bluuebunny/crossref_metadata_2025 huggingface dataset:
Emotional Distress and Medication Use in Two Acute Pain Populations: Jaw and Low Back
Authors: Edwards Deirdre , Gatchel Robert , Adams Laura , Stowell Anna W.
Published: November 2006

Abstract:  The present study was undertaken to compare emotional distress and functional ability between two common pain populations—acute jaw pain (JAW; n = 135) and acute low back pain (LB; n = 71). Patient groups were evaluated and compared on a variety of biopsychosocial measures, including the Beck Depression Inventory (BDI), Multidimensional Pain Inventory (MPI), Characteristic Pain Intensity (CPI), and Ways of Coping Questionnaire. Specific diagnoses were assessed using the Structured Clinical Interview of the Diagnostic and Statistical Manual (DSM‐IV)—I and II, and rates of Axis I and II diagnoses in these groups were further compared to base rates in the general population. Additionally, medication usage was evaluated to determine group differences. Results revealed that JAW patients had lower BDI and CPI scores, as well as a higher level of functioning on the Global Assessment of Functioning assessed by the DSM‐IV. Both acute pain groups also had significantly more Axis I and II disorders than the general population. Additionally, it was found that the JAW group used more benzodiazepines, while the LB group used more schedule II narcotics. A logistic regression model created from these variables found a six‐factor model, composed of the CPI, MPI coping style anomalous, Ways of Coping problem‐solving, Global Assessment of Functioning, anxiety disorders, and Cluster C personality disorder diagnoses, that differentiated the JAW from the LB group. Overall, these findings suggest that the differences identified between these two groups should be considered in developing tailored treatments for individuals with acute low back and jaw pain.
HRTEM Investigations of New AlN Polytypoids in the High‐AlN Region of the AlN–Al2O3–Y2O3 System
Authors: Yu Yingda , Tangen Inger‐Lise , Grande Tor , Høier Ragnvald , Einarsrud Mari‐Ann
Published: November 2006

The AlN polytypoid phases in selected materials in the AlN–Al2O3–Y2O3 system has been investigated using TEM methods. Two new AlN polytypoid phases, 24H and 39R, were identified in the pseudobinary AlN–Al2O3 system. The 39R phase existed as single grains while 24H was observed only between subblocks of 33R and 39R. The new polytypoids are built on the same structural models that are previously reported for the other polytypoids in the same system, consisting of arrays of planar (oxygen‐containing) and corrugated inversion domain boundaries (IDBs). Only one type of interface structure was observed for the planar IDBs of the new polytypoids.
Reactive Hot Pressing of Alumina‐Silicon Carbide Nanocomposites
Authors: Zhang Guo‐Jun , Yang Jian‐Feng , Ando Motohide , Ohji Tatsuki
Published: November 2006

A dense alumina‐silicon carbide (Al2O3–SiC) nanocomposite was synthesized in situ from the reaction of mullite, aluminum, and carbon by reactive hot pressing (RHP). Transmission electron microscopy investigation showed that in situ‐formed, nanometer‐sized SiC particles were mainly entrapped in the matrix grains, whereas submicrometer‐sized particles were located at the grain boundaries or triple points of the Al2O3. In addition, no amorphous phase was observed at the interfaces of the Al2O3 and SiC grains, which indicated strong direct bonding. Fracture‐surface analysis by scanning electron microscopy revealed an intrafracture mode. The bending strength of the nanocomposite RHP‐treated at 1800°C was 795 ± 160 MPa, and the fracture toughness, measured by the indentation method, was 3.1 MPa·m1/2.
So close and yet so far: Health care in our nearest neighbour
Authors: Gunja Naren
Published: November 2006

Emergency medicine is reaching out from traditional westernized birthplaces to the uncharted territories of the developing world. With ever‐increasing links with our near neighbours in Asia, a steady stream of ACEM fellows and trainees are giving their time and resources in aid of their health sector development. Papua New Guinea, being our nearest neighbour, deserves our attention not only for the stark contrast to our own health system experience, but also because of the rising specialty of emergency medicine in that country. I was lucky enough to be part of a concerted programme to train medical students and emergency medicine trainees in the fundamentals of our specialty.
Randomized comparison of the SLIPA (Streamlined Liner of the Pharynx Airway) and the SS‐LM (Soft Seal Laryngeal Mask) by medical students
Authors: Hein Cindy , Owen Harry , Plummer John
Published: November 2006

Objective:  The aim of the study was to compare the Streamlined Liner of the Pharynx Airway (SLIPA; Hudson RCI), a new supraglottic airway device, with the Soft Seal Laryngeal Mask (SS‐LM; Portex) when used by novices.

Methods:  Thirty‐six medical students with no previous airway experience, received manikin training in the use of the SLIPA and the SS‐LM. Once proficient, the students inserted each device in randomized sequence, in two separate patients in the operating theatre. Only two insertion attempts per patient were allowed. Students were assessed in terms of: device preference; success or failure; success at first attempt and time to ventilation.

Results:  Sixty‐seven per cent of the students preferred to use the SLIPA (95% confidence interval 49–81%). The SLIPA was successfully inserted (one or two attempts) in 94% of patients (34/36) and the SS‐LM in 89% (32/36) (P = 0.39). First attempt success rates were 83% (30/36) and 67% (24/36) in the SLIPA and SS‐LM, respectively (P = 0.10). Median time to ventilation was shorter with the SLIPA (40.6 s) than with the SS‐LM (66.9 s) when it was the first device used (P = 0.004), but times were similar when inserting the second device (43.8 s vs 42.9 s) (P = 0.75).

Conclusions:  In the present study novice users demonstrated high success rates with both devices. The SLIPA group achieved shorter times to ventilation when it was the first device they inserted, which might prove to be of clinical significance, particularly in resuscitation attempts. Although the Laryngeal Mask has gained wide recognition for use by both novice users and as a rescue airway in failed intubation, the data presented here suggest that the SLIPA might also prove useful in these areas.
Evaluation of the impact of a paediatric procedural sedation credentialing programme on quality of care
Authors: Priestley Stephen , Babl Franz E , Krieser David , Law Andrew , Miller Joanne , Spicer Maureen , Tully Melissa
Published: November 2006

Objectives: The aim of the present study is to describe changes in documentation, risk assessment and patient care resulting from implementation of a credentialing process for medical and nursing staff in paediatric procedural sedation (PPS) in two EDs – one an urban mixed ED and the other a specialist paediatric ED.

Methods: Chart review of 100 patients undergoing PPS prior to and 100 patients following introduction of the PPS programme. Information was extracted from medical records and sedation checklists. Demographics, drugs used, procedure performed and elements of the pre‐procedural, intra‐procedural and post‐procedural care were compared pre‐ and post implementation of the PPS programme.

Results: Significant improvements in the post‐implementation period compared with pre‐implementation were seen in: frequency of documentation of informed consent (87vs15%,P < 0.0001); evidence of performance of a pre‐procedural risk assessment (87vs1%,P < 0.0001); and appropriate recording of vital signs (58vs27%,P < 0.0001). Improvements were also noted in documentation of weight, allergies, fasting status and recording of drug orders. There were no adverse events recorded in the pre‐programme period and 6 recorded in the post‐programme period.

Conclusion: The implementation of a PPS credentialing programme into these two EDs resulted in significant improvements in risk assessment, monitoring and documentation of important information related to safe PPS. These improvements should result in improved quality and safety of PPS.
Avian influenza pandemic threat and health systems response
Authors: Bradt David A , Drummond Christina M
Published: November 2006

Avian influenza is a panzootic and recurring human epidemic with pandemic potential. Pandemic requirements for a viral pathogen are: a novel virus must emerge against which the general population has little or no immunity; the new virus must be able to replicate in humans and cause serious illness; and the new virus must be efficiently transmitted from person to person. At present, only the first two conditions have been met. Nonetheless, influenza pandemics are considered inevitable. Expected worldwide human mortality from a moderate pandemic scenario is 45 million people or more than 75% of the current annual global death burden. Although mathematical models have predicted that an emerging pandemic could be contained at its source, this conclusion remains controversial among public health experts. The Terrestrial Animal Health Code and International Health Regulations are enforceable legal instruments integral to pandemic preparedness. Donor support in financial, material and technical assistance remains critical to disease control efforts – particularly in developing countries where avian influenza predominately occurs at present. Personal protective equipment kits, decontamination kits and specimen collection kits in lightweight, portable packages are becoming standardized. Air transport border control measures purporting to delay importation and spread of human avian influenza are scientifically controversial. National pandemic plans prioritize beneficiary access to antiviral drugs and vaccines for some countries. Other medical commodities including ventilators, hospital beds and intensive care units remain less well prioritized in national plans. These resources will play virtually no role in care of the overwhelming majority of patients worldwide in a pandemic. Prehospital care, triage and acute care all require additional professional standardization for the high patient volumes anticipated in a pandemic.
Postpartum Sexuality Concerns Among First-Time Parents from One U.S. Academic Hospital
Authors: Pastore Lisa , Owens Annette , Raymond Colleen
Published: November 2006

Introduction

Sexual perceptions and activities are influenced by pregnancy and childbirth due to both physical and emotional changes.

Aim

Our goal was to illuminate the sexuality issues of concern to first-time parents (mothers and fathers) of healthy, singleton newborns in one U.S. academic hospital.

Main Outcome Measures

Number of sexuality concerns and self-reported degree of resolution by months postpartum and gender of parent.

Methods

Anonymous, cross-sectional postal survey of two first-time parent cohorts: 4 months postpartum (113 responses/404 mailed=28.0%) and 12 months postpartum (99 responses/394 mailed=25.1%).

Results

Approximately half of the parents reported questions or concerns on between two and eight of 19 sexuality topics. Only 11% of participating mothers and 17% of participating fathers had one or no concerns (P =0.27 by gender), and 17% of mothers and 9% of fathers had >13 concerns (P =0.12 by gender). There were fewer maternal concerns if they did not live with the father (P =0.01), slightly fewer if the delivery was vaginal vs. cesarean (P =0.07), and no differences by forceps/vacuum use or episiotomy/vaginal tear. The top concerns at 4 months postpartum were quite similar by gender and included when to resume intercourse, birth control, and the sexual impact of physical recovery from delivery. At 12 months, mothers and fathers both frequently reported a sexuality impact from the mother’s body image concerns and desire discrepancy. One year postpartum, there were three sexuality topics with fairly high prevalence (more than one-third parents had this concern) that persisted (no self-reported resolution among at least one-third of parents): child-rearing differences with spouse, greater desire by the man than the woman, and the mother’s body image.

Conclusion

New mothers and fathers both have postpartum sexuality concerns/questions, many of which can be addressed by healthcare providers.
Real-Life Safety and Efficacy of Vardenafil in the Treatment of Erectile Dysfunction—Results from 30,010 U.S. Patients
Authors: Cheng Eric
Published: November 2006

Introduction

Clinical trials show that vardenafil produces effective and satisfactory first-dose success rates and reliability for erection and intercourse in men with erectile dysfunction (ED).

Aim

This study was conducted to evaluate real-life efficacy, safety, and acceptance of vardenafil in men with ED.

Methods

This open-label, prospective study, conducted in 6,740 U.S. centers, included an initial visit and one or two follow-up visits within a 2-month period of the first vardenafil dose. Vardenafil was administered in 5–20 mg doses.

Main Outcome Measures

Efficacy variables included first-dose success rates for vaginal penetration, maintenance of erection, and satisfaction based on physician and patient assessments. Safety was assessed by adverse events (AEs).

Results

A total of 30,010 men were included in the safety/intent-to-treat (S/ITT) analysis, with 26,043 men in the adjusted S/ITT population. Vardenafil improved erectile function in 78% of men, with 75% rating overall efficacy as “satisfying” or “very satisfying.” The overall rates of successful penetration and maintenance with vardenafil following the first dose were 78% and 68%, respectively. For men with mild and moderate ED, first-dose success rates for penetration were 89% and 82%, respectively, and for maintenance, 82% and 71%, respectively. First-dose penetration and maintenance of erection rates were 76% and 66%, respectively, for men with self-reported hypertension, and 70% and 60%, respectively, for men with diabetes mellitus. At study end, 67% of patients preferred to continue using vardenafil. The most frequently reported AEs were headache (4%) and flushing (2%). Vardenafil was well tolerated, with a “satisfied/very satisfied” tolerability rating in 75% of cases as assessed by the physician.

Conclusion

This observational study demonstrated the tolerability and efficacy of vardenafil in men with ED and comorbidities. Vardenafil provided a high rate of first-dose intercourse success and a favorable safety profile in patients with and without comorbid disease.
Efficacy and Patient Satisfaction Associated with Penile Prosthesis Revision Surgery
Authors: Kava Bruce R. , Yang Yulong , Soloway Cynthia T.
Published: November 2006

Introduction

Complications that arise after placement of a penile prosthesis may result in the need for revision surgery. Few contemporary penile prosthesis series have focused solely on describing the efficacy and patient satisfaction associated with penile prosthesis revision surgery.

Aim

To determine the overall success of penile prosthesis revision surgery in providing the patient with a functional implant. Device efficacy and patient satisfaction with penile prosthesis revision surgery will be assessed using psychometrically validated instruments.

Main Outcome Measures

The erectile function (EF) and satisfaction domains of the International Index of Erectile Function (IIEF) were used to quantify the overall efficacy and patient satisfaction with revision surgery.

Methods

Data were derived from a prospective database of consecutive patients undergoing penile prosthesis revision surgery performed by a single surgeon (B.R.K.). Eleven patients filled out the IIEF prior to surgery and 26 completed it following surgery.

Results

Thirty-nine consecutive patients underwent 55 revision procedures related to a prior penile prosthesis. Thirty-four patients (87%) have a functional implant with a median follow-up of 6.5 months (range 1–42 months). Significant improvements in the overall IIEF, EF domain, and satisfaction domain were seen in those patients studied prior to and following revision surgery. The total IIEF, EF domain, and satisfaction domain of the IIEF for the group of 26 responders were 60.7 ± 19.3, 26.6 ± 8.7, and 15.7 ± 5.6, respectively. Patients with fibrotic corporal bodies scored significantly lower on the EF and satisfaction domains than did any other group.

Conclusion

Penile prosthesis revision surgery is highly successful in providing men with a functional implant. The prostheses function well and patients are satisfied with their devices. Further study of those men with corporal fibrosis is warranted in order to determine the factors needed to improve their overall satisfaction with revision surgery.
On two‐parameter models of photon cross sections: Application to dual‐energy CT imaging
Authors: Williamson Jeffrey F. , Li Sicong , Devic Slobodan , Whiting Bruce R. , Lerma Fritz A.
Published: November 2006

The goal of this study is to evaluate the theoretically achievable accuracy in estimating photon cross sections at low energies from idealized dual‐energy x‐ray computed tomography (CT) images. Cross‐section estimation from dual‐energy measurements requires a model that can accurately represent photon cross sections of any biological material as a function of energy by specifying only two characteristic parameters of the underlying material, e.g., effective atomic number and density. This paper evaluates the accuracy of two commonly used two‐parameter cross‐section models for postprocessing idealized measurements derived from dual‐energy CT images. The parametric fit model (PFM) accounts for electron‐binding effects and photoelectric absorption by power functions in atomic number and energy and scattering by the Klein–Nishina cross section. The basis‐vector model (BVM) assumes that attenuation coefficients of any biological substance can be approximated by a linear combination of mass attenuation coefficients of two dissimilar basis substances. Both PFM and BVM were fit to a modern cross‐section library for a range of elements and mixtures representative of naturally occurring biological materials . The PFM model, in conjunction with the effective atomic number approximation, yields estimated the total linear cross‐section estimates with mean absolute and maximum error ranges of 0.6%–2.2% and 1%–6%, respectively. The corresponding error ranges for BVM estimates were 0.02%–0.15% and 0.1%–0.5%. However, for photoelectric absorption frequency, the PFM absolute mean and maximum errors were 10.8%–22.4% and 29%–50%, compared with corresponding BVM errors of 0.4%–11.3% and 0.5%–17.0%, respectively. Both models were found to exhibit similar sensitivities to image‐intensity measurement uncertainties. Of the two models, BVM is the most promising approach for realizing dual‐energy CT cross‐section measurement.
An alternative proof of Bukhgeim and Kazantsev's inversion formula for attenuated fan‐beam projections
Authors: Huang Qiu , Zeng Gengsheng L. , Wu Jiansheng
Published: November 2006

An inversion formula was developed by Bukhgeim and Kazantsev for attenuated fan‐beam projections [Russian Academy of Science Siberian Branch: The Sobolev Institute of Mathematics (2002)]. The inversion formula was obtained by relating the attenuated fan‐beam projections to unattenuated fan‐beam projections and by trickily processing the unattenuated fan‐beam projections. We show in this paper that the inversion formula can be readily obtained from Novikov's inversion formula for the two‐dimensional (2D) attenuated radon transform. The derivation provides an alternative proof of Bukhgeim and Kazantsev's inversion formula by the use of transformation between parallel‐beam coordinates and fan‐beam coordinates and thus is quite elementary.
Improving IMRT dose accuracy via deliverable Monte Carlo optimization for the treatment of head and neck cancer patients
Authors: Dogan Nesrin , Siebers Jeffery V. , Keall Paul J. , Lerma Fritz , Wu Yan , Fatyga Mirek , Williamson Jeffrey F. , Schmidt‐Ullrich Rupert K.
Published: November 2006

The purpose of this work is to investigate the effect of dose‐calculation accuracy on head and neck (H&N) intensity modulated radiation therapy (IMRT) plans by determining the systematic dose‐prediction and optimization‐convergence errors (DPEs and OCEs), using a superposition/convolution (SC) algorithm. Ten patients with locally advanced H&N squamous cell carcinoma who were treated with simultaneous integrated boost IMRT were selected for this study. The targets consisted of gross target volume (GTV), clinical target volume (CTV), and nodal target volumes (CTV nodes). The critical structures included spinal cord, parotid glands, and brainstem. For all patients, three IMRT plans were created: A: an SC optimized plan, B: anplan recalculated with Monte Carlo, and C: an MC optimized plan. For each structure, DPEs and OCEs were estimated asandwhere A, B, and C stand for the three different optimized plans as defined above. Deliverable optimization was used for all plans, that is, a leaf‐sequencing step was incorporated into the optimization loop at each iteration. The range ofin the GTVvaried fromto, while theranged from 0.9% to 7.0%. Thein the contralateral parotidreached 8.2%, while thein the contralateral parotidvaried from 0.91% to 6.99%. Thein cordreached, while thereached to. The magnitude of theanddifferences demonstrate the importance of using the most accurate available algorithm in the deliverable IMRT optimization process, especially for the estimation of normal structure doses.
Clinical implementation of target tracking by breathing synchronized delivery
Authors: Tewatia Dinesh , Zhang Tiezhi , Tome Wolfgang , Paliwal Bhudatt , Metha Minesh
Published: November 2006

Target‐tracking techniques can be categorized based on the mechanism of the feedback loop. In real time tracking, breathing‐delivery phase correlation is provided to the treatment delivery hardware. Clinical implementation of target tracking in real time requires major hardware modifications. In breathing synchronized delivery (BSD), the patient is guided to breathe in accordance with target motion derived from four‐dimensional computed tomography (4D‐CT). Violations of mechanical limitations of hardware are to be avoided at the treatment planning stage. Hardware modifications are not required. In this article, using sliding window IMRT delivery as an example, we have described step‐by‐step the implementation of target tracking by the BSD technique: (1) A breathing guide is developed from patient's normal breathing pattern. The patient tries to reproduce this guiding cycle by following the display in the goggles; (2) 4D‐CT scans are acquired at all the phases of the breathing cycle; (3) The average tumor trajectory is obtained by deformable image registration of 4D‐CT datasets and is smoothed by Fourier filtering; (4) Conventional IMRT planning is performed using the images at reference phase (full exhalation phase) and a leaf sequence based on optimized fluence map is generated; (5) Assuming the patient breathes with a reproducible breathing pattern and the machine maintains a constant dose rate, the treatment process is correlated with the breathing phase; (6) The instantaneous average tumor displacement is overlaid on the dMLC position at corresponding phase; and (7) DMLC leaf speed and acceleration are evaluated to ensure treatment delivery. A custom‐built mobile phantom driven by a computer‐controlled stepper motor was used in the dosimetry verification. A stepper motor was programmed such that the phantom moved according to the linear component of tumor motion used in BSD treatment planning. A conventional plan was delivered on the phantom with and without motion. The BSD plan was also delivered on the phantom that moved with the prescheduled pattern and synchronized with the delivery of each beam. Film dosimetry showed underdose and overdose in the superior and inferior regions of the target, respectively, if the tumor motion is not compensated during the delivery. BSD delivery resulted in a dose distribution very similar to the planned treatments.
Characterization and use of EBT radiochromic film for IMRT dose verification
Authors: Zeidan Omar A. , Stephenson Stacy Ann L. , Meeks Sanford L. , Wagner Thomas H. , Willoughby Twyla R. , Kupelian Patrick A. , Langen Katja M.
Published: November 2006

We present an evaluation of a new and improved radiochromic film, type EBT, for its implementation to IMRT dose verification. Using a characterized flat bed color CCD scanner, the film's dose sensitivity, uniformity, and speed of development post exposure were shown to be superior to previous types of radiochromic films. The film's dose response was found to be very similar to ion chamber scans in water through comparisons of depth dose and lateral dose profiles. The effect of EBT film polarization with delivered dose and film scan orientation was shown to have a significant effect on the scanner's OD readout. In addition, the film's large size, flexibility, and the ability to submerge it in water for relatively short periods of time allowed for its use in both water and solid water phantoms to verify TomoTherapy IMRT dose distributions in flat and curved dose planes. Dose verification in 2D was performed on ten IMRT plans (five head and neck and five prostate) by comparing measured EBT dose distributions to TomoTherapy treatment planning system calculated dose. The quality of agreement was quantified by the gamma index for four sets of dose difference and distance to agreement criteria. Based on this study, we show that EBT film has several favorable features that allow for its use in routine IMRT patient‐specific QA.
Deformable registration of 4D computed tomography data
Authors: Rietzel Eike , Chen George T. Y.
Published: November 2006

Four‐dimensional radiotherapy requires deformable registration to track delivered dose across varying anatomical states. Deformable registration based on B‐splines was implemented to register 4D computed tomography data to a reference respiratory phase. To assess registration performance, anatomical landmarks were selected across ten respiratory phases in five patients. These point landmarks were transformed according to global registration parameters between different respiratory phases. Registration uncertainties were computed by subtraction of transformed and reference landmark positions. The selection of appropriate registration masks to separate independently moving anatomical subunits is crucial to registration performance. The average registration error for five landmarks for each of five patients was . This level of accuracy is acceptable for most radiotherapy applications.
Microbiosensors for Measurement of Microbially Available Dissolved Organic Carbon: Sensor Characteristics and Preliminary Environmental Application
Authors: Köster Marion , Gliesche Christian G. , Wardenga Rainer
Published: November 2006

Microbial respiration-based microbiosensors used for quantification of available dissolved organic carbon (ADOC) instantaneously respired by microorganisms are described. The sensing membranes contained aerobic seawater microorganisms immobilized in a polyurethane hydrogel. Molecular investigations revealed that the bacterial strain used was most closely related toStaphylococcus warneri. This strain was characterized by low substrate selectivity, which was reflected in the response to various mono- and disaccharides, short-chain fatty acids, and amino acids, as determined using Biolog microplates. Specific emphasis was placed on critically assessing biosensor functioning that was affected by preconditioning of the selected bacterial strain, chemical and geometric properties of the sensing membrane (e.g., composition, permeability, and thickness), and the distribution, biomass, and physiological state of immobilized cells, as well as the exposure conditions (e.g., temperature and nutrient supply). The sensors revealed that there was a linear response up to a glucose concentration of 500 μM depending on the type, characteristics, and recent history of the sensors. The detection limit of the sensors was equivalent to about 6 to 10 μM glucose. The 90% response time ranged from 1 to 5 min. Generally, the response of the biosensors became weaker with time. The shelf lives of individual sensors were up to 2 weeks. Measurements based on optical ADOC microbiosensors revealed that in photoautotrophically dominated sandy coastal sediments, the pool sizes and turnover of ADOC were regulated by the photosynthetic activity of benthic microalgae and microbial aerobic respiration. A large increase in ADOC production was observed shortly after the microphytobenthic primary production reached the maximum value at midday, whereas ADOC was consumed by microbial respiration during the night.
Multilocus Sequence Typing System for the EndosymbiontWolbachia pipientis
Authors: Baldo Laura , Dunning Hotopp Julie C. , Jolley Keith A. , Bordenstein Seth R. , Biber Sarah A. , Choudhury Rhitoban Ray , Hayashi Cheryl , Maiden Martin C. J. , Tettelin Hervè , Werren John H.
Published: November 2006

The eubacterial genusWolbachiacomprises one of the most abundant groups of obligate intracellular bacteria, and it has a host range that spans the phyla Arthropoda and Nematoda. Here we developed a multilocus sequence typing (MLST) scheme as a universal genotyping tool forWolbachia.Internal fragments of five ubiquitous genes (gatB,coxA,hcpA,fbpA, andftsZ) were chosen, and primers that amplified across the majorWolbachiasupergroups found in arthropods, as well as other divergent lineages, were designed. A supplemental typing system using the hypervariable regions of theWolbachiasurface protein (WSP) was also developed. Thirty-seven strains belonging to supergroups A, B, D, and F obtained from singly infected hosts were characterized by using MLST and WSP. The number of alleles per MLST locus ranged from 25 to 31, and the average levels of genetic diversity among alleles were 6.5% to 9.2%. A total of 35 unique allelic profiles were found. The results confirmed that there is a high level of recombination in chromosomal genes. MLST was shown to be effective for detecting diversity among strains within a single host species, as well as for identifying closely related strains found in different arthropod hosts. Identical or similar allelic profiles were obtained for strains harbored by different insect species and causing distinct reproductive phenotypes. Strains with similar WSP sequences can have very different MLST allelic profiles and vice versa, indicating the importance of the MLST approach for strain identification. The MLST system provides a universal and unambiguous tool for strain typing, population genetics, and molecular evolutionary studies. The central database for storing and organizingWolbachiabacterial and host information can be accessed athttp://pubmlst.org/wolbachia/.
Genetic Analysis of Bacteriocin 43 of Vancomycin-Resistant
Enterococcus faecium
Authors: Todokoro Daisuke , Tomita Haruyoshi , Inoue Takako , Ike Yasuyoshi
Published: November 2006

A total of 636 vancomycin-resistant
Enterococcus faecium
(VRE) isolates obtained between 1994 and 1999 from the Medical School Hospital of the University of Michigan were tested for bacteriocin production. Of the 277 (44%) bacteriocinogenic strains, 21 were active against
E. faecalis
,
E. faecium
,
E. hirae
,
E. durans
, and
Listeria monocytogenes
. Of those 21 strains, a representative bacteriocin of strain VRE82, designated bacteriocin 43, was found to be encoded on mobilizable plasmid pDT1 (6.2 kbp). Nine open reading frames (ORFs), ORF1 to ORF9, were presented on pDT1 and were oriented in the same direction. The bacteriocin 43 locus (bac43) consists of the bacteriocin gene
bacA
(ORF1) and the immunity gene
bacB
(ORF2). The deduced
bacA
product is 74 amino acids in length with a putative signal peptide of 30 amino acids at the N terminus. The
bacB
gene encodes a deduced 95-amino-acid protein without a signal sequence. The predicted mature BacA protein (44 amino acids) showed sequence homology with the membrane-active class IIa bacteriocins of lactic acid bacteria and showed 86% homology with bacteriocin 31 from
E. faecalis
YI717 and 98% homology with bacteriocin RC714. Southern analysis with a bac43 probe of each plasmid DNA from the 21 strains showed hybridization to a specific fragment corresponding to the 6.2-kbp EcoRI fragment, suggesting that the strains harbored the pDT1-like plasmid (6.2 kb) which encoded the bacteriocin 43-type bacteriocin. The bac43 determinant was not identified among non-VRE clinical isolates.
Diversity and Distribution of
Escherichia coli
Genotypes and Antibiotic Resistance Phenotypes in Feces of Humans, Cattle, and Horses
Authors: Anderson Matthew A. , Whitlock John E. , Harwood Valerie J.
Published: November 2006

Escherichia coli
is the most completely characterized prokaryotic model organism and one of the dominant indicator organisms for food and water quality testing, yet comparatively little is known about the structure of
E. coli
populations in their various hosts. The diversities of
E. coli
populations isolated from the feces of three host species (human, cow, and horse) were compared by two subtyping methods: ribotyping (using HindIII) and antibiotic resistance analysis (ARA). The sampling effort required to obtain a representative sample differed by host species, as
E. coli
diversity was consistently greatest in horses, followed by cattle, and was lowest in humans. The diversity of antibiotic resistance patterns isolated from individuals was consistently greater than the diversity of ribotypes.
E. coli
populations in individuals sampled monthly, over a 7- to 8-month period, were highly variable in terms of both ribotypes and ARA phenotypes. In contrast,
E. coli
populations in cattle and humans were stable over an 8-h period. Following the cessation of antibiotic therapy, the
E. coli
population in the feces of one human experienced a rapid and substantial shift, from a multiply antibiotic-resistant phenotype associated with a particular ribotype to a relatively antibiotic-susceptible phenotype associated with a different ribotype. The high genetic diversity of
E. coli
populations, differences in diversity among hosts, and temporal variability all indicate complex population dynamics that influence the usefulness of
E. coli
as a water quality indicator and its use in microbial source tracking studies.
Validation of a Green Fluorescent Protein-Labeled Strain of
Vibrio vulnificus
for Use in the Evaluation of Postharvest Strategies for Handling of Raw Oysters
Authors: Drake S. L. , Elhanafi D. , Bang W. , Drake M. A. , Green D. P. , Jaykus L. A.
Published: November 2006

In this paper we describe a biological indicator which can be used to study the behavior of
Vibrio vulnificus
, an important molluscan shellfish-associated human pathogen. A
V. vulnificus
ATCC 27562 derivative that expresses green fluorescent protein (GFP) and kanamycin resistance was constructed using conjugation. Strain validation was performed by comparing the GFP-expressing strain (
Vv-
GFP) and the wild-type strain (
Vv
-WT) with respect to growth characteristics, heat tolerance (45°C), freeze-thaw tolerance (−20
o
and −80°C), acid tolerance (pH 5.0, 4.0, and 3.5), cold storage tolerance (5°C), cold adaptation (15°C), and response to starvation. Levels of recovery were evaluated using nonselective medium (tryptic soy agar containing 2% NaCl) with and without sodium pyruvate. The indicator strain was subsequently used to evaluate the survival of
V. vulnificus
in oysters exposed to organic acids (citric and acetic acids) and various cooling regimens. In most cases,
Vv
-GFP was comparable to
Vv
-WT with respect to growth and survival upon exposure to various biological stressors; when differences between the GFP-expressing and parent strains occurred, they usually disappeared when sodium pyruvate was added to media. When
V. vulnificus
was inoculated into shellstock oysters, the counts dropped 2 log
10
after 11 to 12 days of refrigerated storage, regardless of the way in which the oysters were initially cooled. Steeper population declines after 12 days of refrigerated storage were observed for both iced and refrigerated products than for slowly cooled product and product held under conservative harvest conditions. By the end of the refrigeration storage study (22 days), the counts of
Vv
-GFP in iced and refrigerated oysters had reached the limit of detection (10
2
CFU/oyster), but slowly cooled oysters and oysters stored under conservative harvest conditions still contained approximately 10
3
and >10
4
CFU
V. vulnificus
/oyster by day 22, respectively. The
Vv
-GFP levels in the oyster meat remained stable for up to 24 h when the meat was exposed to acidic conditions at various pH values. Ease of detection and comparability to the wild-type parent make
Vv
-GFP a good candidate for use in studying the behavior of
V. vulnificus
upon exposure to sublethal stressors that might be encountered during postharvest handling of molluscan shellfish.
Isolation and Characterization of a Novel Lipase from a Metagenomic Library of Tidal Flat Sediments: Evidence for a New Family of Bacterial Lipases
Authors: Lee Mi-Hwa , Lee Choong-Hwan , Oh Tae-Kwang , Song Jae Kwang , Yoon Jung-Hoon
Published: November 2006

We cloned
lipG
, which encoded a lipolytic enzyme, from a Korean tidal flat metagenomic library. LipG was related to six putative lipases previously identified only in bacterial genome sequences. These enzymes comprise a new family. We partially characterized LipG, providing the first experimental data for a member of this family.
Symbiotic Bacteria Associated with Stomach Discs of Human Lice
Authors: Sasaki-Fukatsu Kayoko , Koga Ryuichi , Nikoh Naruo , Yoshizawa Kazunori , Kasai Shinji , Mihara Minoru , Kobayashi Mutsuo , Tomita Takashi , Fukatsu Takema
Published: November 2006

The symbiotic bacteria associated with the stomach disc, a large aggregate of bacteriocytes on the ventral side of the midgut, of human body and head lice were characterized. Molecular phylogenetic analysis of 16S rRNA gene sequences showed that the symbionts formed a distinct and well-defined clade in the
Gammaproteobacteria
. The sequences exhibited AT-biased nucleotide composition and accelerated molecular evolution. In situ hybridization revealed that in nymphs and adult males, the symbiont was localized in the stomach disc, while in adult females, the symbiont was not in the stomach disc but in the lateral oviducts and the posterior pole of the oocytes due to female-specific symbiont migration. We propose the designation “
Candidatus
Riesia pediculicola” for the louse symbionts.
The
SPI1
Gene, Encoding a Glycosylphosphatidylinositol-Anchored Cell Wall Protein, Plays a Prominent Role in the Development of Yeast Resistance to Lipophilic Weak-Acid Food Preservatives
Authors: Simões T. , Mira N. P. , Fernandes A. R. , Sá-Correia Isabel
Published: November 2006

The
Saccharomyces cerevisiae SPI1
gene encodes a member of the glycosylphosphatidylinositol-anchored cell wall protein family. In this work we show results indicating that
SPI1
expression protects the yeast cell from damage caused by weak acids used as food preservatives. This is documented by a less extended period of adaptation to growth in their presence and by a less inhibited specific growth rate for a parental strain compared with a mutant with
SPI1
deleted. Maximal protection exerted by Spi1p against equivalent concentrations of the various weak acids tested was registered for the more lipophilic acids (octanoic acid, followed by benzoic acid) and was minimal for acetic acid. Weak-acid adaptation was found to involve the rapid activation of
SPI1
transcription, which is dependent on the presence of the Msn2p transcription factor. Activation of
SPI1
transcription upon acetic acid stress also requires Haa1p, whereas this recently described transcription factor has a negligible role in the adaptive response to benzoic acid. The expression of
SPI1
was found to play a prominent role in the development of yeast resistance to 1,3-β-glucanase in benzoic acid-stressed cells, while its involvement in acetic acid-induced resistance to the cell wall-lytic enzyme is slighter. The results are consistent with the notion that Spi1p expression upon weak-acid stress leads to cell wall remodeling, especially for the more lipophilic acids, decreasing cell wall porosity. Decreased cell wall porosity, in turn, reduces access to the plasma membrane, reducing membrane damage, intracellular acidification, and viability loss.
Genetic Characterization of the Phenylacetyl-Coenzyme A Oxygenase from the Aerobic Phenylacetic Acid Degradation Pathway of
Escherichia coli
Authors: Fernández Cristina , Ferrández Abel , Miñambres Baltasar , Díaz Eduardo , García José L.
Published: November 2006

We show here that the
paaABCDE
genes of the
paa
cluster responsible for phenylacetate degradation in
Escherichia coli
W encode a five-component oxygenase that hydroxylates phenylacetyl-coenzyme A (CoA), the first intermediate of the pathway. The primary structure of the subunits of bacterial phenylacetyl-CoA oxygenases revealed that these enzymes constitute the prototype of a new and distinct group of the large bacterial diiron multicomponent oxygenase family.
Culture-Independent Analyses of Temporal Variation of the Dominant Fecal Microbiota and Targeted Bacterial Subgroups in Crohn's Disease
Authors: Scanlan Pauline D. , Shanahan Fergus , O'Mahony Caitlin , Marchesi Julian R.
Published: November 2006

Gut microbiota shows host-specific diversity and temporal stability and significantly contributes to maintenance of a healthy gut. However, in inflammatory bowel disease, this microbiota has been implicated as a contributory factor to the illness. This study compared bacterial dynamics in Crohn's disease patients to those in a control group using a culture-independent method to assess the temporal stability, relative diversity, and similarity of the dominant fecal microbiota,
Clostridium
spp.,
Bacteroides
spp.,
Bifidobacterium
spp., and lactic acid bacteria spp. (LAB) for all individuals. Fecal samples were collected over several time points from individuals with Crohn's disease who were in remission (
n
= 11), from Crohn's disease patients who relapsed into an active Crohn's disease state (
n
= 5), and from a control group (
n
= 18). Denaturing gradient gel electrophoresis profiles were generated for the different microbial groups by specifically targeting different regions of the 16S rRNA gene and were compared on the basis of similarity and diversity. The temporal stability of dominant species for all Crohn's disease patients was significantly lower (
P
< 0.005) than that for the control group. Analysis of group-specific profiles for
Bifidobacterium
spp. found that they were similar in all samples, while the diversity of the LAB varied significantly between the groups, but temporal stability was not significantly altered. We observed significant changes in two functionally important mutualistic groups of bacteria, viz.,
Clostridium
and
Bacteroides
spp., which may have implications for the host's gut health, since some genera are involved in production of short-chain fatty acid, e.g., butyrate.
First Detection of the Ambler Class C 1 AmpC β-Lactamase in
Citrobacter freundii
by a New, Simple Double-Disk Synergy Test
Authors: Ruppé Etienne , Bidet Philippe , Verdet Charlotte , Arlet Guillaume , Bingen Edouard
Published: November 2006

We report on the first detection of an AmpC-type Ambler class C 1 (ACC-1) β-lactamase in
Citrobacter freundi
isolated from a patient also harboring ACC-1-producing
Escherichia coli
and
Klebsiella pneumoniae
. We propose a simple cefoxitin-based double-disk synergy test (DDST) for the specific detection of ACC-1 in members of the family
Enterobacteriaceae
, including natural AmpC producers, in association with a cloxacillin-based DDST as a first-line AmpC-type β-lactamase screening test.
Methods for Detection of
Trichomonas vaginalis
in the Male Partners of Infected Women: Implications for Control of Trichomoniasis
Authors: Hobbs Marcia M. , Lapple Dana M. , Lawing Lisa F. , Schwebke Jane R. , Cohen Myron S. , Swygard Heidi , Atashili Julius , Leone Peter A. , Miller William C. , Seña Arlene C.
Published: November 2006

Trichomonas vaginalis
infection in men is an important cause of nongonococcal urethritis. Effective detection of the parasite in men using culture requires examination of multiple specimens. We compared culture and PCR-enzyme-linked immunosorbent assay in urethral swabs, urine, and semen for
T. vaginalis
detection in male sexual partners of women with trichomoniasis identified by wet mount and culture. Trichomonads were detected by at least one positive test in 205/280 men (73.2%) who submitted at least one specimen for culture and PCR. Whereas InPouch TV culture detected only 46/205 cases (22.5%), PCR detected 201/205 (98.0%). Urethral swab cultures from men with urethritis were more likely to be positive with shorter incubation than specimens from men without urethritis.
T. vaginalis
was detected more often in men with wet-mount-positive partners. Even with a sensitive PCR assay, reliable detection of
T. vaginalis
in male partners required multiple specimens. The majority of male sexual partners in this study were infected, emphasizing the importance of partner evaluation and treatment.
FDJS03 Isolates Causing an Outbreak of Aseptic Meningitis in China That Evolved from a Distinct Echovirus 30 Lineage Imported from Countries of the Commonwealth of Independent States
Authors: Zhao Ya Nan , Perlin David S. , Park Steven , Jiang Ren Jie , Chen Liang , Chen Yue , Gardiner Rebecca , Jiang Qing Wu
Published: November 2006

We compared echovirus 30 strains (FDJS03) which caused an outbreak of aseptic meningitis in China in 2003 with other human enterovirus B strains. Sequencing of the complete genome of FDJS03_84, a representative strain from this outbreak, revealed a mosaic structure with a putative recombination spot within the 2B gene. It was most similar to a strain of the same serotype, E30-14125-00, in the 5′ half of the genome but was almost equidistant to all strains analyzed in most of the 3′ half of the genome. Phylogenetic relationships in the 5′-untranslated region and the VP1 gene indicated that the FDJS03 isolates were closely related to a distinct lineage of E30 which circulated in countries of the Commonwealth of Independent States during 1999 and 2000. It is most likely that the ancestor of FDJS03 isolates experienced multiple recombination events in the nonstructural protein coding region, which were partly observed in the phylogenetic analysis of the 3D region.
Usefulness of Inter-IS
1
Spacer Polymorphisms for Subtyping of
Shigella sonnei
Isolates
Authors: Chiou Chien-Shun , Wei Hsiao-Lun , Wang You-Wen , Liao Jui-Cheng , Li Chun-Chin
Published: November 2006

Shigella sonnei
contains numerous IS
1
elements. The existence of polymorphisms in the length of the inter-IS
1
spacer is a basis for the development of a PCR-based method for the subtyping of
S. sonnei
strains. The usefulness of inter-IS
1
spacer typing (IST) was evaluated and compared with that of pulsed-field gel electrophoresis (PFGE) by characterization of
S. sonnei
isolates from epidemiologically nonrelated cases and outbreaks and of isolates that were indistinguishable by PFGE and that were collected from independent infection events. IST was less discriminatory than PFGE, with discriminatory indices of 0.96 and 0.63, respectively, but was able to compensate for the drawbacks of PFGE. PFGE exhibited a high level of discriminatory power for
S. sonnei
isolates; however, PFGE was also, at times, too discriminatory, which was a disadvantage in constructing the clonal relationships among strains circulating over a period of months or years. Furthermore, IST provided greater subtyping information for isolates indistinguishable by PFGE. The present study indicates that IST is more useful than PFGE for investigating the genetic relationships among
S. sonnei
strains circulating over a longer time span and also for discriminating certain strains which are indistinguishable by PFGE.