bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhibition of hepatic tumour necrosis factor‐α attenuates the anandamide‐induced vasoconstrictive response in cirrhotic rat livers
Authors: Yang Ying‐Ying , Lee Kuei‐Chuan , Huang Yi‐Tsau , Lee Fa‐Yauh , Chau Ga‐Yang , Loong Che‐Chuan , Lin Han‐Chieh , Lee Shou‐Dong
Published: April 2009

Background: Increased anandamide, an endocannabinoid that interacts with both cannabinoid CB1 and CB2 receptors, can induce hepatic vasoconstrictive responses that contribute to the increased intrahepatic resistance (IHR) in cirrhotic rats. Chronic endotoxaemia and the subsequent release of tumour necrosis factor‐α (TNF‐α) are suggested to result in increased anandamide in cirrhotic livers. Thalidomide, which inhibited TNF‐α effectively, has been used clinically in states of chronic TNF‐α elevation with encouraging results. Aims: This study explores the possible effects of thalidomide on hepatic endocannabinoids and microcirculation of cirrhotic rats. Methods: Portal venous pressure (PVP), superior mesenteric arterial blood flow (SMA BF), hepatic TNF‐α, interleukin (IL‐6), protein expression of CB1 and CB2 receptor and thromboxane synthase (TXS) were measured in bile duct‐ligated (BDL) rats receiving 1‐month of vehicle (BDL‐V) or thalidomide (BDL‐thalido). The degree of hepatic fibrosis was also assessed. In the liver perfusion system, IHR and concentration–response curves of the portal perfusion pressure to anandamide were evaluated. Results: In BDL‐thalido rats, PVP, IHR and hepatic levels of TNF‐α and IL‐6, protein expression of CB1 receptors, TXS and hepatic fibrosis were lower than in BDL‐V rats. In BDL‐thalido rat livers, the attenuation of the vasoconstrictive response to anandamide was associated with an upregulation of the CB2 receptor and a downregulation of the CB1 receptor. Nevertheless, SMA BF was not different between BDL‐thalido and BDL‐V rats. Conclusions: Thalidomide decreased the PVP and IHR through the attenuation of anandamide‐induced constrictive response, decreasing the production of TNF‐α, IL‐6 and TXA2 in the liver and the suppression of hepatic fibrogenesis of rats with biliary cirrhosis of this study.
Variability in liver stiffness values from different intercostal spaces
Authors: Kim Seung Up , Kim Ja Kyung , Park Jun Yong , Ahn Sang Hoon , Lee Jung Min , Baatarkhuu Oidov , Choi Eun Hee , Han Kwang‐Hyub , Chon Chae Yoon , Kim Do Young
Published: April 2009

Aim: To investigate the variability in liver stiffness measurement (LSM) values from the fifth, sixth and seventh intercostal space (ICS) and examine whether LSM better predicts significant fibrosis (F2–4) and cirrhosis when LSM is performed at the same site as liver biopsy (LB). Methods: This study enrolled 91 consecutive patients with hepatitis B virus (HBV)‐related chronic liver disease (CLD) who underwent both LB and LSM between September 2007 and January 2009. Results: The mean age of the patients was 45.4 years (66 men and 25 women). F1 fibrosis was noted in 12 patients (13.2%), F2 in 28 (30.7%), F3 in 15 (16.5%) and F4 in 36 (39.6%). The mean LSM values from the fifth, sixth and seventh ICS were 11.6, 11.1 and 10.9 kPa respectively. The mean LSM value from the same site as LB was 11.0 kPa. An interclass correlation analysis showed no significant difference in LSM values from the fifth, sixth and seventh ICS and the same site as LB. The area under the receiver operating characteristic curves of LSM values from the fifth, sixth and seventh ICS and the same site as LB for predicting significant fibrosis were 0.815, 0.838, 0.818 and 0.837, respectively, and those for cirrhosis were 0.919, 0.916, 0.907 and 0.913, respectively, with all overlapping confidence intervals. Conclusions: Any LSM value from the fifth, sixth or seventh ICS can predict significant fibrosis and cirrhosis with considerable accuracy without statistical differences regardless of correspondence with LB site in patients with HBV‐related CLD.
Trust, Confidence, and the 2008 Global Financial Crisis
Authors: Earle Timothy C.
Published: April 2009

The 2008 global financial crisis has been compared to a “once‐in‐a‐century credit tsunami,” a disaster in which the loss of trust and confidence played key precipitating roles and the recovery from which will require the restoration of these crucial factors. Drawing on the analogy between the financial crisis and environmental and technological hazards, recent research on the role of trust and confidence in the latter is used to provide a perspective on the former. Whereas “trust” and “confidence” are used interchangeably and without explicit definition in most discussions of the financial crisis, this perspective uses the TCC model of cooperation to clearly distinguish between the two and to demonstrate how this distinction can lead to an improved understanding of the crisis. The roles of trust and confidence—both in precipitation and in possible recovery—are discussed for each of the three major sets of actors in the crisis, the regulators, the banks, and the public. The roles of trust and confidence in the larger context of risk management are also examined; trust being associated with political approaches, confidence with technical. Finally, the various stances that government can take with regard to trust—such as supportive or skeptical—are considered. Overall, it is argued that a clear understanding of trust and confidence and a close examination of the specific, concrete circumstances of a crisis—revealing when either trust or confidence is appropriate—can lead to useful insights for both recovery and prevention of future occurrences.
Students’ attitudes towards an on‐line orthodontic learning resource
Authors: Linjawi A. L. , Hamdan A. M. , Perryer D. G. , Walmsley A. D. , Hill K. B.
Published: April 2009

Aim:  The purpose of this study was to develop an online undergraduate orthodontic e‐course and assess its success as a learning resource from the students’ perspective.

Methodology:  The orthodontic e‐course was composed of six main components; modules, photo gallery, clinical consultations, glossary, reading lists and resources. Four undergraduate orthodontic lectures were converted into a web‐based format using text, photographs, PowerPoint presentations and animations. The sample was comprised of sixty‐four third year undergraduate dental students at Birmingham Dental School, UK. Their average age was 20.7 years (age range: from 20–25 years). A questionnaire was developed to assess; course design, course delivery, course outcome and the potential use of the e‐course as a teaching method.

Results:  There were no significant difference between genders (P < 0.05). Overall, student responded very positive to positive for course design, course delivery and course outcome. The orthodontic e‐course was still seen by most subjects (86%) as an adjunct and not a replacement of the traditional teaching methods. 34.4% of subjects felt that it should be as an optional supplement and 51.6% felt that it should be integrated with the undergraduate orthodontic curriculum. The significance of the program as a learning resource was reported to be the best aspect of the program.

Conclusion:  Delivery of web‐based material in the undergraduate orthodontic curriculum was seen by students as a significant learning resource which supplements traditional learning methods.
Dentists’ ethical practical knowledge: a critical issue for dental education
Authors: Ardenghi Diego Machado
Published: April 2009

Dentists, just like teachers, when moving from school to the workplace (dental offices and classrooms respectively), may find it difficult to apply theories learned during formal education to the complexities of the workplace environment. These difficulties constitute a critical issue for dental education in the area of ethics. In teacher education, the knowledge teachers develop for dealing with the situations they encounter in the classroom is called teachers’ practical knowledge. In this study, I discuss the concept of teachers’ practical knowledge within the context of dentistry, focusing on the ethical dimensions of dentistry practice, arguing for a dentists’ ethical practical knowledge. In this sense, I articulate the similarities between teachers’ practical knowledge and its equivalent in dental education, suggesting alternatives for dental education that could foster the development of dentists’ ethical practical knowledge.
Experimental evidence for the use of density based interspecific social information in forest birds
Authors: Forsman Jukka T. , Hjernquist Mårten B. , Gustafsson Lars
Published: April 2009

Reproductive success and habitat preference are generally assumed to be negatively associated with densities of con‐ and heterospecific competitors. However, recent theoretical studies have suggested that in some cases habitat preference may have a nonlinear unimodal function in relation to con‐ or heterospecific competitor densities – intermediate densities being preferred. Such a pattern is expected if con‐ or heterospecific densities are used as a proximate cue in habitat selection, which may produce benefits by reducing searching costs and providing information about current habitat quality and costs of competition. At low density the use of such cues, and hence habitat selection, are hampered, whereas at high density costs of competition exceed the benefits of using cues, leading to avoidance. Here, we tested this hypothesis by examining whether arboreal migratory birds use the density of resident titmice (Parusspp.) in habitat selection decisions. Many migrants and titmice species share similar resource needs making titmice density a reliable source of information for migrants. At the scale of habitat patches, we experimentally created a range of titmice densities from low to very high and subsequently measured the density response of migrants. In contrast to the unimodal habitat preference hypothesis, the average species number and total density of migratory birds were positively and linearly correlated with manipulated titmice density. Thus, migrants probably use titmice density as a relative indicator of habitat quality (abundance or quality of food) because foliage gleaners that share similar food resource with titmice, but not ground foragers, showed a positive association with manipulated titmice density. These results emphasize the positive effect of interspecific social information on habitat choice decisions and diversity of migratory bird community.
ConsNet: new software for the selection of conservation area networks with spatial and multi‐criteria analyses
Authors: Ciarleglio Michael , Wesley Barnes J. , Sarkar Sahotra
Published: April 2009

ConsNet is a comprehensive software package for the design of conservation area networks (CANs). The software selects areas to be potentially placed under conservation management for the representation of biodiversity surrogates. Additionally, ConsNet optimizes spatial criteria including compactness, connectivity, replication, and alignment, as well as socio‐economic criteria as specified by users. ConsNet uses an advanced tabu search engine to identify efficient alternatives quickly, offering capabilities beyond existing planning software. The ability to perform ongoing interactive analysis with multi‐criteria objectives makes ConsNet an ideal decision support tool for large scale planning exercises.
Temperature Stability of Electrical Properties of (K0.5Na0.5)1−xLixNb0.95Sb0.05O3 Lead‐Free Ceramics
Authors: Wu Lang , Xiao Dingquan , Li Xiang , Zhu Jianguo , Yu Ping , Sun Yong , Wang Yuanyu
Published: April 2009

(K0.5Na0.5)1−xLixNb0.95Sb0.05O3 (KNLNS‐x, x=0–10 mol%) lead‐free piezoelectric ceramics were prepared by the conventional mixed‐oxide method. The temperature stability of the dielectric, piezoelectric, and ferroelectric properties of the two typical compositions (KNLNS‐2 with orthorhombic phase, and KNLNS‐7 with mixed phases) was investigated systematically. The relationship between the orthorhombic–tetragonal polymorphic phase transition (PPT) of the ceramics and the temperature stability of their electrical properties was also discussed. The electromechanical coupling factors (kp and k31) of the ceramics show the maximum values near the PPT, where the temperature stability of the resonance frequency is relatively poor. After the occurrence of the PPT, the remnant polarization (Pr) of the ceramics shows a marked decrease, and a maximum peak in the coercive field (Ec) is observed. Related mechanisms for the temperature stability of electrical properties were also discussed.
Luminescent Properties of (Ca1−xSrx)3SiO4(Cl1−yFy)2:Eu2+ Phosphors and Their Application for White LED
Authors: Wang Jing , Liu Zongmiao , Ding Weijia , Su Qiang
Published: April 2009

A series of intense green/orange (Ca1−xSrx)3SiO4Cl2:Eu2+ and Ca3SiO4Cl2−2yF2y:Eu2+ phosphors were synthesized by a high‐temperature (HT) solid‐state reaction and were characterized by means of X‐ray powder diffraction spectroscopy, photoluminescence excitation, and emission spectra. Both of the phosphors Ca3SiO4Cl2:Eu2+ with a low temperature (LT)/HT phase show intense broad absorption bands between 250 and 450 nm, matching well with the near‐ultraviolet (n‐UV) (380–420 nm) emission band of InGaN‐based chips, and exhibit a green emission (510 nm) and a tunable yellow (551 nm) to orange emission (577 nm), ascribed to the allowed 5d→4f transition of Eu2+ ion in LT‐ and HT phases, respectively. The green emission can be greatly enhanced by substitution of Ca2+ by Sr2+ and Cl− by F−. The emission intensity of Eu2+ is about 160% (x=0.01, y=0) and 270% (x=0, y=0.03) times as strong as that of Ca3SiO4Cl2:Eu2+. By combining with n‐UV (∼398 nm) InGaN chips, intense white light emitting diodes (LEDs) were made based on a blend of blue chlorophosphate phosphor, green Ca3SiO4Cl2:Eu2+ with a LT phase, and orange Ca3SiO4Cl2:Eu2+ with a HT phase. Tunable warm white (2648–4057 K) LEDs with a high color‐rendering index (86–94) were successfully fabricated.
Nurturing regulatory compliance: Is procedural justice effective when people question the legitimacy of the law?
Authors: Murphy Kristina , Tyler Tom R. , Curtis Amy
Published: April 2009

Procedural justice generally enhances an authority's legitimacy and encourages people to comply with an authority's decisions and rules. We argue, however, that previous research on procedural justice and legitimacy has examined legitimacy in a limited way by focusing solely on the perceived legitimacy of authorities and ignoring how people may perceive the legitimacy of the laws and rules they enforce. In addition, no research to date has examined how such perceptions of legitimacy may moderate the effect of procedural justice on compliance behavior. Using survey data collected across three different regulatory contexts – taxation (Study 1), social security (Study 2), and law enforcement (Study 3) – the findings suggest that one's perceptions of the legitimacy of the law moderates the effect of procedural justice on compliance behaviors; procedural justice is more important for shaping compliance behaviors when people question the legitimacy of the laws than when they accept them as legitimate. An explanation of these findings using a social distancing framework is offered, along with a discussion of the implications the findings have on enforcement.
Cost–benefit analysis: New foundations on shifting sand
Authors: Sinden Amy , Kysar Douglas A. , Driesen David M.
Published: April 2009

New Foundations of Cost–Benefit Analysis, by Matthew Adler and Eric Posner, represents the most ambitious and credible effort to date to build a solid theoretical defense of the use of cost–benefit analysis (CBA) in evaluating government regulation. In this review, three cost–benefit “skeptics” offer their reactions to this ambitious and important book. We note its virtues – its humility, its scrupulousness, its open‐mindedness. We also explore its vices. If preferences are to be “laundered,” is it intellectually defensible to remove the bad but not consider adding the good? Does Adler's and Posner's welfarism really play the limited role they suppose, or does it risk “crowding out” other important deontological and distributional values? If CBA is merely a decision procedure that provides an imperfect proxy of welfare – the moral criterion we really care about – how do we know that the proxy it provides in practice will actually be accurate enough to be useful? Isn't this at bottom an empirical question that cannot be answered by this thoroughly theoretical book? If CBA is no more than an imperfect proxy for welfare, then alternative imperfect decision procedures may perform better in the real world.
Salt, high blood pressure, and performance‐based regulation
Authors: Sugarman Stephen D.
Published: April 2009

Performance‐based regulation is a new approach to public health promotion. The aim of this article is to explain how this idea might be applied to the public health goal of reducing salt consumption as a way of reducing high blood pressure and thereby saving lives. Performance‐based regulation is compared with competing regulatory strategies.
Painful bladder syndrome/interstitial cystitis (history, epidemiology, symptoms, diagnosis and treatments)
Authors: McDermott Patricia
Published: April 2009

Interstitial cystitis (IC) is a condition that is difficult to diagnose. In some cases, it has taken 5 years, and five doctors, before a correct diagnosis has occurred, with patients voiding up to 60 times per 24 h. There is a wide variation in the prevalence rate, identifying the problems of diagnosing and reporting pelvic bladder syndrome/IC. This paper will identify the history and epidemiology of IC, analysis of the associated symptoms, diagnosis and treatments.
Anything to declare sir? Case study review of schistosomiasis haematobium infection
Authors: Drudge‐Coates Lawrence , Khati Vitra
Published: April 2009

Schistosomiasis is the most widespread human disease caused by a parasite. We present the case of a patient from Uganda with asymptomatic frank haematuria, and he was initially diagnosed with an Escherichia coli infection and managed with trimethoprim. Subsequent cystoscopic evaluation and bladder histology confirmed schistosomiasis haematobium, which was treated with praziquantel.
The Legacies of 2007: Remapping the Black Presence in Britain
Authors: Bressey Caroline
Published: April 2009

The 1807/2007 commemorations of the bicentenary of the Parliamentary Act to abolish the British slave trade stimulated a large number of academic and community based projects, from small scale research to the renovation of national museums. This article reviews the academic and other literatures that informed and have emerged from these projects. It explores how contradictions, fractures and openings highlighted by the 1807/2007 bicentenary and these literatures might be taken forward and developed by geographers interested in the making of Britishness, and the relationship between public geographies and public histories.
Modeling Catchment Evolution: From Decoding Geomorphic Processes Signatures toward Predicting Impacts of Climate Change
Authors: Istanbulluoglu Erkan
Published: April 2009

Numerical models of landscape evolution facilitate quantitative understanding of the causal linkages, interactions, and feedbacks between geomorphic processes and landscape morphology under climate and tectonic forcing. Numerical modeling progressively becomes a crucial component of Earth sciences for decoding the signature of the past history, and predicting the future of observed landforms. The past 15 to 20 years have seen major advances in landscape evolution model development and confirmation against observed topography. In this article, first leading geomorphic transport laws are reviewed and their imprint on landscape morphology are discussed using prime examples of numerical model predictions reported in the literature. The article continues with discussing the relevance of the existing geomorphic transport laws and landscape evolution models to address the current and historic climate change impacts on landforms. This article ends with the opinion that climate‐driven variations in environmental variables affecting geomorphic processes will need to be represented in numerical models of landscape evolution for improved predictions of climate control on sediment yields, the natural environment, and landforms.
Clinicovirologic analysis of hepatitis C infection in transfusion‐dependent β‐thalassemia major children
Authors: RAGAB L. , HELAL S. , ZAGHLOUL N. , EL‐RAZIKY M. , AFIFI R. , MUSALLAM K. M. , TAHER A. T.
Published: April 2009

Regular blood transfusion puts β‐thalassemia major patients at a higher risk of developing hepatic iron overload and hepatitis C virus (HCV) infection. The association between several transfusion‐related factors and an increased risk of developing HCV viremia has been reported. The effect of HCV infection on liver damage in transfusion‐dependent thalassemia patients has been poorly described. A sample of 100 Egyptian transfusion‐dependent β‐thalassemia major children were studied. Individual patients underwent full history taking, clinical examination and a panel of laboratory tests including HCV ribonucleic acid polymerase chain reaction (HCV‐PCR) in blood samples. Liver biopsy was performed for 24 patients. HCV‐PCR was positive in 64% of patients. A statistically significant correlation was found between HCV‐PCR positivity (HCV viremia) and shorter inter‐transfusion interval. There was a significant positive correlation between mean serum ferritin level and mean levels of alanine aminotransferase and aspartase aminotransferase. Histopathologic features of both chronic hepatitis and siderosis were present in 91.7% of biopsy specimens, and fibrosis was present in 41.67%. A higher risk of HCV viremia is noted with a shorter inter‐transfusion interval. The reduced role of HCV infection in chronic liver injury in this group of patients may be surpassed by the associated effects of iron overload because of the chronic transfusion. However, the latter finding should be verified in larger studies.
Calculating Cumulants of a Taylor Expansion of a Multivariate Function
Authors: Kamanzi‐wa‐Binyavanga
Published: April 2009

A method, which we believe is simpler and more transparent than the one due toMcCullagh (1984), is described for obtaining the cumulants of a scalar multivariate stochastic Taylor expansion. Its generalisation is also suggested. An important feature, previously not reported, is that the expansion of every cumulant of order≥ 2is made up of separate subseries.

In order to handle certain frequently occurring sums over permutations of members of compound index sets, we introduce a new notation[m]*,wheremis a positive integer.
Production and biological function of volatile esters inSaccharomyces cerevisiae
Authors: Saerens Sofie M. G. , Delvaux Freddy R. , Verstrepen Kevin J. , Thevelein Johan M.
Published: April 2009

The need to understand and control ester synthesis is driven by the fact that esters play a key role in the sensorial quality of fermented alcoholic beverages like beer, wine and sake. As esters are synthesized in yeast via several complex metabolic pathways, there is a need to gain a clear understanding of ester metabolism and its regulation. The individual genes involved, their functions and regulatory mechanisms have to be identified. In alcoholic beverages, there are two important groups of esters: the acetate esters and the medium‐chain fatty acid (MCFA) ethyl esters. For acetate ester synthesis, the genes involved have already been cloned and characterized. Also the biochemical pathways and the regulation of acetate ester synthesis are well defined. With respect to the molecular basis of MCFA ethyl ester synthesis, however, significant progress has only recently been made. Next to the characterization of the biochemical pathways and regulation of ester synthesis, a new and more important question arises: what is the advantage for yeast to produce these esters? Several hypotheses have been proposed in the past, but none was satisfactorily. This paper reviews the current hypotheses of ester synthesis in yeast in relation to the complex regulation of the alcohol acetyl transferases and the different factors that allow ester formation to be controlled during fermentation.
L'ajustement mutuel dans le fonctionnement organique du système multiorganisationnel d'aide et de services aux sans‐abri de Montréal
Authors: Dupuis Alain , Farinas Luc
Published: April 2009

Sommaire :Notre étude de l'organisation du secteur de l'aide et des services aux sans‐abri à Montréal Centre met en lumière un système multiorganisationnel de services de santé et de services sociaux qui n'est pas intégré hiérarchiquement dans son ensemble et qui n'est pas soumis à une « entente de gestion et d'imputabilité» globale propre à une gestion fondée sur la normalisation des résultats. L'étude présente un système d'ensemble de type « organique » plutôt que bureaucratique, largement fondé sur des ajustements mutuels entre les nombreux acteurs publics et « communautaires » de ce secteur. La coordination des services se réalise alors essentiellement dans les interactions entre les intervenants alors qu'ils accomplissent leur travail, et ce avec le soutien des gestionnaires. À l'aide de nombreux extraits d'entrevues, nous étudions le fonctionnement de ce système « organique » sous la forme de trois catégories de processus d'ajustement mutuel qui se superposent et se complètent pour assurer la valeur des services :disjoint unilatéral, conjoint bilatéraletconjoint multilatéral. Selon les sciences de l'organisation, un tel système est potentiellement mieux adaptéà composer avec la complexité des connaissances et des valeurs caractéristiques des services humains, qu'un à système formellement intégré et contrôlé par des règles, des indicateurs et des cibles quantifiables.

Abstract:This study of the organization of the sector dedicated to providing aid and services to the homeless in Central Montreal reveals a multiorganizational health and social services system that is neither hierarchically integrated as a whole nor subject to a comprehensive “management and accountability agreement” specific to standardized results‐based management. The study details a comprehensive system that is “organic,” rather than bureaucratic, and broadly organized based on mutual adjustments among the numerous public and “community” practitioners in this sector. The coordination of services is therefore essentially achieved through the interaction of the workers as they perform their jobs, with the support of management. This study draws on a number of extracts from interviews to examine how this “organic” system operates, in the form of three distinct processes of mutual adjustment that are superimposed and complementary to ensure the value of the services: “unilateral disjoined,”“bilateral joined” and “multilateral joined.” According to organizational science, this type of system is potentially more likely to address the complexities inherent in the knowledge and values that are characteristic of human services than a formally integrated system that is controlled by rules, indicators and quantifiable targets.
Health‐care reform and the dimensions of professional autonomy
Authors: Randall Glen E. , Williams A. Paul
Published: April 2009

Abstract: A “managed competition” model was introduced in the Canadian province of Ontario as part of the government's reform of home care. With this model, it was assumed that competitive forces would encourage quality while driving down costs. While such reforms often achieve cost controls by constraining the incomes and practices of health‐care workers, there has been relatively little analysis of the extent to which self‐governing health‐care professionals, particularly those outside of medicine and nursing, may experience a decline in their ability to control the content and context of their professional work. In this article, the authors analyse the results of thirty‐six in‐depth interviews with representatives of Community Care Access Centres (CCACs), the organizations that purchase and coordinate the delivery of home‐care services, and rehabilitation provider agencies to examine the impact of Ontario's managed competition reform on rehabilitation professionals. Findings suggest that the impact of the reform varied across the economic, political, and clinical dimensions of professional autonomy and that, despite a general loss of autonomy under the managed competition model, market forces also served to mitigate the loss of autonomy, thus contributing to a remarkable resilience of professional autonomy.

Sommaire: Un modèle de « concurrence dirigée » a été introduit récemment dans la province canadienne de l'Ontario dans le cadre de la réforme gouvernementale des soins à domicile. Avec ce modèle, il était présumé que les forces de la concurrence encourageraient la qualité tout en faisant baisser les coûts. Alors que de telles réformes parviennent souvent à maîtriser les coûts en réduisant les revenus et les pratiques des travailleurs de la santé, il y a eu relativement peu d'analyses de faites sur la mesure dans laquelle les professionnels de la santé autonomes, particulièrement ceux qui exercent en dehors de la médecine et de la profession infirmière, connaissent une perte de contrôle sur le contenu et le contexte de leur travail professionnel. Dans le présent article, les auteurs analysent les résultats de trente‐six entrevues en profondeur menées auprès de représentants des Centres d'accès aux soins communautaires (CASC), organismes qui achètent et coordonnent la prestation des services de soins à domicile, et organismes de prestation de soins de réadaptation, afin d'examiner les conséquences de la réforme de la concurrence dirigée de l'Ontario sur les professionnels de la réadaptation. Les résultats laissent entendre que l'effet de la réforme a varié en fonction des dimensions économiques, politiques et cliniques de l'autonomie professionnelle et que, malgré une perte d'autonomie générale liée au modèle de concurrence dirigée, les forces du marché ont également permis d'atténuer la perte d'autonomie, contribuant ainsi à la remarquable résilience dont font preuve ces professionnels en la matiére.
Do crises help remedy regulatory failure? A comparative study of the Walkerton water and Jerusalem banquet hall disasters
Authors: Schwartz Robert , McConnell Allan
Published: April 2009

Abstract: This study explores whether and how policy changes in the aftermath of a crisis. The authors ask why pre‐existing regulatory regimes that are identified as contributory factors to “failure” are not necessarily reformed in the wake of a crisis. The investigation adds to the literature that addresses the classic tension between reformism and conservatism in post‐crisis periods. Regulatory failure is identified as being largely responsible for two crises – the tainted drinking‐water tragedy in Walkerton, Canada, and the collapse of a banquet hall in Jerusalem, Israel. Despite similarities in the nature of media coverage, institutional procedures for investigation and commission findings, these two tragedies differ dramatically in policy change outcomes. A policy streams prism is used to identify, characterize and analyse reasons for very different policy responses to crises associated with regulatory failure.

Sommaire: Cette étude examine si et comment les politiques changent à la suite d'une crise. Les auteurs se posent la question de savoir pourquoi des régimes de réglementation préexistants qui sont identifiés comme étant des facteurs contribuant à l'«échec » ne sont pas nécessairement réformés à la suite d'une crise. L'enquête apporte des éléments à la documentation portant sur la tension classique qui existe entre le réformisme et le conservatisme au cours des périodes postérieures à une crise. L'échec de la réglementation est identifié comme étant largement responsable de deux crises : la tragédie de l'eau potable contaminée à Walkerton, au Canada, et l'effondrement d'une salle de réception à Jérusalem, en Israël. Malgré des similarités dans la nature de la couverture médiatique, dans les procédures institutionnelles de l'enquête et les résultats des commissions, ces deux tragédies diffèrent radicalement dans les résultats des modifications de politiques. Un prisme des courants de politiques est utilisé pour identifier, caractériser et analyser les raisons des réactions très différentes en matière de politiques à des crises associées à l'échec de la réglementation.
Impact of Human Serum Albumin on Oritavancin In Vitro Activity against Enterococci
Authors: McKay Geoffrey A. , Beaulieu Sylvain , Sarmiento Ingrid , Arhin Francis F. , Parr Thomas R. , Moeck Gregory
Published: April 2009

Oritavancin is a lipoglycopeptide with activity against gram-positive pathogens including vancomycin-resistant enterococci. The impact of human serum albumin (HSA) on oritavancin activity against enterococci was compared to those of vancomycin, daptomycin, teicoplanin, and linezolid in vitro using MIC and time-kill methods. Oritavancin MICs increased between 0- and 8-fold in the presence of HSA. In time-kill assays with HSA, oritavancin retained activity, killing or inhibiting enterococci more rapidly than did comparators when peak concentrations were simulated.
AAC(6′)-Iaf, a Novel Aminoglycoside 6′-
N
-Acetyltransferase from Multidrug-Resistant
Pseudomonas aeruginosa
Clinical Isolates
Authors: Kitao Tomoe , Miyoshi-Akiyama Tohru , Kirikae Teruo
Published: April 2009

We report here the characterization of a novel aminoglycoside resistance gene,
aac(6
′
)-Iaf
, present in two multidrug-resistant (MDR)
Pseudomonas aeruginosa
clinical isolates. These isolates, IMCJ798 and IMCJ799, were independently obtained from two patients, one with a urinary tract infection and the other with a decubitus ulcer, in a hospital located in the western part of Japan. Although the antibiotic resistance profiles of IMCJ798 and IMCJ799 were similar to that of MDR
P. aeruginosa
IMCJ2.S1, which caused outbreaks in the eastern part of Japan, the pulsed-field gel electrophoresis patterns for these isolates were different from that for IMCJ2.S1. Both IMCJ798 and IMCJ799 were found to contain a novel chromosomal class 1 integron, In123, which included
aac(6
′
)-Iaf
as the first cassette gene. The encoded protein, AAC(6′)-Iaf, was found to consist of 183 amino acids, with 91 and 87% identity to AAC(6′)-Iq and AAC(6′)-Im, respectively. IMCJ798, IMCJ799, and
Escherichia coli
transformants carrying a plasmid containing the
aac(6
′
)-Iaf
gene and its upstream region were highly resistant to amikacin, dibekacin, and kanamycin but not to gentamicin. The production of AAC(6′)-Iaf in these strains was confirmed by Western blot analysis. Thin-layer chromatography indicated that AAC(6′)-Iaf is a functional acetyltransferase that specifically modifies the amino groups at the 6′ positions of aminoglycosides. Collectively, these findings indicate that AAC(6′)-Iaf contributes to aminoglycoside resistance.
In Vitro Activity of Ceftaroline Alone and in Combination against Clinical Isolates of Resistant Gram-Negative Pathogens, Including β-Lactamase-Producing
Enterobacteriaceae
and
Pseudomonas aeruginosa
Authors: Vidaillac Céline , Leonard Steve N. , Sader Helio S. , Jones Ronald N. , Rybak Michael J.
Published: April 2009

Ceftaroline is a novel broad-spectrum cephalosporin that exhibits bactericidal activity against many gram-positive and -negative pathogens. However, the activity of ceftaroline cannot be solely relied upon for eradication of multidrug-resistant gram-negative isolates, such as
Pseudomonas aeruginosa
and extended-spectrum β-lactamase (ESBL)-producing
Enterobacteriaceae
, which represent a current clinical concern. As drug combinations might be beneficial by potential synergy, we evaluated the in vitro activity of ceftaroline combined with meropenem, aztreonam, cefepime, tazobactam, amikacin, levofloxacin, and tigecycline. Susceptibility testing was performed for 20 clinical
P. aeruginosa
isolates, 10 ESBL-producing
Escherichia coli
isolates, 10 ESBL-producing
Klebsiella pneumoniae
isolates, and 10 AmpC-derepressed
Enterobacter cloacae
isolates. Time-kill experiments were performed for 10 isolates using antimicrobials at one-fourth the MIC. Ceftaroline exhibited a MIC range of 0.125 to 1,024 μg/ml and was reduced 2- to 512-fold by combination with tazobactam (4 μg/ml) for ESBL-producing strains. In time-kill experiments, ceftaroline plus amikacin was synergistic against 90% of the isolates (and indifferent for one
P. aeruginosa
isolate). Ceftaroline plus tazobactam was indifferent for
E. cloacae
and
P. aeruginosa
strains but synergistic against 100% of
E. coli
and
K. pneumoniae
isolates. Combinations of ceftaroline plus meropenem or aztreonam were also synergistic for all
E. coli
and
E. cloacae
isolates, respectively, but indifferent against 90% of the other isolates. Finally, combinations of ceftaroline plus either tigecycline, levofloxacin, or cefepime were indifferent for 100% of the isolates. No antagonism was observed with any combination. Ceftaroline plus amikacin appeared as the most likely synergistic combination. This represents a promising therapeutic option, and further studies are warranted to elucidate the clinical value of ceftaroline combinations against resistant gram-negative pathogens.
An Engineered R-Type Pyocin Is a Highly Specific and Sensitive Bactericidal Agent for the Food-Borne Pathogen
Escherichia coli
O157:H7
Authors: Scholl Dean , Cooley Mike , Williams Steve R. , Gebhart Dana , Martin David , Bates Anna , Mandrell Robert
Published: April 2009

Some strains of
Pseudomonas aeruginosa
produce R-type pyocins, which are high-molecular-weight phage tail-like protein complexes that have bactericidal activity against other
Pseudomonas
strains. These particles recognize and bind to bacterial surface structures via tail fibers, their primary spectrum determinant. R-type pyocins kill the cell by contracting a sheath-like structure and inserting their hollow core through the cell envelope, resulting in dissipation of the cellular membrane potential. We have retargeted an R-type pyocin to
Escherichia coli
O157:H7 by fusing a tail spike protein from an O157-specific phage, φV10, to the pyocin tail fiber. The φV10 tail spike protein recognizes and degrades the O157 lipopolysaccharide. This engineered pyocin, termed AVR2-V10, is sensitive and specific, killing 100% of diverse
E. coli
O157:H7 isolates but no other serotypes tested. AVR2-V10 can kill
E. coli
O157:H7 on beef surfaces, making it a candidate agent for the elimination of this pathogen from food products. All rare AVR2-V10-resistant mutants isolated and examined have lost the ability to produce the O157 antigen and are expected to have compromised virulence. In addition,
E. coli
O157:H7 exposed to and killed by AVR2-V10 do not release Shiga toxin, as is often the case with many antibiotics, suggesting potential therapeutic applications. The demonstration that a novel R-type pyocin can be created in the laboratory by fusing a catalytic tail spike from the family
Podoviridae
to a tail fiber of a member of the family
Myoviridae
is evidence that the plasticity observed among bacteriophage tail genes can, with modern molecular techniques, be exploited to produce nonnatural, targeted antimicrobial agents.
A Fusion Protein Vaccine Containing OprF Epitope 8, OprI, and Type A and B Flagellins Promotes Enhanced Clearance of Nonmucoid
Pseudomonas aeruginosa
Authors: Weimer Eric T. , Lu Haiping , Kock Nancy D. , Wozniak Daniel J. , Mizel Steven B.
Published: April 2009

Although chronic
Pseudomonas aeruginosa
infection is the major cause of morbidity and mortality in cystic fibrosis (CF) patients, there is no approved vaccine for human use against
P. aeruginosa
. The goal of this study was to establish whether a multivalent vaccine containing
P. aeruginosa
type A and B flagellins as well as the outer membrane proteins OprF and OprI would promote enhanced clearance of
P. aeruginosa
. Intramuscular immunization with flagellins and OprI (separate) or OprI-flagellin fusion proteins generated significant antiflagellin immunoglobulin G (IgG) responses. However, only the fusions of OprI with type A and type B flagellins generated OprI-specific IgG. Immunization with a combination of OprF epitope 8 (OprF
311-341
), OprI, and flagellins elicited high-affinity IgG antibodies specific to flagellins, OprI, and OprF that individually promoted extensive deposition of C3 on
P. aeruginosa
. Although these antibodies exhibited potent antibody-dependent complement-mediated killing of nonmucoid bacteria, they were significantly less effective with mucoid isolates. Mice immunized with the OprF
311-341
-OprI-flagellin fusion had a significantly lower bacterial burden three days postchallenge and cleared the infection significantly faster than control mice. In addition, mice immunized with the OprF
311-341
-OprI-flagellin fusion had significantly less inflammation and lung damage throughout the infection than OprF-OprI-immunized mice. Based on our results, OprF
311-341
-OprI-flagellin fusion proteins have substantial potential as components of a vaccine against nonmucoid
P. aeruginosa
, which appears to be the phenotype of the bacterium that initially colonizes CF patients.
Identification ofmigR, a Regulatory Element of theFrancisella tularensisLive Vaccine StrainiglABCDVirulence Operon Required for Normal Replication and Trafficking in Macrophages
Authors: Buchan Blake W. , McCaffrey Ramona L. , Lindemann Stephen R. , Allen Lee-Ann H. , Jones Bradley D.
Published: April 2009

Francisella tularensis, the etiological agent of tularemia, is capable of infecting a wide range of animals and causes a severe, lethal disease in humans. The pathogen evades killing by cells of the innate immune system utilizing genes encoding a pathogenicity island, includingiglABCD, and instead utilizes these cells as a niche for replication and dissemination to other organs within the host. Regulators of theiglgenes (e.g., MglA, SspA, FevR and PmrA) have been identified, but environmental stimuli and mechanisms of regulation are as yet unknown and are likely to involve additional gene products. In this work, we more closely examine the roles that environmental iron and the ferric uptake repressor protein (Fur) play in the regulation of theiglABCDoperon. We also used a genetic approach to identify and characterize a new regulator of theigloperon, designatedmigR(macrophageintracellulargrowthregulator; FTL_1542). Quantitative real-time reverse transcription-PCR in a site-directedmigRmutant confirmed the reduction in the number ofiglCtranscripts in this strain and also demonstrated reduced expression offevR. Comparison of themigRandfevRmutants in monocyte-derived macrophages (MDMs) and epithelial cell lines revealed a reduced ability for each mutant to grow in MDMs, yet only thefevRmutant exhibited impaired replication in epithelial cell lines. Confocal analysis of infected MDMs revealed that although neither mutant reached the MDM cytosol, thefevRmutant was trapped in lamp-1-positive phagosomes, whereas themigRmutant resided in mature phagolysosomes enriched with both lamp-1 and cathepsin D. Disruption ofmigRandfevRalso impaired the ability ofF. tularensisto prevent neutrophil oxidant production. Thus, we have identifiedmigR, a gene that regulates expression of theiglABCDoperon and is essential for bacterial growth in MDMs and also contributes to the blockade of neutrophil NADPH oxidase activity.
Secreted Dipeptidyl Peptidase IV Activity in the Dimorphic Fungal PathogenHistoplasma capsulatum
Authors: Cooper Kendal G. , Woods Jon P.
Published: April 2009

Dipeptidyl peptidase type IV (DppIV) enzymes are broadly distributed phylogenetically and display diverse functions, including intercellular signaling, immunomodulation, protein maturation and processing, metabolism, and nutrient acquisition. We identified a secreted proteolytic activity inHistoplasma capsulatumeffective toward DppIV-specific substrates. In order to determine the gene(s) that encodes this activity, we identified two putativeDPPIVhomologs (HcDPPIVAandHcDPPIVB) inH. capsulatumbased on a homology search withAspergillus fumigatusDppIV. Comparative sequence analysis revealed that HcDppIVA is similar to secreted DppIV enzymes, while HcDppIVB clusters with intracellular DapB-like enzymes. Unexpectedly, silencing ofHcDPPIVAby RNA interference (RNAi) had no effect on secreted DppIV activity and anHcDPPIVA-null deletion mutant also showed no abrogation of secreted DppIV activity. In contrast, RNAi silencing ofHcDPPIVBsignificantly reduced the level of secreted DppIV activity. RNAi silencing ofHcDPPIVBin theHcDPPIVA-null mutant had no additional effect on secreted DppIV activity, indicating thatHcDPPIVAdoes not contribute to secreted activity. RNAi silencing ofHcDPPIVBdid not affect the ability to kill a murine macrophage-like cell line, RAW 264.7, indicating that this gene is not required for infection of macrophages.
Protection ofMycobacterium tuberculosisfrom Reactive Oxygen Species Conferred by themel2Locus Impacts Persistence and Dissemination
Authors: Cirillo Suat L. G. , Subbian Selvakumar , Chen Bing , Weisbrod Torin R. , Jacobs William R. , Cirillo Jeffrey D.
Published: April 2009

Persistence ofMycobacterium tuberculosisin humans represents a major roadblock to elimination of tuberculosis. We describe identification of a locus inM. tuberculosis, mel2, that displays similarity to bacterial bioluminescent loci and plays an important role during persistence in mice. We constructed a deletion of themel2locus and found that the mutant displays increased susceptibility to reactive oxygen species (ROS). Upon infection of mice by aerosol the mutant grows normally until the persistent stage, where it does not persist as well as wild type. Histopathological analyses show that infection with themel2mutant results in reduced pathology and both CFU and histopathology indicate that dissemination of themel2mutant to the spleen is delayed. These data along with growth in activated macrophages and infection of Phox−/−and iNOS−/−mice and bone marrow-derived macrophages suggest that the primary mechanism by whichmel2affects pathogenesis is through its ability to confer resistance to ROS. These studies provide the first insight into the mechanism of action for this novel class of genes that are related to bioluminescence genes. The role ofmel2in resistance to ROS is important for persistence and dissemination ofM. tuberculosisand suggests that homologues in other bacterial species are likely to play a role in pathogenesis.
Galactorrhoea following Acupuncture
Authors: Jenner Chris , Filshie Jacqueline
Published: April 2009

A 41-year-old woman with breast cancer was referred to the pain management clinic for a course of acupuncture for intense pain following a subcutaneous mastectomy and a latissimus dorsi flap reconstruction.

She was treated with a standard course of acupuncture for breast pain, using paravertebral segmental points, trigger points, plus contralateral LI4 on the non-lymphoedematous arm. She experienced an episode of galactorrhoea six days following the first treatment and during the second treatment. She had not previously lactated for four years. CT and MRI of the brain revealed no focal abnormality.

Acupuncture has been used in to promote lactation in the Traditional Chinese literature using the ‘Tianzong’ acupoint SI11. This acupoint coincided with a trigger point over infraspinatus that was included in the neurophysiologically based acupuncture treatment.

Quantitative analysis has shown an increase in the production of prolactin and oxytocin following acupuncture. These hormones are involved in the synthesis and release of milk from mammary glands respectively. This is the first report of galactorrhoea, in the contralateral normal breast, following acupuncture in a patient with breast cancer.