bluuebunny/crossref_metadata_2025 huggingface dataset:
Literacy and Race as Risk Factors for Low Rates of Advance Directives in Older Adults
Authors: Waite Katherine R. , Federman Alex D. , McCarthy Danielle M. , Sudore Rebecca , Curtis Laura M. , Baker David W. , Wilson Elizabeth A. H. , Hasnain‐Wynia Romana , Wolf Michael S. , Paasche‐Orlow Michael K.
Published: February 2013

Objectives

To examine the effect of the relationship between literacy and other individual‐level factors on having an advance directive (AD).

Design

Face‐to‐face structured interview.

Setting

Participants were recruited from an academic general internal medicine clinic and one of four federally qualified health centers in Chicago.

Participants

Seven hundred eighty‐four adults aged 55 to 74.

Measurements

Assessment of participant literacy, sociodemographic factors, and having an AD for medical care.

Results

One‐eighth (12.4%) of participants with low literacy, 26.6% of those with marginal literacy, and 49.5% of those with adequate literacy reported having an AD (P < .001). In multivariable analyses, literacy and race were independently associated with less likelihood of having an AD. Specifically, participants with limited literacy (risk ratio (RR) = 0.45, 95% confidence interval (CI) = 0.22–0.95) and African Americans (RR = 0.64, 95% CI = 0.47–0.88) were less likely to have an AD. Exploratory analyses showed that there was not a significant interaction between the effect of literacy and race.

Conclusion

Limited literacy and African‐American race were significant risk factors for not having an AD in this cohort of older adults. Literacy and race probably represent two separate but important causal pathways that need to be understood to improve how the healthcare system ascertains and protects individuals' advance care preferences.
Medical Students' Recognition and Application of Geriatrics Principles in a New Curriculum
Authors: Nanda Aman , Farrell Timothy W. , Shield Renée R. , Tomas Maria , Campbell Susan E. , Wetle Terrie
Published: February 2013

Given the aging U.S. population, it is imperative that medical students recognize and apply geriatrics principles. To address this need, in 2006, the Warren Alpert Medical School of Brown University integrated geriatrics content into a new medical school curriculum. Preclinical and clinical medical students submitted written reflective journals in response to prompts regarding the geriatrics content of the new medical school curriculum, including their didactic and clinical experiences. An interdisciplinary team used a structured qualitative approach to identify themes, including the recognition and application of geriatrics principles. Thirty medical student journalers submitted 405 journal entries. Themes regarding students' emerging understanding of geriatrics principles included a growing understanding of geriatrics principles, recognition of the importance of psychosocial factors and patient preferences in caring for older adults, recognition of the complexities of treating older adults and application of geriatric principles to clinical situations, and understanding of physicians' roles in managing the care of older adults. Medical student reflective journaling allows medical educators to obtain timely feedback on curricular innovations and helps illuminate the process by which medical students learn to recognize and apply core geriatrics principles.
Temper outbursts in Prader–Willi syndrome: causes, behavioural and emotional sequence and responses by carers
Authors: Tunnicliffe P. , Woodcock K. , Bull L. , Oliver C. , Penhallow J.
Published: February 2013

Background

Temper outbursts are common in Prader–Willi syndrome but rarely described in detail. This study investigated the phenomenology of temper outbursts in terms of antecedents, sequence of behaviours and emotions and intervention strategies used.

Method

A semi‐structured interview about temper outbursts was conducted with the main carers of seven children (9.5 to 16.7 years) and seven adults (24.7 to 47.10 years) with Prader–Willi syndrome (10 male, 4 female). Reliability and validity of the interview results was established.

Results

Various setting events increased and reduced the likelihood of temper outbursts. The most common antecedent was a change to routine or expectation. There were marked similarities in the sequence of behaviours and emotions during temper outbursts, with anger rising quickly followed by expressions of remorse and distress at the end of an outburst.

Discussion

The sequence of behaviours and emotions within outbursts was similar to that described in temper tantrums in typical development. Cognitive and emotional processes are likely to be important in the understanding of temper outbursts with implications for early intervention.
Deficiency of G3BP1, the stress granules assembly factor, results in abnormal synaptic plasticity and calcium homeostasis in neurons
Authors: Martin Sophie , Zekri Latifa , Metz Alexandra , Maurice Tangui , Chebli Karim , Vignes Michel , Tazi Jamal
Published: February 2013

Ras‐GAP SH3‐domain–binding protein, G3BP, is an important component in the assembly of stress granules (SGs), which are cytoplasmic aggregates assembled following translational stress. To assess the physiological function of G3BP, we generated viable G3bp1‐knockout (KO) mice, which demonstrated behavioral defects linked to the CNS‐associated with ataxia phenotype. Immunohistochemistry pinpointed high expression of G3BP in the cytoplasm of hippocampal neurons and Purkinje cells of the cerebellum of wild‐type mice. Also, electrophysiological measurements revealed that the absence of G3BP1 leads to an enhancement of short‐term potentiation (STP) and long‐term depression in the CA1 area of G3bp1 KO mice compared with wild‐type mice. Consistently, G3BP1 deficiency in neurons leads to an increase in intracellular calcium and calcium release in response to (S)‐3,5‐Dihydroxyphenylglycine, a selective agonist of group I metabotropic glutamate receptors. These results show, for the first time, a requirement for G3BP1 in the control of neuronal plasticity and calcium homeostasis and further establish a direct link between SG formation and neurodegenerative diseases.
Neuroprotective effects of PPAR‐γ agonist rosiglitazone in N171‐82Q mouse model of Huntington's disease
Authors: Jin Jing , Albertz Jennifer , Guo Zhihong , Peng Qi , Rudow Gay , Troncoso Juan C. , Ross Christopher A. , Duan Wenzhen
Published: February 2013

Huntington's disease (HD) is a devastating genetic neurodegenerative disease caused by CAG trinucleotide expansion in the exon‐1 region of the huntingtin gene. Currently, no cure is available. It is becoming increasingly apparent that mutant Huntingtin (HTT) impairs metabolic homeostasis and causes transcriptional dysregulation. The peroxisome proliferator‐activated receptor gamma (PPAR‐γ) is a transcriptional factor that plays a key role in regulating genes involved in energy metabolism; recent studies demonstrated that PPAR‐γ activation prevented mitochondrial depolarization in cells expressing mutant HTT and attenuated neurodegeneration in various models of neurodegenerative diseases. PPAR‐γ‐coactivator 1α (PGC‐1 α) transcription activity is also impaired by mutant HTT. We now report that the PPAR‐γ agonist, rosiglitazone (RSG), significantly attenuated mutant HTT‐induced toxicity in striatal cells and that the protective effect of RSG is mediated by activation of PPAR‐γ. Moreover, chronic administration of RSG (10 mg/kg/day, i.p) significantly improved motor function and attenuated hyperglycemia in N171‐82Q HD mice. RSG administration rescued brain derived neurotrophic factor(BDNF) deficiency in the cerebral cortex, and prevented loss of orexin‐A‐immunopositive neurons in the hypothalamus of N171‐82Q HD mice. RSG also prevented PGC‐1α reduction and increased Sirt6 protein levels in HD mouse brain. Our results suggest that modifying the PPAR‐γ pathway plays a beneficial role in rescuing motor function as well as glucose metabolic abnormalities in HD.
Complete House Furnishers: The Retailer as Interior Designer in Nineteenth–Century London
Authors: Edwards Clive
Published: February 2013

This research paper considers the history of a particular moment in the development of the interior decoration/design business. Although the history of interior design practice has been well charted as “art/design history,” the business and professional history has been somewhat neglected, except for work on particular firms. The issues examined relate to four particular aspects. The first covers the distinctions between decorators, upholsterers, furnishers, and architects and how these differences were reflected in the work undertaken. Related to this is a brief examination of why many architects ignored interior work. Secondly, is the nature of the customer base and how it reacted in response to changing social and economic factors. Thirdly, there are the issues of marketing and promotion that were aimed at a much wider audience than architects would expect, and finally a consideration of the house furnisher as a foundation for the development of the professional interior decorator/designer.

To address these issues, the paper offers an overview of the rise, maturity, and change of the house furnisher as the most important contributor to the supply of interior design/decoration advice and products in the second half of the nineteenth century. By taking case studies of important players in the field, the paper will consider why architects gave up their role as arbiters of taste in interior works, and how the house furnishing businesses took over. This is of some interest as it not only explores an issue that still remains in the interior design world—the notion of who controls the work, but also explores the nature and pre–history of professional interior design service providers in the period. Although the scope of this essay is potentially wide ranging, it is limited to the second half of the nineteenth century and focuses on London for its case studies. Through a consideration of primary sources, often using the trade press for commentaries, a sense of the contemporary issues is made. In addition, the recent work by scholars in the field is used to interpret the changes described.

As a foundation for the subsequent development of a profession, the house furnisher had laid a number of ground rules. Apart from the issue of the control of work, they encouraged the development of specialized knowledge, and they recognized the importance of training and education, and to some extent, exercised control of access to the industry.
The Role of Religion and Stress in Sexual Identity and Mental Health Among Lesbian, Gay, and Bisexual Youth
Authors: Page Matthew J. L. , Lindahl Kristin M. , Malik Neena M.
Published: February 2013

This study investigated religious stress, gay‐related stress, sexual identity, and mental health outcomes in lesbian, gay, and bisexual (LGB) adolescents and emerging adults. The model examined negative LGB identity as a mediator of the relationships between (1) religious stress and mental health, and (2) gay‐related stress and mental health. The data indicated that negative LGB identity fully accounted for both relationships. Findings suggest that a negative sense of sexual identity for LGB youth helps explain the links between religious and gay‐related stressors and mental health. As LGB youth may have limited control over these stressors, the importance of helping LGB youth maintain a positive LGB identity, despite homonegative messages from others, is discussed.
Applying a Mixture Design for Consumer Optimization of Black Cherry, Concord Grape and Pomegranate Juice Blends
Authors: Lawless Lydia J.R. , Threlfall Renee T. , Meullenet Jean‐François , Howard Luke R.
Published: February 2013

Expanding interest in the nutraceutical market inspires sensory‐ and nutraceutical‐oriented optimization methods. Black cherry (BlkCh), Concord grape (Con) and pomegranate (Pom) juices were blended according to a mixture design (seven juice treatments) and evaluated by descriptive and consumer panels. Consumers (n = 100) evaluated estimated overall liking (OL), pre‐ and post‐antioxidant information OL, appearance OL, just‐about‐right (JAR) attributes, purchase intent and familiarity to determine an optimum juice formulation and the influence of consumer characteristics on acceptance of nutraceutical‐rich juices. Descriptive (n = 10) and consumer (n = 100) data showed that Con juice attributes (sweetness, Concord flavor, caramelized flavor) were positive, and that the attributes of BlkCh and Pom juices were negative. Post‐antioxidant information OL was high for Con juice (7.48) and low for BlkCh juice (5.01) and Pom juice (5.01). Using the desirability function, juice blend solutions were generated based on OL for pre‐antioxidant‐information (77% Con + 3% Pom + 20% BlkCh) and post‐antioxidant information (75% Con + 12% Pom + 13% BlkCh). Pom juice had the most antioxidants, and the post‐antioxidant information solution had a higher level of Pom. JAR analysis showed that 33% Con + 33% Pom + 33% BlkCh juice had fewer nonoptimal attributes than 100% Pom or 100% BlkCh juice, but had more antioxidants than 100% Con juice. Evaluating consumer OL, diagnostic and descriptive data provided a comprehensive understanding of how products could be adjusted to maximize consumer acceptance.

Practical Applications

Black cherry, Concord grape and pomegranate juice blends are prime candidates for the nutraceutical juice market because of their inherent health‐oriented characteristics and portable convenience. Consumer‐driven approaches to balance the nutraceutical and sensory quality of products are necessary to optimize consumer utility. Merely applying instrumental measures of nutraceutical levels to optimization models does not incorporate how consumers value those attributes; thus, an optimization that applied consumer value of antioxidants in juice products was used, the principle of which could aid in the future development of nutraceutical beverages.
Interrelationship between milk constituents, serum oestradiol and vaginal mucus indicators of oestrus in Egyptian buffaloes
Authors: Kandiel M. M. M. , El‐Naggar R. A. M. , Abdel‐Ghaffar A. E. , Sosa G. A. M. , Abou El‐Roos N. A.
Published: February 2013

The intensity of heat signs in buffaloes is generally low and the incidence of suboestrus varied from 15 to 73% (Buffalopedia). The objective of this study was to investigate the feasibility of monitoring the changes in some milk constituents, oestradiol levels and electrical conductivity of vaginal mucus during peri‐oestrous period in prediction of the timing of oestrus in buffaloes. Twenty‐one Egyptian buffaloes aged 3–9 year, 1st–6th lactations, were examined by oestrous detector and ultrasonographically for monitoring the ovarian and uterine activity for 7 days around the time of standing oestrus. Sodium, potassium, chloride and lactose were assayed in aqueous phase of milk; besides, oestradiol was estimated in serum. Current results declared highly significant acute changes in milk constituents at the time of oestrus characterized by peaking of chloride and sodium levels and lowering of potassium and lactose values. The alternation in milk composition when arranged in decreasing order of magnitude, sodium was the highest (77.78 ± 0.69%), followed by chloride (61.60 ± 1.52%) and potassium (−58.14 ± 10.89%). Concomitantly, milk lactose decreased by 26.07 ± 7.97% compared to baseline levels. Synchronously, vaginal electrical resistance (VER) showed a significant (p < 0.01) decrease, but serum oestradiol 17β levels surged (59.93 ± 7.29 pg/ml) on day of oestrus. Serum oestradiol level was negatively correlated with VER (r = −0.577), potassium (r = −0.661), positively correlated with chloride (r = 0.707) and sodium (r = 0.579) and not correlated with lactose levels. These results for the first time suggested that the changes in constituents of milk during peri‐oestrous period may be used as a practical non‐invasive indicator for oestrous detection and prediction of ovulation in Egyptian buffaloes.
Stones from Mohave County, Arizona: Multiple falls in the “Franconia strewn field”
Authors: Hutson Melinda , Ruzicka Alex , Timothy Jull A. J. , Smaller James E. , Brown Ryan
Published: February 2013

One of the most productive and well‐sampled dense collection areas for meteorites on Earth is the “Franconia strewn field” in Mohave County, Arizona, which since 2002 has yielded hundreds of meteorites in an ellipsoidal area approximately 5 × 16 km across. Based on petrographic, mineral‐chemical, and terrestrial age data, we conclude that among 14 meteorites examined, there are at least 6 and possibly 8 distinct meteorites represented, which fell over a period of approximately 0–20 kyr ago. These include equilibrated H‐chondrites such as Franconia (H5) and Buck Mountains (BM) 001 (H6); H3–6 breccias such as Buck Mountains Wash and BM 004; and L6 chondrites such as BM 002 and BM 003 (which may be paired), Palo Verde Mine, and BM 005. To confidently pair such meteorites often requires thorough petrographic examination, mineral‐chemical analyses, and terrestrial ages. We estimate that 50 ± 10% of the larger specimens in this area are paired, yielding a relatively high value of approximately 2.3–2.9 distinct meteorites km−2. The meteorite flux estimated for Franconia area is higher than the flux inferred from contemporary fireball data for larger masses. We suggest that one large H3–6 meteoroid fell in the area, most likely that of Buck Mountains Wash approximately 4 kyr ago, which produced an elliptical strewn field with masses generally increasing toward one end, and which raised the meteorite productivity in the recovery area.
Relationship between effective population size, inbreeding and adult fitness‐related traits in a steelhead (Oncorhynchus mykiss) population released in the wild
Authors: Naish K. A. , Seamons T. R. , Dauer M. B. , Hauser L. , Quinn T. P.
Published: February 2013

Inbreeding is of concern in supportive breeding programmes in Pacific salmonids, Oncorhynchus spp, where the number of breeding adults is limited by rearing space or poor survival to adulthood, and large numbers are released to supplement wild stocks and fisheries. We reconstructed the pedigree of 6602 migratory hatchery steelhead (Oncorhynchus mykiss) over four generations, to determine the incidence and fitness consequences of inbreeding in a northwest USA programme. The hatchery maintained an effective population size,  = 107.9 from F0 to F2, despite an increasing census size (N), which resulted in a decreasing Ne/N ratio (0.35 in F0 to 0.08 in F2). The reduced ratio was attributed to a small broodstock size, nonrandom transfers and high variance in reproductive success (particularly in males). We observed accumulation of inbreeding from the founder generation (in F4, percentage individuals with inbreeding coefficients Δf > 0 = 15.7%). Generalized linear mixed models showed that body length and weight decreased significantly with increasing Δf, and inbred fish returned later to spawn in a model that included father identity. However, there was no significant correlation between Δf and age at return, female fecundity or gonad weight. Similarly, there was no relationship between Δf and reproductive success of F2 and F3 individuals, which might be explained by the fact that reproductive success is partially controlled by hatchery mating protocols. This study is one of the first to show that small changes in inbreeding coefficient can affect some fitness‐related traits in a monitored population propagated and released to the wild.
Montane refugia predict population genetic structure in theLarge‐blotchedEnsatina salamander
Authors: Devitt Thomas J. , Devitt Susan E. Cameron , Hollingsworth Bradford D. , McGuire Jimmy A. , Moritz Craig
Published: February 2013

Understanding the biotic consequences ofPleistocene range shifts and fragmentation remains a fundamental goal in historical biogeography and evolutionary biology. Here, we combine species distribution models (SDM) from the present and two lateQuaternary time periods with multilocus genetic data (mitochondrialDNAand microsatellites) to evaluate the effect of climate‐induced habitat shifts on population genetic structure in theLarge‐blotchedEnsatina (Ensatina eschscholtzii klauberi), a plethodontid salamander endemic to middle and high‐elevation conifer forest in theTransverse andPeninsularRanges of southernCalifornia and northernBajaCalifornia. A compositeSDMrepresenting the range through time predicts two disjunct refugia, one in southernCalifornia encompassing the core of the species range and the other in theSierraSanPedroMártir of northernBajaCalifornia at the southern limit of the species range. Based on our spatial model, we would expect a pattern of high connectivity among populations within the northern refugium and, conversely, a pattern of isolation due to long‐term persistence of theSierraSanPedroMártir population. Our genetic results are consistent with these predictions based on the hypothetical refugia in that (i) historical measures of population connectivity among stable areas are correlated with gene flow estimates; and (ii) there is strong geographical structure between separate refugia. These results provide evidence for the role of recent climatic change in shaping patterns of population persistence and connectivity within the Transverse and Peninsular Ranges, an evolutionary hotspot.
Macroparasites at peripheral sites of infection are major and dynamic modifiers of systemic antimicrobial pattern recognition responses
Authors: Friberg I. M. , Little S. , Ralli C. , Lowe A. , Hall A. , Jackson J. A. , Bradley J. E.
Published: February 2013

Immune defences and the maintenance of immunological homeostasis in the face of pathogenic and commensal microbial exposures are channelled by innate antimicrobial pattern recognition receptors (PRRs) such as toll‐like receptors (TLRs). Whilst PRR‐mediated response programmes are the result of long‐term host‐pathogen or host–commensal co‐evolutionary dynamics involving microbes, an additional possibility is that macroparasitic co‐infections may be a significant modifier of such interactions. We demonstrate experimentally that macroparasites (the model gastrointestinal nematode, Heligmosomoides) at peripheral sites of infection cause substantial alteration of the expression and function of TLRs at a systemic level (in cultured splenocytes), predominantly up‐regulating TLR2, TLR4 and TLR9‐mediated cytokine responses at times of high standing worm burdens. We consistently observed such effects in BALB/c and C57BL/6 mice under single‐pulse and trickle exposures to Heligmosomoides larvae and in SWR and CBA mice under single‐pulse exposures. A complementary long‐term survey of TLR2‐mediated tumour necrosis factor‐alpha responses in wild wood mice (Apodemus sylvaticus) was consistent with substantial effects of macroparasites under some environmental conditions. A general pattern, though, was for the associations of macroparasites with TLR function to be temporally dynamic and context‐dependent: varying with different conditions of infection exposure in the field and laboratory and with host genetic strain in the laboratory. These results are compelling evidence that macroparasites are a major and dynamic modifier of systemic innate antimicrobial responsiveness in naturally occurring mammals and thus likely to be an important influence on the interaction between microbial exposures and the immune system.
Diversification in a biodiversity hot spot: landscape correlates of phylogeographic patterns in the African spotted reed frog
Authors: Lawson Lucinda P.
Published: February 2013

The Eastern Afromontane Biodiversity Hotspot is known for microendemism and exceptional population genetic structure. The region's landscape heterogeneity is thought to limit gene flow between fragmented populations and create opportunities for regional adaptation, but the processes involved are poorly understood. Using a combination of phylogeographic analyses and circuit theory, I investigate how characteristics of landscape heterogeneity including regional distributions of slope, rivers and streams, habitat and hydrological basins (drainages) impact genetic distance among populations of the endemic spotted reed frog (Hyperolius substriatus), identifying corridors of connectivity as well as barriers to dispersal. Results show that genetic distance among populations is most strongly correlated to regional and local hydrologic structure and the distribution of suitable habitat corridors, not isolation by distance. Contrary to expectations, phylogeographic structure is not coincident with the two montane systems, but instead corresponds to the split between the region's two major hydrological basins (Zambezi and East Central Coastal). This results in a paraphyletic relationship for the Malawian Highlands populations with respect to the Eastern Arc Mountains and implies that the northern Malawian Highlands are the diversity centre for H. substriatus. Although the Malawian Highlands collectively hold the greatest genetic diversity, individual populations have lower diversity than their Eastern Arc counterparts, with an overall pattern of decreasing population diversity from north to south. Through the study of intraspecific differentiation across a mosaic of ecosystem and geographic heterogeneity, we gain insight into the processes of diversification and a broader understanding of the role of landscape in evolution.
The hindgut lumen prokaryotic microbiota of the termite Reticulitermes flavipes and its responses to dietary lignocellulose composition
Authors: Boucias Drion G. , Cai Yunpeng , Sun Yijun , Lietze Verena‐Ulrike , Sen Ruchira , Raychoudhury Rhitoban , Scharf Michael E.
Published: February 2013

Reticulitermes flavipes (Isoptera: Rhinotermitidae) is a highly eusocial insect that thrives on recalcitrant lignocellulosic diets through nutritional symbioses with gut‐dwelling prokaryotes and eukaryotes. In the R. flavipes hindgut, there are up to 12 eukaryotic protozoan symbionts; the number of prokaryotic symbionts has been estimated in the hundreds. Despite its biological relevance, this diverse community, to date, has been investigated only by culture‐ and cloning‐dependent methods. Moreover, it is unclear how termite gut microbiomes respond to diet changes and what roles they play in lignocellulose digestion. This study utilized high‐throughput 454 pyrosequencing of 16S V5‐V6 amplicons to sample the hindgut lumen prokaryotic microbiota of R. flavipes and to examine compositional changes in response to lignin‐rich and lignin‐poor cellulose diets after a 7‐day feeding period. Of the ~475 000 high‐quality reads that were obtained, 99.9% were annotated as bacteria and 0.11% as archaea. Major bacterial phyla included Spirochaetes (24.9%), Elusimicrobia (19.8%), Firmicutes (17.8%), Bacteroidetes (14.1%), Proteobacteria (11.4%), Fibrobacteres (5.8%), Verrucomicrobia (2.0%), Actinobacteria (1.4%) and Tenericutes (1.3%). The R. flavipes hindgut lumen prokaryotic microbiota was found to contain over 4761 species‐level phylotypes. However, diet‐dependent shifts were not statistically significant or uniform across colonies, suggesting significant environmental and/or host genetic impacts on colony‐level microbiome composition. These results provide insights into termite gut microbiome diversity and suggest that (i) the prokaryotic gut microbiota is much more complex than previously estimated, and (ii) environment, founding reproductive pair effects and/or host genetics influence microbiome composition.
Landscape heterogeneity shapes host‐parasite interactions and results in apparent plant–virus codivergence
Authors: Rodelo‐Urrego M. , Pagán I. , González‐Jara P. , Betancourt M. , Moreno‐Letelier A. , Ayllón M. A. , Fraile A. , Piñero D. , García‐Arenal F.
Published: February 2013

Knowledge on how landscape heterogeneity shapes host–parasite interactions is central to understand the emergence, dynamics and evolution of infectious diseases. However, this is an underexplored subject, particularly for plant–virus systems. Here, we analyse how landscape heterogeneity influences the prevalence, spatial genetic structure, and temporal dynamics ofPepper golden mosaicandPepper huasteco yellow veinbegomoviruses infecting populations of the wild pepperCapsicum annuum glabriusculum(chiltepin) inMexico. Environmental heterogeneity occurred at different nested spatial scales (host populations within biogeographical provinces), with levels of human management varying among host population within a province. Results indicate that landscape heterogeneity affects the epidemiology and genetic structure of chiltepin‐infecting begomoviruses in a scale‐specific manner, probably related to conditions favouring the viruses' whitefly vector and its dispersion. Increased levels of human management of the host populations were associated with higher virus prevalence and erased the spatial genetic structure of the virus populations. Also, environmental heterogeneity similarly shaped the spatial genetic structures of host and viruses. This resulted in the congruence between host and virus phylogenies, which does not seem to be due to host‐virus co‐evolution. Thus, results provide evidence of the key role of landscape heterogeneity in determining plant–virus interactions.
Characterization of a second sterol‐esterifying enzyme in Toxoplasma highlights the importance of cholesterol storage pathways for the parasite
Authors: Lige Bao , Sampels Vera , Coppens Isabelle
Published: February 2013

Lipid bodies are eukaryotic structures for temporary storage of neutral lipids such as acylglycerols and steryl esters. Fatty acyl‐CoA and cholesterol are two substrates for cholesteryl ester (CE) synthesis via the ACAT reaction. The intracellular parasite Toxoplasma gondii is incapable of sterol synthesis and unremittingly scavenges cholesterol from mammalian host cells. We previously demonstrated that the parasite expresses a cholesteryl ester‐synthesizing enzyme, TgACAT1. In this article, we identified and characterized a second ACAT‐like enzyme, TgACAT2, which shares 56% identity with TgACAT1. Both enzymes are endoplasmic reticulum‐associated and contribute to CE formation for storage in lipid bodies. While TgACAT1 preferentially utilizes palmitoyl‐CoA, TgACAT2 has broader fatty acid specificity and produces more CE. Genetic ablation of each individual ACAT results in parasite growth impairment whereas dual ablation of ACAT1 and ACAT2 is not tolerated by Toxoplasma. ΔACAT1 and ΔACAT2 parasites have reduced CE levels, fewer lipid bodies, and accumulate free cholesterol, which causes injurious membrane effects. Mutant parasites are particularly vulnerable to ACAT inhibitors. This study underlines the important physiological role of ACAT enzymes to store cholesterol in a sterol‐auxotrophic organism such as Toxoplasma, and furthermore opens up possibilities of exploiting TgACAT as targets for the development of antitoxoplasmosis drugs.
How colorful are fruits? Limited color diversity in fleshy fruits on local and global scales
Authors: Stournaras Kalliope E. , Lo Eugenia , Böhning‐Gaese Katrin , Cazetta Eliana , Matthias Dehling D. , Schleuning Matthias , Stoddard Mary Caswell , Donoghue Michael J. , Prum Richard O. , Martin Schaefer H.
Published: February 2013

The colors of fleshy fruits are considered to be a signal to seed‐dispersing animals, but their diversity remains poorly understood. Using an avian color space to derive a sensory morphospace for fruit color, we tested four hypotheses of fruit color diversity: fruit colors occupy a limited area of the color space; they are less diverse than flower colors; fruit colors within localities are similar to each other; and fruit color diversity reflects phylogeny.

The global fruit color diversity of 948 primarily bird‐dispersed plant species and the color diversity of localities were compared with null models of random, unconstrained evolution of fruit color. Fruit color diversity was further compared with the diversity of 1300 flower colors. Tests of phylogenetic effects on fruit color were used to assess the degree of correspondence with phylogeny.

Global and local fruit color diversity was limited compared with null models and fruits have achieved only half the color diversity of flowers. Interestingly, we found little indication of phylogenetic conservatism.

Constraints resulting from the chemical properties of pigments probably limit global fruit and flower color diversity. Different types of selection on fruits and flowers may further explain the smaller color diversity of fruits.
Radiofrequency‐Assisted Transseptal Perforation for Electrophysiology Procedures in Children and Adults with Repaired Congenital Heart Disease
Authors: ESCH JESSE J. , TRIEDMAN JOHN K. , CECCHIN FRANK , ALEXANDER MARK E. , WALSH EDWARD P.
Published: February 2013

Background

Patients with congenital heart disease carry a high burden of arrhythmias and may pose special challenges when these arrhythmias are addressed invasively. We sought to describe our early experience with radiofrequency (RF) needle transseptal perforation to facilitate ablation procedures in this population.

Methods

Retrospective chart review to identify all cases of attempted transseptal access with a commercial RF needle at Children's Hospital Boston between February 2007 and January 2010.

Results

A total of 10 patients had attempted RF transseptal perforation. Median age was 27 years. Five patients had undergone atrial switch procedures (Mustard/Senning), four had undergone Fontan operations, and one had atrial septal defect repair. The indication for left atrial access was mapping/ablation of atrial flutter in nine cases, and left‐sided accessory pathway in one case. The RF needle was chosen primarily in eight of 10 cases, whereas in the remaining two cases RF was used only after failed attempts with a conventional Brockenbrough needle. Septal material was atrial muscle in five cases, pericardium in three, and synthetic fabric in two. In nine of 10 patients, RF transseptal perforation was successful, including both patients in whom a conventional needle had failed. There were no clinically significant complications.

Conclusions

RF transseptal perforation can be an effective method of obtaining left atrial access for electrophysiologic procedures in patients with complex congenital heart disease, including cases where a conventional Brockenbrough needle has failed.
Allergic contact dermatitis in children: which factors are relevant? (review of the literature)
Authors: de Waard‐van der Spek Flora B. , Andersen Klaus E. , Darsow Ulf , Mortz Charlotte G. , Orton David , Worm Margitta , Muraro Antonella , Schmid‐Grendelmeier Peter , Grimalt Ramon , Spiewak Radoslaw , Rudzeviciene Odilija , Flohr Carsten , Halken Susanne , Fiocchi Alessandro , Borrego Luis M. , Oranje Arnold P.
Published: February 2013

Allergic Contact Dermatitis (ACD) in children is increasing. Sensitization to contact allergens can start in early infancy. The epidermal barrier is crucial for the development of sensitization and elicitation of ACD. Factors that may influence the onset of sensitization in children are atopic dermatitis, skin barrier defects and intense or repetitive contact with allergens. Topical treatment of ACD is associated with cutaneous sensitization, although the prevalence is not high. ACD because of haptens in shoes or shin guards should be considered in cases of persistent foot eruptions or sharply defined dermatitis on the lower legs. Clinical polymorphism of contact dermatitis to clothing may cause difficulties in diagnosing textile dermatitis. Toys are another potentially source of hapten exposure in children, especially from toy‐cosmetic products such as perfumes, lipstick and eye shadow. The most frequent contact allergens in children are metals, fragrances, preservatives, neomycin, rubber chemicals and more recently also colourings. It is very important to remember that ACD in young children is not rare, and should always be considered when children with recalcitrant eczema are encountered. Children should be patch‐tested with a selection of allergens having the highest proportion of positive, relevant patch test reactions. The allergen exposure pattern differs between age groups and adolescents may also be exposed to occupational allergens. The purpose of this review is to alert the paediatrician and dermatologist of the frequency of ACD in young children and of the importance of performing patch tests in every case of chronic recurrent or therapy‐resistant eczema in children.
Prednisolone reduces recurrent wheezing after first rhinovirus wheeze: a 7‐year follow‐up
Authors: Lukkarinen Minna , Lukkarinen Heikki , Lehtinen Pasi , Vuorinen Tytti , Ruuskanen Olli , Jartti Tuomas
Published: February 2013

Background

To better understand the role of human rhinovirus‐associated wheeze as a risk factor for childhood recurrent wheezing, a cohort of young children experiencing their first wheezing episode was followed until school age.

Methods

All 111 hospitalized wheezing children (median age, 12 months) were initially participated in a randomized, double‐blind, placebo‐controlled, parallel trial on the efficacy of oral prednisolone. In this 7‐yr follow‐up, risk factors for recurrent wheezing were analysed, and then, the efficacy of prednisolone was evaluated overall and in pre‐specified subgroups post‐hoc. The main outcome was time to recurrent wheezing.

Results

The strongest independent risk factor for recurrent wheezing was rhinovirus detection (hazard ratio 3.54; 95% confidence interval 1.51–8.30) followed by sensitization (3.47; 1.55–8.30, respectively) age <1 yr (2.45; 1.29–4.65) and eczema (2.33; 1.11–4.90). Overall, prednisolone did not prevent recurrent wheezing. In subgroup analysis, prednisolone was associated with less recurrent wheezing in children affected by rhinovirus (0.32; 0.12–0.90, adjusted to sensitization, young age, viral aetiology and parental asthma) and/or with eczema (0.27; 0.08–0.87, adjusted respectively).

Conclusions

Our data strengthen the role of rhinovirus‐associated wheeze as an important risk factor for recurrent wheezing and asthma in young first‐time wheezing children. Prospective randomized trials on the efficacy of corticosteroids in rhinovirus‐associated early wheezing are warranted. (ClinicalTrials.gov number, NCT 00494624)
Prevalence of confirmed immediate type drug hypersensitivity reactions among school children
Authors: Erkoçoğlu Mustafa , Kaya Aysenur , Civelek Ersoy , Özcan Celal , Çakır Banu , Akan Aysegül , Toyran Müge , Ginis Tayfur , Kocabas Can Naci
Published: February 2013

Background

Despite drug‐related hypersensitivity reactions are an important health problem, epidemiologic data on drug allergy and hypersensitivity are limited, and studies including diagnostic work‐up are scarce. The aim of this study was to determine the actual frequency of immediate type drug hypersensitivity using diagnostic tests in school children with parent‐reported drug allergies.

Methods

This study involved three phases. The first phase is a survey of children with a mean age of 12.9 yrs attending grades 6–8 of primary schools with a questionnaire asking drug‐related symptoms within 2 h of ingestion. The total population of sixth to eight grade school children was 210,000, and a sample size of 9096 was deemed to be representative of Ankara [(p) = 1.0%, α < 0.05, β = 0.8, (d) = 0.2.] During the second phase, a detailed clinical history was obtained by phone from the parents of children who had positive parent‐reported drug allergy. The final stage of the study consisted of a detailed diagnostic work‐up of children with a clinical history consistent with immediate type drug hypersensitivity reaction.

Results

Overall, 11,233 questionnaires were distributed, 10,096 of which were retrieved after completion by parents. The rate of parent‐reported immediate type drug hypersensitivity was 7.87% (792 children). However, phone survey revealed a clinical history suggestive of drug allergy in only 117 children (1.16%). After further diagnostic work‐up, the true frequency of immediate type drug hypersensitivity was 0.11%.

Conclusion

Our results suggest that a positive clinical history is not enough to make a diagnosis of drug allergy, which highlights the significance of undertaking further diagnostic evaluation.
Striving for a zero‐error patient surgical journey through adoption of aviation‐style challenge and response flow checklists: a quality improvement project
Authors: Low Daniel K. , Reed Mark A. , Geiduschek Jeremy M. , Martin Lynn D.
Published: February 2013

Aims

We describe our aim to create a zero‐error system in our pediatric ambulatory surgery center by employing effective teamwork and aviation‐style challenge and response ‘flow checklists’ at key stages of the patient surgical journey. These are used in addition to the existing World Health Organization Surgical Safety Checklists (Ann Surg, 255, 2012 and 44).

Background

Bellevue Surgery Center is a freestanding ambulatory surgery center affiliated with Seattle Children's Hospital, WA, USA. Approximately three thousand ambulatory surgeries are performed each year across a variety of surgical disciplines.

Methods

Key points in the patient surgical journey were identified as high risk (different time points from the WHO safer surgery checklists). These were moments when the team, patient, and equipment have to been reconfigured to maximize patient safety. These points were departure from induction room, arrival in the operating room, departure from operating room, and arrival in the postanesthesia care unit. Traditionally, the anesthesiologist has memorized a list of ‘do‐not‐forget items’ for each of these stages. We recognized the potential for error to occur if the process was solely the responsibility of one individual and their memory. So we created ‘flow checklists’ executed by the team at every one of these high‐risk points. We adopted a challenge and response system for these flow checklists as this is a tried and tested system widely used in aviation for critical tasks such as configuring an aircraft pretakeoff and prelanding.

Results

A staff survey with a 72% response rate (n = 29) showed that the team valued the checklists and thought they contributed to patient safety. To date, we have had zero incidence of omitting any of the 24 items listed on the four flow checklists.

Conclusions

We have created a reproducible model of care involving multiple checklists at high‐risk points in the patient surgical journey. The model is reliable and has a high degree of staff engagement. It promotes patient safety by ensuring the patient, team and equipment are correctly configured at every key transition stage in the surgical journey. We have been able to achieve this with no measurable increase in turnover times or reduction in operating room efficiency.
Interventional Pain Management for Failed Back Surgery Syndrome
Authors: Hussain Arif , Erdek Michael
Published: February 2013

Patients who suffer from the condition known as failed back surgery syndrome (FBSS) present to the offices of physicians, surgeons, and pain specialists alike in overwhelming numbers. This condition has been defined as persistent back and/or leg pain despite having completed spinal surgery. As lumbar surgery continues to grow in prevalence, so will the number patients suffering from FBSS. It is important for physicians treating this population to expand their knowledge of FBSS etiologies and appropriate diagnostic imaging modalities, combined with confirmatory diagnostic injections, and proper technique for interventional pain procedures. In doing so, the physician may adequately be prepared to manage these complex cases in the future, ideally with the support of stronger evidence. Management begins with a systematic evaluation of common FBSS etiologies such as new‐onset stenosis, recurrent herniated nucleus pulposus (HNP), epidural fibrosis, pseudarthrosis, and others. History and physical may be supplemented by imaging including X‐ray, magnetic resonance imaging, or computed tomography myelography. Certain diagnoses may be confirmed with diagnostic procedures such as intra‐articular injections, medial branch blocks, or transforaminal nerve root blocks. Once an etiology is determined, a multidisciplinary approach to treatment is most effective. This includes exercise or physical therapy, psychological counseling, medication, and interventional procedures. The most invasive treatment option, short of revision surgery, is spinal cord stimulation. This intervention has a number of studies demonstrating its efficacy and cost‐effectiveness in this population. Finally, revision surgery may be used when indicated such as with progressive neurological impairment or with issues regarding previous surgical instrumentation.
Of Gods and Kings: Divine Kingship in Ancient Mesopotamia
Authors: Brisch Nicole
Published: February 2013

The idea that any living human being could be worshipped like a god may appear to some people unfathomable or sacrilegious. This is related to how the distinction between humans and god(s) is perceived in a given cultural context; divinity is a concept that has been understood very differently throughout history. This is not a new point but remains all too often underappreciated when discussing the blurring of lines between human and god as evidenced in the deification of kings. In ancient Mesopotamia, one of the oldest high civilizations in the world, it was a short‐lived but nevertheless interesting phenomenon. The first instances of royal deification occur in the third millennium bce during times of political expansion and centralization. Whether this worship continued into the second millennium bce is still a matter of contention, yet Mesopotamian kings always maintained a close proximity to the divine to legitimize and bolster their power.
Same‐Sex Couples, Families, and Marriage: Embracing and Resisting Heteronormativity1
Authors: Hopkins Jason J. , Sorensen Anna , Taylor Verta
Published: February 2013

This article focuses on lesbian and gay couples and families and the politics of same‐sex marriage. Drawing from the literature on same‐sex couples, same‐sex marriage, and queer theory’s concept of heteronormativity, we argue that gay and lesbian couples and families both affirm and challenge heterosexual and gendered family forms. First, we review literature that discusses how same‐sex relationships and families are similar to and different from conventional heterosexual relationships and families. Second, we discuss the socio‐legal and cultural inequalities faced by LGBT families. Third, we discuss the politics of same‐sex marriage, examining the debate among social conservatives, pro‐marriage activists, and queer critics over the desirability of same‐sex marriage. We conclude that the growing visibility of LGBT couples and families has made their exclusion from the institution of marriage more conspicuous and that recognition of LGBT relationships and families seems likely to increase.
A Cross‐National Look at How Welfare States Reduce Inequality
Authors: Moller Stephanie , Misra Joya , Strader Eiko
Published: February 2013

A major shift in welfare state research occurred at the turn of the century as researchers moved from explaining the development of welfare states and variations in spending across welfare states to a focus on welfare state outcomes. One of the key outcomes examined in the literature is inequality. While much of the early literature examined overall spending, followed by analysis of specific taxes and transfers related to old age, unemployment, disability, health, and families, more recent research has included a broader range of welfare state policies including work‐family policies and flexicurity. This essay highlights some important developments in the research on welfare states and inequality.