bluuebunny/crossref_metadata_2025 huggingface dataset:
Multi‐Scale Qualitative Location: A Topology‐Based Model
Authors: Du Shihong , Feng Chen‐Chieh , Wang Qiao , Guo Luo
Published: October 2013

Qualitative locations describe spatial objects by relating the spatial objects to a frame of reference (e.g. a regional partition in this study) with qualitative relations. Existing models only formalize spatial objects, frames of reference, and their relations at one scale, thus limiting their applicability in representing location changes of spatial objects across scales. A topology‐based, multi‐scale qualitative location model is proposed to represent the associations of multiple representations of the same objects with respect to the frames of reference at different levels. Multi‐scale regional partitions are first presented to be the frames of reference at multiple levels of scale. Multi‐scale locations are then formalized to relate multiple representations of the same objects to the multiple frames of reference by topological relations. Since spatial objects, frames of reference, and topological relations in qualitative locations are scale dependent, scale transformation approaches are presented to derive possible coarse locations from detailed locations by incorporating polygon merging, polygon‐to‐line and polygon‐to‐point operators.
In Defence of Cornell Realism: a Reply to Elizabeth Tropman
Authors: Long Joseph
Published: October 2013

Cornell realists claim, among other things, that moral knowledge can be acquired in the same basic way that scientific knowledge is acquired. Recently in this journal Elizabeth Tropman has presented two arguments against this claim. In the present article, I attempt to show that the first argument attacks a straw man and the second mischaracterizes the Cornell realists' epistemology and ends up begging the question. I close by suggesting that, given Tropman's own apparent views, her objections are also probably misplaced.
Microbial screening of unrelated cord blood units in a Chinese cord blood bank
Authors: Zhu L. , Lv H. , Wang Y. , Yang J. , Ni B. , Meng Z.
Published: October 2013

Background

Given limited sample volume available for sterility testing, optimal testing methods and algorithms of cord blood (CB) have not been established according to standards.

Study Design and Methods

The volume of CB unit was reduced to 20 mL in a closed system. Hetastarch and cryopreservation solution was added to the processed CB unit in Class 100 environment. In the routine sterility testing, 20 mL of red blood cells (RBC) sample was cultured in aerobic and anaerobic culture bottles. In verification post‐thaw culture of the final product, some of the discarded final product units were also sampled and cultured after thaw. All the culture bottles were incubated in the BacT/ALERT 3D system.

Results

In the routine sterility testing, 139 of 7032 CB units (1·98%) were contaminated with microorganism. In 84 of these 139 units (60·4%) only the anaerobic bottle was positive. Lactobacillus spp. were the most prevalent contaminant. Sixty‐two discarded CB stem cell units were recultured after thaw. Of these, 10 of 48 units with a positive culturing of RBC sample were negative in the post‐thaw reculture. One of 14 units with negative culturing of RBC sample was contaminated with Bifidobacterium breve in special verification test.

Conclusion

Our study demonstrates the predominant organisms implicated in CB microbial contamination were part of the human intestinal and vaginal flora. The larger sample volume and anaerobic culture would significantly increase the detection rate of microbial contaminated CB. We also found that potential transfusion‐transmitted bacterial infection risk still existed in final product although microbial screening was performed.
Determinants of moderate‐to‐severe anaemia among women of reproductive age in Tanzania: analysis of data from the 2010 Tanzania demographic and health survey
Authors: Wilunda Calistus , Massawe Siriel , Jackson Caroline
Published: October 2013

Objective

To identify determinants of moderate‐to‐severe anaemia among women of reproductive age in Tanzania.

Methods

We included participants from the 2010 Tanzania Demographic and Health Survey, which collected data on socio‐demographic and maternal health and determined haemoglobin levels from blood samples. We performed logistic regression to calculate adjusted odds ratios for associations between socio‐demographic, contextual, reproductive and lifestyle factors, and moderate‐to‐severe anaemia and investigated interactions between certain risk factors.

Results

Of 9477 women, 20.1% were anaemic. Pregnancy was significantly associated with anaemia (adjusted OR 1.75, 95% CI 1.43–2.15), but the effect varied significantly by urban/rural residence, wealth and education. The effect of pregnancy was stronger in women without education and those who were in lower wealth groups, with significant interactions observed for each of these factors. Education was associated with a lower anaemia risk, particularly in the poorest group (OR 0.58, 95% CI 0.43–0.80), and in pregnant women. The risk of anaemia fell with rising iron supplementation coverage. Lack of toilet facilities increased anaemia risk (OR 1.26, 95% CI 1.00–1.60), whereas using hormonal contraception reduced it. There was no association with age, urban/rural residence, wealth or type of cooking fuel in adjusted analysis.

Conclusion

Pregnant women in Tanzania are particularly at risk of moderate‐to‐severe anaemia, with the effect modified by urban/rural residence, education and wealth. Prevention interventions should target women with lower education or without proper sanitation facilities, and women who are pregnant, particularly if they are uneducated or in lower wealth groups.
Prevalence and risk factors of syphilis infection among female sex workers in Shenzhen, China: an observational study (2009–2012)
Authors: Cai R. , Tan J. G. , Chen L. , Richardus J. H. , de Vlas S. J.
Published: October 2013

Objective

To investigate prevalence and risk factors of syphilis infection among female sex workers (FSWs) in Shenzhen, China.

Methods

Observational study among (2009–2012) 1653 FSWs recruited by venue‐based sampling using questionnaire‐based interviews for socio‐demographics, behaviours and syphilis testing results. Logistic regression was used to assess risk factors of syphilis infection.

Results

The overall syphilis prevalence was 4.7%, showing a slightly decreasing trend. Factors significantly associated with syphilis infection were inconsistent condom use (OR = 1.87, P = 0.015), illicit drug use (OR = 5.45, P < 0.001) and older age in years (OR = 1.08, P < 0.001). Venues where FSWs were recruited and duration of commercial sex work were not significantly associated with syphilis infection (P > 0.05).

Conclusions

Syphilis is still common among FSWs in Shenzhen, China. Current comprehensive prevention programmes (e.g. condom promotion and peer education) should be continued to maintain and increase safe sexual practices and to reduce illicit drug use among FSWs. Expanding point‐of‐care syphilis screening programmes may be an important strategy for early diagnosis. We recommend timely and effective treatment programmes to be linked to such screening programmes.
Functional, structural and phylogenetic analysis of domains underlying the Al sensitivity of the aluminum‐activated malate/anion transporter, TaALMT1
Authors: Ligaba Ayalew , Dreyer Ingo , Margaryan Armine , Schneider David J. , Kochian Leon , Piñeros Miguel
Published: October 2013

Triticum aestivum aluminum‐activated malate transporter (TaALMT1) is the founding member of a unique gene family of anion transporters (ALMTs) that mediate the efflux of organic acids. A small sub‐group of root‐localized ALMTs, including TaALMT1, is physiologically associated with in planta aluminum (Al) resistance. TaALMT1 exhibits significant enhancement of transport activity in response to extracellular Al. In this study, we integrated structure–function analyses of structurally altered TaALMT1 proteins expressed in Xenopus oocytes with phylogenic analyses of the ALMT family. Our aim is to re‐examine the role of protein domains in terms of their potential involvement in the Al‐dependent enhancement (i.e. Al‐responsiveness) of TaALMT1 transport activity, as well as the roles of all its 43 negatively charged amino acid residues. Our results indicate that the N‐domain, which is predicted to form the conductive pathway, mediates ion transport even in the absence of the C‐domain. However, segments in both domains are involved in Al3+ sensing. We identified two regions, one at the N‐terminus and a hydrophobic region at the C‐terminus, that jointly contribute to the Al‐response phenotype. Interestingly, the characteristic motif at the N‐terminus appears to be specific for Al‐responsive ALMTs. Our study highlights the need to include a comprehensive phylogenetic analysis when drawing inferences from structure–function analyses, as a significant proportion of the functional changes observed for TaALMT1 are most likely the result of alterations in the overall structural integrity of ALMT family proteins rather than modifications of specific sites involved in Al3+ sensing.
Light‐dependent, plastome‐wide association of the plastid‐encoded RNA polymerase with chloroplast DNA
Authors: Finster Sabrina , Eggert Erik , Zoschke Reimo , Weihe Andreas , Schmitz‐Linneweber Christian
Published: October 2013

Plastid genes are transcribed by two types of RNA polymerases: a plastid‐encoded eubacterial‐type RNA polymerase (PEP) and nuclear‐encoded phage‐type RNA polymerases (NEPs). To investigate the spatio‐temporal expression of PEP, we tagged its α–subunit with a hemagglutinin epitope (HA). Transplastomic tobacco plants were generated and analyzed for the distribution of the tagged polymerase in plastid sub‐fractions, and associated genes were identified under various light conditions. RpoA:HA was detected as early as the 3rd day after imbibition, and was constitutively expressed in green tissue over 60 days of plant development. We found that the tagged polymerase subunit preferentially associated with the plastid membranes, and was less abundant in the soluble stroma fraction. Attachment of RpoA:HA to the membrane fraction during early seedling development was independent of DNA, but at later stages of development, DNA appears to facilitate attachment of the polymerase to membranes. To survey PEP‐dependent transcription units, we probed for nucleic acids enriched in RpoA:HA precipitates using a tobacco chloroplast whole‐genome tiling array. The most strongly co‐enriched DNA fragments represent photosynthesis genes (e.g. psbA, psbC, psbD and rbcL), whose expression is known to be driven by PEP promoters, while NEP‐dependent genes were less abundant in RpoA:HA precipitates. Additionally, we demonstrate that the association of PEP with photosynthesis‐related genes was reduced during the dark period, indicating that plastome‐wide PEP–DNA association is a light‐dependent process.
Increased leaf mesophyll porosity following transient retinoblastoma‐related protein silencing is revealed by microcomputed tomography imaging and leads to a system‐level physiological response to the altered cell division pattern
Authors: Dorca‐Fornell Carmen , Pajor Radoslaw , Lehmeier Christoph , Pérez‐Bueno Marísa , Bauch Marion , Sloan Jen , Osborne Colin , Rolfe Stephen , Sturrock Craig , Mooney Sacha , Fleming Andrew
Published: October 2013

The causal relationship between cell division and growth in plants is complex. Although altered expression of cell‐cycle genes frequently leads to altered organ growth, there are many examples where manipulation of the division machinery leads to a limited outcome at the level of organ form, despite changes in constituent cell size. One possibility, which has been under‐explored, is that altered division patterns resulting from manipulation of cell‐cycle gene expression alter the physiology of the organ, and that this has an effect on growth. We performed a series of experiments on retinoblastoma‐related protein (RBR), a well characterized regulator of the cell cycle, to investigate the outcome of altered cell division on leaf physiology. Our approach involved combination of high‐resolution microCT imaging and physiological analysis with a transient gene induction system, providing a powerful approach for the study of developmental physiology. Our investigation identifies a new role for RBR in mesophyll differentiation that affects tissue porosity and the distribution of air space within the leaf. The data demonstrate the importance of RBR in early leaf development and the extent to which physiology adapts to modified cellular architecture resulting from altered cell‐cycle gene expression.
Multiple microscopic approaches demonstrate linkage between chromoplast architecture and carotenoid composition in diverse Capsicum annuum fruit
Authors: Kilcrease James , Collins Aaron M. , Richins Richard D. , Timlin Jerilyn A. , O'Connell Mary A.
Published: October 2013

Increased accumulation of specific carotenoids in plastids through plant breeding or genetic engineering requires an understanding of the limitations that storage sites for these compounds may impose on that accumulation. Here, using Capsicum annuum L. fruit, we demonstrate directly the unique sub‐organellar accumulation sites of specific carotenoids using live cell hyperspectral confocal Raman microscopy. Further, we show that chromoplasts from specific cultivars vary in shape and size, and these structural variations are associated with carotenoid compositional differences. Live‐cell imaging utilizing laser scanning confocal (LSCM) and confocal Raman microscopy, as well as fixed tissue imaging by scanning and transmission electron microscopy (SEM and TEM), all demonstrated morphological differences with high concordance for the measurements across the multiple imaging modalities. These results reveal additional opportunities for genetic controls on fruit color and carotenoid‐based phenotypes.
PEX5, the Shuttling Import Receptor for Peroxisomal Matrix Proteins, Is a Redox‐Sensitive Protein
Authors: Apanasets Oksana , Grou Cláudia P. , Van Veldhoven Paul P. , Brees Chantal , Wang Bo , Nordgren Marcus , Dodt Gabriele , Azevedo Jorge E. , Fransen Marc
Published: October 2013

Peroxisome maintenance depends on the import of nuclear‐encoded proteins from the cytosol. The vast majority of these proteins is destined for the peroxisomal lumen and contains a C‐terminal peroxisomal targeting signal, called PTS1. This targeting signal is recognized in the cytosol by the receptor PEX5. After docking at the peroxisomal membrane and release of the cargo into the organelle matrix, PEX5 is recycled to the cytosol through a process requiring monoubiquitination of an N‐terminal, cytosolically exposed cysteine residue (Cys11 in the human protein). At present, the reason why a cysteine, and not a lysine residue, is the target of ubiquitination remains unclear. Here, we provide evidence that PTS1 protein import into human fibroblasts is a redox‐sensitive process. We also demonstrate that Cys11 in human PEX5 functions as a redox switch that regulates PEX5 activity in response to intracellular oxidative stress. Finally, we show that exposure of human PEX5 to oxidized glutathione results in a ubiquitination‐deficient PEX5 molecule, and that substitution of Cys11 by a lysine can counteract this effect. In summary, these findings reveal that the activity of PEX5, and hence PTS1 import, is controlled by the redox state of the cytosol. The potential physiological implications of these findings are discussed.
Simultaneous extracorporeal membrane oxygenation and therapeutic plasma exchange procedures are tolerable in both pediatric and adult patients
Authors: Dyer Mitchell , Neal Matthew D. , Rollins‐Raval Marian A. , Raval Jay S.
Published: October 2013

Background

Extracorporeal membrane oxygenation (ECMO) has been used in patients with pulmonary and/or cardiac disease. In rare circumstances, some patients may have to undergo simultaneous therapeutic plasma exchange (TPE). We sought to characterize simultaneous ECMO and TPE procedures at our institution.

Study Design and Methods

Retrospective analysis of medical records was performed for patients who underwent simultaneous ECMO and TPE. Patient demographics, diagnoses, TPE indications and variables, procedural complications, blood use, laboratory data, and outcomes were collected.

Results

Seventy‐six patients underwent 293 simultaneous ECMO and TPE procedures; the majority involved pediatric patients, and most patients weighed less than 15 kg. In children, the two most frequent reasons for ECMO were congenital cardiac disease and sepsis; in adults, they were congestive heart failure or cardiomyopathy and severe pulmonary disease. In children, the two most frequent indications for TPE while on ECMO were multisystem organ failure and coagulopathy; in adults, they were humoral rejection of cardiac and pulmonary allografts. Blood product utilization during simultaneous ECMO and TPE was substantial in all patients. The complications of simultaneous ECMO and TPE were hypocalcemia (47 and 27.6% in children and adults, respectively) and hypotension (22.1 and 34.2% in children and adults, respectively). Approximately 45% of children and adults had resolutions of their apheresis indications after completing their TPE regimen.

Conclusions

Despite the hypocalcemic and hypotensive reactions that occurred during simultaneous ECMO and TPE, apheresis treatment regimens were successfully completed in all patients. With clear communication between ECMO and apheresis teams, along with close patient and instrument monitoring, simultaneous ECMO and TPE is tolerable and can be performed in critically ill children and adults.
Pathogen inactivation and removal methods for plasma‐derived clotting factor concentrates
Authors: Klamroth Robert , Gröner Albrecht , Simon Toby L.
Published: October 2013

Pathogen safety is crucial for plasma‐derived clotting factor concentrates used in the treatment of bleeding disorders. Plasma, the starting material for these products, is collected by plasmapheresis (source plasma) or derived from whole blood donations (recovered plasma). The primary measures regarding pathogen safety are selection of healthy donors donating in centers with appropriate epidemiologic data for the main blood‐transmissible viruses, screening donations for the absence of relevant infectious blood‐borne viruses, and release of plasma pools for further processing only if they are nonreactive for serologic markers and nucleic acids for these viruses. Despite this testing, pathogen inactivation and/or removal during the manufacturing process of plasma‐derived clotting factor concentrates is required to ensure prevention of transmission of infectious agents. Historically, hepatitis viruses and human immunodeficiency virus have posed the greatest threat to patients receiving plasma‐derived therapy for treatment of hemophilia or von Willebrand disease. Over the past 30 years, dedicated virus inactivation and removal steps have been integrated into factor concentrate production processes, essentially eliminating transmission of these viruses. Manufacturing steps used in the purification of factor concentrates have also proved to be successful in reducing potential prion infectivity. In this review, current techniques for inactivation and removal of pathogens from factor concentrates are discussed. Ideally, production processes should involve a combination of complementary steps for pathogen inactivation and/or removal to ensure product safety. Finally, potential batch‐to‐batch contamination is avoided by stringent cleaning and sanitization methods as part of the manufacturing process.
Postoperative management of severe acute anemia in a Jehovah's Witness
Authors: de Araújo Azi Liana Maria Tôrres , Lopes Fernando Muniz , Garcia Luis Vicente
Published: October 2013

Background

Low levels of hemoglobin (Hb) are not rare in patients who refuse blood components but this case is unique due to the severity of anemia and the possibility that her previous episode of acute normovolemic hemodilution has influenced her outcome.

Case Report

We report an incident involving acute blood loss after surgery with an extremely low hematocrit. Despite her Hb levels (2.8 g/dL) she remained lucid, expressing her wish not to receive transfusion. When the patient lost consciousness (Hb, 1.4 g/dL) she was promptly sedated, curarized, and put onto mechanical controlled ventilation. Aggressive erythropoietin therapy increased the patient's Hb level by 240% in 10 days, despite a high platelet count. This case demonstrates that critical levels of oxygen delivery may be lower than previously thought possible.

Conclusion

This case is an example of the resilience of the human body in an extreme circumstance. It might be the most severe case of anemia that a person has survived without any sequelae.
Partial engraftment following plerixafor rescue after failed sibling donor peripheral blood stem cell harvest
Authors: Eyre Toby A. , King Andrew J. , Peniket Andrew , Rocha Vanderson , Collins Graham P. , Pawson Rachel
Published: October 2013

Background

Rarely, healthy donors fail adequate peripheral blood stem cell (PBSC) mobilization. If the recipient has already received conditioning chemotherapy, this can result in the donor undergoing urgent marrow harvest under general anesthesia. Plerixafor is a novel CXCR4 antagonist, licensed for autologous PBSC harvest (PBSCH) in patients who failed mobilization with granulocyte–colony‐stimulating factor (G‐CSF) alone. Experience using plerixafor in healthy allogeneic donors failing G‐CSF mobilization is scarce.

Case Report

A 65‐year‐old patient was referred for a reduced‐intensity conditioning sibling allograft for relapsed follicular lymphoma. She received fludarabine, melphalan, and alemtuzumab conditioning. Her 68‐year‐old brother was fully HLA matched. PBSCH was planned on Day −1 after 4 days of 10 μg/kg G‐CSF. Day 1 PBSCH collected an inadequate number of CD34+ 0.35 × 106/kg cells. Despite increasing G‐CSF (16 μg/kg), Day 2 yielded 0.33 × 106/kg CD34+ cells, giving a suboptimal total dose. He proceeded to a third PBSCH day after plerixafor (0.24 mg/kg) and G‐CSF (16 μg/kg) were given the evening before. A total of 1.79 × 106/kg CD34+ cells were harvested, giving a total dose of 2.46 × 106/kg CD34+ cells. After initial neutrophil engraftment on Day +13, the patient's neutrophils gradually decreased to 0.02 × 109/L by Day +74. A marrow aspirate on Day +81 was markedly hypocellular. Total white blood cell chimerism was near 100% donor on Days +32, +74, and +102. Despite chimeric‐only engraftment, the patient remains platelet and red blood cell transfusion dependent.

Conclusion

Rescue plerixafor to assist PBSCH in healthy allogeneic donors has been effective in terms of CD34+ cell number mobilized. It is unclear whether the partial engraftment seen was coincidental or related to a difference in PBSC quality.
Fibrinogen as a therapeutic target for bleeding: a review of critical levels and replacement therapy
Authors: Levy Jerrold H. , Welsby Ian , Goodnough Lawrence T.
Published: October 2013

Fibrinogen plays a critical role in achieving and maintaining hemostasis and is fundamental to effective clot formation. There is increasing awareness of the important role of fibrinogen as a key target for the treatment and prevention of acquired bleeding. Fibrinogen is the first coagulation factor to fall to critically low levels (<1.0 g/L) during major hemorrhage (normal plasma fibrinogen levels range from 2.0 to 4.5 g/L), and current guidelines recommend maintaining the plasma fibrinogen level above 1.5 g/L. Fibrinogen supplementation can be achieved using plasma or cryoprecipitate; however, there are a number of safety concerns associated with these allogeneic blood products and there is a lack of high‐quality evidence to support their use. Additionally, there is sometimes a long delay associated with the preparation of frozen products for infusion. Fibrinogen concentrate provides a promising alternative to allogeneic blood products and has a number of advantages: it allows a standardized dose of fibrinogen to be rapidly administered in a small volume, has a very good safety profile, and is virally inactivated as standard. Administration of fibrinogen concentrate, often guided by point‐of‐care viscoelastic testing to allow individualized dosing, has been successfully used as hemostatic therapy in a range of clinical settings, including cardiovascular surgery, postpartum hemorrhage, and trauma. Results show that fibrinogen concentrate is associated with a reduction or even total avoidance of allogeneic blood product transfusion. Fibrinogen concentrate represents an important option for the treatment of coagulopathic bleeding; further studies are needed to determine precise dosing strategies and thresholds for fibrinogen supplementation.
Peripheral blood stem cell yield calculated using preapheresis absolute CD34+ cell count, peripheral blood volume processed, and donor body weight accurately predicts actual yield at multiple centers
Authors: Hosing Chitra , Saliba Rima M. , Hamerschlak Nelson , Kutner Jose Mauro , Sakashita Araci Massami , Kondo Andrea Tiemi , Rodrigues Morgani , Fernande Juliana Folloni , Chiattone Alexandre , Chiattone Viviane C. , Barros Jose C. , Chiattone Carlos S. , Chiattone Ricardo , Popat Uday , Qazilbash Muzaffar , Tang Xiao Wen , Wu Depei , Majilis Alejandro , de Lima Marcos , Anguita Timoleon
Published: October 2013

Background

Accurate prediction of stem cell yield is important for planning leukapheresis procedures. A formula has been published (Pierelli et al., Vox Sang 2006;91:126‐34) to estimate the CD34+ dose collected on the first day of leukapheresis that was based on the preapheresis peripheral blood (PB) CD34+ counts, the blood volume processed, and the donor's weight. The aim of this study was to assess the predictive value of this formula.

Study Design and Methods

Data were retrospectively collected on 1126 consecutive PB stem cell harvests conducted at five institutions. Information on age, sex, diagnosis, weight, preapheresis absolute peripheral CD34+ count, total blood volume processed, and CD34+ cells harvested per kilogram of body weight on the first day of apheresis was collected.

Results

Among donors at least 18 years old, Pearson's correlation coefficient (r) between actual yield (AY) and predicted yield (PY) was 0.76. To characterize this correlation, AY and PY were classified as being within the conventionally acceptable CD34+ doses (>2 × 106‐5 × 106 cells/kg), below this range (≤2 × 106 cells/kg), or above it (>5 × 106 cells/kg). The positive predictive value (PPV) of PY was estimated considering the distribution of AY as the “gold standard.” PPV was relatively high for PY of more than 5 × 106 cells/kg (85%), moderate for PY of not more than 2 × 106 cells/kg (72%), and low for PY more than 2 × 106 to 5 × 106 cells/kg (56%). A consistent pattern was observed within institutions.

Conclusion

The formula of Pierelli et al. is associated with a PPV that is high, moderate, and relatively low for the corresponding predicted CD34+ doses.
Improved blood utilization using real‐time clinical decision support
Authors: Goodnough Lawrence T. , Shieh Lisa , Hadhazy Eric , Cheng Nathalie , Khari Paul , Maggio Paul
Published: October 2013

Background

We analyzed blood utilization at Stanford Hospital and Clinics after implementing real‐time clinical decision support (CDS) and best practice alerts (BPAs) into physician order entry (POE) for blood transfusions.

Study Design and Methods

A clinical effectiveness (CE) team developed consensus with a suggested transfusion threshold of a hemoglobin (Hb) level of 7 g/dL, or 8 g/dL for patients with acute coronary syndromes. The CDS was implemented in July 2010 and consisted of an interruptive BPA at POE, a link to relevant literature, and an “acknowledgment reason” for the blood order.

Results

The percentage of blood ordered for patients whose most recent Hb level exceeded 8 g/dL ranged at baseline from 57% to 66%; from the education intervention by the CE team August 2009 to July 2010, the percentage decreased to a range of 52% to 56% (p = 0.01); and after implementation of CDS and BPA, by end of December 2010 the percentage of patients transfused outside the guidelines decreased to 35% (p = 0.02) and has subsequently remained below 30%. For the most recent interval, only 27% (767 of 2890) of transfusions occurred in patients outside guidelines. Comparing 2009 to 2012, despite an increase in annual case mix index from 1.952 to 2.026, total red blood cell (RBC) transfusions decreased by 7186 units, or 24%. The estimated net savings for RBC units (at $225/unit) in purchase costs for 2012 compared to 2009 was $1,616,750.

Conclusion

Real‐time CDS has significantly improved blood utilization. This system of concurrent review can be used by health care institutions, quality departments, and transfusion services to reduce blood transfusions.
Carboplatin versus alternating carboplatin and doxorubicin for the adjuvant treatment of canine appendicular osteosarcoma: a randomized, phaseIIItrial
Authors: Skorupski K. A. , Uhl J. M. , Szivek A. , Allstadt Frazier S. D. , Rebhun R. B. , Rodriguez C. O.
Published: October 2013

Despite numerous published studies describing adjuvant chemotherapy for canine appendicular osteosarcoma, there is no consensus as to the optimal chemotherapy protocol. The purpose of this study was to determine whether either of two protocols would be associated with longer disease‐free interval (DFI) in dogs with appendicular osteosarcoma following amputation. Dogs with histologically confirmed appendicular osteosarcoma that were free of gross metastases and underwent amputation were eligible for enrollment. Dogs were randomized to receive either six doses of carboplatin or three doses each of carboplatin and doxorubicin on an alternating schedule. Fifty dogs were included. Dogs receiving carboplatin alone had a significantly longer DFI (425 versus 135 days) than dogs receiving alternating carboplatin and doxorubicin (P= 0.04). Toxicity was similar between groups. These results suggest that six doses of carboplatin may be associated superior DFI when compared to six total doses of carboplatin and doxorubicin.
Use of optimized aminotransferase methods in regulated preclinical studies
Authors: Tarrant Jacqueline , Meyer Denny , Katavolos Paula
Published: October 2013

Background

The serum activities of ALT and AST are key indicators of liver toxicity in the drug safety evaluation of laboratory animals and patients. To ensure that the full aminotransferase activity is measured, exogenous Pyridoxyl‐5‐Phosphate (P5P) cofactor is included in the assay reagent. Clinical pathology laboratories make a choice to use aminotransferase assays with or without the added P5P cofactor, and the impact of assay selection on safety assessment is not well understood.

Objectives

The objective of this report was to investigate the effect of aminotransferase assay selection on the detection of liver toxicity based on a literature review.

Methods

Literature in public databases was searched using combinations of the search terms alanine aminotransferase, aspartate aminotransferase, pyridoxyl‐5‐phosphate, holoenzyme, apoenzyme, enzyme inhibition, artifact, clinical pathology, toxicology, and safety assessment. Regulations or guidance documents published by health authorities specifying clinical pathology evaluation in nonclinical and clinical safety studies of biopharmaceuticals, chemicals, and devices were also reviewed.

Results

Aminotransferase testing is not standardized in safety assessment studies and consequently, laboratories use aminotransferase assays with or without P5P cofactor. Individual studies have demonstrated mean differences of approximately 10–20% in serum ALT activity in animal and human populations. The impact of aminotransferase testing without P5P on detection of toxicity and decision‐making in drug development has not been systematically evaluated.

Conclusions

The use of different assays for measuring aminotransferase activity contributes to the variability in data between laboratories and studies. Standardizing aminotransferase assays is an avenue for improving the diagnostic performance in drug safety evaluation.
A case in Europe of feline histoplasmosis apparently limited to the skin
Authors: Fischer Nina M. , Favrot Claude , Monod Michel , Grest Paula , Rech Katia , Wilhelm Sylvia
Published: October 2013

Background

Histoplasma capsulatum has a worldwide distribution, but reports in Europe remain rare. We present the second report of histoplasmosis in a cat in Europe and, to the best of our knowledge, the first case of feline histoplasmosis infection apparently limited to the skin.

Case report

A 6‐year‐old male castrated outdoor cat was presented to the dermatology service with a history of skin lesions evolving over 1 month and consisting of multiple papules and nodules on the head and neck. General examination was unremarkable. Cytological examination of the ulcerated nodules revealed a pyogranulomatous infiltrate, with numerous macrophages containing oval yeast‐like cells, 2–5 μm in size, with a central, lightly basophilic core surrounded by a clear halo. A tentative diagnosis of fungal infection was made, and skin biopsy specimens were taken. Histological examination confirmed the cytology findings, and Grocott staining showed numerous organisms suggestive of Histoplasma within macrophages. Thoracic radiographs, abdominal ultrasound and routine laboratory testing were unremarkable. Fungal culture of a nodule was negative. PCR of total DNA extracted from the infected tissue and subsequent sequencing confirmed the diagnosis of H. capsulatum var. capsulatum. Surgical excision of the other nodules was performed, and the cat was treated with oral itraconazole 5 mg/kg once daily; 12 weeks after initial consultation, no lesions were visible. No recurrence was observed during an 8 month follow‐up period.

Conclusions and clinical importance

Histoplasmosis should be included in the differential diagnosis of nodular diseases of cats worldwide.
Evaluation of a New German blood donor questionnaire
Authors: Sümnig A. , Lembcke H. , Weber H. , Deitenbeck R. , Greffin K. , Bux J. , Greinacher A.
Published: October 2013

Background and Objectives

In Germany, blood donors must complete a donor history questionnaire (DHQ). In 2011, a new standardized DHQ for Germany was proposed which included questions about sexual risk behaviour that raised concerns about acceptance by donors.

Materials and Methods

We assessed the acceptability and ease of use of the new DHQ in two German donor populations, by asking the donors to complete a paper survey evaluating the design and clarity of the questions of the new DHQ with a focus on the questions addressing sexual risk behaviour.

Results

In Greifswald, 2000 donors (mean age 32 ± 12 years) participated, and in Hagen 2088 donors (mean age 48 ± 14 years). Ratings between the two populations showed only minor differences. Donors reported that the questions in the new DHQ were understandable and clearly structured. Perception of comfort level with questions addressing sexual risk behaviour differed significantly depending on donor characteristics such as age, gender and educational level. Overall, the new DHQ seems to deter approximately 5% of potential donors from blood donation.

Conclusion

The new DHQ was acceptable to the vast majority of donors. Potential donors who were older, male gender and less educated were most at risk of refusing to donate and may benefit from educational interventions.
Blood donation by African migrants and refugees in Australia: the role of demographic and socio‐economic factors
Authors: McQuilten Z. , Waters N. , Polonsky M. , Renzaho A.
Published: October 2013

Background and Objectives

To establish blood donation rates among African refugees and migrants and identify demographic and socio‐economic factors that are associated with their blood donation.

Materials and Methods

A cross‐sectional survey of 425 migrants and refugees living in Victoria and South Australia was used to assess blood donation status. The association between blood donation and demographic and socio‐economic factors was assessed using multiple logistic regression analysis.

Results

Overall, 73 participants (17·2%; 95% CI: 13·6–20·8) reported having donated blood previously. Of the total sample, 2·4% (95% CI: 0·9–3·8) reported having given blood in Australia; 12·9% (95% CI: 9·7–16·1) had given blood prior to migration to Australia (i.e. country of birth or transition); and 1·9% (95% CI: 0·6–3·2) indicated they had given blood in an unspecified country. In the univariate model, age, country of birth, blood donation knowledge, religion, educational attainment, migration and employment status were all associated with blood donation status. However, in the multivariate model, only age >45 years (odds ratio [OR] 5·72; 95% CI 2·11–15·46), African region of origin (OR 15·89; 95% CI 3·89–65) and blood donation knowledge (OR 4·46; 95% CI 1·57–12·7) were associated with blood donation.

Conclusions

In order to increase the number of blood donors among African migrants, promoting knowledge and awareness of issues associated with blood donation in Australia should be emphasized. Consideration should be given to identifying these potential migrant donors to improve the availability of compatible blood for patients of African descent.
Longer storage of red blood cells is associated with increased in vitro erythrophagocytosis
Authors: Veale M. F. , Healey G. , Sparrow R. L.
Published: October 2013

Background and Objectives

Refrigerated storage of red blood cells (RBCs) induces numerous changes that may target the cells for erythrophagocytosis following transfusion. The influence of storage upon the phagocytosis of unseparated and fractionated young and old stored RBCs was investigated using two in vitro quantitative phagocytosis assays.

Materials and Methods

Leucocyte‐depleted RBC units were sampled at day 1 or 42 of storage. Young and old RBCs were fractionated at day 1 by density centrifugation and stored in paediatric packs for up to 42 days. RBCs were labelled with the fluorescent dye PKH26 and incubated with the human monocytic cell line THP‐1. Erythrophagocytosis was quantified by flow cytometry and plate fluorometric assays.

Results

A higher proportion of THP‐1 cells phagocytosed RBCs stored for 42 days compared with 1 day (41% and 24% respectively; P < 0·0001). This was associated with an increased mean number of RBCs phagocytosed per THP‐1 cell (5·2 ± 0·6 and 3·3 ± 0·2 respectively; P < 0·002). Erythrophagocytosis of fractionated young and old RBCs increased with longer storage duration up to 28 days (P < 0·05). However, no significant differences were observed between erythrophagocytosis of young and old RBCs.

Conclusion

The susceptibility of stored RBCs to erythrophagocytosis significantly increased with longer storage time of the RBC units. Storage duration of RBCs had a greater influence on in vitro erythrophagocytosis than the chronological age of the RBCs at donation.
Comparison of river and canal water dissolved organic matter fluorescence within an urbanised catchment
Authors: Carstea Elfrida M. , Baker Andy , Savastru Roxana
Published: October 2013

Recently, growing interest has been shown in the study of canal water quality, yet no research using continuous fluorescence monitoring to characterise dissolved organic matter (DOM) has been performed. This paper evaluated DOM characteristics at hourly resolution. A comparison was made between canal and nearby urban river fluorescence spectra, to emphasise the specific nature of canal water DOM. Results showed that canal water had a significant proportion of microbially derived DOM, while the urban river had a greater proportion of terrestrially derived fractions. The microbial character of canal water DOM originated from the low flow of water, the nutrients predominance and continuous DOM processing. Hence, DOM fluorescence is invariant over a timescale of days, and recreational navigation and precipitation events have no major influence on DOM characteristics. Our results are expected to be applicable to future research on highly regulated freshwater systems for DOM quantity estimation or for water quality models.
Distribution of herbicide‐resistant acetyl‐coenzyme A carboxylase alleles in Lolium rigidum across grain cropping areas of South Australia
Authors: Malone J M , Boutsalis P , Baker J , Preston C
Published: October 2013

Resistance to the acetyl‐coenzyme A carboxylase (ACCase)‐inhibiting herbicides in Lolium rigidum is widespread in grain cropping areas of South Australia. To better understand the occurrence and spread of resistance to these herbicides and how it has changed with time, the carboxyl transferase (CT) domain of the ACCase gene from resistant L. rigidum plants, collected from both random surveys of the mid‐north of Southern Australia over 10 years as well as stratified surveys in individual fields, was sequenced and target site mutations characterised. Amino acid substitutions occurring as a consequence of these target site mutations, at seven positions in the ACCase gene previously correlated with herbicide resistance, were identified in c. 80% of resistant individuals, indicating target site mutation is a common mechanism of resistance in L. rigidum to this herbicide mode of action. Individuals containing multiple amino acid substitutions (two, and in two cases, three substitutions) were also found. Substitutions at position 2041 occurred at the highest frequency in all years of the large area survey, while substitutions at position 2078 were most common in the single farm analysis. This study has shown that target site mutations leading to amino acid substitutions in ACCase of L. rigidum are widespread across South Australia and that these mutations have likely evolved independently in different locations. The results indicate that seed movement, both within and between fields, may contribute to the spread of resistance in a single field. However, over a large area, the independent appearance and selection of target site mutations conferring resistance through herbicide use is the most important factor.
A Systematic Review of Reviews of Behavioral Interventions to Promote Condom Use
Authors: von Sadovszky Victoria , Draudt Breana , Boch Samantha
Published: October 2013

Background

Sexually transmitted infections (STIs) are a major public health problem. Realistically, condom use is still the primary means to prevent STIs. Because many behavioral intervention studies have been performed to increase condom use across multiple populations and many reviews have been done, a review of all these reviews is warranted.

Aims

The purpose of this paper is to examine Level I evidence of behavioral intervention studies to promote condom use. The purpose of this evidence‐based practice (EBP) review is to examine the evidence and determine: (a) if behavioral interventions are effective; and (b) if they are, what are the common characteristics of successful interventions that need to be implemented in practice.

Methods

A systematic search for literature was conducted in the following databases: Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, PubMed, and Psychological and Behavioral Sciences Collection. The following parameters were used for the search: (a) a meta‐analysis or level 1 synthesis of literature containing only intervention (randomized control trials or quasi‐experimental) studies; (b) peer‐reviewed journals; (c) published in the past 10 years (2002–2012); (d) had adolescents or adults as the sample (13–44 years of age); and (e) were published in English.

Results

Behavioral interventions were effective in promoting condom use and other safer sexual practices and reducing STIs. They were not effective in promoting abstinence. Tailoring to certain characteristics of the population and including skills building exercises were primary characteristics in the successful interventions

Implications

There is a preponderance of evidence that behavioral interventions do promote condom use and reduce STIs across diverse groups of individuals. Clinicians can use these interventions with confidence in practice.
A Survey of U.S. Obstetrician‐Gynecologists' Clinical and Epidemiological Knowledge of Cryptosporidiosis in Pregnancy
Authors: Domjahn B. T. , Hlavsa M. C. , Anderson B. , Schulkin J. , Leon J. , Jones J. L.
Published: October 2013

Although cryptosporidiosis is frequently diagnosed in the U.S., there has been very little assessment of obstetrician–gynaecologist knowledge about this disease. In 2010, we surveyed U.S. obstetricians about the diagnosis, treatment and epidemiology of cryptosporidiosis. Data were examined through univariable analysis and multivariable regression models. Of 1000 obstetrician–gynaecologists surveyed, 431 (43.1%) responded. Only 44.4% of respondents correctly identified that prolonged, intermittent diarrhoea would lead them to consider cryptosporidiosis in a differential diagnosis. Routine ova and parasites (O&P) testing was incorrectly chosen to identify Cryptosporidium in stool by 30.4% of respondents. Questions about nitazoxanide, the only drug approved by the U.S. Food & Drug Administration (FDA) for treatment of cryptosporidiosis, were the most frequently missed questions. Only 9.0% of respondents correctly classified nitazoxanide as an FDA pregnancy Category B drug, and only 5.6% of respondents correctly indicated that FDA approved nitazoxanide for immunocompetent patients aged ≥1 years. Regarding prevention‐ and control‐related knowledge, only 14.1% of respondents correctly indicated that alcohol‐based hand sanitizers were not effective at inactivating Cryptosporidium spp., and <10% correctly indicated that cryptosporidiosis is a reportable disease in their state of practice. Multivariable analysis found that ≥19 years in practice was positively associated with O&P diagnostic testing knowledge, while rural and urban non‐inner city practice location, compared with suburban practice location, was positively associated with nitazoxanide knowledge. The low level of knowledge among obstetrician–gynaecologists about cryptosporidiosis indicates a need to develop resources for physicians about all aspects of cryptosporidiosis, particularly on diagnosis, treatment and prevention strategies.
Molecular Dynamics Simulation of Normal and Explosive Boiling on Nanostructured Surface
Authors: Reza Seyf Hamid , Zhang Yuwen
Published: October 2013

Molecular Dynamics (MD) simulation is carried out to investigate the normal and explosive boiling of thin film adsorbed on a metal substrate whose surface is structured by an array of nanoscale spherical particles. The molecular system is comprised of the liquid and vapor argon as well as a copper wall. The nanostructures have spherical shape with uniform diameters while the thickness of liquid film is constant. The effects of transvers and longitudinal distances as well as the diameter of nanoparticles are analyzed. The simulation is started from an initial configuration for three phases (liquid argon, vapor argon and solid wall); after equilibrating the system at 90 K, the wall is heated suddenly to a higher temperature that is well beyond the critical temperature of argon. Two different superheat degrees are selected: a moderately high temperature of 170 K for normal evaporation and much higher temperature 290 K for explosive boiling. By monitoring the space and time dependences of temperature and density as well as net evaporation rate, the normal and explosive boiling process on a flat surface with and without nanostructures are investigated. The results show that the nanostructure has significant effect on evaporation/boiling of thin film. The degrees of superheat and size of nanoparticles have significant effects on the trajectories of particles and net evaporation rate. For the cases with nanostructure, liquid responds very quickly and the number of evaporation molecules increases with increasing the size of particles from 1 to 2 nm while it decreases for d = 3 nm.