bluuebunny/crossref_metadata_2025 huggingface dataset:
Dependency Modeling and Model Management in Mechatronic Design
Authors: Qamar Ahsan , Paredis Christiaan J. J. , Wikander Jan , During Carl
Published: December 2012

Mechatronic design is traditionally supported through domain-specific design activities throughout the product development process. The partitioning into domain-specific problems leads to a situation where product properties influence each other, hence giving rise to dependencies. These dependencies play a key role in the prediction of properties and, as a result, in the decision-making process. The important question is how to manage the dependencies for efficient and effective decision making? The aim of this paper is threefold. First, we investigate the nature of dependencies and study how to model them. The paper proposes appropriate terminology taking into account the synthesis and analysis nature of both the properties and the dependencies. This terminology will be the core of the new dependency modeling language. The concepts related to dependency modeling are then illustrated through a simple robot design example, where the creation and importance of a dependency model are explained. Second, we study practical approaches for consistency management and model management in the presence of dependencies. Six levels-of-detail in modeling dependencies are presented; emphasizing that modeling at a higher level-of-detail ensures that more inconsistencies are avoided. Available languages such as OMG SysML™ are evaluated for a possible creation of the dependency models leading toward executable dependency networks. However, at present, SysML does not provide sufficiently rich language constructs to model dependencies. Third, we compare our dependency modeling approach to other state-of-the-art approaches such as dependency modeling with a design structure matrix (DSM), and highlight the benefits of the terminology proposed in this paper. We aim to convince the reader that there is substantial value in modeling dependencies explicitly, especially to avoid inconsistencies, which is not the current state of practice. However, an overall value from dependency modeling can only be obtained if the cost of creating the dependency model is reasonable. Issues such as human interaction/effort and model management through product lifecycle management (PLM) are discussed.
Robust Optimization of Mixed-Integer Problems Using NURBs-Based Metamodels
Authors: Steuben John C. , Turner Cameron J.
Published: December 2012

The optimization of mixed-integer problems is a classic problem with many industrial and design applications. A number of algorithms exist for the numerical optimization of these problems, but the robust optimization of mixed-integer problems has been explored to a far lesser extent. We present here a general methodology for the robust optimization of mixed-integer problems using nonuniform rational B-spline (NURBs) based metamodels and graph theory concepts. The use of these techniques allows for a new and powerful definition of robustness along integer variables. In this work, we define robustness as an invariance in problem structure, as opposed to insensitivity in the dependent variables. The application of this approach is demonstrated on two test problems. We conclude with a performance analysis of our new approach, comparisons to existing approaches, and our views on the future development of this technique.
Ultra-compact, high-yield intra-cavity contacts for GaAs/AlGaAs-based vertical-cavity surface-emitting lasers
Authors: Lin Chin-Han , Thibeault Brian J. , Zheng Yan , Rodwell Mark J. W. , Coldren Larry A. , Mehta Alok , Husain Anis
Published: December 2012

A novel method of fabricating compact intra-cavity contacts with high yield for GaAs/AlGaAs-based vertical-cavity surface-emitting lasers is presented. By carefully tailoring the composition of high-aluminum content layer, a highly selective Al2O3 etch-stop layer can be formed simultaneously with the oxide aperture during wet thermal oxidation. With this technique, contact metals can be uniformly deposited on deeply embedded contact layers over large substrate areas. Utilizing this embedded etch-stop design, dual intra-cavity contacted three-terminal vertical-cavity surface-emitting lasers were fabricated, demonstrating submilliampere threshold currents, over 54% differential quantum efficiencies and over 9 mW output powers.
Tree Leaf Shadows to the Sun's Density: A Surprising Route
Authors: Mallmann A. James
Published: December 2012

Rays of sunlight that strike raindrops produce rainbows that provide information about the spectrum of sunlight. Rays of sunlight that strike airborne ice crystals produce halos, sun pillars, and many other patterns of light and color in the sky. Analysis of those patterns makes it possible to determine the types and orientations of the ice crystals. Rays of sunlight that strike opaque objects produce shadow patterns that can be seen on any clear day. I was surprised to discover that the shadow patterns produced when sunlight strikes tree leaves provide all the information needed to determine the average density of the Sun. It seems unlikely that the Sun's density could be determined without knowing its mass or its volume. And, although it may seem even more unlikely, the density of the Sun can be determined using only information available in the shadows of tree leaves.
Pressure-Height Properties of Water with Automated Data Collection
Authors: Bates Alan
Published: December 2012

Instrumentation available for teachers and students has changed considerably during the last 20 years. The data logger-sensor system has the advantage of taking reliable measurements over time with suitable sample rates. This experiment is not an open-ended investigation but an opportunity to explore the established relationship between the pressure exerted by a fluid above a point in a cylinder of water and the height of water above that point. Both motion and pressure sensors1 are employed, leading to a measurement of the acceleration due to gravity. Earlier electronic data sampling techniques have been used to investigate fluid properties in a variety of experiments.2
TIM Family Proteins Promote the Lysosomal Degradation of the Nuclear Receptor NUR77
Authors: Balasubramanian Savithri , Kota Satya Keerthi , Kuchroo Vijay K. , Humphreys Benjamin D. , Strom Terry B.
Published: December 2012

The cell surface receptor TIM-1 attenuates kidney cell death after injury in vitro.
Architecture of a CRAC
Authors: Vinson Valda
Published: December 2012

The unusual architecture of this ion-channel pore regulates the flow of calcium into cells.
Sewing Up DNA Repair
Authors: Riddihough Guy
Published: December 2012

The complete set of proteins required for a mutagenic DNA-repair pathway is defined in
Escherichia coli
.
The Good Side of Inflammation
Authors: Hines Pamela J.
Published: December 2012

An inflammatory response to traumatic injury promotes neurogenesis and repair in the zebrafish brain.
Hippo Backs PTEN
Authors: Wong Wei
Published: December 2012

Activation of the Hippo pathway suppresses the activity of the mTOR pathway.
Tumorigenic Role for Cancer Metabolism
Authors: Foley John F.
Published: December 2012

Loss of the histone deacetylase SIRT6 leads to increased glycolysis and tumorigenesis independently of known oncogenes.
In Vitro
Analysis of Albendazole Sulfoxide Enantiomers Shows that (+)-(
R
)-Albendazole Sulfoxide Is the Active Enantiomer against Taenia solium
Authors: Paredes Adriana , de Campos Lourenço Tiago , Marzal Miguel , Rivera Andrea , Dorny Pierre , Mahanty Siddhartha , Guerra-Giraldez Cristina , García Hector H. , Nash Theodore E. , Cass Quezia B. ,   the Cysticercosis Working Group in Peru
Published: December 2012

Albendazole is an anthelmintic drug widely used in the treatment of neurocysticercosis (NCC), an infection of the brain with
Taenia solium
cysts. However, drug levels of its active metabolite, albendazole sulfoxide (ABZSO), are erratic, likely resulting in decreased efficacy and suboptimal cure rates in NCC. Racemic albendazole sulfoxide is composed of ABZSO (+)-(
R
)- and (−)-(
S
) enantiomers that have been shown to differ in pharmacokinetics and activity against other helminths. The antiparasitic activities of racemic ABZSO and its (+)-(
R
)- and (−)-(
S
) enantiomers against
T. solium
cysts were evaluated
in vitro
. Parasites were collected from naturally infected pigs, cultured, and exposed to the racemic mixture or to each enantiomer (range, 10 to 500 ng/ml) or to praziquantel as a reference drug. The activity of each compound against cysts was assayed by measuring the ability to evaginate and inhibition of alkaline phosphatase (AP) and parasite antigen release. (+)-(
R
)-ABZSO was significantly more active than (−)-(
S
)-ABZSO in suppressing the release of AP and antigen into the supernatant in a dose- and time-dependent manner, indicating that most of the activity of ABZSO resides in the (+)-(
R
) enantiomer. Use of this enantiomer alone may lead to increased efficacy and/or less toxicity compared to albendazole.
Interactions of Oximino-Substituted Boronic Acids and β-Lactams with the CMY-2-Derived Extended-Spectrum Cephalosporinases CMY-30 and CMY-42
Authors: Kotsakis Stathis D. , Caselli Emilia , Tzouvelekis Leonidas S. , Petinaki Efi , Prati Fabio , Miriagou Vivi
Published: December 2012

CMY-30 and CMY-42 are extended-spectrum (ES) derivatives of CMY-2. ES characteristics are due to substitutions of Gly (CMY-30) and Ser (CMY-42) for Val211 in the Ω-loop. To characterize the effects of 211 substitutions, we studied the interactions of CMY-2, -30, and -42 with boronic acid transition state inhibitors (BATSIs) resembling ceftazidime and cefotaxime, assessed thermal stability of the enzymes in their free forms and in complexes with BATSIs and oximino-β-lactams, and simulated, using molecular dynamics (MD), the CMY-42 apoenzyme and the CMY-42 complexes with ceftazidime and the ceftazidime-like BATSI. Inhibition constants showed that affinities between CMY-30 and CMY-42 and the R1 groups of BATSIs were lower than those of CMY-2. ES variants also exhibited decreased thermal stability either as apoenzymes or in covalent complexes with oximino compounds. MD simulations further supported destabilization of the ES variants. Val211Ser increased thermal factors of the Ω-loop backbone atoms, as previously observed for CMY-30. The similar effects of the two substitutions seemed to be due to a less-constrained Tyr221 likely inducing concerted movement of elements at the edges of the active site (Ω-loop–Q120 loop–R2 loop/H10 helix). This inner-protein movement, along with the wider R1 binding cleft, enabled intense vibrations of the covalently bound ceftazidime and ceftazidime-like BATSIs. Increased flexibility of the ES enzymes may assist the productive adaptation of the active site to the various geometries of the oximino substrates during the reaction (higher frequency of near-attack conformations).
Dissemination of a Carbapenem-Resistant Acinetobacter baumannii Strain Belonging to International Clone II/Sequence Type 2 and Harboring a Novel AbaR4-Like Resistance Island in Latvia
Authors: Saule Mara , Samuelsen Ørjan , Dumpis Uga , Sundsfjord Arnfinn , Karlsone Aija , Balode Arta , Miklasevics Edvins , Karah Nabil
Published: December 2012

An outbreak of hospital-acquired
Acinetobacter baumannii
infections, caused by a
bla
OXA-23
-positive carbapenem-resistant strain belonging to international clone II/ST2, was detected in Latvia. The strain was partially equipped with the
armA
gene and the
intI1-aacA4-catB8-aadA1-qacE
Δ
1
class 1 integron. In addition, the strain carried AbaR25, a novel AbaR4-like resistance island of ∼46,500 bp containing structures similar to the previously described AbaR22 and Tn
6167
islands. AbaR25 was characterized by the occurrence of a second copy of Tn
6022a
interrupted by Tn
2006
carrying the
bla
OXA-23
gene.
Genetic Determinants of Intrinsic Colistin Tolerance in Acinetobacter baumannii
Authors: Hood M. Indriati , Becker Kyle W. , Roux Christelle M. , Dunman Paul M. , Skaar Eric P.
Published: December 2012

Acinetobacter baumanniiis a leading cause of multidrug-resistant infections worldwide. This organism poses a particular challenge due to its ability to acquire resistance to new antibiotics through adaptation or mutation. This study was undertaken to determine the mechanisms governing the adaptability ofA. baumanniito the antibiotic colistin. Screening of a transposon mutant library identified over 30 genes involved in inducible colistin resistance inA. baumannii. One of the genes identified waslpsB, which encodes a glycosyltransferase involved in lipopolysaccharide (LPS) synthesis. We demonstrate that loss of LpsB function results in increased sensitivity to both colistin and cationic antimicrobial peptides of the innate immune system. Moreover, LpsB is critical for pathogenesis in a pulmonary model of infection. Taken together, these data define bacterial processes required for intrinsic colistin tolerance inA. baumanniiand underscore the importance of outer membrane structure in both antibiotic resistance and the pathogenesis ofA. baumannii.
Active Escape of Orientia tsutsugamushi from Cellular Autophagy
Authors: Ko Youngho , Choi Ji-Hye , Ha Na-Young , Kim Ik-Sang , Cho Nam-Hyuk , Choi Myung-Sik
Published: December 2012

Orientia tsutsugamushi
, the causative agent of scrub typhus, is an obligate intracellular pathogen. After entry into host cells, the bacterium rapidly escapes from the endosomal pathway and replicates in the cytosol of eukaryotic host cells. Here we show that
O. tsutsugamushi
infection efficiently promotes cellular autophagy, a cell-autonomous defense mechanism of innate immunity. However, most of the internalized bacteria barely colocalized with the induced autophagosomes, even when stimulated with rapamycin, a chemical inducer of autophagy. Treatment of infected cells with tetracycline suppressed bacterial evasion from autophagy and facilitated
O. tsutsugamushi
targeting to autophagosomes, suggesting that the intracellular pathogen may be equipped with a bacterial factor or factors that block autophagic recognition. Finally, we also found that chemical modulators of cellular autophagy or genetic knockout of the
atg3
gene does not significantly affect the intracellular growth of
O. tsutsugamushi
in vitro. These results suggest that
O. tsutsugamushi
has evolved to block autophagic microbicidal defense by evading autophagic recognition even though it activates the autophagy pathway during the early phase of infection.
Transcriptional Regulation of the
nadA
Gene in Neisseria meningitidis Impacts the Prediction of Coverage of a Multicomponent Meningococcal Serogroup B Vaccine
Authors: Fagnocchi Luca , Biolchi Alessia , Ferlicca Francesca , Boccadifuoco Giuseppe , Brunelli Brunella , Brier Sébastien , Norais Nathalie , Chiarot Emiliano , Bensi Giuliano , Kroll J. Simon , Pizza Mariagrazia , Donnelly John , Giuliani Marzia Monica , Delany Isabel
Published: December 2012

The NadA adhesin is a major component of 4CMenB, a novel vaccine to prevent meningococcus serogroup B (MenB) infection. Under
in vitro
growth conditions,
nadA
is repressed by the regulator NadR and poorly expressed, resulting in inefficient killing of MenB strains by anti-NadA antibodies. Interestingly, sera from children infected with strains that express low levels of NadA in laboratory growth nevertheless recognize the NadA antigen, suggesting that NadA expression during infection may be different from that observed
in vitro
. In a strain panel covering a range of NadA levels, repression was relieved through deleting
nadR
. All
nadR
knockout strains expressed high levels of NadA and were efficiently killed by sera from subjects immunized with 4CMenB. A selected MenB strain, NGP165, mismatched for other vaccine antigens, is not killed by sera from immunized infants when the strain is grown
in vitro
. However, in an
in vivo
passive protection model, the same sera effectively protected infant rats from bacteremia with NGP165. Furthermore, we identify a novel hydroxyphenylacetic acid (HPA) derivative, reported by others to be produced during inflammation, which induces expression of NadA
in vitro
, leading to efficient antibody-mediated killing. Finally, using bioluminescent reporters,
nadA
expression in the infant rat model was induced
in vivo
at 3 h postinfection. Our results suggest that during infectious disease, NadR repression is alleviated due to niche-specific signals, resulting in high levels of NadA expression from any
nadA
-positive (
nadA
+
) strain and therefore efficient killing by anti-NadA antibodies elicited by the 4CMenB vaccine.
Carbon Storage Regulator A Contributes to the Virulence of Haemophilus ducreyi in Humans by Multiple Mechanisms
Authors: Gangaiah Dharanesh , Li Wei , Fortney Kate R. , Janowicz Diane M. , Ellinger Sheila , Zwickl Beth , Katz Barry P. , Spinola Stanley M.
Published: December 2012

The carbon storage regulator A (CsrA) controls a wide variety of bacterial processes, including metabolism, adherence, stress responses, and virulence.
Haemophilus ducreyi
, the causative agent of chancroid, harbors a homolog of
csrA
. Here, we generated an unmarked, in-frame deletion mutant of
csrA
to assess its contribution to
H. ducreyi
pathogenesis. In human inoculation experiments, the
csrA
mutant was partially attenuated for pustule formation compared to its parent. Deletion of
csrA
resulted in decreased adherence of
H. ducreyi
to human foreskin fibroblasts (HFF); Flp1 and Flp2, the determinants of
H. ducreyi
adherence to HFF cells, were downregulated in the
csrA
mutant. Compared to its parent, the
csrA
mutant had a significantly reduced ability to tolerate oxidative stress and heat shock. The enhanced sensitivity of the mutant to oxidative stress was more pronounced in bacteria grown to stationary phase compared to that in bacteria grown to mid-log phase. The
csrA
mutant also had a significant survival defect within human macrophages when the bacteria were grown to stationary phase but not to mid-log phase. Complementation in
trans
partially or fully restored the mutant phenotypes. These data suggest that CsrA contributes to virulence by multiple mechanisms and that these contributions may be more profound in bacterial cell populations that are not rapidly dividing in the human host.
Interleukin-6 Is Essential for Primary Resistance to Francisella tularensis Live Vaccine Strain Infection
Authors: Kurtz Sherry L. , Foreman Oded , Bosio Catharine M. , Anver Miriam R. , Elkins Karen L.
Published: December 2012

We employedFrancisella tularensislive vaccine strain (LVS) to study mechanisms of protective immunity against intracellular pathogens and, specifically, to understand protective correlates. One potential molecular correlate identified previously was interleukin-6 (IL-6), a cytokine with pleotropic roles in immunity, including influences on T and B cell functions. Given its role as an immune modulator and the correlation with successful anti-LVS vaccination, we examined the role IL-6 plays in the host response to LVS. IL-6-deficient (IL-6 knockout [KO]) mice infected with LVS intradermally or intranasally or anti-IL-6-treated mice, showed greatly reduced 50% lethal doses compared to wild-type (WT) mice. Increased susceptibility was not due to altered splenic immune cell populations during infection or decreased serum antibody production, as IL-6 KO mice had similar compositions of each compared to WT mice. Although LVS-infected IL-6 KO mice produced much less serum amyloid A and haptoglobin (two acute-phase proteins) than WT mice, there were no other obvious pathophysiological differences between LVS-infected WT and IL-6 KO mice. IL-6 KO or WT mice that survived primary LVS infection also survived a high-dose LVS secondary challenge. Using anin vitrooverlay assay that measured T cell activation, cytokine production, and abilities of primed splenocytes to control intracellular LVS growth, we found that IL-6 KO total splenocytes or purified T cells were slightly defective in controlling intracellular LVS growth but were equivalent in cytokine production. Taken together, IL-6 is an integral part of a successful immune response to primary LVS infection, but its exact role in precipitating adaptive immunity remains elusive.
Significant and serious dehydration does not affect skeletal muscle cramp threshold frequency
Authors: Braulick Kyle W , Miller Kevin C , Albrecht Jay M , Tucker Jared M , Deal James E
Published: December 2012

Objective

Many clinicians believe that exercise-associated muscle cramps (EAMC) occur because of dehydration. Experimental research supporting this theory is lacking. Mild hypohydration (3% body mass loss) does not alter threshold frequency (TF), a measure of cramp susceptibility, when fatigue and exercise intensity are controlled. No experimental research has examined TF following significant (3–5% body mass loss) or serious hypohydration (>5% body mass loss). Determine if significant or serious hypohydration, with moderate electrolyte losses, decreases TF.

Design

A prepost experimental design was used. Dominant limb flexor hallucis brevis cramp TF, cramp electromyography (EMG) amplitude and cramp intensity were measured in 10 euhydrated, unacclimated men (age=24±4 years, height=184.2±4.8 cm, mass=84.8±11.4 kg). Subjects alternated exercising with their non-dominant limb or upper body on a cycle ergometer every 15 min at a moderate intensity until 5% body mass loss or volitional exhaustion (3.8±0.8 h; 39.1±1.5°C; humidity 18.4±3%). Cramp variables were reassessed posthypohydration.

Results

Subjects were well hydrated at the study's onset (urine specific gravity=1.005±0.002). They lost 4.7±0.5% of their body mass (3.9±0.5 litres of fluid), 4.0±1.5 g of Na+and 0.6±0.1 g K+via exercise-induced sweating. Significant (n=5) or serious hypohydration (n=5) did not alter cramp TF (euhydrated=15±5 Hz, hypohydrated=13±6 Hz; F1,9=3.0, p=0.12), cramp intensity (euhydrated= 94.2±41%, hypohydrated=115.9±73%; F1,9=1.9, p=0.2) or cramp EMG amplitude (euhydrated=0.18±0.06 µV, hypohydrated= 0.18±0.09 µV; F1,9=0.1, p=0.79).

Conclusions

Significant and serious hypohydration with moderate electrolyte losses does not alter cramp susceptibility when fatigue and exercise intensity are controlled. Neuromuscular control may be more important in the onset of muscle cramps than dehydration or electrolyte losses.
Simulation training for improving the quality of care for older people: an independent evaluation of an innovative programme for inter-professional education
Authors: Ross Alastair J , Anderson Janet E , Kodate Naonori , Thomas Libby , Thompson Kellie , Thomas Beth , Key Suzie , Jensen Heidi , Schiff Rebekah , Jaye Peter
Published: December 2012

Introduction

This paper describes the evaluation of a 2-day simulation training programme for staff designed to improve teamwork and inpatient care and compassion in an older persons’ unit.

Objective

The programme was designed to improve inpatient care for older people by using mixed modality simulation exercises to enhance teamwork and empathetic and compassionate care.

Methods

Healthcare professionals took part in: (a) a 1-day human patient simulation course with six scenarios and (b) a 1-day ward-based simulation course involving five 1-h exercises with integrated debriefing. A mixed methods evaluation included observations of the programme, precourse and postcourse confidence rating scales and follow-up interviews with staff at 7–9 weeks post-training.

Results

Observations showed enjoyment of the course but some anxiety and apprehension about the simulation environment. Staff self-confidence improved after human patient simulation (t=9; df=56; p<0.001) and ward-based exercises (t=9.3; df=76; p<0.001). Thematic analysis of interview data showed learning in teamwork and patient care. Participants thought that simulation had been beneficial for team practices such as calling for help and verbalising concerns and for improved interaction with patients.

Areas to address in future include widening participation across multi-disciplinary teams, enhancing post-training support and exploring further which aspects of the programme enhance compassion and care of older persons.

Conclusions

The study demonstrated that simulation is an effective method for encouraging dignified care and compassion for older persons by teaching team skills and empathetic and sensitive communication with patients and relatives.
Family witnessed resuscitation: nationwide survey of 337 prehospital emergency teams in France
Authors: Belpomme Vanessa , Adnet Frederic , Mazariegos Ixchel , Beardmore Matt , Duchateau François-Xavier , Mantz Jean , Ricard-Hibon Agnes
Published: December 2012

Objective

To assess the practices and opinions of prehospital emergency medical services (EMS) with regard to family witnessed resuscitation (FWR) and to analyse the differences between physicians’ and nurses’ responses.

Design

An anonymous questionnaire (30 yes/no questions on demographics and FWR) was sent to all prehospital emergency staff (physicians, nurses and support staff) working for the 377 Mobile Intensive Care Units in France.

Results

Of the 2689 responses received 2664 were analysed. Mean respondent age was 38±8 years, the male to female ratio was 1:2. 87% of respondents had already performed FWR and 38% had offered relatives the option to be present during resuscitation. Most respondents (90%) felt that FWR might cause psychological trauma to the family; 70% thought that FWR might impact on the duration of resuscitation and 68% on EMS team concentration. In the 28% of cases when relatives had asked to be present, 59% of respondents had acquiesced but only 27% were willing to invite relatives to be routinely present.

Conclusions

Prehospital EMS teams in France seems to support FWR but are not yet ready to offer it systematically to relatives. Following our survey, written guidelines are currently in development in our department. These guidelines could be the first step of a national strategy for developing FWR in France. We await results from other studies of family members’ opinions to compare prehospital practitioners’ and family members’ views to further develop our practice.
A descriptive analysis of patients with an emergency department diagnosis of acute pericarditis
Authors: Hooper Andrew J , Celenza Antonio
Published: December 2012

Aim

To describe clinical characteristics, assessment and treatment of patients diagnosed in an emergency department (ED) with acute pericarditis.

Methods

A medical record review of patients with an ED diagnosis of pericarditis conducted in an adult tertiary hospital over a 5-year period. Variables collected included pain characteristics, associated symptoms, physical examination findings, investigation results, ED treatment and disposition.

Results

179 presentations were included, with 73.9% men and a mean age of 38.8 years. The majority of patients described pleuritic chest pain worse with inspiration with half characterising the pain as sharp or stabbing, with others describing tightness, dullness or cramping. Radiation to the left shoulder occurred in 2.8% and change of pain with posture occurred in 46.4%. A pericardial rub was documented in 19 presentations. All patients had an ECG recorded with ST segment elevation present in 69.3% and PR segment depression in 49.2%. Nearly 90% of patients had troponin testing but only 6.4% of these were positive. Only 8.1% of cases were treated with colchicine. No patients required pericardiocentesis. Patients with high-risk factors were more likely to have previous pericarditis, dyspnoea, nausea, abnormal investigation results, treatment with colchicine and admission to hospital. However, 16.9% of patients without risk factors were admitted, and 46.9% of patients with at least one risk factor were discharged.

Conclusions

Pericarditis may not follow the classical clinical description. Admission and discharge decisions appear to relate to individual clinical characteristics rather than known risk factors. Use of colchicine for treatment in ED is infrequent.
Comparison of the costs of care during acute illness by two community children's nursing teams
Authors: Callery Peter , Kyle Richard G , Weatherly Helen , Banks Michele , Ewing Carol , Powell Peter , Kirk Susan
Published: December 2012

Objective

To compare the costs associated with care by two community children's nursing teams (CCNT).

Design

A case study incorporating questionnaire survey, analysis of routinely collected data and analysis of costs in the north-west England.

Patients

Children with acute illness referred for CCNT care.

Interventions

Two CCNT provided care for 273 children during acute illness in order to reduce the number and duration of hospital admissions.

Main Outcome Measures

Costs of CCNT, other services and costs to families.

Results

The objectives of both CCNT included shortening and avoiding hospitalisations. Most (45 (58%) in case A and 150 (77%) in case B) children were referred for infections. There were differences in the proportion of children who had been hospitalised (45 (57.7%) and 78 (40%)), the mean number of services used before referral to CCNT (1.6 and 2.2) and the staffing profile of the CCNT. There was a statistically significant difference in the overall mean cost to the NHS of CCNT care (£146 and £238, 95% CI for difference of means 7 to 184), associated with higher proportions of children having telephone-only contact (two (3%) and 46 (24%)) and children using almost twice as many other health services during care by one CCNT (means 0.27 and 0.51).

Conclusions

Costs of CCNT care can vary widely when all health service use is taken into account. Differences in the way CCNT are integrated with the urgent care system, and the way in which CCNT care is organised, could contribute to variations in costs.
Patient-controlled analgesia compared with interval analgesic dosing for reducing complications in blunt thoracic trauma: a retrospective cohort study
Authors: Asha Stephen Edward , Curtis Kate Anne , Taylor Colman , Kwok Allan
Published: December 2012

Objectives

To determine if complications from blunt thoracic trauma are reduced with patient-controlled analgesia (PCA) compared with interval analgesic dosing given as needed. Secondary aims were to investigate the influence of PCA on hospital length of stay (LOS) and cost.

Methods

In this retrospective cohort study, patients were identified using the hospital trauma registry and clinical information department. Data on analgesic method, outcomes and confounders were obtained from the medical record. Costing data were obtained from the case-mix department. The analysis used logistic regression for the primary outcome and a generalised linear model for the secondary outcomes to adjust for potential confounders.

Results

227 patients were included. In the PCA group, 17/52 (33%) patients had a complication compared with 26/175 (15%) in the interval dosing group. The adjusted odds for a complication in patients receiving PCA was not significantly different from the adjusted odds in those receiving interval dosing (OR=1.2, 95% CI 0.3 to 4.6, p=0.83). The median LOS was 8.9 days in the PCA group and 4.6 days in the interval dosing group. The adjusted LOS for patients receiving PCA was 10% shorter than those receiving interval dosing (relative difference 0.9, 95% CI 0.6 to 1.3, p=0.52). The median hospital cost was $A11 107 in the PCA group (IQR $A7520–$A15 744) and $A4511 (IQR $A2687–$A8248) in the interval dosing group. The adjusted total hospital costs for patients receiving PCA was 10% higher than for those receiving interval dosing (relative difference 1.1, 95% CI 0.8 to 1.5, p=0.44).

Conclusions

PCA did not reduce complications, hospital LOS or costs compared with interval analgesic dosing.
The role of the physician in laboratory medicine: a European perspective
Authors: Misbah Siraj A , Kokkinou Vana , Jeffery Katie , Oosterhuis Wytze , Shine Brian , Schuh Anna , Theodoridis Theodore
Published: December 2012

Advances in medical laboratory technology have driven major changes in the practice of laboratory medicine over the past two decades by the development of automated, cross-disciplinary single platform analysers. This has led to the blurring of boundaries between traditional disciplines and the emergence of core automated or blood science laboratories. This paper was commissioned by the Union of European Medical Specialists to examine the changing role of laboratory-based physicians in the light of these advances by focusing on the added value of expert interpretation of test results and resultant improvements in clinical outcomes. The paper also considers the broad range of responsibilities of laboratory-based physicians and the difficulties in precisely measuring how this translates into improved clinical outcomes. Given its provenance, the paper concentrates predominantly on the role of laboratory-based physicians while acknowledging the essential and vital role of scientists in running diagnostic laboratory services.
Birt–Hogg–Dubé syndrome: clinicopathological features of the lung
Authors: Furuya Mitsuko , Nakatani Yukio
Published: December 2012

Birt–Hogg–Dubé syndrome (BHD) is an autosomal dominant inherited disorder characterised by fibrofolliculomas, renal tumours, pulmonary cysts and pneumothorax. The pulmonary cysts and repeated episodes of pneumothorax are the clinical hallmarks for discovering families affected by the syndrome. This disorder is caused by mutations in the gene coding for folliculin (FLCN). FLCN forms a complex with FLCN-interacting protein 1 (FNIP1) and FNIP2 (also known as FNIPL), and the complex cross-talks with signalling molecules such as 5′-AMP-activated protein kinase (AMPK) and the mammalian target of rapamycin (mTOR). HeterozygousFlcnknockout mice and rats withFlcngene mutations develop renal cysts, adenomas and/or carcinomas. These findings suggest that FLCN functions as a tumour suppressor that inhibits renal carcinogenesis. However, the mechanisms of the formation of pulmonary cysts and pneumothorax associated with heterozygous mutations inFLCNare poorly understood. Resected lung specimens from patients with BHD are often misdiagnosed by pathologists as non-specific blebs or bullae or emphysema, and patients with BHD who have pulmonary cysts and repeated pneumothorax frequently do not receive appropriate medical investigations. This review discusses the clinical and pathological features of lungs of patients with BHD, focusing on the diagnostic pathology and possible mechanisms of cyst formation.
Consent of the recently bereaved to post-mortem targeted angiography research: 207 adult cases
Authors: Saunders Sarah L , Amoroso Jasmin , Morgan Bruno , Rutty Guy
Published: December 2012

Aims

To present our experience of prospective telephone consenting for post-mortem CT angiography (PMCT-A) research using HM coroners’ cases.

Methods

Local ethics committee, research and development office, and local HM coroners gave their permission for the families of the deceased, in cases where a ‘routine’ coroner's autopsy had been authorised, to be approached for their consent to PMCT-A research before the autopsy examination. A forensic pathologist or trial consenter telephoned the next of kin, discussed the nature of the study and obtained verbal informed consent for post-mortem imaging, angiography, case-dependent histological and toxicology sampling and for the use of the images for teaching and training. Thematic analyses of the reasons for giving or refusing consent are provided.

Results

Of the 207 cases approached, seven relatives refused to enter their next of kin into the study (96.6% consent rate).

Conclusions

This study shows that prospective consenting for HM coroners’ cases to be used for autopsy research is feasible in adults, and can be done ethically, and in the limited time available, by obtaining the consent of the next of kin by telephone before autopsy.
The role of interventional radiology in the management of deep vein thrombosis
Authors: Mehrzad Homoyoon , Freedman Jonathan , Harvey John Julian J , Ganeshan Arul
Published: December 2012

Deep venous thrombosis is a common life-threatening disorder with a significant mortality rate. The current standard anticoagulation therapy has proven inadequate in prevention of long-term post-thrombotic symptoms in patients with large clot burdens. Over the last two decades, advances in endovascular therapies have delivered a range of new treatment options including catheter-directed thrombolysis, percutaneous mechanical thrombectomy, venoplasty and stenting and inferior vena caval filter devices. Although there has been growing experience and guidelines in the treatment of deep vein thrombosis, there remains a wide variation in clinical practice nationally. This paper aims to raise the awareness of these emerging therapies and reviews the available evidence for their use.
Foundation doctors’ views on whether their medical school prepared them well for work: UK graduates of 2008 and 2009
Authors: Goldacre Michael J , Lambert Trevor W , Svirko Elena
Published: December 2012

Purpose of the study

The transition from medical student to junior doctor is a critical stage in career progression. We report junior doctors’ views 1 year after graduation on whether their medical school prepared them well for clinical work.

Study design

Questionnaire surveys of the medical graduates of 2008 and 2009, from all UK medical schools, 1 year after graduation. Responses were compared with those of UK medical graduates of 1999, 2000, 2002 and 2005. The main outcome measure was the doctors’ level of agreement that medical school had prepared them well for work.

Results

53% of 2008 graduates and 49% of 2009 graduates agreed that their medical school had prepared them well. The percentage who felt unprepared has fallen from 31% of the 1999–2005 graduates, combined, to 19% of the 2008 and 2009 graduates (the remainder gave neutral responses). Combining 2008 and 2009 graduates’ responses, percentages who agreed that they had been well prepared ranged from 83% (95% CI 78 to 89) at the medical school with the highest level of agreement to 27% (95% CI 20 to 34) at the lowest. 25% of doctors specified that feeling unprepared had been a serious or medium-sized problem for them (only 2.7% regarded it as serious).

Conclusions

Medical schools need feedback from their graduates about elements of medical school training that could improve preparedness for medical work. It also seems likely that there are some reasonably straightforward lessons that medical schools could learn from each other.
Understanding MRI: basic MR physics for physicians
Authors: Currie Stuart , Hoggard Nigel , Craven Ian J , Hadjivassiliou Marios , Wilkinson Iain D
Published: December 2012

More frequently hospital clinicians are reviewing images from MR studies of their patients before seeking formal radiological opinion. This practice is driven by a multitude of factors, including an increased demand placed on hospital services, the wide availability of the picture archiving and communication system, time pressures for patient treatment (eg, in the management of acute stroke) and an inherent desire for the clinician to learn. Knowledge of the basic physical principles behind MRI is essential for correct image interpretation. This article, written for the general hospital physician, describes the basic physics of MRI taking into account the machinery, contrast weighting, spin- and gradient-echo techniques and pertinent safety issues. Examples provided are primarily referenced to neuroradiology reflecting the subspecialty for which MR currently has the greatest clinical application.
HTLV-1 cosmopolitan and HTLV-2 subtype b among pregnant women of non-endemic areas of Argentina
Authors: Berini Carolina A , Delfino Cecilia , Torres Oscar , García Gabriela , Espejo Rogelio , Pianciola Luis , Juarez Mirna , Arribere Graciela , Nadal Mónica , Eirin Maria E , Biglione Mirna M
Published: December 2012

Objectives

The objective of this study was to estimate the prevalence of human T cell lymphotropic virus (HTLV)-1/2, HIV-1, hepatitis B virus (HBV),Trypanosoma cruzi,Treponema pallidumandToxoplasma gondiiinfections and to identify the subtypes/subgroups of HTLV-1/2 among pregnant women (PW) from non-endemic provinces of Argentina.

Methods

Methods A total of 2403 samples were screened for HTLV-1/2 and confirmed by western blot and PCR. The long terminal repeat (LTR) of HTLV-1 and HTLV-2 were amplified. Phylogenetic analysis was performed by Neighbour Joining by using molecular evolutionary genetics analysis (MEGA) 4.0.

Results

Among a total of 2403 PW studied, 6 (0.25%) tested positive for HTLV-1/2 (3 HTLV-1 (0.12%) and 3 HTLV-2 (0.12%)). The total prevalence when distributed by province was 0.3% (3/804) for Buenos Aires (BA), 0.4% (1/241) for BA surroundings, 0.1% (1/707) for Neuquen and 1.0% (1/95) for Ushuaia. In San Juan, no PW were HTLV-1/2 positive. The prevalence was similar when compared with rates among blood donors of the same areas and years. The phylogenetic analysis classified one sequence as HTLV-1 aA and one as HTLV-2b. The prevalence of HIV-1, HBV, T cruzi, T pallidum and T gondii was 0.6%, 0.2%, 1.4%, 1.2% and 20.9%, respectively. One case of HTLV-1/HIV-1 and one of HTLV-2/HIV-1 co-infection were detected.

Conclusions

HTLV-1/2, which have been associated with different diseases, are circulating among PW of Argentina, even in non-endemic areas. Therefore, testing should be recommended in women who have risk factors for these infections given that the majority of HTLV-1/2 mother to child transmission can be prevented by the avoidance of breast feeding.
Vulnerabilities, health needs and predictors of high-risk sexual behaviour among female adolescent sex workers in Kunming, China
Authors: Zhang Xu-Dong , Temmerman Marleen , Li Yan , Luo Wei , Luchters Stanley
Published: December 2012

Objectives

This study assessed social and behavioural predictors for sexual risk taking and sexually transmitted infections (STIs) including HIV among adolescent female sex workers (FSWs) from Kunming, China. Additionally, health services needs and use were assessed.

Methods

A cross-sectional survey was conducted in 2010. Using snowball and convenience sampling, self-identified FSWs were recruited from four urban areas in Kunming. Women consenting to participate were administered a semi-structured questionnaire by trained interviewers identified from local peer-support organisations. Following interview, a gynaecological examination and biological sampling to identify potential STIs were undertaken. Descriptive and multivariable logistic regression analyses were performed.

Results

Adolescent FSWs had a mean age of 18.2 years and reported numerous non-paying sexual partners with very low rate of consistent condom use (22.2%). Half (50.3%) the respondents had sex while feeling drunk at least once in the past week, of whom 56.4% did not use condom protection. STI prevalence was high overall (30.4%) among this group. Younger age, early sexual debut, being isolated from schools and family, short duration in sex work, and use of illicit drugs were found to be strong predictors for unprotected sex and presence of an STI. Conversely, having access to condom promotion, free HIV counselling and testing, and peer education were associated with less unprotected sex. The majority reported a need for health knowledge, free condoms and low-cost STI diagnosis and treatment.

Conclusions

There is an urgent need to improve coverage, accessibility and efficiency of existing interventions targeting adolescent FSWs.
Second generation HIV surveillance in Pakistan: policy challenges and opportunities
Authors: Munro Michelle , Holte-McKenzie Merydth , Ahmed Sadia , Archibald Chris P , Blanchard James F , Thompson Laura H
Published: December 2012

From 2004 to 2011, the Canada-Pakistan HIV/AIDS Surveillance Project (HASP) worked with government and non-government partners in Pakistan to design and implement an HIV second generation surveillance (SGS) system. Insights into the development of scalable cost effective surveillance methodologies, implementation, use of data for HIV prevention and human rights were gained over the course of HASP. An ideal SGS system would be affordable, able to be implemented independently by local partners and produce data that could be readily applied in policy and programmes. Flexibility in design and implementation is important to ensure that any SGS system is responsive to information needs, political changes and changes in key population dynamics and HIV epidemics. HASP's mapping methodology is innovative and widely accepted as best practice, but sustainability of the SGS system it developed is a challenge.
Outbreaks of African horse sickness in Senegal, and methods of control of the 2007 epidemic
Authors: Diouf N. D. , Etter E. , Lo M. M. , Lo M. , Akakpo A. J.
Published: December 2012

Since first being detected in Nigeria in January 2007, African horse sickness virus serotype 2 (AHSV‐2) has spread throughout the northern hemisphere, and was first reported in Senegal. A retrospective study was conducted from December 2009 to April 2010 using data collected in the field combined with information available at the Direction of Veterinary Services. The epidemic started in the Dakar region with two outbreaks in March and June 2007, respectively, and spread in several parts of the country between July and November 2007. During this period, 232 outbreaks and 1137 horse deaths were reported. The epidemic was controlled by mass vaccination using a polyvalent‐attenuated vaccine. This retrospective study was conducted with various assumptions of AHSV‐2 introduction, and provides recommendations for implementing an early warning surveillance system for African horse sickness in Senegal.
The involvement of ethylene in programmed cell death and climacteric-like behaviour during the remodelling of lace plant (Aponogeton madagascariensis) leaves
Authors: Dauphinee A.N. , Wright H. , Rantong G. , Gunawardena A.H.L.A.N.
Published: December 2012

Programmed cell death (PCD) plays an important role in several plant developmental processes. The phytohormone ethylene has been implicated in PCD signalling in many plant systems, but it is also important in developmental processes such as seed germination, flowering, and climacteric fruit ripening. Lace plant (Aponogeton madagascariensis (Mirbel) H. Bruggen) is an aquatic monocot that develops perforated leaves via the deletion of cells through developmentally regulated PCD. The plant is ideal for studying PCD; however, little is known about the regulation of cellular death involved in this system. The current study examines ethylene as a potential signalling molecule in lace plant PCD and investigates climacteric-like behaviour during lace plant leaf development. Whole plants were treated with the ethylene biosynthesis inhibitor aminoethoxyvinylglycine (AVG), the ethylene precursor 1-aminocyclopropane-1-carboxylic acid (ACC), or a combination of both. Subsequently, ethylene levels were monitored, and leaf development was analyzed. The results indicate that ethylene is involved in lace plant PCD signalling. AVG-treated plants had significantly lower ethylene outputs and a significant reduction in perforation formation. The inhibitory effect of AVG was recovered when AVG and ACC were applied simultaneously. The data presented here show for the first time, to our knowledge, climacteric-like behaviour during the remodelling of leaves.