bluuebunny/crossref_metadata_2025 huggingface dataset:
Microbial diversity and dynamics in multi‐ and single‐compartment anaerobic bioreactors processing sulfate‐rich waste streams
Authors: Briones Aurelio M. , Daugherty Becky J. , Angenent Largus T. , Rausch Kent D. , Tumbleson Mike E. , Raskin Lutgarde
Published: August 2006

We investigated bacterial and archaeal community structures and population dynamics in two anaerobic bioreactors processing a carbohydrate‐ and sulfate‐rich synthetic wastewater. A five‐compartment anaerobic migrating blanket reactor (AMBR) was designed to promote biomass and substrate staging, which partially separates the processes of methanogenesis and sulfidogenesis in the middle and outer compartment(s) respectively. The second reactor was a conventional, single‐compartment upflow anaerobic sludge blanket (UASB) reactor. Both reactors, which were seeded with the same inoculum, performed well when the influent chemical oxygen demand (COD)/SO42– mass ratio was 24.4. The AMBR performed worse than the UASB reactor when the influent COD/SO42– mass ratio was decreased to 5.0 by raising the sulfate load. Terminal restriction fragment length polymorphism analyses of bacterial 16S rRNA genes showed that the increase in sulfate load had a greater impact on bacterial diversity and community structure for the five AMBR compartments than for the UASB reactor. Moreover, bacterial community profiles across AMBR compartments became more similar through time, indicating a converging, rather than a staged community. While similar populations were abundant in both reactors at the beginning of the experiment, fermenting bacteria (clostridia, streptococci), and sulfate‐reducing bacteria became more abundant in the AMBR, after shifting to a higher sulfate load, while a novel Thermotogales‐like population eventually became predominant in the UASB reactor. A similar shift in the community structure of the hydrogenotrophic methanogens in the AMBR occurred: representatives of the Methanobacteriaceae out‐competed the Methanospirillaceae after increasing the sulfate load in the AMBR, while the archaeal community structure was maintained in the UASB.
Dyslipidaemia in diabetic patients: time for a rethink
Authors: Shepherd J.
Published: August 2006

Patients with type 2 diabetes have a marked increase in the risk of premature coronary heart disease (CHD). One of the underlying reasons for this increased risk is atherogenic dyslipidaemia, which is common in this patient group and characterized by low plasma levels of high‐density lipoprotein cholesterol (HDL‐C), increased levels of serum triglycerides, specifically very low‐density lipoprotein triglycerides, and an increase in small, dense low‐density lipoprotein (LDL) particles. Current management strategies focus on the initial use of statin or fibrate therapy (the latter approach indicated in patients with pronounced hypertriglyceridaemia). Recent treatment guidelines also emphasize the need for reduction in LDL‐cholesterol (LDL‐C) below 100 mg/dl (2.6 mmol/l) in diabetic patients, as this patient group has a clustering of cardiovascular risk factors that collectively lead to an excess risk of premature mortality. Multidrug lipid‐modifying therapy has been proposed to further reduce CHD risk in diabetic patients. Adding nicotinic acid to primary statin therapy would be a logical approach based on the complementary therapeutic benefits of these treatments. Nicotinic acid is the most potent agent currently available for raising HDL‐C and is also effective in reducing triglycerides and LDL‐C. Moreover, clinical trial data have shown that nicotinic acid can be safely used in diabetic patients. Data from the Arterial Biology for the Investigation of the Treatment Effects of Reducing Cholesterol (ARBITER 2) study in patients with established CHD and low HDL‐C (27% of whom had type 2 diabetes) show the atheroprotective effects of nicotinic acid/statin combination therapy. The clinical benefits of this combination therapy are indicated by subgroup analyses from the HDL‐Atherosclerosis Treatment Study, which showed 40% reduction in coronary event frequency in patients with impaired glucose tolerance. Together, these data support the proposed strategy of aggressive multidrug treatment of diabetic dyslipidaemia to improve patient outcome.
The role of angiotensin II type 1 receptor blockers in the prevention and management of diabetes mellitus
Authors: Mathur G. , Noronha B. , Rodrigues E. , Davis G.
Published: August 2006

Angiotensin II Receptor blockers (ARBs) are an important addition to the current range of medications available for treating a wide spectrum of diseases including cardiovascular diseases. Coronary heart disease (CHD) is the most common cause of death in the United Kingdom and worldwide. More importantly, the presence of the metabolic syndrome and the likelihood of diabetes mellitus taking on epidemic proportions in the years to come all threaten to maintain the mortality rate due to CHD.

This review article focuses on the clinical studies that have helped define the trends in the usage of these agents in the prevention and treatment of diabetes mellitus and its complications and also explores possible mechanisms of action and future developments.
No effect of inhibition of insulin secretion by diazoxide on weight loss in hyperinsulinaemic obese subjects during an 8‐week weight‐loss diet
Authors: Due A. , Flint A. , Eriksen G. , Møller B. , Raben A. , Hansen J. B. , Astrup A.
Published: August 2006

Aim:  Obesity is positively associated with hyperinsulinaemia, and it has been suggested that hyperinsulinaemia may contribute to maintain the obese state in insulin‐resistant obese individuals. The aim of the present study was to investigate the effect of inhibition of insulin secretion by diazoxide on weight loss in obese, normoglycaemic (fasting plasma glucose of ≥6.1 mmol/l), hyperinsulinaemic (fasting plasma insulin of ≥100 pmol/l) adults during a 2.5 MJ/day energy‐deficient diet.

Methods:  In an 8‐week, double‐blind, placebo‐controlled parallel design, 35 overweight and obese subjects (age: 23–54 years, body mass index: 27–66 kg/m2) were randomized either to 2 mg/kg/day (maximum 200 mg/day) of oral diazoxide or to placebo. Body composition and resting energy expenditure (REE) were measured before and after the intervention. Blood samples, and appetite sensations by visual analogue scales, were collected during fasting, during an oral glucose tolerance test (OGTT) and 4 h postprandially after a test meal. Subsequently, an ad libitum meal was given.

Results:  Thirty‐one subjects completed the protocol. Eight weeks of diazoxide decreased incremental area under the response curve (iAUC) for insulin (iAUCinsulin) and for C‐peptide (iAUCC‐peptide) and increased iAUC for glucose (iAUCglucose) during the OGTT and the test meal compared with the use of placebo (p < 0.003). No differences in changes between the groups in body weight, body fat, REE or appetite were observed during the 8‐week trial.

Conclusion:  These findings do not suggest that hyperinsulinaemia per se contributes to maintenance of the obese state, and insulin secretion inhibition seems not a promising drug target.
Conceptualizing Knowledge Creation: A Critique of Nonaka's Theory*
Authors: Gourlay Stephen
Published: August 2006

abstract Nonaka's proposition that knowledge is created through the interaction of tacit and explicit knowledge involving four modes of knowledge conversion is flawed. Three of the modes appear plausible but none are supported by evidence that cannot be explained more simply. The conceptual framework omits inherently tacit knowledge, and uses a radically subjective definition of knowledge: knowledge is in effect created by managers. A new framework is proposed suggesting that different kinds of knowledge are created by different kinds of behaviour. Following Dewey, non‐reflectional behaviour is distinguished from reflective behaviour, the former being associated with tacit knowledge, and the latter with explicit knowledge. Some of the implications for academic and managerial practice are considered.
Alliance Capability as a Mediator Between Experience and Alliance Performance: An Empirical Investigation into the Alliance Capability Development Process*
Authors: Heimeriks Koen H. , Duysters Geert
Published: August 2006

abstract This study centres around the way in which firms can enhance alliance performance through the development of alliance capabilities. Whereas most research has focused on inter‐firm antecedents of alliance performance, research on intra‐firm antecedents pointing to prior experience and internal mechanisms to foster knowledge transfer has only recently emerged. As little is known about how firms develop alliance capabilities, this study aims to uncover how differences in sources of alliance capabilities explain performance heterogeneity. The data are derived from a detailed survey held among alliance managers and Vice‐Presidents of 151 firms. The survey covers over 2600 alliances for the period 1997–2001. This study not only finds that alliance capabilities partially mediate between alliance experience and alliance performance, but also yields novel insights into the micro‐level building blocks underlying the process of alliance capability development.
WILLENDORF AWARD AW0001 Establishment of the concept of visceral fat syndrome and the discovery of adiponectin
Authors: Matsuzawa Y
Published: August 2006

Clinical studies in recent years have demonstrated that the extent of obesity does not necessarily determine the development of obesity‐related diseases such as type2 diabetes, hyperlipidemia, hypertension, but fat distribution is a much more important determinant In 1983, we reported a method for fat analysis using CT scan which enabled us to analyze in intraabdominal adipose tissue, namely visceral fat as well as subcutaneous fat. Then we demonstrated that visceral fat accumulation correlated to the disturbance of lipid and glucose metabolism, insulin resistance, hypertension and cardiovascular disease in obese subjects and even in non‐obese subjects. From these clinical studies, we proposed the concept of ‘visceral fat syndrome’ in which multiple risk factors cluster through visceral fat accumulation. Besides, this syndrome is designated to be a very atherogenic state. Visceral fat syndrome is corresponding to the concept of metabolic syndrome recently noted. In order to clarify the molecular mechanism why visceral fat accumulation correlates to plural common diseases and also directly to atherosclerosis, we started a project for the analysis of adipose tissue using random sequence of expressed genes in adipose tissues. We found unexpectedly that adipose tissue, especially visceral fat, expressed strongly the genes encoding secretory proteins most of which are important bioactive substances (named as adipocytokines). In addition to known adipocytokines, several novel adipose‐specific genes were identified. Among them, a collagen‐like protein encoded by an adipose most abundant gene (apM‐1) is the most important novel adipocytokine which is named adiponectin. Adiponectin has anti‐diabetic, anti‐atherogenic, anti‐oncogenic and anti‐inflammatory properties and its plasma levels decreases with visceral fat accumulation, suggesting that this molecules may play a central role in the visceral fat syndrome or metabolic syndrome. In this lecture, I would like to present the importance of adiponectin together with other adipocytokines in lifestyle‐related diseases relevant to visceral fat accumulation.
ANDRE‐MAYER AWARD AW0002 The leptin‐melanocortin pathway in human physiology: insights from genetics
Authors: Farooqi IS
Published: August 2006

Considerable attention has been paid to the secular changes in food intake and physical activity that underlie the recent rise in the prevalence of obesity. However, there is compelling evidence that inter‐individual differences in susceptibility to obesity have strong genetic determinants. In the past decade, there have been major advances in our understanding of the molecular constituents of the pathways that control mammalian energy homeostasis. We and others have described six human obesity syndromes that arise from genetic defects. We have identified several patients with congenital leptin deficiency. These children are hyperphagic, develop severe disabling obesity, impaired T cell mediated immunity and hypogonadotropic hypogonadism. In a clinical trial of daily subcutaneous injections of recombinant human leptin, sustained, beneficial effects on appetite, fat mass, hyperinsulinaemia and hyperlipidaemia have been observed. Leptin administration also permits the full progression of appropriately timed puberty and reverses impaired T cell mediated immunity. We have recruited over 2000 severely obese children to the Genetics of Obesity Study (GOOS). Using a candidate gene approach, we have identified several loss of function mutations in the melanocortin 4 receptor (MC4R), which cause a dominantly inherited syndrome that accounts for up to 5% of patients with severe, early‐onset obesity, making this the commonest obesity syndrome to date. MC4R deficiency is characterized by hyperphagia, severe hyperinsulinaemia and increased linear growth and there is evidence for a genotype‐phenotype correlation, as complete loss of function mutations result in a more severe phenotype. The characterization of these syndromes and of patients with mutations in the genes encoding the leptin receptor, pro‐opiomelanocortin (POMC) and prohormone convertase ‐1, has provided a better mechanistic understanding of the regulation of appetite and body weight in humans, which will have implications for the treatment of obesity and other metabolic disorders.
BJORNTORP FELLOWSHIP AW0006 The involvement of galanin‐like peptide in energy balance: a role for inflammation?
Authors: Lawrence CB , Allan SM , Rothwell NJ , Luckman SM
Published: August 2006

Galanin‐like peptide (GALP) is thought to play a role in energy balance within the central nervous system. Experimental evidence shows that GALP has dichotomous actions on energy homeostasis; producing orexigenic effects in the short‐term, but anorexigenic effects over the longer‐term. These anorexic actions of GALP are very similar to that seen after peripheral or central injection of the cytokine interleukin‐1 (IL‐1). Thus the aim of this study was to test the hypothesis that IL‐1 mediates the effects of GALP on energy balance. Intracerebroventricular (icv) injection of GALP (1.6 nmol) in male Sprague‐Dawley rats stimulated food intake over 1 h, but decreased feeding, body weight at 24 h and cause a rise in core body temperature over 8 h (indirect evidence of an increase in energy expenditure). These longer‐term actions were inhibited by co‐infusion of the IL‐1 receptor antagonist, IL‐1ra. However, IL‐1ra had no effect on GALP‐induced acute stimulation of feeding. GALP injection (icv) also stimulated production of IL‐1 protein in selected brain areas, such as the periventricular brain region and these IL‐1 expressing cells were microglia. These data suggest GALP induces expression of IL‐1 in the brain and the anorexic and febrile actions of GALP are mediated by this cytokine.
Transforming the Danish Film Field Via ‘Professionalization’, Penetration and Integration
Authors: Mathieu Chris
Published: August 2006

Using a qualitative case study of the transformations of the infrastructure of the Danish film field by the Danish Film Institute and its CEO, three basic questions about entrepreneurial agency are raised. The first deals with the relationship between the institutional environment and the personal backgrounds of entrepreneurial actors. The study finds that certain actors can be seen as possessing extreme or unique levels of legitimacy resulting in being rewarded with tremendous resources and opportunities for strategic action. The second question has to do with how, and what sort of role transformations can take place from a structurally central, but static position in a field. Here ‘intermediary entrepreneurialism’ was used to penetrate and integrate the field in such a way as to turn a structurally fixed position from a weak to a strong nexus. The third question deals with how transformations can be effected by an organization that straddles three prominent institutional fields and logics – the state, market and artistic expression. Here, the key role of the term ‘professionalization’ is emphasized, arguing that this term proved evocative and compelling in each institutional field. The case also adds to our understanding of institutional and transformation processes in creative industries by focusing on two less‐studied contexts – the role and strategies of centrally placed actors in initiating and leading transformational activities, and the role that entrepreneurial ‘bureaucrats’ can play in transforming creative industries.
UK Film Companies: Project‐Based Organizations Lacking Entrepreneurship and Innovativeness?
Authors: Davenport John
Published: August 2006

The growth of project‐based forms of organization has been interpreted as a response to rapidly changing technological and market environments. Companies operating in this way are assumed to be inherently innovative, continually breaking up and reconfiguring teams of workers whose highly developed skills enable them to multi‐task and apply their knowledge in novel situations, in which new technology is swiftly assimilated and deployed. Project workers, who may engage in repeat contracting with different employers, belong to technical communities wherein knowledge is developed and resides. The transformation from vertical integration to project‐based working in the film industry would thus appear to privilege innovation. However, in the UK film industry at least, this study suggests that, in spite of freelance working, crew and technicians follow highly specialized, hierarchical careers, and that the organization of production is virtually the same as it was at the height of the Hollywood ‘Studio System’. Furthermore, it will be argued that the informal, reputational networks that operate in the UK industry may act as a barrier to development rather than as an engine of change.
The Development of Creative Capabilities in and out of Creative Organizations: Three Case Studies
Authors: Napier Nancy K. , Nilsson Mikael
Published: August 2006

This paper describes and analyses how creative organizations develop and use routines and processes to strengthen their creative capabilities. Using an exploratory framework based in resource‐based theory and creativity literature, it focuses on the role of the creative entrepreneur as a key component for organizations developing creative capabilities. The creative entrepreneur or agent builds collaboration, exploits knowledge and enhances relationships in and out of an organization. Drawing on three in‐depth case studies from different sectors (theatre, sports and software), the article expands the idea of creative capabilities to encompass routines and processes in organizations in industries generally not considered ‘creative’. Furthermore, it outlines how the creative entrepreneur is instrumental in developing and using the creative routines so that they form creative capabilities. Based on the analysis, the article discusses creative capabilities, collaboration in the process, and the creative entrepreneur’s role in developing and using them.
Creativity (Ideas) Management in Industrial R&D Organizations: A Crea‐Political Process Model and an Empirical Illustration of Corus RD&T
Authors: Bakker Han , Boersma Kees , Oreel Sytse
Published: August 2006

Creativity management is a crucial topic to consider in the debate about the innovative research department. Against the background of discussions about individual creativity and organizational commitment, this article argues that the creative process in organizations is a matter of political strategies. The ideator literally has to sell his/her idea. The article therefore comes up with a crea‐political process model in which there is ample room for the thought that ideas emerge and survive within a social‐political context. In addition, the crea‐political process model is used to analyse the way in which the Corus Group Research Development and Technology (RD&T) department has implemented an electronic idea‐management system. The system, called eureka!, has been designed as a straightforward platform to capture, review, evaluate and select creative ideas. The findings challenge the literature on idea management in organizations to consider the political activities of ideators in the whole process of creativity.
UNDERDETERMINATION AND THE ARGUMENT FROM INDIRECT CONFIRMATION
Authors: Bangu Sorin
Published: August 2006

In this paper I criticize one of the most convincing recent attempts to resist the underdetermination thesis, Laudan’s argument from indirect confirmation. Laudan highlights and rejects a tacit assumption of the underdetermination theorist, namely that theories can be confirmed only by empirical evidence that follows from them. He shows that once we accept that theories can also be confirmed indirectly, by evidencenotentailed by them, the skeptical conclusion does not follow. I agree that Laudan is right to reject this assumption, but I argue that his explanation of how the rejection of this assumption blocks the skeptical conclusion is flawed. I conclude that the argument from indirect confirmation is not effective against the underdetermination thesis.
CREATING IDENTITIES, CREATING VALUES?
Authors: Black Oliver
Published: August 2006

A popular view is that we create our own identities and values. An attractive version of this is the thesis that the creation of values follows from the creation of identities. The thesis is best supported by a conception of identity in terms of projects and a conception of values that are internal to projects. The line of thought is: I create my projects; in creating my projects, I create values internal to them; so I create those values. This paper argues that the thesis faces a dilemma: it is either true but uninteresting or interesting but false. The dilemma persists whether the values in question are conceived as purpose‐relative, as moral, or as both purpose‐ relative and moral.
PAPINEAU ON ETIOLOGICAL TELEOSEMANTICS FOR BELIEFS
Authors: Mendola Joseph
Published: August 2006

Teleosemantics holds that the contents of psychological states depend crucially on the functions of such states. Etiological accounts of function hold that the functions of things depend on their histories, especially their evolutionary or learning histories. Etiological teleosemantics combines these two features. Consider the case of beliefs. Since selection rests on the stable effects of things, since beliefs have no obvious effects independent of unstable desires, and since desires themselves have mental content, beliefs may seem a hard case for etiological teleosemantics. But David Papineau deploys the effects of beliefs mediated by conation in an artful way to evade these difficulties. I argue that accounts with such an architecture are false.
MIND‐INDEPENDENCE DISAMBIGUATED: SEPARATING THE MEAT FROM THE STRAW IN THE REALISM/ANTI‐REALISM DEBATE
Authors: Page Sam
Published: August 2006

The notion of mind‐independence plays a central role in the contemporary realism/anti‐realism debate, but the notion is severely ambiguous and consequently the source of considerable misunderstanding. In this paper, four kinds of mind‐independence are distinguished: ontological, causal, structural, and individuative independence. Appreciating these distinctions entails that one can reject the individuative independence of the natural world, and still maintain that the natural world is causally and structurally independent of us. This paper argues that so‐called anti‐realists, especially Rorty, Putnam, and Goodman, are not opposed to the causal and structural independence of the natural world, as is frequently alleged, but rather its individuative independence. An acceptance of these points will hopefully put an end to the prevalence of strawmen in the debate, and focus attention on meatier issues.
DOES DESCARTES DENY CONSCIOUSNESS TO ANIMALS?
Authors: Thomas Janice
Published: August 2006

Contrary to longstanding opinion, Descartes does not deny all feeling and awareness to non‐human animals. Though he undoubtedly denies that animals think, a case can be made that he nonetheless would allow them organism consciousness, perceptual consciousness, access consciousness and even phenomenal consciousness. Descartes does not employ or accept an ‘all‐or‐nothing’ view of consciousness. He merely denies (not that this is a small thing) that animals have the capacity for self‐conscious reflective reception or awareness of sensations and feelings.
Getting the Word Out: Notes on the Social Organization of Notification
Authors: Ryan Dan
Published: August 2006

Even when the timing, sequence, and manner of notification are instrumentally inconsequential, how one conveys information affects the meaning of the telling. This article introduces the concepts of “notification norms” and the “information order,” showing how the former constrain the behavior of nodes in social networks as well as enabling manipulation of the relationships that comprise those networks. “Notification” is defined as information transmission motivated by role obligations and notification norms as social rules that govern such transmission. These rules produce patterns of information dissemination different from what individual volition would yield and from what technology makes possible. The capacity to wield a socially sanctioned repertoire of notification rules is a learned competence. Competent notifiers must also understand the local epistemological ecology—the distribution and trajectory of information, as well as the projects, concerns, and priorities of one's fellows. This study of notification introduces the broader concept of “the information order” and is a first step in the project of a sociology of information.
Unemployment, Life Satisfaction and Retrospective Error
Authors: Jürges Hendrik
Published: August 2006

The paper compares current and 1-year retrospective data on unemployment in the German Socio-Economic Panel study. 13% of all unemployment spells are not reported 1 year later, and another 7% are misreported. The ratio of retrospective to current unemployment has increased in recent years and is related to salience of unemployment measures such as the loss of life satisfaction that is associated with unemployment. Individuals with weak labour force attachment, e.g. women with children or individuals who are close to retirement, have the greatest propensity to under-report unemployment retrospectively. The data are consistent with evidence on retrospective bias found by cognitive psychologists and survey methodologists.
Long‐term assessment of nevirapine‐containing highly active antiretroviral therapy in antiretroviral‐naive HIV‐infected patients: 3‐year follow‐up of the VIRGO study
Authors: Reliquet V , Allavena C , François‐Brunet C , Perré P , Bellein V , Garré M , May T , Souala F , Besnier J‐M , Raffi F
Published: August 2006

Objectives

Data on the durability of antiretroviral regimens over a 3‐year period have only rarely been reported. The aim of this study was to evaluate the long‐term efficacy and safety of one or two daily doses of nevirapine (NVP), in combination with stavudine (d4T) and didanosine (ddI), in HIV‐infected patients.

Methods

This study was a follow‐up of the VIR (amune) Grand Ouest (VIRGO) study, a 12‐month open‐label trial to assess the safety and immunovirological activity of NVP‐d4T‐ddI combination therapy in antiretroviral‐naive HIV‐1‐infected adults with baseline CD4 counts ≥200 cells/μL and plasma viral loads ≥5000 HIV‐1 RNA copies/mL. Of the 100 patients included in the study, the 67 patients remaining on the initial triple therapy at the end of the study (1 year) were offered an extra 24 months of follow‐up.

Results

Of the 60 patients who extended follow‐up, 46 were still being treated with d4T‐ddI‐NVP at month 36; 91% (39/43) had a plasma viral load <500 copies/mL (data were missing for three patients). CD4 cell counts increased over 36 months. Safety and tolerance were good with no unexpected long‐term toxicity.

Conclusion

After 3 years of treatment with NVP‐d4T‐ddI, nearly half of the patients were still receiving the initial antiretroviral therapy with a sustained and durable immunovirological benefit. Long‐term toxicity was mainly related to the nucleoside reverse transcriptase inhibitor components of the regimen.
Resistance development over 144 weeks in treatment‐naive patients receiving tenofovir disoproxil fumarate or stavudine with lamivudine and efavirenz in Study 903*
Authors: Margot NA , Lu B , Cheng A , Miller MD ,   the Study 903 Team
Published: August 2006

Objective

Study 903 was a 144‐week, randomized, double‐blind, active‐controlled study of tenofovir disoproxil fumarate (TDF) therapy in treatment‐naive HIV‐1‐infected patients. Patients received either TDF (n=299) or stavudine (d4T) (n=301) with lamivudine (3TC) and efavirenz (EFV). Resistance analyses were performed at baseline and at virological failure to determine the effects of baseline resistance and the patterns of resistance at virological failure.

Methods

Plasma HIV‐1 from patients at baseline and at virological failure (>400 HIV‐1 RNA copies/mL at week 144 or early discontinuation) was analysed phenotypically and by population sequencing.

Results

Sixteen per cent of patients were classified as having virological failure (47 on TDF and 49 on d4T; P=0.91). Patients with non‐B HIV‐1 subtypes or baseline nucleoside reverse transcriptase inhibitor (NRTI)‐associated mutations responded similarly to the overall population. Resistance to EFV (K103N and others) or 3TC (M184V) developed most frequently (8.3% and 5.8%, respectively) and similarly in the two arms. In the d4T arm, a variety of NRTI mutations developed: K65R (n=2), L74V (n=2), V75M (n=1), and T69A+Y115H (n=1). K65R developed in eight TDF patients (2.7%); in seven of these eight patients, within 48 weeks. All eight patients began new regimens with a protease inhibitor (PI) and NRTIs, including two patients who remained on TDF; five of the eight patients achieved HIV RNA <50 copies/mL in second‐line therapy with the remaining patients having no follow‐up or being nonadherent.

Conclusions

Treatment of HIV‐1 with TDF, 3TC and EFV was highly effective, with <3% of patients developing resistance to TDF over 144 weeks.
Evaluation of hypophosphataemia in tenofovir disoproxil fumarate (TDF)‐exposed and TDF‐unexposed HIV‐infected out‐patients receiving highly active antiretroviral therapy
Authors: Buchacz K , Brooks JT , Tong T , Moorman AC , Baker RK , Holmberg SD , Greenberg A ,   the HIV Outpatient Study (HOPS) Investigators
Published: August 2006

Objectives

Cases of hypophosphataemia (often coincident with renal dysfunction) have been reported in HIV‐infected patients taking tenofovir disoproxil fumarate (TDF), but randomized placebo‐controlled trials of HIV‐infected persons with normal baseline renal function have found a comparable incidence of hypophosphataemia in the TDF and placebo groups. We assessed the incidence of grade 2 and higher hypophosphataemia in the HIV Outpatient Study (HOPS).

Methods

We analysed a prospective cohort of patients who initiated either a TDF‐containing highly active antiretroviral therapy (HAART) regimen [TDF‐exposed (TDF+) group; n=165] or a TDF‐sparing HAART regimen [TDF‐unexposed (TDF–) group; n=90], and who had normal baseline phosphate and creatinine values.

Results

The TDF+and TDF−groups had comparable median follow‐up times (10.9 vs 8.8 months, respectively; P=0.18) and number of phosphate measurements (median=3 for both) and were similar on most clinical and demographic factors. During follow up, 12.7% of TDF+vs 6.7% of TDF−patients developed grade 2 hypophosphataemia (2.0–2.4 mg/dL), and 2.4% of TDF+patients vs 0% of TDF−patients developed grade 3 hypophosphataemia (1.0–1.9 mg/dL); none developed grade 4 hypophosphataemia (<1.0 mg/dL). The incidence of grade 2 or higher hypophosphataemia was 16.7 per 100 person‐years among TDF+patients vs 8.0 per 100 person‐years among TDF−patients (P=0.11).

Conclusions

The incidence of hypophosphataemia was somewhat elevated in HOPS patients who took TDF‐containing HAART compared with those who took TDF‐sparing HAART during the first 1 to 2 years of observation, but the difference was not statistically significant. Longer follow‐up of a larger population is needed to determine if this trend towards an association achieves statistical significance and to evaluate the clinical consequences of hypophosphataemia.
Longitudinal assessment (1995–2003) of hospitalizations of HIV‐infected patients within a geographical population in Canada
Authors: Krentz HB , Dean S , Gill MJ
Published: August 2006

Objectives

To determine the frequency of and reasons for hospitalization of adult HIV‐infected patients compared with the general population.

Methods

Length of stay, primary/secondary diagnoses and discharge status were reviewed for all HIV‐infected patients admitted to Calgary‐area hospitals between 1995 and 2003. Admissions were classified as HIV‐ or non‐HIV‐related using International Classification of Diseases, 9th and 10th revisions (ICD‐9/10) codes and confirmed by chart review. Summary comparative data on admissions for the general population were obtained from the regional administrative database.

Results

HIV‐infected adults were hospitalized more than twice as frequently, experienced longer stays (median length 5 vs 3 days, respectively) and had higher in‐hospital mortality rates (9.1 vs 1.3 per 100 admissions, respectively) than the general population (P<0.01). Hospitalizations of HIV‐infected patients declined by 58% from 1995 to 2003. Patients newly diagnosed with HIV infection accounted for 15% of all HIV‐related hospitalizations. HIV‐related admissions for known HIV‐infected patients decreased from 12 per 100 patient‐years‐followed in 1995 to 3 per 100 patient‐years‐followed in 2003. Low CD4 counts, AIDS, and no current use of highly active antiretroviral therapy (HAART) were strongly correlated with hospitalizations (P<0.01). Non‐HIV‐related hospitalizations for HIV‐infected patients increased by 42% and were associated with comorbidities (e.g. substance use and psychological disorders).

Conclusion

Despite the reduction in HIV‐related hospitalizations following the introduction of HAART, all‐cause hospitalization rates have increased and have started to erode this benefit.
Serum prostate‐specific antigen levels in older men with or at risk of HIV infection
Authors: Vianna LE , Lo Y , Klein RS
Published: August 2006

Objectives

The aim of the study was to determine the rate of, and factors associated with, elevated prostate‐specific antigen (PSA) levels in older men with or at risk of HIV infection.

Methods

Using a cross‐sectional analysis, we interviewed 534 men ≥49 years old at risk for HIV infection on demographics, behaviours and medical history. Laboratory testing included serum PSA level and HIV serology, and T‐cell subsets for those who were HIV seropositive. Elevated PSA level was defined as >4.0 ng/mL, and men with elevated PSA levels were referred for urological evaluation.

Results

Fifteen per cent of men were white, 55% black, and 23% Hispanic; median age was 53 years (range 49–80 years); 74% were sexually active; 65% currently smoked cigarettes; and 16% had taken androgens. Among 310 HIV‐positive men, CD4 counts were >500 cells/μL in 31%, 200–500 cells/μL in 51%, and <200 cells/μL in 19%. Twenty men (4%) had elevated PSA. On univariate analysis, only older age was significantly associated with elevated PSA, and there was no significant difference in the number of men with elevated PSA between HIV‐positive and HIV‐negative men (nine of 310 vs 11 of 224; P=0.28). On multivariate analysis, older age remained the only variable associated with elevated PSA level [reference group ≤50 years; adjusted odds ratio (ORadj) 1.0 for age 51–60 years; ORadj 5.9 (95% confidence interval 1.2–30.1) for age ≥61 years] adjusted for HIV status, family history of prostate cancer, and androgen use.

Conclusions

Among older men, PSA levels increased with age but did not differ by HIV status. The clinical use of PSA levels in older men currently do not need to be modified for those with HIV infection.
Transmitted drug‐resistant HIV‐1 in primary HIV‐1 infection; incidence, evolution and impact on response to antiretroviral therapy
Authors: Fox J , Dustan S , McClure M , Weber J , Fidler S
Published: August 2006

Objectives

The aim of the study was to determine the incidence and persistence of transmitted drug‐resistant HIV‐1 in an incident cohort between 2000 and 2004, and to investigate the impact of transmitted drug‐resistant HIV‐1 on the response to antiretroviral therapy (ART).

Methods

A prospective, nonrandomized study was carried out on 140 individuals identified with primary HIV‐1 infection (PHI). PHI was defined as an HIV‐positive antibody test with an HIV antibody‐negative result in the prior 6 months (n=69); positive HIV DNA in the absence of antibody (n=30); an evolving titre positive HIV antibody test (n=23), or an incident ‘detuned’ assay (B clade viruses only) (n=18). Genotypic resistance testing was performed at baseline, following ART and annually over a 4‐year period.

Results

The prevalence of transmitted drug‐resistant HIV‐1 infection between January 2000 and June 2004 was nine in 140 (6.0%) and the annual incidence was stable. Seven of these nine patients had a single point mutation conferring single‐class drug resistance and the other two patients had multiple mutations conferring multiclass drug resistance (MDR). In eight of the nine cases, mutations conferring drug resistance persisted for more than 12 months off therapy. In contrast to transmitted MDR HIV‐1, the virological response to initial ART and CD4 decline were comparable in those with wild‐type virus, virus with ‘polymorphisms’ (secondary mutations) and virus with single drug‐resistance mutations.

Conclusions

The incidence of transmitted drug‐resistant HIV remained stable and low over a 4‐year period. Although MDR remains rare, its presence significantly affects the response to first‐line ART, predisposes towards the accumulation of new resistance mutations and is associated with a more rapid CD4 decline.
Neoliberalism, Contingency and Urban Policy: The Case of Social Housing in Ontario
Authors: HACKWORTH JASON , MORIAH ABIGAIL
Published: August 2006

Various authors have argued that common understandings of neoliberalism are flawed because they do not adequately account for its geographical contingency or internal contradictions. Many have suggested that neoliberalism is either too internally riven with contradiction to be considered a singular consistent project, or that its implementation is so locally contingent that we cannot plausibly speak of one ideal‐type placeless ideology. Primarily based on interviews with over half of the municipal housing providers in Ontario, this article explores the extent to which the meta‐ideas of neoliberalism are filtered and manifest (or not) locally. Social policy has been neoliberalized in Ontario at least since the advent of the ‘common sense revolution’ in 1995, when a Tory government was elected on a platform of neoliberal reform. The experience of social housing in the province, before, after and during the transition offers a useful window into the debate about the dissonance (or lack thereof) between ideal‐type and contingent neoliberalism. Based on this case, we argue that, despite its obvious conceptual flaws, it is politically and analytically important to understand ideal‐type neoliberalism better.
Desegregation and Integration as Linked or Distinct? Evidence from a Previously ‘White’ Suburb in Post‐apartheid Cape Town
Authors: LEMANSKI CHARLOTTE L.
Published: August 2006

This article analyses whether the physical desegregation of a residential neighbourhood ultimately facilitates the social integration of its residents. Desegregation is measured quantitatively (i.e. using census data for a suburb in which no single race comprises more than 50% and at least one other racial group comprises 25%), and social integration is assessed qualitatively using indicators such as friendship, common local identity, sharing local facilities and involvement in local institutions. Essentially this research is concerned with whether labelling a suburb ‘desegregated’ is a superficial term that whilst implying racial mixing actually masks social segregation; and also whether assumptions that urban policies of desegregation ultimately facilitate social integration are accurate. This desegregation/integration nexus is explored by examining the lives of residents of a desegregated Cape Town neighbourhood. South Africa provides a timely context because the legacy of apartheid’s spatial and social design continues to dominate the urban scene despite policy efforts to promote both desegregation and integration.
Cervical Spine Joint Hypermobility: A Possible Predisposing Factor for New Daily Persistent Headache
Authors: Rozen TD , Roth JM , Denenberg N
Published: August 2006

The objective of this study was to suggest that joint hypermobility (specifically of the cervical spine) is a predisposing factor for the development of new daily persistent headache (NDPH). Twelve individuals (10 female, 2 male) with primary NDPH were evaluated by one of two physical therapists. Each patient was tested for active cervical range of motion and for the presence of excessive intersegmental vertebral motion in the cervical spine. All patients were screened utilizing the Beighton score, which determines degree of systemic hypermobility. Eleven of the 12 NDPH patients were found to have cervical spine joint hypermobility. Ten of the 12 NDPH patients had evidence of widespread joint hypermobility with the Beighton score. Based on our findings we suggest that joint hypermobility, specifically of the cervical spine, may be a predisposing factor for the development of NDPH.
Functional Gastrointestinal Disorders in Migrainous Children: Efficacy of Flunarizine
Authors: Boccia G , Del Giudice E , Crisanti AF , Strisciuglio C , Romano A , Staiano A
Published: August 2006

The aim of this study was to evaluate the prevalence of functional gastrointestinal disorders (FGIDs) in children with migraine headache and the effects of flunarizine on gastrointestinal manifestations. We studied 50 migrainous children (mean age 8.63 years). The clinical pattern and the diagnosis of FGIDs were obtained from structured questionnaires. All subjects underwent measurement of total gastric emptying time (TGEt) performed by real-time ultrasonography of the gastric antrum at baseline (T0). In the second part of the study, we evaluated 10 migrainous children (mean age 9.8 years) with associated FGIDs. In these 10 patients, repeated TGEt evaluation together with a detailed symptom history was obtained after 1 (T1) and 2 months (T2) of treatment with flunarizine. Control groups were composed of 10 migrainous children without FGIDs (mean age 9.2 years) and nine sex- and age-matched healthy children. Gastrointestinal disorders were present in 70% of the patients. Migrainous children with FGIDs had significantly ( P < 0.01) more prolonged TGEt than subjects without FGIDs. Prior to therapy, all migrainous children with FGIDs had prolongation of TGEt compared with controls ( P < 0.05). Patients on flunarizine had a significant decrease in TGEt at both 1 ( P < 0.01) and 2 months ( P = 0.002) of therapy. The mean frequency of abdominal pain per month was significantly ( P < 0.001) reduced at T1 compared with T0. The mean frequency of vomiting per month was significantly decreased at T1 ( P < 0.05) and even more so at T2 ( P < 0.01). Finally, the mean frequency of headache per month was significantly reduced only at T2 ( P < 0.05), whereas the mean duration of headache was significantly decreased at T1 ( P < 0.01) with no difference between T1 and T2. Most children with migraine report FGIDs, associated with a delayed gastric emptying. Flunarizine decreases the frequency and duration of migrainous episodes as well as the gastrointestinal symptoms.
Nummular Headache: Three New Cases
Authors: Dach F , Speciali J , Eckeli A , Rodrigues GG , Bordini CA
Published: August 2006

Nummular headache is proposed as a distinct type of headache in the Appendix of the second edition of the International Classification of Headache Disorders (ICHD-II). It is a chronic condition, with the following characteristics: pain is felt on a small circumscribed cranial area; pain is of mild to moderate intensity; there is no evidence of a structural abnormality. Herein, three cases fulfilling the ICHDII proposed criteria (code A13.7.1) for nummular headache are reported.
The carcinogenicity of smegma: debunking a myth
Authors: Van Howe RS , Hodges FM
Published: August 2006

Background  Smegma is widely believed to cause penile, cervical and prostate cancer. This nearly ubiquitous myth continues to permeate the medical literature despite a lack of valid supportive evidence.

Methods  A historical perspective of medical ideas pertaining to smegma is provided, and the original studies in both animals and humans are reanalysed using the appropriate statistical methods.

Results  Evidence supporting the role of smegma as a carcinogen is found wanting.

Conclusions  Assertions that smegma is carcinogenic cannot be justified on scientific grounds.
Quality of life before and 6 weeks after treatment in a dermatological outpatient treatment unit
Authors: Maroti M , Ulff E , Wijma B
Published: August 2006

Background  Dermatological disease affects quality of life to a great extent. Treatments are time‐consuming and many patients have problems adhering to treatment. Attending an outpatient unit regularly during an intensive treatment period may enable patients to cope with their illness, adhere to treatment and thus improve their quality of life.

Objective  To study the effect on quality of life of 6 weeks of regular treatment in the outpatient unit in the County Hospital of Jönköping, by means of a questionnaire and interviews.

Methods  The Dermatology Life Quality Index (DLQI) was distributed to 50 consecutive patients with psoriasis, atopic dermatitis or pruritus attending our outpatient treatment unit. Nine of the patients were interviewed during treatment about factors that might influence their quality of life.

Results  The DLQI scores before treatment indicated a low quality of life. Women were more affected than men. After 6 weeks of treatment there was a clear improvement, with a 57% reduction in the scores. The answers from the interviews indicated important areas of concern such as withdrawal from public places, adoption of special clothing habits and concern about personal relationships.

Conclusion  Dermatological diseases have an important influence on patients’ quality of life. Attending an outpatient treatment unit was in this series of cases associated with improved quality of life as measured with the DLQI.