bluuebunny/crossref_metadata_2025 huggingface dataset:
Rothschilds' strategies in international non‐ferrous metals markets, 1830–1940
Authors: López‐Morell Miguel Á. , O'kean José M.
Published: February 2014

The aim of this article is to analyse the strategies employed by the Rothschilds up to 1940 to gain control and limit competition in the international non‐ferrous metals markets. It examines how they opted for inelastic demand products of highly concentrated supply which lent themselves to market control (mercury, nickel, lead, and copper and sulphur) by taking administrative monopolies (mercury from the state‐owned Almadén mines in Spain) or by controlling the leading businesses of the respective markets (Le Nickel, Peñarroya, and Rio Tinto). The article also analyses how in some cases the family was able to gain worldwide monopolies, and how in other cases they promoted collusive oligopolies with the competition in any number of forms in their quest to maintain profitability and steer well clear of any competition.
Continuous infusion of local anaesthetic following laparoscopic hysterectomy—a randomised controlled trial
Authors: Andrews V , Wright JT , Zakaria F , Banerjee S , Ballard K
Published: February 2014

Objective

To estimate whether a continuous infusion of intraperitoneal local anaesthetic for 48 hours following laparoscopic hysterectomy reduced the need for opioids delivered with a patient‐controlled analgesia pump.

Design

Double‐blind randomised placebo‐controlled trial.

Setting

District general hospital in the UK.

Population

Women undergoing a laparoscopic hysterectomy for a benign indication.

Methods

Women were randomised to receive either 0.5% levobupivicaine or 0.9% normal saline via an ON‐Q elastomeric pump for 48 hours postoperatively. The amount of opioids used via the patient‐controlled analgesia pump was recorded and pain was measured using an 11‐point Box Scale.

Main outcome measures

The primary outcome was the amount of patient‐administered morphine used over the first 48 postoperative hours. Secondary outcomes were length of hospital stay, oral analgesia use and level of patient‐reported pain.

Results

Sixty women participated and completed the trial. There was no difference (P = 0.59) in the median amount of patient‐administered morphine used between the levobupivicaine (23 mg) and placebo (18.5 mg) groups; median group difference 3.0 (95% CI −7.0 to 14.0). There was also no difference in the length of hospital stay with 40% of the treatment group remaining in hospital >48 hours compared with 30% of the placebo group (P = 0.08). Pain scores at all postoperative time points remained similar, with a median group difference in pain scores of 1.0 (95% CI −1.0 to 2.0) at the end of the first postoperative day.

Conclusions

Continuous infusion of 0.5% levobupivicaine into the peritoneal cavity following laparoscopic hysterectomy does not have any opioid‐sparing effects.
The relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction
Authors: van Delft K , Sultan AH , Thakar R , Schwertner‐Tiepelmann N , Kluivers K
Published: February 2014

Objective

To establish the relationship between postpartum levator ani muscle (LAM) avulsion and signs and/or symptoms of pelvic floor dysfunction (PFD).

Design

Observational longitudinal cohort study.

Setting

District General University Hospital, UK.

Population or sample

Primigravida at 36 weeks' gestation and 3 months postpartum.

Methods

Pelvic floor muscle strength (PFMS) and pelvic organ prolapse were assessed clinically using validated methods. Transperineal ultrasound was performed to identify LAM avulsion and measure hiatus dimensions. Validated questionnaires evaluated sexual function, urinary and faecal incontinence.

Main outcome measures

PFD signs and symptoms related to LAM avulsion.

Results

Two hundred and sixty nine primigravida without LAM avulsion participated and 71% (n = 191) returned postpartum. LAM avulsion was found in 21% of vaginal deliveries (n = 30, 95%CI 15.1–28.4%). Women with minor and major avulsion had worse PFMS (P < 0.038) and more anterior compartment prolapse (maximum stage 2; P < 0.024). Antenatal hiatus antero‐posterior diameter on ultrasound was significantly smaller in women sustaining avulsion (P = 0.011). Postnatal measurements were significantly increased following avulsion. Women with major avulsion were less sexually active at both antenatal and postnatal periods (P < 0.030). These women had more postnatal urinary incontinence and symptoms such as reduced vaginal sensation and ‘too loose vagina’. No postnatal differences were found for faecal incontinence, prolapse symptoms or quality of life. The correlation of differences in variables was only slight–fair with avulsion severity.

Conclusions

Twenty one percent of women sustain LAM avulsion during their first vaginal delivery with significant impact on signs and symptoms of PFD. As avulsion has been described as the missing link in the development of prolapse; longer term follow‐up is vital.
Disease spectrum in patients with elevated serum tryptase levels
Authors: Aberer Elisabeth , Savic Sandra , Bretterklieber Agnes , Reiter Harald , Berghold Andrea , Aberer Werner
Published: February 2014

Background

Elevated serum tryptase levels can be a sign of mastocytosis, which is a rare disease associated with systemic and/or skin manifestations.

Objective

To investigate patients with elevated tryptase levels in regard to their underlying diseases, and to determine whether increased tryptase can be used as a diagnostic marker for underlying mastocytosis.

Methods

In a retrospective study the data of 96 patients with serum tryptase levels higher than 15 μg/L were systematically analysed. In 48 patients control investigations for baseline tryptase were performed.

Results

Fifty‐three of the 96 patients had tryptase levels ≥20 μg/L. A mere 16% of the 96 patients suffered from mastocytosis and had the highest tryptase levels (P < 0.001). The remaining patients had anaphylaxis (36%), urticaria and angioedema (26%), local reactions to insect bites (4%), drug reactions (3%), or miscellaneous diagnoses (15%). Only 16 of these had acute symptoms at tryptase investigation. In all, 48 patients had a follow up; in 7/48 patients with acute symptoms normal tryptase levels were seen at control investigations, but 41/48 (85%) patients showed continuously elevated tryptase levels >15 μg/L and in 30 patients (62%) even values >20 μg/L; 11 of these patients had anaphylaxis, five urticaria, five other diagnoses and nine patients mastocytosis.

Conclusion

More than 50% of patients with non‐mastocytosis such as urticaria and angioedema, drug or anaphylactic reactions repeatedly had tryptase levels higher than 20 μg/L. Since baseline tryptase >20 μg/L is a minor criterion for mastocytosis, these patients should be inspected for skin lesions of mastocytosis and receive a diagnostic body work‐up for systemic mastocytosis including a bone marrow biopsy.
Ethical Considerations for Outcome‐adaptive Trial Designs: A Clinical Researcher's Perspective
Authors: Saxman Scott Brian
Published: February 2014

In a typical comparative clinical trial the randomization scheme is fixed at the beginning of the study, and maintained throughout the course of the trial. A number of researchers have championed a randomized trial design referred to as ‘outcome‐adaptive randomization.’ In this type of trial, the likelihood of a patient being enrolled to a particular arm of the study increases or decreases as preliminary information becomes available suggesting that treatment may be superior or inferior. While the design merits of outcome‐adaptive trials have been debated, little attention has been paid to significant ethical concerns that arise in the conduct of such studies. These include loss of equipoise, lack of processes for adequate informed consent, and inequalities inherent in the research design which could lead to perceptions of injustice that may have negative implications for patients and the research enterprise. This article examines the ethical difficulties inherent in outcome‐adaptive trials.
Activation states of blood eosinophils in asthma
Authors: Johansson M. W.
Published: February 2014

Asthma is characterized by airway inflammation rich in eosinophils. Airway eosinophilia is associated with exacerbations and has been suggested to play a role in airway remodelling. Recruitment of eosinophils from the circulation requires that blood eosinophils become activated, leading to their arrest on the endothelium and extravasation. Circulating eosinophils can be envisioned as potentially being in different activation states, including non‐activated, pre‐activated or ‘primed’, or fully activated. In addition, the circulation can potentially be deficient of pre‐activated or activated eosinophils, because such cells have marginated on activated endothelium or extravasated into the tissue. A number of eosinophil surface proteins, including CD69, L‐selectin, intercellular adhesion molecule‐1 (ICAM‐1, CD54), CD44, P‐selectin glycoprotein ligand‐1 (PSGL‐1, CD162), cytokine receptors, Fc receptors, integrins including αM integrin (CD11b), and activated conformations of Fc receptors and integrins, have been proposed to report cell activation. Variation in eosinophil activation states may be associated with asthma activity. Eosinophil surface proteins proposed to be activation markers, with a particular focus on integrins, and evidence for associations between activation states of blood eosinophils and features of asthma are reviewed here. Partial activation of β1 and β2 integrins on blood eosinophils, reported by monoclonal antibodies (mAbs) N29 and KIM‐127, is associated with impaired pulmonary function and airway eosinophilia, respectively, in non‐severe asthma. The association with lung function does not occur in severe asthma, presumably due to greater eosinophil extravasation, specifically of activated or pre‐activated cells, in severe disease.
Impacts of Paternal Care and Seasonal Change on Offspring Survival: A Multiseason Experimental Study of a Caribbean Frog
Authors: Lehtinen Richard M. , Green Sara E. , Pringle Jessica L.
Published: February 2014

Parental care is widespread among animals and many studies have investigated how environmental conditions influence parental care strategies. However, few studies have coupled observations of the frequency and form of parental care with manipulative studies on the function of care across multiple seasons. To address this gap, we made field observations and conducted male removal experiments in a glass frog with paternal egg attendance from the island of Tobago, West Indies. To test the hypothesis that seasonality impacts the frequency, form, and function of parental care, field observations and male removal experiments were undertaken three times, twice during the rainy season, and once in the dry season. We found seasonal differences in the frequency of egg attendance with males increasing the frequency of this behavior in the dry season, likely in response to a greater risk of clutch desiccation. We also found that clutches in which the male was removed had strongly reduced survivorship compared with controls and this pattern did not change seasonally. However, sources of mortality were strongly influenced by season. Arthropod predation was the primary source of mortality during the wet season, but in the dry season, desiccation was more important. Together, these results suggest that seasonal variation is both impacting care function as well as shaping the form that parental care takes.
Immunology of infective preterm delivery in the mare
Authors: Lyle S. K.
Published: February 2014

Placentitis is reported to be the cause of 9.8–33.5% of abortions, stillbirths and perinatal losses in horses. Bacterial infections are responsible for 53% of placentitis cases withStreptococcus equissp.zooepidemicusbeing isolated in 28% of these cases. Clinically, mares may have a vaginal discharge, show udder development, lactate prenatally and deliver a premature or dead foal. Major aspects of the pathogenesis of infectious preterm delivery that may require more effective therapeutic targeting are myometrial contraction, immunological aspects of preterm delivery, and the effects of proinflammatory cytokine signalling on activation of the fetal hypothalamic–pituitary–adrenal axis. This article focuses on current knowledge of inflammatory signalling secondary to equine placentitis, and the interplay among inflammation, loss of myometrial quiescence and activation of the fetal hypothalamic–pituitary–adrenal axis.
The “Quiet Migration”: Is Intercountry Adoption a Successful Intervention In the Lives of Vulnerable Children?
Authors: Misca Gabriela
Published: February 2014

Over the past decades international adoption has become a global phenomenon involving cross‐border movement of vulnerable children, mainly from poor, undeveloped countries to wealthier countries. Debates around international adoptions invoke often‐passionate arguments for and against. At times seen as the ultimate form of imperialism, trafficking and exploitation of children, international adoptions are also praised as successful interventions in the lives of the most vulnerable children worldwide. This article draws on research findings on the outcomes of international adoption and its impact on various aspects of adopted children's development and identifies the gaps relating to evidence‐based interventions best suited to the needs of these children postinternational adoption.

Keypoints

Based on the reviewed research findings, this paper supports the following arguments:

overall, children adopted internationally can and do thrive in their adoptive countries;

such success is guaranteed by the high commitment of adoptive parents and the availability of post‐adoption support services;

there is, however, a lack of evidence‐based practice relating to interventions best suited to the needs of these children post‐international adoption;

following a globally standardised process and strict protocols may help alleviate illicit activity in international adoptions;

existing guidelines must be tightened to ensure that children are the central focus in intercountry adoption and that their development is not affected by cross‐border movement.
Structural and redox properties of the small laccase Ssl1 from Streptomyces sviceus
Authors: Gunne Matthias , Höppner Astrid , Hagedoorn Peter‐Leon , Urlacher Vlada B.
Published: February 2014

Laccases (EC 1.10.3.2) are members of the multicopper oxidase family. They oxidize diverse electron‐rich substrates through electron abstraction by the type 1 copper ion in the enzyme active site. Abstracted electrons are transferred to the trinuclear copper cluster, where molecular oxygen serves as final acceptor and is reduced to water. Laccase activity is assumed to depend on the redox potential of its type 1 copper ion. Whereas numerous studies have been undertaken to elucidate the determinants of the redox potential of type 1 copper ions in one‐domain cupredoxins and in three‐domain laccases, such experimental investigations are lacking for recently described, small, two‐domain laccases. In this work, the crystal structure of the small laccase Ssl1 from Streptomyces sviceus was solved, and the positions that might influence the redox potential of Ssl1 were depicted. On the basis of this knowledge, several Ssl1 variants were constructed with an increase in redox potential of 16–81 mV, from 375 mV to 391–456 mV. Mutation of residues in close proximity to the type 1 copper center resulted in a predicted increase in the redox potential of the copper center; however, there was a reduced specific activity for the oxidation of 2,6‐dimethoxyphenol, which has a relatively low redox potential. Mutations more distant to the type 1 copper also led to an increased redox potential of the copper center, and resulted in variants able to oxidize the high redox potential substrates 1,2‐dihydroxyanthraquinone‐3‐sulfonic acid (Alizarin Red S) and indigo carmine more efficiently than wild‐type Ssl1.

Database

The atomic coordinates of the structure of Ssl1 laccase from Streptomyces sviceus and structure factors have been deposited in the RCSB Protein Data Bank (4M3H)

Structured digital abstract

•Ssl1 and Ssl1 bind by x-ray crystallography (View interaction)
High‐severity fire corroborated in historical dry forests of the western United States: response to Fulé et al.
Authors: Williams Mark A. , Baker William L.
Published: February 2014

Accurate assessment of changing fire regimes is important, since climatic change and people may be promoting more wildfires. Government wildland fire policies and restoration programmes in dry western US forests are based on the hypothesis that high‐severity fire was rare in historical fire regimes, modern fire severity is unnaturally high and restoration efforts should focus primarily on thinning forests to eliminate high‐severity fire. Using General Land Office (GLO) survey data over large dry‐forest landscapes, we showed that the proportion of historical forest affected by high‐severity fire was not insignificant, fire severity has not increased as a proportion of total fire area and large areas of dense forest were present historically (Williams & Baker, Global Ecology and Biogeography, 21, 1042–1052, 2012; W&B). In response, Fulé et al. (Global Ecology and Biogeography, 2013, doi: 10.1111/geb.12136; FE) suggest that our inferences are unsupported and land management based on our research could be damaging to native ecosystems. Here, we show that the concerns of FE are unfounded. Their criticism comes from misquoting W&B, mistaking W&B's methods, misusing evidence (e.g. from Aldo Leopold) and missing substantial available evidence. We also update corroboration for the extensive historical high‐severity fire shown by W&B. We suggest that restoration programmes are misdirected in seeking to reduce all high‐severity fire in dry forests, given findings from spatially extensive GLO data and other sources.
Good Governance Means Performance and Results
Authors: Rotberg Robert I.
Published: February 2014

If the object of developing and developed world leaders is to uplift their peoples continually, then it is essential to measure approximations of actual service deliveries (what we ought to mean by “governance”), not to rate nations impressionistically according to the perceived quality of their operations, their perceived impartiality (as per Rothstein), the extent of their bureaucratic autonomy (as per Fukuyama and others), or their capacity to coax or coerce citizens. Only in that positive manner can we distinguish the governments that are producing abundant political goods (i.e., good governance) from those that no longer are, or never did.
Salvage treatment for local recurrence of hepatocellular carcinoma after local ablation therapy
Authors: Imai Katsunori , Beppu Toru , Chikamoto Akira , Mima Kosuke , Okabe Hirohisa , Hayashi Hiromitsu , Nitta Hidetoshi , Ishiko Takatoshi , Baba Hideo
Published: February 2014

Aim

Local recurrence of hepatocellular carcinoma (HCC) after local ablation therapy (LAT) is a serious problem; however, the optimal treatment strategy remains unclear.

Methods

A retrospective analysis was conducted of 50 patients with local recurrence of HCC after LAT that underwent either salvage hepatectomy (n = 23) or radiofrequency ablation (RFA; n = 27). Their background characteristics, intraoperative data, and postoperative short‐ and long‐term outcome were analyzed.

Results

The RFA group was found to be significantly associated with an impaired liver functional reserve, smaller number and size of tumors. The hepatectomy group showed a significantly longer operation time, greater intraoperative blood loss and more frequent red blood cell transfusion. In‐hospital stay mortality and morbidity rate did not significantly differ. The disease‐free and overall survival showed no significant difference between the groups. Although local recurrence after salvage treatment was found in zero (0%) for hepatectomy and in seven (25.9%) for RFA, that did not affect the overall survival. The tumor size at the prior LAT was identified as an independent prognostic factor for disease‐free survival and serum albumin for overall survival.

Conclusion

Whereas salvage hepatectomy for local recurrent HCC is recommended for selected patients in terms of its good local control effect, salvage RFA is also acceptable because it is less invasive and also has a reasonable long‐term outcome.
Dividend Policy Irrelevancy and the Construct of Earnings
Authors: Gao Zhan , Ohlson James A. , Ostaszewski Adam J.
Published: February 2014

This paper analyzes the characteristics of earnings in valuation settings where the dividend policy is irrelevant to equity value. The paper first demonstrates an equivalent characterization of dividend policy irrelevancy (DPI) in a general linear dynamic. It then proceeds to show how DPI leads to ideal and practical constructs of earnings and examines their analytical properties. We further demonstrate that earnings properties can be used to deduce the core approach in practical equity valuation – namely, measures of growth in expected earnings explain the price to forward earnings ratio. However, unlike dividends, free cash flow cannot generally be claimed to be irrelevant to value.
Role of Aliskiren on Arterial Stiffness and Endothelial Function in Patients With Primary Hypertension
Authors: Bonadei Ivano , Vizzardi Enrico , D'Aloia Antonio , Sciatti Edoardo , Raddino Riccardo , Metra Marco
Published: February 2014

Arterial stiffness and endothelial dysfunction are important determinants of cardiovascular events in patients with arterial hypertension. There are few data regarding the role of aliskiren on the central hemodynamics and endothelial function in patients with uncontrolled arterial hypertension. The aim of this study was to assess the addition of aliskiren to other antihypertensive drug treatment for arterial stiffness and endothelial function. Thirty uncontrolled hypertensive patients (mean age, 60.4±12.2 years), without any other cardiovascular risk factors, were enrolled. Augmentation index (AIx) and carotid‐femoral pulse wave velocity (cfPWV) by applanation tonometry and reactive hyperemia peripheral arterial tonometry (RH PAT)index using peripheral arterious tonometry at baseline and after 6 months of aliskiren titrated to 300 mg once a day was evaluated. The addition of aliskiren had no effect on values of centralAIx (33.26±10.74% vs 28.86±10.74%;P=.36) but did significantly improve values of cfPWV(9.36±2.65 m/s vs 8.72±2.48 m/s;P=.04) andRH PATindex (1.64±0.57 vs 1.75±0.45;P=.05). In addition to improving systolic and diastolic blood pressure, the addition of aliskiren to concomitant antihypertensive drugs in uncontrolled hypertensive patients may be effective in improving aortic stiffness and endothelial function. These results encourage further studies to evaluate the use of aliskiren for cardiovascular prevention.
Snus (Swedish smokeless tobacco) use and risk of stroke: pooled analyses of incidence and survival
Authors: Hansson J. , Galanti M. R. , Hergens M.‐P. , Fredlund P. , Ahlbom A. , Alfredsson L. , Bellocco R. , Engström G. , Eriksson M. , Hallqvist J. , Hedblad B. , Jansson J.‐H. , Pedersen N. L. , Trolle Lagerros Y. , Östergren P.‐O. , Magnusson C.
Published: February 2014

Background

Snus is a moist smokeless tobacco product with high nicotine content. Its use has a short‐term effect on the cardiovascular system, but the relationship between snus use and stroke is unclear.

Objective

The aim of this study was to assess the associations between use of snus and incidence of and survival after stroke, both overall and according to subtypes.

Methods

Pooled analyses of eight Swedish prospective cohort studies were conducted, including 130 485 men who never smoked. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) of incidence and death after diagnosis using Cox proportional hazard regression models and case fatality and survival using logistic regression and Kaplan–Meier methods, respectively.

Results

No associations were observed between the use of snus and the risk of overall stroke (HR 1.04, 95% CI 0.92–1.17) or of any of the stroke subtypes. The odds ratio (OR) of 28‐day case fatality was 1.42 (95% CI 0.99–2.04) amongst users of snus who had experienced a stroke, and the HR of death during the follow‐up period was 1.32 (95% CI 1.08–1.61).

Conclusion

Use of snus was not associated with the risk of stroke. Hence, nicotine is unlikely to contribute importantly to the pathophysiology of stroke. However, case fatality was increased in snus users, compared with nonusers, but further studies are needed to determine any possible causal mechanisms.
Low testosterone in a male adolescent bodybuilder: Which diagnosis holds more weight?
Authors: Woodhill Ineke , Cooper Chris , Zacharin Margaret , Cukier Kimberly , Vuillermin Peter
Published: February 2014

We present the case of a 16‐year‐old male who presented reporting a 6‐month history of lowered mood, fatigue, anhedonia, disturbed sleep and heightened anxiety. On further questioning he reported restricted eating and weightlifting for at least 1 h on a daily basis. Investigations revealed findings compatible with secondary hypogonadism. The potential causes of secondary hypogonadism including structural lesions, muscle dysmorphia and use of illicit anabolic steroids are discussed.
Acceptability and psychometric properties of Brøset Violence Checklist in psychiatric care settings in China
Authors: Yao X. , Li Z. , Arthur D. , Hu L. , An F‐R. , Cheng G.
Published: February 2014

Accessible summary

Short‐term risk assessment instrument owns great importance for psychiatric nurses in China; however, the lack of a standardized violence risk assessment instrument has disadvantaged them in clinical practice.

The Brøset Violence Checklist (BVC), a behavioural observation tool, is the most frequently cited instrument available for evaluating violence risk in psychiatric inpatients, then worth to be tested in Chinese culture.

This study, conducted in two closed wards in a psychiatric hospital in Beijing, revealed that the instrument has favourable reliability, validity and predictive accuracy in Chinese population.

BVC provides nurses with a quick and easily administered method to screening out patients with violence potential, thus allowing for early intervention. Feedback from the nurses was quite encouraging and the further use of BVC seems promising.

The lack of standardized violence risk assessment instrument has disadvantaged nurses in clinical practice in China, where violent behaviour is an increasing problem. This study conducted a validation of the Brøset Violence Checklist that has proven effective in violence risk prediction in other countries. A sample of 296 patients consecutively admitted to two wards of a psychiatric hospital in Beijing was recruited. These patients were assessed on day shift and evening shift for the first seven days of hospitalization. Violence data and preventive measures were concurrently collected from nursing records and case reports. A total of 3707 assessments for 281 patients were collected revealing 93 episodes of violence among 55 patients. Receiver operating characteristics yielded an area under the curve of 0.85. At the cut‐off point of one, its sensitivity/specificity was 78.5%/88.2% and the corresponding positive/negative predictive value was 14.6%/99.4%. In some false positive cases, intense preventive measures had been implemented. Positive feedback from the nurses was gained. The Brøset Violence Checklist was proved as an easy‐to‐use and time‐saving instrument, therefore, regarded as a promising tool to determine if the psychiatric users are potentially violent in the short term.
Identification of a natural intergenotypic recombinant hepatitis delta virus genotype 1 and 2 in Vietnamese HBsAg‐positive patients
Authors: Sy B. T. , Nguyen H. M. , Toan N. L. , Song L. H. , Tong H. V. , Wolboldt C. , Binh V. Q. , Kremsner P. G. , Velavan T. P. , Bock C.‐T.
Published: February 2014

Hepatitis D virus (HDV) infection is acquired as a co‐ /superinfection of Hepatitis B virus (HBV) and can modulate the pathophysiology of chronic hepatitis B and related liver diseases including hepatocellular carcinoma. Among the eight distinct HDV genotypes reported, relatively few studies have attempted to investigate the prevalence of HDV mixed genotypes and RNA recombination of HDV. With a recorded prevalence of 10–20% HBV infection in Vietnam, this study investigated the HDV variability, HDV genotypes and HDV recombination among twenty‐one HDV isolates in Vietnamese HBsAg‐positive patients. HDV subgenomic and full‐length genome sequences were obtained using newly established HDV‐specific RT‐PCR techniques. The nucleotide homology was observed from 74.6% to 99.4% among the investigated full‐length genome of the HDV isolates. We observed HDV genotype 1 and HDV genotype 2 in the investigated Vietnamese patients. Although no HDV genotype mixtures were observed, we report here a newly identified recombinant of HDV genotypes (HDV 1 and HDV 2). The identified recombinant HDV isolate C03 revealed sequence homology to both HDV genotype 1 (nt1 to nt907) and HDV genotype 2 (nt908 to nt1675; HDAg coding region) with a breakpoint at nt908. Our findings demonstrate the prevalence of intergenotypic recombination between HDV genotypes 1 and 2 in a Vietnamese HBsAg‐positive patient. Extended investigation on the distribution and prevalence of HDV, HDV mixed genotypes and recombinant HDV genotypes in a larger Vietnamese population offers vital insights into understanding of the micro‐epidemiology of HDV and subsequent pathophysiology in chronic HBV‐ /HDV‐related liver diseases.
The School Food Plan: Putting food at the heart of the school day
Authors: Schabas L.
Published: February 2014

The School Food Plan, published in July 2013 by the Department for Education, is the latest chapter in England's school food reform drive over the past decade. In contrast to conventional independent reviews, which put forward recommendations for consideration, the School Food Plan lays out actions, which are currently being implemented.

The plan sets out 16 actions across policy and industry, ranging from changes to the national curriculum and school food standards, to industry‐led taskforces. The implementation of the Plan is expected to run for two years, after which the actions will be fully embedded into everyday school food activity, with an expected enduring positive impact on health and attainment.

This paper gives a brief overview of the School Food Plan, providing the background to the Plan along with a summary of its central principles. It also offers an update on the 16 actions, taking into account the Government's subsequent announcement that universal free school meals for Reception to Year 2 (pupils aged 4–7) will be provided by September 2014.
Tight junctions and IBS ‐ the link between epithelial permeability, low‐grade inflammation, and symptom generation?
Authors: Piche T.
Published: February 2014

In this issue of Neurogastroenterology and Motility, Dr Ewa Wilcz‐Villega and colleagues report low expression of E‐cadherin, a tight junction protein involved in the regulation of paracellular permeability, in the colonic mucosa of patients with the irritable bowel syndrome (IBS) with predominance of diarrhea (IBS‐D) or alternating symptoms (IBS‐A). These findings constitute an improvement in our knowledge of epithelial barrier disruption associated with IBS. There is mounting evidence to indicate that a compromised epithelial barrier is associated with low‐grade immune activation and intestinal dysfunction in at least a proportion of IBS patients. During the last 10 years of research, much interest has focused on the increase in the number of different types of immune cells in the gut mucosa of IBS patients including: mast cells, T lymphocytes, and other local cells such as enteroendocrine cells. The inflammatory mediators released by these cells or other luminal factors could be at the origin of altered epithelial barrier functions and enteric nervous system signaling, which lead to gut hypersensitivity. A current conceptual framework states that clinical symptoms of IBS could be associated with structural and functional abnormalities of the mucosal barrier, highlighting the crucial importance of elucidating the contributory role of epithelial barrier defects in the pathogenesis of IBS. More importantly, disruption of the epithelial barrier could also participate in the generation of persistent abdominal pain and discomfort mimicking IBS in patients with inflammatory bowel diseases considered in remission. This mini review gives a brief summary of clinical and experimental evidence concerning the mechanisms underlying epithelial barrier defects in IBS.
Effect of a low‐flatulogenic diet in patients with flatulence and functional digestive symptoms
Authors: Azpiroz F. , Hernandez C. , Guyonnet D. , Accarino A. , Santos J. , Malagelada J.‐R. , Guarner F.
Published: February 2014

Background

Diets rich in fermentable residues increase intestinal gas production. Our aim was to demonstrate the potential effects of diet on gas‐related symptoms.

Methods

The effect of a low‐flatulogenic test diet (restricted to foodstuffs low in fermentable residues; n = 15) was compared to that of a balanced control diet (Mediterranean type; n = 15) in 30 patients complaining of flatulence and other abdominal symptoms using a randomized parallel design. The following outcomes were measured daily: number of anal gas evacuations by an event marker, severity of gas‐related symptoms by 0–10 scales, and sensation of digestive comfort by a −5 (unpleasant) to +5 (pleasant) scale. Measurements were taken pretreatment for 3 days on their habitual diet and for 7 days during the treatment phase.

Key Results

No pretreatment differences were detected between patients allocated to the control or test diets. The test diet significantly reduced the number of gas evacuations (by 54 ± 10%; p = 0.002 vs basal diet) whereas the control diet had a lesser effect (reduction by 28 ± 9%; p = 0.059 vs basal diet; p = 0.089 vs test diet). Compared to the control diet, the test diet significantly reduced flatulence (by 48 ± 7% vs 27 ± 8%, respectively; p = 0.018), abdominal distension (by 48 ± 4% vs 22 ± 12%, respectively; p = 0.038), and enhanced digestive well‐being (by 149 ± 18% vs 58 ± 22%, respectively; p = 0.006).

Conclusions & Inferences

In patients with gas‐related symptoms, a low‐flatulogenic diet produces immediate beneficial effects with digestive, cognitive, and emotive dimensions. The number of gas evacuations is an objective biological marker of response to dietary treatment.
Anhydrobiosis: an unsolved problem
Authors: CROWE JOHN H.
Published: February 2014

This article comments on: Differential proteomics of dehydration and rehydration in bryophytes: evidence towards a common desiccation tolerance mechanism
Chlamydomonas NZF1, a tandem‐repeated zinc finger factor involved in nitrate signalling by controlling the regulatory gene NIT2
Authors: HIGUERA JOSE JAVIER , FERNANDEZ EMILIO , GALVAN AURORA
Published: February 2014

The Chlamydomonas reinhardtii NIT2 gene plays a central role in nitrate assimilation, thus, nit2 mutants are not able to sense or to use nitrate for growth. NIT2 protein is an RWP‐RK‐type transcriptional factor related to nodule inception (Nin, NLP) proteins from plants. NIT2 expression is down‐regulated in ammonium and up‐regulated under nitrogen deprivation. However, intracellular nitrate is required to activate NIT2 for subsequent expression of NIA1 and other nitrate assimilation genes. In this work, mutants defective in nitrate sensing have been studied. The identification of genomic regions affected allows proposing putative loci/genes for nitrate signalling in the alga. Among them, a CrNZF1 (Nitrate Zinc Finger 1) that encodes a tandem zinc finger protein CCCH‐type. In the nzf1 mutant, the expression of the regulatory gene NIT2 is decreased and also that of nitrate assimilation genes. In this mutant, polyadenylated forms of NIT2 with different lengths could be detected, whereas in the wild type there appeared preferentially the longest forms. CrNZF1 is proposed to regulate NIT2 polyadenylation and thus nitrate signalling and nitrate‐dependent growth in the alga.
Pregnenolone treatment reduces severity of negative symptoms in recent‐onset schizophrenia: An 8‐week, double‐blind, randomized add‐on two‐center trial
Authors: Ritsner Michael S. , Bawakny Hisham , Kreinin Anatoly
Published: February 2014

Aims

Management of recent‐onset schizophrenia (SZ) and schizoaffective disorder (SA) is challenging owing to frequent insufficient response to antipsychotic agents. This study aimed to test the efficacy and safety of the neurosteroid pregnenolone in patients with recent‐onset SZ/SA.

Methods

Sixty out‐ and inpatients who met DSM‐IV criteria for SZ/SA, with suboptimal response to antipsychotics were recruited for an 8‐week, double‐blind, randomized, placebo‐controlled, two‐center add‐on trial, that was conducted between 2008 and 2011. Participants were randomized to receive either pregnenolone (50 mg/day) or placebo added on to antipsychotic medications. The primary outcome measures were the Positive and Negative Symptoms Scale and the Assessment of Negative Symptoms scores. Secondary outcomes included assessments of functioning, and side‐effects.

Results

Analysis was by linear mixed model. Fifty‐two participants (86.7%) completed the trial. Compared to placebo, adjunctive pregnenolone significantly reduced Positive and Negative Symptoms Scale negative symptom scores with moderate effect sizes (d = 0.79). Significant improvement was observed in weeks 6 and 8 of pregnenolone therapy among patients who were not treated with concomitant mood stabilizers (arms × visit × mood stabilizers; P = 0.010). Likewise, pregnenolone significantly reduced Assessment of Negative Symptoms scores compared to placebo (d = 0.57), especially on blunted affect, avolition and anhedonia domain scores. Other symptoms, functioning, and side‐effects were not significantly affected by adjunctive pregnenolone. Antipsychotic agents, benzodiazepines and sex did not associate with pregnenolone augmentation. Pregnenolone was well tolerated.

Conclusions

Thus, add‐on pregnenolone reduces the severity of negative symptoms in recent‐onset schizophrenia and schizoaffective disorder, especially among patients who are not treated with concomitant mood stabilizers. Further studies are warranted.
Neonatal case of classic maple syrup urine disease: Usefulness of 1H‐MRS in early diagnosis
Authors: Sato Takeshi , Muroya Koji , Hanakawa Junko , Asakura Yumi , Aida Noriko , Tomiyasu Moyoko , Tajima Go , Hasegawa Tomonobu , Adachi Masanori
Published: February 2014

We describe a male neonate with classic maple syrup urine disease (MSUD) in metabolic crisis. On day 7 of life, he was referred to hospital because of coma and metabolic acidosis with maple syrup odor. On day 4 after admission, brain magnetic resonance imaging findings were consistent with encephalopathy due to MSUD. Proton magnetic resonance spectroscopy (1H‐MRS) showed a large methyl resonance peak at 0.9 p.p.m. The diagnosis of MSUD was confirmed on low branched‐chain α‐keto acid dehydrogenase complex activity in lymphocyte. 1H‐MR spectra were obtained in 10 min, while it took at least several days to obtain the results of other diagnostic examinations. In convalescence, the peak at 0.9 p.p.m. decreased. The large methyl resonance peak at 0.9 p.p.m. in brain 1H‐MRS would be one of the earliest clues to the diagnosis of classic MSUD in the neonatal period, especially in metabolic crisis.
Two children with obesity‐related glomerulopathy identified in a school urinary screening program
Authors: Kawasaki Yukihiko , Isome Masato , Ono Atsushi , Suzuki Yuichi , Takano Kei , Suyama Kazuhide , Hosoya Mitsuaki
Published: February 2014

The incidence of obesity‐related glomerulopathy (ORG) has increased over the last decade, but there have been few reports on ORG in Japanese children. Reported herein are two children with ORG identified on school urinary screening (SUS). Patient 1 was a 12‐year‐old boy in whom proteinuria was first detected on SUS. His body mass index (BMI) was 33.8 kg/m2 and he had hypertension and hyperuricemia. Patient 2, a 10‐year‐old boy, also had proteinuria identified on SUS. His BMI was 34.8 kg/m2, and he had fatty liver, hyperuricemia, and hypercholesterolemia. Both were diagnosed with ORG based on obesity, proteinuria, and renal pathological findings. After treatment, including candesartan, food restriction and physical exercise, urinary protein excretion was decreased in both cases. We believe that such school urinary screening programs may be effective for the early identification and treatment of children with ORG.
Development of a Causal Model for Elder Mistreatment
Authors: Ziminski Pickering Carolyn E. , Phillips Linda R.
Published: February 2014

Elder mistreatment (EM) is an act committed by a person in a trusted relationship with an elderly person. Through the process of theory synthesis, a new model was developed, which explains the development of aggression (physical and verbal) toward elders by adult children inEM. The proposed model is set within the context of intimate partner violence and emphasizes that rather than arising in caregiving, aggression may be evident in the pre‐caregiving relationship and continue into caregiving situations. An understanding of the causal origins ofEMis essential in designing intervention to help families have healthy relationships.
Risk‐Reduction Strategies to Expand Radon Care Planning with Vulnerable Groups
Authors: Larsson Laura S.
Published: February 2014

Objectives

Radon is the second leading cause of lung cancer in the United States and the leading cause of lung cancer among nonsmokers. Residential radon is the cause of approximately 21,000 U.S. lung cancer deaths each year. Dangerous levels of radon are just as likely to be found in low‐rise apartments and townhomes as single‐family homes in the same area. The preferred radon mitigation strategy can be expensive and requires structural modifications to the home. The public health nurse (PHN) needs a collection of low‐cost alternatives when working with low‐income families or families who rent their homes.

Method

A review of the literature was performed to identify evidence‐based methods to reduce radon risk with vulnerable populations.

Results

Fourteen recommendations for radon risk reduction were categorized into four strategies. Nine additional activities for raising awareness and increasing testing were also included.

Discussion

The results pair the PHN with practical interventions and the underlying rationale to develop radon careplans with vulnerable families across housing types. The PHN has both the competence and the access to help families reduce their exposure to this potent carcinogen.
Broader Health Coverage is Good for the Nation’s Health: Evidence from Country Level Panel Data
Authors: Moreno-Serra Rodrigo , Smith Peter C.
Published: February 2014

Progress towards universal health coverage involves providing people with access to needed health services without entailing financial hardship and is often advocated on the grounds that it improves population health. The paper offers econometric evidence on the effects of health coverage on mortality outcomes at the national level. We use a large panel data set of countries, examined by using instrumental variable specifications that explicitly allow for potential reverse causality and unobserved country-specific characteristics. We employ various proxies for the coverage level in a health system. Our results indicate that expanded health coverage, particularly through higher levels of publicly funded health spending, results in lower child and adult mortality, with the beneficial effect on child mortality being larger in poorer countries.
Likelihood Ratio Tests for Dependent Data with Applications to Longitudinal and Functional Data Analysis
Authors: Staicu Ana‐Maria , Li Yingxing , Crainiceanu Ciprian M. , Ruppert David
Published: February 2014

This paper introduces a general framework for testing hypotheses about the structure of the mean function of complex functional processes. Important particular cases of the proposed framework are as follows: (1) testing the null hypothesis that the mean of a functional process is parametric against a general alternative modelled by penalized splines; and (2) testing the null hypothesis that the means of two possibly correlated functional processes are equal or differ by only a simple parametric function. A global pseudo‐likelihood ratio test is proposed, and its asymptotic distribution is derived. The size and power properties of the test are confirmed in realistic simulation scenarios. Finite‐sample power results indicate that the proposed test is much more powerful than competing alternatives. Methods are applied to testing the equality between the means of normalizedδ‐power of sleep electroencephalograms of subjects with sleep‐disordered breathing and matched controls.
Transfusion‐associated anaphylaxis during anaesthesia and surgery – a retrospective study
Authors: Lindsted G. , Larsen R. , Krøigaard M. , Garvey L. H. , Poulsen L. K. , Mosbech H. , Sørensen B. , Norgaard A.
Published: February 2014

Background and Objectives

Transfusion‐associated anaphylaxis (TAA) is a severe adverse reaction reported to occur in 1:9000–90 000 transfusions. According to the Danish Registration of Transfusion Risks (DART), the frequency is 1:300 000 transfusions, which suggests insufficient reporting of TAA in Denmark. Our aims were to identify possible cases of TAA, to characterize their symptoms and tryptase levels and to investigate the reporting of TAA to the haemovigilance systems.

Material and methods

We reviewed 245 patients with suspected allergic reactions during anaesthesia and surgery, investigated at the Danish Anaesthesia Allergy Centre (DAAC). Based on the outcome of this investigation, the patients were classified as DAAC positive (confirmed hypersensitivity to identified agent, n = 112), or DAAC negative (no confirmed hypersensitivity, n = 133). Data on case history, details of blood transfusion and results of laboratory and clinical investigations were collected. TAA cases were identified according to the recommendations of the International Society of Blood Transfusion (ISBT).

Results

Ten possible TAA cases (30% of all transfused patients) were identified, all DAAC negative. The frequency of elevated serum tryptase, hypotension and male sex was significantly higher among these cases compared with the remaining DAAC negative (P < 0·05), but not different from the DAAC‐positive patients. One case had been reported to the Blood Bank haemovigilance system and none to DART.

Conclusion

We identified unreported cases of possible TAA, which resembled the DAAC‐positive patients with respect to elevated tryptase and symptoms. By applying the ISBT criteria of adverse transfusion reactions, we conclude that TAA during anaesthesia and surgery is likely to be underreported in Denmark.