bluuebunny/crossref_metadata_2025 huggingface dataset:
Co‐expression analysis as tool for the discovery of transport proteins in photorespiration
Authors: Bordych C. , Eisenhut M. , Pick T. R. , Kuelahoglu C. , Weber A. P. M.
Published: April 2013

Shedding light on yet uncharacterised components of photorespiration, such as transport processes required for the function of this pathway, is a prerequisite for manipulating photorespiratory fluxes and hence for decreasing photorespiratory energy loss. The ability of forward genetic screens to identify missing links is apparently limited, as indicated by the fact that little progress has been made with this approach during the past decade. The availability of large amounts of gene expression data and the growing power of bioinformatics, paired with availability of computational resources, opens new avenues to discover proteins involved in transport of photorespiratory intermediates. Co‐expression analysis is a tool that compares gene expression data under hundreds of different conditions, trying to find groups of genes that show similar expression patterns across many different conditions. Genes encoding proteins that are involved in the same process are expected to be simultaneously expressed in time and space. Thus, co‐expression data can aid in the discovery of novel players in a pathway, such as the transport proteins required for facilitating the transfer of intermediates between compartments during photorespiration. We here review the principles of co‐expression analysis and show how this tool can be used for identification of candidate genes encoding photorespiratory transporters.
Effects of water nanodroplets on skin moisture and viscoelasticity during air‐conditioning
Authors: Ohno Hideo , Nishimura Naoki , Yamada Kuniyuki , Shimizu Yuuki , Iwase Satoshi , Sugenoya Junichi , Sato Motohiko
Published: April 2013

Background/purpose

In air‐conditioned rooms, dry air exacerbates some skin diseases, for example, senile xerosis, atopic dermatitis, and surface roughness. Humidifiers are used to improve air dryness, which often induces excess humidity and thermal discomfort. To address this issue, we investigated the effects of water nanodroplets (mist) on skin hydration, which may increase skin hydration by penetrating into the interstitial spaces between corneocytes of the stratum corneum (SC) without increasing air humidity.

Methods

We examined biophysical parameters, including skin conductance and transepidermal water loss (TEWL), and biomechanical parameters of skin distension/retraction before and after suction at the forehead, lateral canthus, and cheek, with or without mist, in a testing environment (24°C, 35% relative humidity) for 120 min.

Results

In the group without mist, TEWL values significantly decreased at all the sites after 1 h compared with the initial values. However, in the presence of mist, TEWL values were maintained at the initial values through the test, yielding significant differences vs. the group without mist. There were no significant differences between mist and mist‐free groups in terms of skin conductance. Skin distension was significantly increased in the group with mist compared with that in the group without mist at the forehead and cheek, suggesting a softening effect of mist.

Conclusion

Skin deformation of the face was improved by mist, suggesting hydration of the SC by mist. The change in TEWL was influenced by mist, suggesting supply of water to the skin, particularly the SC, by mist. These data indicated that a mist of water nanodroplets played an important role in softening skin in an air‐conditioned room without increasing excess humidity.
A Trickle or a Torrent? Understanding the Extent of Summer “Melt” Among College‐Intending High School Graduates
Authors: Castleman Benjamin L. , Page Lindsay C.
Published: April 2013

Objectives

The object of this study was to examine whether college‐intending, low‐income high school graduates are particularly susceptible to having their postsecondary education plans change, or even fall apart, during the summer after high school graduation. College access research has largely overlooked this time period. Yet, previous research indicates that a sizeable share of low‐income students who had paid college deposits reconsidered where, and even whether, to enroll in the months following graduation. We assess the extent to which this phenomenon—commonly referred to as “summer melt”—is broadly generalizable.

Methods

We employ two data sources, a national survey and administrative data from a large metropolitan area, and regression analysis to estimate the prevalence of summer melt.

Results

Our analyses reveal summer melt rates of sizeable magnitude: ranging from 8 to 40 percent.

Conclusions

Our results indicate that low‐income, college‐intending students experience high rates of summer attrition from the college pipeline. Given the goal of improving the flow of low‐income students to and through college, it is imperative to investigate how to effectively intervene and mitigate summer melt.
Evaluation of urine‐circulating cathodic antigen (Urine‐CCA) cassette test for the detection of Schistosoma mansoni infection in areas of moderate prevalence in Ethiopia
Authors: Erko Berhanu , Medhin Girmay , Teklehaymanot Tilahun , Degarege Abraham , Legesse Mengistu
Published: April 2013

Objective

To evaluate the diagnostic performance of antigen detecting urine‐CCA cassette test for the detection of Schistosoma mansoni infection in areas of moderate prevalence in Ethiopia.

Methods

Stool specimens were collected from 620 schoolchildren on three consecutive days. The samples were microscopically examined using double Kato slides; midstream urine specimens were also collected for three consecutive days and tested for S. mansoni. The sensitivity of the urine‐CCA cassette test was determined using combined results of six Kato–Katz thick smears and three urine‐CCA cassette tests as gold standard. The specificity of the urine‐CCA cassette test was evaluated in an area where schistosomiasis is not endemic.

Results

Prevalence of S. mansoni infection as determined by single urine‐CCA cassette test was 65.9%, by single Kato–Katz smear 37.3% and by six Kato–Katz thick smears 53.1% (P < 0.001). A single urine‐CCA cassette test was significantly (P < 0.001) more sensitive (89.1%), had a lower negative predictive value (78.2%), was more accurate (92.6%) and agreed better with the gold standard (k = 0.83) than one or six Kato–Katz thick smears. However, both the Kato–Katz and urine‐CCA cassette test showed 100% specificity in endemic settings.

Conclusions

In moderate and high prevalence areas, urine‐CCA cassette test is more sensitive than the Kato–Katz method and can be used for screening and mapping of S. mansoni infection.
Mutations in epidermis‐specific HD‐ZIP IV genes affect floral organ identity in Arabidopsis thaliana
Authors: Kamata Naoko , Okada Hitomi , Komeda Yoshibumi , Takahashi Taku
Published: April 2013

Development of the epidermis involves members of the class–IV homeodomain‐leucine zipper (HD‐ZIP IV) transcription factors. The Arabidopsis HD‐ZIP IV family consists of 16 members, among which PROTODERMAL FACTOR 2 (PDF2) and ARABIDOPSIS THALIANA MERISTEM LAYER 1 (ATML1) play an indispensable role in the differentiation of shoot epidermal cells; however, the functions of other HD‐ZIP IV genes that are also expressed specifically in the shoot epidermis remain to be fully elucidated. We constructed double mutant combinations of these HD‐ZIP IV mutant alleles and found that the double mutants of pdf2‐1 with homeodomain glabrous1‐1 (hdg1‐1), hdg2‐3, hdg5‐1 and hdg12‐2 produced abnormal flowers with sepaloid petals and carpelloid stamens in association with the reduced expression of the petal and stamen identity gene APETALA 3 (AP3). Expression of another petal and stamen identity gene PISTILATA (PI) was less affected in these mutants. We confirmed that AP3 expression in pdf2‐1 hdg2‐3 was normally induced at the initial stages of flower development, but was attenuated both in the epidermis and internal cell layers of developing flowers. As the expression of PDF2 and these HD‐ZIP IV genes during floral organ formation is exclusively limited to the epidermal cell layer, these double mutations may have non‐cell‐autonomous effects on AP3 expression in the internal cell layers. Our results suggest that cooperative functions of PDF2 and other members of the HD‐ZIP IV family in the epidermis are crucial for normal development of floral organs in Arabidopsis.
Head‐to‐head comparison of two transcription‐mediated amplification assay versions for detection of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus Type 1 in blood donors
Authors: Grabarczyk Piotr , van Drimmelen Harry , Kopacz Aneta , Gdowska Jolanta , Liszewski Grzegorz , Piotrowski Dariusz , Górska Joanna , Kuśmierczyk Jolanta , Candotti Daniel , Łętowska Magdalena , Lelie Nico , Brojer Ewa
Published: April 2013

Background

The second triplex transcription‐mediated amplification (TMA) assay version (Ultrio Plus, Novartis Diagnostics) uses an additional reagent enhancing the disruption of hepatitis B virus (HBV) particles and release of DNA for the target capture probe. This study compares the performance of this new assay version with the previous one (Ultrio).

Study Design and Methods

For analytical sensitivity assessment the World Health Organization HBV, hepatitis C virus (HCV), and human immunodeficiency virus (HIV) international standards and various genotype dilution panels were used. Individual donations (IDs) from 9980 first‐time donors were screened simultaneously by serology and both TMA assay versions.

Results

The 50 and 95% limits of detection (LODs) for HBV using Ultrio Plus were 0.8 (0.6‐1.0) and 4.6 (3.2‐7.2) IU/mL, respectively, 2.4 (1.4‐4.8)‐fold more sensitive than Ultrio. The TMA assay versions had comparable LODs for HIV‐1 and HCV. The improvement factors on analytical sensitivity panels of HBV Genotypes A to G ranged from 1.3 to 7.3 and 50% LODs (95% confidence interval) reduced from 12.5 (10‐15) to 3.8 (3.2‐4.4) copies/mL. One Ultrio Plus HBV Genotype D yield sample missed by the Ultrio assay in the donor screening study was detected with ninefold higher sensitivity. The specificities of ID nucleic acid test (ID‐NAT) and serologic testing in a similar repeat test algorithm were 100 and 99.41%, respectively.

Conclusion

More efficient target capture chemistry in the new TMA assay version significantly improved sensitivity and diminished variability in detecting HBV strains of various genotypes. We recommend a triplicate ID‐NAT repeat test strategy to eliminate discriminatory tests on false‐non–repeat‐reactive (anti‐HBc–nonreactive) donations.
Ecological Surveillance for West Nile in Catalonia (Spain), Learning from a Five‐Year Period of Follow‐up
Authors: Alba A. , Allepuz A. , Napp S. , Soler M. , Selga I. , Aranda C. , Casal J. , Pages N. , Hayes E. B. , Busquets N.
Published: April 2013

To enhance early detection of West Nile virus (WNV) transmission, an integrated ecological surveillance system was implemented in Catalonia (north‐eastern Spain) from 2007 to 2011. This system incorporated passive and active equine surveillance, periodical testing of chicken sentinels in wetland areas, serosurveillance wild birds and testing of adult mosquitoes. Samples from 298 equines, 100 sentinel chickens, 1086 wild birds and 39 599 mosquitoes were analysed. During these 5 years, no acute WNV infection was detected in humans or domestic animal populations in Catalonia. WNV was not detected in mosquitoes either. Nevertheless, several seroconversions in resident and migrant wild birds indicate that local WNV or other closely related flaviviruses transmission was occurring among bird populations. These data indicate that bird and mosquito surveillance can detect otherwise silent transmission of flaviviruses and give some insights regarding possible avian hosts and vectors in a European setting.
Large-Eddy Simulation of a Tunnel Ventilation Fan
Authors: Borello Domenico , Corsini Alessandro , Delibra Giovanni , Fiorito Mario , Sheard Anthony G.
Published: April 2013

In this paper we discuss a computational method focused on the prediction of unsteady aerodynamics, adequate for industrial turbomachinery. Here we focus on a single rotor device selected from a new family of large tunnel ventilation axial flow fans. The flow field in the fan was simulated using the open source code OpenFOAM, with a large-eddy simulation (LES) approach. The sub-grid scale (SGS) closure relied on a one-equation model, that requires us to solve a differential transport equation for the modeled SGS turbulent kinetic energy. The use of such closure was here considered as a remedial strategy in LES of high-Reynolds industrial flows, being able to tackle the otherwise insufficient resolution of turbulence spectrum. The results show that LES of the fan allows to predict the pressure rise capability of the fan and to reproduce the most relevant flow features, such as three-dimensional separation and secondary flows.
Variation of the Expansion Coefficient of Nanofluids With Temperature: A Correction for Conductivity Data
Authors: Michaelides Efstathios E.
Published: April 2013

The two constituent phases of the nanofluids have thermal expansion coefficients that are significantly different. Moreover, the variability of the thermal expansion coefficients of fluids with temperature is significantly higher than that of solid materials. The mismatch of the thermal expansion coefficients creates changes of the volumetric fraction of solids with temperature changes. The changes can be significant with fluids that have high thermal expansion coefficients, such as refrigerants and fluids that operate close to their critical points. Since the thermal conductivity of nanofluids is a very strong function of the volumetric fraction of the nanoparticles, these changes of the volumetric fraction may cause significant effects on the thermal conductivity of the nanofluids, which must be accounted for in any design process.
CT‐perfusion versus [15O]H2O PET in lung tumors: Effects of CT‐perfusion methodology
Authors: Kramer G. M. , Yaqub M. , Bahce I. , Smit E. F. , Lubberink M. , Hoekstra O. S. , Boellaard R.
Published: April 2013

Purpose:

Nowadays, PET and dynamic contrast enhanced CT or MRI are used to assess tumor blood perfusion. Although [15O]H2O PET is the gold standard, it is hardly available for routine clinical practice, due to the short half‐life of 15O. However, the lack of uniformity in scanning and analytic methods limits the use of CT perfusion (CTP) in clinical trials and practice. This study compares [15O]H2O PET with CT based perfusion in lung tumors and assesses the effects of various CTP postprocessing and analytical methods on the CTP results using [15O]H2O PET as the reference technique.

Methods:

Various CTP analysis and image postprocessing methods were assessed. Furthermore, parametric images were obtained using the Slope method. Volumes of interests were defined using several different segmentation methods including Hounsfield unit based contouring thresholds, both with and without framewise application of dynamic contouring thresholds to exclude lung tissue or intravascular contrast. A head‐to‐head comparison of tumor perfusion obtained by CTP and [15O]H2O PET was performed using linear regressions, Bland‐Altman plots, and an intraclass correlation coefficient (ICC). In addition, the different postprocessing methods were compared reciprocally.

Results:

In six lung cancer patients, perfusion assessed using CTP studies combined with the Slope method correlated best with [15O]H2O PET (ICC = 0.88; R2 = 0.89; Y = 0.80). The Mullani‐Gould method showed best correlation with the Slope method (ICC ≥ 0.71; R2 ≥ 0.80; Y = 0.71–1.35). These correlations were obtained using dynamic contouring thresholds and show the influence of CTP postprocessing methods.

Conclusions:

Tumor perfusion assessed by CTP in combination with dynamic contouring thresholds using the Slope method correlates well with [15O]H2O PET. This suggests that CTP can be used as a method to evaluate tumor perfusion in lung cancer.
Optimization of normalized prescription isodose selection for stereotactic body radiation therapy: Conventional vs robotic linac
Authors: Ding Chuxiong , Solberg Timothy D. , Hrycushko Brian , Xing Lei , Heinzerling John , Timmerman Robert D.
Published: April 2013

Purpose:

Although modern technology has allowed for target dose escalation by minimizing normal tissue dose, the dose delivered to a tumor and surrounding tissues still depends largely on the inherent characteristics of the radiation delivery platform. This work aims to determine the optimal prescription isodose line that minimizes normal tissue irradiation for stereotactic body radiation therapy (SBRT) for a conventional linear accelerator and a robotic delivery platform.

Methods:

Spherical targets with diameters of 10, 20, and 30 mm were constructed in the lungs and liver of a computer based digital torso phantom which simulates respiratory and cardiac motion. Normal tissue contours included normal lung, normal liver, and a concentric 10 mm shell of normal tissue extending from the spherical target surface. For linac planning, noncoplanar, nonopposing three dimensional (3D) conformal beams were designed, and variable prescription isodose lines were achieved by varying the MLC block margin. For CyberKnife planning, variable prescription isodose lines were achieved by inverse planning. True 4D dose calculations were used for the moving target and surrounding tissue based on each of ten phases of a 4D CT dataset. Doses of 60 Gy in three fractions were prescribed to cover 95% of the target tumor. Commonly used conformality, dosimetric, and radiobiological indices for lung and liver SBRT were used to compare different plans and determine the optimally prescribed isodose line for each treatment platform.

Results:

For linac plans, the average optimal prescription isodose line based on all indices evaluated occurred between 59% and 69% for lung tumors and between 67% and 77% for liver tumors depending on the tumor size. CyberKnife plans had average optimal prescription isodose lines occurring between 40% and 48% for lung tumors and between 41% and 42% depending on the tumor size. However, prescription isodose lines under 50% are not advised to prevent large heterogeneous dose distributions within the target.

Conclusions:

The choice of prescription isodose line was shown to have a significant impact on parameters commonly used as constraints for lung and liver SBRT treatment planning for both linac‐based and CyberKnife delivery platforms. By methodically choosing the prescription isodose line, normal tissue toxicities from SBRT may be reduced.
A Pyrrolo-Pyrimidine Derivative Targets Human Primary AML Stem Cells in Vivo
Authors: Saito Yoriko , Yuki Hitomi , Kuratani Mitsuo , Hashizume Yoshinobu , Takagi Shinsuke , Honma Teruki , Tanaka Akiko , Shirouzu Mikako , Mikuni Junko , Handa Noriko , Ogahara Ikuko , Sone Akiko , Najima Yuho , Tomabechi Yuri , Wakiyama Motoaki , Uchida Naoyuki , Tomizawa-Murasawa Mariko , Kaneko Akiko , Tanaka Satoshi , Suzuki Nahoko , Kajita Hiroshi , Aoki Yuki , Ohara Osamu , Shultz Leonard D. , Fukami Takehiro , Goto Toshio , Taniguchi Shuichi , Yokoyama Shigeyuki , Ishikawa Fumihiko
Published: April 2013

A pyrrolo-pyrimidine kinase inhibitor, RK-20449, eliminates chemotherapy-resistant human primary AML stem cells in vivo.
Male Circumcision Significantly Reduces Prevalence and Load of Genital Anaerobic Bacteria
Authors: Liu Cindy M. , Hungate Bruce A. , Tobian Aaron A. R. , Serwadda David , Ravel Jacques , Lester Richard , Kigozi Godfrey , Aziz Maliha , Galiwango Ronald M. , Nalugoda Fred , Contente-Cuomo Tania L. , Wawer Maria J. , Keim Paul , Gray Ronald H. , Price Lance B.
Published: April 2013

Male circumcision reduces female-to-male HIV transmission. Hypothesized mechanisms for this protective effect include decreased HIV target cell recruitment and activation due to changes in the penis microbiome. We compared the coronal sulcus microbiota of men from a group of uncircumcised controls (
n
= 77) and from a circumcised intervention group (
n
= 79) at enrollment and year 1 follow-up in a randomized circumcision trial in Rakai, Uganda. We characterized microbiota using16S rRNA gene-based quantitative PCR (qPCR) and pyrosequencing, log response ratio (LRR), Bayesian classification, nonmetric multidimensional scaling (nMDS), and permutational multivariate analysis of variance (PerMANOVA). At baseline, men in both study arms had comparable coronal sulcus microbiota; however, by year 1, circumcision decreased the total bacterial load and reduced microbiota biodiversity. Specifically, the prevalence and absolute abundance of 12 anaerobic bacterial taxa decreased significantly in the circumcised men. While aerobic bacterial taxa also increased postcircumcision, these gains were minor. The reduction in anaerobes may partly account for the effects of circumcision on reduced HIV acquisition.

IMPORTANCE
The bacterial changes identified in this study may play an important role in the HIV risk reduction conferred by male circumcision. Decreasing the load of specific anaerobes could reduce HIV target cell recruitment to the foreskin. Understanding the mechanisms that underlie the benefits of male circumcision could help to identify new intervention strategies for decreasing HIV transmission, applicable to populations with high HIV prevalence where male circumcision is culturally less acceptable.
Assembly and Annotation of Pneumocystis jirovecii from the Human Lung Microbiome
Authors: Cushion Melanie T. , Keely Scott P.
Published: April 2013

Pneumocystis jirovecii
is a fungus that causes
Pneumocystis
pneumonia in immunosuppressed patients and has been closely associated with AIDS since the beginning of the AIDS epidemic. Because
in vitro
cultivation of
P. jirovecii
is not possible, progress has been hindered in our understanding of its life cycle, mode of transmission, metabolic function, and genome. Limited amounts of
P. jirovecii
can be obtained from infected patients, but the occurrence of bacteria, other fungi, and human cells in clinical samples presents new challenges for whole-genome sequencing and downstream bioinformatic analysis. In a recent article, Cissé et al. used cell immunoprecipitation enrichment together with whole-genome amplification to generate sufficient quantities of DNA for Roche 454 and Illumina sequencing [O. H. Cissé, M. Pagni, and P. M. Hauser, mBio 4(1):e00428-12, 2012, doi:10.1128/mBio.00428-12]. In addition, a bioinformatic pipeline was devised to sort and assemble lung microbiome reads, thereby generating an 8.1-Mb
P. jirovecii
genome comprised of 356 contigs with an N
50
(median length of all contigs) of 41.6 kb. Knowledge of this genome will open new avenues of research, including the identification of nutritional requirements for
in vitro
cultivation as well as the identification of new and novel drug and vaccine targets.
Analysis of Vibrio cholerae Genome Sequences Reveals Unique
rtxA
Variants in Environmental Strains and an
rtxA
-Null Mutation in Recent Altered El Tor Isolates
Authors: Dolores Jazel , Satchell Karla J. F.
Published: April 2013

Vibrio cholerae
genome sequences were analyzed for variation in the
rtxA
gene that encodes the multifunctional autoprocessing RTX (MARTX) toxin. To accommodate genomic analysis, a discrepancy in the annotated
rtxA
start site was resolved experimentally. The correct start site is an ATG downstream from
rtxC
resulting in a gene of 13,638 bp and deduced protein of 4,545 amino acids. Among the El Tor O1 and closely related O139 and O37 genomes,
rtxA
was highly conserved, with nine alleles differing by only 1 to 6 nucleotides in 100 years. In contrast, 12 alleles from environment-associated isolates are highly variable, at 1 to 3% by nucleotide and 3 to 7% by amino acid. The difference in variation rates did not represent a bias for conservation of the El Tor
rtxA
compared to that of other strains but rather reflected the lack of gene variation in overall genomes. Three alleles were identified that would affect the function of the MARTX toxin. Two environmental isolates carry novel arrangements of effector domains. These include a variant from RC385 that would suggest an adenylate cyclase toxin and from HE-09 that may have actin ADP-ribosylating activity. Within the recently emerged altered El Tor strains that have a classical
ctxB
gene, a mutation arose in
rtxA
that introduces a premature stop codon that disabled toxin function. This null mutant is the genetic background for subsequent emergence of the
ctxB7
allele resulting in the strain that spread into Haiti in 2010. Thus, similar to classical strains, the altered El Tor pandemic strains eliminated
rtxA
after acquiring a classical
ctxB
.

IMPORTANCE
Pathogen evolution involves both gain and loss of factors that influence disease. In the environment, bacteria evolve rapidly, with nucleotide diversity arising by genetic modification. Such is occurring with
Vibrio cholerae
, exemplified by extensive diversity and unique variants of the
rtxA
-encoded multifunctional autoprocessing RTX (MARTX) toxin among environment-associated strains that cause localized diarrheal outbreaks and food-borne disease. In contrast, seventh pandemic El Tor
V. cholerae
strains associated with severe diarrhea have changed minimally until the altered El Tor emerged as the most frequent cause of cholera, including in the 2010 Haiti epidemic. These strains have increased virulence attributed to a new variant of the major virulence factor, cholera toxin. It is revealed that these strains also have an inactivated MARTX toxin gene. A similar inactivation occurred during classical cholera pandemics, highlighting that evolution of El Tor cholera is following a similar path of increased dependence on cholera toxin, while eliminating other secreted factors.
Spontaneous multivessel coronary artery dissection with anomalous coronary artery
Authors: Mahadevappa Nagesh , Singh Bhupinder , Bhairappa Shivakumar , Nanjappa Manjunath
Published: April 2013

Spontaneous coronary artery dissection (SCAD) is one of the rare causes of acute coronary syndrome in young healthy individuals especially women without having any conventional risk factors for coronary artery disease. We describe a case of 34-year-old healthy man with diffuse multiple SCADs who presented with acute coronary syndrome and was managed conservatively with an uneventful course on long-term follow-up.
A rare occurrence and management of familial schwannomatosis
Authors: Reddy Ramesh G , Banda Vanaja Reddy , Gunadal Shankar , Banda Naveen Reddy
Published: April 2013

We are presenting a familial schwannomatosis without the features of neurofibromatosis (NF). We retrospectively reviewed the hospital charts, radiology films, operative notes and pathology slides of the patient. There was a family history of schwannomatosis. The patient had contrast-enhanced MRI, which was negative for vestibular schwannomas. The patient underwent surgical excision of symptomatic lesions. Histopathology confirmed these lesions as schwannomas consisting of areas of Antoni A and B, and immunohistochemical study was positive for S-100 protein. We recommend surgery for symptomatic lesions. Asymptomatic tumours can be monitored. Regular follow-up is essential as they may develop fresh lesions at any time. The relevant literature is discussed.
Multifocal osteonecrosis in systemic lupus erythematosus: case report and review of the literature
Authors: Fajardo-Hermosillo Luis D , López-López Linnette , Nadal Anaida , Vilá Luis M
Published: April 2013

Osteonecrosis is a relatively common comorbidity in systemic lupus erythematosus (SLE), but avascular necrosis in multiple sites is unusual. Multifocal osteonecrosis is defined as osteonecrotic lesions affecting three or more separate anatomic sites. We report a case of a 24-year-old woman diagnosed with SLE when she presented with mucocutaneous, haematological and mild renal manifestations. Initially, she was treated with prednisone and hydroxychloroquine and her condition remained stable. Two years later, she developed severe bilateral pretibial ulcers intractable to immunosuppressive therapy and broad-spectrum antibiotics. MRI of both legs disclosed osteonecrosis of the distal tibia, proximal tibia, distal fibula and talus bilaterally. She had elevated anticardiolipin antibodies for which she was treated with chronic anticoagulation resulting in complete healing of the leg ulcers and no further episodes of osteonecrosis. In addition to this case, we review the demographic, clinical and pharmacological features of 14 cases reported in the literature.
An unexpected cause of pleural effusion in paediatric emergency medicine
Authors: Ozbek Seda , Gumus Meltem , Yuksekkaya Hasan Ali , Batur Abdussamed
Published: April 2013

Pancreaticopleural fistula (PPF) is an uncommon complication of chronic pancreatitis leading to a large and recurrent pleural effusion. Since the patients presented predominantly with respiratory symptoms, diagnosis and treatment were often delayed. We describe a child who was admitted to our paediatric emergency department with an acute onset of dyspnoea and unilateral massive pleural effusion caused by PPF. Multidetector CT is an easily accessible method that is able to show both the thoracic and abdominal findings non-invasively. The clinical and imaging features of this unusual entity are discussed.
A false-positive ST segment elevation during exercise stress test
Authors: Srinivas Sunil Kumar , Hirapur Iranna S , Bhairappa Shivakumar , Manjunath Cholenahally Nanjappa
Published: April 2013

A 56-year-old man with multiple risk factors undergoing evaluation for chest pain developed ST elevations in multiple leads during exercise stress test. These ST elevations were not classical of ischaemic pattern. The coronary angiogram showed normal coronaries. The false-positive ST elevation was due to an error in the computer-synthesised averaging algorithm.
Unusual aetiology of malignant spinal cord compression
Authors: Boland Jason , Rennick Adrienne
Published: April 2013

Malignant spinal cord compression (MSCC) is an oncological emergency requiring rapid diagnosis and treatment to prevent irreversible spinal cord injury and disability. A case is described in a 45-year-old male with renal cell carcinoma in which the presentation of the MSCC was atypical with principally proximal left leg weakness with no evidence of bone metastasis. This was due to an unusual aetiology of the MSCC as the renal carcinoma had metastasised to his left psoas muscle causing a lumbosacral plexopathy and infiltrated through the intervertebral disc spaces, initially causing left lateral cauda equina and upper lumbar cord compression, before complete spinal cord compression. This case illustrates the varied aetiology of MSCC and reinforces the importance of maintaining a high index of suspicion of the possibility of spinal cord compression.
ORGAN DONATION IN PAEDIATRIC ICUS
Authors: Gillis Jonathan
Published: April 2013

No abstract
ADVANCE CARE PLANNING IN A COMMUNITY SETTING FOR PEOPLE WITH CHRONIC DISEASE
Authors: Beedham S , Cockayne Mark
Published: April 2013

Background

The Silver Chain Group, one of Australia's largest primary health care providers, recognised that it is in a unique position to offer Advanced Care Planning (ACP) to large numbers of clients in their own home.

Aim

The project aim was to develop a process and tools for the introduction of ACP within the community for people with chronic disease.

Methods

Clients with chronic disease and receiving community nursing services were invited to participate. Specific tools and processes were developed. Registered Nurses (RNs) provided clients with information and referral to the project nurse. Clients were visited at home to facilitate ACP conversation, liaising with GPs, and assist with completion of documentation where required. Data including demographics and outcomes of interviews with clients and staff were collected and analysed.

Results

Thirty-three clients were visited and engaged in advanced care planning; 12 completed advanced health directives. Seventeen clients engaged in end of life conversations with the RN and did not require further intervention. Interviews with clients demonstrated satisfaction with the outcome. Staff highlighted concerns with delivering the information relating to personal discomfort and professional capability. Tools and processes for community ACP were developed with recommendations for sustainable implementation.

Discussion

The evaluation highlighted client and staff recommendations which include staff education and change management processes required to align culture and meet client needs.

Conclusion

This project has been effective in highlighting the role of ACP within a large national primary health care organisation, and understanding the requirements of sustainable and systemic implementation.
ESSENTIAL ADVANCE CARE PLANNING: DEACTIVATION OF IMPLANTABLE CARDIOVERTER DEFIBRILLATORS (ICDS) AT END OF LIFE
Authors: Reymond L , Israel F , Korczyk D
Published: April 2013

Background

Implantable cardioverter defibrillators (ICDs) reduce mortality in patients with certain cardiac conditions and are widely used in contemporary cardiac care. Increasingly, patients with ICDs are referred to palliative care services for management either of cardiac conditions, related co-morbidities or unrelated diseases. An ICD can have the defibrillator component deactivated thus avoiding futile and painful electrical shocks to the dying patient. Developing a strategy to sensitively manage deactivation of ICDs is an essential component of contemporary end of life/advance care planning.

Aim

To develop a strategy to ensure timely defibrillator deactivation in palliative patients across all environments of care.

Methods

Following a literature search concerning deactivation of ICDs, issues were explored in clinical meetings and workshop sessions. Stakeholders including cardiologists/electro-physiologists, specialist palliative care clinicians, general practitioners, lawyers, ethicists and patient liaison representatives drafted the strategy.

Results

The strategy was endorsed by Queensland Health, documented as a Clinical Practice Guideline and disseminated. It includes components relating to patient/relative wishes and history taking, communication between stakeholders, clinical alert notifications, procedures for emergency deactivation of devices, consent and documentation processes. Magnets for emergency use are located in palliative care units and doctors' medical bags.

Discussion

This inclusive strategy has decreased the risk of futile shocks in palliative patients in part by emphasising a particular component of advance care planning. It has been used successfully in acute, community and residential aged care settings.

Conclusion

Palliative care services need to adapt to contemporary clinical advances and incorporate such advances into the patients' advance care plans.
ADVANCE CARE PLANNING IN MENTAL HEALTH: LEGAL ISSUES AND NEW DEVELOPMENTS
Authors: Weller P
Published: April 2013

Background

Advance Care Planning (ACP) in mental health raises a series of unique legal questions. Writing about ‘advance statements’ in Scotland, Jacqueline Atkinson identified them as the questions of nomenclature, capacity, content and legal status (Atkinson 2003). International comparisons of ACP in mental health shows that the broader human rights context in which mental health laws operate also influences the scope and interpretation of the key issues that underpin ACP practice.

Aim

The aim this paper is to indentify prominent legal issues in ACP in mental health in Australia in light of the growing impact of the Convention on the Rights of Persons with Disabilities (CRPD).

Methods

The analysis is based on the author's research as Post Doctoral Research Fellow and Deputy Director of the Centre for the Advancement of Law and Mental Health in the Faculty of Law at Monash University. This paper will discuss the four key issues by presenting an analysis on international and Australian jurisprudence with respect to the question of mandated housing and accommodation for people with mental health problems.

Discussion

This approach highlights recent developments in the law, shedding light on the relationship between compulsory mental health laws and the common law. It illustrates the emerging recognition in law that the preferences of the person have significance in care and treatment decisions, highlighting areas of law and practice that remain uncertain.

Conclusion

The paper argues that ACP practice in mental health will be facilitated by practical research into the law and its effects.
MATURE MINORS AND REFUSAL OF MEDICAL TREATMENT
Authors: Tobin C
Published: April 2013

Background

In all Australian states, except South Australia, a minor is able to consent to treatment (provided he or she demonstrates a ‘sufficient understanding and intelligence to enable him or her to understand fully’ the proposed medical treatmenti) but not to refuse medical treatment. It has been argued that the law is inconsistent on this matter, that logic and consistency (as well as the modern understanding of the autonomy of the minor) would say that a minor who is sufficiently mature to consent to treatment should also be mature enough to refuse it, even if this causes the minor to die or suffer adverse consequences.

Aim

An analysis of whether Australian law should allow a minor to refuse medical treatment.

Method

The analysis of case law, legislation and academic opinion expressed in both legal and ethical journals.

Results

As this is not an empirical study but a study of legal and ethical argument, the results are canvassed in the Discussion.

Discussion

This paper canvasses the arguments for and against the recognition of such a right. It argues that the refusal of medical treatment is not merely the converse of the right to consent to medical treatment: refusal requires a higher level of maturity, in particular an appreciation of the long-term consequences of a decision to refuse treatment.

Conclusion

This study concludes that Australian law should not recognise a right of the mature minor to refuse medical treatment.
FAMILY CENTERED ADVANCE CARE PLANNING FOR TEENS WITH CANCER (FACE-TC): 3-MONTHS OUT: ADVANCE DIRECTIVES, PSYCHOLOGICAL ADJUSTMENT, AND QUALITY OF LIFE
Authors: Lyon M E , Jacobs S , Briggs L , Cheng Y I , Wang J
Published: April 2013

Background

Teens with cancer want to talk about their goals/values for end-of-life care. Yet, advance care planning rarely occurs for them.

Aim

To pilot-test 3-month outcomes of the FACE-TC Advance Care Planning (ACP) intervention (n=17 dyads) versus Treatment As Usual (TAU) control (n=13 dyads) regarding advance directives, psychological adjustment, and quality of life.

Methods

A 2-group, randomised, controlled trial in hospital-based inpatient/outpatient oncology units clinics from 2009–2012 with teens with cancer aged 14 to 21 years and their family (N=30 adolescent/family dyads). FACE-TC consist of three, weekly, 60 min sessions in a dyadic format with a trained/certified interviewer: (1) Lyon Advance Care Planning Survey©; (2) Respecting Choices Interview; (3) Five Wishes©.Three 60 min sessions were conducted 1 week apart. Three-month outcome measures were: advance directive; Beck Depression-II (BDI-II) and Anxiety Inventories (BAI); and Pediatric Quality of Life (Peds QL). Two teens did not complete follow-up (1 died, 1 host-graft disease), so 3-month analysis was with 28 dyads.

Results

Adolescents' mean age was 16; 60% male; 43% Black. Advance directives documented in medical record at 3-month follow-up were 100% for intervention teens, 0% for controls (16 vs 0, p<0.0001). Measures of anxiety, depression and quality of life at 3-month follow-up did not significantly differ between FACE-TC and TAU groups for teens or their families, controlling for corresponding baseline measures.

Discussion/Conclusion

The FACE-TC dyads completed ACP without harm. FACE-TC was not inferior to TAU. Three-month follow-up was too short and sample size too small to determine if FACE-TC was beneficial.
AN AUDIT OF THE PREVALENCE AND CHARACTERISTICS OF ADVANCE CARE PLANNING FOR PATIENTS FROM RESIDENTIAL AGED CARE FACILITIES (RACFS) REFERRED TO THE MOBILE ASSESSMENT AND TREATMENT SERVICE (MATS)
Authors: Jafari B , Austin N , Lemke R , Poojary S
Published: April 2013

Background

Advance Care Planning (ACP) ensures recognition of a person's wishes and promotes autonomy, however, completion and implementation has been a challenge.

Aim

To assess the prevalence of ACP in patients from Residential Aged Care Facilities (RACFs) referred to the ‘Residential In-reach’ service of Alfred Health known as Mobile Assessment and Treatment Service (MATS), and to assess how the process of ACP has been approached by the mangers of those facilities.

Methods

Part A: Prospective audit of documentation of ACP for 100 patients referred to MATS

Part B: De-identified, paper-based surveys of the managers of the RACFs where the patients from part A of the study were residing.

Results

Part A: The prevalence of ACP, Medical Enduring Power Of Attorney and ‘Not for Resuscitation’ form were 38%, 37% and 35%, respectively. Patients with ACP or a separate ‘NFR’ form were significantly more likely to be living in high care compared to low care facilities (79% vs 21%, p=0.049 and 80% vs 20%, p=0.032, respectively).

Part B: There was a significant inconsistency between the facilities with regards to ‘facility requirements’ for ACP, ‘person responsible’, ‘documentation’ and ‘GP involvement’.

Discussion

This study found a low prevalence of ACP, MEPOA and ‘NFR’ form in patients from RACFs referred to MATS. There was also lack of a systematic approach in the process of ACP.

Conclusion

There is a need for structured policy coupled with appropriate funding as well as further education of both public and health professionals.
PATIENTS' RIGHTS IN INTENSIVE CARE UNITS
Authors: Kleanthous E
Published: April 2013

Background

The principle of patient autonomy is important in all European laws about Patients Rights. However, little research has been done investigating healthcare providers, relatives and patients' knowledge and attitudes regarding patients' rights. As far, almost none has been done investigating patients rights in intensive care units.

Aim

A review of literature will be presented regarding knowledge and attitudes of healthcare providers, relatives and patients regarding patients' rights in intensive care units and especially the principle of autonomy in decision making process.

Methods

For this review CINAHL, Pubmed and Medline were searched under the keywords ‘patient rights’, ‘critically ill’ and ‘autonomy’, ‘decision-making’.

Results

Patient rights have been included in the research findings as a main issue in intensive care units among other important issues, such as decision-making, privacy and end of life care. Health care professionals must understand patients' and families' wishes and increase the communication in the intensive care units in order to provide patient autonomy and privacy.

Discussion

It was evident from the literature review that critically ill patients cannot actively participate in decisions about their health and treatment, but the health care professionals and families must respect them as human beings. Patient rights are fundamental for all the people in the hospitals.

Conclusion

Further research is needed to determine the extent to which patients' rights are respected in intensive care units and in addition to examine the knowledge and attitudes of health care professionals and relatives regarding patients' rights of critically ill patients
UNDERSTANDING HOW CANCER PATIENTS ACTUALISE, RELINQUISH, AND REJECT ADVANCE CARE PLANNING: IMPLICATIONS FOR PRACTICE
Authors: Michael N , Stepanov N , Spruyt O , Pollard A , Clayton J , O'Callaghan C
Published: April 2013

Background

Although advance care planning (ACP) is recognised as intégral to quality cancer care, it remains poorly integrated in many settings. Given cancer patients' unpredictable disease trajectories and equivocal treatment options, a disease specific ACP model may be necessary.

Aims

To examine how Australian cancer patients consider ACP and inform the development of an Australian Cancer Centre's ACP programme.

Methods

A constructivist research approach drawing on the Medical Research Council framework for complex interventions. Participants described their initial understanding of ACP, received ACP information, and finally completed a semi-structured interview assisted by the vignette technique. Qualitative inter-rater reliability was integrated.

Results

Twenty-nine patients from the lung and gastro-intestinal tumour streams were approached with 18 completing the study. Participants initially had scant knowledge of ACP. On obtaining further information, their responses indicated that: For cancer patients, ACP is an individualised, dynamic, and shared process characterised by myriad variations in choices to actualise, relinquish, and/or reject its individual components. Actualisation of each component involves considering, possibly conversing about, planning, and communicating a decision, usually iteratively. Reactions can change over time and are informed by values, memories, personalities, health perceptions, appreciation of prognoses, and trust or doubts in their substitute decision makers.

Discussion/Conclusion

Findings endorse the value of routinely, though sensitively discussing ACP with cancer patients at various times points across their disease trajectory. Nonetheless, ACP may also be relinquished or rejected and ongoing offers for ACP in some patients may be offensive to their value system.
PALLIATIVE CARE PRACTICE WITH HIV/AIDS
Authors: Nandaula Sarah
Published: April 2013

Involvement of people living with HIV/AIDS in the continuum care

Introduction

In fulfilling the mission, hospice provides care package that includes holistic assessment counselling, medical care and also provides support in terms of antiretroviral therapy. Home based care, social support, nutrition support, capacity building and advocacy are also given by Hospice Africa

Description

Group therapy composed of people living with HIV/AIDS and cancer and the entire gather around and sensitise the rest of patients still in denial land also educate the public on cancer and HIV/AIDS care, support and prevention through dancing, drama, making crafts and sharing life experience. Clients representatives, who are members of centre advisory committees and board of trustees, are involved in care of clients in the community. Palliative care is done by these clients reps in their communities and families are taught by home based teams and groups to families. Emotionally they are counselled spiritual support is also given and pain relief given by medical personnel. Clients are empowered to reveal their status by teaching them about disclosure both to family members and to their children. Families are advised to visit their patients frequently and encouraged them every day by telling them how much they have improved.

Lessons Learnt

Support structures are useful in proper management of palliative care—the family structures and relatives including counselling are necessary for palliative care. Nutritional support, spiritual support and pain managements very important in palliative care.

Recommendations

People living with HIV/AIDS should always include palliative care in their role as caregivers. The best person to understand how it feels like to be very sick is the one who has been through the same situation so care structures should make use of these people.