bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Significance of Tumor-Associated Inflammatory Cells in Metastatic Neuroblastoma
Authors: Asgharzadeh Shahab , Salo Jill A. , Ji Lingyun , Oberthuer André , Fischer Matthias , Berthold Frank , Hadjidaniel Michael , Liu Cathy Wei-Yao , Metelitsa Leonid S. , Pique-Regi Roger , Wakamatsu Peter , Villablanca Judith G. , Kreissman Susan G. , Matthay Katherine K. , Shimada Hiroyuki , London Wendy B. , Sposto Richard , Seeger Robert C.
Published: August 2012

Purpose

Children diagnosed at age ≥ 18 months with metastatic MYCN-nonamplified neuroblastoma (NBL-NA) are at high risk for disease relapse, whereas those diagnosed at age < 18 months are nearly always cured. In this study, we investigated the hypothesis that expression of genes related to tumor-associated inflammatory cells correlates with the observed differences in survival by age at diagnosis and contributes to a prognostic signature.

Methods

Tumor-associated macrophages (TAMs) in localized and metastatic neuroblastomas (n = 71) were assessed by immunohistochemistry. Expression of 44 genes representing tumor and inflammatory cells was quantified in 133 metastatic NBL-NAs to assess age-dependent expression and to develop a logistic regression model to provide low- and high-risk scores for predicting progression-free survival (PFS). Tumors from high-risk patients enrolled onto two additional studies (n = 91) served as independent validation cohorts.

Results

Metastatic neuroblastomas had higher infiltration of TAMs than locoregional tumors, and metastatic tumors diagnosed in patients at age ≥ 18 months had higher expression of inflammation-related genes than those in patients diagnosed at age < 18 months. Expression of genes representing TAMs (CD33/CD16/IL6R/IL10/FCGR3) contributed to 25% of the accuracy of a novel 14-gene tumor classification score. PFS at 5 years for children diagnosed at age ≥ 18 months with NBL-NA with a low- versus high-risk score was 47% versus 12%, 57% versus 8%, and 50% versus 20% in three independent clinical trials, respectively.

Conclusion

These data suggest that interactions between tumor and inflammatory cells may contribute to the clinical metastatic neuroblastoma phenotype, improve prognostication, and reveal novel therapeutic targets.
Prognostic Significance of Signet Ring Gastric Cancer
Authors: Taghavi Sharven , Jayarajan Senthil N. , Davey Adam , Willis Alliric I.
Published: August 2012

Purpose

Studies in Asia have questioned the dictum that signet ring cell carcinoma (SRC) has a worse prognosis than other forms of gastric cancer. Our study determined differences in presentation and outcomes between SRC and gastric adenocarcinoma (AC) in the United States.

Patients and Methods

The National Cancer Institute Surveillance, Epidemiology, and End Results database was reviewed for SRC and AC from 2004 to 2007.

Results

We reviewed 10,246 cases of patients with gastric cancer, including 2,666 of SRC and 7,580 of AC. SRC presented in younger patients (61.9 v 68.7 years; P < .001) and less often in men (52.7% v 68.7%; P < .001). SRC patients were more frequently black (11.3% v 10.9%), Asian (16.4% v 13.2%), American Indian/Alaska Native (0.9% v 0.8%), or Hispanic (23.3% v 14.0%; P < .001). SRC was more likely to be stage T3-4 (45.8% v 33.3%), have lymph node spread (59.7% v 51.8%), and distant metastases (40.2% v 37.6%; P < .001). SRC was more likely to be found in the lower (30.7% v 24.2%) and middle stomach (30.6% v 20.7%; P < .001). Median survival was not different between the two (AC, 14.0 months v SRC, 13.0 months; P = .073). Multivariable analyses demonstrated SRC was not associated with mortality (hazard ratio [HR], 1.05; 95% CI, 0.96 to 1.11; P = .150). Mortality was associated with age (HR, 1.01; 95% CI, 1.01 to 1.02; P < .001), black race (HR, 1.10; 95% CI, 1.01 to 1.20; P = .026), and tumor grade. Variables associated with lower mortality risk included Asian race (HR, 0.83; 95% CI, 0.77 to 0.91; P < .001) and surgery (HR, 0.37; 95% CI, 0.34 to 0.39; P < .001).

Conclusion

In the United States, SRC significantly differs from AC in extent of disease at presentation. However, when adjusted for stage, SRC does not portend a worse prognosis.
Evidence for Therapeutic Drug Monitoring of Targeted Anticancer Therapies
Authors: Gao Bo , Yeap Shang , Clements Arthur , Balakrishnar Bavanthi , Wong Mark , Gurney Howard
Published: August 2012

Therapeutic drug monitoring (TDM) provides valuable guidance for dose adjustment of antibiotics, immunosuppressives, antiepileptics, and other drugs, but its use for traditional anticancer therapies has been limited. Perhaps the most important obstacle is the impractical requirement of multiple blood samples to adequately define systemic exposure of drugs that have a short elimination half-life and are given by intermittent intravenous injections. However, the newer targeted anticancer therapies have different pharmacokinetic (PK) and dosing characteristics compared with traditional cytotoxic drugs, making it possible to estimate the steady-state drug exposure with a single trough-level measurement. Recent evidence indicates that certain PK parameters, including trough levels, are correlated with clinical outcomes for many of these agents, including imatinib, sunitinib, rituximab, and cetuximab. Although the current evidence is insufficient to mandate TDM in routine practice, a concerted investigation should be encouraged to determine whether the steady-state trough measurements of targeted agents will have a practical place in the clinical care of patients with cancer.
An Unruly Death
Authors: Tang Denise Tse-Shang
Published: August 2012

This essay aims to give an overview of Hong Kong queer media productions by presenting specific media representations that speak to local queer sensibilities and sexual politics. I investigate the nature of a localized queer nonchalance that cultivates an environment readable as both tolerant and limiting of queer desires, as well as resistant of the rumors of a broader cultural death. One of the case studies includes, to use Helen Hok-Sze Leung's term, “do-it-yourself” queer cultural projects that focus on reaching out to LGBT communities rather than to a wider mainstream public reception. Another example involves gender-crossing performances and cultural productions from mainstream media icons in popular culture. Finally, I discuss gossip magazine coverage of queer celebrity rumors. I locate my concerns in questioning whether mass-media practices can perversely normalize same-sex sexuality in our everyday lives.
Prevalence of hepatitis in early syphilis among an HIV cohort
Authors: Manavi K , Dhasmana D , Cramb R
Published: August 2012

To investigate the prevalence of syphilitic hepatitis among a group of HIV-infected patients we performed a cross-sectional observational study of consecutive HIV-infected patients with early syphilis attending University Hospital Birmingham between 1 January 2005 and 31 August 2008. The AIDS Clinical Trials Group grading for abnormal liver enzymes was used to identify hepatitis. A total of 62 HIV-infected patients were diagnosed with early syphilis during the study period. Twelve (19.3%) of them demonstrated abnormal liver enzymes consistent with syphilitic hepatitis involving raised levels of alanine aminotransferase, aspartate transaminase, alkaline phosphatase or gamma-glutamyl transferase (GGT). Grade 3 hepatotoxicity was observed among five patients. None of the patients with syphilitic hepatitis had grade IV hepatitis or abnormal bilirubin levels. Liver biopsy was not carried out in any of the patients, and following completion of treatment of syphilis all abnormal liver enzymes returned to normal levels after a median of 16 weeks. Exclusion of syphilis must be considered when investigating hepatic disease in HIV-infected patients.
The prevalence of six species of Mycoplasmataceae in an HIV/AIDS population in Jiangsu Province, China
Authors: Wang B , Wu J-R , Guo H-J , Yang H-T , Ai J , Hui M , Chan C-Y
Published: August 2012

This study employed culture and polymerase chain reaction (PCR) to examine the prevalence of Ureaplasma urealyticum, Mycoplasma hominis, Mycoplasma genitalium, Mycoplasma fermentans, Mycoplasma penetrans and Mycoplasma pirum in 210 HIV/AIDS patients, 455 sexually transmitted infection (STI) clinic attendees and 245 healthy volunteers from first-void urine specimens for men and endocervical swabs for women. U. urealyticum and M. hominis were detected in 107 (51.0%) and 69 (32.9%) patients in the HIV/AIDS group. At least one of the other four organisms was detected in 34 (16.2%) HIV/AIDS patients, 29 (6.4%) STI clinic attendees and six (2.5%) healthy volunteers. This study showed that U. urealyticum, M. hominis and M. fermentans were significantly more prevalent in HIV/AIDS patients, as were other mycoplasmas. Our results suggest a possible role for co-infection.
Sexual coercion prior to imprisonment: prevalence, demographic and behavioural correlates
Authors: Malacova E , Butler T , Yap L , Grant L , Richards A , Smith A M A , Donovan B
Published: August 2012

Little is known about experiences of sexual coercion among prisoners prior to incarceration. Prisoner populations are routinely excluded from national surveys of sexual health which also tend to under-represent marginalized groups. We surveyed 2351 randomly selected men and women, aged 18–64 years, in New South Wales and Queensland prisons who participated in a computer-assisted telephone interview. Around 60% of women and 14% of men self-reported having been sexually coerced prior to incarceration, with 60% of these experiences occurring before the age of 16 years. Factors independently associated with a self-reported history of sexual coercion were: homosexual and bisexual identity, being unable to work, separated marital status, higher level of education (among women), having been paid for sex, a past sexually transmissible infection (among men), drug use (among women) and a history of mental health problems. Prior sexual coercion was associated with unwanted sexual contact and physical assault while in prison. The high prevalence of sexual coercion reported by prisoners and its association with a range of factors indicates a need for a greater acknowledgement of the potential consequences of this within the criminal justice system. This could entail providing counselling and support services within the correctional setting.
Rescreening for abnormal vaginal flora in pregnancy and re-treating with clindamycin vaginal cream significantly increases cure and improvement rates
Authors: Lamont R F , Taylor-Robinson D , Bassett P
Published: August 2012

We investigated 199 pregnant women with bacterial vaginosis (BV) who received clindamycin vaginal cream (CVC) for three days and compared with 205 women treated with placebo. The vaginal flora was assessed at each visit. At the second visit, 71% in the CVC group were cured/improved, compared with 12% in the placebo group ( P < 0.001). At visit 3 about 90% who responded to initial CVC treatment were still cured/improved. Of women who initially failed to respond to CVC and were given an additional seven-day course, 33% were cured/improved by the third visit, compared with 15% who failed to respond to placebo initially and were given a further seven-day course ( P = 0.02). By visit 4, half the women in the CVC group who received additional treatment remained cured/improved, compared with 26% who had additional placebo ( P = 0.004). In the CVC group, a change from abnormal to normal rose from 71% (visit 2) to 76% (visit 3) and 79% (visit 4). A similar trend was seen in women who received placebo but the proportions were significantly lower (12%, 24% and 33%, respectively). There is value in rescreening and re-treating women who remain BV-positive after initial clindamycin treatment.
Primary syphilitic chancre on the upper arm in an HIV-1-infected patient
Authors: Aichelburg M C , Rieger A
Published: August 2012

A 32-year-old HIV-infected man presented with an ulcerating skin lesion with indurated borders on the upper right arm. Both dark-field microscopy and syphilis serology confirmed the diagnosis of primary syphilis. Extragenital syphilitic chancres are uncommon but nevertheless have to be kept in mind as they often delay diagnosis.
HIV-1 and herpes simplex virus type-2 genital shedding among co-infected women using self-collected swabs in Chiang Rai, Thailand
Authors: Forhan S E , Dunne E F , Sternberg M R , Whitehead S J , Leelawiwat W , Thepamnuay S , Chen C , Evans-Strickfaden TT , McNicholl J M , Markowitz L E
Published: August 2012

We analysed 528 genital self-collected swabs (SCS) from 67 HIV-1 and herpes simplex virus type-2 (HSV-2) co-infected women collected during the placebo month of a randomized crossover clinical trial of suppressive acyclovir in Chiang Rai, Thailand. In this first longitudinal study of HIV-1 and HSV-2 co-infected women using genital SCS specimens, we found frequent mucosal HIV-1 shedding. Overall, 372 (70%) swabs had detectable HIV-1 RNA with median HIV-1 viral load of 2.61 log10 copies/swab. We found no statistically significant association between detectable HIV-1 RNA and HSV-2 DNA in the same SCS specimen (adjusted odds ratio [aOR] 1.40; 95% confidence intervals [CI], 0.78–2.60, P = 0.25). Only baseline HIV-1 plasma viral load was independently associated with genital HIV-1 RNA shedding (aOR, 7.6; 95% CI, 3.3–17.2, P < 0.0001). SCS may be useful for future HIV-1 and HSV-2 studies because this method allows for frequent genital sampling, and inclusion of genital sites other than the cervix.
Missed opportunities for identifying primary HIV within genitourinary medical/HIV services
Authors: Sharrocks K , Jones C B , Naftalin C , Darling D , Fisher M , Fidler S , Fox J
Published: August 2012

To assess the ability of three genitourinary medical centres to clinically identify primary HIV infection (PHI). Cases of recently acquired HIV infection, identified using the Health Protection Agency (HPA) avidity assay on all HIV diagnoses from January to August 2009, were investigated by case-note review. Sixty-four individuals were identified as PHI using the HPA avidity assay. Of 64 individuals, 31 (48%) were identified clinically. Imperial College identified 8/26 (31%), Guys and St Thomas’ 15/27 (56%) and Brighton 8/11 (73%). Clinical suspicion of PHI was associated with reported unprotected anal intercourse ( P = 0.017), seroconversion symptoms ( P = 0.0004), a negative HIV test within six months ( P = 0.024) and avidity assay result availability ( P = 0.0169). Seventy percent of PHI cases missed had a documented risk factor. Thirty-five percent of those clinically identified with PHI were documented as informed of the associated enhanced infectivity. Suspicion of PHI was low despite documented risk factors and recent HIV-negative antibody tests. Counselling to prevent onward transmission was suboptimal.
An audit of chaperone use for intimate examinations in an integrated sexual health clinic
Authors: Allberry C , Fernando I
Published: August 2012

We performed an audit at the Edinburgh Chalmers Sexual Health Centre to examine if the use and documentation of chaperones complies with the guidance set out by the General Medical Council (GMC) and other regulatory bodies. The case-notes of patients seen in the non-specialist, morning clinics over a one-week period were studied. Only 20 of the 104 genital examinations undertaken were recorded as chaperoned. Only in five of the unchaperoned examinations was it documented that a chaperone was declined. Thus, a total of 24% patients had documentation regarding the presence of a chaperone or the offer of one. However, these results show that our department is certainly lacking in documentation of this, if not the use of chaperones itself. This falls short of the GMC guidance for good practice: primarily in place not only to protect patients from harm, but also to safeguard clinicians against false accusations of impropriety.
Boron-based pronucleophiles in catalytic (asymmetric) C(sp3)–allyl cross-couplings
Authors: Schneider Uwe , Huang Yi-Yong , Chakrabarti Ananya , Dao Hai Thanh , Morita Naohide , Kobayashi Shū
Published: August 2012

Allylic and allenyl boronates or boranes were uncovered as suitable pronucleophiles in catalytic C–C bond formations with C(sp3) electrophiles such as O,O-acetals and N,O-aminals or ethers and carbohydrates. These transformations were most efficiently catalyzed by In(I) triflate. Importantly, chiral counteranion-directed, catalytic asymmetric allylation and allenylation of N,O-aminals was developed by employing a catalyst system composed of In(I) chloride and a chiral silver 2,2'-dihydroxy-1,1'-binaphthalene (BINOL)-phosphate.
The Effects of Early Internationalization on Performance Outcomes in Young International Ventures: The Mediating Role of Marketing Capabilities
Authors: Zhou Lianxi , Wu Aiqi , Barnes Bradley R.
Published: August 2012

In an emerging market context, this article examines the impact of early international market entry on marketing capability development and performance outcomes in young and small entrepreneurial firms. The authors identify the importance of marketing capabilities and the boundary conditions associated with international commitment, as well as the type of international market entered (developed vs. emerging market), to determine performance outcomes in early internationalization. With survey data from more than 300 senior managers in China, the results indicate that early foreign market entry enhances a young venture's marketing capabilities, which in turn leads to international growth. The findings also reveal that young ventures tend to be in a better position to improve their marketing capabilities when their senior management demonstrates a high level of commitment to foreign markets. Furthermore, the impact of marketing capabilities on the performance outcomes of early internationalization seems more salient among ventures that target developed, rather than emerging, foreign markets. Theoretically, through the lens of organizational learning and the development of marketing capabilities, this article contributes to the study of international new ventures by demonstrating that marketing capabilities serve as enabling factors that help young international ventures mitigate their liabilities of foreignness to achieve international performance outcomes.
Stakeholders and Marketing Capabilities in International New Ventures: Evidence from Ireland, Sweden, and Denmark
Authors: Evers Natasha , Andersson Svante , Hannibal Martin
Published: August 2012

Few studies have examined the dynamic capabilities perspective in the context of international new ventures (INVs) and, in particular, toward their marketing activities. Using a cross-country case approach, this article explores the role of stakeholders in the marketing capability–building processes of INVs in Ireland, Sweden, and Denmark. The study reveals that different stakeholders play a critical role in influencing how INVs build their marketing capabilities to respond effectively to the dynamic nature of international markets in which they operate. The results show that different stakeholder groups (allied, cooperative, neutral, and entrepreneur) can influence the learning processes (single-, double-, and triple-loop) of the firm and can determine the nature of dynamic marketing capabilities (incremental, renewing, and regenerative) needed to create and sustain international competitive advantage. Furthermore, “effectuation logic” can explain how entrepreneurs manage and leverage stakeholder relationships in marketing capability processes to cocreate value for the firm. By incorporating dynamic capabilities, stakeholder, and learning theories, this study offers a dynamic, process-oriented model for INV research and provides much-needed qualitative insights into the dynamic capabilities theory of the firm.
Mourning, Remembrance, and Mahler's “Resurrection”
Authors: Kangas Ryan R
Published: August 2012

“You must have had the experience of burying someone dear to you,” wrote Gustav Mahler in a letter explaining his Second Symphony to the music critic Max Marschalk, suggesting that the critic's own experiences with death might help him better understand the symphony. Inversely, if listeners bring personal losses to bear on the piece, Mahler's Second Symphony offers one possible model for coping with death. If we take the distinction that Sigmund Freud draws between two responses to loss—melancholia and mourning—as a discursive frame, Mahler's Second Symphony may be heard as an attempt to come to terms with the death of a loved one by moving gradually from melancholia to mourning. According to Freud, a melancholic subject cannot truly cope with the traumatic experience and instead reenacts it, but someone who mourns truly remembers the loss and thus commemorates the dead, allowing them to live on, if only in memory.

Framed in such a way, the early movements of Mahler's Second Symphony—characterized by the alternation between halting sections that dissolve almost as soon as they begin and long-breathed melodies that seem to unfold effortlessly—suggest the melancholic subject's struggle between despair in the face of abject meaninglessness and a manic euphoria, neither of which addresses the loss. By contrast, the text in the symphony's final movement, adapted by Mahler from Friedrich Klopstock's chorale on the resurrection of the dead, encourages true remembrance of the deceased as a figure beyond death. Heard as a musical enactment of mourning, the final movement suggests that the dead who are mourned are resurrected through remembrance. Forcing us to acknowledge Mahler's death on some level, the final movement completes the work of mourning by engendering the composer's own resurrection in our memories as we witness each performance of his Second Symphony.
Assessment of Controversial Pediatric Asthma Management Options Using GRADE
Authors: Boluyt Nicole , Rottier Bart L. , de Jongste Johan C. , Riemsma Rob , Vrijlandt Elianne J.L.E. , Brand Paul L.P.
Published: August 2012

OBJECTIVES:

To develop explicit and transparent recommendations on controversial asthma management issues in children and to illustrate the usefulness of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach in rating the quality of evidence and strength of recommendations.

METHODS:

Health care questions were formulated for 3 controversies in clinical practice: what is the most effective treatment in asthma not under control with standard-dose inhaled corticosteroids (ICS; step 3), the use of leukotriene receptor antagonist for viral wheeze, and the role of extra fine particle aerosols. GRADE was used to rate the quality of evidence and strength of recommendations after performing systematic literature searches. We provide evidence profiles and considerations about benefit and harm, preferences and values, and resource use, all of which played a role in formulating final recommendations.

RESULTS:

By applying GRADE and focusing on outcomes that are important to patients and explicit other considerations, our recommendations differ from those in other international guidelines. We prefer to double the dose of ICS instead of adding a long-acting β-agonist in step 3; ICS instead of leukotriene receptor antagonist are the first choice in preschool wheeze, and extra fine particle ICS formulations are not first-line treatment in children with asthma. Recommendations are weak and based on low-quality evidence for critical outcomes.

CONCLUSIONS:

We provide systematically and transparently developed recommendations about controversial asthma management options. Using GRADE for guideline development may change recommendations, enhance guideline implementation, and define remaining research gaps.
Neonatal Hyperbilirubinemia in the Low-Intermediate–Risk Category on the Bilirubin Nomogram
Authors: Bromiker Ruben , Bin-Nun Alona , Schimmel Michael S. , Hammerman Cathy , Kaplan Michael
Published: August 2012

OBJECTIVE:

Predischarge bilirubin screening predicts neonatal hyperbilirubinemia. We evaluated the incidence of false-negative bilirubin screening among readmissions for hyperbilirubinemia.

METHODS:

In healthy term and late preterm, predominantly breastfeeding newborns, predischarge transcutaneous bilirubin values were plotted on the hour of life–specific bilirubin nomogram and confirmed with plasma total bilirubin in those with a transcutaneous reading ≥75th percentile, or between the 41st and 75th percentiles in the presence of predictive icterogenic risk factors. False-negative bilirubin screen was defined as a predischarge bilirubin value ≤75th percentile in a newborn who was subsequently readmitted for phototherapy.

RESULTS:

Of a total of 25 439 neonates born between 2008 and 2009, 143 (0.56%) were readmitted with a mean plasma total bilirubin of 18.7 ± 1.7 mg/dL at 125 ± 54 hours. False-negative predischarge bilirubin screen was identified in 46 (32.2%). Of these, 6 (4.2%) were in the low-risk zone (≤40th percentile, relative risk [RR] = 1) and 40 (28%) in the intermediate-low–risk zone (41st–75th percentile, RR 7.62 [95% confidence interval 3.23–17.96]). Of those in the high-risk zones, 76 (53.1%) were in the intermediate-high–risk zone (76th–95th percentile, RR 25.32 [11.03–58.10]) and 21 (14.7%) in the high-risk zone (>95th percentile, RR 27.78 [11.23–68.70]).

CONCLUSIONS:

Predischarge bilirubin levels in newborns classified as low risk did not eliminate the risk of readmission for hyperbilirubinemia. All newborns including those at low risk must be vigilantly observed for subsequent hyperbilirubinemia.
Bone Mineral Density and Vitamin D Status Among African American Children With Forearm Fractures
Authors: Ryan Leticia Manning , Teach Stephen J. , Singer Steven A. , Wood Rachel , Freishtat Robert , Wright Joseph L. , McCarter Robert , Tosi Laura , Chamberlain James M.
Published: August 2012

OBJECTIVE:

To determine whether African American children with forearm fractures have decreased bone mineral density and an increased prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D level ≤20 ng/mL) compared with fracture-free control patients.

METHODS:

This case-control study in African American children, aged 5 to 9 years, included case patients with forearm fracture and control patients without fracture. Evaluation included measurement of bone mineral density and serum 25-hydroxyvitamin D level. Univariable and multivariable analyses were used to test for associations between fracture status and 2 measures of bone health (bone mineral density and 25-hydroxyvitamin D level) while controlling for other potential confounders.

RESULTS:

The final sample included 76 case and 74 control patients. There were no significant differences between case and control patients in age, gender, parental education level, enrollment season, outdoor play time, height, or mean dietary calcium nutrient density. Cases were more likely than control patients to be overweight (49.3% vs 31.4%, P = .03). Compared with control patients, case patients had lower whole body z scores for bone mineral density (0.62 ± 0.96 vs 0.98 ± 1.09; adjusted odds ratio 0.38 [0.20–0.72]) and were more likely to be vitamin D deficient (47.1% vs 40.8%; adjusted odds ratio 3.46 [1.09–10.94]).

CONCLUSIONS:

These data support an association of lower bone mineral density and vitamin D deficiency with increased odds of forearm fracture among African American children. Because suboptimal childhood bone health also negatively impacts adult bone health, interventions to increase bone mineral density and correct vitamin D deficiency are indicated in this population to provide short-term and long-term benefits.
Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome
Authors: Marcus Carole L. , Brooks Lee J. , Ward Sally Davidson , Draper Kari A. , Gozal David , Halbower Ann C. , Jones Jacqueline , Lehmann Christopher , Schechter Michael S. , Sheldon Stephen , Shiffman Richard N. , Spruyt Karen
Published: August 2012

OBJECTIVE:

This technical report describes the procedures involved in developing recommendations on the management of childhood obstructive sleep apnea syndrome (OSAS).

METHODS:

The literature from 1999 through 2011 was evaluated.

RESULTS AND CONCLUSIONS:

A total of 3166 titles were reviewed, of which 350 provided relevant data. Most articles were level II through IV. The prevalence of OSAS ranged from 0% to 5.7%, with obesity being an independent risk factor. OSAS was associated with cardiovascular, growth, and neurobehavioral abnormalities and possibly inflammation. Most diagnostic screening tests had low sensitivity and specificity. Treatment of OSAS resulted in improvements in behavior and attention and likely improvement in cognitive abilities. Primary treatment is adenotonsillectomy (AT). Data were insufficient to recommend specific surgical techniques; however, children undergoing partial tonsillectomy should be monitored for possible recurrence of OSAS. Although OSAS improved postoperatively, the proportion of patients who had residual OSAS ranged from 13% to 29% in low-risk populations to 73% when obese children were included and stricter polysomnographic criteria were used. Nevertheless, OSAS may improve after AT even in obese children, thus supporting surgery as a reasonable initial treatment. A significant number of obese patients required intubation or continuous positive airway pressure (CPAP) postoperatively, which reinforces the need for inpatient observation. CPAP was effective in the treatment of OSAS, but adherence is a major barrier. For this reason, CPAP is not recommended as first-line therapy for OSAS when AT is an option. Intranasal steroids may ameliorate mild OSAS, but follow-up is needed. Data were insufficient to recommend rapid maxillary expansion.
Circumcision Policy Statement
Authors:   TASK FORCE ON CIRCUMCISION, Blank Susan , Brady Michael , Buerk Ellen , Carlo Waldemar , Diekema Douglas , Freedman Andrew , Maxwell Lynne , Wegner Steven
Published: August 2012

Male circumcision is a common procedure, generally performed during the newborn period in the United States. In 2007, the American Academy of Pediatrics (AAP) formed a multidisciplinary task force of AAP members and other stakeholders to evaluate the recent evidence on male circumcision and update the Academy’s 1999 recommendations in this area. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it. Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV. The American College of Obstetricians and Gynecologists has endorsed this statement.
Role of Pt Nanoparticles in Photoreactions on TiO2 Photoelectrodes
Authors: An Woo-Jin , Wang Wei-Ning , Ramalingam Balavinayagam , Mukherjee Somik , Niedzwiedzki Dariusz M. , Gangopadhyay Shubhra , Biswas Pratim
Published: August 2012

Highly efficient Pt-TiO2 composite photoelectrodes were synthesized by combining two novel deposition methods: ACVD and a room temperature RF (radio frequency) magnetron sputtering method. A room temperature RF magnetron sputtering method allowed uniform deposition of Pt nanoparticles (NPs) onto the as-synthesized nanostructured columnar TiO2 films by ACVD. Pt NP sizes from 0.5 to 3 nm demonstrating a high particle density (>1012 cm−2) could be achieved by varying deposition time with constant pressure and power intensity. As-synthesized Pt-TiO2 films were used as photoanodes for water photolysis. Pt nanoparticles deposited onto the TiO2 film for 20s produced the highest photocurrent (7.92 mA/cm2 to 9.49 mA/cm2) and maximized the energy conversion efficiency (16.2 % to 21.2 %) under UV illumination. However, as the size of Pt particles increased, more trapping sites for photogenerated electron-hole pairs decreased photoreaction.
Análise do posicionamento de indústrias calçadistas na região de Franca
Authors: Machado Neto Alfredo José , Giraldi Janaina de Moura Engracia
Published: August 2012

Este estudo analisa estratégias de posicionamento da indústria calçadista da região de Franca (SP) com relação ao mercado interno. O trabalho apresenta um panorama da indústria calçadista nacional; em seguida, são apresentados os resultados de uma pesquisa empírica empreendida com empresas da região. Uma análise de conglomerados permitiu identificar quatro diferentes grupos de empresas com base em cinco variáveis (preços praticados, custos de produção, qualidade dos produtos, tecnologia de produção e capacidade de inovação), utilizando três diferentes estratégias: foco no segmento de calçados masculinos para um público de renda baixa (grupo 1), baixo custo (grupos 2 e 3), e diferenciação por meio de produtos de melhor qualidade e preços mais altos (grupo 4). Ao final, foram sugeridas alternativas estratégicas para as empresas consideradas em posição desfavorável em comparação às concorrentes.
Odour emission ability (OEA) and its application in assessing odour removal efficiency
Authors: Wang Xinguang , Parcsi Gavin , Sivret Eric , Le Hung , Wang Bei , Stuetz Richard M.
Published: August 2012

Odourous emissions from sewer networks and wastewater treatment plants (WWTPs) can significantly impact a local population. Sampling techniques such as wind tunnels and flux hood chambers are traditionally used to collect area source samples for subsequent quantification of odour emission rates using dilution olfactometry, however these methods are unsuitable for assessing liquid samples from point sources due to the large liquid volumes required. To overcome this limitation, a gas phase sample preparation method was developed for assessing the total Odour Emission Ability (OEA) from a liquid sample. The method was validated using two volatile organic sulphur compounds (VOSCs), dimethyl-trisulphide (DMTS) and bismethylthiomethane (BMTM) that are frequently detected from sewers and WWTPs and are relatively stable compared with common VOSCs like mercaptan or methyl mercaptan. The recovery rates of DMTS and BMTM were quantified by injecting a known volume of a standard liquid sample into Tedlar bags using a static injection and a dynamic injection methodology. It was confirmed that both dynamic and static injection methods at ambient condition achieved high recovery rates with no need to consider increasing evaporation by elevating the temperature. This method can also be used to assess odour removal effectiveness of liquids by comparing the OEA before and after the treatment tests. Two application examples were presented.
Biological oxidation of sulphides by microorganisms present in the scum layer of UASB reactors treating domestic wastewater
Authors: Garcia G. P. , Souza C. L. , Glória R. M. , Silva S. Q. , Chernicharo C. A. L.
Published: August 2012

This study aimed at the identification of microorganisms present in the scum layer of the settler compartment of upflow anaerobic sludge blanket (UASB) reactors, and to evaluate their role in the biological oxidation of sulphides. The experiments were conducted using scum samples taken from two pilot-scale UASB reactors, both treating domestic wastewater. Microorganisms similar to Beggiatoa sp., Thiotrix sp. and species of cyanobacteria were identified based on their morphology, and most of them have been shown to be capable of carrying out sulphur oxidation. Tests of biological oxidation of sulphides using scum and cultures of the cyanobacteria Phormidium and Pseudoanabaena showed a significant decrease in the concentrations of the sulphides, suggesting that the microorganisms present in the scum layer can play a role in the minimization of odour emissions.
Volatilization of hydrogen sulfide from a quiescent surface
Authors: de Cassia Feroni Rita , Santos Jane Meri , Reis Neyval Costa
Published: August 2012

Air–water mass transfer of hydrogen sulfide from a shallow tank with a quiescent surface under the influence of weak wind stress on the water surface was studied numerically using a two-dimensional model. The flow field in the tank was investigated using a computational code based on a finite volume, which is used to numerically solve momentum, mass and continuity conservation equations. The results show that water phase flow field is strongly dependent on the wind-induced surface velocity and the aspect ratio of the tank. Based on the numerical study, the liquid-side mass transfer coefficient is correlated with Reynolds number (Re), tank aspect ratio (AR) and Schmidt number (Sc). Overall mass transfer coefficient (KL) values extend further downstream as the Re number increases.
A strategy for reducing pollutants at source in order to obtain sustainable agricultural recycling of wastewater sludge
Authors: Mattsson A. , Mattsson J. , Davidsson F.
Published: August 2012

The Swedish licensing system for wastewater sludge use in agriculture, REVAQ, sets challenges. These include a maximum nominal accumulation rate of 0.2%/year on farmland, for specified metals, to be reached by 2025. Here a model is suggested, and applied for the Gothenburg regional wastewater treatment plant, Gryaab, to quantify historic sludge quality improvements and necessary future development. Local sampling campaigns covering two decades show a substantial reduction of heavy metals and ecologically harmful organic substances (such as adsorbable organic halogens, nonylphenols, phthalates, naphthalenes and polycyclic aromatic hydrocarbons) from households and society at large. For the metals studied the historic mass flow reduction to sludge varies from 1 to 2%/year for mercury, zinc and copper to 15%/year for silver. Copper needs further reduction, involving water pipes and copper roofing. Silver is rare in soil, and significant reduction from already low levels is needed to reach the accumulation goal. Further reduction of other metals involves addressing storm- and drainage water entering the sewers and the sediments already in the sewers. Fulfilling the goals of REVAQ implies national and local measures affecting public and private stakeholders including property owners, the wastewater collection system, commercial businesses and legislating authorities.
ADM1 performance using SS-OFMSW with non-acclimated inoculums
Authors: El-Fadel M. , Maroun R. , Bou Fakher Eldeen R. , Ghanimeh S.
Published: August 2012

This paper assesses the anaerobic digestion (AD) of the source-sorted organic fraction of municipal solid waste (SS-OFMSW). For this purpose, an experimental programme was implemented involving the operation and monitoring of two bench-scale anaerobic digesters, continuously fed with SS-OFMSW. The mathematical model (ADM1) was then applied to simulate the process of AD of SS-OFMSW. While start-up of the digesters was relatively slow, re-inoculation with cattle manure with effluent dilution reduced the acclimation period and achieved better stability, accommodating a feeding rate at an OLR = 2.39 kg TVS m−3 day−1. The high recorded methane gas production rate, reaching (0.1–2.5 m3 CH4/m3 reactor day), confirms the excellent biodegradability of the type of waste used (SS-OFMSW) and its suitability for AD. Satisfactory simulations of soluble chemical oxygen demand (COD), pH, and methane composition of biogas were obtained, whereas volatile fatty acid (VFA) concentrations in both reactors were over-predicted albeit capturing its general trend.
Influence of photoperiod on carbon dioxide and methane emissions from two pilot-scale stabilization ponds
Authors: Silva Juan P. , Ruiz José L. , Peña Miguel R. , Lubberding Henk , Gijzen Huub
Published: August 2012

Greenhouse gas (GHG) emissions (CO2, CH4) from pilot-scale algal and duckweed-based ponds (ABP and DBP) were measured using the static chamber methodology. Daylight and nocturnal variations of GHG and wastewater characteristics (e.g. chemical oxygen demand (COD), pH) were determined via sampling campaigns during midday (12:30–15:30) and midnight (00:30–03:30) periods. The results showed that under daylight conditions in ABP median emissions were −232 mg CO2 m−2 d−1 and 9.9 mg CH4 m−2 d−1, and in DBP median emissions were −1,654.5 mg CO2 m−2 d−1 and 71.4 mg CH4 m−2 d−1, respectively. During nocturnal conditions ABP median emissions were 3,949.9 mg CO2 m−2 d−1, 12.7 mg CH4 m−2 d−1, and DBP median emissions were 5,116 mg CO2 m−2 d−1, 195.2 mg CH4 m−2 d−1, respectively. Once data measured during daylight were averaged together with nocturnal data the median emissions for ABP were 1,566.8 mg CO2 m−2 d−1 and 72.1 mg CH4 m−2 d−1, whilst for DBP they were 3,016.9 mg CO2 m−2 d− and 178.9 mg CH4 m−2 d−1, respectively. These figures suggest that there were significant differences between CO2 emissions measured during daylight and nocturnal periods (p < 0.05). This shows a sink-like behaviour for both ABP and DBP in the presence of solar light, which indicates the influence of photosynthesis in CO2 emissions. On the other hand, the fluxes of CH4 indicated that DBP and ABP behave as net sources of CH4 during day and night, although higher emissions were observed from DBP. Overall, according to the compound average (daylight and nocturnal emissions) both ABP and DBP systems might be considered as net sources of GHG.
Nutrient and trace element supply in anaerobic digestion plants and effect of trace element application
Authors: Lindorfer H. , Ramhold D. , Frauz B.
Published: August 2012

To investigate process behaviour and process disturbances in anaerobic digestion (AD) plants, samples of more than 1500 main digesters were taken and concentrations of macro- and micronutrients as well as volatile fatty acids were analyzed. Out of these samples, 600 digesters using energy crops only and 80 digesters using waste substrates were selected to compare the chemical composition as a result of different substrate feeding. High variations in element concentrations were found in both groups. In 60 plants with low micronutrient levels, trace elements were added and process changes were observed. A significant decrease of volatile fatty acids and an increase in digester performance were measured after trace element application. Furthermore, an increase of bacterial biomass could be detected.
Biofiltration of hydrogen sulfide by Sulfolobus metallicus at high temperatures
Authors: Morales M. , Silva J. , Morales P. , Gentina J. C. , Aroca G.
Published: August 2012

Biofiltration of reduced sulfur compounds such as hydrogen sulfide has been mainly applied to emissions at mild temperatures (25 to 35 °C). However, an important number of industrial gaseous emission containing sulfur compounds, from diverse industrial sectors (petroleum refinery, cellulose production, smelting, rendering plants and food industries) are emitted at temperatures over 50 °C. Most of the studies on thermophilic systems report that a higher elimination capacity can be obtained at elevated temperature, allowing the design of smaller equipment for the same loading rate than that required for removing the same load under mesophilic conditions. A biotrickling filter inoculated with Sulfolobus metallicus, which operates at three different residence times, 60, 80 and 120 s, and two different temperatures (45 and 55 °C) for treating H2S is reported. The input loads of H2S were progressively increased from 0 to 100 gS/m3. The aim of this study was to determine the capacity and ability of S. metallicus to oxidize H2S at high temperatures. The better removal capacity of H2S obtained was 37.1 ± 1.7 gS/m3 h at 55 °C for a residence time of 120 s. The difference of the removal capacity of H2S between the two temperatures was 4 g/m3 h on average of sulfur removal for the different residence times.
Performance of a modified RBC system in simulated municipal wastewater treatment
Authors: Yun-lu Tang , Dong-fang Liu , Xian-rong Meng , Jie Yu , Jin Wang , Yu-xing Liu , Ke-xun Li , Lander James
Published: August 2012

A new method based on rotating biological contactor (RBC) was employed for solving the problems of long hydraulic retention times (HRT) low specific surface area and organic loading rates (OLR) in conventional RBCs. The system showed its particular adsorption ability of microorganisms in the biofilm-attaching period. Microbes on the first cage were observed in comparison with the second one. Packing biodisc also had a good shock load tolerance. It was observed that the system performance improved at higher HRTs, while at the increased level of input OLR, the removal performance worsened slightly. The positive role of rotational speed in the treatment of municipal wastewater was more pronounced in the range of 10–12 rpm. Chemical oxygen demand (COD) removal rate achieved 94% under the optimal operating conditions, which were HRT of 1.5 h, rotational speed of 9.9 rpm. The modified RBC system is highly beneficial to engineering application for better system performance and lower energy consumption.
Estimating the recreational carrying capacity of a lowland river section
Authors: Lorenz Stefan , Pusch Martin T.
Published: August 2012

Recreational boating represents a major human use of inland waters in many regions. However, boating tourism may affect the ecological integrity of surface waters in multiple ways. In particular, surface waves produced by boating may disturb freshwater invertebrates, such as interrupting the filtration activity of benthic mussels. As mussels may significantly contribute to self-purification, disturbance may have crucial impacts on water quality, and thus on water tourism. In this paper we calculate the carrying capacity of a river section for sustainable boating tourism based on the preservation of water quality. This approach is complemented by spatial and social approaches for carrying capacity estimates. The ecological carrying capacity significantly decreases with lower water levels during summer. Hence, the analysis of variables that influence the river's carrying capacity allows the formation of recommendations for management measures that integrate social, touristic and ecological aspects.
Removal of Cu(II) ions from aqueous solutions using N-carboxymethyl chitosan
Authors: Wang C. X. , Song Q. P.
Published: August 2012

N-carboxymethyl chitosan (NCMC) was synthesized by reacting chitosan with chloroacetic acid in water under triethylamine (Et3N) as catalyst. The chemical structures of NCMC were characterized by Fourier transform infrared (FT-IR) and hydrogen-1 nuclear magnetic resonance (1H-NMR) spectroscopy and confirmed that carboxymethylation occurred on the amino groups. Samples of NCMC were used for removal of Cu(II) from aqueous solution. The effects of degree of substitution of NCMC, initial pH value and adsorption kinetics on the adsorption were studied. Adsorption experiments showed that NCMC has a high adsorption speed and high adsorption capacity for remove Cu(II) from aqueous solution. The adsorption kinetics data were best fitted with the pseudo-second-order model. The experimental equilibrium data of Cu(II) on the NCMC were both fitted to the Langmuir model and Freundlich model, which revealed that the maximum capacity for monolayer saturation was 147.93 mg/g.