combined to provide a detailed understanding of biomineral structures and their analysis for application in materials science.
Oxygen isotope composition inModiolus modiolusaragonite in the context of biological and crystallographic control
Authors: Cusack M. , Parkinson D. , Freer A. , Pérez-Huerta A. , Fallick A. E. , Curry G. B.
Published: September 2008

Living systems exert exquisite control on all aspects of biomineral production and organic components, including proteins, are essential to this biological control. The protein-rich extrapallial (EP) fluid of bivalve molluscs is a strong candidate for the source of such proteins. Differences in calcium carbonate polymorphs betweenModiolus modiolusandMytilus edulisare concurrent with differences in EP fluid protein profiles. In conjunction with this biological control is the environmental influence which is interpreted using proxies such as δ18O to determine the history of ambient seawater temperature. In the horse mussel,Modiolus modiolus, the difference in oxygen isotope fractionation in the nacreous aragonite and the prismatic aragonite layer results in respective δ18O values of 2.1±0.2% and 2.5±0.2%. These δ18O values result in estimates of ambient seawater of 12.1±0.6°C and 10.2±0.6°C for nacreous and prismatic aragonite, respectively. Electron backscatter diffraction is used here to determine the crystallographic orientation at high spatial resolution, allowing the measurements of stable isotopes to be accurately mapped in terms of shell architecture. These preliminary data suggest that it is essential to account for both polymorph and crystal habit when deciphering ambient seawater temperature using δ18O as a proxy.
Structural characterization and chemical composition of aragonite and vaterite in freshwater cultured pearls
Authors: Soldati A. L. , Jacob D. E. , Wehrmeister U. , Hofmeister W.
Published: September 2008

Vaterite and aragonite polymorphs in freshwater cultured pearls from mussels of the genus Hyriopsis (Unionidae) were structurally and compositionally characterized by Raman spectroscopy, Micro computer tomography, high resolution field emission scanning electron microscopy, electron microprobe analysis and laser ablation inductively coupled plasma mass spectrometry. The appearance of vaterite in pearls is related to the initial stages of biomineralization, although we demonstrate that vaterite can not be a precursor to aragonite. It is not related to a particular crystal habit and therefore does not have a structural functionality in the pearls. Larger contents of elements typically bound to organic molecules, such as P and S in vaterite, as well as larger total organic contents in vaterite as opposed to aragonite in conjunction with larger concentrations of Mn2+ and Mg2+, imply a stabilizing role of organic macromolecules and X2+ ions for biological vaterite. Distribution coefficients between aragonite and vaterite for provenance-independent elements, such as Mn and Mg (0.27 and 0.04, respectively) agree very well with those observed in fish otoliths.
Trace-element distributions in fish otoliths: natural markers of life histories, environmental conditions and exposure to tailings effluence
Authors: Halden N. M. , Friedrich L. A.
Published: September 2008

Otoliths, the earbones of teleost (bony) fish, are constructed from alternating layers of aragonite and protein. Laser ablation inductively coupled plasma mass spectrometry and proton-induced X-ray emission are used to obtain spatially well-resolved trace element line-scans that show trace-element concentrations are correlated with the annular structure. Zoned Sr and Zn signatures are common whereas other elements such as Cu, Pb, Li and Cs can be related to the proximity of mineral deposits. Aragonite in otoliths can incorporate a wide range of trace elements at the low-ppm level including alkali- and alkaline-earth elements and base metals; Se has also been detected in proximity to coal mines. These trace elements, in combination with the annular structures, are an important archive for recording information on environments occupied by fish, environmental change and exposure to pollutants.
Crystallization of biogenic Ca-carbonate within organo-mineral micro-domains. Structure of the calcite prisms of the PelecypodPinctada margaritifera(Mollusca) at the submicron to nanometre ranges
Authors: Baronnet A. , Cuif J. P. , Dauphin Y. , Farre B. , Nouet J.
Published: September 2008

Atomic force microscopy (AFM) and transmission electron microscopy (TEM) were used to investigate the fine structure of the calcite prisms from the pearl-oyster shellPinctada margaritifera. The AFM analysis shows that the prisms are made of densely packed circular micro-domains (in the 0.1 μm range) surrounded by a dense cortex. The TEM images and diffraction patterns allow the internal structure of the micro-domains to be described. Each of them is enriched in Ca-carbonate. Hosted in distinct regions of each prism, some are fully amorphous, and some others fully crystallized as subunits of a large calcite single crystal. At the border separating the two regions, micro-domains display a crystallized core and an amorphous rim. Such a border probably marks out an arrested crystallization front having propagated through a previously bio-controlled architecture of the piling of amorphous micro-domains. Compared to recent data concerning the stepping mode of growth of the calcite prisms and the resulting layered organization at the μm-scale, these results give unexpected views regarding the modalities of biocrystallization.
Mineralogical approaches to the study of biomineralization in fish otoliths
Authors: Melancon S. , Fryer B. J. , Gagnon J. E. , Ludsin S. A.
Published: September 2008

This paper highlights new research on the biomineralization of otoliths and uses a mineralogical approach to understand mechanisms of crystal growth and metal incorporation into otoliths. Petrographic observations of the nucleation of otolith growth in the core for several fish species reveals that sagittal otoliths appear to nucleate around a few or many nucleation sites (primordia) and that these sites vary in size (ranging in diameter from 1 to 20 μm), depending on the species. Spectroscopic data show a large Mn-enrichment in the primordia within the core but the reasons for this enrichment are still unclear (e.g. organic matter or possibly another material other than CaCO3). This study also provides the first multi trace-element data for endolymph fluid and the growing otolith; we found large enrichments (Ca and Sr) and depletions (Na, K, Zn and Rb) of elements in the otolith relative to the endolymph. The last part of this paper examines the effect of crystal structure on the microchemistry ofotoliths. Our investigation helps understand how the chemical characteristics of the metal ions (i.e. ionic radii) and the crystalline structure interact to cause differential trace-metal uptake between the CaCO3polymorphs, aragonite and vaterite.
Biological enhancement of soil carbonate precipitation: passive removal of atmospheric CO2
Authors: Manning D. A. C.
Published: September 2008

Soils are the dominant terrestrial sink for carbon, containing three times as much C as above-ground plant biomass, and acting as a host for both organic and inorganic C, as soil organic matter and pedogenic carbonates, respectively. This article reviews evidence for the generation within the soil solution of dissolved C derived from plants and recognition of its precipitation as carbonates. It then considers the potential value of this process for artificially-mediated CO2 sequestration within soils. The ability of crops such as wheat to produce organic acid anions as root exudates is substantial, generating 70 mol/(y kg) of exuded C, equivalent to the plant's own ‘body weight’. This is still an order of magnitude less than measured C production from Icelandic woodlands (Moulton et al., 2000), which have no other possible source of C. Thus, there is apparently no shortage of available dissolved C, as bicarbonate in solution, and so the formation of pedogenic carbonates will be controlled by the availability of Ca. This is derived from mineral weathering, primarily of silicate minerals (natural plagioclase feldspars and pyroxenes; artificial cement and slag minerals). Within the UK, existing industrial arisings of calcium silicate minerals from quarrying, demolition and steel manufacture that are fine-grained and suitable for incorporation into soils are sufficient to account for 3 MT CO2 per year, compensating for half of the emissions from UK cement manufacture. Pursuing these arguments, it is shown that soils have a role to play as passive agents in the removal of atmospheric CO2, analogous to the use of reed beds to clean contaminated waters.
Phase transitions of BaCO3 at high pressures
Authors: Ono S. , Brodholt J. P. , Price G. D.
Published: September 2008

First-principles simulations and high-pressure experiments were used to study the stability of BaCO3 carbonates at high pressures. Witherite, which is orthorhombic and isotypic with CaCO3 aragonite, is stable at ambient conditions. As pressure increases, BaCO3 transforms from witherite to an orthorhombic post-aragonite structure at 8 GPa. The calculated bulk modulus of the post-aragonite structure is 60.7 GPa, which is slightly less than that from experiments. This structure shows an axial anisotropicc ompressibility and the a axis intersects with the c axis at 70 GPa, which implies that the pressure-induced phase transition reported in previous experimental study is misidentified. Although a pyroxene-like structure is stable in Mg- and Ca-carbonates at pressures >100 GPa, our simulations showed that this structure does not appear in BaCO3.
In situ X-ray absorption spectroscopy measurement of vapour-brine fractionation of antimony at hydrothermal conditions
Authors: Pokrovski G. S. , Roux J. , Hazemann J.-L. , Borisova A. YU. , Gonchar A. A. , Lemeshko M. P.
Published: September 2008

Despite the growing geological evidence that fluid boiling and vapour-liquid separation affect the distribution of metals in magmatic-hydrothermal systems significantly, there are few experimental data on the chemical status and partitioning of metals in the vapour and liquid phases. Here we report on an in situ measurement, using X-ray absorption fine structure (XAFS) spectroscopy, of antimony speciation and partitioning in the system Sb2O3-H2O-NaCl-HCl at 400°C and pressures 270—300 bar corresponding to the vapour-liquid equilibrium. Experiments were performed using a spectroscopic cell which allows simultaneous determination of the total concentration and atomic environment of the absorbing element (Sb) in each phase. Results show that quantitative vapour-brine separation of a supercritical aqueous salt fluid can be achieved by a controlled decompression and monitoring the X-ray absorbance of the fluid phase. Antimony concentrations in equilibrium with Sb2O3 (cubic, senarmontite) in the coexisting vapour and liquid phases and corresponding SbIII vapour-liquid partitioning coefficients are in agreement with recent data obtained using batch-reactor solubility techniques. The XAFS spectra analysis shows that hydroxy-chloride complexes, probably Sb(OH)2Cl0, are dominant both in the vapour and liquid phase in a salt-water system at acidic conditions. This first in situ XAFS study of element fractionation between coexisting volatile and dense phases opens new possibilities for systematic investigations of vapour-brine and fluid-melt immiscibility phenomena, avoiding many experimental artifacts common in less direct techniques.
Impact of residue accessible surface area on the prediction of protein secondary structures
Authors: Momen-Roknabadi Amir , Sadeghi Mehdi , Pezeshk Hamid , Marashi Sayed-Amir
Published: September 2008

Background

The problem of accurate prediction of protein secondary structure continues to be one of the challenging problems in Bioinformatics. It has been previously suggested that amino acid relative solvent accessibility (RSA) might be an effective factor for increasing the accuracy of protein secondary structure prediction. Previous studies have either used a single constant threshold to classify residues into discrete classes (buries vs. exposed), or used the real-value predicted RSAs in their prediction method.

Results

We studied the effect of applying different RSA threshold types (namely, fixed thresholds vs. residue-dependent thresholds) on a variety of secondary structure prediction methods. With the consideration of DSSP-assigned RSA values we realized that improvement in the accuracy of prediction strictly depends on the selected threshold(s). Furthermore, we showed that choosing a single threshold for all amino acids is not the best possible parameter. We therefore used residue-dependent thresholds and most of residues showed improvement in prediction. Next, we tried to consider predicted RSA values, since in the real-world problem, protein sequence is the only available information. We first predicted the RSA classes by RVP-net program and then used these data in our method. Using this approach, improvement in prediction was also obtained.

Conclusion

The success of applying the RSA information on different secondary structure prediction methods suggest that prediction accuracy can be improved independent of prediction approaches. Thus, solvent accessibility can be considered as a rich source of information to help the improvement of these methods.
Methodology capture: discriminating between the "best" and the rest of community practice
Authors: Eales James M , Pinney John W , Stevens Robert D , Robertson David L
Published: September 2008

Background

The methodologies we use both enable and help define our research. However, as experimental complexity has increased the choice of appropriate methodologies has become an increasingly difficult task. This makes it difficult to keep track of available bioinformatics software, let alone the most suitable protocols in a specific research area. To remedy this we present an approach for capturing methodology from literature in order to identify and, thus, define best practice within a field.

Results

Our approach is to implement data extraction techniques on the full-text of scientific articles to obtain the set of experimental protocols used by an entire scientific discipline, molecular phylogenetics. Our methodology for identifying methodologies could in principle be applied to any scientific discipline, whether or not computer-based. We find a number of issues related to the nature of best practice, as opposed to community practice. We find that there is much heterogeneity in the use of molecular phylogenetic methods and software, some of which is related to poor specification of protocols. We also find that phylogenetic practice exhibits field-specific tendencies that have increased through time, despite the generic nature of the available software. We used the practice of highly published and widely collaborative researchers ("expert" researchers) to analyse the influence of authority on community practice. We find expert authors exhibit patterns of practice common to their field and therefore act as useful field-specific practice indicators.

Conclusion

We have identified a structured community of phylogenetic researchers performing analyses that are customary in their own local community and significantly different from those in other areas. Best practice information can help to bridge such subtle differences by increasing communication of protocols to a wider audience. We propose that the practice of expert authors from the field of evolutionary biology is the closest to contemporary best practice in phylogenetic experimental design. Capturing best practice is, however, a complex task and should also acknowledge the differences between fields such as the specific context of the analysis.
C-reactive protein exerts angiogenic effects on vascular endothelial cells and modulates associated signalling pathways and gene expression
Authors: Turu Marta M , Slevin Mark , Matou Sabine , West David , Rodríguez Cristina , Luque Ana , Grau-Olivares Marta , Badimon Lina , Martinez-Gonzalez Jose , Krupinski Jerzy
Published: September 2008

Background

Formation of haemorrhagic neovessels in the intima of developing atherosclerotic plaques is thought to significantly contribute to plaque instability resulting in thrombosis. C-reactive protein (CRP) is an acute phase reactant whose expression in the vascular wall, in particular, in reactive plaque regions, and circulating levels increase in patients at high risk of cardiovascular events. Although CRP is known to induce a pro-inflammatory phenotype in endothelial cells (EC) a direct role on modulation of angiogenesis has not been established.

Results

Here, we show that CRP is a powerful inducer of angiogenesis in bovine aortic EC (BAEC) and human coronary artery EC (HCAEC). CRP, at concentrations corresponding to moderate/high risk (1–5 μg/ml), induced a significant increase in proliferation, migration and tube-like structure formationin vitroand stimulated blood vessel formation in the chick chorioallantoic membrane assay (CAM). CRP treated with detoxi-gel columns retained such effects. Western blotting showed that CRP increased activation of early response kinase-1/2 (ERK1/2), a key protein involved in EC mitogenesis. Furthermore, using TaqMan Low-density Arrays we identified key pro-angiogenic genes induced by CRP among them were vascular endothelial cell growth factor receptor-2 (VEGFR2/KDR), platelet-derived growth factor (PDGF-BB), notch family transcription factors (Notch1 and Notch3), cysteine-rich angiogenic inducer 61 (CYR61/CCN1) and inhibitor of DNA binding/differentiation-1 (ID1).

Conclusion

This data suggests a role for CRP in direct stimulation of angiogenesis and therefore may be a mediator of neovessel formation in the intima of vulnerable plaques.
Neonatal tetanus in Turkey; what has changed in the last decade?
Authors: Dikici Bunyamin , Uzun Hakan , Yilmaz-Keskin Ebru , Tas Taskin , Gunes Ali , Kocamaz Halil , Konca Capan , Tas Mehmet A
Published: September 2008

Background

Neonatal tetanus (NT) is still considered as one of the major causes of neonatal death in many developing countries. The aim of the present study was to assess the characteristics of sixty-seven infants with the diagnosis of neonatal tetanus followed-up in the Pediatric Infectious Diseases Ward of Dicle University Hospital, Diyarbakir, between 1991 and 2006, and to draw attention to factors that may contribute (or may have contributed) to the elimination of the disease in Diyarbakir.

Methods

The data of sixty-seven infants whose epidemiological and clinical findings were compatible with neonatal tetanus were reviewed. Patients were stratified into two groups according to whether they survived or not to assess the effect of certain factors in the prognosis. Factors having a contribution to the higher rate of tetanus among newborn infants were discussed.

Results

A total of 55 cases of NT had been hospitalized between 1991 and 1996 whereas only 12 patients admitted in the last decade. All of the infants had been delivered at home by untrained traditional birth attendants (TBA), and none of the mothers had been immunized with tetanus toxoid during her pregnancy. Twenty-eight (41.8%) of the infants died during their follow-up. Lower birth weight, younger age at onset of symptoms and at the time admission, the presence of opisthotonus, risus sardonicus and were associated with a higher mortality rate.

Conclusion

Although the number of neonatal tetanus cases admitted to our clinic in recent years is lower than in the last decade efforts including appropriate health education of the masses, ensurement of access to antenatal sevices and increasing the rate of tetanus immunization among mothers still should be made in our region to achieve the goal of neonatal tetanus elimination.
Increasing the frequency of hand washing by healthcare workers does not lead to commensurate reductions in staphylococcal infection in a hospital ward
Authors: Beggs Clive B , Shepherd Simon J , Kerr Kevin G
Published: September 2008

Background

Hand hygiene is generally considered to be the most important measure that can be applied to prevent the spread of healthcare-associated infection (HAI). Continuous emphasis on this intervention has lead to the widespread opinion that HAI rates can be greatly reduced by increased hand hygiene compliance alone. However, this assumes that the effectiveness of hand hygiene is not constrained by other factors and that improved compliance in excess of a given level, in itself, will result in a commensurate reduction in the incidence of HAI. However, several researchers have found the law of diminishing returns to apply to hand hygiene, with the greatest benefits occurring in the first 20% or so of compliance, and others have demonstrated that poor cohorting of nursing staff profoundly influences the effectiveness of hand hygiene measures. Collectively, these findings raise intriguing questions about the extent to which increasing compliance alone can further reduce rates of HAI.

Methods

In order to investigate these issues further, we constructed a deterministic Ross-Macdonald model and applied it to a hypothetical general medical ward. In this model the transmission of staphylococcal infection was assumed to occur after contact with the transiently colonized hands of HCWs, who, in turn, acquire contamination only by touching colonized patients. The aim of the study was to evaluate the impact of imperfect hand cleansing on the transmission of staphylococcal infection and to identify, whether there is a limit, above which further hand hygiene compliance is unlikely to be of benefit.

Results

The model demonstrated that if transmission is solely via the hands of HCWs, it should, under most circumstances, be possible to prevent outbreaks of staphylococcal infection from occurring at a hand cleansing frequencies < 50%, even with imperfect hand hygiene. The analysis also indicated that the relationship between hand cleansing efficacy and frequency is not linear – as efficacy decreases, so the hand cleansing frequency required to ensure R0 < 1 increases disproportionately.

Conclusion

Although our study confirmed hand hygiene to be an effective control measure, it demonstrated that the law of diminishing returns applies, with the greatest benefit derived from the first 20% or so of compliance. Indeed, our analysis suggests that there is little benefit to be accrued from very high levels of hand cleansing and that in most situations compliance > 40% should be enough to prevent outbreaks of staphylococcal infection occurring, if transmission is solely via the hands of HCWs. Furthermore we identified a non-linear relationship between hand cleansing efficacy and frequency, suggesting that it is important to maximise the efficacy of the hand cleansing process.
Endothelin 1 levels in relation to clinical presentation and outcome of Henoch Schonlein purpura
Authors: Fessatou S , Nicolaidou P , Gourgiotis D , Georgouli H , Douros K , Moustaki M , Fretzayas A
Published: September 2008

Background

Henoch Schonlein purpura (HSP) is a common vasculitis of small vessels whereas endothelin-1 (ET-1) is usually reported elevated in vasculities and systematic inflammation. The aim of the present study was to investigate whether ET-1 levels are correlated with the clinical presentation and the outcome of HSP.

Methods

The study sample consisted of thirty consecutive patients with HSP. An equal number of healthy patients of similar age and the same gender were served as controls. The patients' age range was 2–12.6 years with a mean ± SD = 6.3 ± 3 years. All patients had a physical examination with a renal, and an overall clinical score. Blood and urinary biochemistry, immunology investigation, a skin biopsy and ET-1 measurements in blood and urine samples were made at presentation, 1 month later and 1 year after the appearance of HSP. The controls underwent the same investigation with the exception of skin biopsy.

Results

ET-1 levels in plasma and urine did not differ between patients and controls at three distinct time points. Furthermore the ET-1 were not correlated with the clinical score and renal involvement was independent from the ET-1 measurements. However, the urinary ET-1 levels were a significant predictor of the duration of the acute phase of HSP (HR = 0.98, p = 0.032, CI0.96–0.99). The ET-1 levels did not correlate with the duration of renal involvement.

Conclusion

Urinary ET-1 levels are a useful marker for the duration of the acute phase of HSP but not for the length of renal involvement.
Commercial weight loss diets meet nutrient requirements in free living adults over 8 weeks: A randomised controlled weight loss trial
Authors: Truby Helen , Hiscutt Rebecca , Herriot Anne M , Stanley Manana , deLooy Anne , Fox Kenneth R , Baic Susan , Robson Paula J , Macdonald Ian , Taylor Moira A , Ware Robert , Logan Catherine , Livingstone MBE
Published: September 2008

Objective

To investigate the effect of commercial weight loss programmes on macronutrient composition and micronutrient adequacy over a 2 month period.

Design

Adults were randomly allocated to follow the Slim Fast Plan, Weight Watchers Pure Points Programme, Dr Atkins' New Diet Revolution, or Rosemary Conley's "Eat Yourself Slim" Diet & Fitness Plan.

Setting

A multi-centre randomised controlled trial.

Subjects

293 adults, mean age 40.3 years and a mean BMI 31.7 (range 27–38) were allocated to follow one of the four diets or control group. Subjects completed a 7-day food and activity diary at baseline (prior to randomisation) and after 2 months. Diet records were analysed for nutrient composition using WinDiets (research version).

Results

A significant shift in the macronutrient composition of the diet with concurrent alteration of the micronutrient profile was apparent with all diets. There was no evidence to suggest micronutrient deficiency in subjects on any of the dietary regimens. However, those sub-groups with higher needs for specific micronutrients, such as folate, iron or calcium may benefit from tailored dietary advice.

Conclusion

The diets tested all resulted in considerable macronutrient change and resulted in an energy deficit indicating dietary compliance. Health professionals and those working in community and public health should be reassured of the nutritional adequacy of the diets tested.

Trial Registration Number

NCT00327821
Yttrium-90 microsphere induced gastrointestinal tract ulceration
Authors: South Christopher D , Meyer Marty M , Meis Gregory , Kim Edward Y , Thomas Fred B , Rikabi Ali A , Khabiri Hooman , Bloomston Mark
Published: September 2008

Background

Radiomicrosphere therapy (RT) utilizing yttrium-90 (90Y) microspheres has been shown to be an effective regional treatment for primary and secondary hepatic malignancies. We sought to determine a large academic institution's experience regarding the extent and frequency of gastrointestinal complications.

Methods

Between 2004 and 2007, 27 patients underwent RT for primary or secondary hepatic malignancies. Charts were subsequently reviewed to determine the incidence and severity of GI ulceration.

Results

Three patients presented with gastrointestinal bleeding and underwent upper endoscopy. Review of the pretreatment angiograms showed normal vascular anatomy in one patient, sclerosed hepatic vasculature in a patient who had undergone prior chemoembolization in a second, and an aberrant left hepatic artery in a third. None had undergone prophylactic gastroduodenal artery embolization. Endoscopic findings included erythema, mucosal erosions, and large gastric ulcers. Microspheres were visible on endoscopic biopsy. In two patients, gastric ulcers were persistent at the time of repeat endoscopy 1–4 months later despite proton pump inhibitor therapy. One elderly patient who refused surgical intervention died from recurrent hemorrhage.

Conclusion

Gastrointestinal ulceration is a known yet rarely reported complication of 90Y microsphere embolization with potentially life-threatening consequences. Once diagnosed, refractory ulcers should be considered for aggressive surgical management.
Evidence that the Amyloid beta Precursor Protein-intracellular domain lowers the stress threshold of neurons and has a "regulated" transcriptional role
Authors: Giliberto Luca , Zhou Dawang , Weldon Richard , Tamagno Elena , De Luca Pasquale , Tabaton Massimo , D'Adamio Luciano
Published: September 2008

Background

Regulated intramembrane proteolysis of the β-amyloid precursor protein by the γ-secretase yields two peptides. One, amyloid-β, is the major component of the amyloid plaques found in Alzheimer's disease patients. The other, APP IntraCellular Domain, has been involved in regulation of apoptosis, calcium flux and gene transcription. To date, a few potential target genes transcriptionally controlled by AID, alone or complexed with Fe65/Tip60, have been described. Although the reports are controversial: these include KAI1, Neprilysin, p53, EGFR, LRP and APP itself. Furthermore, p53 has been implicated in AID mediated susceptibility to apoptosis. To extend these findings, and assess their in vivo relevance, we have analyzed the expression of the putative target genes and of the total brain basal transriptoma in transgenic mice expressing AID in the forebrain. Also, we have studied the susceptibility of primary neurons from such mice to stress and pro-apoptotic agents.

Results

We found that AID-target genes and the mouse brain basal transcriptoma are not influenced by transgenic expression of AID alone, in the absence of Fe65 over-expression. Also, experiments conducted on primary neurons from AID transgenic mice, suggest a role for AID in sensitizing these cells to toxic stimuli. Overall, these findings hint that a role for AID, in regulating gene transcription, could be induced by yet undefined, and possibly stressful, stimuli in vivo.

Conclusion

Overall, these data suggest that the release of the APP intracellular domain may modulate the sensitivity of neuronal cells to toxic stimuli, and that a transcriptional role of AID could be inscribed in signaling pathways thatare not activated in basal conditions.
Carcinoid tumour of the appendix in children: a case report
Authors: Christianakis Efstratios , Paschalidis Nikolaos , Chorti Maria , Filippou Georgios , Rizos Spiros , Filippou Dimitrios
Published: September 2008

Carcinoids are the most common tumours of the appendix. These tumours show prevalence in white children. The clinical presentation of the appendiceal carcinoids is similar to that of acute appendicitis, although in many cases the tumour is diagnosed incidentally during an operation. The diagnosis should be confirmed histologically. The prognosis in patients with local disease is excellent. In small lesions isolated appendicectomy is considered as the most appropriate treatment, while in larger lesions right colectomy should be performed. We report a case of a carcinoid tumour in the tip of the appendix of a thirteen year old girl which was diagnosed intraoperatively. The patient received isolated appendicectomy due to the small size of the lesion. Ten years after the operation there is no evidence of recurrence or metastases, and the patient is considered free of disease.
A polymorphism in the human serotonin 5-HT2A receptor gene may protect against systemic sclerosis by reducing platelet aggregation
Authors: Beretta Lorenzo , Cossu Marta , Marchini Maurizio , Cappiello Francesca , Artoni Andrea , Motta Giovanna , Scorza Raffaella
Published: September 2008

Introduction

Platelet aggregation may contribute to the pathogenesis of systemic sclerosis: following activation, platelets release significant amounts of serotonin – which promotes vasoconstriction and fibrosis, and further enhances aggregation. The C+1354T polymorphism in the exonic region of the serotonin 2A receptor gene determining the His452Tyr substitution was associated with blunted intracellular responses after serotonin stimulation, and may have a role in susceptibility to scleroderma.

Methods

One hundred and fifteen consecutive systemic sclerosis patients and 140 well-matched healthy control individuals were genotyped by sequence-specific primer-PCR for the His452Tyr substitution of the serotonin 2A receptor gene, and associations were sought with scleroderma and its main clinical features. The functional relevance of the His452Tyr substitution was also assessed by evaluating the aggregation of platelet-rich plasma from His452/His452and His452/Tyr452healthy individuals after stimulation with adenosine diphosphate ± serotonin.

Results

The T allele of the C+1354T polymorphism was underrepresented in scleroderma patients compared with control individuals (5.2% versus 12.4%,P< 0.001, chi-square test and 1,000-fold permutation test) and its carriage reduced the risk for systemic sclerosis (odds ratio = 0.39, 95% confidence interval = 0.19 to 0.85,P< 0.01). Platelets from His452/Tyr452healthy subjects more weakly responded to serotonin stimulation compared with platelets from His452/His452individuals (3.2 ± 2.6-fold versus 9.6 ± 8.6-fold increase in aggregation,P= 0.017 by Kolmogorov–Smirnov test andP= 0.003 after correction for baseline adenosine diphosphate-induced aggregation values).

Conclusion

The His452Tyr substitution may influence susceptibility to systemic sclerosis by altering platelet aggregation in response to serotonin.
The relationship between inflammation and new bone formation in patients with ankylosing spondylitis
Authors: Baraliakos Xenofon , Listing Joachim , Rudwaleit Martin , Sieper Joachim , Braun Juergen
Published: September 2008

Introduction

Spinal inflammation as detected by magnetic resonance imaging and new bone formation as identified by conventional radiographs are characteristic of ankylosing spondylitis. Whether and how spondylitis and syndesmophyte formation are linked are unclear. Our objective was to investigate whether and how spinal inflammation are associated with new bone formation in ankylosing spondylitis.

Methods

Spinal magnetic resonance images and conventional radiographs from 39 ankylosing spondylitis patients treated with anti-tumour necrosis factor (anti-TNF) agents at baseline and after 2 years were analysed for syndesmophyte formation at vertebral edges with or without inflammatory lesions at baseline.

Results

Overall, 922 vertebral edges at the cervical and lumbar spine were analysed. At baseline, the proportion of vertebral edges with and without inflammation (magnetic resonance imaging) that showed structural changes (conventional radiographs) was similar (in total, 16.6% of all vertebral edges in 71.4% of patients). From the perspective of syndesmophyte formation (n = 26, 2.9%) after 2 years, there were more vertebral edges without (62%) than with (38%) inflammation at baseline (P = 0.03). From the perspective of spinal inflammation at baseline (n = 153 vertebral edges), more syndesmophytes developed at vertebral edges with (6.5%) than without (2.1%) inflammation (P = 0.002, odds ratio 3.3, 95% confidence interval 1.5 to 7.4). Inflammation persisted in 31% of the initially inflamed vertebral edges (n = 132), and new lesions developed in 8% of the vertebral edges without inflammation at baseline (n = 410). From the perspective of spinal inflammation after 2 years (n = 72 vertebral edges), 5.6% of the vertebral edges showed syndesmophyte development in contrast to 1.9% of the vertebral edges with new syndesmophytes without inflammation (P = 0.06).

Conclusions

These findings obtained in patients treated with anti-TNF agents suggest linkage and some dissociation of inflammation and new bone formation in ankylosing spondylitis. Although syndesmophytes were also found to develop at sites where no inflammation had been seen by magnetic resonance imaging at baseline, it was more likely that syndesmophytes developed in inflamed vertebral edges. More effective suppression of spinal inflammation may be required to inhibit structural damage in ankylosing spondylitis.
Elevated autoantibody content in rheumatoid arthritis synovia with lymphoid aggregates and the effect of rituximab
Authors: Rosengren Sanna , Wei Nathan , Kalunian Kenneth C , Zvaifler Nathan J , Kavanaugh Arthur , Boyle David L
Published: September 2008

Introduction

The purpose of this study was to quantitatively evaluate the contribution of synovial lymphoid aggregates to autoantibody (rheumatoid factor [RF] and anti-cyclic citrullinated peptide [anti-CCP]) and total immunoglobulin (IgG and IgM) production in rheumatoid arthritis (RA) patients and the effect thereon of the B-cell-depleting antibody, rituximab, in the ARISE (Assessment of Rituximab's Immunomodulatory Synovial Effects) trial.

Methods

Autoantibodies as well as total IgM and IgG were quantified by enzyme-linked immunosorbent assay in extracts of synovial tissues and matched serum from patients with RA or osteoarthritis (OA). Synovial biopsies and serum were obtained at baseline and 8 weeks following rituximab therapy in 14 RA patients. A synovial/serum index (SSI) was calculated as the ratio of synovial to serum antibody/albumin, with values above 1 representing synovial enrichment. Lymphoid aggregates were evaluated histologically.

Results

Anti-CCP IgG, but not RF-IgM, was significantly enriched in RA synovia compared with serum. Total IgM and IgG were also enriched in RA, but not in OA. SSI correlated significantly with mRNA content for both IgM and IgG, demonstrating that it reflected synovial immunoglobulin production. RA synovia with lymphocyte aggregates contained significantly elevated RF-IgM and anti-CCP IgG compared with tissues with diffuse lymphoid infiltration. Rituximab treatment did not affect synovial autoantibody or total immunoglobulin SSI overall. However, in aggregate-containing tissues, rituximab significantly reduced total IgM and IgG SSI as well as IgM and IgG1 mRNA. Surprisingly, RF-IgM and anti-CCP IgG SSIs were unchanged by rituximab in aggregate-containing synovia.

Conclusions

Combined with earlier observations that synovial lymphoid aggregates are unaltered by rituximab treatment, these data suggest that lymphoid aggregates may provide a protective niche for autoantibody-producing cells.

Trial Registration

The ARISE trial is registered at ClinicalTrials.gov as number NCT00147966.