bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Exposure to Antibiotics Has Caused Accumulation of Resistance Determinants in the Gut Microbiota of Honeybees
Authors: Tian Baoyu , Fadhil Nibal H. , Powell J. Elijah , Kwong Waldan K. , Moran Nancy A.
Published: October 2012

Antibiotic treatment can impact nontarget microbes, enriching the pool of resistance genes available to pathogens and altering community profiles of microbes beneficial to hosts. The gut microbiota of adult honeybees, a distinctive community dominated by eight bacterial species, provides an opportunity to examine evolutionary responses to long-term treatment with a single antibiotic. For decades, American beekeepers have routinely treated colonies with oxytetracycline for control of larval pathogens. Using a functional metagenomic screen of bacteria from Maryland bees, we detected a high incidence of tetracycline/oxytetracycline resistance. This resistance is attributable to known resistance loci for which nucleotide sequences and flanking mobility genes were nearly identical to those from human pathogens and from bacteria associated with farm animals. Surveys using diagnostic PCR and sequencing revealed that gut bacteria of honeybees from diverse localities in the United States harbor eight tetracycline resistance loci, including efflux pump genes (
tetB
,
tetC
,
tetD
,
tetH
,
tetL
, and
tetY
) and ribosome protection genes (
tetM
and
tetW
), often at high frequencies. Isolates of gut bacteria from Connecticut bees display high levels of tetracycline resistance. Resistance genes were ubiquitous in American samples, though rare in colonies unexposed for 25 years. In contrast, only three resistance loci, at low frequencies, occurred in samples from countries not using antibiotics in beekeeping and samples from wild bumblebees. Thus, long-term antibiotic treatment has caused the bee gut microbiota to accumulate resistance genes, drawn from a widespread pool of highly mobile loci characterized from pathogens and agricultural sites.

IMPORTANCE
We found that 50 years of using antibiotics in beekeeping in the United States has resulted in extensive tetracycline resistance in the gut microbiota. These bacteria, which form a distinctive community present in healthy honeybees worldwide, may function in protecting bees from disease and in providing nutrition. In countries that do not use antibiotics in beekeeping, bee gut bacteria contained far fewer resistance genes. The tetracycline resistance that we observed in American samples reflects the capture of mobile resistance genes closely related to those known from human pathogens and agricultural sites. Thus, long-term treatment to control a specific pathogen resulted in the accumulation of a stockpile of resistance capabilities in the microbiota of a healthy gut. This stockpile can, in turn, provide a source of resistance genes for pathogens themselves. The use of novel antibiotics in beekeeping may disrupt bee health, adding to the threats faced by these pollinators.
A Single Native Ganglioside GM
1
-Binding Site Is Sufficient for Cholera Toxin To Bind to Cells and Complete the Intoxication Pathway
Authors: Jobling Michael G. , Yang ZhiJie , Kam Wendy R. , Lencer Wayne I. , Holmes Randall K.
Published: October 2012

Cholera toxin (CT) from
Vibrio cholerae
is responsible for the majority of the symptoms of the diarrheal disease cholera. CT is a heterohexameric protein complex with a 240-residue A subunit and a pentameric B subunit of identical 103-residue B polypeptides. The A subunit is proteolytically cleaved within a disulfide-linked loop to generate the A1 and A2 fragments. The B subunit of wild-type (wt) CT binds 5 cell surface ganglioside GM
1
(GM
1
) molecules, and the toxin-GM
1
complex traffics from the plasma membrane (PM) retrograde through endosomes and the Golgi apparatus to the endoplasmic reticulum (ER). From the ER, the enzymatic A1 fragment retrotranslocates to the cytosol to cause disease. Clustering of GM
1
by multivalent toxin binding can structurally remodel cell membranes in ways that may assist toxin uptake and retrograde trafficking. We have recently found, however, that CT may traffic from the PM to the ER by exploiting an endogenous glycosphingolipid pathway (A. A. Wolf et al., Infect. Immun. 76:1476–1484, 2008, and D. J. F. Chinnapen et al., Dev. Cell 23:573–586, 2012), suggesting that multivalent binding to GM
1
is dispensable. Here we formally tested this idea by creating homogenous chimeric holotoxins with defined numbers of native GM
1
binding sites from zero (nonbinding) to five (wild type). We found that a single GM
1
binding site is sufficient for activity of the holotoxin. Therefore, remodeling of cell membranes by mechanisms that involve multivalent binding of toxin to GM
1
receptors is not essential for toxicity of CT.

IMPORTANCE
Through multivalent binding to its lipid receptor, cholera toxin (CT) can remodel cell membranes in ways that may assist host cell invasion. We recently found that CT variants which bind no more than 2 receptor molecules do exhibit toxicity, suggesting that CT may be able to enter cells by coopting an endogenous lipid sorting pathway without clustering receptors. We tested this idea directly by using purified variants of CT with zero to five functional receptor-binding sites (BS). One BS enabled CT to intoxicate cells, supporting the conclusion that CT can enter cells by coopting an endogenous lipid-sorting pathway. Although multivalent receptor binding is not essential, it does increase CT toxicity. These findings suggest that achieving higher receptor binding avidity or affecting membrane dynamics by lipid clustering and membrane remodeling may be driving forces for evolution of AB
5
subunit toxins that can bind multivalently to cell membrane lipid receptors.
Gain in lung function after weight reduction in severely obese children
Authors: van de Griendt E J , van der Baan-Slootweg O H , van Essen-Zandvliet E E M , van der Palen J , Tamminga-Smeulders C L J , Benninga M A , van Aalderen W M C
Published: October 2012

Aim

The primary objective of this prospective cohort study was to determine the effect of weight loss on pulmonary function values in extremely obese children.

Methods

Obese children participated in a 26-week in-hospital or outpatient multidisciplinary treatment programme. Waist circumference was measured and pulmonary function tests were performed at enrolment and after 6 months.

Results

The data of 112 children were analysed. The children had a mean age of 14.4 (range 8.5–18.9) years and 62.5% were girls. The mean SD score-body mass index (SDS-BMI) was +3.38 at baseline and +2.91 after the intervention. Lung function improved significantly: functional vital capacity increased by 3.08% (95% CI 1.16% to 5.00%) of the predicted value, forced expiratory volume in 1 s (FEV1) by 2.91% (95% CI 1.11% to 4.71%) of the predicted value, total lung capacity by 2.27% (95% CI 1.16% to 5.00%) of the predicted value, and expiratory reserve volume (ERV) by 14.8% (95% CI 8.66% to 20.88%) of the predicted value. The increase in ERV correlated with the reduction in SDS-BMI and with the reduction in waist circumference. FEV1 did not correlate with the reduction in either SDS-BMI or waist circumference.

Conclusions

Weight loss in severely obese children correlated with an improvement in lung function, especially ERV. The improvement in ERV correlated with the decrease in SDS-BMI and waist circumference.
The prevalence and clinical significance of sonographic tendon abnormalities in asymptomatic ballet dancers: a 24-month longitudinal study
Authors: Comin Jules , Cook Jill L , Malliaras Peter , McCormack Moira , Calleja Michelle , Clarke Andrew , Connell David
Published: October 2012

Introduction

Sonographic abnormalities of the achilles and patellar tendons are common findings in athletes, and tendinopathy is a common cause of pain and disability in athletes. However, it is unclear whether the sonographic changes are pathological or adaptive, or if they predict future injury.

We undertook a cohort study to determine what sonographic features of the achilles and patellar tendons are consistent with changes as a result of ballet training, and which may be predictive of future development of disabling tendon symptoms.

Methods

The achilles and patellar tendons of 79 (35 male, 44 female) professional ballet dancers (members of the English Royal Ballet) were examined with ultrasound, measuring proximal and distal tendon diameters and assessing for the presence of hypoechoic change, intratendon defects, calcification and neovascularity. All subjects were followed for 24 months for the development of patellar tendon or achilles-related pain or injury severe enough to require time off from dancing.

Results

Sonographic abnormalities were common among dancers, both male and female, and in both achilles and patellar tendons. Disabling tendon-related symptoms developed in 10 dancers and 14 tendons: 7 achilles (3 right, 4 left) and 7 patellar (2 right, 5 left). The presence of moderate or severe hypoechoic defects was weakly predictive for the development of future disabling tendon symptoms (p=0.0381); there was no correlation between any of the other sonographic abnormalities and the development of symptoms.

There was no relationship between achilles or patellar tendons’ diameter, either proximal or distal, with an increased likelihood of developing tendon-related disability.

Conclusion

The presence of sonographic abnormalities is common in ballet dancers, but only the presence of focal hypoechoic changes predicts the development of future tendon-related disability. This suggests that screening of asymptomatic individuals may be of use in identifying those who are at higher risk of developing tendon-related disability, which may in turn allow targeted modifications of training or other preventative regimens.
Three-year follow-up of a randomised clinical trial of intravenous versus oral iron for anaemia in pregnancy
Authors: Khalafallah Alhossain A , Dennis Amanda E , Ogden Kath , Robertson Iain , Charlton Ruth H , Bellette Jackie M , Shady Jessica L , Blesingk Nep , Ball Madeleine
Published: October 2012

Background

To date, there are no data available concerning the impact of iron therapy on the long-term well-being and health-related quality of life (HRQoL) in pregnancy.

Objective

To assess the long-term effect of iron therapy on HRQoL in pregnancy.

Design

This is a follow-up study conducted between January 2010 and January 2011 of an earlier randomised open-label clinical trial of intravenous and oral iron versus oral iron for pregnancy-related iron deficiency anaemia. We used a modified version of the SF-36 questionnaire together with the original prospective HRQoL data collected during and after pregnancy.

Participants and interventions

Of the original evaluable 183 pregnant Caucasian women randomised to receive oral iron or a single intravenous iron polymaltose infusion followed by oral iron maintenance, 126 women completed the follow-up HRQoL study.

Methods

The participants were followed up 4 weeks after treatment, predelivery and postdelivery for a median period of 32 months (range, 26–42) with a well-being and HRQoL questionnaire using a modified SF-36 QoL-survey and child growth charts as set by the Australasian Paediatric Endocrine Group (APEG).

Results

Patients who received intravenous iron demonstrated significantly higher haemoglobin and serum ferritin levels (p<0.001). There were strong associations between iron status and a number of the HRQoL parameters, with improved general health (p<0.001), improved vitality (physical energy) (p<0.001), less psychological downheartedness (p=0.005), less clinical depression (p=0.003) and overall improved mental health (p<0.001). The duration of breastfeeding was longer (p=0.046) in the intravenous iron group. The babies born in both groups recorded similarly on APEG growth chart assessments.

Conclusions

Our data suggest that HRQoL is improved until after pregnancy in anaemic pregnant women by repletion of their iron stores during pregnancy. About 80% of the intravenous iron group showed a maintained normal ferritin until delivery with long-term benefits. Further studies to confirm these findings are warranted.
Children's surgery: a national survey of consultant clinical practice
Authors: Mason David G , Shotton Hannah , Wilkinson Kathleen A , Gough Michael J , Alleway Robert , Freeth Heather , Mason Marisa
Published: October 2012

Objectives

To survey clinical practice and opinions of consultant surgeons and anaesthetists caring for children to inform the needs for training, commissioning and management of children's surgery in the UK.

Design

The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) hosted an online survey to gather data on current clinical practice of UK consultant surgeons and anaesthetists caring for children.

Setting

The questionnaire was circulated to all hospitals and to Anaesthetic and Surgical Royal Colleges, and relevant specialist societies covering the UK and the Channel Islands and was mainly completed by consultants in District General Hospitals.

Participants

555 surgeons and 1561 anaesthetists completed the questionnaire.

Results

32.6% of surgeons and 43.5% of anaesthetists considered that there were deficiencies in their hospital's facilities that potentially compromised delivery of a safe children's surgical service. Almost 10% of all consultants considered that their postgraduate training was insufficient for current paediatric practice and 20% felt that recent Continued Professional Development failed to maintain paediatric expertise. 45.4% of surgeons and 39.2% of anaesthetists considered that the current specialty curriculum should have a larger paediatric component. Consultants in non-specialist paediatric centres were prepared to care for younger children admitted for surgery as emergencies than those admitted electively. Many of the surgeons and anaesthetists had <4 h/week in paediatric practice. Only 55.3% of surgeons and 42.8% of anaesthetists participated in any form of regular multidisciplinary review of children undergoing surgery.

Conclusions

There are significant obstacles to consultant surgeons and anaesthetists providing a competent surgical service for children. Postgraduate curricula must meet the needs of trainees who will be expected to include children in their caseload as consultants. Trusts must ensure appropriate support for consultants to maintain paediatric skills and provide the necessary facilities for a high-quality local surgical service.
Incidence of obstetric anal sphincter injuries after training to protect the perineum: cohort study
Authors: Laine Katariina , Skjeldestad Finn Egil , Sandvik Leiv , Staff Anne Cathrine
Published: October 2012

Objective

To compare the incidence of obstetric anal sphincter injuries (OASIS) in two time periods, before and after implementing a training programme for improved perineal support aimed at reducing the incidence of obstetric anal sphincter injuries. The secondary aim was to study incidence of obstetric anal sphincter injuries in subgroups defined by risk factors for OASIS.

Design

Population-based cohort study.

Setting

University hospital setting in Oslo, Norway.

Participants

Two cohorts of all delivering women in the largest hospital in Norway during two time periods (2003–2005 and 2008–2010) were studied. After excluding caesarean sections and preterm deliveries (< week 32), the study population consisted of 31 709 deliveries, among which 907 women were identified with obstetric anal sphincter injury.

Primary and secondary outcome measures

Incidence of OASIS in two time periods. Maternal, obstetrical and foetal risk factors for OASIS were collected from the hospital obstetric database. Univariate analyses and multivariate logistic regression analyses, presenting adjusted ODs for OASIS, were performed.

Results

The OASIS incidence was significantly reduced by 50%, from 4% (591/14787) in the first time period to 1.9% (316/16 922) in the second. This reduction could not be explained by changes in population characteristics or OASIS risk factors during the study years. The reduction of incidence of OASIS between the two study periods was consistent across subgroups of women; regardless of parity, delivery method and infant birth weight.

Conclusions

A marked reduction in the incidence of OASIS was observed in all studied subgroups of women after implementing the training programme for perineal protection. Further, this reduction could not be explained by the differences in patient characteristics across the study period. These findings indicate that the training programme with improved perineal protection markedly reduced the risk of OASIS.
Early assisted discharge with generic community nursing for chronic obstructive pulmonary disease exacerbations: results of a randomised controlled trial
Authors: Utens Cecile M A , Goossens Lucas M A , Smeenk Frank W J M , Rutten-van Mölken Maureen P M H , van Vliet Monique , Braken Maria W , van Eijsden Loes M G A , van Schayck Onno C P
Published: October 2012

Objectives

To determine the effectiveness of early assisted discharge for chronic obstructive pulmonary disease (COPD) exacerbations, with home care provided by generic community nurses, compared with usual hospital care.

Design

Prospective, randomised controlled and multicentre trial with 3-month follow-up.

Setting

Five hospitals and three home care organisations in the Netherlands.

Participants

Patients admitted to the hospital with an exacerbation of COPD. Patients with no or limited improvement of respiratory symptoms and patients with severe unstable comorbidities, social problems or those unable to visit the toilet independently were excluded.

Intervention

Early discharge from hospital after 3 days inpatient treatment. Home visits by generic community nurses. Primary outcome measure was change in health status measured by the Clinical COPD Questionnaire (CCQ). Treatment failures, readmissions, mortality and change in generic health-related quality of life (HRQL) were secondary outcome measures.

Results

139 patients were randomised. No difference between groups was found in change in CCQ score at day 7 (difference in mean change 0.29 (95% CI −0.03 to 0.61)) or at 3 months (difference in mean change 0.04 (95% CI –0.40 to 0.49)). No difference was found in secondary outcomes. At day 7 there was a significant difference in change in generic HRQL, favouring usual hospital care.

Conclusions

While patients’ disease-specific health status after 7-day treatment tended to be somewhat better in the usual hospital care group, the difference was small and not clinically relevant or statistically significant. After 3 months, the difference had disappeared. A significant difference in generic HRQL at the end of the treatment had disappeared after 3 months and there was no difference in treatment failures, readmissions or mortality. Early assisted discharge with community nursing is feasible and an alternative to usual hospital care for selected patients with an acute COPD exacerbation.

Trial registration:NetherlandsTrialRegister NTR 1129.
Handover training: does one size fit all? The merits of mass customisation
Authors: Kicken Wendy , Van der Klink Marcel , Barach Paul , Boshuizen HPA
Published: October 2012

Background

Experts have recommended training and standardisation as promising approaches to improve handovers and minimise the negative consequences of discontinuity of care. Yet the content and delivery of handover training have been only superficially examined and described in literature.

Objective

The aim of this study was to formulate recommendations for effective handover training and to examine whether standardisation is a viable approach to training large numbers of healthcare professionals.

Methods

A training needs analysis was conducted by means of a questionnaire, which was filled out by 96 healthcare professionals in primary and secondary care in the Netherlands, Spain, Sweden and Poland. Preferences and recommendations regarding training delivery aspects and training topics that should be included in the handover training were measured.

Results

The majority of the participants recommended a short conventional training session with practice assignments, to be completed in small, multidisciplinary groups. Formal examination, e-learning and self-study were not favoured. Recommended training topics were: communication skills, standardised procedures, knowing what to hand over, alertness to vulnerable patient groups and awareness of responsibility.

Conclusions

The idea of completely standardised handover training is not in line with the identified differences in preferences and recommendations between different handover stakeholders. Mass customisation of training, in which generic training is adapted to local or individual needs, presents a promising solution to address general and specific needs, while containing the financial and time costs of designing and delivering handover training.
Beliefs and experiences can influence patient participation in handover between primary and secondary care—a qualitative study of patient perspectives
Authors: Flink Maria , Öhlén Gunnar , Hansagi Helen , Barach Paul , Olsson Mariann
Published: October 2012

Background

Communication between healthcare settings at patient transfers between primary and secondary care, ‘handover’, is a critical and risky process for patients. Patients’ views on their roles in these processes are often lacking despite the knowledge that patient participation contributes to enhanced safety and wellbeing.

Objective

This study aims to improve the knowledge and understanding of patients’ perspectives about their participation in handover.

Methods

Twenty-three Swedish patients with chronic diseases were individually interviewed about their experiences with handovers between three clinical microsystems: emergency room, emergency ward and primary healthcare centres. Data were analysed using inductive qualitative content analysis.

Results

Patients participated within the microsystems by exchanging information, and between microsystems by making contact with and conveying information to their next healthcare provider. Enablers for participation included positive encounters with providers, patient empowerment and beliefs about organisational factors. Patients’ trust in their providers, and providers’ attitudes were important factors in patients’ willingness to communicate. Patients who thought medical records access was shared across microsystems volunteered less information to their providers. Patients with experiences of non-effective handovers took more responsibility in the handover to ensure continuity of care.

Conclusions

Patients participate actively in handovers when they feel a need for involvement to ensure continuity of care, and are less active when they perceive that their contribution is unnecessary or not valued. In acute care settings with short hospital stays and less time to establish a trusting relationship between patients and their providers, discharge encounters may be important enablers for patient engagement in handovers. The advantages of a redundant handover process need to be considered.
Improving the correct prescription and dosage of gentamicin
Authors: Qureshi Dr. Imran , Habayeb Mr. Hani , Grundy Dr. Clive
Published: October 2012

Gentamicin is an amino glycoside antibiotic, which is used predominantly in gram-negative infections but also has anti-staphylococcal activity. It is commonly used because of its lack of diffogenicity. There are recognised issues with its dosing of which time is a major factor.

A baseline study demonstrated that dosing was only being carried out correctly 30% of the time. This has serious consequences for the treatment of infections. This quality improvement project intervened with the use of a gentamicin calculator, which enabled users to perform three complex mathematical equations simultaneously without error. Post measurement demonstrated that correct dosing had increased to 92%, which was a significant increase.
A comparison of three supraglottic airway devices used by healthcare professionals during paediatric resuscitation simulation
Authors: Schunk Domagoj , Ritzka Markus , Graf Bernhard , Trabold Benedikt
Published: October 2012

Objective

The aim of this study was to determine the best airway device among the laryngeal mask, I-gel and the laryngeal tube used by healthcare professional groups with different levels of experience with paediatric airway management.

Method

Three groups of healthcare professionals were separately provided with brief supervised training in using the three devices. Afterwards the participants were asked to place the airway device. For every participant, the positioning of each device was recorded. The success rate and timing of insertion were measured. Furthermore, each insertion was scored for the ease of insertion, clinical and fibreoptic verification of the position and successful ventilation.

Results

A total of 66 healthcare providers (22 paramedics, 22 nurse anaesthetists and 22 anaesthesia residents) participated in the study. The median time of insertion of both the laryngeal mask and the tube was significantly longer than for the I-gel for all professional groups (p<0.001). The success rate with the I-gel was higher than that with the laryngeal mask or tube (p<0.001). Except for the laryngeal mask, there were no differences among the professional groups regarding the fibreoptic evaluation.

Conclusions

In terms of both the time required for successful placement and the rate of successful placement, the I-gel is superior to the laryngeal mask and tube in paediatric resuscitation simulations by healthcare professional groups with different levels of experience with paediatric airway management.
Comparison of outcomes in patients with head trauma, taking preinjury antithrombotic agents
Authors: Falzon Claire Marie , Celenza Antonio , Chen Weiwen , Lee Gabriel
Published: October 2012

Background

This study compares clinical outcomes in patients with head trauma, taking preinjury antiplatelet drugs (aspirin, clopidogrel) and anticoagulants (warfarin).

Methods

A prospective observational cohort study of prognosis in head-injured patients was undertaken in the emergency (ED) department of an adult tertiary hospital with a statewide neurosurgical service from 2008 to 2010. A convenience sample of patients taking warfarin, aspirin, clopidogrel or mixed therapy presenting to the ED with head trauma were included and followed-up over 3–18 months. Outcomes were severity of brain injury on neuroimaging, intensive care unit admission, intracranial surgery, intracranial complications, death in hospital, altered Glasgow Coma Score (GCS) on hospital discharge, and mortality and function scores on follow-up.

Results

Overall, 345 patients were included in the study. Of these, 164, 70, 55 and 56 were taking aspirin, warfarin, clopidogrel and combination agents, respectively, with 250 having neuroimaging in the ED. Neuroimaging was significantly more likely to be undertaken in patients with a more urgent triage score (p<0.001), an abnormal GCS (p=0.004), older patients (p=0.039), and those taking warfarin (p<0.001). In patients receiving neuroimaging and admitted to hospital, the proportion with acute brain injury, poor hospital outcomes or overall poor outcomes were not statistically different between the agent groups.

Conclusions

A high proportion of patients taking warfarin underwent neuroimaging, but brain injury and admission rates were comparable between groups. There were no significant differences in short-term outcomes between the groups. The overall mortality is higher for patients on antiplatelet agents than warfarin.
The effect of admitted patients in the emergency department on rates of hospital admissions
Authors: Fogarty Eoin M , Cummins Fergal
Published: October 2012

Emergency Department overcrowding with admitted inpatients is a common international occurrence. We undertook a retrospective review to compare patient admission rates from patients presenting to our Emergency Department with the level of overcrowding with admitted inpatients on that particular day in the Emergency Department. Over the 2-year study period there was no change in the rate or absolute number of admissions per day compared with the level of inpatient overcrowding.
Predictors of outcome in routine care for Cryptococcal meningitis in Western Kenya: lessons for HIV outpatient care in resource-limited settings
Authors: Kendi Caroline , Penner Jeremy , Koech Julius , Nyonda Mary , Cohen Craig R , Bukusi Elizabeth A , Ngugi Evelyn , Meyer Ana-Claire Lew
Published: October 2012

Purpose

Cryptococcal meningitis is a leading cause of mortality among HIV-infected individuals in sub-Saharan Africa but little is known about its treatment and outcomes in decentralised HIV outpatient settings. We assessed adherence to treatment guidelines and determined predictors of survival.

Design

A computerised laboratory database identified HIV-infected adults with cryptococcal meningitis at Family AIDS Care and Education Services in Nyanza Province, Kenya, between 2005–2009. Medical records were reviewed. Kaplan-Meier survival curves were generated. Bivariate and multivariate Cox proportional hazards models were used to determine associations between key clinical characteristics and survival.

Results

Medical records were located for 79% (71/90). Mortality was 38% (27/71) over a median follow-up period of 201 days (IQR: 10–705 days). Adherence to local guidelines for treatment of cryptococcal meningitis was 48% (34/71). Higher body mass index was associated with improved survival (HR: 0.82, 95% CI (0.68 to 0.99)) even after controlling for factors such as age, CD4 cell count, receipt of highly active anti-retroviral therapy, and treatment with any anti-fungal therapy.

Conclusions

Cryptococcal meningitis diagnosed in routine HIV outpatient settings is largely treated as an outpatient and adherence to treatment guidelines is poor. Body mass index is a critical independent predictor of outcome. Additional research to determine the most effective strategies to reduce premature mortality is urgently needed.
Systematic review examining differences in HIV, sexually transmitted infections and health-related harms between migrant and non-migrant female sex workers
Authors: Platt Lucy , Grenfell Pippa , Fletcher Adam , Sorhaindo Annik , Jolley Emma , Rhodes Tim , Bonell Chris
Published: October 2012

Objectives

To assess the evidence of differences in the risk of HIV, sexually transmitted infections (STI) and health-related behaviours between migrant and non-migrant female sex workers (FSWs).

Methods

Systematic review of published peer-reviewed articles that reported data on HIV, STIs or health-related harms among migrant compared with non-migrant FSWs. Studies were mapped to describe their methods and focus, with a narrative synthesis undertaken to describe the differences in outcomes by migration status overall and stratified by country of origin. Unadjusted ORs are presented graphically to describe differences in HIV and acute STIs among FSWs by migration and income of destination country.

Results

In general, migrant FSWs working in lower-income countries are more at risk of HIV than non-migrants, but migrants working in higher-income countries are at less risk. HIV prevalence was higher among migrant FSWs from Africa in high-income countries. Migrant FSWs in all countries are at an increased risk of acute STIs. Study designs, definitions of FSWs and recruitment methods are diverse. Behavioural data focussed on sexual risks.

Discussion

The lack of consistent differences in risk between migrants and non-migrants highlights the importance of the local context in mediating risk among migrant FSWs. The higher prevalence of HIV among some FSWs originating from African countries is likely to be due to infection at home where HIV prevalence is high. There is a need for ongoing monitoring and research to understand the nature of risk among migrants, how it differs from that of local FSWs and changes over time to inform the delivery of services.
Cervical human papillomavirus detection is not affected by menstrual phase
Authors: Tota Joseph E , Ramanakumar Agnihotram V , Mahmud Salaheddin M , Trevisan Andrea , Villa Luisa L , Franco Eduardo L ,   the Ludwig-McGill Cohort Study Group
Published: October 2012

Objectives

In many settings, human papillomavirus (HPV) DNA testing already plays an important role in cervical cancer screening. It is unclear whether hormonal fluctuations associated with menstrual phase or oral contraceptive (OC) use have any effect on HPV detection. We evaluated the effects of OC use and timing of cervical sampling in relation to women's last menstrual period (LMP) on HPV detection, and viral load in the Brazilian Ludwig–McGill cohort study.

Methods

Women in the cohort were followed every 4–6 months, and at each clinic visit they were asked to complete a questionnaire and to provide a cervical sample for HPV testing. Specimens from 6093 patient visits (n=2209 women) were categorised according to date of LMP into four distinct phases: follicular (days 5–9), midcycle (days 10–15), luteal (days 16–22), or late luteal (days 23–31).

Results

Compared with follicular phase (referent group), HPV detection did not differ according to reported LMP for midcycle (OR=1.14, 95% CI 0.95 to 1.37), luteal (OR=1.03, 95% CI 0.85 to 1.25), or late luteal menstrual phase (OR=1.01, 95% CI 0.83 to 1.24), and was also not influenced by OC use. Analyses restricted to high-risk HPV types (grouped) and HPVs 16 and 18 (separately), produced similar non-significant associations. For HPV-positive samples, we found that the menstrual phase did not influence the total viral load.

Conclusions

These results indicate HPV detection is not associated with menstrual phase. Our findings suggest that standardising the timing of specimen collection for HPV testing is not necessary.
DoAtopobium vaginae, Megasphaerasp. andLeptotrichiasp. change the local innate immune response and sialidase activity in bacterial vaginosis?
Authors: Marconi Camila , Donders Gilbert G , Parada Cristina M G L , Giraldo Paulo C , da Silva Márcia Guimarães
Published: October 2012

Objectives

To investigate if the participation ofAtopobium vaginae,Megasphaerasp. andLeptotrichiasp. in the bacterial community of bacterial vaginosis (BV) is associated with distinct patterns of this condition.

Methods

In this cross-sectional controlled study, 205 women with BV and 205 women with normal flora were included. Vaginal rinsing samples were obtained for measuring the levels of pro-inflammatory cytokines and bacterial sialidases. Real-time PCR was used to quantify the BV-associated bacteria and to estimate the total bacterial load using the 16S rRNA. Principal component analysis (PCA) using the measured parameters was performed to compare the BV samples with lower and higher loads of the species of interest.

Results

Higher bacterial load (p<0.001), levels of interleukin 1-β (p<0.001) and sialidase activity (p<0.001) were associated with BV. Women with BV and higher relative loads ofA vaginae,Megasphaerasp. andLeptotrichiasp. presented increased sialidase activity, but unchanged cytokine levels. PCA analysis did not indicate a different pattern of BV according to the loads ofA vaginae,Megasphaerasp. andLeptotrichiasp.

Conclusions

Greater participation ofA vaginae,Megasphaerasp. andLeptotrichiasp. in vaginal bacterial community did not indicate a less severe form of BV; moreover, it was associated with increased sialidase activity.
Male circumcision reduces penile high-risk human papillomavirus viral load in a randomised clinical trial in Rakai, Uganda
Authors: Wilson Lauren E , Gravitt Patti , Tobian Aaron A R , Kigozi Godfrey , Serwadda David , Nalugoda Fred , Watya Stephen , Wawer Maria J , Gray Ronald H
Published: October 2012

Objectives

Male circumcision reduces penile high-risk human papillomavirus (HR-HPV) prevalence in randomised trials. The goal of this study was to examine the effect of circumcision on HPV viral load among HPV-infected men in a randomised trial of male circumcision.

Methods

In a randomised trial to assess the efficacy of circumcision on HIV acquisition in Rakai, Uganda, HIV-negative men were randomised to immediate (intervention) or delayed (control) circumcision and followed over 24 months. We performed quantitative-PCR HPV viral load assays on penile swabs which tested positive by Linear Array (LA) for six HR-HPV genotypes and estimated viral load in the remaining types by LA signal strength.

Results

At 24 months, circumcision intervention arm men infected with one of the six selected HR-HPV genotypes had a lower viral load and significantly reduced HR-HPV high LA band intensity (PRR=0.61, 95% CI 0.43 to 0.86) compared to infected men in the control arm of the trial. The decreased viral load associated with circumcision was seen among HPV infections acquired after enrolment but not among infections that persisted from trial enrolment to 24 months (p=0.80).

Conclusions

The decreased penile HR-HPV shedding observed among HPV-infected circumcised men may help to explain the protective association observed between circumcision and reduced acquisition of HR-HPV in female partners.
Comment on “Vegetation height and egg coloration differentially affect predation rate and overheating risk: an experimental test mimicking a ground-nesting bird” 1Appears in Can. J. Zool. 90(6): 694–703. doi: 10.1139/z2012-035.
Authors: Ruxton Graeme D.
Published: October 2012

It is often assumed that darker colored avian eggs are more at risk from overheating in direct sunlight than paler eggs. In fact, the evidence for this lies solely in studies using unnatural pigments; studies with natural pigments find no such effect. I argue that risk of egg overheating likely affects the behaviour of birds nesting in hot environments, but there is no evidence or physical reason to expect it to have a strong influence on egg coloration.
mtDNA and AFLP markers demonstrate limited genetic differentiation within thePyganodon cataracta–Pyganodon fragilisfreshwater mussel complex in Atlantic Canada
Authors: Stanton L.M. , Hoeh W.R. , McAlpine D.F. , Hebda A. , Stewart D.T.
Published: October 2012

Two nominal species of freshwater mussels, Pyganodon cataracta (Say, 1817) (eastern floater) and Pyganodon fragilis (Lamarck, 1819) (Newfoundland floater), occur in Atlantic Canada, but their taxonomic status has been controversial. We analyzed the female-transmitted mitochondrial cytochrome c oxidase subunit I (i.e., FCOI) and nuclear internal transcribed spacer region (ITS-1) gene sequences, as well as multilocus amplified fragment length polymorphism (AFLP) markers, to evaluate genetic variation in Pyganodon specimens from Atlantic Canada. We found that Pyganodon samples from this region displayed no or extremely low (i.e., <0.5%) genetic divergence for ITS-1 and FCOI sequence data, respectively. Inferences from nested clade analysis of FCOI haplotypes suggest restricted gene flow with isolation by distance and contiguous range expansion. Analysis of molecular variance inferred from presence or absence of nuclear-encoded AFLP bands showed moderate geographic structuring among provinces but no correspondence between mtDNA haplotypes and AFLP profiles. Similarly, there was no correspondence between presence of a single or a double loop on the umbo and FCOI haplotype. These mtDNA and AFLP markers demonstrate limited genetic differentiation within the Pyganodon cataracta–Pyganodon fragilis freshwater mussel complex in Atlantic Canada and question the species-level distinctness of these putative taxa.
Effects of formalin preservation on invertebrate stable isotope values over decadal time scales
Authors: Rennie Michael D. , Ozersky Ted , Evans David O.
Published: October 2012

Stable isotope values derived from chemically preserved organisms are a valuable resource for documenting long-term ecosystem changes. However, isotopic correction factors of preservation effects applied to samples stored for decades are frequently based on studies lasting only months, assuming that the effects of preservation stabilize within a short time frame. Very few studies test this critical assumption. We validated this assumption for formalin-preserved invertebrate tissues, finding no significant difference between mean isotopic δ13C and δ15N values of material stored 1–15 years across taxa. Preservation effects were evaluated for Amphipoda, Chironomidae, Dreissenidae, Ephemeroptera, Gastropoda, Isopoda, Sphaeridae, Oligochaeta, and Trichoptera. On average, freshwater benthos δ13C was lower by approximately 2‰ after formalin fixation, whereas δ15N values were not different from control samples. Fixation effects were similar among taxa, but were more pronounced in Gastropoda and Sphaeridae for δ13C and in Trichoptera for δ15N. We reviewed the literature to show that preserved freshwater zooplankton δ13C were slightly but significantly lower relative to control samples (–0.2‰) and higher in δ15N (+0.25‰). The mean decline among marine invertebrate δ13C was greater than for freshwater invertebrates after 1+ years of formalin preservation, but effects on δ15N were not different between marine and freshwater invertebrates.
Foraging habitat and diet of Song Sparrows (Melospiza melodia) nesting in farmland: a stable isotope approach
Authors: Girard J. , Baril A. , Mineau P. , Fahrig L.
Published: October 2012

Agricultural intensification has been linked to declines in farmland and grassland bird populations in Europe and in North America. One factor thought to be behind these declines is reduced invertebrate food abundance in the breeding season, leading to reduced reproductive success. However, little is known about foraging habitat or diet of farmland birds in North America. We used stable isotopes to study foraging habitat and diet of Song Sparrows ( Melospiza melodia (A. Wilson, 1810)), a common hedgerow-breeding bird, by collecting claw clippings of Song Sparrow nestlings from farms in eastern Ontario, Canada. Mean values of δ13C and δ15N were compared between claws and invertebrate food sources from adjacent land-cover types, using a Bayesian mixing model. The portion of nestling diet that came from seminatural and forage habitats was higher than expected, based on the proportion of seminatural and forage cover at the nest. This was particularly evident at nests with low seminatural cover, where hedgerows were the only noncrop habitat. The most important food sources for Song Sparrow nestlings were hoppers (Auchenorrhyncha) and caterpillars (Lepidoptera). Management actions to increase invertebrate abundance in hedgerows may benefit Song Sparrows and other farmland birds with minimal impact on crop yield.
ON THE ⋆-PRODUCT QUANTIZATION AND THE DUFLO MAP IN THREE DIMENSIONS
Authors: ROSA LUIGI , VITALE PATRIZIA
Published: October 2012

We analyze the ⋆-product induced on ℱ(ℝ3) by a suitable reduction of the Moyal product defined on ℱ(ℝ4). This is obtained through the identification ℝ3≃𝔤*, with 𝔤 a three-dimensional Lie algebra. We consider the 𝔰𝔲(2) case, exhibit a matrix basis and realize the algebra of functions on 𝔰𝔲(2)* in such a basis. The relation to the Duflo map is discussed. As an application to quantum mechanics we compute the spectrum of the hydrogen atom.
RELATIVISTIC WAVE EQUATIONS OF n-BODY SYSTEMS OF FERMIONS AND ANTIFERMIONS OF VARIOUS MASSES IN QUANTUM ELECTRODYNAMICS
Authors: EMAMI-RAZAVI MOHSEN , BERGERON NANTEL , DAREWYCH JURIJ W.
Published: October 2012

The variational method in a reformulated Hamiltonian formalism of quantum electrodynamics (QED) is used to derive relativistic wave equations for systems consisting of n fermions and antifermions of various masses. The derived interaction kernels of these equations include one-photon exchange interactions. The equations have the expected Schrödinger non-relativistic limit. Application to some exotic few lepton systems is discussed briefly.
MODELING NEURONAL RESPONSE TO SIMULTANEOUS AND SEQUENTIAL MULTI-SITE SYNAPTIC STIMULATION
Authors: JOHNSTON DAVID , MEKHAIL SIMON PETER , GO MARY ANN , DARIA VINCENT R.
Published: October 2012

The flow of information in the brain theorizes that each neuron in a network receives synaptic inputs and sends off its processed signals to neighboring neurons. Here, we model these synaptic inputs to understand how each neuron processes these inputs and transmits neurotransmitters to neighboring neurons. We use the NEURON simulation package to stimulate a neuron at multiple synaptic locations along its dendritic tree. Accumulation of multiple synaptic inputs causes changes in the neuron's membrane potential leading to firing of an action potential. Our simulations show that simultaneous synaptic stimulation approaches firing of an action potential at lesser inputs compared to sequential stimulation at multiple sites distributed along several dendritic branches.
EEG TRANSFER ENTROPY TRACKS CHANGES IN INFORMATION TRANSFER ON THE ONSET OF VISION
Authors: MADULARA M. D. , FRANCISCO P. A. B. , NAWANG S. , AROGANCIA D. C. , CELLUCCI C. J. , RAPP P. E. , ALBANO A. M.
Published: October 2012

We investigate the pairwise mutual information and transfer entropy of ten-channel, free-running electroencephalographs measured from thirteen subjects under two behavioral conditions: eyes open resting and eyes closed resting. Mutual information measures nonlinear correlations; transfer entropy determines the directionality of information transfer. For all channel pairs, mutual information is generally lower with eyes open compared to eyes closed indicating that EEG signals at different scalp sites become more dissimilar as the visual system is engaged. On the other hand, transfer entropy increases on average by almost two-fold when the eyes are opened. The largest one-way transfer entropies are to and from the Oz site consistent with the involvement of the occipital lobe in vision. The largest net transfer entropies are from F3 and F4 to almost all the other scalp sites.
WHITE NOISE PATH INTEGRAL TREATMENT OF THE PROBABILITY DISTRIBUTION FOR THE AREA ENCLOSED BY A POLYMER LOOP IN CROSSED ELECTRIC-MAGNETIC FIELDS
Authors: GEMAO BEVERLY V. , BORNALES JINKY B.
Published: October 2012

The probability density for the area A enclosed by a polymer loop in crossed electric-magnetic fields is evaluated using the Hida-Streit formulation. In this approach, the many possible conformations of the polymer, x(v) and y(v), are represented by paths and are parametrized in terms Brownian motion. When the magnetic field is switched off, results agree with the works of Khandekar and Wiegel5
STUDIES IN FRACTIONAL POISSON MEASURES
Authors: DA SILVA JOSÉ LUÍS , OLIVEIRA MARIA JOÃO
Published: October 2012

In this paper we investigate the quasi-invariance property of fractional Poisson measures with respect to the diffeomorphism subgroup and we construct spaces of test and generalized functions associated to the corresponding fractional Lebesgue-Poisson measures.
DECAY TO EQUILIBRIUM FOR JUMP PROCESSES WITH HEAVY TAILS
Authors: DA SILVA JOSÉ LUÍS , KUNA TOBIAS
Published: October 2012

The case is made for a more careful analysis of the large time asymptotic of infinite particle systems in the thermodynamic limit beyond zero density. The insufficiency of current analysis even in the model case of free particles is demonstrated. Recent advances based on more sophisticated analytical tools like functions of mean variation and Hardy spaces are sketched.
VALIDITY OF THE BOGOLIUBOV APPROXIMATION FOR THE BOSE-EINSTEIN CONDENSATION IN A TRAP
Authors: EZAWA HIROSHI , WATANABE KEIJI , NAKAMURA KOICHI
Published: October 2012

In treating system of bosons localized in a trapping potential, having a macroscopic number N0 of them condensing at the lowest single-particle level v0, Bogoliubov approximation is to replace the creation/annihilation operators [Formula: see text] of the state v0 by [Formula: see text]. We show that this approximation is justified if the inter-particle potential is repulsive in the sense specified. In fact, we show, by using [Formula: see text], that [Formula: see text] is effectively of the order [Formula: see text] under the condition stated.