bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient and service user engagement in research: a systematic review and synthesized framework
Authors: Shippee Nathan D. , Domecq Garces Juan Pablo , Prutsky Lopez Gabriela J. , Wang Zhen , Elraiyah Tarig A. , Nabhan Mohammed , Brito Juan P. , Boehmer Kasey , Hasan Rim , Firwana Belal , Erwin Patricia J. , Montori Victor M. , Murad M Hassan
Published: June 2013

Background

There is growing attention towards increasing patient and service user engagement (PSUE) in biomedical and health services research. Existing variations in language and design inhibit reporting and indexing, which are crucial to comparative effectiveness in determining best practices.

Objective

This paper utilizes a systematic review and environmental scan to derive an evidence‐based framework for PSUE.

Design

A metanarrative systematic review and environmental scan/manual search using scientific databases and other search engines, along with feedback from a patient advisory group (PAG).

Eligible sources

English‐language studies, commentaries, grey literature and other sources (including systematic and non‐systematic reviews) pertaining to patient and public involvement in biomedical and health services research.

Data extracted

Study description (e.g. participant demographics, research setting) and design, if applicable; frameworks, conceptualizations or planning schemes for PSUE‐related endeavours; and methods for PSUE initiation and gathering patients'/service users' input or contributions.

Results

Overall, 202 sources were included and met eligibility criteria; 41 of these presented some framework or conceptualization of PSUE. Sources were synthesized into a two‐part framework for PSUE: (i) integral PSUE components include patient and service user initiation, reciprocal relationships, colearning and re‐assessment and feedback, (ii) sources describe PSUE at several research stages, within three larger phases: preparatory, execution and translational.

Discussion and Conclusions

Efforts at developing a solid evidence base on PSUE are limited by the non‐standard and non‐empirical nature of much of the literature. Our proposed two‐part framework provides a standard structure and language for reporting and indexing to support comparative effectiveness and optimize PSUE.
Total and unbound darunavir pharmacokinetics in pregnant women infected with HIV‐1: results of a study of darunavir/ritonavir 600/100 mg administered twice daily
Authors: Zorrilla CD , Wright R , Osiyemi OO , Yasin S , Baugh B , Brown K , Coate B , Verboven P , Mrus J , Falcon R , Kakuda TN
Published: June 2013

Objectives

Antiretroviral therapy during pregnancy is recommended to reduce the risk of mother‐to‐child transmission of HIV and for maternal care management. Physiological changes during pregnancy can affect pharmacokinetics, potentially altering pharmacological activity. We therefore evaluated the pharmacokinetics of twice‐daily (bid) darunavir in HIV‐1‐infected pregnant women.

Methods

HIV‐1‐infected pregnant women receiving an antiretroviral regimen containing darunavir/ritonavir 600/100 mg bid were enrolled in this study. Total and unbound darunavir and total ritonavir plasma concentrations were obtained over 12 h during the second and third trimesters and postpartum. Total darunavir and ritonavir plasma concentrations were determined using a validated high‐performance liquid chromatography tandem mass spectrometry assay and unbound darunavir was determined using 14C‐darunavir‐fortified plasma. Pharmacokinetic parameters were derived using noncompartmental analysis.

Results

Data were available for 14 women. The area under the plasma concentration–time curve from 0 to 12 h (AUC12h) for total darunavir was 17–24% lower during pregnancy than postpartum. The AUC12h for unbound darunavir was minimally reduced during pregnancy vs. postpartum. The minimum plasma concentration (Cmin) of total and unbound darunavir was on average 43–86% and 10–14% higher, respectively, during pregnancy vs. postpartum. The antiviral response (< 50 HIV‐1 RNA copies/mL) was 33% at baseline and increased to 73–90% during treatment; the percentage CD4 count increased over time. One serious adverse event was reported (increased transaminase). All 12 infants born to women remaining in the study at delivery were HIV‐1‐negative; four of these infants were premature.

Conclusions

Total darunavir exposure decreased during pregnancy. No clinically relevant change in unbound (active) darunavir occurred during pregnancy, suggesting that no dose adjustment is required for darunavir/ritonavir 600/100 mg bid in pregnant women.
The influence of epigenetics in relation to oral health
Authors: Lod S , Johansson T , Abrahamsson KH , Larsson L
Published: June 2013

The immune response is influenced by genetic and epigenetic factors, as well as disease and environmental factors. The term ‘epigenetics’ describes changes in the genome that influence the gene expression without altering the DNA sequence. In contrast to genetic changes in the DNA, epigenetic changes are reversible and are influenced by environmental factors. The aim of this study is to review the literature on epigenetic modifications with respect to oral health and inflammatory conditions in the oral cavity and to discuss the potential use of this new research field for the dental hygienists' and/or dentists' clinical work. Relevant publications were identified using the PubMed database without limits. The searches were conducted during January to March 2012 and resulted in articles published between 1912 and 2012. Key factors such as environment, diet, smoking, bacteria and inflammation were identified to be relevant to oral health. The result of this review article shows that there is a void in the research on epigenetics in relation to oral health. Identification of epigenetic modifications correlating with oral health may not only present a link between the influence of genetics and that of the environment on oral diseases but also provide new treatment models and tools for the dental professionals.
What If There Were Three? Audit Pricing within the Big 4 and the PricewaterhouseCoopers' Premium in the Australian Audit Market
Authors: Ferguson Andrew , Scott Tom
Published: June 2013

This paper examines intra‐Big 4 audit fee premiums in the Australian market. During the period examined (2002–2004), there is both Big 4 and intra‐Big 4 market dominance. The three largest firms – the ‘Big 3’ (Ernst & Young, KPMG and PricewaterhouseCoopers) – hold over 80 per cent of audit fees for companies listed on the Australian Securities Exchange. We find the main feature of the Australian audit market over this period is a PwC brand premium, which suggests price competition and thus no collusive pricing. Within the Big 4, audit pricing effects are likely to be a growing area of inquiry in future audit pricing literature. Overall, our study implies that regulatory concerns about a lack of a competition in the audit market during this period are inconsistent with the audit pricing evidence.
Infusion volume control and calculation using metronome and drop counter based intravenous infusion therapy helper
Authors: Park Kyungnam , Lee Jangyoung , Kim Soo‐young , Kim Jinwoo , Kim Insoo , Choi Seung Pill , Jeong Sikyung , Hong Sungyoup
Published: June 2013

This study assessed the method of fluid infusion control using an IntraVenous Infusion Controller (IVIC). Four methods of infusion control (dial flow controller, IV set without correction, IV set with correction and IVIC correction) were used to measure the volume of each technique at two infusion rates. The infused fluid volume with a dial flow controller was significantly larger than other methods. The infused fluid volume was significantly smaller with an IV set without correction over time. Regarding the concordance correlation coefficient (CCC) of infused fluid volume in relation to a target volume, IVIC correction was shown to have the highest level of agreement. The flow rate measured in check mode showed a good agreement with the volume of collected fluid after passing through the IV system. Thus, an IVIC could assist in providing an accurate infusion control.
Psychological and organizational impact of bullying over and above negative affectivity: A survey of two nursing contexts
Authors: Rodwell John , Demir Defne , Steane Peter
Published: June 2013

Limited research exists on the impact of bullying across psychological and/or organizationally orientated outcomes for nurses working within different nursing contexts. Research that has explored these outcomes has not considered the potential confounding effects of negative affectivity (NA). This study's aim was to examine the extent hospital and aged care nurses are impacted by bullying on these outcomes, while considering NA. A total of 267 hospital nurses/midwives and 168 aged care nurses from an Australian healthcare organization responded to a survey. The results revealed hospital nurses/midwives who experienced bullying reported higher levels of psychological distress, as well as lower commitment and job satisfaction levels. Aged care nurses who experienced bullying reported lower levels of well‐being and commitment. NA was a significant covariate for most analyses. Thus, nurses across these contexts are affected by bullying in relation to psychological and organizational‐orientated outcomes over and above the effects of NA, particularly for commitment.
Health status of hearing‐impaired children and adolescents
Authors: Kirman Aslı , Yildirim Sari Hatice
Published: June 2013

This descriptive study was conducted to identify factors that affect the general health status of hearing‐impaired children and adolescents aged 6–18. One hundred six hearing‐impaired students were sampled from two primary schools and a high school in Izmir, Turkey. The data were collected utilizing the Child Health Questionnaire (CHQ). Children and adolescents' physical health mean score and psychological health mean score were M = 47.4 ± 10.2 and M = 49.4 ± 9.5, respectively. Statistically significant differences in health status were found between the categories of age, mother's educational level and economic status of the family. The general health status of children and adolescents was found to be positive.
Quality of life and anticipatory grieving among parents living with a child with cerebral palsy
Authors: Al‐Gamal Ekhlas
Published: June 2013

The purpose of this study was to describe the quality of life and anticipatory grieving among Jordanian parents living with a child with cerebral palsy. A cross‐sectional, descriptive, correlational design was used with 204 Jordanian parents. Both mothers and fathers were recruited from health‐care centres that provided comprehensive care for children with cerebral palsy in Jordan and from schools for special education. Structured interviews were conducted using the Marwit and Meuser Caregiver Grief Inventory Cerebral Palsy and Quality of Life Index. The majority of the parents reported that providing care for a child with cerebral palsy is requiring more emotional energy and determination than ever expected. There was a significant negative correlation between total anticipatory grief score and total quality of life score and all subscales. This indicates that parents with high level of intensity of anticipatory grief had lower quality of life. No statistically significant differences were found in anticipatory grief and quality of life responses between mothers and fathers. The outcomes of this study have important implications for encouraging family‐centred care and inform policy to improve the lives of children with cerebral palsy and their parents.
Construct validity and reliability of the Single Checking Administration of Medications Scale
Authors: O'Connell Beverly , Hawkins Mary , Ockerby Cherene
Published: June 2013

Research indicates that single checking of medications is as safe as double checking; however, many nurses are averse to independently checking medications. To assist with the introduction and use of single checking, a measure of nurses' attitudes, the thirteen‐item Single Checking Administration of Medications Scale (SCAMS) was developed. We examined the psychometric properties of the SCAMS. Secondary analyses were conducted on data collected from 503 nurses across a large Australian health‐care service. Analyses using exploratory and confirmatory factor analyses supported by structural equation modelling resulted in a valid twelve‐item SCAMS containing two reliable subscales, the nine‐item Attitudes towards single checking and three‐item Advantages of single checking subscales. The SCAMS is recommended as a valid and reliable measure for monitoring nurses' attitudes to single checking prior to introducing single checking medications and after its implementation.
Seasonal asthma caused by airborne Platanus pollen
Authors: SUBIZA J. , CABRERA M. , VALDIVIESO R. , SUBIZA J.‐L. , JEREZ M. , JIMÉNEZ J. A. , NARGANES M. J. , SUBIZA E.
Published: June 2013

This work describes three patients suffering from bronchial asthma after being naturally exposed to airborne plane‐tree pollen. The three patients gave immediate response in skin tests and dual response in bronchial provocations using Platanus hybrida extract. There was specific seric IgE activity against this/these antigen(s) with the CAP system. The three patients also showed significant correlation (P < 0·001) between their rhinitis and asthma symptom‐scores registered on their diary cards and plane‐tree pollen counts, collected using the Burkard spore trap. Among 187 patients living in Madrid and who came to our centre with a history of rhinitis and/or seasonal asthma, we found a prevalence of positive skin‐prick tests to Platanus of 56%, only surpassed by gramineous pollen (Dactylis glomerata and/or Trisetum paniceum) 92% and Olea europaea 63%. The aerobiological sampling of the pollen content of the air in Madrid, carried out between 1 January 1979 and 31 December 1993 revealed an airborne presence (per cent of total yearly pollen count, mean of 1979–1993) of 14·9% for the Platanus, 14·8% for grasses, 9·8% for Olea and 3·6% for Plantago. The Platanus is one of the most frequently found pollens in the atmosphere over Madrid. At present, in this geographical area, a high percentage of patients with pollinosis are sensitive to this pollen. At least in some of these patients Platanus pollen is capable of inducing rhinitis and bronchial asthma.
A double‐blind comparison of fluticasone propionate aqueous nasal spray, terfenadine tablets and placebo in the treatment of patients with seasonal allergic rhinitis to grass pollen
Authors: DARNELL R. , PECOUD A. , RICHARDS D. H.
Published: June 2013

Fluticasone Propionate Aqueous Nasal Spray (FPANS) contains a topically active glucocorticoid fluticasone propionate which has been used successfully for the treatment of seasonal allergic rhinitis. This multicentre, randomized, double‐blind, double‐dummy, placebo‐controlled, parallel group study was designed to compare the efficacy and tolerability of FPANS with terfenadine tablets or placebo in controlling the symptoms of allergic rhinitis to grass pollen. Two hundred and fourteen patients were treated for 6 weeks during the grass pollen season with either FPANS 200 μg once daily, terfenadine tablets (60 mg) twice daily or placebo. Efficacy was evaluated by the analysis of symptom‐free days and median symptom scores. Patients receiving FPANS had significantly more days free of nasal blockage on waking (P = 0·012) and during the day (P = 0·01) and of rhinorrhoea (P = 0·027) than those receiving terfenadine. Additionally, in terms of absolute efficacy, patients receiving FPANS demonstrated significantly more days free of the above symptoms (P = 0·017, P = 0·028, P = 0·004, respectively) and of sneezing (P < 0·001) than those receiving placebo. There were no significant differences in symptoms of nasal itching, eye symptoms, of symptoms of drowsiness between the three treatment groups. Patients in the FPANS group had significantly lower median symptom scores for nasal blockage on waking (P < 0·001) and during the day (P < 0·018) than those in the terfenadine group and significantly lower scores for nasal blockage on waking (P < 0·001), sneezing (P < 0·013) and rhinorrhoea (P = 0·005) than those in the placebo group. The use of rescue medication was similar in all three treatment groups. Adverse events were similar in nature and frequency in all three treatment groups, most were mild and considered by the investigator at each centre unlikely to be related or unrelated to the study treatment. There were very few clinically significant laboratory abnormalities observed in any group. It is concluded that FPANS (200 μg once daily) is an effective and well‐tolerated treatment for seasonal allergic rhinitis and is significantly more effective than terfenadine (60 mg twice daily) in controlling nasal blockage at all times of the day and rhinorrhoea.
The importance of eosinophil activation for the development of allergen‐induced bronchial hyperreactivity in conscious, unrestrained guinea‐pigs
Authors: SANTING R. E. , HOEKSTRA Y. , PASMAN Y. , ZAAGSMA J. , MEURS H.
Published: June 2013

Using a newly developed guinea‐pig model of asthma, characterized by allergen‐induced early and late phase asthmatic reactions, bronchial hyperreactivity (BHR) and airway inflammation, the importance of eosinophil activation for the development of BHR to inhaled histamine was investigated at 6 h (after the early reaction) and 24 h (after the late reaction) after allergen provocation. Eosinophil activation was assessed by a sensitive kinetic assay for eosinophil peroxidase (EPO) activity, suitable for bronchoalveolar lavage (BAL) analysis. A significant 2±9‐fold (P < 0±01) increase in bronchial reactivity to histamine was observed at 6 h after allergen exposure, which was associated with a 2±9‐fold increase in the number of eosinophils (P < 0±05) and a 6±7‐fold increase in EPO activity (P < 0±01) in the BAL fluid. At 24 h after allergen exposure the bronchial reactivity to histamine was lower (1±7‐fold), but still significantly enhanced (P < 0±01). By contrast, the number of eosinophils was further increased compared with 6 h after provocation (3±8‐fold, P < 0±05), while the EPO activity remained stable at 6 h levels. The number of eosinophils was significantly correlated with EPO activity at 6 h (r = 0±62; P < 0±05), but not at 24 h after provocation. No significant correlation was observed between the number of eosinophils in the BAL fluid and BHR to histamine at either time point. Remarkably, EPO activity was significantly correlated to BHR at 24 h (r = 0±66; P < 0±004), but not at 6 h after provocation. These results indicate that: newly infiltrated eosinophils have the highest activation state during the early asthmatic reaction; EPO may play a role in the development of BHR to inhaled histamine after the late reaction and that besides EPO, additional mechanisms may contribute to BHR to histamine after the early asthmatic reaction.
Characteristics and Macroeconomic Determinants of Youth Employment in Africa
Authors: Anyanwu John C.
Published: June 2013

The purpose of this paper is to present the characteristics of youth employment in Africa as well as investigate its macroeconomic determinants, with a view to proffering some solutions. Our empirical estimates, using available cross‐sectional data over the period 1991–2009 show that a nation's domestic investment rate is found to be positively and significantly associated with youth employment in the overall Africa and sub‐Saharan estimations. However, domestic investment rate is negatively and significantly associated with youth employment in North Africa. Government consumption expenditures negatively and significantly affect youth employment in sub‐Saharan Africa. Rising inflation is negatively and significantly associated with youth employment in North Africa. The level of real GDP per capita has a negative and statistically significant effect in both the overall Africa and North Africa youth employment. The quadratic term of real GDP per capita is positive in sign and significant only in the youth employment estimation for the whole of Africa. We find that real GDP growth positively and significantly affects youth employment in the overall Africa, sub‐Saharan and North Africa estimations. Other important variables considered are globalization indicators (FDI and trade openness), credit to the private sector, ICT infrastructure, education, demographic factors, institutionalized democracy, time trend, net oil‐exporting/importing country, and regional dummies. Key policy implications include increased productive domestic investment; promoting government expenditure effectiveness; reforming the fiscal systems for consolidation by all levels of government; effective regulation of FDI for domestic job creation; improvements in the diversification, competitiveness and value addition of African export commodities; encouragement of entrepreneurship and access to financing for the youth; greater productive infrastructure development; up‐skilling, better training and education for the low‐skilled workforce; the promotion of effective democracy that will design policies friendly to youth job creation; and efficient management of oil and other natural resources throughout the value chain.
La croissance économique est‐elle pro‐pauvres au Niger?
Authors: Daouda Youssoufou Hamadou
Published: June 2013

L'idée de savoir si la croissance économique est pro‐pauvres au Niger vient d'un constat: malgré les bonnes performances macroéconomiques au cours de la décennie 2000, la pauvreté reste à un niveau élevé. Dans cet article, deux objectifs sont poursuivis. Premièrement, à l'aide d'une approche fondée sur Kakwani et al. (2002), la croissance pro‐pauvres est examinée selon les spécificités régionales et le milieu de résidence. D'après les résultats obtenus, il ressort globalement que la croissance économique nigérienne est pro‐pauvres, sauf dans les villes (Niamey notamment) où elle semble être pro‐riches — l'interférence négative de l'inégalité a plus que contrebalancé l'effet positif de la croissance. Deuxièmement, un exercice de simulation est proposé afin d'estimer le niveau de croissance requis pour réduire de 50% la pauvreté, conformément aux objectifs de développement du millénaire. L'étude montre que le Niger ne pourra parvenir à un tel but qu'en maintenant un taux de croissance annuel de 10,5%, et ce, seulement pour l'horizon 2020.
Growth Empirics: Evidence from Sierra Leone
Authors: Kallon Kelfala M.
Published: June 2013

In this paper, I use a novel approach to estimate Sierra Leone's aggregate capital stock from gross fixed investment and depreciation. Using Johanssen's maximum‐likelihood cointegration methodology, I then estimate the parameters of the country's long‐run per capita aggregate production function. Thereafter, the sources of economic growth are calculated, the key finding being that economic growth in post‐independence Sierra Leone has been propelled by mostly capital accumulation. The implications of this capital‐driven growth on poverty reduction and income distribution are then discussed. Policy recommendations for how to simultaneously promote economic growth and improve the living standard of the average Sierra Leonean are also provided.
Beyond Fundamentals: Investor Sentiment and Exchange Rate Forecasting
Authors: Heiden Sebastian , Klein Christian , Zwergel Bernhard
Published: June 2013

This paper examines the relation between investor sentiment and exchange rate movements. We use a unique dataset of private and institutional investors’ sentiment and discover that institutional sentiment significantly predicts returns over medium‐term horizons in the EUR/USD market. While institutional investors seem to correctly identify the medium‐run direction of this market, private investors’ sentiment emerges as a contrarian indicator at first sight, however, its predictive power fluctuates heavily and is sample dependent. Our results point towards local investors having an informational advantage in exchange rate forecasting. We test for economic relevance with a simple but realistic out‐of‐sample trading strategy which yields significant results.
Tiny Prices in a Tiny Market: Evidence from Portugal on Optimal Share Prices
Authors: Pereira João Pedro , Cutelo Teresa
Published: June 2013

The Portuguese stock market provides a natural experimental area to analyse theories of optimal price per share. Its characteristics suggest that prices should be very low. Using a sample of 20 stocks from the main Portuguese Stock Index from 1999 to 2010, we observe that Portuguese corporations indeed seek extremely low prices per share through stock splits and similar actions. However, we find that low‐price stocks are actually less liquid than high‐price stocks. Furthermore, low‐price stocks trade at lower valuation ratios. Our results do not support any of the existing theories on optimal price per share and therefore add to the nominal share price puzzle.
Bank Size and Systemic Risk
Authors: Pais Amelia , Stork Philip A.
Published: June 2013

The global financial crisis that started in mid‐2007 illustrates the relevance of systemic risk. One key driver of the systemic instability that materialised in the crisis was the elevated level of stress in large banks. We use EVT to analyse the effect of size on banks’ univariate and systemic risk across ten countries as well as across the EU. Our findings show that size has little impact on banks’ univariate risk (as measured by VaR), but that large banks have significantly higher systemic risk. Furthermore, systemic risk has significantly increased for banks of all sizes since the beginning of the crisis.
Product Market Competition, Corporate Governance, and Firm Value: Evidence from the EU Area
Authors: Ammann Manuel , Oesch David , Schmid Markus M.
Published: June 2013

This paper investigates whether the valuation effect of corporate governance depends on the degree of competition in the companies’ product markets in a large international sample covering 14 countries from the European Union (EU). Besides providing external validity of previous US‐centred studies, this paper uses more comprehensive and reliable measures of both product market competition and corporate governance. Consistent with the hypothesis that product market competition acts as a substitute for corporate governance as competitive pressure imposes discipline on managers to maximise firm value, our results show that corporate governance significantly increases firm value in non‐competitive industries only. When investigating the channels through which firm value may be increased, we find that good governance for firms in non‐competitive industries leads them to have more capital expenditures, spend less on acquisitions, and be less likely to diversify. Our results are robust to a large number of robustness checks including the use of alternative measures of competition and governance, as well as using alternative regression specifications.
Management, Women and Gender Capital
Authors: Ross‐Smith Anne , Huppatz Kate
Published: June 2013

A generation of women have sustained careers in senior management. We use Bourdieu's concepts of field together with contemporary feminist interpretations of embodied cultural capital to analyse a group of such women's narratives of their own managerial experiences. We extend feminist analyses of gender capital and argue it may be an important cultural resource by which women develop and sustain their careers in senior management. Drawing on selected findings of an empirical study of senior managers in Australian organizations and a recent theoretical analysis of women's narratives using Bourdieu and feminist interpretations of Bourdieu, we examine whether women wield gender capital in the management field. We propose that gender capital, as articulated in contemporary feminist theory, provides an unexplored but potentially powerful explanatory mechanism for furthering our understanding of the complex and different ways the presence of women in senior managerial roles may shape contemporary management discourses and practices.
Using functional traits to investigate the determinants of crustacean zooplankton community structure
Authors: Vogt Richard J. , Peres‐Neto Pedro R. , Beisner Beatrix E.
Published: June 2013

Understanding the various processes contributing to community assembly is among the central aims of ecology. As a means of exploring this topic we quantified the relative influences of habitat filtering and competition in establishing patterns of community functional trait diversity across a landscape of lakes. Habitat filtering has been invoked in shaping community structure when co‐occurring taxa are more similar in their traits than expected by chance (under‐dispersion), and competition has been inferred as a structuring agent when co‐occurring taxa are less similar (over‐dispersion). We tested these hypotheses in crustacean zooplankton communities using a functional trait‐based approach based on five traits defining zooplankton feeding and habitat preferences across 51 lakes spanning several large limnological gradients. In general, zooplankton communities were functionally less diverse than random assemblages created from the same regional species pool. Furthermore, functional diversity was strongly correlated with variables related to lake productivity, suggesting that access to resources was the chief habitat filtering process constraining zooplankton functional diversity. This pattern was driven by the predominantly herbivorous cladocerans as opposed to the more commonly omnivorous, and sometimes carnivorous, copepods.
Evaluating the role of biotic interactions in structuring communities using a gradient analysis of multiple interacting guilds
Authors: Shevtsov Jane , Wickings Kyle , Patten Bernard C.
Published: June 2013

The extent to which ecological communities are coherent entities as opposed to mere intersections of individual species distributions has long been one of the fundamental questions of ecology. Gradient analysis is one commonly used tool for addressing this question; however, all such studies have used organisms from a single taxon or guild. This risks missing important connections due to non‐competitive interactions, which should be more likely to occur between members of different guilds. Such organisms are unlikely to compete for resources and can have complementary niches that promote non‐competitive interactions. We examined the abundances of taxa in four interacting guilds along an elevation gradient in a forest in the southern Appalachian mountains. A causal discovery algorithm was used to investigate the relative frequencies of interguild and intraguild interactions. These were approximately equally common once taxonomic richness was taken into account. We used elements of metacommunity structure analysis to study the extent to which species distributions are non‐independent and tested the hypothesis that combinations of two or more interacting guilds exhibit more coherence than single guilds. In this analysis, all guilds other than collembola were classified as Clementsian or quasi‐Clementsian. (Collembola were classified as random.) When sets of multiple guilds were examined, Clementsian and quasi‐Clementsian structures predominated. We also compared boundary conjunction, measured as Morisita’s index (MI) for these sets of guilds to the weighted average of the guilds’ MI values. Only sets of directly interacting guilds had higher‐than‐baseline boundary conjunction values, and such boundary conjunction values are found in all but one set of directly interacting guilds. Our results highlight the importance of inter‐guild interactions in structuring patterns of cooccurrence. Trophic interactions and plant–fungus symbioses (mutualistic and/or pathogen–host) appear particularly important.
Fluconazole resistant oral candidiasis in HIV‐infected patients
Authors: Tumbarello M , Tacconelli E , Caldarola G , Morace G , Cauda R , Ortona L
Published: June 2013

OBJECTIVE: To evaluate the risk factors associated with the emergence of fluconazole resistant Candida spp. in HIV‐infected patients with oral candidiasis. METHODS: Candida spp. were isolated from oral swabs and tested in vitro for resistance to fluconazole. The factors potentially correlated with vazole‐resistent Candida spp. infections were investigated.

RESULTS: Fifty‐one out of 118 patients (43%) with oral candidiasis had fluconazole resistant Candida spp. The following factors were significantly associated with the development of fluconazole resistance: (1) more than five episodes of oral candidiasis in the previous year (P < 0.001); (2) fluconazole therapy in the previous 6 months (P < 0.001); (3) C3 category of HIV infection (P< 0.001); and (4) low number of TCD4+ cells (<50 mm3, P = 0.002). According to multivariate analysis, previous therapy with fluconazole was the only risk factor that independently influenced the development of Candida spp. resistance (P = 0.003).

CONCLUSIONS: The prophylaxis and therapy of mild fungal infections in HIV‐infected patients, which may lead to azole resistance, should be carefully considered.
Is erythematous candidiasis associated with advanced HIV disease?
Authors: Robinson PG , Challacombe SJ , Sheiham A , Zakrzewska JM
Published: June 2013

OBJECTIVES: A multicentre collaborative study by the London HIV and Dentistry Group failed to associate the presence of erythematous candidiasis (EC) with advanced HIV disease. Data from a study of the periodontal health of homosexual men attending a genito‐urinary medicine clinic presented an opportunity to investigate social and medical factors related to the presence of EC and mucosal disease.

SUBJECTS AND METHODS: 312 men with HIV were examined by a single examiner blinded to HIV status; 22.8% had an indicator condition for AIDS; 37.8% had CD4 lymphocyte counts less than 200 cells mm−3; and 53.8% met the 1993 case definition for AIDS; 59.6% of the men with HIV had oral manifestations of the infection. The most common were: oral hairy leukoplakia, 44.2%; EC, 26.9%; and pseudomembranous candidiasis (PC), 11.5%.

RESULTS: Advanced HIV disease was a less powerful predictor of EC than PC. Advanced HIV disease also predicted the presence of hairy leukoplakia and mucosal ulceration. EC was strongly associated with tobacco use. CONCLUSIONS: While methodological differences explain some variation with previous research, these data also suggest that EC and PC may not carry the same prognostic significance and longitudinal studies are required to confirm these findings.
Overview: Kaposi's sarcoma, oral neoplasms
Authors: Zakrzewska JM
Published: June 2013

Since the last international workshop on the oral manifestations of HIV in 1993 there has been extremely rapid progress in our knowledge of the possible aetiology of Kaposi's sarcoma (KS) and this is reflected in this section which concentrates mainly on the epidemiology and molecular aspects of KS. Research continues in assessing potential links of oral neoplasms and especially in non‐Hodgkin's lymphomas in patients with HIV/AIDS.
Management of oral Kaposi's sarcoma and a proposal for clinical staging
Authors: Epstein JB
Published: June 2013

Kaposi's sarcoma (KS) is the most common neoplastic disease in patients with disease due to human immunodeficiency virus (HIV), and oral KS (OKS) is the commonest oral neoplasia. OKS has been managed by local excision, intralesional chemotherapy regional radiotherapy, and systemic chemotherapy. Comparison between studies is difficult as the severity of oral involvement is not well defined in most studies. This paper reviews the approach to the management of OKS and also presents a proposal for the clinical staging of OKS. Clinical staging of OKS will facilitate comparisons of outcomes of treatment of OKS and improve our understanding of the natural history of the neoplasia, which has varied presentation and rates of progression.
Oral lymphoma in HIV infection
Authors: Jordan RCK , Chong L , DiPierdomenico S , Satira F , Main JHP
Published: June 2013

OBJECTIVE: This study reports the main clinical and histological features, and the treatment and outcomes of six HIV‐associated oral lymphomas.

SUBJECTS: During the period 1991–1995, six cases of lymphoma presenting in the oral cavity were diagnosed in this clinic. All six patients were men ranging in age from 36 to 62 years with CD4 counts below 100 cells mm−3.

RESULTS: In five patients, oral lymphoma was the first AIDS defining disease. Four lesions occurred on the gingiva, one on the palate and one on the tongue. The duration of symptoms prior to presentation ranged from 2 weeks to 14 months. In all but one patient, the lesions presented as red, exophytic masses and were diagnosed clinically as Kaposi's sarcoma. None of the five lesions presenting on the palate or gingiva showed radiographic evidence of bone destruction. Metastatic work‐up failed to diagnose lymphoma elsewhere in the five cases where this was performed. Histological diagnoses included two small, non‐cleaved (Burkitt's type) lymphomas, two immunoblastic lymphomas, one large cell lymphoma and one small, non‐cleaved (non‐Burkitt's) lymphoma.

CONCLUSION: These findings highlight the uncommon clinical presentation of this disease and despite its relative rarity, demonstrate the need to maintain a high degree of suspicion in any unusual oral lesion in this group of patients.
Epstein‐Barr virus infection and expression in oral lesions
Authors: Raab‐Traub N , Webster‐Cyriaque J
Published: June 2013

OBJECTIVE: The prevalence of Epstein‐Barr virus (EBV) and the recently discovered Kaposi's sarcoma associated herpes virus, human herpesvirus 8 (KSHV or HHV8), was determined within oral lesions common to HIV infection including OHL, pseudoOHL (PHL), oral lymphoma, oral aphthous ulcers, and an oral Kaposi's sarcoma.

METHODS: DNA and RNA were extracted from oral lesions. EBV and HHV8 genomes were detected by Southern blot and polymerase chain reaction (PCR), and viral expression was analyzed using PCR amplification of cDNA.

RESULTS: Multiple EBV strains were detected within OHL with recombination across repeat sequences generating new viral variants. EBV expression in OHL included expression of some viral genes, usually expressed in latent infections, that induce the EBV receptor. EBV replication was detected only within OHL lesions but not within adjacent Kaposi's tissue or oral aphthous ulcers while HHV8 was only detected within the Kaposi's lesions.

CONCLUSIONS: These findings indicate that the OHL lesion is unique with viral replication and superinfection with additional EBV strains. Expression of the EBV receptor within the OHL lesion may promote superinfection which then activates EBV replication. The consistent detection of EBV replication only within OHL lesions and the detection of HHV8 only within Kaposi's sarcoma, strengthens the etiologic link between EBV and HHV8 infection to these specific pathologies.
The expression of the Epstein‐Barr virus nuclear antigen (EBNA‐I) in oral hairy leukoplakia
Authors: Cruchley AT , Murray PG , Niedobitek G , Reynolds GM , Williams DM , Young LS
Published: June 2013

OBJECTIVE: Oral hairy leukoplakia (OHL) is characterised by the presence of a replicative Epstein‐Barr virus (EBV) in the superficial layers of the epithelium. There is some doubt, however, whether this reflects activation of a latent infection of the basal epithelial cells. EBV latency is associated with the expression of the viral gene product EBNA‐I and the aim of this study was to investigate EBNA‐I expression in OHL.

METHODS: 22 biopsies of clinically suspicious OHL and three cases of normal mucosa were available as fresh frozen or paraffin embedded material. EBNA‐I was detected immunocytochemically using a rat monoclonal antibody (IH4‐I) following microwave irradiation. Lytic EBV infection was confirmed by the identification of the BZLF‐I protein.

RESULTS: 16 of the 22 cases displayed focal replicative EBV meeting the criteria for OHL, and in 13 of these, EBNA‐I expression was restricted to the nuclei of epithelial cells in the upper layers of the epithelium. EBNA‐I expression was absent from the basal cells in all cases and in the nine BZLF‐I negative mucosal biopsies.

CONCLUSION: These findings suggest that lytic EBV infection in OHL is not the result of activation of a latent infection of basal cells and suggests a role for EBNA‐I, not only in latent EBV infection, but also in virus replication.
Oral ulcers in HIV‐infected patients: An update on epidemiology and diagnosis
Authors: Ficarra G
Published: June 2013

Oral ulcers observed during the course of HIV infection may be very severe. Such manifestations may interfere with oral functions and alter the patients' quality of life. It is important to stress that when HIV‐infected individuals present with ulcerative lesions of the oral cavity, neoplastic processes and rare infections must be included in the differential diagnosis. Nontumefactive oral ulcers in HIV‐positive patients may be a source of diagnostic difficulties because of the diverse array of underlying pathologic entities and multiplicity of etiologic agents. Biopsy should always be performed on long‐standing ulcers, since either infection or a neoplastic process may be present. In the absence of infection or neoplasm, such lesions are then designated ulcers not otherwise specified.
Severe oral ulceration in patients with HIV infection: A case series
Authors: Zakrzewska JM , Robinson P , Williams IG
Published: June 2013

OBJECTIVE: Oral ulceration occurs in an estimated 2–4% of patients with HIV infection. This retrospective observational study describes the aetiology and characteristics of 94 HIV‐positive patients with either severe and/or recurrent oral ulceration presenting at a dedicated HIV dental unit over a 4‐year period.

METHODS: Case records were reviewed for diagnosis investigations, CD4 count, CDC stage and treatment modality.

RESULTS: Of the 94 patients 50% had an AIDS diagnosis. In patients with asymptomatic HIV disease minor recurrent oral ulceration was the commonest diagnosis whilst large non‐specific neutropenic ulcers were more frequently seen in patients with symptomatic disease with low CD4 counts. A variety of treatment modalities were used including thalidomide. An algorithm is presented for the management of patients with severe oral ulceration.
Good ethical practice in the dental treatment of patients with HIV/AIDS
Authors: Doyal L
Published: June 2013

Patients with HIV/AIDS have challenged the ethics of the dental profession. The seriousness, infectious character and social stigma of the illness have led to a range of ethical dilemmas about the treatment of such patients. This paper attempts to resolve some of the more difficult questions through exploring the moral boundaries of the rights and duties of both patients and dental practitioners.

To accomplish this aim, the moral foundation for the general clinical duties of care is outlined, especially the obligations of providing treatment to a high standard, respecting the rights of patients to informed consent and doing both without personal prejudice. After illustrating why these duties require moral character as well as intellectual understanding, their practical consequences are outlined for specific issues in the treatment of seropositive patients. It is argued that patients should never be tested without their informed consent and that dentists have a duty to display courage, sensitivity and rigorous respect for confidentiality in the treatments they offer. The obligations of seropositive dentists are also considered, including their own obligations for disclosure toward regulatory authorities and patients. The moral debt which the dental profession owes to seropositive patients is highlighted.
Dental lesions: Diagnosis and treatment
Authors: Phelan JA
Published: June 2013

Oral health care has been an integral part of the care of patients with HIV infection and AIDS since the disease was first identified in the early eighties. The spectrum of HIV‐associated opportunistic diseases occurring in the oral cavity propelled dental health care providers to the forefront of patient care. Infection control issues soon became important in oral health care for patients infected with HIV, and for the first decade these two issues overshadowed the concerns about appropriate management of the dental needs of HIV‐infected patients.

Several concerns need to be considered in the management of dental care for patients infected with HIV. These include decreased salivary flow and increased sugar intake, prevention and management of routine inflammatory gingival and periodontal disease as well as the atypical forms of gingival and periodontal disease associated with HIV infection (linear gingival erythema [LGE], necrotizing ulcerative gingivitis [NUG] and necrotizing ulcerative periodontitis [NUP]). Finally, although reports of complications secondary to dental treatment of HIV‐infected individuals are rare, it is important to consider those factors related to the medical status of HIV‐infected patients which may interfere with oral health care These include potential bleeding problems related to thrombocytopenia and disease or medication related liver abnormalities, increased risk of local infection particularly in patients with severe neutropenia and adverse effects of multiple medications taken by HIV patients.

Prevention and management of dental and periodontal disease in HIV‐infected individuals is important to self esteem, quality of life and maintenance of adequate nutritional intake. Oral health care continues to be an important component of overall health care for HIV‐infected patients.
Treatment of HIV‐associated periodontal diseases
Authors: Robinson PG
Published: June 2013

Three presentations of periodontal disease are associated with HIV infection: necrotising periodontal disease; forms of atypical gingivitis and exacerbated attachment loss. Necrotising disease resembling aggressive acute necrotising ulcerative gingivitis and is the most acute and painful of these. Response to treatment by debridement of lesions, irrigation with aqueous chlorhexidine solution and oral metronidazole 200 mg, tds is almost diagnostic of the condition. Affected individuals are prone to relapse. Prevention by meticulous home care and frequent hygiene recalls is advised. The forms of atypical gingivitis are classically not plaque related. This means that persistence of gingivitis in the absence of plaque is required to establish the diagnosis. There is a consensus that these diseases are related to candidiasis. Treatment with antifungals may be contraindicated due to the emergence of resistant strains of Candida spp. Exacerbated attachment loss may be the legacy of repeated episodes of necrotic disease or may be due to accelerated periodontitis. In either event the principles of treatment are to encourage and facilitate plaque removal.
Oral aspects of HIV infection in children
Authors: Ramos‐Gomez FJ
Published: June 2013

Most infants with congenital HIV infection appear normal at birth. Clinical difficulties usually begin as the first year proceeds, and in about half of the children oral manifestations are the first signs. Oral manifestations are commonly found in HIV‐positive asymptomatic and pediatric AIDS patients, they are the earliest clinical signs of HIV infection and disease progression in children, and may be used as diagnostic markers, especially in developing countries. Studies have established an accurate association between oral manifestations and progression of HIV disease in children. Since the mouth is easily accessed for clinical examination, the important oral signs should be utilized in the diagnosis and early intervention of AIDS in these vulnerable populations.