bluuebunny/crossref_metadata_2025 huggingface dataset:
Deconstructing Affirmative Action
Authors: Margaret Thornton
Published: October 2011

The phrase affirmative action (AA) has been in use in Australia for two decades, mainly in the context of improving the profile of women in the workplace. Federal legislation was enacted in 1986 but the formalistic focus on the preparation of plans, numerosity and the lodgment of reports has deflected attention away from the elusive substance of AA. The procedural veil will be lifted to focus more closely on the nature of the substance, with particular regard to managerial positions. It will be argued that the construction of femininity and masculinity, through what are termed ‘the fictive feminine’ and ‘the imagined masculine’, is resistant to structural change. However, the adoption of co-operative workplace practices, as advocated by a recent influential Australian Government report, does have the potential to challenge the gender polarity.
Sexual Harassment in the Workplace in Relation to EC Legislation
Authors: Bakirci Kadriye
Published: October 2011

The first part of the article is an outline of the nature of sexual harassment, its extent and the growing awareness of it. The second part considers why there was a need for a community initiative and looks at the extent of sexual harassment in the Member States, the consequences of sexual harassment, legal remedies and the impact it has on the community's principles, including health and safety at the workplace and the competitiveness of undertakings. The third part describes various legal instruments in the EC. The fourth part analyses the European Commission Recommendation and Code of Practice on Sexual Harassment. This section also looks at the status of the Code and why some kinds of sexual harassment are excluded from legal remedy by having sexual harassment related to the Equal Treatment Directive. Some comparisons are made between UK and US case law in this context. The fifth part concerns recommendations.
Claims-Making and the Prosecution of Black Defendants in Drug Trafficking Trials: the Influence of Deprivation
Authors: Kalunta-Crumpton Anita
Published: October 2011

The relationship between the prosecution and black 1 people has nowhere received a specific or full notice as far as analysis is concerned. On the basis of detailed observations of drug trafficking trials at a London Crown Court, this paper reveals the prosecution of cases concerning black defendants. In doing so, it demonstrates how drug trafficking cases were socially constructed through the process of claimsmaking, a rhetorical activity that entails the use of language to present and fathom claims effectively in order to persuade. The prosecution described the defendants alleged involvement in drug trafficking as a profit making venture and within the process of claims-making constructed a relationship between drug trafficking and socio-economic deprivation. Subtly, racial imageries of crime and deprivation appeared to be represented in the prosecution discourse as evidence of drug trafficking. It is concluded that the defendants faced a higher likelihood of being officially classed as drug traffickers.
Pregnancy, Equality and the European Court of Justice: Interrogating Gillespie
Authors: Conaghan Joanne
Published: October 2011

The object of this paper is to highlight and scrutinise the continuing difficulties which characterise national and European judicial efforts to reconcile the apparently conflicting needs of the workplace and its pregnant workers. In particular, the prevailing dominant legal conceptualisation of pregnancy as an aspect of sexual equality generates an unsatisfactory indeterminacy and manipulability in relation to the determination and application of women's legal rights. This is well illustrated in the decision of the European Court of Justice in Gillespie v Northern Ireland Health and Social Services Board [1996]. Both the decision itself and its legal aftermath suggest that the difficulties traditionally associated with the application of the equality principle to the condition of pregnancy are far from resolved.
The Legal Approach to Equal Opportunities in Europe: Past, Present and Future
Authors: McCrudden Christopher
Published: October 2011

The aim of this paper is to provide an overview for non-specialists of the body of law relating to equality of opportunity between women and men under European Community law. The paper considers the history of the development of equality law in EC law, describing the development of Article 119, the development of the three most important directives in the 1970s, the growth of litigation surrounding Article 119 and these Directives, the controversy over supplementary directives in the 1980s, the adoption of the Pregnancy Directive in the 1990s, and the increasing use of ‘soft law’ instruments such as in the area of equal pay and sexual harassment. The paper considers how the jurisprudence of the European Court of Justice has interpreted these legal provisions, concentrating on various themes: the concept of ‘indirect discrimination’, the appropriate use of positive action policies, and the meaning of equal pay for work of equal value, amongst other issues. The paper considers how these provisions are enforced. It sets out the role of the Commission in bringing infringement actions, the role of individual litigation in the Member States’ courts, and the role of the European Court of Justice under Article 177 references. In particular, the paper considers the extent to which the Court of Justice has scrutinised the adequacy of national enforcement of equality rights, and the principles underlying legal remedies for breach of European equality law. Finally, the paper considers the factors which are likely to influence the future of equal opportunities law in the European Community in the near future.
Forearm bone mineral density and incidence of hip fractures in Swedish urban and rural men 1987–2002
Authors: Rosengren Björn E. , Ahlborg Henrik G. , Gärdsell Per , Sernbo Ingemar , Nilsson Jan-Åke , Daly Robin M. , Karlsson Magnus K
Published: October 2011

Background: It is not known whether the recently described break in the trend in hip fracture incidence in many settings applies in both women and men, depends on changes in bone mineral density (BMD) or changes in other risk factors, or whether it is apparent in both urban and rural settings. Methods: We evaluated changes in annual hip fracture incidence from 1987 to 2002 in Swedish men aged ≥60 years in one urban ( n = 25,491) and one rural population ( n = 16,432) and also secular differences in BMD, measured by single-photon absorptiometry at the distal radius and multiple other risk factors for hip fracture in a population-based sub-sample of the urban and the rural men aged 60–80 years in 1988/89 ( n = 202 vs. 121) and in 1998/99 ( n = 79 vs. 69). Results: No statistically significant changes in the annual age-adjusted hip fracture incidence per 10,000 were apparent from 1987 to 2002 in urban (0.38 per year, 95% CI −0.12 to 0.88) or rural men (−0.05 per year, 95% CI −0.63 to 0.53). BMD was similar in 1988/89 and 1998/99 when examining both urban (−19.6 mg/cm2, 95% CI −42.6 to 3.5) and rural (−23.0 mg/cm2, 95% CI −52.1 to 6.1) men. Conclusions: Since no secular change in age-adjusted hip fracture incidence was found during the study period, a levelling off in hip fracture incidence is present also in Swedish men. Because BMD on a group level was similar in 1988/89 and 1998/99, changes in other risk factors ought to be either of minor importance or counteracted by changes in different risk factors.
Going live: News innovations amid constraints in the Chinese coverage of the Iraq War
Authors: Liang Limin
Published: October 2011

This article uses structuration and cultural production theories to analyze innovations in news-making practices during the 2003 coverage of the first major phase of the Iraq War at the English Service of China’s state broadcaster, CCTV International (renamed CCTV News in 2010). It examines forces leading to the changes and their impact on news routine and news content, finding that innovation, the introduction of live studio interviews, accompanied by various uncertainty reduction measures, creates room for more diversity of opinions. The special position of CCTV International in China’s media system allowed greater media experiment to be made possible, as newsmakers adopted ways to contend the boundary of official discourse. The study also shows that changes in news routine have been maintained over time.
Mother-child conversations at 36 months and at pre-kindergarten: Relations to children's school readiness
Authors: Cristofaro Tonia N. , Tamis-LeMonda Catherine S.
Published: October 2011

The contributions of mothers’ and children's oral language to children's school readiness were longitudinally examined among 75 low-income mothers and children. When children were 36 months, mothers’ and children's lexical diversity, mothers’ wh-questions, and children's PPVT-III scores were assessed from play interactions. At pre-kindergarten, mothers and children shared a personal narrative, and various aspects of mothers’ and children's narratives were coded. Children were assessed on their knowledge about print, letter-word identification, mathematical skills and sustained attention, and scores were combined into a single factor of school readiness. Structural equation analyses yielded two pathways to school readiness. Mothers’ wh-questions and lexical diversity predicted children's PPVT-III scores at 36 months, which in turn predicted children's school readiness. Mothers’ 36-month lexical diversity predicted mothers’ narrative prompts, which related to children's narrative contributions. Children's narrative contributions in turn predicted school readiness. Mother-child conversations support the school readiness of children from low-income backgrounds.
Quality of life in early dementia: Comparison of rural patient and caregiver ratings at baseline and one year
Authors: Heggie Marcie , Morgan Debra , Crossley Margaret , Kirk Andrew , Wong Patrick , Karunanayake Chandima , Beever Rob
Published: October 2011

This study examined change in patient and caregiver ratings of patient quality of life (QOL) over one year in individuals with dementia living in rural and remote settings. The sample was selected from non-institutionalized patients who were assessed at an interprofessional memory clinic. Measures of QOL, cognitive function, depression, and functional ability were completed by the patient. Caregivers completed measures of patient QOL and behavior, and their own burden and distress. At baseline (clinic day) 119 patients and family caregivers were assessed. Thirty-two families had complete data at clinic day and one-year follow-up. There was no significant change in either patient or caregiver-rated QOL over one year. Significant predictors of patient self-rated QOL were patient symptoms of depressed mood and functional ability at clinic day, and symptoms of depressed mood and clinic day QOL at one year. Significant predictors of caregiver-rated patient QOL were caregiver burden, patient functional ability, and symptom severity at clinic day, and caregiver burden at one year. Patient and caregiver ratings of patient QOL were moderately associated, but neither patients nor their caregivers reported a significant change in patient QOL. Changes in QOL over time remain a unique individual experience that cannot be entirely predicted by analytical models.
A grounded theory longitudinal study of carers’ experiences of caring for people with dementia
Authors: Lin Mei-Chun , Macmillan Maureen , Brown Norrie
Published: October 2011

Introduction

Increasingly the provision of care for older people with dementia has shifted from institutions to the community. This has resulted in an increase in burden and a reduction in autonomy for those who care for these individuals.

Aims

This study sought to identify, describe and explore the changes in the carers’ experiences of looking after a relative living with dementia, and the effects of caring on the carers’ autonomy and health over time.

Research Methods

A longitudinal, grounded theory approach in three phases was used. In-depth interviews were conducted with six spouses at the beginning, at six months and at eighteen months. A constant comparative analysis of taped and transcribed interviews was used.

Findings

Four categories emerged: My Life Changed, Commitment, Responsibility and Duty, and Support. The core category My Life Changed was identified as representing the beginning of the caregiving journey; and the learning from experience that occurred as a consequence of that journey, offering a new perspective on the experience of carers. Commitment refers to a deepened and sustained element; Responsibility and Duty increases over time and finally Support refers to the fluctuating nature of help provided by formal and informal sources. All participants experienced changes in the caregiving journey; the degree and nature of necessary adaptations varied.

Conclusions

A Theory of Caring emerged, but what changes were experienced did not appear to conform to any fixed pattern. All carers learned by experience to manage their situations. For all carers their autonomy and health was challenged.
Formally Developing Creative Leadership as a Driver of Organizational Innovation
Authors: Williams Felice , Foti Roseanne J
Published: October 2011

The Problem: The need for leadership development, especially as it pertains to organizational innovation, has become more imperative over the last few years. Because creativity is an important process that precedes innovation, organizations can directly stimulate innovation through the formal development of creative leaders. The Solution: By training leaders in creative problem solving and related thinking skills, as well as creating an environment conducive to developing creative leaders, organizations can better equip themselves to develop and sustain innovation. Stakeholders: Academics engaged in the study of HRD; HRD professionals engaged in training for leadership creativity, developing creativity performance measures for leaders, and assessing creative leadership performance.
Leveraging Technology to Develop Creative Leadership Capacity
Authors: Antes Alison L. , Schuelke Matthew J.
Published: October 2011

Leaders must think creatively and facilitate the creative work of others, but traditional approaches to developing leaders have not fully addressed this need. A key problem with regard to developing creative and innovative leadership capacity is the lack of clearly articulated objectives for developmental programs. Moreover, novel developmental tools and techniques may be necessary to develop these capacities. We provide a synthesis of what the existing literature indicates must be developed to facilitate creative and innovative leadership. We present the requisite knowledge and skills—complete with developmental objectives, learning prompts, and reflection questions—in a practical, summarized format. Next, we explore how creative/innovative leadership capacity in organizations might be enhanced by leveraging technology via simulations, e-mentoring, multisource feedback, social media, and succession planning programs. The design and implementation of a creative/innovative leadership program requires a shared investment by key stakeholders—senior executives, employees, managers/leaders, mentors, information technology experts, and human resource development professionals. We review the key concerns for these stakeholders and outline specific considerations for human resource development professionals.
Developing Leadership for Creative Efforts
Authors: Mumford Michael D. , Gibson Carter
Published: October 2011

Effective leader performance is critical to the success of creative efforts. Although, in recent years, the importance of leadership to creative efforts has begun to be recognized, little work has been done examining how organizations should develop people to lead these efforts. The present issue of Advances in Developing Human Resources presents a number of techniques that might be used to develop those who will be asked to lead creative efforts. The implications of these observations for HRD professionals in developing the leaders of creative efforts are discussed.
Design and Analysis of Cognitive Interviews for Comparative Multinational Testing
Authors: Miller Kristen , Fitzgerald Rory , Padilla José-Luis , Willson Stephanie , Widdop Sally , Caspar Rachel , Dimov Martin , Gray Michelle , Nunes Cátia , Prüfer Peter , Schöbi Nicole , Schoua-Glusberg Alisú
Published: October 2011

This article summarizes the work of the Comparative Cognitive Testing Workgroup, an international coalition of survey methodologists interested in developing an evidence-based methodology for examining the comparability of survey questions within cross-cultural or multinational contexts. To meet this objective, it was necessary to ensure that the cognitive interviewing (CI) method itself did not introduce method bias. Therefore, the workgroup first identified specific characteristics inherent in CI methodology that could undermine the comparability of CI evidence. The group then developed and implemented a protocol addressing those issues. In total, 135 cognitive interviews were conducted by participating countries. Through the process, the group identified various interpretive patterns resulting from sociocultural and language-related differences among countries as well as other patterns of error that would impede comparability of survey data.
Recognizing Cesarean Delivery on Maternal Request as a Social Problem
Authors: Yamamoto Sherry L.
Published: October 2011

Nearly one in three babies in the United States are now born surgically. While many causes for this surge in cesareans have been suggested, the phenomenon of cesarean delivery on maternal request (CDMR) has been the subject of the most controversy. Utilizing Hilgartner and Bosk’s public arenas model, this article examines the ways in which CDMR has been framed and a collective definition of the problem established. Recognizing CDMR as a social problem is the first step to creating policies to ensure that the health and safety of mothers and babies are protected.
Cognitive-Behavioral Group Treatment for a Sexually Abused Child and a Nonoffending Caregiver
Authors: Hubel Grace S. , Maldonado Rosalita C. , Tavkar Poonam , Hansen David J. , Flood Mary Fran
Published: October 2011

This study presents the case of 11-year-old Amanda and her mother (Ms. Jones) who completed Project SAFE (Sexual Abuse Family Education), a manualized group treatment for sexually abused children and their nonoffending caregivers. Amanda experienced sexual abuse by her stepfather on multiple occasions over a 4-year period. Prior to treatment, Amanda reported symptoms of anxiety, posttraumatic stress, and fear related to victimization. Ms. Jones also reported clinically significant internalizing problems for Amanda. Ms. Jones presented with stress related to parenting, as well as depression and anxiety. Both Amanda and Ms. Jones completed the entire 12-session protocol. Amanda and Ms. Jones’s progress throughout treatment are described, along with implications of the case and recommendations for clinicians and students. Results support the efficacy of the group modality, the importance of including nonoffending caregivers, and the necessity of broad treatment strategies when treating children who have experienced sexual abuse.
Complex Abdominal Wall Repair Using a Porcine Dermal Matrix
Authors: Gentile Pietro , Colicchia Gianfranco Marcello , Nicoli Fabio , Cervelli Giulio , Curcio Cristiano Beniamino , Brinci Lorenzo , Cervelli Valerio
Published: October 2011

Management of complex abdominal defects remains a significant challenge for many surgeons, especially in contaminated fields. Currently, available biosynthetic grafts include human cadaveric dermis (AlloDerm), porcine dermal (Permacol and Strattice), and submucosal (Surgisis) sources. All these grafts are composed of an acellular collagen scaffold to provide a bridge for tissue incorporation and neovascularization. The authors describe a case report of a woman who required dual mesh explantation and successive reparative surgery using a porcine dermal matrix for a complex and infected abdominal wound. Twelve months postdischarge the patient remains well, she is pain free, and she returned home to full activities with complete wound closure and without any evidence of residual or recurrent hernia. The patient was satisfied with her cosmetic results. In conclusion, the authors’ experience shows that the use of Permacol, a porcine dermal matrix, has been successful in treating an infected abdomen and a vast abdominal wall defect.
Commemoration and processes of appropriation: The Italian Communist Party and the Italian Resistance (1943–48)
Authors: Cossu Andrea
Published: October 2011

Scholarship on collective memory often conceives struggles over the past as directly dependent on the structure of interests in the present. However, temporal constraints affect the way the past is selected and represented. In this article I focus on the appropriation of the memory of the Resistance by the Italian Communist Party in the years between 1943 and 1948. I highlight, following a growing literature on the path dependence of memory, that the consolidation of the memory of this period was conditioned not only by the political culture of the organization, but also by the internal dynamics and the specific genre of communist commemoration.
Fine needle aspiration at endoscopic ultrasound with a novel side-port needle: a pilot experience
Authors: Kaffes Arthur , Corte Crispin
Published: October 2011

Background: Diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration (EUS FNA) varies relating to the equipment used and the site targeted. Multiple needle passes are usually required to obtain a diagnosis. A new needle incorporating a side port carries a theoretical advantage regarding acquisition of cytological material.

Methods: To demonstrate the safety and efficacy of the Olympus side-port needle across a spectrum of indications for EUS FNA, a prospective collection of 16 consecutive cases was undertaken at a tertiary gastroenterology referral centre in metropolitan Sydney, Australia. EUS FNA was performed with the novel Olympus side-port needle. EUS FNA was otherwise performed in the conventional fashion. The number of needle passes required for diagnosis, number of passes total, diagnosis on cytology and conclusive diagnosis were recorded.

Results: Diagnostic material was obtained at the first pass in 56.2% of patients. Mean number of passes required to reach a diagnosis was 2.1. Diagnosis was made on first pass in 62.5% of solid non-lymph-node lesions. The diagnosis was reached in 94%.

Conclusions: The novel side-port needle is safe and effective; further evaluation with a prospective randomized trial is warranted.
Optimizing outcomes in multiple sclerosis: consensus guidelines for the diagnosis and treatment of multiple sclerosis in Latin America
Authors: Carrá Adriana , Macías-Islas Miguel Ángel , Gabbai Alberto Alan , Correale Jorge , Bolaña Carlos , Sotelo Eduardo Duriez , Bonitto Juan García , Vergara-Edwards Fernando , Vizcarra-Escobar Darwin
Published: October 2011

Objective: The prevalence of multiple sclerosis (MS) in Latin America varies across different studies but an intermediate risk and increased frequency of the disease have been reported in recent years. The circumstances of Latin American countries are different from those of Europe and North America, both in terms of differential diagnoses and disease management.

Methods: An online survey on MS was sent to 855 neurologists in nine Latin American countries. A panel of nine experts in MS analyzed the results.

Results: Diagnostic and therapeutic recommendations were outlined with special emphasis on the specific needs and circumstances of Latin America. The experts proposed guidelines for MS diagnosis, treatment, and follow up, highlighting the importance of considering endemic infectious diseases in the differential diagnoses of MS, the identification of patients at high risk of developing MS in order to maximize therapeutic opportunities, early treatment initiation, and cost-effective control of treatment efficacy, as well as global assessment of disability.

Conclusions: The experts recommended that healthcare systems allocate a longer consultation time for patients with MS, which must be conducted by neurologists trained in the management of the disease. All drugs currently approved must be available in all Latin American countries and must be covered by healthcare plans. The expert panel supported the creation of a permanent forum to discuss future clinical and therapeutic recommendations that may be useful in Latin American countries.
Profiting through Teamwork
Authors: Noone Breffni M. , Hultberg Tess
Published: October 2011

Revenue management and sales staffs collaborate substantially in making decisions regarding rate setting, accepting group business, and forecasting. However, according to a survey of 82 sales and revenue management executives at three hotel chains (47 revenue managers and 35 sales executives), hotels could foster even better coordination between revenue management and sales by educating each group regarding the other group’s responsibilities. This might reduce sales staff frustrations about the way revenue managers make rate recommendations, and it might help revenue managers understand the importance that sales executives place on maintaining a relationship with a group, even when room rates do not meet targets. Forecasting is a major function for revenue managers, who take numerous factors into account, and some sales executives also are responsible for forecasting, primarily using one data source. Thus, the two groups focus on the data in different ways. Respondents suggest several ways to strengthen the relationship, including on-the-job training and education. For both groups, implementing performance assessments that involve several measures would allow the two groups to have some measures in common. Useful measures might include a group’s total revenue contribution, which is not commonly applied among these respondents. Another measure, the hotel’s total revenue or contribution, is a worthwhile consideration for both revenue managers and sales executives.
Shifting Pneumothorax
Authors: Bassily-Marcus Adel M. , Oropello John , Shaik Arif , Kohli-Seth Roopa , Manasia Anthony , DelGiudice Rosanna , Benjamin Ernest
Published: October 2011

A 62-year-old woman was admitted for elective bilateral nephrectomies for symptomatic large bilateral polycystic kidneys. In the immediate postoperative period, the patient was hypotensive requiring multiple crystalloid boluses and received stress dose steroids. On postoperative day 4, while on mechanical ventilation, the patient developed a large hydropneumothorax on the left. Sonographic evaluation of the right lung did not show signs of pneumothorax; however, the left lung ultrasound scan revealed signs consistent with pneumothorax. A 28F chest tube was inserted on the left side to drain the hydropneumothorax. On entering the left thoracic cavity with Kelly clamp, there was no air release, only clear serous pleural fluid drained, with absence of air leak from the drainage system. The post–chest tube insertion chest X-ray revealed resolution of the left pneumothorax with development of a new contralateral right pneumothorax, demonstrating a shift of the pneumothorax from the left to the right side. This study reports a case of nonsimultaneous bilateral spontaneous pneumothorax using lung ultrasound in the diagnosis with a literature review and discussion on the possible explanation of this unique phenomenon.
Specific features of medicines safety and pharmacovigilance in Africa
Authors: Isah Ambrose O. , Pal Shanthi N. , Olsson Sten , Dodoo Alexander , Bencheikh Rachida Soulayami
Published: October 2011

The thalidomide tragedy in the late 1950s and early 1960s served as a wakeup call and raised questions about the safety of medicinal products. The developed countries rose to the challenge putting in place systems to ensure the safety of medicines. However, this was not the case for low-resource settings because of prevailing factors inherent in them. This paper reviews some of these features and the current status of pharmacovigilance in Africa. The health systems in most of the 54 countries of Africa are essentially weak, lacking in basic infrastructure, personnel, equipment and facilities. The recent mass deployment of medicines to address diseases of public health significance in Africa poses additional challenges to the health system with notable safety concerns. Other safety issues of note include substandard and counterfeit medicines, medication errors and quality of medicinal products. The first national pharmacovigilance centres established in Africa with membership of the World Health Organization (WHO) international drug monitoring programme were in Morocco and South Africa in 1992. Of the 104 full member countries in the programme, there are now 24 African countries with a further nine countries as associate members. The pharmacovigilance systems operational in African countries are based essentially on spontaneous reporting facilitated by the introduction of the new tool Vigiflow. The individual case safety reports committed to the WHO global database (Vigibase) attest to the growth of pharmacovigilance in Africa with the number of reports rising from 2695 in 2000 to over 25,000 in 2010. There is need to engage the various identified challenges of the weak pharmacovigilance systems in the African setting and to focus efforts on how to provide resources, infrastructure and expertise. Raising the level of awareness among healthcare providers, developing training curricula for healthcare professionals, provisions for paediatric and geriatric pharmacovigilance, engaging the pharmaceutical industries as well as those for herbal remedies are of primary concern.
Forceps biopsy and suction catheter for sampling in pulmonary nodules and infiltrates
Authors: Peschke Antje , Wiedemann Bärbel , Höffken Gert , Koschel Dirk
Published: October 2011

Transbronchial lung biopsy with forceps is a standard procedure in bronchoscopic tissue sampling. Suction catheter aspiration is another technique, but it is not widely known and almost no data exist regarding its diagnostic efficiency.

272 patients were included in a prospective and randomised study between February 2007 and October 2009. All were referred for bronchoscopic evaluation of pulmonary nodules/masses or infiltrates. We compared the diagnostic yield of forceps biopsy and suction catheter aspiration for a definite diagnosis and looked at whether such a diagnosis depends on the underlying pulmonary change.

All patients underwent bronchoscopy with forceps biopsy and catheter aspiration. A definitive diagnosis was reached in a total of 183 (67.3%) patients, with catheter aspiration in 140 (51.5%) patients and with forceps biopsy in 136 (50.0%) patients. In 90 (33.1%) patients, a definite diagnosis could only be reached with the combination of both techniques. The diagnostic yield of forceps biopsy was better than catheter aspiration in infiltrates (p=0.027), but was no different in nodules or masses (p=0.09).

Suction catheter aspiration is a useful technique of bronchoscopic tissue sampling. The combination of catheter aspiration and forceps biopsy results in a higher diagnostic yield than either method used alone.
Radon and COPD mortality in the American Cancer Society Cohort
Authors: Turner Michelle C. , Krewski Daniel , Chen Yue , Pope C. Arden , Gapstur Susan M. , Thun Michael J.
Published: October 2011

Although radon gas is a known cause of lung cancer, the association between residential radon and mortality from non-malignant respiratory disease has not been well characterised.

The Cancer Prevention Study-II is a large prospective cohort study of nearly 1.2 million Americans recruited in 1982. Mean county-level residential radon concentrations were linked to study participants' residential address based on their ZIP code at enrolment (mean±sd53.5±38.0 Bq·m−3). Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for non-malignant respiratory disease mortality associated with radon concentrations. After necessary exclusions, a total of 811,961 participants in 2,754 counties were included in the analysis.

Throughout 2006, there were a total of 28,300 non-malignant respiratory disease deaths. Radon was significantly associated with chronic obstructive pulmonary disease (COPD) mortality (HR per 100 Bq·m−31.13, 95% CI 1.05–1.21). There was a significant positive linear trend in COPD mortality with increasing categories of radon concentrations (p<0.05).

Findings suggest residential radon may increase COPD mortality. Further research is needed to confirm this finding and to better understand possible complex inter-relationships between radon, COPD and lung cancer.
Distinct epithelial gene expression phenotypes in childhood respiratory allergy
Authors: Giovannini-Chami Lisa , Marcet Brice , Moreilhon Chimène , Chevalier Benoît , Illie Marius I. , Lebrigand Kévin , Robbe-Sermesant Karine , Bourrier Thierry , Michiels Jean-François , Mari Bernard , Crénesse Dominique , Hofman Paul , de Blic Jacques , Castillo Laurent , Albertini Marc , Barbry Pascal
Published: October 2011

Epithelial cell contribution to the natural history of childhood allergic respiratory disease remains poorly understood. Our aims were to identify epithelial pathways that are dysregulated in different phenotypes of respiratory allergy.

We established gene expression signatures of nasal brushings from children with dust mite-allergic rhinitis, associated or not associated with controlled or uncontrolled asthma. Supervised learning and unsupervised clustering were used to predict the different subgroups of patients and define altered signalling pathways. These profiles were compared with those of primary cultures of human nasal epithelial cells stimulated with either interleukin (IL)-4, IL-13, interferon (IFN)-α, IFN-β or IFN-γ, or duringin vitrodifferentiation.

A supervised method discriminated children with allergic rhinitis from healthy controls (prediction accuracy 91%), based on 61 transcripts, including 21 T-helper cell (Th) type 2-responsive genes. This method was then applied to predict children with controlled or uncontrolled asthma (prediction accuracy 75%), based on 41 transcripts: nine of them, which were down-regulated in uncontrolled asthma, are directly linked to IFN. This group also includedGSDML, which is genetically associated with asthma.

Our data revealed a Th2-driven epithelial phenotype common to all children with dust mite allergic rhinitis. It highlights the influence of epithelially expressed molecules on the control of asthma, in association with atopy and impaired viral response.
Factors associated with hospital mortality in community-acquired legionellosis in France
Authors: Chidiac C. , Che D. , Pires-Cronenberger S. , Jarraud S. , Campèse C. , Bissery A. , Weinbreck P. , Brun-Buisson C. , Sollet J-P. , Ecochard R. , Desenclos J-C. , Etienne J. , Vanhems P. ,   the French Legionnaires’ Disease Study Group
Published: October 2011

The aims of this study were to describe the clinical, biological and radiological features of community-acquired (CA) Legionnaires’ disease (LD) and identify the predictors of mortality in hospitalised patients.

Demographic data, risk factors, clinical and biological features, medical management, complications, and outcome from 540 hospitalised patients with confirmed CA LD were prospectively recorded.

8.1% of patients (44 out of 540) died. The predictors of survival after Kaplan–Meier analysis were male sex (p=0.01), age <60 yrs (p=0.02), general symptoms (p=0.006), intensive care unit (ICU) stay (p<0.001), and class II–III Pneumonia Severity Index score (p=0.004). Six predictors of death were identified by multivariate analysis: age (per 10-yr increment) (relative hazard (RH) 1.50, 95% CI 1.21–1.87), female sex (RH 2.00, 95% CI 1.08–3.69), ICU admission (RH 3.31, 95% CI 1.67–6.56), renal failure (RH 2.73, 95% CI 1.42–5.27), corticosteroid therapy (RH 2.54, 95% CI 1.04–6.20) and C-reactive protein (CRP) >500 mg·L−1(RH 2.14, 95% CI 1.02–4.48). Appropriate antibiotic therapy was prescribed for 70.8% (292 out of 412) of patients after admission and for 99.8% (537 out of 538) of patients after diagnosis confirmation.

In conclusion, female sex, age, ICU stay, renal failure, corticosteroid treatment and increased level of CRP are significant risk factors for mortality in CA LD.
Validation of lung function prediction equations from patient survival data
Authors: Ward Helen , Cooper Brendan , Miller Martin R.
Published: October 2011

Diagnosing and managing pulmonary disease usually requires judging lung function against predicted values. We explored patient survival data to help identify the best equations for our population.

The earliest spirometry, lung volumes and gas transfer data for all Caucasian patients were extracted from our database. Survival status was available for 8,139 patients. Lung function as standardised residuals (SR) from various prediction equations was used in Cox regression to predict the hazard ratio (HR) for death.

The best lung function predictor of all-cause mortality was diffusing capacity of the lung for carbon monoxide (DL,CO), followed by forced vital capacity (FVC). These were best with the equations of Miller, derived from a US population, with Chi-squared values of 1,468 and 1,043 forDL,COand FVC, respectively, having taken age, sex, smoking status and body mass index into account. The HR (95% CI) for SR < -3 were 8.5 (6.0–12.1) and 2.9 (2.3–3.5), respectively. Spirometric equation prediction models varied less than those forDL,CO, with the Miller equations being slightly better than Lambda-Mu-Sigma (LMS) equations. SomeDL,COequations introduced sex bias (male sex HR of 3.0versus1.5 for other equations).

We conclude that LMS or Miller spirometry equations and Miller’sDL,COequations were best for our patient population. Using patient survival data is a new approach to help select which lung function prediction equations to use.
Prevalence of inappropriate tuberculosis treatment regimens: a systematic review
Authors: Langendam M.W. , van der Werf M.J. , Huitric E. , Manissero D.
Published: October 2011

A potential threat to the success of new tuberculosis (TB) drugs is the development of resistance. Using drugs in appropriate regimens, such as those recommended in the World Health Organization (WHO) treatment guidelines, prevents the development of resistance. We performed a systematic review to assess the prevalence of inappropriate prescription of TB drugs for the treatment of TB.

MEDLINE, EMBASE and other databases were searched for relevant articles in January 2011. Observational studies published from 2000 that included TB patients receiving treatment were selected. A treatment regimen was considered inappropriate if the regimen was not a WHO recommended regimen.

37 studies were included. Inappropriate treatment regimens were prescribed in 67% of studies. The percentage of patients receiving inappropriate regimens varied between 0.4% and 100%. In 19 studies the quality of treatment regimen reporting was low.

Despite the fact that assessment of inappropriate treatment was hampered by low quality of reporting, our data indicate a reasonable amount of inappropriate prescription of TB treatment regimens. Thus, there is a risk that new drugs will be used in inappropriate treatment regimens, even with WHO guidelines in place, introducing the risk of resistance development. This article highlights the need to improve implementation of the WHO treatment of TB guidelines.
Multidrug resistance after inappropriate tuberculosis treatment: a meta-analysis
Authors: van der Werf Marieke J. , Langendam Miranda W. , Huitric Emma , Manissero Davide
Published: October 2011

We conducted a systematic review and meta-analysis to assess the evidence for the postulation that inappropriate tuberculosis (TB) regimens are a risk for development of multidrug-resistant (MDR)-TB.

MEDLINE, EMBASE and other databases were searched for relevant articles in January 2011. Cohort studies including TB patients who received treatment were selected and data on treatment regimen, drug susceptibility testing results and genotyping results before treatment and at failure or relapse were abstracted from the articles.

Four studies were included in the systematic review and two were included in the meta-analysis. In these two studies the risk of developing MDR-TB in patients who failed treatment and used an inappropriate treatment regimen was increased 27-fold (RR 26.7, 95% CI 5.0–141.7) when compared with individuals who received an appropriate treatment regimen.

This review provides evidence that supports the general opinion that the development of MDR-TB can be caused by inadequate treatment, given the drug susceptibility pattern of theMycobacterium tuberculosisbacilli. It should be noted that only two studies provided data for the meta-analysis. The information can be used to advocate for adequate treatment for patients based on drug resistance profiles.
Alarming levels of drug-resistant tuberculosis in Belarus: results of a survey in Minsk
Authors: Skrahina Alena , Hurevich Henadz , Zalutskaya Aksana , Sahalchyk Evgeni , Astrauko Andrei , van Gemert Wayne , Hoffner Sven , Rusovich Valiantsin , Zignol Matteo
Published: October 2011

Resistance to anti-tuberculosis (TB) medicines is a major public health threat in most countries of the former Soviet Union. As no representative and quality-assured information on the magnitude of this problem existed in Belarus, a survey was conducted in the capital city of Minsk.

Between November 2009 and December 2010, 156 consecutively diagnosed new and 68 previously treated culture-positive TB patients residing in Minsk were enrolled in the survey.Mycobacterium tuberculosisisolates were obtained from each patient and tested for susceptibility to first- and second-line anti-TB drugs.

Multidrug-resistant (MDR)-TB was found in 35.3% (95% CI 27.7–42.8) of new patients and 76.5% (95% CI 66.1–86.8) of those previously treated. Overall, nearly one in two patients enrolled had MDR-TB. Extensively drug-resistant TB was reported in 15 of the 107 MDR-TB patients (14.0%, 95% CI 7.3–20.7). Patients <35 yrs of age have shown a two times higher odds ratio of multidrug-resistant TB than those aged >35 yrs.

The findings of this survey in Minsk city are alarming and represent the highest proportions of MDR-TB ever recorded in the world. This study greatly contributes to the understanding of the burden of drug-resistant TB in urban areas of Belarus.
Targets of anti-endothelial cell antibodies in pulmonary hypertension and scleroderma
Authors: Dib Hanadi , Tamby Mathieu C. , Bussone Guillaume , Regent Alexis , Berezné Alice , Lafine Claudine , Broussard Cédric , Simonneau Gérald , Guillevin Loïc , Witko-Sarsat Véronique , Humbert Marc , Mouthon Luc
Published: October 2011

Anti-endothelial cell antibodies (AECAs) have been identified in patients with systemic sclerosis (SSc) with and without pulmonary arterial hypertension (PAH) and in patients with idiopathic pulmonary arterial hypertension (iPAH). However, their target antigens remain poorly identified.

Sera from 24 patients with SSc without PAH, 20 patients with SSc with PAH, 30 with iPAH and 12 healthy controls were collected. Target antigens were identified by two-dimensional electrophoresis and immunoblotting in protein extracts of human umbilical vein endothelial cells. Targeted antigens were identified by mass spectrometry.

Serum immunoglobulin G from patients with SSc with or without PAH and patients with iPAH specifically recognised 110, 82 and 37 protein spots, respectively. Among others, target antigens of AECAs included lamin A/C, tubulin β-chain and vinculin. One-dimension immunoblotting experiments confirmed the identification of lamin A/C and tubulin β-chain.

In conclusion, our results confirm the presence of AECA in patients with systemic sclerosis with and without pulmonary arterial hypertension and in those with idiopathic pulmonary arterial hypertension, and provide evidence for the identification of target antigens of these autoantibodies including lamin A/C and tubulin β-chain.
RefNetBuilder: a platform for construction of integrated reference gene regulatory networks from expressed sequence tags
Authors: Li Ying , Gong Ping , Perkins Edward J , Zhang Chaoyang , Wang Nan
Published: October 2011

Background

Gene Regulatory Networks (GRNs) provide integrated views of gene interactions that control biological processes. Many public databases contain biological interactions extracted from experimentally validated literature reports, but most furnish only information for a few genetic model organisms. In order to provide a bioinformatic tool for researchers who work with non-model organisms, we developed RefNetBuilder, a new platform that allows construction of putative reference pathways or GRNs from expressed sequence tags (ESTs).

Results

RefNetBuilder was designed to have the flexibility to extract and archive pathway or GRN information from public databases such as the Kyoto Encyclopedia of Genes and Genomes (KEGG). It features sequence alignment tools such as BLAST to allow mapping ESTs to pathways and GRNs in model organisms. A scoring algorithm was incorporated to rank and select the best match for each query EST. We validated RefNetBuilder using DNA sequences of Caenorhabditis elegans, a model organism having manually curated KEGG pathways. Using the earthworm Eisenia fetida as an example, we demonstrated the functionalities and features of RefNetBuilder.

Conclusions

The RefNetBuilder provides a standalone application for building reference GRNs for non-model organisms on a number of operating system platforms with standard desktop computer hardware. As a new bioinformatic tool aimed for constructing putative GRNs for non-model organisms that have only ESTs available, RefNetBuilder is especially useful to explore pathway- or network-related information in these organisms.
Whole genome analysis of linezolid resistance in Streptococcus pneumoniae reveals resistance and compensatory mutations
Authors: Billal Dewan S , Feng Jie , Leprohon Philippe , Légaré Danielle , Ouellette Marc
Published: October 2011

Background

Several mutations were present in the genome of Streptococcus pneumoniae linezolid-resistant strains but the role of several of these mutations had not been experimentally tested. To analyze the role of these mutations, we reconstituted resistance by serial whole genome transformation of a novel resistant isolate into two strains with sensitive background. We sequenced the parent mutant and two independent transformants exhibiting similar minimum inhibitory concentration to linezolid.

Results

Comparative genomic analyses revealed that transformants acquired G2576T transversions in every gene copy of 23S rRNA and that the number of altered copies correlated with the level of linezolid resistance and cross-resistance to florfenicol and chloramphenicol. One of the transformants also acquired a mutation present in the parent mutant leading to the overexpression of an ABC transporter (spr1021). The acquisition of these mutations conferred a fitness cost however, which was further enhanced by the acquisition of a mutation in a RNA methyltransferase implicated in resistance. Interestingly, the fitness of the transformants could be restored in part by the acquisition of altered copies of the L3 and L16 ribosomal proteins and by mutations leading to the overexpression of the spr1887 ABC transporter that were present in the original linezolid-resistant mutant.

Conclusions

Our results demonstrate the usefulness of whole genome approaches at detecting major determinants of resistance as well as compensatory mutations that alleviate the fitness cost associated with resistance.