bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of associations and development of atazanavir resistance after unplanned treatment interruptions
Authors: Tinago W , O'Halloran JA , O'Halloran RM , Macken A , Lambert JS , Sheehan GJ , Mallon PWG
Published: November 2013

Objectives

Although current guidelines recommend resistance testing prior to antiretroviral therapy (ART) reinitiation after treatment interruptions, virological failure of first‐line ritonavir‐boosted, protease‐inhibitor (PI/r)‐containing ART is associated with low emergent PI resistance. In patients experiencing unscheduled treatment interruptions (UTrIs) on ritonavir‐boosted atazanavir (ATV/r) ART regimens, we hypothesized low emergence of PI mutations conferring resistance to ATV/r.

Methods

In a retrospective assessment of HIV‐infected patients initiating ATV/r‐containing ART, using logistic regression we determined factors associated with UTrI, the prevalence of emergent resistance mutations and virological response after ART reinitiation.

Results

A total of 202 patients [median age 33 years (interquartile range (IQR) 29–40 years); 52% female; median CD4 count 184 cells/μL (IQR 107–280 cells/μL); median HIV RNA 4.6 log10 HIV‐1 RNA copies/mL (IQR 3.2–5.1 copies/mL)] initiated ATV/r between 2004 and 2009; 80 (43%) were ART naïve. One hundred and ten patients (55%) underwent 195 UTrIs after a median (IQR) 25 (10–52) weeks on ART, with a median (IQR) UTrI duration of 10 (3–31) weeks. Fifty‐four of 110 patients (49%) underwent more than one UTrI. The commonest reasons for UTrI were nonadherence (52.7%) and drug intolerance (20%). Baseline HIV RNA > 100 000 copies\mL [odds ratio (OR) 3.6; 95% confidence interval (CI) 1.3–9.95] and being HCV positive, an injecting drug user or on methadone (OR 2.4; 95% CI 1.3–4.4) were independently associated with UTrI. In 39 patients with at least two resistance assays during UTrIs, 72 new mutations emerged; four nucleoside reverse transcriptase inhibitor (NRTI), two nonnucleoside reverse transcriptase inhibitor (NNRTI) and 66 protease inhibitor (PI) resistance mutations. All emergent PI resistance mutations were minor mutations. At least 65% of patients were re‐suppressed on ATV/r reinitiation.

Conclusions

In this PI‐treated cohort, UTrIs are common. All emergent PI resistance mutations were minor and ATV/r retained activity and efficacy when reintroduced, even after several UTrIs, raising questions regarding the need for routine genotypic resistance assays in PI/r‐treated patients prior to ART reinitiation after UTrI.
A simplified combination antiretroviral therapy regimen enhances adherence, treatment satisfaction and quality of life: results of a randomized clinical trial
Authors: Langebeek N , Sprenger HG , Gisolf EH , Reiss P , Sprangers MAG , Legrand JC , Richter C , Nieuwkerk PT
Published: November 2013

Objectives

The aim of the study was to investigate the effect of a simplified regimen, in terms of reducing pill burden, dietary requirements and possible adverse effects, on patients' adherence, treatment satisfaction and quality of life (QoL).

Methods

Antiretroviral‐naïve patients who achieved a viral load < 50 HIV‐1 RNA copies/ml after induction therapy with twice‐daily (bid) lopinavir/ritonavir (LPV/r) and fixed‐dose zidovudine (ZDV)/lamivudine (3TC) (CBV) were randomly assigned to continue CBV/LPV/r or switch to fixed‐dose ZDV/3TC/abacavir (TZV). Patients completed standardized questionnaires on adherence, treatment satisfaction and QoL at randomization (between weeks 12 and 24) and at weeks 48, 72 and 96.

Results

Patients on CBV/LPV/r were more likely to have skipped medicines in the last week (P = 0.035) and during the preceding weekend (P = 0.027) than patients on TZV. Patients on CBV/LPV/r were significantly less satisfied with the convenience of their treatment (P = 0.004) and tended to be less satisfied with the side effects of their treatment (P = 0.091) and continuation of their present treatment (P = 0.056) than patients on TZV. Patients on CBV/LPV/r reported significantly lower levels of role functioning (P = 0.013) than patients on TZV.

Conclusions

In this randomized controlled trial, simplification of therapy to fixed‐dose TZV among patients with suppressed HIV RNA was perceived to be more convenient, and resulted in improved adherence and better role functioning, than continuing treatment with CBV/LPV/r.
Discovery of protective B‐cell epitopes for development of antimicrobial vaccines and antibody therapeutics
Authors: Sharon Jacqueline , Rynkiewicz Michael J. , Lu Zhaohua , Yang Chiou‐Ying
Published: November 2013

Protective antibodies play an essential role in immunity to infection by neutralizing microbes or their toxins and recruiting microbicidal effector functions. Identification of the protective B‐cell epitopes, those parts of microbial antigens that contact the variable regions of the protective antibodies, can lead to development of antibody therapeutics, guide vaccine design, enable assessment of protective antibody responses in infected or vaccinated individuals, and uncover or localize pathogenic microbial functions that could be targeted by novel antimicrobials. Monoclonal antibodies are required to link in vivo or in vitro protective effects to specific epitopes and may be obtained from experimental animals or from humans, and their binding can be localized to specific regions of antigens by immunochemical assays. The epitopes are then identified with mapping methods such as X‐ray crystallography of antigen–antibody complexes, antibody inhibition of hydrogen–deuterium exchange in the antigen, antibody‐induced alteration of the nuclear magnetic resonance spectrum of the antigen, and experimentally validated computational docking of antigen–antibody complexes. The diversity in shape, size and structure of protective B‐cell epitopes, and the increasing importance of protective B‐cell epitope discovery to development of vaccines and antibody therapeutics are illustrated through examples from different microbe categories, with emphasis on epitopes targeted by broadly neutralizing antibodies to pathogens of high antigenic variation. Examples include the V‐shaped Ab52 glycan epitope in the O‐antigen of Francisella tularensis, the concave CR6261 peptidic epitope in the haemagglutinin stem of influenza virus H1N1, and the convex/concave PG16 glycopeptidic epitope in the gp120 V1/V2 loop of HIV type 1.
Adjunctive therapies and immunomodulating agents for severe influenza
Authors: Hui David S. C. , Lee Nelson
Published: November 2013

The value of adjunctive immunomodulatory therapies in treating severe influenza and other respiratory viral infections remains uncertain. Although often used, systemic corticosteroids may increase the risk of mortality and morbidity (e.g. secondary infections) in severe influenza and other viral infections, especially if there is delay or lack of effective antiviral therapy. Non‐randomized studies suggest that convalescent plasma appears useful as add‐on therapy for patients with severe acute respiratory syndrome, avian influenza A(H5N1), and influenza A (H1N1) 2009 pandemic [A(H1N1)pdm09), but it is limited by its availability. A recent randomized controlled trial (RCT) comparing hyperimmune globulin prepared from convalescent plasma against normal intravenous gammaglobulin (IVIG) manufactured before 2009 as control in patients with severe A(H1N1)pdm09 infection on standard antiviral treatment has shown that the hyperimmune globulin group who received treatment within 5 days of symptom onset had a lower viral load and reduced mortality compared with the controls. A number of agents with immunomodulatory effects (e.g. acute use of statins, N‐acetylcysteine, macrolides, PPAR agonists, IVIG, celecoxib, mesalazine) have been proposed for influenza management. However, more animal and detailed human observational studies and preferably RCTs controlling for the effects of antiviral therapy and disease severity are needed for evaluating these agents. The role of plasmapheresis and hemoperfusion as rescue therapy also merits more investigation.
Antivirals in the 2009 pandemic – lessons and implications for future strategies
Authors: Berera Deeva , Zambon Maria
Published: November 2013

The World Health Organization's declaration of an imminent swine‐origin influenza A pandemic in April 2009 triggered the global launch of national pandemic preparedness plans. An integral component of pandemic preparedness in many countries was the targeted use of antiviral therapy for containment, disease mitigation, and treatment. The 2009 pandemic marked the first pandemic during which influenza antivirals were available for global use. Although most national pandemic plans included provisions for antiviral treatment, these pre‐determined protocols required frequent updating as more information became available about the virus, and its susceptibility to antiviral agents, the epidemiology of infection, and the population groups that were most susceptible to severe disease. National public health agencies in countries with both plans for use of antivirals and pre‐existing stockpiles, including those in Japan, the United Kingdom, and the United States, operated distinctly different antiviral distribution and treatment programs from one another. In the 3 years following the pandemic, there is still little comparison of the diversity of national antiviral treatment policies and drug distribution mechanisms that were implemented, whether they had any mitigating effects and which might be most efficient. The purpose of this study is to outline roles of antiviral medicines in a pandemic period, provide insights into the diversity of antiviral treatment and distribution policies applied by selected countries between April 2009–July 2010, and to stimulate discussion on whether these policies remain appropriate for implementation in future pandemics.
Detection and management of antiviral resistance for influenza viruses
Authors: Boivin Guy
Published: November 2013

Neuraminidase inhibitors (NAIs) are first‐line agents for the treatment and prevention of influenza virus infections. As for other antivirals, the development of resistance to NAIs has become an important concern particularly in the case of A(H1N1) viruses and oseltamivir. The most frequently reported change conferring oseltamivir resistance in that viral context is the H275Y neuraminidase mutation (N1 numbering). Recent studies have shown that, in the presence of the appropriate permissive mutations, the H275Y variant can retain virulence and transmissibility in some viral backgrounds. Most oseltamivir‐resistant influenza A virus infections can be managed with the use of inhaled or intravenous zanamivir, another NAI. New NAI compounds and non‐neuraminidase agents as well as combination therapies are currently in clinical evaluation for the treatment for severe influenza infections.
Ventilatory strategies and supportive care in acute respiratory distress syndrome
Authors: Luks Andrew M.
Published: November 2013

While antiviral therapy is an important component of care in patients with the acute respiratory distress syndrome (ARDS) following influenza infection, it is not sufficient to ensure good outcomes, and additional measures are usually necessary. Patients usually receive high levels of supplemental oxygen to counteract the hypoxemia resulting from severe gas exchange abnormalities. Many patients also receive invasive mechanical ventilation for support for oxygenation, while in resource‐poor settings, supplemental oxygen via face mask may be the only available intervention. Patients with ARDS receiving mechanical ventilation should receive lung‐protective ventilation, whereby tidal volume is decreased to 6 ml/kg of their predicted weight and distending pressures are maintained ≤30 cm H2O, as well as increased inspired oxygen concentrations and positive end‐expiratory pressure (PEEP) to prevent atelectasis and support oxygenation. While these measures are sufficient in most patients, a minority develop refractory hypoxemia and may receive additional therapies, including prone positioning, inhaled vasodilators, extracorporeal membrane oxygenation, recruitment maneuvers followed by high PEEP, and neuromuscular blockade, although recent data suggest that this last option may be warranted earlier in the clinical course before development of refractory hypoxemia. Application of these “rescue strategies” is complicated by the lack of guidance in the literature regarding implementation. While much attention is devoted to these strategies, clinicians must not lose sight of simple interventions that affect patient outcomes including head of bed elevation, prophylaxis against venous thromboembolism and gastrointestinal bleeding, judicious use of fluids in the post‐resuscitative phase, and a protocol‐based approach to sedation and spontaneous breathing trials.
Inferring temporal shifts in landuse intensity from functional response traits and functional diversity patterns: a study of Scotland's machair grassland
Authors: Lewis Rob J. , Marrs Rob H. , Pakeman Robin J.
Published: November 2013

Plant functional response traits, which consistently respond to the environment, are useful for identifying drivers of vegetation change, particularly in response to disturbance gradients. Similarly, functional diversity indices have proven useful for investigating processes governing community assembly, particularly patterns of functional convergence/divergence.

This study investigated the functional ecology of biodiverse, seminatural coastal grasslands (Scottish machair) at the national scale. We examined temporal shifts in functional response traits and functional diversity metrics using a series of null model, multivariate and regression analyses. The aim was to link temporal shifts in traits and diversity metrics to environmental variables in which to gauge the contribution of landuse change to plant functional composition and processes governing plant assembly.

We observed significant shifts in the composition of 8 out of 12 functional response traits at the national scale, whereas at the regional scale all traits displayed at least one significant shift. Ordination of response traits found PC axis 1 (accounting for 39% of the variation) to be positively correlated to vegetation height and negatively correlated to specific leaf area, similar to that expected along a disturbance gradient. Significant changes in functional diversity indices were also observed at both national and regional scales, with varying convergence/divergence patterns observed across individual regions. We found functional richness (t = 4.87, p < 0.001) and divergence (t = 9.3, p < 0.001) to increase along PC axis 1, suggesting greater convergence and lower divergence along a disturbance gradient.

This study demonstrates the potential for using functional diversity indices in combination with response traits as a sensitive method for detecting landuse change and its impacts on biodiversity. We conclude that landuse change, particularly management declines and intensification is a major driver governing change among the functional composition and functional diversity for machair grasslands, influencing convergence/divergence patterns, and subsequently community assembly processes.
Optimization of a Process and Development of a Shelf Life Prediction Model for Instant Multigrain Dalia Mix
Authors: Singh Bhanu Pratap , Jha Alok , Sharma Nitya , Rasane Prasad
Published: November 2013

Instant multigrain dalia mix based on sorghum, pearlmillet and maize was developed. Physicochemical changes in the dalia mix stored at 10, 25, 37 and 45C for 180 days were monitored. Hydroxy methyl furfural (HMF), free fatty acids (FFA) and thiobarbituric acid (TBA) value for the product increased significantly with increase in temperature and progression of storage period. The correlation between chemical reactions with the sensory properties of the product was determined to predict the shelf life. The activation energy (Ea), Arrhenius constant (A0), Q10 value and other parameters like enthalpy, entropy and free energy of activation were determined. The reaction kinetics of HMF formation followed the first order reaction while change in TBA and formation of FFA followed the zero order reaction kinetics. The Ea, A0 and Q10 value for the change in TBA were 65.46 kJ/mol, 1.22 × 1011 M/week and 1.30, respectively. The potential shelf life of instant multigrain dalia mix was 71 weeks at 10C.

Practical Applications

Dalia is a traditional cereal and milk‐based porridge, popularly consumed in the Indian subcontinent. It is commonly prepared using wheat, milk and sugar and has a poor shelf life. Coarse cereals such as sorghum, pearl millet and maize, offers nutritional advantages over wheat and rice. Development of a process for manufacture of multigrain dalia mix containing these coarse cereals, with a extended shelf life of more than 71 weeks at 10C could result in product diversification, value addition and export promotion of the product in the form of convenience food.
Potentially Inappropriate Medication Use in Veterans Residing in Community Living Centers: Have We Gotten Better?
Authors: Dosa David , Cai Shubing , Gidmark Stefanie , Thomas Kali , Intrator Orna
Published: November 2013

Objectives

To evaluate the use of medications classified as inappropriate according to the Health Plan Employer Data and Information Set (HEDIS) in elderly veterans residing in Department of Veterans Affairs (VA) nursing homes from 2004 to 2009 and to identify participant‐specific correlates of use.

Design

Retrospective, cross‐sectional study using VA administrative data merged with participant‐specific data from the Minimum Data Set.

Setting

VA nursing homes (community living centers (CLCs)).

Participants

Veterans aged 65 and older residing in CLCs at the time of the prescribed medication use (N = 176,168).

Measurements

The number of exposed veterans aged 65 and older per facility receiving at least one HEDIS high‐risk medication was determined.

Results

Between 2004 and 2009, 28,970 of 176,168 (mean 16.4 ± 9.5%) veterans received at least one HEDIS high‐risk medication. Over the period, the number of veterans receiving high‐risk medications decreased steadily from 23.9 ± 10.0% in 2004 to 10.0 ± 6.6% in 2009. Nevertheless, large facility variations remained in 2009, with rates from 0% to 44.4%. Certain characteristics were also associated with HEDIS high‐risk medication use, including female sex (odds ratio (OR) = 1.6; 95% confidence interval (CI) = 1.25–2.04), cancer (OR = 1.19, 95% CI = 1.08–1.32), renal disease (OR = 1.16, 95% CI = 1.01–1.33), chronic obstructive pulmonary disease (OR = 1.16, 95% CI = 1.05–1.28), and diabetes mellitus (OR = 1.11, 95% CI = 1.02–1.22). Protective characteristics included age 75 and older (OR = 0.81, 95% CI = 0.73–0.90) and having a diagnosis of moderate (OR = 0.72, 95% CI = 0.64–0.82) or severe (OR = 0.72, 95% CI = 0.61–0.85) cognitive impairment.

Conclusion

The use of HEDIS medications among elderly veterans residing in VA nursing homes has markedly improved. Nevertheless, significant variations between facilities and certain subpopulations remain. A low percentage of women at VA CLCs make comparisons with community nursing homes difficult.
Evaluation of Macroscopic and Microscopic Components of Partial Resistance to Leaf Rust in Durum Wheat
Authors: Soleiman Nour H. , Solis Ignacio , Sillero Josefa C. , Herrera‐Foessel Sybil A. , Ammar Karim , Martinez Fernando
Published: November 2013

Leaf rust, caused by the fungus Puccinia triticina, is considered one of the most important foliar diseases in durum wheat. Hypersensitive resistance (HR) may be rapidly overcome by the pathogen when resistant cultivars are grown on a large acreage or following changes in virulence in the pathogen population. Prolonging the durability of the resistance requires uses of other types of resistance such as partial resistance (PR). In this study, six durum wheat lines provided by the International Center for Corn and Wheat Improvement (CIMMYT) with a high level of PR to leaf rust were studied in monocyclic tests in a growth chamber. Inoculations were performed on both primary and fifth leaves using the Spanish race DGB/BN. UV fluorescence microscopy was employed to determine microscopic components of the resistance, such as the number of early aborted infection units not associated with plant cell necrosis (EA−) and relative colony size (RCS) of the established infection units. Macroscopic components of PR such as latency period, infection frequency and uredinium size were measured as well. All six resistant lines were characterized by a higher EA− and smaller RCS respect to the susceptible control ‘Don Rafael’. Line 3 showed the highest level of PR. It had 22% of EA− compared with 4% in the susceptible control, and the smallest RCS (17% respect to RCS of ‘Don Rafael’) at adult plant stage. Both EA− and RCS had a high heritability (more than 97%) and the correlation with macroscopic parameters (latency period and uredinium size) was also high (significant at 0.001 level). Hence, PR to leaf rust in these durum wheat genotypes has been revealed at microscopic level (higher EA− and smaller RCS).
Refugia, colonization and diversification of an arid‐adapted bird: coincident patterns between genetic data and ecological niche modelling
Authors: Barrientos Rafael , Kvist Laura , Barbosa Andrés , Valera Francisco , Khoury Fares , Varela Sara , Moreno Eulalia
Published: November 2013

Phylogeographical studies are common in boreal and temperate species from the Palaearctic, but scarce in arid‐adapted species. We used nuclear and mitochondrial markers to investigate phylogeography and to estimate chronology of colonization events of the trumpeter finch Bucanetes githagineus, an arid‐adapted bird. We used 271 samples from 16 populations, most of which were fresh samples but including some museum specimens. Microsatellite data showed no clear grouping according to the sampling locations. Microsatellite and mitochondrial data showed the clearest differentiation between Maghreb and Canary Islands and between Maghreb and Western Sahara. Mitochondrial data suggest differentiation between different Maghreb populations and among Maghreb and Near East populations, between Iberian Peninsula and Canary Islands, as well as between Western Sahara and Maghreb. Our coalescence analyses indicate that the trumpeter finch colonized North Africa during the humid Marine Isotope Stage 5 (MIS5) period of the Sahara region 125 000 years ago. We constructed an ecological niche model (ENM) to estimate the geographical distribution of climatically suitable habitats for the trumpeter finch. We tested whether changes in the species range in relation to glacial–interglacial cycles could be responsible for observed patterns of genetic diversity and structure. Modelling results matched with those from genetic data as the species' potential range increases in interglacial scenarios (in the present climatic scenario and during MIS5) and decreases in glacial climates (during the last glacial maximum, LGM, 21 000 years ago). Our results suggest that the trumpeter finch responded to Pleistocene climatic changes by expanding and contracting its range.
SYNDEMICS AND HUMAN HEALTH: IMPLICATIONS FOR PREVENTION AND INTERVENTION
Authors: Singer Merrill , Bulled Nicola , Ostrach Bayla
Published: November 2013

Use of the syndemics concept has diffused from medical anthropology to an array of health‐related disciplines. This development reflects a growing awareness that diseases and disease sufferers do not exist in a vacuum and that many of the most damaging human epidemics are the possible or probable consequence, not of a single disease acting alone but of several diseases acting in tandem. Syndemics offer a useful conceptual framework for the study of global health inequality. As work guided by a syndemics perspective is conducted on a range of diseases and in diverse regions of the world, the practical health implications of this approach are beginning to unfold.
CULTURAL PHENOMENA AND THE SYNDEMIC FACTOR: SUBSTANCE ABUSE, VIOLENCE, HIV, AND DEPRESSION AMONG HISPANIC WOMEN
Authors: Gonzalez‐Guarda Rosa M. , McCabe Brian E. , Vermeesch Amber L. , Cianelli Rosina , Florom‐Smith Aubrey L. , Peragallo Nilda
Published: November 2013

Researchers exploring the health of Hispanics in South Florida utilizing a combination of qualitative and quantitative research methods have identified that substance abuse, violence, risky sexual behavior, and depression are not only conceptualized as tightly interrelated health and social problems, but also hold together in a measurement model to represent an underlying phenomenon (i.e., the Syndemic Factor). The purpose of this study is to test hypothesized relationships between cultural phenomena and the Syndemic Factor among community‐dwelling Hispanic women. Standardized questionnaires assessing Acculturation, Hispanic Stress, Familism, and the Syndemic Factor were administered to a cross‐sectional sample of 548 Hispanic women from South Florida. Structural equation modeling was used to analyze relationships. The model explained 61 percent of the variance in the Syndemic Factor. There was a large positive relationship between the Syndemic Factor and Hispanic Stress, and a small inverse relationship between the Syndemic Factor and Familism. Women with high Hispanic Acculturation and low U.S. Acculturation scored lower on the Syndemic Factor than Integrated/Bicultural women. Familism buffered the relationship between Hispanic Stress and the Syndemic Factor. Structural, community, family, and individual prevention strategies that address underlying conditions associated with the Syndemic Factor must be developed and formally evaluated.
Roman Urbanism: A View from the Countryside
Authors: Taylor Jeremy
Published: November 2013

The towns of Roman Britain have been subject to a long tradition of empirical research and discussion, but far less attention has been paid to the landscape context in which they developed. This paper considers the implications of this caveat for our understanding of Roman urbanism and suggests that most previous approaches have internalized the study of towns as social institutions and have failed to give due weight to the role of local rural agency in influencing the character of urban development. In so doing, it is suggested that the potential role of other important and competing nodes of economic, political and religious life, such as forts, fortresses, vici and small towns as well as rural sanctuaries and other settlements, is also not given due consideration in discussing the distinctive character of urbanism in Roman Britain.
Cooking Pots and Islamicization in the Early Medieval Vega of Granada (Al‐Andalus, Sixth to Twelfth Centuries)
Authors: Carvajal Jose C. , Day Peter M.
Published: November 2013

In this paper we undertake a petrographic analysis of cooking wares in order to explore the relationship between cultural change and issues of production, consumption and distribution of cooking wares, and particularly between political authority and the location of workshops in the early Islamic Vega of Granada, a region in south‐eastern Spain. This work offers the possibility of testing the potential of thin section petrography in combination with a detailed archaeological study and a well‐documented historical background. Examination of both the technology and microprovenance of wares within the Vega has led to a fruitful set of results with an important impact on our understanding of the place of ceramic material culture on both the local and the regional scale.
Straight video blades are advantageous than curved blades in simulated pediatric difficult intubation
Authors: Saracoglu Kemal T. , Eti Zeynep , Kavas Ayse D. , Umuroglu Tumay
Published: November 2013

Background

It is still controversial which laryngoscope may be a better option in unanticipated difficult airway in pediatric patients. The aim of the present study was to compare two direct and two video‐assisted laryngoscope devices for the management of difficult pediatric airway.

Methods

Forty‐five anesthesiology residents and nurse anesthetists participated in the study. Macintosh, Miller, Storz Miller, and McGrath Mac curved laryngoscopes were used for tracheal intubation of 3–6‐month Airsim Pierre Robin manikin. We compared the duration of successful intubation, number of attempts, glottic view grades, severity of dental trauma, the use of optimization maneuvers, and the difficulty of use of the devices with straight and curved laryngoscope blades.

Results

Successful intubation duration was significantly lower in Storz Miller device, and the number of intubation attempts was significantly higher in the Macintosh laryngoscope (P < 0.01). According to the Cormack and Lehane classification, Grades 1 and 2 glottic view was 20% for Macintosh and 40% for Miller laryngoscope, while it was 100% for Storz Miller and 80% for McGrath (P < 0.001). Difficulty VAS scores of Storz Miller device were significantly lower than the scores of Macintosh, Miller, and McGrath laryngoscopes (15.7 ± 14.89, 34.7 ± 26.44, 31.5 ± 26.74, 33.4 ± 26.67 mm, respectively; P < 0.01).

The severity of dental trauma was significantly lower in Storz Miller compared with Macintosh, Miller, and McGrath laryngoscopes (0.96 ± 1.04, 1.67 ± 1.15, 1.38 ± 1.05, 1.42 ± 1.27, respectively; P < 0.01).

Conclusion

Storz Miller laryngoscope was found to have advantages over the other laryngoscopes in regard to glottic view, duration of successful intubation, number of attempts, dental trauma severity, need for additional maneuvers, and ease of use.
Generalizing from Unrepresentative Experiments: A Stratified Propensity Score Approach
Authors: O'Muircheartaigh Colm , Hedges Larry V.
Published: November 2013

The paper addresses means of generalizing from an experiment based on a non-probability sample to a population of interest and to subpopulations of interest, where information is available about relevant covariates in the whole population. Using stratification based on propensity score matching with an external populationwide data set, an estimator of the population average treatment effect is constructed. An example is presented in which the applicability of a major education intervention in a non-probability sample of schools in Texas, USA, is assessed for the state as a whole and for its constituent counties. The implications of the results are discussed for two important situations: how to use this methodology to establish where future experiments should be conducted to improve this generalization and how to construct a priori a strategy for experimentation which will maximize both the initial inferential power and the final inferential basis for a series of experiments.
Dental erosion due to GERD in patients with developmental disabilities: case theory
Authors: Rada Robert E.
Published: November 2013

Gastroesophageal reflux disease (GERD) is a common finding among individuals in our society. Unfortunately, the condition is even more prevalent in individuals with developmental disabilities. There are significant comorbidities that can affect the upper gastrointestinal tract. Erosion of tooth surfaces may be the first comorbidity that is detected in individuals unable to express physical discomfort associated with GERD. The dentist should be aware of these findings and able to refer the patient for medical management. In addition, an awareness of preventive regimens and restorative options is essential in maintaining a healthy dentition for these individuals.
A newHLA‐A*03null allele – A*03:162Ncaused by an exon 4 insertion and discovered during an external quality assessment exercise
Authors: Bengtsson M. , Street J. , Johnson J. , Harvey C. , Corbin S. , Darke C.
Published: November 2013

HLA‐A*03:162Ndiffers fromA*03:01:01:01by an exon 4, 664‐665insCATGcausingE198AandA199X.
Analysis of UK river restoration using broad‐scale data sets
Authors: Smith Benjamin , Clifford Nicholas J. , Mant Jenny
Published: November 2013

This paper uses data from the UK River Restoration Centre's National River Restoration Inventory (NRRI) and the UK Environment Agency's River Habitat Survey (RHS) to analyse the relationship between restoration technique and the physical catchment context in which they have been implemented. Specifically we tested the relationship between categories of restoration technique and energy conditions, the relationship between restoration project and degree of channel modification, and whether the associations between restoration and physical catchment attributes have changed over time. Significant associations between categories of restoration technique and catchment variables were found, with direct morphological interventions needed in lower energy conditions; however, the analysis shows no change over time. This work shows that analysis of existing data sets can provide useful information to support the science and practice of river restoration and suggests that further analysis of existing ecological and geomorphological data sets provides an important learning opportunity to strengthen river restoration.
The impact of wastewater irrigation on the chemical quality of groundwater
Authors: Paruch Adam M.
Published: November 2013

The purpose of this investigation was to assess the groundwater impact of irrigation with industrial wastewater (baker's yeast wastewater, BYW) and to determine if agricultural reuse can be considered as an efficient wastewater treatment method. The impact of the irrigation and the status of the groundwater quality were determined using chemical parameters that are typical contaminants of BYW and characterise the content of total suspended solids (TSSs), organic matter (biochemical and chemical oxygen demands), nutrients (Norg, N‐NH4, N‐NO3, Ntotal, Ptotal and K), salts (Cl, SO4 and Na) and pH. The study revealed that BYW irrigation did not cause a significant increase in the content of these parameters in groundwater at a low water table region (WTR). However, at a high WTR, the irrigation had an extremely significant (P < 0.001) impact on the chemical status of groundwater that has been demonstrated by substantially high values of COD, N‐NH4, Cl, SO4 and Na.
Modelling the surface circulation and thermal structure of a tropical reservoir using three‐dimensional hydrodynamic lake model and remote‐sensing data
Authors: Curtarelli Marcelo Pedroso , Alcântara Enner , Rennó Camilo Daleles , Assireu Arcilan Trevenzoli , Bonnet Marie Paule , Stech José Luiz
Published: November 2013

Diurnal variations in surface circulation, heat budget and thermal structure were investigated in a tropical reservoir using a synergistic approach that combines in situ observations, remote‐sensing data and numerical modelling. The study area, the Itumbiara Reservoir (Brazil) at the beginning of the austral winter, is characterized by the presence of a weak thermal stratification and the passage of several cold fronts. Both in situ observations and numerical modelling showed that the surface circulation is wind‐driven. The strongest water current was observed at 13:00 h, which lagged behind the strongest wind. The daily heat budget was negative during the period and was controlled by short‐wave radiation and latent heat flux. The diurnal cycle of stratification was at its maximum at 17:00 h, and the surface mixed layer deepens at night. The colder waters of the Paranaíba River contribute to the stability of the water column near the river‐reservoir transition zone.
The Goldfish Over the Rainbow
Authors: Aguiar Carlos E. , Santos Antonio C. F. , Lopes Eric B. , Santos Walter S.
Published: November 2013

A goldfish isn't always visible inside its fishbowl. If the fish gets sufficiently close to the bowl glass, it will disappear for certain angles of observation. In a recent paper in this journal,1 Zhu and Shi explained the effect in terms of total internal reflection. We show in what follows that the phenomenon involves some richer optics: a rainbow defines one of the boundaries of the “blind zone” where the fish disappears.
Vacuum Energy and Inflation: 4. An Inflationary Universe
Authors: Huggins Elisha
Published: November 2013

In this paper the focus will be on how an entire universe can possibly be created within 10−35 seconds starting from a region of space about 10−45 meters across. To do this, we will closely follow the ideas of Alan Guth, who came up with the idea of an inflationary universe.1
Average Annual Rainfall Over the Globe
Authors: Agrawal D. C.
Published: November 2013

The atmospheric recycling of water is a very important phenomenon on the globe because it not only refreshes the water but it also redistributes it over land and oceans/rivers/lakes throughout the globe. This is made possible by the solar energy intercepted by the Earth. The half of the globe facing the Sun, on the average, intercepts1 1.74×1017 J of solar radiation per second and it is divided over various channels as given in Table 1. It keeps our planet warm and maintains its average temperature2 of 288 K with the help of the atmosphere in such a way that life can survive. It also recycles the water in the oceans/rivers/ lakes by initial evaporation and subsequent precipitation; the average annual rainfall over the globe is around one meter. According to M. King Hubbert1 the amount of solar power going into the evaporation and precipitation channel is 4.0×1016 W. Students can verify the value of average annual rainfall over the globe by utilizing this part of solar energy. This activity is described in the next section.
Rocking and Rolling Rattlebacks
Authors: Cross Rod
Published: November 2013

A rattleback is a well-known physics toy that has a preferred direction of rotation. If it is spun about a vertical axis in the “wrong” direction, it will slow down, start rocking from end to end, and then spin in the opposite (i.e. preferred) direction. Many articles have been written about rattlebacks. Some are highly mathematical 1, 2 and others are purely descriptive.3–5 It is surprising that there is still no simple physical explanation. By that, I mean an explanation that can be given to a high school student and one that does not involve an obscure set of complicated equations.
Mass as a Form of Energy in a Simple Example
Authors: Dib Claudio
Published: November 2013

A major consequence of special relativity, expressed in the relation E0=mc2, is that the total energy content of an object at rest, including its thermal motion and binding energy among its constituents, is a measure of its inertia, i.e., its mass. This relation was first stated by Einstein.1 He showed that, in order to be consistent with the principles of special relativity, there must be a loss of inertia in a block that emits two pulses of electromagnetic radiation. A pedagogical difficulty with this example is that radiation is a purely relativistic phenomenon, and so the connection with the examples one learns in introductory mechanics courses is not simple. Here we use a more familiar example of masses and springs, where the nonrelativistic limit can be easily found and where the potential energy is clearly shown to be part of the mass of the bound system.
The Jar Magic — Instructional Activities for Teaching Air Pressure
Authors: Ku Bing-Hong , Chen Chyong-Sun
Published: November 2013

There are a variety of impressive activities designed for teaching the concept of air pressure to junior high school students. Water, glasses, balloons, plastic bottles, and suction cups are some of the items commonly used in these experiments.1–3 For example, if we take a glass of water, cover it with a piece of cardboard, and invert the glass, amazingly, no water spills out. Further, one may also use balloons and plastic bottles as the components in another experiment.1–3 Place a balloon in a plastic bottle and spread the balloon's mouth over the bottle's rim. Inflate the balloon by blowing into it. Students will be astonished at the fact that the balloon remains inflated even though its mouth is open. Making suction cups “stick” to the wall is also an instance of proving how air pressure works.
Is a Simple Measurement Task a Roadblock to Student Understanding of Wave Phenomena?
Authors: Kryjevskaia Mila , Stetzer MacKenzie R. , Heron Paula R. L.
Published: November 2013

We present results from our ongoing investigation of student understanding of periodic waves and interference phenomena at the introductory physics level. We have found that many students experience significant difficulties when they attempt to express a distance of interest in terms of the wavelength of a periodic wave. We argue that for these students such difficulties may be a significant barrier to understanding important wave phenomena such as interference and diffraction.
Regulation of Epithelial Morphogenesis by the G Protein–Coupled Receptor Mist and Its Ligand Fog
Authors: Manning Alyssa J. , Peters Kimberly A. , Peifer Mark , Rogers Stephen L.
Published: November 2013

The GPCR Mist is required for Fog-induced contractility in cells and acts parallel to Fog in
Drosophila
epithelial morphogenesis.
Dissecting Hippo Interactions
Authors: Ray L. Bryan
Published: November 2013

A proteomics approach for protein-protein interactions reveals new components of a conserved cell signaling pathway.
p21: Protector of Progenitor Pools
Authors: Ferrarelli Leslie K.
Published: November 2013

The cell cycle inhibitor p21 maintains neural stem cell pools through a cell cycle–independent mechanism.
Population Pharmacokinetic and Pharmacogenetic Analysis of Nevirapine in Hypersensitive and Tolerant HIV-Infected Patients from Malawi
Authors: Dickinson Laura , Chaponda Masautso , Carr Daniel F. , van Oosterhout Joep J. , Kumwenda Johnstone , Lalloo David G. , Pirmohamed Munir , Heyderman Robert S. , Khoo Saye H.
Published: November 2013

We modeled nevirapine (NVP) pharmacokinetics in HIV-infected Malawian patients to assess the relationship between drug exposure and patient characteristics, genetic polymorphisms, and development of hypersensitivity reaction (HSR). One thousand one hundred seventeen patients were prospectively recruited and followed for 26 weeks with multiple or single serum samples obtained in a subset of patients for NVP quantification. Single nucleotide polymorphisms (SNPs) withinCYP2B6andCYP3A4genes were typed. Nonlinear mixed effects modeling was utilized to assess the influence of patient characteristics and host genetics on NVP apparent oral clearance (CL/F) and to explore the relationship between NVP CL/F and HSR. Published haplotype distributions were used to simulate NVP concentrations in Caucasians versus Africans. One hundred eighty patients (101 female) were included in the model; 25 experienced HSR. No associations between patient demographics or HSR and NVP CL/F were evident. A significant relationship betweenCYP2B6c.983T>C andCYP2B6c.516G>T and NVP CL/F was observed (P< 0.01). NVP CL/F was reduced by 23% and 36% in patients withCYP2B6983TT/516TT and 983TC/516GG or GT, respectively, compared to the reference genotype. Simulated exposures suggested similar proportions (13 to 17%) of patients with subtherapeutic NVP among Caucasians and an African population. Influence ofCYP2B6polymorphisms on NVP CL/F in this population is in agreement with other reports. Our data indicate a lack of association between NVP exposure and HSR. Based on these data, dose optimization based solely on ethnicity (without individual gene testing) is unlikely to impact on risk of treatment failure or toxicity even in an African population with high carriage of poor metabolizer mutations.
Efficient B Cell Responses to Borrelia hermsii Infection Depend on BAFF and BAFFR but Not TACI
Authors: Dickinson Gregory S. , Sun Guizhi , Bram Richard J. , Alugupalli Kishore R.
Published: November 2013

T cell-independent antibody responses develop rapidly, within 3 to 4 days, and are critical for preventing blood-borne pathogens from evolving into life-threatening infections. The interaction of BAFF, also known as BLyS, with its receptors BAFFR and TACI on B cells is critical for B cell homeostasis and function. Using a synthetic polysaccharide antigen, it has previously been shown that TACI is critical for T cell-independent antibody responses. To examine the role of BAFFR and TACI in T cell-independent antibody responses to an active infection, we utilized the
Borrelia hermsii
infection system. In this infection system, T cell-independent responses mediated by the B1b cell subset are critical for controlling bacteremia. We found that B1b cells express BAFFR and TACI and that the surface expression of both receptors is upregulated on B1b cells following exposure to whole
B. hermsii
cells. Surprisingly, we found that TACI
−/−
mice are not impaired either in specific antibody responses to
B. hermsii
or in controlling
B. hermsii
bacteremia. In contrast, TACI-deficient mice immunized with heat-killed type 3 serotype pneumococcus cells are impaired in generating pneumococcal polysaccharide-specific responses and succumb to challenge with live type 3 serotype pneumococcus, indicating that TACI is required for T cell-independent antibody responses to bacterial-associated polysaccharides. Although we have found that TACI is dispensable for controlling
B. hermsii
infection, mice deficient in BAFFR or BAFF exhibit impairment in
B. hermsii
-specific IgM responses and clearance of bacteremia. Collectively, these data indicate a disparity in the roles for TACI and BAFFR in primary T cell-independent antibody responses to bacterial pathogens.
Protection from Clostridium difficile Infection in CD4 T Cell- and Polymeric Immunoglobulin Receptor-Deficient Mice
Authors: Johnston Pehga F. , Gerding Dale N. , Knight Katherine L.
Published: November 2013

Clostridium difficile
rivals methicillin-resistant
Staphylococcus aureus
as the primary hospital-acquired infection.
C. difficile
infection (CDI) caused by toxins A and/or B can manifest as mild diarrhea to life-threatening pseudomembranous colitis. Although most patients recover fully from CDI, ∼20% undergo recurrent disease. Several studies have demonstrated a correlation between anti-toxin antibody (Ab) and decreased recurrence; however, the contributions of the systemic and mucosal Ab responses remain unclear. Our goal was to use the CDI mouse model to characterize the protective immune response to
C. difficile
. C57BL/6 mice infected with epidemic
C. difficile
strain BI17 developed protective immunity against CDI and did not develop CDI upon rechallenge; they generated systemic IgG and IgA as well as mucosal IgA Ab to toxin. To determine if protective immunity to
C. difficile
could be generated in immunodeficient individuals, we infected
CD4
−/−
mice and found that they generated both mucosal and serum IgA anti-toxin Abs and were protected from CDI upon rechallenge, with protection dependent on major histocompatibility complex class II (MHCII) expression; no IgG anti-toxin Ab was found. We found that protection was likely due to neutralizing mucosal IgA Ab. In contrast,
pIgR
−/−
mice, which lack the receptor to transcytose polymeric Ab across the epithelium, were also protected from CDI, suggesting that although mucosal anti-toxin Ab may contribute to protection, it is not required. We conclude that protection from CDI can occur by several mechanisms and that the mechanism of protection is determined by the state of immunocompetence of the host.