bluuebunny/crossref_metadata_2025 huggingface dataset:
Preparation of flexible epoxy/clay nanocomposites: effect of preparation method, clay modifier and matrix ductility
Authors: Jagtap SB , Rao V Srinivasa , Ratna D
Published: November 2012

In the present report, we studied the effect of different parameters such as preparation methods, different types of modified clay and matrix flexibility on thermomechanical properties of flexible epoxy/clay nanocomposites. The unmodified clay (cloisite Na+) was organically modified with decylamines having different number of carbon atoms using an ion exchange method in organo-aqueous solution. The modified clays were characterized by thermogravimetric analysis and X-ray diffraction analysis. Using laboratory modified clay and commercial clay, a series of nanocomposites were made by using solution intercalation and monomer intercalation methods. The dispersion of clay and enhancement in properties of nanocomposites was found to be better for solution intercalation method (use of small amount of solvent) compared to monomer intercalation method. Among all the modified clay, the tetradecylamine-modified clay-based composite showed the effective improvement in the mechanical and dynamic mechanical properties. Addition of 7--9 wt% Cloisite TDA in the epoxy matrix exhibited around 450% and 680% improvement in tensile strength and tensile modulus compared to the neat epoxy. The dispersibility of modified clay in the epoxy matrix was assessed by X-ray diffraction and transmission electron microscopic analysis and the result shows the intercalated morphology of prepared composites. Reinforcing effect was found to be more prominent in a matrix with higher flexibility.
Acute Care Nurses’ Spiritual Care Practices
Authors: Gallison Barry S. , Xu Yan , Jurgens Corrine Y. , Boyle Suzanne M.
Published: November 2012

The purpose of this study was to identify barriers in providing spiritual care to hospitalized patients. A convenience sample ( N = 271) was recruited at an academic medical center in New York City for an exploratory, descriptive questionnaire. The Spiritual Care Practice (SCP) questionnaire assesses spiritual care practices and perceived barriers to spiritual care. The SCP determines the percentage that provides spiritual support and perceived barriers inhibiting spiritual care. The participation rate was 44.3% ( N = 120). Most (61%) scored less than the ideal mean on the SCP. Although 96% ( N = 114) believe addressing patients spiritual needs are within their role, nearly half (48%) report rarely participating in spiritual practices. The greatest perceived barriers were belief that patient’s spirituality is private, insufficient time, difficulty distinguishing proselytizing from spiritual care, and difficulty meeting needs when spiritual beliefs were different from their own. Although nurses identify themselves as spiritual, results indicate spirituality assessments are inadequate. Addressing barriers will provide nurses opportunities to address spirituality. Education is warranted to improve nurses’ awareness of the diversity of our society to better meet the spiritual needs of patients. Understanding these needs provide the nurse with opportunities to address spirituality and connect desires with actions to strengthen communication and the nurse–patient relationship.
Knowing, Caring, and Telehealth Technology
Authors: Nagel Daniel A. , Pomerleau Sophie G. , Penner Jamie L.
Published: November 2012

The use of technology in delivery of health care services is rapidly increasing, and more nurses are using telehealth to provide care by distance to persons with complex health challenges. The rapid uptake of telehealth modalities and dynamic evolution of technologies has outpaced the generation of empirical knowledge to support nursing practice in this emerging field, specifically in relation to how nurses come to know the person and engage in holistic care in a virtual environment. Knowing the person and nursing care have historically been associated with physical presence and close proximity in the nurse–client relationship, and the use of telehealth can limit the ways in which a nurse can observe the person, potentiate perceptions of distance, and lead to a reductionist perspective in care. The purpose of this article is to illuminate the dynamic and evolving nature of nursing practice in relation to the use of telehealth and to highlight gaps in nursing knowledge specific to knowing the person in a virtual environment. Such an understanding is necessary to inform future research and generate empirical evidence to support nurses in providing ethical, safe, effective, and holistic care by distance to persons through telehealth technology.
How to Pass the False-Belief Task Before Your Fourth Birthday
Authors: Rubio-Fernández Paula , Geurts Bart
Published: November 2012

The experimental record of the last three decades shows that children under 4 years old fail all sorts of variations on the standard false-belief task, whereas more recent studies have revealed that infants are able to pass nonverbal versions of the task. We argue that these paradoxical results are an artifact of the type of false-belief tasks that have been used to test infants and children: Nonverbal designs allow infants to keep track of a protagonist’s perspective over a course of events, whereas verbal designs tend to disrupt the perspective-tracking process in various ways, which makes it too hard for younger children to demonstrate their capacity for perspective tracking. We report three experiments that confirm this hypothesis by showing that 3-year-olds can pass a suitably streamlined version of the verbal false-belief task. We conclude that young children can pass the verbal false-belief task provided that they are allowed to keep track of the protagonist’s perspective without too much disruption.
Thomas Campion’s iambic and quantitative Sapphic: Further evidence for phonological weight in Elizabethan English quantitative and non-quantitative meters
Authors: Roberts-Smith Jennifer
Published: November 2012

Fulfilling a central goal of a generation of Elizabethan English metrical theory often referred to as the ‘quantitative movement’, Thomas Campion succeeded in demonstrating the role of syllable quantity, or phonological weight, in Elizabethan iambic pentameter. Following Kristin Hanson (2001, 2006), this article parses Campion’s scansions of Early Modern English syllables, according to moraic theory, into resolved moraic trochees. The analysis demonstrates that (1) Campion distinguished between syllable weight (syllable quantity) and stress or strength (accent) in Early Modern English; (2) Campion prohibited syllabic consonants in English iambic pentameter, despite the fact that they were attested in Early Modern English as a whole; (3) in a successful adaptation of the Latin rule of ‘position’, as described by William Lily and John Colet’s Short Introduction of Grammar (1567), Campion re-syllabified coda consonants followed by vowels; and (4) Campion employed syllabic elision as a means of avoiding pyrrhic syllable combinations that resulted in non-maximal filling of long positions in a line of English iambic pentameter. His two iambic pentameters – the ‘pure’ and the ‘licentiate’ – are both accentual and quantitative meters that, in accordance with moraic theory, integrate stress and strength with syllable weight. He contrasted stress and weight in the quantitative Sapphic lyric ‘Come let us sound with melodie’ (Campion, 1601). Hanson’s (2001, 2006) reconsideration of the role of syllable quantity in Elizabethan metrical theory and Elizabethan poetry should be continued.
The Pilgrim’s Progress: Allegory or novel?
Authors: Crisp Peter
Published: November 2012

A tradition going back to Coleridge asserts that The Pilgrim’s Progress is not a true allegory but rather a proto-novel expressive of early modern individualism. The work is radically individualistic, but it is also truly an allegory. Recent research has emphasized how closely related metaphor often is to metonymy and how intimately the two can interact to produce metaphtonymy. This interaction is just as important in allegory as in purely linguistic metaphor and metonymy. The Pilgrim’s Progress makes subtle use of conceptual metaphtonymy to express its individualism. Although the degree of individualism these cognitive structures express is greater than anything in earlier allegorical tradition, the structures themselves are inherited from medieval allegories such as Everyman. This sharing of major cognitive structure with earlier medieval allegories shows that The Pilgrim’s Progress is truly an allegory. An area in which the interaction of metaphor and metonymy is particularly notable is that of blending. The occurrence of highly creative blending in at least some of its scenes is further evidence for the truly allegoric nature of The Pilgrim’s Progress.
Living in the In-Between
Authors: Rallison Lillian B. , Raffin-Bouchal Shelley
Published: November 2012

Medical advances in recent years have led to an increased life span for children with progressive, neurodegenerative illnesses. The purpose of this hermeneutic inquiry was to explore the experience of families caring for their child at home. In-depth, audiorecorded interviews with six families (13 interviews) living in western Canada were transcribed and analyzed. The illness journey was revealed to be complex and unpredictable. We discovered many metaphors that spoke to the child’s/family’s life and explored the paradox of duality, such as holding both joy and sorrow, and containing both suffering and love. We outline implications for policy development within the area of respite care and coordination of services for families. The voices of families must be a vital component to influence and guide education and service development within the emerging specialty of pediatric palliative care.
Efficacy vs. effectiveness: Erlotinib in previously treated non-small-cell lung cancer
Authors: Sheikh Naureen , Chambers Carole R
Published: November 2012

Background:

A randomized trial carried out by Shepherd et al. in patients with advanced or metastatic non-small-cell lung cancer showed statistically significant benefit of erlotinib over placebo in prolonging overall survival and progression-free survival.

Objectives:

The primary outcome was to compare overall survival of patients treated with erlotinib for non-small-cell lung cancer at Alberta Health Services – Cancer Care to the overall survival seen in the pivotal trial. Secondary outcomes included comparing progression-free survival, overall response rate, and duration of response between the two patient populations.

Methods:

A retrospective review of charts was conducted for patients with locally advanced or metastatic non-small-cell lung cancer who received erlotinib therapy after failure of at least one prior chemotherapy regimen between 1 August 2006 and 31 July 2009. Survival data was analyzed using the Kaplan-Meier method.

Results:

Median overall survival and progression-free survival were 5.19 months and 2.46 months, respectively, in Alberta Health Services – Cancer Care patients. The rate of response was 11% (median duration of response, 6.7 months). The likelihood of a response to erlotinib was higher among nonsmokers ( p < 0.0001) and those with response to prior chemotherapy ( p = 0.0896). In multivariate analysis, good performance status ( p = 0.0109) and response to prior therapy ( p < 0.0001) were favorable factors for survival.

Conclusions:

In a clinical setting, erlotinib does not perform as well in terms of median overall survival as reported in the pivotal trial (5.19 vs. 6.70 months).
Cigarette Smoke Condensate Induces Differential Expression and Promoter Methylation Profiles of Critical Genes Involved in Lung Cancer in NL-20 Lung Cells In Vitro
Authors: Word Beverly , Lyn-Cook Lascelles E. , Mwamba BiBi , Wang Honggang , Lyn-Cook Beverly , Hammons George
Published: November 2012

Establishing early diagnostic markers of harm is critical for effective prevention programs and regulation of tobacco products. This study examined effects of cigarette smoke condensate (CSC) on expression and promoter methylation profile of critical genes (DAPK, ECAD, MGMT, and RASSF1A) involved in lung cancer development in different human lung cell lines. NL-20 cells were treated with 0.1-100 μg/ml of CSC for 24 to 72 hrs for short-term exposures. DAPK expression or methylation status was not significantly affected. However, CSC treatment resulted in changes in expression and promoter methylation profile of ECAD, MGMT, and RASSF1A. For chronic studies, cells were exposed to 1 or 10 μg/ml CSC up to 28 days. Cells showed morphological changes associated with transformation and changes in invasion capacities and global methylation status. This study provides critical data suggesting that epigenetic changes could serve as an early biomarker of harm due to exposure to cigarette smoke.
Examining restricted and repetitive behaviors in young children with autism spectrum disorder during two observational contexts
Authors: Stronach Sheri , Wetherby Amy M
Published: November 2012

This prospective study of the FIRST WORDS® Project examined restricted and repetitive behaviors in a sample of 55 toddlers at a mean age of 20 months who were later diagnosed with autism spectrum disorder. Restricted and repetitive behaviors were coded using the Repetitive Movement and Restricted Interest Scales in two video-recorded observation methods–structured sampling procedures in a clinic and naturalistic everyday activities at home. Measures of restricted and repetitive behaviors were higher in the clinic setting than in the home observation, especially for behaviors involving object use. Repetitive movements with objects in the clinic predicted nonverbal developmental scores and Autism Diagnostic Observation Schedule social affect scores at later follow-up. In contrast, repetitive movements with objects at home significantly predicted later Autism Diagnostic Observation Schedule restricted and repetitive behaviors scores. These results support the utility of the Repetitive Movement and Restricted Interest Scales to detect restricted and repetitive behaviors in toddlers and suggest that observations of restricted and repetitive behaviors in clinic and home settings may provide unique and important diagnostic information for improving early detection of autism spectrum disorder.
Object exploration at 6 and 9 months in infants with and without risk for autism
Authors: Koterba Erin A , Leezenbaum Nina B , Iverson Jana M
Published: November 2012

During the first year of life, infants spend substantial amounts of time exploring objects they encounter in their daily environments. Perceptuo-motor information gained through these experiences provides a foundation for later developmental advances in cognition and language. This study aims to examine developmental trajectories of visual, oral, and manual object exploration in infants with and without risk for autism spectrum disorder before the age of 1 year. A total of 31 infants, 15 of whom had an older sibling with autism and who were therefore at heightened risk for autism spectrum disorder, played with sounding and nonsounding rattles at 6 and 9 months of age. The results suggest that heightened-risk infants lag behind their low-risk peers in the exploration of objects. The findings are discussed in terms of how delays in object exploration in infancy may have cascading effects in other domains.
A sub-aerial biofilms investigation and new approach in biocide application in cultural heritage conservation: Holy Virgin Church (Gradac Monastery, Serbia)
Authors: Stupar Miloš , Grbić Milica Ljaljević , Simić Gordana Subakov , Jelikić Aleksa , Vukojević Jelena , Sabovljević Marko
Published: November 2012

Sub-aerial biofilms (SAB) on frescoes and façade of the Holy Virgin Church (Gradac Monastery, Serbia) were investigated to study the effectiveness of benzalkonium chloride (BAC) as a biocide. Antifungal activity of Origanum vulgare essential oil as a natural product with confirmed high fungicidal potential was also tested against fungi causing alterations on the frescoes. Chemical and mineralogical composition of the church historical mortar showed the dominance of calcareous minerals. In large areas on the church façade, coloured biopatinas formed by different groups of coccoid and filamentous cyanobacteria, green algae and filamentous fungi were found. Epilithic lichens and bryophytes were also present on the church exterior suggesting long-term ecological succession. The presence on the frescoes, of human pathogenic fungus Aspergillus fumigatus were found in the internal environment. Aspergillus and Penicillium species isolated from painted walls were subject to an in vitro biocidal assay with the biocide BAC. An aqueous solution of 0.25% and 0.15% BAC was able to reduce the viability of all the tested fungal isolates after exposure to the solution for 5 min, while exposure to an aqueous solution of 0.05% for 30 min reduced conidial viability. Origanum vulgare essential oil also showed strong antifungal potential against selected fungal isolates.
Where is the governance in Internet governance?
Authors: van Eeten Michel JG , Mueller Milton
Published: November 2012

The governance of the Internet provides one of the most important arenas in which new ideas regarding Internet studies can be applied and tested. This paper critiques the prevailing conceptualization of Internet governance. The label is routinely applied to the study of a few formal global institutions with limited or no impact on governance, but not to studies of the many activities that actually shape and regulate the use and evolution of the Internet, such as Internet service provider interconnection, security incident response or content filtering. Consequently, current conceptualizations of Internet governance inflate the presence and influence of state actors. Furthermore, they undermine efforts to understand how large-scale distributed systems in the global economy can be governed in the absence of formalized international regimes. We conclude by discussing how concepts of networked governance can be applied and extended to illuminate the study of Internet governance.
Web historiography and Internet Studies: Challenges and perspectives
Authors: Brügger Niels
Published: November 2012

I argue that web historiography should be placed higher on the Internet Studies’ research agenda, since a better understanding of the web of the past is an important condition for gaining a more complete understanding of the web of today, regardless of our focus (e.g. political economy, language and culture, social interaction or everyday use). Building on reflections about ’historiography’ and the ’web’, I discuss several major challenges of web historiography vis-à-vis historiography in general, focusing on the characteristics of the archived website and the web sphere, and the consequences of these characteristics for web historians. I conclude by outlining future directions for web historiography.
Adherence Issues for Oral Antineoplastics
Authors: Krikorian Susan A. , Shamim Kanza
Published: November 2012

Nonadherence to antineoplastics is a growing concern because of the increasing number of novel oral targeted anticancer therapies. Many of these agents are administered on a chronic continuous schedule for an indefinite period of time where adherence is crucial to achieve optimal disease control and prolong survival. Many factors are known to contribute to medication nonadherence. Prevention, early detection, and management of adverse drug reactions associated with oral targeted therapies require close vigilance. Knowing how to prevent and manage adverse drug reactions will help clinicians develop strategies to promote patient adherence to oral anticancer treatment regimens. Optimal adherence requires a dynamic patient-provider alliance through education, communication, ongoing monitoring, and follow-up.
Physical inactivity is associated with low self efficacy and social support among patients with hypertension in Nigeria
Authors: Idowu OA , Adeniyi AF , Atijosan OJ , Ogwumike OO
Published: November 2012

Background

Physical inactivity is a major factor in the development of many chronic illnesses, including hypertension. Evidence highlighting links among physical activity participation and psychosocial constructs such as self efficacy, social support and perceived barriers among hypertensive patients in the Nigerian population is scarce. This study explored the associations between physical activity and each of self efficacy, social support and perceived barriers.

Methods

Two hundred and twelve patients receiving treatment in two tertiary health institutions located in Ekiti State, Nigeria were surveyed cross-sectionally. Physical activity level, self efficacy, social support and perceived barriers were measured with the International Physical Activity Questionnaire, Exercise Self-Efficacy Scale, Medical Outcomes Social Support Scale and Exercise Benefits and Barrier Scale respectively.

Results

Level of physical activity was significantly associated with self efficacy ( rs = 0.67, p < 0.01,  = 0.45) and social support ( rs = 0.80, p < 0.01,  = 0.64), with most participants (56.1%) being physically inactive. However, no association was found between physical activity level and perceived barriers ( rs = 0.07, p > 0.01,  = 0.005).

Conclusion

Most of the hypertensive patients presented with low levels of physical activity. Physical activity was associated with psychosocial constructs including self efficacy and social support but not with perceived barriers.
Gender on Display: Peformativity in Fashion Modelling
Authors: Entwistle Joanne , Mears Ashley
Published: November 2012

Gender performativity has had significant influences in cultural studies and sociology, yet empirical cases of the theory remain scarce. While some analysis examines performativity in work, the focus is on organizations and how gender ‘gets done and undone’ within them with little attention paid to bodies outside organizations. Based on two empirical studies of freelancing fashion models, we extend Butler’s gender performativity to analyse the routine bodily practices and gender performances of men and women in fashion, investigating what happens when men and women perform the same work but under different gendered expectations. Fashion modelling presents a case that reproduces heteronormative definitions of femininity while potentially challenging traditional notions of masculinity and work. Observing ‘everyday transgressions’, we evidence how gender performativity, while largely reiterative of normative heterosexuality, may subtly confound the conventions. Observing how models ‘do and undo’ gender extends the analysis of gender at work to non-organizational bodies that tend to be under-represented within the literature.
Rapid cytological analysis of endobronchial ultrasound-guided aspirates in sarcoidosis
Authors: Plit Marshall L. , Havryk Adrian P. , Hodgson Alan , James Daniel , Field Andrew , Carbone Sonia , Glanville Allan R. , Bashirzadeh Farzad , Chay Anna M. , Hundloe Justin , Pearson Rebecca , Fielding David
Published: November 2012

Rapid on-site evaluation (ROSE) of endobronchial ultrasound-guided transbronchial needle aspirates (EBUS-TBNA) has not been compared to final detailed cytological analysis in patients with suspected sarcoidosis.

To assess the diagnostic accuracy of EBUS-TBNA with ROSE in patients with suspected sarcoidosis, a prospective two-centre study performed EBUS-TBNA with ROSE of cellular material followed by transbronchial lung biopsy (TBLB) and endobronchial biopsy (EBB). The diagnostic accuracy of EBUS-TBNA with ROSE was compared to the final cytological assessment and to TBLB and EBB.

Analysis confirmed 49 out of 60 cases of sarcoidosis. ROSE sensitivity was 87.8% (specificity 91%, positive predictive value 97.7%). ROSE slide interpretation in combination with the final fixed slide and cell block preparations had a sensitivity of 91.8% (specificity 100%, positive predictive value 100%). 67% of patients were confirmed as having sarcoidosis on TBLB and 29% on EBB. Interobserver agreement between cytotechnologists and pathologists was very good (κ=0.91, 95% CI 0.80–1.0 and κ=0.91, 95% CI 0.79–1.0, respectively).

EBUS-TBNA with ROSE has high diagnostic accuracy and interobserver agreement and informs the bronchoscopist in theatre whether additional diagnostic procedures need to be undertaken. EBUS-TBNA with ROSE should therefore be considered as the first-line investigation of sarcoidosis.
Rapid molecular TB diagnosis: evidence, policy making and global implementation of Xpert MTB/RIF
Authors: Weyer Karin , Mirzayev Fuad , Migliori Giovanni Battista , Van Gemert Wayne , D'Ambrosio Lia , Zignol Matteo , Floyd Katherine , Centis Rosella , Cirillo Daniela M. , Tortoli Enrico , Gilpin Chris , de Dieu Iragena Jean , Falzon Dennis , Raviglione Mario
Published: November 2012

If tuberculosis (TB) is to be eliminated as a global health problem in the foreseeable future, improved detection of patients, earlier diagnosis and timely identification of rifampicin resistance will be critical. New diagnostics released in recent years have improved this perspective but they require investments in laboratory infrastructure, biosafety and staff specialisation beyond the means of many resource-constrained settings where most patients live. Xpert MTB/RIF, a new assay employing automated nucleic acid amplification to detectMycobacterium tuberculosis, as well as mutations that confer rifampicin resistance, holds the promise to largely overcome these operational challenges. In this article we position Xpert MTB/RIF in today’s TB diagnostic landscape and describe its additional potential as an adjunct to surveillance and surveys, taking into account considerations of pricing and ethics. In what could serve as a model for the future formulation of new policy on diagnostics, we trace the unique process by which the World Health Organization consulted international expertise and systematically assessed published evidence and freshly emerging experience from the field ahead of its endorsement of the Xpert MTB/RIF technology in 2010, summarise subsequent research findings and guidance on who to test and how, and provide perspectives on scaling up the new technology.
MirSNP, a database of polymorphisms altering miRNA target sites, identifies miRNA-related SNPs in GWAS SNPs and eQTLs
Authors: Liu Chenxing , Zhang Fuquan , Li Tingting , Lu Ming , Wang Lifang , Yue Weihua , Zhang Dai
Published: November 2012

Background

Numerous single nucleotide polymorphisms (SNPs) associated with complex diseases have been identified by genome-wide association studies (GWAS) and expression quantitative trait loci (eQTLs) studies. However, few of these SNPs have explicit biological functions. Recent studies indicated that the SNPs within the 3’UTR regions of susceptibility genes could affect complex traits/diseases by affecting the function of miRNAs. These 3’UTR SNPs are functional candidates and therefore of interest to GWAS and eQTL researchers.

Description

We developed a publicly available online database, MirSNP (http://cmbi.bjmu.edu.cn/mirsnp), which is a collection of human SNPs in predicted miRNA-mRNA binding sites. We identified 414,510 SNPs that might affect miRNA-mRNA binding. Annotations were added to these SNPs to predict whether a SNP within the target site would decrease/break or enhance/create an miRNA-mRNA binding site. By applying MirSNP database to three brain eQTL data sets, we identified four unreported SNPs (rs3087822, rs13042, rs1058381, and rs1058398), which might affect miRNA binding and thus affect the expression of their host genes in the brain. We also applied the MirSNP database to our GWAS for schizophrenia: seven predicted miRNA-related SNPs (p < 0.0001) were found in the schizophrenia GWAS. Our findings identified the possible functions of these SNP loci, and provide the basis for subsequent functional research.

Conclusion

MirSNP could identify the putative miRNA-related SNPs from GWAS and eQTLs researches and provide the direction for subsequent functional researches.
Enterococcus and Streptococcusspp. associated with chronic and self-medicated urinary tract infections in Vietnam
Authors: Poulsen Louise Ladefoged , Bisgaard Magne , Son Nguyen Thai , Trung Nguyen Vu , An Hoang Manh , Dalsgaard Anders
Published: November 2012

Background

Urinary tract infections (UTI) are one of the most common infections among women worldwide. E. coli often causes more than 75% of acute uncomplicated UTI, however, little is known about how recurrent UTIs and indiscriminate use of antimicrobials affect the aetiology of UTIs. This study aimed to establish the aetiology of UTI in a population of recurrent and self-medicated patients referred from pharmacies to a hospital in Hanoi, Vietnam and to describe genotypes and antimicrobial susceptibility of the associated bacterial pathogens. The aetiology of bacterial pathogens associated with UTI (defined as ≥ 104 CFU/ml urine) was established by phenotypic and molecular methods. Enterococcus faecalis isolates were typed by Multi Locus Sequence Typing (MLST), Pulsed-Field Gel Electrophoresis (PFGE) and antimicrobial susceptibility testing.

Methods

Urine samples from 276 patients suffering symptoms of urinary tract infection were collected and cultured on Flexicult agar® allowing for detection of the most common urine pathogens. Patients were interviewed about underlying diseases, duration of symptoms, earlier episodes of UTI, number of episodes diagnosed by doctors and treatment in relation to UTI. All tentative E. faecalis and E. faecium isolates were identified to species level by PCR, 16S rRNA and partial sequencing of the groEL gene. E. faecalis isolates were further characterized by Multi Locus Sequence Typing and antimicrobial susceptibility testing.

Results

Mean age of 49 patients was 48 yrs (range was 11–86 yrs) and included 94% women. On average, patients reported to have suffered from UTI for 348 days (range 3 days-10 years, and experienced 2.7 UTIs during the previous year). Cephalosporins were reported the second drug of choice in treatment of UTI at the hospital. E. faecalis (55.1%), E. coli (12.2%) and Streptococcus gallolyticus subsp. pasteurianus (8.2%) were main bacterial pathogens. MIC testing of E. faecalis showed susceptibility to ampicillin, penicillin and vancomycin, but high-level resistance against gentamicin (48.1%). MLST revealed 12 Sequence Types (ST) of which ST 16 made up 44.5% and showed closely related PFGE types.

Conclusion

The different aetiology of UTI compared with reports elsewhere, where E. coli dominates, may be a result of chronic and recurrent UTIs together with indiscriminate use of antimicrobials. The similar genotypes shown by epidemiologically unrelated ST 16 isolates in Vietnam and elsewhere, suggest that E. faecalis ST 16 might represent a globally distributed clone. Treatment of UTI with cephalosporins may select for E. faecalis as it is intrinsic resistant and further studies are needed to establish the source(s) and role of E. faecalis ST 16 in acute UTI.
Comparison of toxin removal outcomes in online hemodiafiltration and intra-dialytic exercise in high-flux hemodialysis: A prospective randomized open-label clinical study protocol
Authors: Maheshwari Vaibhav , Samavedham Lakshminarayanan , Rangaiah Gade Pandu , Loy Yijun , Ling Lieng Hsi , Sethi Sunil , Leong Titus Lau Wai
Published: November 2012

Background

Maintenance hemodialysis (HD) patients universally suffer from excess toxin load. Hemodiafiltration (HDF) has shown its potential in better removal of small as well as large sized toxins, but its efficacy is restricted by inter-compartmental clearance. Intra-dialytic exercise on the other hand is also found to be effective for removal of toxins; the augmented removal is apparently obtained by better perfusion of skeletal muscles and decreased inter-compartmental resistance. The aim of this trial is to compare the toxin removal outcome associated with intra-dialytic exercise in HD and with post-dilution HDF.

Methods/design

The main hypothesis of this study is that intra-dialytic exercise enhances toxin removal by decreasing the inter-compartmental resistance, a major impediment for toxin removal. To compare the HDF and HD with exercise, the toxin rebound for urea, creatinine, phosphate, and β2-microglobulin will be calculated after 2 hours of dialysis. Spent dialysate will also be collected to calculate the removed toxin mass. To quantify the decrease in inter-compartmental resistance, the recently developed regional blood flow model will be employed. The study will be single center, randomized, self-control, open-label prospective clinical research where 15 study subjects will undergo three dialysis protocols (a) high flux HD, (b) post-dilution HDF, (c) high flux HD with exercise. Multiple blood samples during each study session will be collected to estimate the unknown model parameters.

Discussion

This will be the first study to investigate the exercise induced physiological change(s) responsible for enhanced toxin removal, and compare the toxin removal outcome both for small and middle sized toxins in HD with exercise and HDF. Successful completion of this clinical research will give important insights into exercise effect on factors responsible for enhanced toxin removal. The knowledge will give confidence for implementing, sustaining, and optimizing the exercise in routine dialysis care. We anticipate that toxin removal outcomes from intra-dialytic exercise session will be comparable to that obtained by standalone HDF. These results will encourage clinicians to combine HDF with intra-dialytic exercise for significantly enhanced toxin removal.

Trial registration

ClinicalTrials.gov number, NCT01674153
A multi-centre qualitative study exploring the experiences of UK South Asian and White Diabetic Patients referred for renal care
Authors: Wilkinson Emma , Randhawa Gurch , Feehally John , Farrington Ken , Greenwood Roger , Choi Peter , Lightstone Liz
Published: November 2012

Background

An exploration of renal complications of diabetes from the patient perspective is important for developing quality care through the diabetic renal disease care pathway.

Methods

Newly referred South Asian and White diabetic renal patients over 16 years were recruited from nephrology outpatient clinics in three UK centres - Luton, West London and Leicester – and their experiences of the diabetes and renal care recorded.

A semi-structured qualitative interview was conducted with 48 patients. Interview transcripts were analysed thematically and comparisons made between the White and South Asian groups.

Results

23 South Asian patients and 25 White patients were interviewed. Patient experience of diabetes ranged from a few months to 35 years with a mean time since diagnosis of 12.1 years and 17.1 years for the South Asian and White patients respectively. Confusion emerged as a response to referral shared by both groups. This sense of confusion was associated with reported lack of information at the time of referral, but also before referral. Language barriers exacerbated confusion for South Asian patients.

Conclusions

The diabetic renal patients who have been referred for specialist renal care and found the referral process confusing have poor of awareness of kidney complications of diabetes. Healthcare providers should be more aware of the ongoing information needs of long term diabetics as well as the context of any information exchange including language barriers.
Development of a gene therapy strategy to target hepatocellular carcinoma based inhibition of protein phosphatase 2A using the α-fetoprotein promoter enhancer and pgk promoter: an in vitro and in vivo study
Authors: Li Wei , Li Dao-Ming , Chen Kai , Chen Zheng , Zong Yang , Yin Hong , Xu Ze-Kuan , Zhu Yi , Gong Fei-Ran , Tao Min
Published: November 2012

Background

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths worldwide. Current therapies are insufficient, making HCC an intractable disease. Our previous studies confirmed that inhibition of protein phosphatase 2A (PP2A) may provide a promising therapeutic strategy for cancer. Unfortunately, constitutive expression of PP2A in normal tissues limits the application of PP2A inhibition. Thus, a HCC-specific gene delivery system should be developed. The α-fetoprotein (AFP) promoter is commonly used in HCC-specific gene therapy strategies; however, the utility of this approach is limited due to the weak activity of the AFP promoter. It has been shown that linking the AFP enhancer with the promoter of the non-tissue-specific, human housekeeping phosphoglycerate kinase (pgk) gene can generate a strong and HCC-selective promoter.

Methods

We constructed a HCC-specific gene therapy system to target PP2A using the AFP enhancer/pgk promoter, and evaluated the efficiency and specificity of this system both in vitro and in vivo.

Results

AFP enhancer/pgk promoter-driven expression of the dominant negative form of the PP2A catalytic subunit α (DN-PP2Acα) exerted cytotoxic effects against an AFP-positive human hepatoma cell lines (HepG2 and Hep3B), but did not affect AFP-negative human hepatoma cells (SK-HEP-1) or normal human liver cells (L-02). Moreover, AFP enhancer/pgk promoter driven expression of DN-PP2Acα inhibited the growth of AFP-positive HepG2 tumors in nude mice bearing solid tumor xenografts, but did not affect AFP-negative SK-HEP-1 tumors.

Conclusions

The novel approach of AFP enhancer/pgk promoter-driven expression of DN-PP2Acα may provide a useful cancer gene therapy strategy to selectively target HCC.
Doxorubicin-enriched, ALDHbr mouse breast cancer stem cells are treatable to oncolytic herpes simplex virus type 1
Authors: Zhuang Xiufen , Zhang Wen , Chen Yatong , Han Xiangping , Li Jie , Zhang Yu , Zhang Youhui , Zhang Shuren , Liu Binlei
Published: November 2012

Background

The primary objective of this study was to test whether oncolytic herpes simplex virus type 1 (HSV1) could eradicate chemoresistant cancer stem cells (CSCs).

Methods

The fluorescent aldefluor reagent-based technique was used to identify and isolate ALDHbr cells as CSCs from the 4T1 murine breast cancer cell line. The presence of ALDHbr 4T1 cells was also examined in 4T1 breast cancer transplanted in immune-competent syngeneic mice.

Results

Compared with ALDHlo cells, ALDHbr cells had a markedly higher ability to form tumor spheres in vitro and a higher tumorigenic potential in vivo. ALDHbr cells also exhibited increased doxorubicin resistance in vitro, which correlated with a selective increase in the percentage of ALDHbr cells after doxorubicin treatment and an increased expression of P-glycoprotein (P-gp), a known chemoresistance factor. In contrast, oncolytic HSV1 was able to kill ALDHbr cells in vitro and even more markedly in vivo. Furthermore, in in vivo studies, systemic administration of doxorubicin followed by intratumoral injection of oncolytic HSV1 resulted in much more significant suppression of tumor growth with increased median survival period compared with each treatment given alone (p<0.05). Though more CD8+ T lymphocytes were induced by oncolytic HSV1, no significant specific T cell response against CSCs was detected in vivo.

Conclusions

These results suggested that the use of oncolytic HSV1 following doxorubicin treatment may help eradicate residual chemoresistant CSCs in vivo.
A cluster-randomised clinical trial comparing two cardiovascular health education strategies in a child population: the Savinghearts project
Authors: Sánchez-Gómez Luis María , Fernández-Luque María Jesús , Ruiz-Díaz Lourdes , Sánchez-Alcalde Rosa , Sierra-García Belén , Mayayo-Vicente Soledad , Ruiz-López Marta , Loeches-Belinchón Pilar , López-Gónzález Javier , González-Gamarra Amelia , Gallego-Arenas Angela , Cubillo-Serna Ana , Gil-Juberias Gema , Pérez-Cayuela Pilar , Cañedo-Arguelles Celina Arana , García-Pascual Julia Natividad , Ruiz-Chércoles Esther , Suarez-Fernández Carmen , Garcia-Polo Iluminada , Abad-Perez Daniel , Ballesteros-Arribas Juan M , Izquierdo-Martínez Maravillas , Salvador-Alcaide Elena , Arribas-Vela Ana B , Alonso-Pérez Juan M , Veja-Piris Lorena , Rodríguez-Salvanés Francisco , Novella-Arribas Blanca
Published: November 2012

Background

This paper describes a methodology for comparing the effects of an eduentertainment strategy involving a music concert, and a participatory class experience involving the description and making of a healthy breakfast, as educational vehicles for delivering obesity-preventing/cardiovascular health messages to children aged 7–8 years.

Methods/design

This study will involve a cluster-randomised trial with blinded assessment. The study subjects will be children aged 7–8 years of both sexes attending public primary schools in the Madrid Region. The participating schools (n=30) will be randomly assigned to one of two groups: 1) Group MC, in which the children will attend a music concert that delivers obesity-preventing/cardiovascular health messages, or 2) Group HB, in which the children will attend a participatory class providing the same information but involving the description and making of a healthy breakfast. The main outcome measured will be the increase in the number of correct answers scored on a knowledge questionnaire and in an attitudes test administered before and after the above interventions. The secondary outcome recorded will be the reduction in BMI percentile among children deemed overweight/obese prior to the interventions. The required sample size (number of children) was calculated for a comparison of proportions with an α of 0.05 and a β of 0.20, assuming that the Group MC subjects would show values for the measured variables at least 10% higher than those recorded for the subjects of Group HB. Corrections were made for the design effect and assuming a loss to follow-up of 10%. The maximum sample size required will be 2107 children. Data will be analysed using summary measurements for each cluster, both for making estimates and for hypothesis testing. All analyses will be made on an intention-to-treat basis.

Discussion

The intervention providing the best results could be recommended as part of health education for young schoolchildren.

Trial registration

Clinicaltrials.gov: NCT01418872
The Prevention Of WEight Regain in diabetes type 2 (POWER) study: the effectiveness of adding a combined psychological intervention to a very low calorie diet, design and pilot data of a randomized controlled trial
Authors: Berk Kirsten AC , Buijks Hanneke , Ozcan Behiye , van’t Spijker Adriaan , Busschbach Jan JV , Sijbrands Eric JG
Published: November 2012

Background

Obesity is of major pathogenetic importance to type 2 diabetes, it contributes to poor glycemic control and increases the risk of cardiovascular disease. Over 80% of patients with diabetes type 2 are overweight. To achieve a more favourable risk profile, changes in diet and lifestyle are needed. However, current treatment programs for obese DM type 2 patients are not effective in the long term. In this RCT, we compare the effectiveness of a Combined Psychological Intervention (CPI) and usual care in maintaining the favourable effects on weight and risk profile during 2 years of follow-up after a Very Low Calorie Diet (VLCD).

Methods and design

In a randomised parallel group intervention study, 140 patients with type 2 diabetes and overweight (BMI>27 kg/m2) will be recruited from the outpatient department of the Erasmus Medical Centre.

After obtaining ≥5% of weight loss with a VLCD, participants will be randomly assigned to CPI or usual care for 10 weeks. CPI consists of cognitive behaviour therapy, problem solving therapy and proactive coping.

Primary outcome measure is weight change (kg).

Other outcome measures are Body Mass Index (BMI = weight (kg)/length (m)2), waist circumference (cm), systolic blood pressure (mmHg), HbA1c (mmol/mol), lipid levels (LDL, HDL, TG (mmol/l) and chol/HDL-ratio), antidiabetic agents and doses, cardiovascular risk profile (UKPDS), lifestyle and quality of life (EuroQol EQ-5D). Psychosocial parameters are also studied, as secondary outcomes as well as determinants for weight loss.

When successful, we want to conduct an analysis of the cost effectiveness of the intervention as compared to usual care.

Discussion

We expect that a CPI after a VLCD will be effective in maintaining weight loss and improving cardiovascular risk and glycaemic control, while being cost-effective and improving quality of life in patients with type 2 diabetes.

Clinical trials registration

trialregister.nl NTR2264
Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial
Authors: Filardo Giuseppe , Kon Elizaveta , Di Martino Alessandro , Di Matteo Berardo , Merli Maria Letizia , Cenacchi Annarita , Fornasari Pier Maria , Marcacci Maurilio
Published: November 2012

Background

Platelet Rich Plasma (PRP), a blood-derived product rich in growth factors, is a promising treatment for cartilage defects but there is still a lack of clinical evidence. The aim of this study is to show, through a randomized double blind prospective trial, the efficacy of this procedure, by comparing PRP to Hyaluronic Acid (HA) injections for the treatment of knee chondropathy or osteoarthritis (OA).

Methods

109 patients (55 treated with HA and 54 with PRP) were treated and evaluated at 12 months of follow-up. The patients were enrolled according to the following inclusion criteria: age> 18 years, history of chronic (at least 4 months) pain or swelling of the knee and imaging findings of degenerative changes of the joint (Kellgren-Lawrence Score up to 3). A cycle of 3 weekly injections was administered blindly. All patients were prospectively evaluated before and at 2, 6, and 12 months after the treatment by: IKDC, EQ-VAS, TEGNER, and KOOS scores. Range of motion and knee circumference changes were measured over time. Adverse events and patient satisfaction were also recorded.

Results

Only minor adverse events were detected in some patients, such as mild pain and effusion after the injections, in particular in the PRP group, where a significantly higher post-injective pain reaction was observed (p=0.039). At the follow-up evaluations, both groups presented a clinical improvement but the comparison between the two groups showed a not statistically significant difference in all scores evaluated. A trend favorable for the PRP group was only found in patients with low grade articular degeneration (Kellgren-Lawrence score up to 2).

Conclusions

Results suggest that PRP injections offer a significant clinical improvement up to one year of follow-up. However, conversely to what was shown by the current literature, for middle-aged patients with moderate signs of OA, PRP results were not better than those obtained with HA injections, and thus it should not be considered as first line treatment. More promising results are shown for its use in low grade degeneration, but they still have to be confirmed.