bluuebunny/crossref_metadata_2025 huggingface dataset:
CTX-M-27- and CTX-M-14-producing, ciprofloxacin-resistant Escherichia coli of the H30 subclonal group within ST131 drive a Japanese regional ESBL epidemic
Authors: Matsumura Yasufumi , Johnson James R. , Yamamoto Masaki , Nagao Miki , Tanaka Michio , Takakura Shunji , Ichiyama Satoshi ,   on behalf of the Kyoto–Shiga Clinical Microbiology Study Group, Matsumura Yasufumi , Yamamoto Masaki , Nagao Miki , Takakura Shunji , Ichiyama Satoshi , Fujita Naohisa , Komori Toshiaki , Yamada Yukiji , Shimizu Tsunehiro , Hayashi Akihiko , Ono Tamotsu , Watanabe Harumi , Fujihara Naoko , Higuchi Takeshi , Moro Kunihiko , Shigeta Masayo , Kida Kaneyuki , Terada Hiromi , Tsuboi Fusayuki , Sugimoto Yoshihisa , Fukumoto Chiyoko
Published: February 2015

Objectives

The global increase in ESBL-producing Escherichia coli is associated with the ST131 clonal group, especially its CTX-M-15-producing H30Rx subset. To understand the rapid spread of ESBL-producing E. coli in Japan, we investigated the molecular epidemiology and ESBL-associated genetic environments of Japanese ST131 isolates.

Methods

Between 2001 and 2012, 1079 ESBL-producing E. coli isolates were collected at 10 Japanese acute-care hospitals. ESBL types, ST131 status, fimH allele, H30Rx-defining sequences and ESBL-associated genetic environments were defined using PCR and sequencing. Subclonal groups were defined based on fimH allele and H30Rx status.

Results

Overall, 461 (43%) of the 1079 ESBL-producing E. coli isolates represented ST131. According to fimH-based subclonal typing, the ST131 isolates included 398 fimH allele 30 (H30) isolates, 49 H41 isolates, 10 H22 isolates and 4 other fimH-type isolates. The 398 H30 isolates included 396 ciprofloxacin-resistant H30R isolates, of which 64 (16%) represented the H30Rx subset. Between 2001 and 2007, the CTX-M-14-producing H30R subgroup predominated, accounting for 46% of ST131 isolates, whereas the CTX-M-27-producing H30R and CTX-M-15-producing H30Rx subgroups were rarely detected. In contrast, from 2008 onward the latter two subgroups rose to dominance, accounting for 45% and 24% of ST131 isolates, respectively, versus only 15% for the (formerly dominant) CTX-M-14-producing H30R subgroup. The emergent CTX-M-27-H30R subgroup frequently had an IS26-ΔISEcp1-blaCTX-M-27-ΔIS903D-IS26-like structure, whereas the older CTX-M-14-H30R subgroup frequently had an ISEcp1-blaCTX-M-14-IS903D-like structure.

Conclusions

This Japanese regional ESBL-producing E. coli epidemic is closely associated with newly identified CTX-M-27- and CTX-M-14-producing ST131 H30R subclonal groups and with mobile elements IS26, ISEcp1 and IS903D.
Synergy of chemotherapy and immunotherapy revealed by a genome-scale analysis of murine tuberculosis
Authors: Rodrigues Rodrigo F. , Zárate-Bladés Carlos R. , Rios Wendy M. , Soares Luana S. , Souza Patricia R. M. , Brandão Izaíra T. , Masson Ana P. , Arnoldi Frederico G. C. , Ramos Simone G. , Letourneur Franck , Jacques Sébastien , Cagnard Nicolas , Chiocchia Gilles , Silva Celio L.
Published: February 2015

Objectives

Although TB immunotherapy improves the results of conventional drug treatment, the effects of combining chemotherapy and immunotherapy have never been systematically evaluated. We used a comprehensive lung transcriptome analysis to directly compare the activity of combined chemotherapy and immunotherapy with that of single treatments in a mouse model of TB.

Methods

Mycobacterium tuberculosis-infected mice in the chronic phase of the disease (day 30) received: (i) isoniazid and rifampicin (drugs) daily for 30 days; (ii) DNA immunotherapy (DNA), consisting of four 100 μg injections at 10 day intervals; (iii) both therapies (DNA + drugs); or (iv) saline. The effects were evaluated 10 days after the end of treatment (day 70 post-infection).

Results

In all groups a systemic reduction in the load of bacilli was observed, bacilli became undetectable in the drugs and DNA + drugs groups, but the whole lung transcriptome analysis showed 867 genes exclusively modulated by the DNA + drugs combination. Gene enrichment analysis indicated that DNA + drugs treatment provided synergistic effects, including the down-regulation of proinflammatory cytokines and mediators of fibrosis, as confirmed by real-time PCR, ELISA, histopathology and hydroxyproline assay.

Conclusions

Our results provide a molecular basis for the advantages of TB treatment using combined chemotherapy and DNA immunotherapy and demonstrate the synergistic effects obtained with this strategy.
International patterns of palliative care in neuro-oncology: a survey of physician members of the Asian Society for Neuro-Oncology, the European Association of Neuro-Oncology, and the Society for Neuro-Oncology
Authors: Walbert Tobias , Puduvalli Vinay K. , Taphoorn Martin J.B. , Taylor Andrew R. , Jalali Rakesh
Published: February 2015

Background

Brain tumor patients have limited survival and suffer from high morbidity requiring specific symptom management. Specialized palliative care (PC) services have been developed to address these symptoms and provide end-of-life treatment. Global utilization patterns of PC in neuro-oncology are unknown.

Methods

In a collaborative effort between the Society for Neuro-Oncology (SNO), the European Association of Neuro-Oncology (EANO), and the Asian Society for Neuro-Oncology (ASNO), a 22-question survey was distributed. Wilcoxon 2-sample and Kruskal-Wallis tests were used to assess differences in responses.

Results

Five hundred fifty-two evaluable responses were received. The most significant differences were found between Asia-Oceania (AO) and Europe as well as AO and United States/Canada (USA-C). USA-C providers had more subspecialty training in neuro-oncology, but most providers had received no or minimal training in palliative care independent of region. Providers in all 3 regions reported referring patients at the onset of symptoms requiring palliation, but USA-C and European responders refer a larger total proportion of patients to PC (P < .001). Physicians in AO and Europe (both 46%) as well as 29% of USA-C providers did not feel comfortable dealing with end-of-life issues. Most USA-C patients (63%) are referred to hospice compared with only 8% and 19% in AO and Europe (P < .001), respectively.

Conclusion

This is the first report describing global differences of PC utilization in neuro-oncology. Significant differences in provider training, culture, access, and utilization were mainly found between AO and USA-C or AO and Europe. PC patterns are more similar in Europe and USA-C.
Repeated short-term spectral softening in the low/hard state of the Galactic black hole candidate Swift J1753.5−0127
Authors: Yoshikawa Akifumi , Yamada Shin'ya , Nakahira Satoshi , Matsuoka Masaru , Negoro Hitoshi , Mihara Tatehiro , Tamagawa Toru
Published: February 2015

We report MAXI and Swift observations of short-term spectral softenings of the Galactic black hole X-ray binary Swift J1753.5−0127 in the low/hard state. These softening events are characterized by a simultaneous increase of soft X-rays (2–4 keV) and a decrease of hard X-rays (15–50 keV) lasting for a few tens of days. The X-ray energy spectra during the softening periods can be reproduced with a model consisting of a multi-color disk blackbody and its Comptonized component. The fraction of the Comptonized component decreased from 0.30 to 0.15 when the spectrum became softer; meanwhile the inner disk temperature (Tin) increased from 0.2 to 0.45 keV. These results imply that the softening events are triggered by a short-term increase of the mass accretion rate. During the observed spectral softening events, the disk flux (Fdisk) and Tin did not obey the Fdisk ∝ (Tin )4 relation, suggesting that the inner disk radius does not reach the innermost stable circular orbit.
Genetic Analysis of Resistance to Leaf Rust and Yellow Rust in Spring Wheat Cultivar Kenya Kongoni
Authors: Calvo-Salazar V. , Singh R. P. , Huerta-Espino J. , Cruz-Izquierdo S. , Lobato-Ortiz R. , Sandoval-Islas S. , Vargas-Hernández M. , German S. , Silva P. , Basnet B. R. , Lan C. X. , Herrera-Foessel S. A.
Published: February 2015

The Kenyan wheat (Triticum aestivum L.) ‘Kenya Kongoni’ exhibits high levels of adult plant resistance (APR) to leaf rust (LR) and yellow rust (YR). We determined the genomic regions associated with LR and YR resistance in a population of 148 recombinant inbred lines generated from a cross between ‘Avocet-YrA’ and Kenya Kongoni. Field experiments to characterize APR to LR and YR were conducted in four and two Mexican or Uruguayan environments, respectively. A linkage map was constructed with 438 diversity arrays technology and 16 simple-sequence repeat markers by JoinMap 4.1 software. Genetic analyses showed that resistance to both rusts was determined by four to five APR genes, including Lr46/Yr29 and Sr2/Lr27/Yr30. Quantitative trait loci (QTL) analysis indicated that pleiotropic APR loci QYLr.cim-1BL corresponding to Lr46/Yr29 and QYLr.cim-7BL that is a putative novel QTL accounted for 5 to 57% and 12 to 35% of the phenotypic variation for resistance to LR and YR, respectively. These loci, in combination with another three LR QTL and two YR QTL, respectively, conferred high levels of resistance to both LR and YR in wheat under Mexican and Uruguayan environments. Among other detected QTL, QLr.cim-1DS, QLr.cim-2BL, and QYLr.icm-7BL may be new loci for APR to both rusts in common wheat.
Evolution in action: climate change, biodiversity dynamics and emerging infectious disease
Authors: Hoberg Eric P. , Brooks Daniel R.
Published: February 2015

Climatological variation and ecological perturbation have been pervasive drivers of faunal assembly, structure and diversification for parasites and pathogens through recurrent events of geographical and host colonization at varying spatial and temporal scales of Earth history. Episodic shifts in climate and environmental settings, in conjunction with ecological mechanisms and host switching, are often critical determinants of parasite diversification, a view counter to more than a century of coevolutionary thinking about the nature of complex host–parasite assemblages. Parasites are resource specialists with restricted host ranges, yet shifts onto relatively unrelated hosts are common during phylogenetic diversification of parasite lineages and directly observable in real time. The emerging Stockholm Paradigm resolves this paradox:Ecological Fitting(EF)—phenotypic flexibility and phylogenetic conservatism in traits related to resource use, most notably host preference—provides many opportunities for rapid host switching in changing environments, without the evolution of novel host-utilization capabilities. Host shifts via EF fuel the expansion phase of theOscillation Hypothesisof host range and speciation and, more generally, the generation of novel combinations of interacting species within theGeographic Mosaic Theory of Coevolution.In synergy, an environmental dynamic ofTaxon Pulsesestablishes an episodic context for host and geographical colonization.
The impact of climate change on the geographical distribution of two vectors of Chagas disease: implications for the force of infection
Authors: Medone Paula , Ceccarelli Soledad , Parham Paul E. , Figuera Andreína , Rabinovich Jorge E.
Published: February 2015

Chagas disease, caused by the parasiteTrypanosoma cruzi, is the most important vector-borne disease in Latin America. The vectors are insects belonging to the Triatominae (Hemiptera, Reduviidae), and are widely distributed in the Americas. Here, we assess the implications of climatic projections for 2050 on the geographical footprint of two of the main Chagas disease vectors:Rhodnius prolixus(tropical species) andTriatoma infestans(temperate species). We estimated the epidemiological implications of current to future transitions in the climatic niche in terms of changes in the force of infection (FOI) on the rural population of two countries: Venezuela (tropical) and Argentina (temperate). The climatic projections for 2050 showed heterogeneous impact on the climatic niches of both vector species, with a decreasing trend of suitability of areas that are currently at high-to-moderate transmission risk. Consequently, climatic projections affected differently the FOI for Chagas disease in Venezuela and Argentina. Despite the heterogeneous results, our main conclusions point out a decreasing trend in the number of new cases ofTr. cruzihuman infections per year between current and future conditions using a climatic niche approach.
Climate change impacts on West Nile virus transmission in a global context
Authors: Paz Shlomit
Published: February 2015

West Nile virus (WNV), the most widely distributed virus of the encephalitic flaviviruses, is a vector-borne pathogen of global importance. The transmission cycle exists in rural and urban areas where the virus infects birds, humans, horses and other mammals. Multiple factors impact the transmission and distribution of WNV, related to the dynamics and interactions between pathogen, vector, vertebrate hosts and environment. Hence, among other drivers, weather conditions have direct and indirect influences on vector competence (the ability to acquire, maintain and transmit the virus), on the vector population dynamic and on the virus replication rate within the mosquito, which are mostly weather dependent. The importance of climatic factors (temperature, precipitation, relative humidity and winds) as drivers in WNV epidemiology is increasing under conditions of climate change. Indeed, recent changes in climatic conditions, particularly increased ambient temperature and fluctuations in rainfall amounts, contributed to the maintenance (endemization process) of WNV in various locations in southern Europe, western Asia, the eastern Mediterranean, the Canadian Prairies, parts of the USA and Australia. As predictions show that the current trends are expected to continue, for better preparedness, any assessment of future transmission of WNV should take into consideration the impacts of climate change.
Minimum Information for Reporting Next Generation Sequence Genotyping (MIRING): Guidelines for Reporting HLA and KIR Genotyping via Next Generation Sequencing
Authors: Mack Steven J. , Milius Robert P , Gifford Benjamin D , Sauter Jürgen , Hofmann Jan , Osoegawa Kazutoyo , Robinson James , Groeneweg Mathjis , Turenchalk Gregory S , Adai Alex , Holcomb Cherie , Rozemuller Erik H , Penning Maarten T , Heuer Michael L , Wang Chunlin , Salit Marc L , Schmidt Alexander H , Parham Peter R , Müller Carlheinz , Hague Tim , Fischer Gottfried , Fernandez-Viňa Marcelo , Hollenbach Jill A , Norman Paul J , Maiers Martin
Published: February 2015

The development of next-generation sequencing (NGS) technologies for HLA and KIR genotyping is rapidly advancing knowledge of genetic variation of these highly polymorphic loci. NGS genotyping is poised to replace older methods for clinical use, but standard methods for reporting and exchanging these new, high quality genotype data are needed. The Immunogenomic NGS Consortium, a broad collaboration of histocompatibility and immunogenetics clinicians, researchers, instrument manufacturers and software developers, has developed the Minimum Information for Reporting Immunogenomic NGS Genotyping (MIRING) reporting guidelines. MIRING is a checklist that specifies the content of NGS genotyping results as well as a set of messaging guidelines for reporting the results. A MIRING message includes five categories of structured information – message annotation, reference context, full genotype, consensus sequence and novel polymorphism – and references to three categories of accessory information – NGS platform documentation, read processing documentation and primary data. These eight categories of information ensure the long-term portability and broad application of this NGS data for all current histocompatibility and immunogenetics use cases. In addition, MIRING can be extended to allow the reporting of genotype data generated using pre-NGS technologies. Because genotyping results reported using MIRING are easily updated in accordance with reference and nomenclature databases, MIRING represents a bold departure from previous methods of reporting HLA and KIR genotyping results, which have provided static and less-portable data. More information about MIRING can be found online at miring.immunogenomics.org.
The peptide NCbz-Val-Tyr-OMe and aromatic π–π interactions
Authors: Nicholas Sumesh
Published: February 2015

The peptideN-benzyloxycarbonyl-L-valyl-L-tyrosine methyl ester or NCbz-Val-Tyr-OMe (where NCbz isN-benzyloxycarbonyl and OMe indicates the methyl ester), C23H28N2O6, has an extended backbone conformation. The aromatic rings of the Tyr residue and the NCbz group are involved in various attractive intra- and intermolecular aromatic π–π interactions which stabilize the conformation and packing in the crystal structure, in addition to N—H...O and O—H...O hydrogen bonds. The aromatic π–π interactions include parallel-displaced, perpendicular T-shaped, perpendicular L-shaped and inclined orientations.
Two polymorphs of 5-cyclohexyl-5-ethylbarbituric acid and their packing relationships with other barbiturates
Authors: Gelbrich Thomas , Meischberger Isabella , Griesser Ulrich J.
Published: February 2015

Polymorph (Ia) (m.p. 474 K) of the title compound, C12H18N2O3, displays an N—H...O=C hydrogen-bonded layer structure which containsR66(28) rings connecting six molecules, as well asR22(8) rings linking two molecules. The 3-connected hydrogen-bonded net resulting from these interactions has thehcbtopology. Form (Ib) (m.p. 471 K) displays N—H...O=C hydrogen-bonded looped chains in which neighbouring molecules are linked to one another by two differentR22(8) rings. Polymorph (Ia) is isostructural with the previously reported form II of 5-(2-bromoallyl)-5-isopropylbarbituric acid (noctal) and polymorph (Ib) is isostructural with the known crystal structures of four other barbiturates.
Crystal structure of chlorido(2-{[2-(4-chlorophenyl)hydrazin-1-ylidene-κN1](phenyl)methyl}pyridine-κN)(η5-pentamethylcyclopentadienyl)iridium(III) tetraphenylborate
Authors: Devika Neelakandan , Raja Nandhagopal , Ananthalakshmi Subbiah , Therrien Bruno
Published: February 2015

The title compound, [Ir(η5-C5Me5)Cl(C18H14ClN3)]B(C6H5)4, is chiral at the metal center and crystallizes as a racemate. In the cation, the hydrazinylidenepyridine ligand isN,N-coordinated through theN-pyridyl andN-hydrazinylidene groups forming a five-membered metallacycle. An intramolecular C—H...Cl hydrogen bond is observed. In the crystal, centrosymmetrically-related cations are connected by C—Cl...π interactions, forming a dimeric structure. The crystal packing is further stabilized by weak interionic C—H...π interactions.
Leadership for health commissioning in the new NHS
Authors: Coleman Anna , Segar Julia , Checkland Kath , McDermott Imelda , Harrison Stephen , Peckham Stephen
Published: February 2015

Purpose

– The purpose of this paper is to explore the early experiences of those involved with the development of Clinical Commissioning Groups (CCGs), examining how the aspiration towards a “clinically-led” system is being realised. The authors investigate emerging leadership approaches within CCGs in light of the criterion for authorisation that calls for “great leaders”.

Design/methodology/approach

– Qualitative research was carried out in eight case studies (CCGs) across England over a nine-month period (September 2011 to May 2012) when CCGs were in their early development. The authors conducted a mix of interviews (with GPs and managers), observations (at CCG meetings) and examined associated documentation. Data were thematically analysed.

Findings

– The authors found evidence of two identified approaches to leadership – positive deviancy and responsible guardianship – being undertaken by GPs and managers in the developing CCGs. Historical experiences and past ways of working appeared to be influencing current developments and a commonly emerging theme was a desire for the CCG to “do things differently” to the previous commissioning bodies. The authors discuss how the current reorganisation threatens the guardianship approach to leadership and question if the new systems being implemented to monitor CCGs’ performance may make it difficult for CCGs to retain creativity and innovation, and thus the ability to foster the positive deviant approach to leadership.

Originality/value

– This is a large scale piece of qualitative research carried out as CCGs were beginning to develop. It provides insight into how leadership is developing in CCGs highlighting the complexity involved in these roles.
Trust, but verify: fraud in small businesses
Authors: Kramer Bonita
Published: February 2015

Purpose

– The purpose of this paper is to raise awareness about internal fraud in small businesses among small business owners, managers, and consultants.

Design/methodology/approach

– Recent statistics from international fraud surveys are presented, and the theory of why people commit fraud is described. The most common internal fraud schemes as identified in the international fraud surveys are explained, as well as some of the related red flags and preventative measures. Examples of actual internal frauds perpetrated in small businesses are discussed.

Findings

– This paper summarizes pertinent facts that repeatedly show small businesses are most vulnerable to fraud and suffer a disproportionate median loss when compared to larger businesses. External audits by Certified Public Accountants cannot be relied upon to detect fraud. Owners, managers, and advisors are strongly encouraged to have knowledge of how fraud can affect their organizations in order to prevent or detect fraud and avoid the devastating effect it can have on the small business’s viability.

Practical implications

– Fraud knowledge can help owners, managers, and advisors prevent small businesses from falling victim to fraud.

Originality/value

– This paper addresses a critical issue to small businesses, but has so far been largely neglected in the literature. While large financial statement frauds receive widespread publicity, they are relatively uncommon compared to asset misappropriation fraud schemes suffered by small businesses.
A cross-cultural comparison of online behavioural advertising knowledge, online privacy concerns and social networking using the technology acceptance model and social cognitive theory
Authors: Ratten Vanessa
Published: February 2015

Purpose

– This paper aims to cross-culturally compare how consumers in China and Australia adopt cloud computing services. Cloud computing is one of the major innovation advances in information technology. In order for more consumers to adopt cloud computing as a technological innovation, there needs to be a better understanding of the issues involved in consumer adoption processes for online retailers. While there is an increasing amount of interest in cloud computing as a technological innovation, there is an important need to examine the reasons why consumers purchase cloud computing services for online retailers.

Design/methodology/approach

– In this paper, the technology acceptance model and social cognitive theory are identified as the theoretical frameworks to understand the consumer purchase intention of cloud computing services. A set of research hypotheses are stated from both theoretical frameworks to test their relationship with a consumer’s intention to adopt cloud computing as a technological innovation. These hypotheses focus on perceived usefulness, perceived ease of use, online behavioural advertising knowledge, social networks and online privacy concerns, which will help online retailers understand how cloud computing can be utilized by consumers to store and access online retail information.

Findings

– The findings of the study outline the different areas of technological innovation research that are needed to advance the information technology industry in the future. The findings suggest that perceived ease of use, perceived usefulness and online privacy concerns can determine a consumer’s intention to adopt cloud computing, but online behavioural advertising knowledge and social networks differ among consumers in different countries.

Originality/value

– The key issues influencing consumer adoption of cloud computing are outlined, which due to the emerging nature of this technological innovation will influence the regulation and marketing of cloud computing services by firms and governments in the technology sector.
Integrated reporting and assurance: where can research add value?
Authors: Simnett Roger , Huggins Anna Louise
Published: February 2015

Purpose

– This paper aims to provide insights into salient issues in the development of the Integrated Reporting () Framework, and emerging issues in the implementation of this Framework, with the aim of identifying opportunities for future research. The International Integrated Reporting Council (IIRC) has recently produced a reporting framework for the preparation of a concise, user-oriented corporate report which expands the scope of a company’s reporting using a multiple capitals concept and requires a description of a company’s business model, allowing a better communication of its value creation proposition. To gain international acceptance, the market-based benefits of adopting the framework must be demonstrated.

Design/methodology/approach

– The paper takes the form of an archival analysis of the responses to the IIRC’s public consultation phases, providing insights into arguments for and against salient aspects of the framework, and identifying issues that would benefit from future research.

Findings

– Identifying issues that arose during the framework preparation, this paper identifies a range of future research opportunities and outlines the research approaches by which academics can assess the costs and benefits of companies reporting in accordance with the  Framework and assuring this information.

Research limitations/implications

– Research opportunities associated with the International ) Framework and associated assurance are identified.

Practical implications

– This paper provides insights and details of the process of adoption of  and has implications for adopters and assurance providers of integrated reports, standard setters and regulators. The development of a sophisticated business case informed by rigorous research will be critical to the further uptake of .

Social implications

– Research opportunities identified include the expansion of the  Framework to reporting entities other than corporations, including government and not-for-profit organisations, as well as measurement and assurance of a broader array of capitals, including social capital.

Originality/value

– The paper identifies  research opportunities from an archival analysis of the responses to the IIRC’s public consultation phases, providing insights into arguments for and against salient aspects of the framework that would benefit from future research.
Identification of Saliva Using MicroRNA Biomarkers for Forensic Purpose
Authors: Wang Zheng , Zhang Ji , Wei Wei , Zhou Di , Luo Haibo , Chen Xiaogang , Hou Yiping
Published: February 2015

In the forensic science community, microRNA (miRNA) profiling has started to be explored as an alternative tool for body fluid identification. Several origins of body fluid can be distinguished by measuring differential expression patterns of particular miRNAs. However, most of reported saliva miRNAs are nonoverlapping and debatable. The aim of this study was to develop a strategy of identifying saliva using miRNA biomarkers for forensic purpose. Eight miRNA candidates were selected to examine expression abundance in forensically relevant body fluids using hydrolysis probes quantitative real‐time PCR (TaqMan qPCR). Results revealed that none of them was truly saliva specific, and only miR‐200c‐3p, miR‐203a, and miR‐205‐5p were higher or more moderate expression in saliva. A stepwise strategy that combines each of three miRNAs with different body fluid‐specific miRNAs was developed, and three miRNA combinations could effectively differentiate saliva from other body fluids.
Simulation as a high stakes assessment tool in emergency medicine
Authors: O'Leary Fenton
Published: February 2015

The Australasian College for Emergency Medicine (ACEM) will introduce high stakes simulation‐based summative assessment in the form of Objective Structured Clinical Examinations (OSCEs) into the Fellowship Examination from 2015. Miller's model emphasises that, no matter how realistic the simulation, it is still a simulation and examinees do not necessarily behave as in real life. OSCEs are suitable for assessing the CanMEDS domains of Medical Expert, Communicator, Collaborator and Manager. However, the need to validate the OSCE is emphasised by conflicting evidence on correlation with long‐term faculty assessments, between essential actions checklists and global assessment scores and variable interrater reliability within individual OSCE stations and for crisis resource management skills. Although OSCEs can be a valid, reliable and acceptable assessment tool, the onus is on the examining body to ensure construct validity and high interrater reliability.
Hibiscus sabdariffa Leaf Polyphenolic Extract Induces Human Melanoma Cell Death, Apoptosis, and Autophagy
Authors: Chiu Chun‐Tang , Hsuan Shu‐Wen , Lin Hui‐Hsuan , Hsu Cheng‐Chin , Chou Fen‐Pi , Chen Jing‐Hsien
Published: February 2015

Melanoma is the least common but most fatal form of skin cancer. Previous studies have indicated that an aqueous extract of Hibiscus sabdariffa leaves possess hypoglycemic, hypolipidemic, and antioxidant effects. In this study, we want to investigate the anticancer activity of Hibiscus leaf polyphenolic (HLP) extract in melanoma cells. First, HLP was exhibited to be rich in epicatechin gallate (ECG) and other polyphenols. Apoptotic and autophagic activities of HLP and ECG were further evaluated by DAPI stain, cell‐cycle analysis, and acidic vascular organelle (AVO) stain. Our results revealed that both HLP and ECG induced the caspases cleavages, Bcl‐2 family proteins regulation, and Fas/FasL activation in A375 cells. In addition, we also revealed that the cells presented AVO‐positive after HLP treatments. HLP could increase the expressions of autophagy‐related proteins autophagy‐related gene 5 (ATG5), Beclin1, and light chain 3‐II (LC3‐II), and induce autophagic cell death in A375 cells. These data indicated that the anticancer effect of HLP, partly contributed by ECG, in A375 cells. HLP potentially could be developed as an antimelanoma agent.
Comparison of neonatal outcomes in women with gestational diabetes with moderate hyperglycaemia on metformin or glibenclamide – A randomised controlled trial
Authors: George Anne , Mathews Jiji E. , Sam Dibu , Beck Manisha , Benjamin Santosh J. , Abraham Anuja , Antonisamy Balevendra , Jana Atanu K. , Thomas Nihal
Published: February 2015

Background

Two oral hypoglycaemic agents, metformin and glibenclamide, have been compared with insulin in separate large randomised controlled trials and have been found to be as effective as insulin in gestational diabetes. However, very few trials have compared metformin with glibenclamide.

Materials and Methods

Of 159 South Indian women with fasting glucose ≥5.5 mmol/l and ≤7.2 mmol/l and/or 2‐h post‐prandial value ≥6.7 mmol/l and ≤13.9 mmol/l after medical nutritional therapy consented to be randomised to receive either glibenclamide or metformin. 80 women received glibenclamide and 79 received metformin. Neonatal outcomes were assessed by neonatologists who were unaware that the mother was part of a study and were recorded by assessors blinded to the medication the mother was given. The primary outcome was a composite of neonatal outcomes namely macrosomia, hypoglycaemia, need for phototherapy, respiratory distress, stillbirth or neonatal death and birth trauma. Secondary outcomes were birthweight, maternal glycaemic control, pregnancy induced hypertension, preterm birth, need for induction of labour, mode of delivery and complications of delivery.

Results

Baseline characteristics were similar but for the higher fasting triglyceride levels in women on metformin. The primary outcome was seen in 35% of the glibenclamide group and 18.9% of the metformin group [95% CI 16.1 (2.5, 29.7); P = 0.02]. The difference in outcome related to a higher rate of neonatal hypoglycaemia in the glibenclamide group (12.5%) versus none in the metformin group [95% CI 12.5(5.3, 19.7); P = 0.001]. Secondary outcomes in both groups were similar.

Conclusion

In a south Indian population with gestational diabetes, metformin was associated with better neonatal outcomes than glibenclamide.
Who provides care for people dying of cancer? A comparison of a rural and metropolitan cohort in a South Australian bereaved population study
Authors: Burns Catherine M. , Dal Grande Eleonora , Tieman Jennifer , Abernethy Amy P. , Currow David C.
Published: February 2015

Objective

To examine and compare urban and rural palliative care service availability and patterns of care from randomised, population‐based surveys of caregivers of people at the end of life.

Design, Setting & Participants

Survey responses on the death of ‘someone close’ from 23,588 interviews of South Australians conducted between 2001 and 2007 are analysed.

Interventions

A randomised population survey.

Main Outcome Measures

Explored palliative care service availability, caregiving provided, and characteristics of the deceased and their caregivers.

Results

There was no difference in reported rates of accessing specialist palliative care services between rural and urban respondents (in unadjusted and adjusted analyses) nor did the proportion of people for whom cancer was their life‐limiting illness. There was greater reliance on friends than first degree relatives in hands‐on care provided at the end of life in rural settings. The rates of reported need for more support did not differ between urban and rural respondents for caregivers of people at the end of life.

Conclusion

Use of palliative care services was similar for rural and urban caregivers for someone close at the end of life with similar levels of met and unmet needs.
Assessment and diagnosis of suspected glaucoma in patients with mucopolysaccharidosis
Authors: Ashworth Jane , Flaherty Maree , Pitz Susanne , Ramlee Azura
Published: February 2015

Purpose

The mucopolysaccharidoses (MPS) are a group of rare lysosomal storage disorders, characterized by the accumulation of glycosaminoglycans within multiple organ systems including the eye. This study aimed to determine the prevalence of glaucoma in patients with MPS, as well as the characteristics, diagnosis and management of patients with MPS and glaucoma.

Methods

A multicentre retrospective case‐note review was carried out by ophthalmologists from four tertiary referral centres to identify patients with MPS who had been treated for glaucoma. Clinical ophthalmological data were collected using standardized data collection forms.

Results

Fourteen patients were identified (27 eyes) of 294 patients with MPS. The prevalence of glaucoma ranged from 2.1% to 12.5%. The median age at diagnosis of glaucoma was 8 years. Diagnostic evaluation of glaucoma was incomplete in many patients: intraocular pressure was documented in all eyes, but optic disc appearance was only assessed in 67%, central corneal thickness in 26%, visual fields in 19% and iridocorneal angle in 15%.

Conclusions

Patients with MPS need regular assessment for possible glaucoma including during childhood. Multiple factors contribute to the challenges of assessment, diagnosis and monitoring of glaucoma in these patients.
Ethical, Legal, and Clinical Considerations when Disclosing a High‐Risk Syndrome for Psychosis
Authors: Mittal Vijay A. , Dean Derek J. , Mittal Jyoti , Saks Elyn R.
Published: February 2015

There are complex considerations when planning to disclose an attenuated psychosis syndrome (APS) diagnosis. In this review, we evaluate ethical, legal, and clinical perspectives as well as caveats related to full, non‐ and partial disclosure strategies, discuss societal implications, and provide clinical suggestions. Each of the disclosure strategies is associated with benefits as well as costs/considerations. Full disclosure promotes autonomy, allows for the clearest psychoeducation about additional risk factors, helps to clarify and/or correct previous diagnoses/treatments, facilitates early intervention and bolsters communication between providers but there are important considerations involving heritability, comorbidity, culture, and stigma. Non‐disclosure advances nonmaleficence by limiting stigma and stress (which may inadvertently exacerbate the condition), and confusion (related to the rapidly evolving diagnosis) in a sensitive developmental period but is complicated by varying patient preferences and the possibility that, as new treatments without adverse effects become available, the risk with false positives no longer justifies the accompanying loss of autonomy. Partial disclosure balances ethical considerations by focusing on symptoms instead of labels, but evidence that laypersons may interpret this information as a pseudo‐diagnosis and that symptoms alone also contribute to stigma limits the efficacy of this approach. In addition, there are notable societal considerations relating to disclosure involving conservatorship, the reach of insurance companies, and discrimination. We advocate a hybrid approach to disclosure and recommend future research aimed at understanding the effects of stigma on clinical course and a renewed focus on those help‐seeking cases that do not transition but remain clinically relevant.
Does pressing a button make it easier to pass an exam? Evaluating the effectiveness of interactive technologies in higher education
Authors: Castillo‐Manzano Jose I. , Castro‐Nuño Mercedes , Sanz Díaz María Teresa , Yñiguez Rocio
Published: February 2015

The aim of this paper was to evaluate how audience response system (ARS) technology may increase improvements in academic performance in higher education, using the first year of the Administration and Business Management degree course at the University of Seville (Spain) as a case study. The experiment assesses whether the use of ARSs increases the likelihood that students will pass the final examinations in the subject of Principles of Economics. An econometric model is applied to a sample of 119 students in an intervention group, with a control group of 322. The statistically significant results show that at the very least, ARSs improve performance in the theoretical examination, albeit with certain limitations. It is concluded that ARSs should be used frequently to optimize outcomes, not just as a sporadic event during the course.
Wound‐related complications and clinical outcomes following open globe injury repair
Authors: Kong George YX , Henderson Robert H , Sandhu Sukhpal S , Essex Rohan W , Allen Penelope J , Campbell William G
Published: February 2015

Background

Careful surgical management of traumatic wounds is important in open globe injury repair. This study examines the clinical outcomes following repair of open globe injuries with particular focus on wound‐related issues.

Design

Retrospective, cohort study of consecutive open globe injuries presenting to a tertiary referral eye hospital from 1 January 2009 to 31 December 2011.

Participants

A total of 267 eyes of 263 patients, mainly male (82.5%) with a mean age of 44.8 (range: 4–97) years. Average follow up was 6.9 months.

Methods

All cases classified according to Ocular Trauma Classification Group.

Main Outcome Measures

Visual outcomes, risk factors for and rates of postoperative complications and endophthalmitis.

Results

There were 83 globe ruptures, 182 penetrating and 2 perforating eye injuries, of which 43 cases had intraocular foreign body. Factors contributing to final visual acuity (VA) <6/60 were poor presenting VA (odds ratio [OR] = 16.0, 95% confidence interval [CI]: 4.81–53.1), globe rupture (OR = 4.64, [1.99–10.8]), retinal detachment (OR = 3.40, [1.19–9.74]) and age ≥50 (OR = 2.45, [1.05–5.74]). Wound leak occurred in 44 eyes (16%). Of these, 18 (41%) proceeded to re‐suturing. Factors contributing to wound leak were stellate‐shaped wound (OR = 3.28, [1.39–7.73]) and delayed presentation (OR = 2.80, [1.02–7.71]). Ten eyes (3.7%) developed endophthalmitis. Factors associated with endophthalmitis were delayed presentation (OR = 8.91, [1.71–46.6]), microbial keratitis (OR = 12.5, [1.85–85.0]) and lens capsule breach (OR = 12.4, [1.85–83.1]).

Conclusions

Wound leak is an important postoperative complication of open globe injury repair. Delayed presentation is an important risk factor for postoperative wound leak and endophthalmitis. Prompt and meticulous wound management of open globe injury may reduce these complications.
Quantifying the erosion of natural darkness in the global protected area system
Authors: Gaston Kevin J. , Duffy James P. , Bennie Jonathan
Published: February 2015

The nighttime light environment of much of the earth has been transformed by the introduction of electric lighting. This impact continues to spread with growth in the human population and extent of urbanization. This has profound consequences for organismal physiology and behavior and affects abundances and distributions of species, community structure, and likely ecosystem functions and processes. Protected areas play key roles in buffering biodiversity from a wide range of anthropogenic pressures. We used a calibration of a global satellite data set of nighttime lights to determine how well they are fulfilling this role with regard to artificial nighttime lighting. Globally, areas that are protected tend to be darker at night than those that are not, and, with the exception of Europe, recent regional declines in the proportion of the area that is protected and remains dark have been small. However, much of these effects result from the major contribution to overall protected area coverage by the small proportion of individual protected areas that are very large. Thus, in Europe and North America high proportions of individual protected areas (>17%) have exhibited high levels of nighttime lighting in all recent years, and in several regions (Europe, Asia, South and Central America) high proportions of protected areas (32–42%) have had recent significant increases in nighttime lighting. Limiting and reversing the erosion of nighttime darkness in protected areas will require routine consideration of nighttime conditions when designating and establishing new protected areas; establishment of appropriate buffer zones around protected areas where lighting is prohibited; and landscape level reductions in artificial nighttime lighting, which is being called for in general to reduce energy use and economic costs.
Potential role of CC chemokine receptor 6 in prediction of late‐onset cytomegalovirus infection following solid organ transplant
Authors: Camargo Jose F. , Resende Mariangela R. , Zamel Ricardo , Klement William , Bhimji Alyajahan , Huibner Sanja , Kumar Deepali , Humar Atul , Jurisica Igor , Keshavjee Shaf , Kaul Rupert , Husain Shahid
Published: February 2015

CCR6 is a chemokine receptor involved in homing memory T cells, particularly Th17 cells, to sites of mucosal inflammation. Despite the critical role of memory T cells in long‐term protective immunity against cytomegalovirus (CMV), a virus that reactivates at multiple mucosal sites, the ability of CCR6 or other Th17 marker expression to predict CMV reactivation following transplantation is not clear. Using 11‐color flow cytometry, in this prospective single‐center pilot study, we measured the expression of CCR6 and other markers of T‐cell function in peripheral blood samples obtained from 21 SOT recipients at the time of discontinuation of anti‐CMV prophylaxis. CMV viremia was monitored on a monthly basis after discontinuation of prophylaxis. Eleven patients (52%) developed CMV viremia during the six‐month follow‐up period. Late‐onset CMV infection was preceded by an immune phenotype characterized by increased CCR6 expression on bulk CD4+ T cells and a reduced number of circulating CMV IE‐1‐specific Th1 (CD4+ IFN‐γ+) cells. Among the markers evaluated, CCR6 was the best single predictor of late‐onset CMV infection. Our results suggest that CCR6 expression at the time of discontinuation of antiviral prophylaxis might be a useful predictor of late‐onset CMV reactivation and provide the basis for future larger prospective studies.
Managing Human Tissue Transfer Across National Boundaries – An Approach from an Institution in South Africa
Authors: Mahomed Safia , Behrens Kevin , Slabbert Melodie , Sanne Ian
Published: February 2015

With biobank research on the increase and the history of exploitation in Africa, it has become necessary to manage the transfer of human tissues across national boundaries. There are many accepted templates of Material Transfer Agreements (MTAs) that currently exist internationally. However, these templates do not address the specific concerns of South Africa and even of Africa as a continent. This article will examine three significantly important ethico‐legal concepts that were deliberated and carefully adapted by a South African Institution to suit the transfer of Human Biological Materials (HBMs) and associated data for biobank research, namely: informed consent; benefit sharing arrangements; and ownership together with intellectual property rights in human tissues. The discussion includes an analysis of current practice; the ethico‐legal challenges in the South African/African context; the decisions made with regard to how the related ethico‐legal challenges were addressed in the MTA; and justifications for implementing these decisions. The processes considered could be of benefit to other developing world countries who consider it necessary to manage the transfer of HBMs across national boundaries.
Simultaneous in vivo imaging of blood and lymphatic vessel growth in Prox1–GFP/Flk1::myr–mCherry mice
Authors: Zhu Jimmy , Dugas‐Ford Jennifer , Chang Michael , Purta Patryk , Han Kyu‐Yeon , Hong Young‐Kwon , Dickinson Mary E. , Rosenblatt Mark I. , Chang Jin‐Hong , Azar Dimitri T.
Published: February 2015

The ability to visually observe angiogenesis and lymphangiogenesis simultaneously and repeatedly in living animals would greatly enhance our understanding of the inter‐dependence of these processes. To generate a mouse model that allows such visualization via in vivo fluorescence imaging, we crossed Prox1–GFP mice with Flk1::myr–mCherry mice to generate Prox1–GFP/Flk1::myr–mCherry mice, in which lymphatic vessels emit green fluorescence and blood vessels emit red fluorescence. Corneal neovascularization was induced in these mice using three injury models: implantation of a vascular endothelial growth factor (VEGF) pellet, implantation of a basic fibroblast growth factor (bFGF) pellet, and alkali burn injury. Vessel growth was observed in vivo by stereomicroscopy on days 0, 3, 7 and 10 after pellet implantation or alkali injury as well as in flat‐mounted corneas via confocal microscopy after the final in vivo imaging time point. We observed blood and lymphatic vessel growth in all three models, with the most significant growth occurring from days 0–7. Upon VEGF stimulation, the growth kinetics of blood and lymphatic vessels were similar. Blood vessels exhibited similar growth patterns in VEGF‐ and bFGF‐stimulated corneas. Alkali burn injury induced robust angiogenesis and lymphangiogenesis. The intrinsic fluorescence of blood and lymphatic endothelial cells in Prox1–GFP/Flk1::myr–mCherry mice permitted simultaneous in vivo imaging of angiogenesis and lymphangiogenesis. This allowed us to differentiate the processes as well as observe their inter‐dependence, and will be valuable in development of therapies targeting angiogenesis and/or lymphangiogenesis.