bluuebunny/crossref_metadata_2025 huggingface dataset:
Nosocomial Penicillin-Resistant Pneumococcal Infections at a Midwestern University Hospital
Authors: Little J. Russell , Miller James , Kahn Michael G.
Published: September 2009

We analyzed 333 isolates of Streptococcus pneumoniae from adult inpatients over a continuous 30-month period. Twenty-five percent of isolates were resistant to penicillin, and 18% of tested strains were not susceptible to ceftriaxone. For 29 (15%) of 199 evaluable patients, S pneumoniae was isolated from a culture first obtained >48 hours after admission, and chart review satisfied our case definition for nosocomial infection. S pneumoniae isolates were penicillin-resistant in 14 of 29 nosocomial and 34 of 170 community-acquired cases (odds ratio, 3.73; 95% confidence interval, 1.53-9.15; P =.01)
Mortality as an Outcome in Hospital-Acquired Pneumonia
Authors: Rello Jordi , Valles Jordi
Published: September 2009

The most common route of entry of pathogens into the lung in patients managed in the intensive-care unit is aspiration of contaminated oropharyngeal secretions or gastric contents. In intubated patients, the risk of this type of infection is particularly high. Knowledge of specific risk factors for specific microorganisms, along with the origin of acquisition (primary endogenous, secondary endogenous, or exogenous), will permit a more rational and effective method of prevention. Attributable mortality is highly dependent on the institution of a correct initial antibiotic choice, as well as the interaction between the virulence of the pathogen responsible and host defenses. However, survival in these patients is determined primarily by the degree of severity at the time of pneumonia diagnosis and the response to initial therapy. As a consequence, the number of preventable deaths is likely to be much smaller than the total. Therapy requires both supportive and specific measures. When diagnostic information becomes available, it permits the rescue of some patients with inadequate therapy or simplifies the spectrum of the empirical therapy. Initial antibiotic choice should be based on expected etiologic pathogens, while knowledge of local microbial epidemiology and susceptibility patterns is crucial.
Economic Consequences of Hospital Infections in a 1,000-Bed University Hospital in Norway
Authors: Andersen Bjørg Marit
Published: September 2009

Hospital infections were studied among 41,000 patients admitted to a 1,000-bed university hospital in Oslo, Norway. A prevalence rate of 8.5% in 1995 contributed to 14,500 days of extra stay in the hospital. The direct economic consequences of hospital infections was 40 to 50 million Norwegian kroner ($6-$7 million). The extra direct cost per infected patient was 14,300 Norwegian kroner ($2,200). Hospital infections are generating high extra costs and morbidity in countries with good general health care and with few problems with resistant bacteria.
Rates of Tuberculosis Infection in Healthcare Workers Providing Services to HIV-Infected Populations
Authors: Zahnow Karen , Matts John P. , Hillman David , Finley Elizabeth , Brown Lawrence S. , Torres Ramon A. , Ernst Jerome , El-Sadr Wafaa , Perez George , Webster Carol , Barber Beverly , Gordin Fred M. ,   Terry Beirn Community Programs for Clinical Research on AIDS
Published: September 2009

OBJECTIVE:

To assess the prevalence of tuberculosis (TB) or a positive skin test in healthcare workers (HCWs) providing services to human immunodeficiency virus (HIV)-infected individuals and to determine prospectively the incidence of new infections in this population.

DESIGN:

This prospective cohort study enrolled 1,014 HCWs working with HIV-infected populations from 10 metropolitan areas. Purified protein derivative (PPD) tuberculin skin tests were placed at baseline and every 6 months afterwards on those without a history of TB or a positive PPD. Demographic, occupational, and TB exposure data also were collected.

SETTING:

Outpatient clinics, hospitals, private practice offices, and drug treatment programs providing HIV-related healthcare and research programs.

PARTICIPANTS:

A voluntary sample of staff and volunteers from 16 Community Programs for Clinical Research on AIDS units.

RESULTS:

Factors related to prior TB or a positive skin test at baseline included being foreign-born, increased length of time in health care, living in New York City, or previous bacille Calmette-Guerín vaccination. The rate of PPD conversion was 1.8 per 100 person years of follow-up. No independent relation was found between the amount or type of contact with HIV-infected populations and the risk of TB infection.

CONCLUSION:

These data provide some reassurance that caring for HIV-infected patients is not related to an increased rate of TB infection among HCWs in these settings.
Management and Outcome of Tuberculosis in Two St Louis Hospitals, 1988 to 1994
Authors: L'Ecuyer Paul B. , Woeltje Keith F. , Seiler Sondra M. , Fraser Victoria J.
Published: September 2009

Objective:

To describe management and outcome of tuberculosis (TB) and current practices for isolation in two urban hospitals in the Midwest.

Design:

Retrospective cohort study.

Setting:

Barnes Hospital and Jewish Hospital, tertiary-care and community hospitals affiliated with Washington University School of Medicine in St Louis, Missouri.

Patients:

All adult patients with a positive culture for Mycobacterium tuberculosis from 1988 to 1994.

Results:

We identified 122 cases at Barnes and Jewish Hospitals (36.5/100,000 hospital discharges), median age was 59.0 years, 61.5% were non-Caucasian, and 54.9% resided within the city limits. Underlying risk conditions were common: substance abuse (25%), recent TB contact (24%), and foreign birth (13%). Coexistent human immunodeficiency virus infection (8%) was uncommon. Of skin-tested cases, 22% were anergic; of the rest, 22% tested negative. Almost 20% of cases had prior positive skin tests, and thus were preventable, but had not received adequate prophylaxis. Of hospitalized patients with pulmonary TB, 70% received respiratory isolation. Antibiotic resistance was recognized in 16%; only 19% of cases initially received four-drug therapy. TB-related death occurred in 16%.

Conclusions:

In this area, TB cases primarily involve traditional risk groups without HIV coinfection. Current infection control practices, diagnostic strategies, and initial treatment regimens are suboptimal. Education about local disease epidemiology is needed to prevent nosocomial TB transmission.
A Randomized Crossover Study of Disposable Thermometers for Prevention of Clostridium difficile and Other Nosocomial Infections
Authors: Jernigan John A. , Siegman-Igra Yardena , Guerrant Richard C. , Farr Barry M.
Published: September 2009

OBJECTIVE:

To test the hypothesis that use of disposable thermometers would result in lower rates of nosocomial Clostridium difficile diarrhea and of total nosocomial infections, compared with electronic thermometers.

DESIGN:

Prospective randomized crossover trial.

SETTING:

A 700-bed university hospital providing primary and tertiary care.

PATIENTS:

All patients admitted to a group of 20 inpatient nursing units.

INTERVENTIONS:

20 nursing units were randomized into two groups. One group randomly was assigned exclusive use of single-use disposable thermometers for patient temperature measurement, and the other group was assigned exclusive use of electronic thermometers. After 6 months, the assignments were reversed.

MAIN OUTCOME MEASURES:

Rates of C difficile infections, total nosocomial diarrheal episodes, and total nosocomial infections were prospectively followed in each study unit over 11 months.

RESULTS:

26,350 patients were admitted to the study units and hospitalized for 120,529 patient days. There were 947 nosocomial infections (7.86 per 1,000 patient days). Nosocomial C difficile- associated diarrhea defined by positivity to both toxin B (titer ≥1:10) and toxin A was detected in 32 patients (3.4% of all nosocomial infections). A significantly lower rate of nosocomial C difficile-associated diarrhea was observed with disposable thermometer use (0.16 per 1,000 patient days) compared with electronic thermometer use (0.37 per 1,000 patient days, relative risk [RR]=0.44; 95% confidence interval [CI95], 0.21-0.93, P=.026). There was no difference in overall rates of nosocomial infection between the disposable and electronic groups (8.03 and 7.68 infections per 1,000 patient days, respectively; RR, 1.04; CI95, 0.92-1.19; P=.52) or in the overall rate of nosocomial diarrhea (3.34 and 3.40 per 1,000 patient days, respectively; RR, .98; CI95, 0.81-1.19; P=.87).

CONCLUSIONS:

The incidence of nosocomial C difficile diarrhea was reduced significantly by using single-use, disposable thermometers as compared with electronic thermometers, but there was no effect on either the overall rate of nosocomial diarrhea or the rate of total nosocomial infections.
Hepatitis B and Hemodialysis: The Impact of Universal Precautions in Preventing the Transmission of Bloodborne Viruses
Authors: Kroes Aloys C.M. , van Bommel Eric F.H. , Kluytmans Jan A.J.W. , Weimar Willem
Published: September 2009

A detailed description is presented of the hemodialysis treatment for 6 weeks of a patient strongly positive for hepatitis B virus ([HBV], hepatitis B surface antigen, hepatitis B e antigen, HBV DNA), which was performed without any special precautions. All 59 patients potentially exposed to the HBV-positive patient, of whom 29 appeared fully unprotected by antibody, were followed for at least 9 months but remained negative. This illustrates the feasibility of following Universal Precautions instead of using exceptional procedures for one single agent
Handwashing Quality: Impact of a Special Program
Authors: Coignard Bruno , Grandbastien Bruno , Berrouane Yasmina , Krembel Christiane , Queverue Martine , Salomez Jean-Louis , Martin Guy
Published: September 2009

To evaluate the impact of a program on basic handwashing quality, a before-after audit was performed in a university hospital. We defined a 13-step protocol to describe a proper basic handwash (BHW). The proportion of BHW that satisfied this checklist increased significantly, from 4.2% before the program to 18.6% after, but these low proportions suggest that simpler alternatives to BHW should be studied
The Risk of Infection Associated With Intra-arterial Catheters for Cancer Chemotherapy
Authors: Raad Issam , Abi-Said Dima , Carrasco Cesar H. , Umphrey Jan , Hill Lou Anne
Published: September 2009

Objective:

To determine the frequency of, and risk factors for, infections associated with intra-arterial catheters used for cancer chemotherapy.

Methods:

Between September 1992 and September 1995, we conducted a surveillance study of all 807 intra-arterial catheters placed for chemotherapy at our center. The insertion site was disinfected with povidone iodine and alcohol, and the arterial catheter was placed using maximal sterile barrier precautions. Upon removal, all intravascular segments were submitted for semiquantitative culture.

Results:

No episodes of catheter-related bloodstream infection (95% confidence interval [CI95], 0%-1.6%) were observed. However, the risk of colonization (>15 colony-forming units) of arterial catheters was 15% (CI95, 12%-17%). Retrospective risk-factor analysis conducted on 224 intra-arterial catheters placed for chemotherapy in 1993 showed that colonization was associated significantly with duration of catheterization (median of 1 day for culture-negative catheters vs median of 4 days for culture-positive catheters, P<.001). Age, gender, prior radiotherapy, underlying cancer, neutropenia, and hypoalbuminemia were not associated with catheter colonization.

Conclusion:

Intra-arterial catheters for cancer chemotherapy placed under maximal sterile barrier precautions for a short period of time are associated with a very low risk of bloodstream infection.
Use of Amoxicillin-Clavulanate and Resistance in Escherichia coli Over a 4-Year Period
Authors: Natsch Stephanie , Conrad Christian , Hartmeier Cora , Schmid Beat
Published: September 2009

Objective:

To reduce the use of amoxicillin-clavulanate after high-resistance rates in Escherichia coli were detected.

Design:

Intervention study; the interventions were introduced successively over a 4-year period while closely monitoring the resistance patterns.

Setting:

A 260-bed acute-care hospital in Switzerland.

Interventions:

Introduction of therapeutic guidelines for specific departments or indications, which proposed alternative antibiotics to amoxicillin-clavulanate. The perioperative prophylactic use of amoxicillin-clavulanate was eliminated completely.

Results:

The absolute amount of amoxicillin-clavulanate consumed decreased by 23%, from 24.8 g per 100 patient days in 1992 to 18.5 g per 100 patient days in 1995. The number of courses, a parameter that takes the prophylactic use into account, decreased by 62% from 2.3 per 100 patient days in 1992 to 0.9 per 100 patient days in 1995. The percentage of sensitive strains increased from 54.9% (n=512) in 1992 and 54.0% (n=506) in 1993 to 72.1% (n=546) in 1994 and 83.1% (n=668) in 1995. No major changes were detected for other antimicrobials, such as cotrimoxazole, tetracycline, or cefuroxime, used in this 4-year period.

Conclusions:

A decrease in the use of amoxicillin-clavulanate was followed by an increase in susceptibility of E coli to it. It was not possible to prove a causative relationship. Only a temporal association was discovered. The reduction of the use of amoxicillin-clavulanate was achieved through the implementation of treatment guidelines, facilitated through a close collaboration among the clinical pharmacists, the infection control practitioner, the microbiology laboratory, and the physicians in charge of the respective departments.
Experience With Two Validation Methods in a Prevalence Survey on Nosocomial Infections
Authors: Gastmeier Petra , Kampf Günter , Hauer Thomas , Schlingmann Jürgen , Schumacher Martin , Daschner Franz , Rüden Henning
Published: September 2009

Objective:

To determine whether an investigator effect remained on the first German study on the prevalence of nosocomial infections Nosokomiale Infektionen in Deutschland Erfassung und Prävention (NIDEP), despite extensive validation efforts.

Design:

Two validation methods were applied: bedside validation and validation by case studies. In both cases, the results of the four investigators were compared with the diagnosis of gold standard observers.

Setting:

Validation measures were applied before, intermittently, during, and at the end of the surveillance period in 72 acute-care hospitals with 14,966 patients.

Results:

The overall sensitivity in the bedside-validation periods was 89.0%; the overall specificity was 99.5%. For validation by case studies, overall sensitivity was 95.6%, and overall specificity was 92.8%. At the end of the surveillance, a remarkable investigator effect was found.

Conclusion:

Despite validation results that were assessed as satisfactory, based on available literature, an investigator effect was observed. This underlines the need for data validation and the formulation of recommendations for data validation. Clarification of the Centers for Disease Control and Prevention criteria for pneumonia and primary bloodstream infection and the inclusion of some diagnostic test results may reduce or prevent an investigator effect in future studies.
Distribution, size frequency, and sex ratios of blacktip reef sharks Carcharhinus melanopterus at Palmyra Atoll: a predator‐dominated ecosystem
Authors: Papastamatiou Y.P. , Caselle J.E. , Friedlander A.M. , Lowe C.G.
Published: September 2009

Blacktip reef sharks Carcharhinus melanopterus were the most abundant predator in the lagoons at Palmyra Atoll. They were evenly distributed throughout the lagoons, although there was some evidence of sexual segregation. Males reach sexual maturity between 940–1020 mm LT. Bird remains were found in some C. melanopterus stomachs. C. melanopterus at Palmyra appear to be smaller than those at other locations.
Kinship affects innate responses to a predator in bluegillLepomis macrochiruslarvae
Authors: Hain T.J.A. , Neff B.D.
Published: September 2009

Naïve kin groups and mixed‐family groups of bluegillLepomis macrochiruslarvae were exposed to a novel predator cue. The larvae responded by increasing shoal cohesiveness in kin groups but not in mixed‐family groups; moreover, larvae sired by males of the ‘cuckolder’ life history tended to have an enhanced ability to respond to direct cues of kinshipv. larvae sired by males of the ‘parental’ life history, which instead appeared to respond to cues of life history rather than relatednessper se. The increased shoal cohesion among related individuals probably confers a survival benefit and indicates that the antipredatory shoaling response is innate inL. macrochirus.
31P nuclear magnetic resonance measurements of phosphate metabolites and intracellular pH in turbot Psetta maxima red blood cells using a novel flow method
Authors: Thebault M. T. , Pichavant K. , Kervarec N.
Published: September 2009

A method for oxygenating and mixing suspensions of turbot Psetta maxima red blood cells (RBC) was tested in 31P nuclear magnetic resonance (NMR) spectroscopy. In normoxia, the levels of inorganic phosphate (Pi) and nucleoside triphosphates (NTP) were stable up to 140 min and intracellular pH (pHi) was maintained and decreased oxygen partial pressure (PO 2) from 30 to 15 and 600 Pa produced a significant fall in the intensity of NTP resonance, balanced by an increase in the Pi signal. Treatment of RBC with 0· 5 M isoproterenol during hypoxia exposure did not affect the pattern of changes in NTP or pHi induced by hypoxia and the effect was manifest only on Pi levels.
Transgenerational marking of freshwater fishes with enriched stable isotopes: a tool for fisheries management and research
Authors: Munro A.R. , Gillanders B.M. , Thurstan S. , Crook D.A. , Sanger A.C.
Published: September 2009

A promising new method of marking larval freshwater fishes with enriched stable isotopes by means of injecting the maternal parent with the marking agent was investigated. The 138Ba:137Ba ratios in the otoliths of larval golden perch Macquaria ambigua were compared to determine the effect of injecting female broodstock with different dosages of enriched 137Ba at various times before spawning. There was 100% mark success in the progeny of fish injected with 20 μg g−1 of enriched 137Ba 24 h before inducing spawning with hormones and 40 μg g−1 administered at the same time as inducement of spawning. Injection of 40 μg g−1 enriched 137Ba 21 days before spawning resulted in only 81% mark success and suggests rapid elimination of barium in M. ambigua. Injection with enriched 137Ba did not significantly affect the fertilization rate, number of fertilized eggs or hatching rate compared with long‐term hatchery records. These results suggest that transgenerational marking is an effective and affordable means of mass‐marking larval fishes. Thousands of larval fishes can be permanently marked with a unique artificial isotopic mark via a single injection into the maternal parent, thus avoiding the handling of individual fishes or having to deal with chemical baths. Because no single mark or tagging method is suitable for all situations, transgenerational marking with enriched stable isotopes provides another method for researchers and managers to discriminate both hatchery‐reared and wild fishes.
Australian Bachelor of Midwifery students' mental health literacy: An exploratory study
Authors: McCann Terence V. , Clark Eileen
Published: September 2009

Many pregnant and post‐partum women experience mental health problems, but midwives are frequently ill‐equipped to provide support. The purpose of this study, conducted in Melbourne, Australia, was to examine first‐year Bachelor of Midwifery students' mental health literacy about post‐partum women with schizophrenia, using the vignette of “Mary”. A non‐probability sample of 38 commencing students was used. The results showed that the students had a mainly lay person‐informed conceptualization of mental health interventions for post‐partum women. They acknowledged that Mary had a mental health problem that might have a more favorable outcome with professional support, but this agreement did not extend to their understanding of the consequences of the failure to receive professional help. They believed that negative outcomes were less likely and positive outcomes were just as likely for Mary than for others in the community. The findings highlight the need for mental health theory and clinical subjects to be incorporated in midwifery curricula.
Use of educational games in the health professions: A mixed‐methods study of educators' perspectives in the UK
Authors: Blakely Gillian , Skirton Heather , Cooper Simon , Allum Peter , Nelmes Pam
Published: September 2009

Educational games have been shown to be effective in supporting learning, especially to reinforce knowledge, and students are generally positive about the use of games. The aim of this mixed‐methods study that was conducted in the UK was to explore educators' views towards the use of educational games in the health sciences. The data were collected via semistructured interviews with 13 health educators and an online survey that was completed by 97 health educators. Three factors influence the use of classroom games: reflective practice, the impact of games on students, and the impact of logistical factors. Educators assess their own performance and the impact of the games on students when planning their use; however, large classes and the need for preparation time have a negative impact on educators' willingness to use games. Similar constraints might restrict the use of active learning strategies, such as simulation, that are crucial for enabling health professionals to develop competence. These issues require consideration when planning educational methods.
TRANSFUSION COMPLICATIONS: Transfusion‐transmitted babesiosis in Rhode Island
Authors: Asad Shadaba , Sweeney Joseph , Mermel Leonard A.
Published: September 2009

BACKGROUND: Babesiosis is caused by an intraerythrocytic protozoan transmitted by ticks. Blood transfusion is another mode of transmission.

STUDY DESIGN AND METHODS: This was a retrospective study based on babesiosis cases reported to the Rhode Island Department of Health between 1999 and 2007. Additional cases were also identified.

RESULTS: Twenty‐one cases of transfusion‐transmitted babesiosis (TTB) were identified from 1999 through 2007. From 2005 through 2007, the incidence approached one case per 9000 units of blood transfused. One of 21 (5%) TTB cases was diagnosed in July, in sharp contrast to 65 of 152 (43%) of the total babesiosis cases diagnosed during July in Rhode Island. Many cases were identified when a complete blood count with a differential was routinely requested and parasites were noted by laboratory technologists. Most patients with TTB had underlying conditions known to predispose to symptomatic infection.

CONCLUSION: Blood transfusion is an important mode of Babesia transmission. The current screening method of omitting donors with a history of babesiosis may be effective in preventing some, but not all, cases of TTB and current processing of blood products does not eradicate this parasite. Thus, a better screening test is needed. Alternatively, pathogen reduction technology could be utilized to prevent this mode of transmission.
Atrial Tachycardia with Atypical Wenckebach Atrioventricular Block after Slow Pathway Ablation
Authors: RAKOVEC PETER
Published: September 2009

A case of a patient with dual supraventricular tachycardias, atrioventricular nodal tachycardia, and atrial tachycardia is presented. The former was successfully ablated, whereas the latter was inducible after the ablation of the former, but without clinical importance during follow‐up. However, this tachycardia showed interesting characteristics, including dual atrioventricular Wenckebach periodicity, presumably due to multiple slow pathways.
Perspectives on FDA's Regulation of Nanotechnology: Emerging Challenges and Potential Solutions
Authors: Sandoval Brianna (MacDonald)
Published: September 2009

ABSTRACT:  While public attention has been focused on Escherichia coli outbreaks, genetic engineering, and mad cow disease, nanotechnology has quietly taken its place at the forefront of scientific innovation and is poised to revolutionize numerous industries and fields of study. Although nanotechnology has been on the radar of researchers and developers for decades, it is only in the past few years that real‐world applications have become a pervasive reality. Some of the most promising applications are in the areas of consumer products regulated by the U.S. Food and Drug Administration (FDA), including new and over‐the‐counter drugs, medical devices, cosmetics, and food and food packaging. Despite the incredible social and economic potential of nanotechnology, FDA faces numerous hurdles in the regulation of these products. This article explores the current state of our scientific understanding of nanotechnology, human and environmental health and safety concerns, the strengths and weaknesses of FDA's existing regulatory authority, and current efforts to address these and other issues relating to the development, understanding, and promotion of nanotechnology. In addition, the article proposes various regulatory and policy considerations FDA should take into account in addressing nano‐based concerns.
Investigation Delayed Is Justice Denied: Proposals for Expediting Forensic Examinations of Digital Evidence*
Authors: Casey Eoghan , Ferraro Monique , Nguyen Lam
Published: September 2009

Abstract:  There is an urgent need to reduce the growing backlog of forensic examinations in Digital Forensics Laboratories (DFLs). Currently, DFLs routinely create forensic duplicates and perform in‐depth forensic examinations of all submitted media. This approach is rapidly becoming untenable as more cases involve increasing quantities of digital evidence. A more efficient and effective three‐tiered strategy for performing forensic examinations will enable DFLs to produce useful results in a timely manner at different phases of an investigation, and will reduce unnecessary expenditure of resources on less serious matters. The three levels of forensic examination are described along with practical examples and suitable tools. Realizing that this is not simply a technical problem, we address the need to update training and establish thresholds in DFLs. Threshold considerations include the likelihood of missing exculpatory evidence and seriousness of the offense. We conclude with the implications of scaling forensic examinations to the investigation.
IL‐6 Stimulates but is not essential for stratum corneum formation and permeability barrier development during gestation
Authors: Jiang Yan J. , Lu Biao , Crumrine Debbie , Elias Peter M. , Feingold Kenneth R.
Published: September 2009

Please cite this paper as: IL‐6 Stimulates but is not essential for stratum corneum formation and permeability barrier development during gestation. Experimental Dermatology 2010; 19: e31–e36.

Abstract:  The regulation of epidermal ontogenesis is a complex process. Previous studies have shown that cytokines (IL‐1, TNFα and IL‐6) regulate permeability barrier homeostasis in adult mice. Recently, we reported that IL‐1 and TNFα accelerate stratum corneum (SC) formation and permeability barrier development in foetal rodents. Here, we determined whether IL‐6 also regulates SC formation and permeability barrier development during late gestation. Using a rat skin explant model, we demonstrated that IL‐6 accelerates permeability barrier formation in a time‐ and dose‐dependent fashion. This acceleration of barrier formation is attributable to (a) accelerated lamellar membrane maturation, (b) formation of a multi‐layer SC and (c) enhanced expression of epidermal differentiation markers. When comparing epidermis of IL‐6‐deficient (knockout mice) and wild‐type foetal mice at days 16–18, we could not detect any abnormalities in either SC formation or the expression of differentiation markers in knockout (KO) mice. In parallel, the basal expression levels of IL‐6 mRNA in epidermis and IL‐6 protein in amniotic fluid were very low, with only a minimal change in IL‐6 receptor mRNA levels in epidermis of days 16–22 foetal mice. These low IL‐6 levels may account, at least in part, for the absence of epidermal abnormalities in IL‐6 KO mice. In conclusion, exogenous IL‐6 accelerates epidermal ontogenesis, but it is not essential for normal epidermal maturation.
The efficacy of chlorhexidine gluconate in canine skin preparation – practice survey and clinical trials
Authors: Evans L. K. M. , Knowles T. G. , Werrett G. , Holt P. E.
Published: September 2009

Objectives:To determine the use in practice and efficacy of different concentrations of chlorhexidine gluconate for canine pre‐operative skin preparation.

Methods:Questionnaires were used to establish which antiseptics and techniques were used for patients undergoing elective neutering. In a clinical study, five different concentrations of chlorhexidine gluconate – 0 per cent (tap water, as a control) 1, 2, 3 and 4 per cent – were tested on 50 dogs undergoing elective ovariohysterectomies and orchidectomies.

Results:A variety of preparation practices occurred but only 21 per cent of the veterinary nurses surveyed were aware of the concentration and contact time they used whilst preparing animals. The clinical study revealed there was a significant difference (P<0·001) between the different concentrations used. All concentrations of chlorhexidine were significantly more effective than the control tap water. There was a tendency towards increasing efficacy as concentration increased from 1 to 4 per cent but this was not statistically significant.

ClinicalSignificance:The lack of significant differences in efficacy between the different concentrations of chlorhexidine gluconate means that current practices may be adequate, although if the chlorhexidine gluconate concentrations and contact times used are unknown, they may be lower than those tested here and, possibly, ineffective, especially if contact times are short.
Optimization of Gelatin Extraction from Silver Carp Skin
Authors: Boran G. , Regenstein J.M.
Published: September 2009

ABSTRACT:  Fish skins are a by‐product of the fish processing industry that can be successfully processed into gelatin. This study was designed to optimize the extraction process to obtain the highest yield, gel strength, and viscosity for gelatin production from silver carp skin. A fractional factorial design (2 levels, resolution III, 29‐5) was chosen to screen 9 parameters to determine the most significant ones. Those found to be significant were optimized to determine the maximum value for 3 dependent variables mentioned above. The hydroxyproline content and hydroxyproline/protein ratio of the skin were 1.7% and 6.5%, respectively. The protein content of the skin was 26%. The hydroxyproline content of the gelatin for the sample giving the highest hydroxyproline/protein ratio was 10.9%. This sample was arbitrarily called pure gelatin and the purity of the remaining samples was between 71.8% and 97%. The highest protein and gelatin recovery was 78.1% and 98.8% of the total available, respectively. The latter, gelatin recovery, is proposed to be used instead of protein yield. Four variables were determined as significant in screening and these variables were studied by a central composite rotatable design (4‐factor and 5‐level with 6 central points) to model the system and response surface methodology was used for optimization. The optimum extraction conditions were 50 °C for the extraction temperature, 0.1 N HCl for the acid concentration, 45 min for the acid pretreatment time, and finally 4 : 1 (v/w) for the water/skin ratio. The predicted responses for these extraction conditions were 630 g gel strength, 6.3 cP viscosity, and 80.8% gelatin recovery. The data suggest that silver carp skin gelatin is similar to those of fish gelatins currently being exploited commercially.
Current and future use of the mannitol bronchial challenge in everyday clinical practice
Authors: Porsbjerg Celeste , Backer Vibeke , Joos Guy , Kerstjens Huib Adrianus Marie , Rodriguez‐Roisin Roberto
Published: September 2009

Objectives:  Asthma is a disease associated with inflammation, airway hyperresponsiveness (AHR) and airflow limitation. Clinical diagnosis and management of asthma often relies on assessment of lung function and symptom control, but these factors do not always correlate well with underlying inflammation. Bronchial challenge tests (BCTs) assess AHR, and can be used to assist in the diagnosis and management of asthma.

Data Source:  Data presented at the symposium ‘Use of inhaled mannitol for assessing airways disease’ organised by the Allied Respiratory Professionals Assembly (9) of the European Respiratory Society (ERS) at the ERS Congress, Berlin 2008.

Results:  Indirect challenge tests such as exercise testing, hypertonic saline or adenosine 5′‐monophosphate (AMP) are more specific though less sensitive than direct challenge tests (such as methacholine) for identifying patients with active asthma. Indirect BCTs may be used to diagnose exercise‐induced bronchoconstriction or AHR consistent with active asthma, to evaluate AHR that will respond to treatment with anti‐inflammatory drugs and to determine the effectiveness and optimal dosing of such therapy. An ideal indirect challenge test should be standardised and reproducible, and the test result should correlate with the degree of airway inflammation. The mannitol BCT provides a standardised and rapid point‐of‐need test to identify currently active asthma, and is clinically useful in the identification of patients with asthma who are likely to benefit from inhaled corticosteroid therapy.

Conclusion:  In the future, mannitol BCT may be added to lung function and symptom assessment to aid in the everyday management of asthma.

Please cite this paper as: Porsbjerg C, Backer V, Joos G, Kerstjens HAM and Rodriguez‐Roisin R. Current and future use of the mannitol bronchial challenge in everyday clinical practice. The Clinical Respiratory Journal 2009; 3: 189–197.
ACTIVE 3D VISION THROUGH GAZE RELOCATION IN A HUMANOID ROBOT
Authors: SANTINI FABRIZIO , NAMBISAN ROHIT , RUCCI MICHELE
Published: September 2009

Motion parallax, the relative motion of 3D space at different distances experienced by a moving agent, is one of the most informative visual cues of depth and distance. While motion parallax is typically investigated during navigation, it also occurs in most robotic head/eye systems during rotations of the cameras. In these systems, as in the eyes of many species, the optical nodal points do not lie on the axes of rotation. Thus, a camera rotation shifts an object's projection on the sensor by an amount that depends not only on the rotation amplitude, but also on the distance of the object with respect to the camera. Several species rely on this cue to estimate distance. An oculomotor parallax is present also in the human eye, and during normal eye movements, displaces the stimulus on the retina by an amount that is well within the range of sensitivity of the visual system. We developed an anthropomorphic robot equipped with an oculomotor system specifically designed to reproduce the images impinging on the human retina. In this study, we thoroughly characterize the oculomotor parallax emerging while replicating human eye movements and describe a method for combining 3D information resulting from pan and tilt rotations of the cameras. We show that emulation of the dynamic strategy by which humans scan a visual scene gives accurate estimation of distance within the space surrounding the robot.
REPRESENTING CONTEXT-DEPENDENT INFORMATION IN CULTURAL COLLECTIONS
Authors: GERGATSOULIS MANOLIS , LILIS PANTELIS D. , LOURDI IRENE , PAPATHEODOROU CHRISTOS
Published: September 2009

An extension of the Dublin Core Collections Application Profile (DCCAP) suitable for representing context-dependent collection level metadata, is presented in this paper. The extended model, called Multidimensional DCCAP, is based on a multidimensional extension of RDF. Contexts are specified by assigning values to a set of appropriately chosen parameters called dimensions. The proposed extension allows the user to encode metadata for each defined context enriching substantially in this way the expressive power of the metadata model. Multidimensional DCCAP metadata model allows to represent the collection development evolution as well as to keep information created for various users categories, with various degrees of detail, or even in different languages.
The dynamics of personal territories on the web
Authors: Beauvisage Thomas
Published: September 2009

In this paper, we present a long-term study of user-centric Web traffic data collected in 2000--2002 and 2005--2006 from two large representative panels of French Internet users. Our work focuses on the dynamics of personal territories on the Web and their evolution between 2000 and 2006. At the session level, we distinguish four profiles of browsing dynamics in 2005--2006, and point out the growing dichotomy between straight routine sessions and exploratory browsing. At a global level, we observe that although each individual's corpus of visited sites is permanently growing, his browsing practices are structured around routine well-known sites which operate as links providers to new sites. We argue that this tension between the known and the unknown is constitutive of Web practices and is a fundamental property of personal Web territories.
The role of vascular endothelial growth factor SNPs as predictive and prognostic markers for major solid tumors
Authors: Jain Lokesh , Vargo Craig A. , Danesi Romano , Sissung Tristan M. , Price Douglas K. , Venzon David , Venitz Jürgen , Figg William D.
Published: September 2009

Angiogenesis is crucial for development and metastasis of tumors, and vascular endothelial growth factor (VEGF) is a key mediator of this process. The importance of VEGF in tumorigenesis and tumor progression makes it an attractive target for the development of anticancer therapies. Inhibition of angiogenesis has shown promising clinical efficacy; however, not all patients treated with antiangiogenic agents derive benefit from them. Some patients are predisposed to refractory disease, whereas others develop resistance after initial response. Patients may also have different severity of drug-related adverse events. Optimization of drug administration based on disease status and individual responsiveness is important in limiting the treatment failure and minimization of side-effects. Single nucleotide polymorphisms (SNP) in VEGF may alter VEGF protein concentrations, influence the process of angiogenesis, and may relate to interindividual variation in the risk and progression of selected tumors, and their resistance to treatments. This review examines the role of SNPs in the VEGF gene as predictive and prognostic markers for major solid tumors, including the breast, non-small cell lung, colorectal, and prostate cancers. Selected VEGF SNPs seem to be associated with risk of these cancers; however, there is lack of unanimity in findings, in part influenced by differences in study design and analysis. [Mol Cancer Ther 2009;8(9):2496–508]
Coexisting Gastric Varices Should Not Preclude Prophylactic Ligation of Large Esophageal Varices in Cirrhosis
Authors: Schepke Michael , Biecker Erwin , Appenrodt Beate , Heller Joerg , Sauerbruch Tilman
Published: September 2009

Background/Aims: Coexisting gastric varices at baseline or the risk of their formation during treatment could alter the approach for primary bleeding prophylaxis in patients with large esophageal varices. Methods: Data analysis of 152 patients with cirrhosis and large esophageal varices included in the German multicenter trial on primary prevention of variceal bleeding. Results: 20 patients (13.6%) had coexisting gastric varices at baseline (GOV+). 10 of those each received either band ligation or propranolol, respectively. During follow-up (34.4 ± 18.9 months) new gastric varices occurred in 2/75 (2.7%, ligation) and 4/77 (5.2%, propranolol) patients, respectively. One patient with newly developed gastric varices bled (propranolol group). GOV+ patients had a better baseline liver function and overall survival. Bleeding incidence did not differ significantly between GOV+ and GOV– patients (3-year actuarial risk: 20.0 ± 10.6% (GOV+), 38.1 ± 4.4% (GOV–), p = 0.195). Among GOV+ patients, bleeding occurred in 3/10 patients of the propranolol group and in 0/10 in the ligation group (p = 0.038). Conclusion: Prophylactic band ligation of large esophageal varices is safe and effective also in patients with coexisting gastric varices. Band ligation did not increase the risk of secondary gastric varices compared to propranolol.
Involvement of Lupus Enteritis in a Patient with Lupus Cystitis and Nephritis
Authors: Akitake Reiko , Nakase Hiroshi , Ueno Satoru , Miyamoto Shinichi , Iehara Noriyuki , Chiba Tsutomu
Published: September 2009

We present the case of a patient with lupus enteritis accompanied by both lupus cystitis and lupus nephritis without a history of systemic lupus erythematosus. The patient had a 2-month history of diarrhea and pollakiuria and was admitted to our hospital. Physical examination showed abdominal tenderness. Laboratory data revealed reductions in both total protein and albumin, elevated serum creatinine levels, and elevated antinuclear and anti-Smith antibodies. Urinalysis revealed proteinuria. Stool and urine cultures were negative. Abdominal computed tomography revealed diffuse edematous wall thickening, dilatation of the small intestine suggesting paralytic ileus, and irregular wall thickening of the urinary bladder. Histological results of the cystic and renal biopsies revealed interstitial cystitis and membranous nephropathy which were suggestive of lupus cystitis and lupus nephritis, respectively. The patient’s gastrointestinal symptoms were finally diagnosed as resulting from lupus enteritis. After initiating 30 mg oral prednisolone daily, the diarrhea and pollakiuria subsided, and renal function became normal. Lupus enteritis should always be considered in the differential diagnosis when patients complaining of chronic diarrhea of unknown etiology are encountered.
Effects of Cigarette Smoking and Restraint Stress on Human Colon Tumor Growth in Mice
Authors: Wong Helen Pui Shan , Li Zhi Jie , Shin Vivian Yvonne , Tai Emily Kin Ki , Wu William Ka Kei , Yu Le , Cho Chi Hin
Published: September 2009

Background: Cigarette smoking is a risk factor for colon cancer. Studies suggest that stress increases the incidence and promotes the development of cancers. Cigarette smoking and stress are closely associated, as people often smoke under stressful conditions and both of them can activate the adrenergic nervous system. Aims: To investigate the effects of cigarette smoking and restraint stress on colon cancer growth and the possible underlying mechanisms in these pathological processes. Methods: Nude mice bearing a HT-29 human colon cancer xenograft were either exposed to cigarette smoke and/or restraint stress. Cotinine and epinephrine levels in plasma of nude mice were measured by enzyme immunoassays. Expression of cyclooxygenase-2 (COX-2) and B-cell lymphoma-2 (Bcl-2) in tumor tissues were detected by Western blot. Prostaglandin E2 (PGE2) concentrations were determined by enzyme immunoassay. Results: 4% cigarette smoking together with restraint stress 1 h daily for 33 days promoted tumor growth in nude mice. This was accompanied by the increase of plasma levels of cotinine and epinephrine in these animals. They also enhanced the COX-2, Bcl-2 expressions and PGE2 levels in tumor tissues. Conclusion: These findings are important in understanding the pathogenesis of colon cancer, particularly related to cigarette smoking and stress.
Relationship between Preterm Labor and Thrombophilic Gene Polymorphism: A Prospective Sequential Cohort Study
Authors: Uvuz Firdevs , Kilic Sevtap , Yilmaz Nafiye , Tuncay Gorkem , Cakar Esra , Yuksel Beril , Bilge Umit
Published: September 2009

Objective: Premature labor is still the leading cause of infant mortality and morbidity worldwide. Multiple etiological factors including genetics and environment are held responsible for preterm birth. However, scientific data regarding the link between premature birth and genetics are limited. Subjects and Methods: In this study, we included 50 women who had premature labor (group 1) but did not have any known risks for a premature delivery such as uterine anomaly, polyhydramnios, hypertension, and diabetes mellitus, and another 50 healthy women who had term labor as control (group 2). We compared these two patient groups for MTHFR C677T, MTHFR C1298T, prothrombin 20210A, factor V and ACE polymorphisms. Results: We could not detect a statistical significance between groups for polymorphisms in MTHFR C677T, MTHFR C1298T, prothrombin 20210A, factor V and ACE polymorphisms. Conclusion: We investigated the relationship between premature and term labor and thrombophilic gene polymorphism. However, we found no associations with premature or term labor with the parameters included.
Primary Health Care Use and Reasons for Hospital Admissions in Dementia Patients in France: Database Study for 2007
Authors: Tuppin Philippe , Kusnik-Joinville Odile , Weill Alain , Ricordeau Philippe , Allemand Hubert
Published: September 2009

Objectives: To identify outpatient and hospital health care usage among dementia patients compared to controls. Methods: Analysis of the French National Health Insurance general regime reimbursement database, linked to the national hospitalization database for 2007; 258,809 subjects over the age of 60 with dementia were compared to a sample of 88,296 controls. Results: Dementia patients more frequently had at least one annual visit to private psychiatrists and neurologists (21.9%, relative risk, RR = 7.0), nursing care (52%, RR = 1.3), physiotherapy (37%, RR = 1.45), and hospitalization (40.8%, RR = 1.7), and they less frequently consulted other private specialists (62%, RR = 0.85). Many diagnosis groups were significantly more frequent in dementia patients: nervous system (RR = 5.3), psychiatry (RR = 9.1), respiratory medicine (RR = 1.8), unspecified (RR = 2.4). Hospitalizations for endoscopy, radiotherapy, chemotherapy, and treatment of disabilities such as cataracts (RR = 0.7) were less frequent. Higher relative levels of health care use decreased with age for dementia patients. Conclusions: Although the use of some forms of health care can be explained by the clinical condition induced by dementia, others must be interpreted in light of modes of medical and social management and ethical justification for screening and investigations.