bluuebunny/crossref_metadata_2025 huggingface dataset:
Grassroots literacy and the written record: Asbestos activism in South Africa
Authors: Trimbur John
Published: September 2013

This article uses two key terms – ‘grassroots literacy’ and the ‘written record’ – to examine writing produced by the Asbestos Interest Group (AIG), a community organization in Kuruman, South Africa. The article considers the formation of theAIG's grassroots literacy in terms of the unequal distribution of semiotic resources in a stratified world system, with particular attention to how the allotment of the means of representation enables and constrains the capacity of texts to move across social locations. The article analyzes how theAIGnegotiates the paperwork of state, legal, and medical bureaucracies in compensation cases for asbestos‐related disease. It examines how theAIG's grassroots texts, such as monthly reports and handwritten/drawn maps, manage or not to circulate translocally, to take on semiotic mobility by making theAIG's interests known in the written record.

Lekwalonyana le, le dirisa mareomagolo a mabedi – ‘go ruta baagi go buisa le go kwala’ le ‘rekoto e e kwadilweng’ – go lekola mokwalo o o tlhagisitsweng ke Abestos Interest Group (AIG), mogatlho wa set haba kwa Kuruman, Aforika Borwa. Lekwalonyana le, le sekaseka go tlhamiwa ga go ruta baagi go buisa le go kwala keAIGgo ya ka go aba ga tiriso ya didiriswa tsa matshwao ka mokgwa o o sa lekalekaneng mo bathong go lebeletswe thata mokgwa wa go aba ka kemedi e e kgotshang le go thibela bokgoni ba dipolelwana tse di kgonang go fitlhelela batho mo ba nnang. Lekwalonyana le, le sekaseka mokgwa oAIGe buisanang le tiro ya dikwalo tsa puso, tsa semolao le maparego a boitekanelo mo go neeleng ditlhapiso mo dikgetseng tse di amanang le abesetose e e tlholang bolwetsi jwa mafatlha. [Setswana]
Incidence and mortality trends for biliary tract cancers in Austria
Authors: Pinter Matthias , Hucke Florian , Zielonke Nadine , Waldhör Thomas , Trauner Michael , Peck‐Radosavljevic Markus , Sieghart Wolfgang
Published: September 2013

Background & Aims

The epidemiology of biliary tract cancers (BTC) varies between geographical regions and has changed over time globally. We investigated the incidence and mortality trends of patients diagnosed with BTC over a 20‐year period in Austria.

Methods

Patients diagnosed with intrahepatic (iCCC)/extrahepatic cholangiocarcinoma (eCCC), ampullary carcinoma, gall bladder carcinoma (GBC), overlapping lesions or unspecified carcinomas of the biliary tract and liver were included. Data on age‐adjusted incidence were obtained from the Austrian National Cancer Registry which compiles data on all newly diagnosed cancers. Data on age‐adjusted mortality were obtained from the national death registry (Statistics Austria).

Results

Between 1990 and 2009, 15201 patients were diagnosed with BTC (m/f=42/58%; mean age, 73 years). The median survival of all patients with BTC was 4.8 months with a 1‐/5‐year survival rate of 31%/10%. In iCCC, the incidence and mortality rates increased from 1990 to 2009 in both men and women while in eCCC, the incidence and mortality rates decreased over time in both sexes. In ampullary carcinoma, the incidence slightly decreased in men and remained stable in women. The mortality rate remained stable in both sexes. In GBC, the age‐adjusted incidence and mortality rates dramatically decreased in both sexes.

Conclusions

GBC and iCCC were the most common entities amongst BTC. While incidence and mortality rates of iCCC increased in men and women over time, incidence and mortality rates of eCCC and GBC decreased in both sexes. Other carcinomas of the biliary tract i.e. ampullary carcinoma were rarely diagnosed.
Mortality and morbidity of very preterm infants in Romania: How are we doing?
Authors: Suciu Laura Mihaela , Puscasiu Lucian , Szabo Bela , Cucerea Manuela , Ognean Maria Livia , Oprea Ioan , Bell Edward F.
Published: September 2013

Background

Birth before 28 weeks of gestation is associated with high mortality and morbidity. The purpose of this study was to examine characteristics associated with in‐hospital mortality and morbidity among extremely low‐birthweight neonates admitted to three tertiary care centers in Romania.

Methods

The study was conducted in three Romanian hospitals with level‐III neonatal intensive care units. We studied singleton live births at the established Romanian limit of viability (i.e., 25–28 weeks' gestational age) born between January 2007 and December 2010 (n = 227). Infants born in non‐level‐III facilities transferred to these three centers were included in our study (n = 39). Descriptive and multivariate statistical analyses were used to describe the population and examine outcomes and risk factors.

Results

During the study period, 62 neonates (27.3%) were delivered at 25 weeks, 56 (24.7%) were delivered at 26 weeks, 56 (24.7%) at 27 weeks, and 53 (23.3%) at 28 weeks. Overall in‐hospital mortality was 65% (from 85% at 25 weeks to 35% at 28 weeks). The rates for major morbidities were necrotizing enterocolitis 8.8%, bronchopulmonary dysplasia 12.5%, and retinopathy of prematurity (stage higher than 2) 26.2%.

Conclusions

During 2007–2010, in‐hospital survival of infants admitted to three neonatal intensive care units in Romania was 35% and ranged from 14% at 25 weeks to 64% at 28 weeks.
A validation study to find highly correlated parameters with visual assessment for clinical evaluation of cosmetic anti‐cellulite products
Authors: Yoo Mi Ae , Seo Young Kyoung , Ryu Ja Hyun , Back Ji Hwoon , Koh Jae Sook
Published: September 2013

Background/purpose

There has been growing interest in cellulite on parts of the body; however, no objective assessment has been specifically established. This study aims to demonstrate an optimized method by comparing the existing assessments of cellulite.

Methods

In Test 1, for subjects of 20 healthy females who have cellulite, we measured volume and roughness of cellulite using fringe projection method, roughness using replica method, dermo‐subcutaneous interface length and subcutaneous thickness using ultrasonography and skin temperature using infrared ray, elasticity and blood flow. In Test 2, we applied an anti‐cellulite cosmetic to 28 subjects for 6 weeks and observed if they have any changes.

Results

In Test 1, the effective parameter that is the most correlated with visual assessment was volume of skin measured using fringe projection method (r = 0.780). Dermo‐subcutaneous interface length (r = 0.355) and subcutaneous thickness (r = 0.502) measured using ultrasonography followed in order. In Test 2, after applying a tested product, the correlation coefficient of volume of skin, of dermo‐subcutaneous interface length and of subcutaneous thickness are 0.409 (P = 0.000), 0.275 (P = 0.016) and 0.311 (P = 0.012) respectively.

Conclusion

We conclude that visual assessment, volume of skin (cavities), dermo‐subcutaneous interface length and subcutaneous thickness are optimized methods for assessing an effect of cosmetics on cellulite.
Dispute Settlement at the WTO: Impacts of a No Deal in the US‐Brazil Cotton Dispute
Authors: Lakatos Csilla , Walmsley Terrie
Published: September 2013

On the day before Brazil was to start imposing retaliatory sanctions against the United States in the WTO dispute settlement case regarding unfair domestic and export upland cotton subsidies, the parties have reached a preliminary concession aimed at settling this eight‐year‐long trade dispute. In this paper, we explore the economywide impacts of a no deal with specific emphasis on intellectual property retaliation in a computable general equilibrium framework. As awarded by a WTO dispute settlement panel, Brazil would have been entitled to $591 million in retaliatory sanctions in goods sectors and $238 million in intellectual property sanctions. We find that retaliation by Brazil would have led to welfare gains for all countries except the United States. Most importantly, however, had Brazil not been allowed to retaliate in the form of suspension of intellectual property rights, the impact of trade retaliation alone would have been negative for both Brazil and the United States, a case of shooting oneself in the foot to shoot at the other person's foot.
Muscle afferents and cardiorespiratory control: the Birmingham connection
Authors: White Michael J.
Published: September 2013

New findings

What is the topic of this review?

This brief review describes the work of Professor John Coote and colleagues at the University of Birmingham, which has contributed to understanding of the role of muscle afferent involvement in cardiorespiratory control in exercise.

What advances does it highlight?

The seminal findings of John Coote's early work are highlighted, as well as more recent developments in the field, especially the role of muscle afferents in the control of human ventilation during exercise.

Through the work of John Coote, research into the role of muscle afferent involvement in cardiorespiratory control has had strong links with Birmingham since the late 1960s. This brief review gives an historical background to John's early work and how his research and mentorship of colleagues continues to have a profound influence on the field today.
Identification of Critical Net Positive Suction Head From Noise and Vibration in a Radial Flow Pump for Different Leading Edge Profiles of the Vane
Authors: Christopher S. , Kumaraswamy S.
Published: September 2013

Experimental investigations concerning cavitation in radial flow pump for three different leading edge profiles of the vane were carried out in an open circuit system. The operating condition of the radial flow pump under cavitating case was understood by measurement of noise and vibration along with the pump parameters for various speeds and flow rates. The outcome of the experimental results revealed that the noise and vibration were better predictors of inception and development of cavitation. Further observation inferred from critical net positive suction head (NPSH) curve of 3% head drop and critical NPSH value of noise and vibration are presented.
Flow and Heat Transfer of Powell–Eyring Fluid Over a Stretching Surface: A Lie Group Analysis
Authors: Jalil Mudassar , Asghar Saleem
Published: September 2013

In this study, the flow and heat transfer of Powell–Eyring fluid over a permeable stretching surface is examined. By using Lie group analysis, the symmetries of the equations are found. Four finite parameter and one infinite parameter Lie group of transformations are obtained. Similarity transformations for the problem are derived with help of these symmetries. The governing system of partial differential equations is transformed to a system of ordinary differential equations by using the similarity transformations. These equations are solved numerically using the Keller-box method. A comparison is performed with analytical results as well as previously published work, and an excellent agreement is observed between the results. The effects of governing parameters on the velocity and temperature profiles, the skin friction, and local Nusselt number are analyzed and discussed. It is observed that both the skin friction and local Nusselt number increase due to an increase in suction/injection parameter fw. The effects of the Prandtl number Pr, temperature power index m, and fluid parameter ε are found to increase the local Nusselt number whereas the effect of the fluid parameter δ is to decrease it. The obtained results elucidate that the skin friction reduces with increase in ε while opposite behavior is noticed for increasing values of δ.
Design and Testing of an Adjustable Linkage for a Variable Displacement Pump
Authors: Wilhelm Shawn R. , Van de Ven James D.
Published: September 2013

A variable displacement hydraulic pump/motor with high efficiency at all operating conditions, including low displacement, is beneficial to multiple applications. Two major energy loss terms in conventional pumps are the friction and lubrication leakage in the kinematic joints. This paper presents the synthesis, analysis, and experimental validation of a variable displacement sixbar crank-rocker-slider mechanism that uses low friction pin joints instead of planar joints as seen in conventional variable pump/motor architectures. The novel linkage reaches true zero displacement with a constant top dead center position, further minimizing compressibility energy losses. The synthesis technique develops the range of motion for the base fourbar crank-rocker and creates a method of synthesizing the output slider dyad. It is shown that the mechanism can be optimized for minimum footprint and maximum stroke with a minimum base fourbar transmission angle of 30 deg and a resultant slider transmission angle of 52 deg. The synthesized linkage has a dimensionless stroke of 2.1 crank lengths with a variable timing ratio and velocity and acceleration profiles in the same order of magnitude as a comparable crank-slider mechanism. The kinematic and kinetic results from an experimental prototype linkage agree well with the model predictions.
Kinematic Analysis and Stiffness Validation of Origami Cartons
Authors: Qiu C. , Aminzadeh Vahid , Dai Jian S.
Published: September 2013

Origami-type cartons have been widely used in packaging industry because of their versatility, but there is a lack of systematic approach to study their folding behavior, which is a key issue in designing packaging machines in packaging industry. This paper addresses the fundamental issue by taking the geometric design and material property into consideration, and develops mathematical models to predict the folding characteristics of origami cartons. Three representative types of cartons, including tray cartons, gable cartons, and crash-lock cartons were selected, and the static equilibrium of folding process was developed based on their kinematic models in the frame work of screw theory. Subsequently, folding experiments of both single crease and origami carton samples were conducted. Mathematical models of carton folding were obtained by aggregating single crease's folding characteristics into the static equilibrium, and they showed good agreements with experiment results. Furthermore, the mathematical models were validated with folding experiments of one complete food packaging carton, which shows the overall approach has potential value in predicting carton's folding behavior with different material properties and geometric designs.
Evaluation of motion correction methods in human brain PET imaging—A simulation study based on human motion data
Authors: Jin Xiao , Mulnix Tim , Gallezot Jean‐Dominique , Carson Richard E.
Published: September 2013

Purpose:

Motion correction in PET has become more important as system resolution has improved. The purpose of this study was to evaluate the accuracy of event‐by‐event and frame‐based MC methods in human brain PET imaging.

Methods:

Motion compensated image reconstructions were performed with static and dynamic simulated high resolution research tomograph data with frame‐based image reconstructions, using a range of measured human head motion data. Image intensities in high‐contrast regions of interest (ROI) and parameter estimates in tracer kinetic models were assessed to evaluate the accuracy of the motion correction methods.

Results:

Given accurate motion data, event‐by‐event motion correction can reliably correct for head motions. The average ROI intensities and the kinetic parameter estimatesVT and BPND were comparable to the true values. The frame‐based motion correction methods with correctly aligned attenuation map using the average of externally acquired motion data or motion data derived from image registration give comparable quantitative accuracy. For large intraframe (>5 mm) motion, the frame‐based methods produced ∼9% bias in ROI intensities, ∼5% in VT, and ∼10% in BPND estimates. In addition, in real studies that lack a ground truth, the normalized weighted residual sum of squared difference is a potential figure‐of‐merit to evaluate the accuracy of motion correction methods.

Conclusions:

The authors conclude that frame‐based motion correction methods are accurate when the intraframe motion is less than 5 mm and when the attenuation map is accurately aligned. Given accurate motion data, event‐by‐event motion correction can reliably correct for head motion in human brain PET studies.
Revisit of combined parallel‐beam/cone‐beam or fan‐beam/cone‐beam imaging
Authors: Zeng Gengsheng L.
Published: September 2013

Purpose:

This aim of this paper is to revisit the parallel‐beam/cone‐beam or fan‐beam/cone‐beam imaging configuration, and to investigate whether this configuration has any advantages.

Methods:

Twenty years ago, it was suggested to simultaneously use a parallel‐beam (or a fan‐beam) collimator and a cone‐beam collimator to acquire single photon emission computed tomography data. The motivation was that the parallel‐beam (or the fan‐beam) collimator can provide sufficient sampling, while the cone‐beam collimator is able to provide higher photon counts. Even with higher total counts, this hybrid system does not give significant improvement (if any) in terms of image noise and artifacts reduction. If a conventional iterative maximum‐likelihood expectation‐maximization algorithm is used to reconstruct the image, the resultant reconstruction may be worse than the parallel‐beam‐only (or fan‐beam‐only) system. This paper uses the singular value decomposition (SVD) analysis to explain this phenomenon.

Results:

The SVD results indicate that the parallel‐beam‐only and the fan‐beam‐only system outperform the combined systems.

Conclusions:

The optimal imaging system does not necessary to be the one that generates the projections with highest signal‐to‐noise ratio and best resolution.
Predicting pathologic tumor response to chemoradiotherapy with histogram distances characterizing longitudinal changes in 18F‐FDG uptake patterns
Authors: Tan Shan , Zhang Hao , Zhang Yongxue , Chen Wengen , D'Souza Warren D. , Lu Wei
Published: September 2013

Purpose:

A family of fluorine‐18 (18F)‐fluorodeoxyglucose (18F‐FDG) positron‐emission tomography (PET) features based on histogram distances is proposed for predicting pathologic tumor response to neoadjuvant chemoradiotherapy (CRT). These features describe the longitudinal change of FDG uptake distribution within a tumor.

Methods:

Twenty patients with esophageal cancer treated with CRT plus surgery were included in this study. All patients underwent PET/CT scans before (pre‐) and after (post‐) CRT. The two scans were first rigidly registered, and the original tumor sites were then manually delineated on the pre‐PET/CT by an experienced nuclear medicine physician. Two histograms representing the FDG uptake distribution were extracted from the pre‐ and the registered post‐PET images, respectively, both within the delineated tumor. Distances between the two histograms quantify longitudinal changes in FDG uptake distribution resulting from CRT, and thus are potential predictors of tumor response. A total of 19 histogram distances were examined and compared to both traditional PET response measures and Haralick texture features. Receiver operating characteristic analyses and Mann‐Whitney U test were performed to assess their predictive ability.

Results:

Among all tested histogram distances, seven bin‐to‐bin and seven crossbin distances outperformed traditional PET response measures using maximum standardized uptake value (AUC = 0.70) or total lesion glycolysis (AUC = 0.80). The seven bin‐to‐bin distances were:L2 distance (AUC = 0.84), χ2 distance (AUC = 0.83), intersection distance (AUC = 0.82), cosine distance (AUC = 0.83), squared Euclidean distance (AUC = 0.83), L1 distance (AUC = 0.82), and Jeffrey distance (AUC = 0.82). The seven crossbin distances were: quadratic‐chi distance (AUC = 0.89), earth mover distance (AUC = 0.86), fast earth mover distance (AUC = 0.86), diffusion distance (AUC = 0.88), Kolmogorov‐Smirnov distance (AUC = 0.88), quadratic form distance (AUC = 0.87), and match distance (AUC = 0.84). These crossbin histogram distance features showed slightly higher prediction accuracy than texture features on post‐PET images.

Conclusions:

The results suggest that longitudinal patterns in18F‐FDG uptake characterized using histogram distances provide useful information for predicting the pathologic response of esophageal cancer to CRT.
Predicting diagnostic error in radiology via eye‐tracking and image analytics: Preliminary investigation in mammography
Authors: Voisin Sophie , Pinto Frank , Morin‐Ducote Garnetta , Hudson Kathleen B. , Tourassi Georgia D.
Published: September 2013

Purpose:

The primary aim of the present study was to test the feasibility of predicting diagnostic errors in mammography by merging radiologists’ gaze behavior and image characteristics. A secondary aim was to investigate group‐based and personalized predictive models for radiologists of variable experience levels.

Methods:

The study was performed for the clinical task of assessing the likelihood of malignancy of mammographic masses. Eye‐tracking data and diagnostic decisions for 40 cases were acquired from four Radiology residents and two breast imaging experts as part of an IRB‐approved pilot study. Gaze behavior features were extracted from the eye‐tracking data. Computer‐generated and BIRADS images features were extracted from the images. Finally, machine learning algorithms were used to merge gaze and image features for predicting human error. Feature selection was thoroughly explored to determine the relative contribution of the various features. Group‐based and personalized user modeling was also investigated.

Results:

Machine learning can be used to predict diagnostic error by merging gaze behavior characteristics from the radiologist and textural characteristics from the image under review. Leveraging data collected from multiple readers produced a reasonable group model [area under the ROC curve (AUC) = 0.792 ± 0.030]. Personalized user modeling was far more accurate for the more experienced readers (AUC = 0.837 ± 0.029) than for the less experienced ones (AUC = 0.667 ± 0.099). The best performing group‐based and personalized predictive models involved combinations of both gaze and image features.

Conclusions:

Diagnostic errors in mammography can be predicted to a good extent by leveraging the radiologists’ gaze behavior and image content.
Fungal Diversity in Permafrost and Tallgrass Prairie Soils under Experimental Warming Conditions
Authors: Penton C. Ryan , StLouis Derek , Cole James R. , Luo Yiqi , Wu Liyou , Schuur E. A. G , Zhou Jizhong , Tiedje James M.
Published: September 2013

Soil fungi play a major role in terrestrial ecosystem functioning through interactions with soil structure, plants, micro- and mesofauna, and nutrient cycling through predation, pathogenesis, mutualistic, and saprotrophic roles. The diversity of soil fungi was assessed by sequencing their 28S rRNA gene in Alaskan permafrost and Oklahoma tallgrass prairie soils at experimental sites where the effect of climate warming is under investigation. A total of 226,695 reads were classified into 1,063 genera, covering 62% of the reference data set. Using the Bayesian Classifier offered by the Ribosomal Database Project (RDP) with 50% bootstrapping classification confidence, approximately 70% of sequences were returned as “unclassified” at the genus level, although the majority (∼65%) were classified at the class level, which provided insight into these lesser-known fungal lineages. Those unclassified at the genus level were subjected to BLAST analysis against the ARB-SILVA database, where ∼50% most closely matched nonfungal taxa. Compared to the more abundant sequences, a higher proportion of rare operational taxonomic units (OTU) were successfully classified to genera at 50% bootstrap confidence, indicating that the fungal rare biosphere in these sites is not composed of sequencing artifacts. There was no significant effect after 1 year of warming on the fungal community structure at both sites, except perhaps for a few minor members, but there was a significant effect of sample depth in the permafrost soils. Despite overall significant community structure differences driven by variations in OTU dominance, the prairie and permafrost soils shared 90% and 63% of all fungal sequences, respectively, indicating a fungal “seed bank” common between both sites.
Novel Method for Genomic Promoter Shuffling by Using Recyclable Cassettes
Authors: Tian Xuelei , Xu Xin , Xiao Wei
Published: September 2013

Genetic elements of interest can be introduced into the
Saccharomyces cerevisiae
genome via homologous recombination. The current method is to link such an element to a selectable marker gene to be integrated into the target locus. However, the marker gene in this method cannot be reused, which limits repeated manipulation of the yeast genome. An alternative method is to utilize a counterselectable gene, such as
URA3
, with flanking tandem repeats. After integration,
URA3
along with one copy of the repeat can be popped out via internal recombination, leaving behind one copy of the unwanted repeat. Here we describe a novel concept of genetic element shuffling in which the tandem repeats are made of the desired genetic element, so that after integration and popping out, only one copy of the element remains at the desired locus to function. As a proof of principle, we constructed three recyclable cassettes (

P
PGK1
-URA3-P
PGK1

,

P
GAL1
-URA3-P
GAL1

, and

P
tetO7
-URA3-P
tetO7

) and integrated them upstream of an engineered chromosomal

P
HIS3
-mCherry-Myc

locus. After promoter shuffling, the
mCherry-Myc
gene was regulated precisely as anticipated.
C
1
Metabolism in Corynebacterium glutamicum: an Endogenous Pathway for Oxidation of Methanol to Carbon Dioxide
Authors: Witthoff Sabrina , Mühlroth Alice , Marienhagen Jan , Bott Michael
Published: September 2013

Methanol is considered an interesting carbon source in “bio-based” microbial production processes. Since
Corynebacterium glutamicum
is an important host in industrial biotechnology, in particular for amino acid production, we performed studies of the response of this organism to methanol. The
C. glutamicum
wild type was able to convert
13
C-labeled methanol to
13
CO
2
. Analysis of global gene expression in the presence of methanol revealed several genes of ethanol catabolism to be upregulated, indicating that some of the corresponding enzymes are involved in methanol oxidation. Indeed, a mutant lacking the alcohol dehydrogenase gene
adhA
showed a 62% reduced methanol consumption rate, indicating that AdhA is mainly responsible for methanol oxidation to formaldehyde. Further studies revealed that oxidation of formaldehyde to formate is catalyzed predominantly by two enzymes, the acetaldehyde dehydrogenase Ald and the mycothiol-dependent formaldehyde dehydrogenase AdhE. The Δ
ald
Δ
adhE
and Δ
ald
Δ
mshC
deletion mutants were severely impaired in their ability to oxidize formaldehyde, but residual methanol oxidation to CO
2
was still possible. The oxidation of formate to CO
2
is catalyzed by the formate dehydrogenase FdhF, recently identified by us. Similar to the case with ethanol, methanol catabolism is subject to carbon catabolite repression in the presence of glucose and is dependent on the transcriptional regulator RamA, which was previously shown to be essential for expression of
adhA
and
ald
. In conclusion, we were able to show that
C. glutamicum
possesses an endogenous pathway for methanol oxidation to CO
2
and to identify the enzymes and a transcriptional regulator involved in this pathway.
The Transfer-Messenger RNA-Small Protein B System Plays a Role in Avian Pathogenic Escherichia coli Pathogenicity
Authors: Mu Xiaohui , Huan Haixia , Xu Huiqing , Gao Qingqing , Xiong Liping , Gao Ruxia , Gao Song , Liu Xiufan
Published: September 2013

Extraintestinal pathogenic
Escherichia coli
(ExPEC) is capable of colonizing outside of the intestinal tract and evolving into a systemic infection. Avian pathogenic
E. coli
(APEC) is a member of the ExPEC group and causes avian colibacillosis. Transfer-mRNA-small protein B (tmRNA-SmpB)-mediated
trans
-translation is a bacterial translational control system that directs the modification and degradation of proteins, the biosynthesis of which has stalled or has been interrupted, facilitating the rescue of ribosomes stalled at the 3′ ends of defective mRNAs that lack a stop codon. We found that disruption of one, or both, of the
smpB
or
ssrA
genes significantly decreased the virulence of the APEC strain E058, as assessed by chicken infection assays. Furthermore, the mutants were obviously attenuated in colonization and persistence assays. The results of quantitative real-time reverse transcription-PCR analysis indicated that the transcription levels of the transcriptional regulation gene
rfaH
and the virulence genes
kpsM
,
chuA
, and
iss
were significantly decreased compared to those of the wild-type strain. Macrophage infection assays showed that the mutant strains reduced the replication and/or survival ability in the macrophage HD11 cell line compared to that of the parent strain, E058. However, no significant differences were observed in ingestion by macrophages and in chicken serum resistance between the mutant and the wild-type strains. These data indicate that the tmRNA-SmpB system is important in the pathogenesis of APEC O2 strain E058.
Role for
cis
-Acting RNA Sequences in the Temperature-Dependent Expression of the Multiadhesive Lig Proteins in Leptospira interrogans
Authors: Matsunaga James , Schlax Paula J. , Haake David A.
Published: September 2013

The spirochete
Leptospira interrogans
causes a systemic infection that provokes a febrile illness. The putative lipoproteins LigA and LigB promote adhesion of
Leptospira
to host proteins, interfere with coagulation, and capture complement regulators. In this study, we demonstrate that the expression level of the LigA and LigB proteins was substantially higher when
L. interrogans
proliferated at 37°C instead of the standard culture temperature of 30°C. The RNA comprising the 175-nucleotide 5′ untranslated region (UTR) and first six
lig
codons, whose sequence is identical in
ligA
and
ligB
, is predicted to fold into two distinct stem-loop structures separated by a single-stranded region. The ribosome-binding site is partially sequestered in double-stranded RNA within the second structure. Toeprint analysis revealed that
in vitro
formation of a 30S-tRNA
fMet
-mRNA ternary complex was inhibited unless a 5′ deletion mutation disrupted the second stem-loop structure. To determine whether the
lig
sequence could mediate temperature-regulated gene expression
in vivo
, the 5′ UTR and the first six codons were inserted between the
Escherichia coli
l
-arabinose promoter and
bgaB
(β-galactosidase from
Bacillus stearothermophilus
) to create a translational fusion. The
lig
fragment successfully conferred thermoregulation upon the β-galactosidase reporter in
E. coli
. The second stem-loop structure was sufficient to confer thermoregulation on the reporter, while sequences further upstream in the 5′ UTR slightly diminished expression at each temperature tested. Finally, the expression level of β-galactosidase was significantly higher when point mutations predicted to disrupt base pairs in the second structure were introduced into the stem. Compensatory mutations that maintained base pairing of the stem without restoring the wild-type sequence reinstated the inhibitory effect of the 5′ UTR on expression. These results indicate that
ligA
and
ligB
expression is limited by double-stranded RNA that occludes the ribosome-binding site. At elevated temperatures, the ribosome-binding site is exposed to promote translation initiation.
Finely Tuned Regulation of the Aromatic Amine Degradation Pathway in Escherichia coli
Authors: Zeng Ji , Spiro Stephen
Published: September 2013

FeaR is an AraC family regulator that activates transcription of the
tynA
and
feaB
genes in
Escherichia coli
. TynA is a periplasmic topaquinone- and copper-containing amine oxidase, and FeaB is a cytosolic NAD-linked aldehyde dehydrogenase. Phenylethylamine, tyramine, and dopamine are oxidized by TynA to the corresponding aldehydes, releasing one equivalent of H
2
O
2
and NH
3
. The aldehydes can be oxidized to carboxylic acids by FeaB, and (in the case of phenylacetate) can be further degraded to enter central metabolism. Thus, phenylethylamine can be used as a carbon and nitrogen source, while tyramine and dopamine can be used only as sources of nitrogen. Using genetic, biochemical and computational approaches, we show that the FeaR binding site is a TGNCA-N
8
-AAA motif that occurs in 2 copies in the
tynA
and
feaB
promoters. We show that the coactivator for FeaR is the product rather than the substrate of the TynA reaction. The
feaR
gene is upregulated by carbon or nitrogen limitation, which we propose reflects regulation of
feaR
by the cyclic AMP receptor protein (CRP) and the nitrogen assimilation control protein (NAC), respectively. In carbon-limited cells grown in the presence of a TynA substrate,
tynA
and
feaB
are induced, whereas in nitrogen-limited cells, only the
tynA
promoter is induced. We propose that
tynA
and
feaB
expression is finely tuned to provide the FeaB activity that is required for carbon source utilization and the TynA activity required for nitrogen and carbon source utilization.
Myocarditis along with acute ischaemic cerebellar, pontine and lacunar infarction following viper bite
Authors: Bhatt Alok , Menon Aravind Ajakumar , Bhat Rama , Ramamoorthi Kusugodlu
Published: September 2013

Cerebrovascular complications are rare following viper bites. A 65-year-old man presented with loss of consciousness and developed haemiparesis following a viper bite. Coagulation parameters were severely deranged. MRI showed acute ischaemic infarction on the left side in the precentral and postcentral gyrus, hemipons and cerebellum. Troponin T was elevated and transient left bundle branch block was seen. The patient had a good outcome following treatment with Anti Snake Venom and supportive therapy. Possible mechanisms of infarction are discussed.
Closing left gastroschisis with vanishing left testis
Authors: Patel Ramnik V , Sinha C K , More Bharat , Rajimwale Ashok
Published: September 2013

We report a baby boy with gastroschisis with left non-palpable undescended testis who had a defect on the left side of an intact and normal umbilical cord and had associated testicular atrophy and abnormalities of the ductus deferens. They were successfully managed by primary repair and had uneventful recovery. Subsequent inguinal exploration confirmed blind ending vas deferens and vanishing left undescended testis. Our case confirms vascular accidents at the narrow abdominal wall defect can lead to vanishing testis following attempts at closing gastroschisis making the defect narrow and compromising the blood supply to the testis.
Acupuncture applied as a sensory discrimination training tool decreases movement-related pain in patients with chronic low back pain more than acupuncture alone: a randomised cross-over experiment
Authors: Wand Benedict Martin , Abbaszadeh Sam , Smith Anne Julia , Catley Mark Jon , Moseley G Lorimer
Published: September 2013

Background

High-quality clinical evidence suggests that although acupuncture appears superior to usual care in the management of chronic low back pain, there is little meaningful difference between true and sham acupuncture. This suggests that the benefits of acupuncture are mediated by the placebo response. An alternative explanation is that sham acupuncture is an active treatment and shares a mechanism of action with traditionally applied acupuncture. One plausible candidate for this mechanism is improvement in self-perception mediated through the sensory discrimination-like qualities of acupuncture. We aimed to compare the effects of acupuncture with a sensory discrimination training component to acupuncture without.

Methods

25 people with chronic low back pain were enroled in a randomised cross-over experiment. We compared the effect of acupuncture delivered when sensory discrimination is optimised to acupuncture delivered when it is not, on movement-related back pain immediately after each intervention.

Results

We found that the average pain intensity after participants had received acupuncture with sensory discrimination training (2.8±2.5) was less than when they received acupuncture without sensory discrimination training (3.6±2.0). This difference was statistically significant (after adjustment; mean difference=−0.8, 95% CI −1.4 to −0.3; p=0.011).

Conclusions

Our findings are consistent with the idea that acupuncture may offer specific benefit that is not dependent on precisely where the needles are inserted so much as that the patient attends to where they are inserted. If so, the location of the needles might be better focused on the painful area and the need for penetration of the skin may be mitigated.
Respiratory dysrhythmia in dementia with Lewy bodies: a cross-sectional study
Authors: Hibi Shinichiro , Yamaguchi Yasuhiro , Umeda-Kameyama Yumi , Iijima Katsuya , Takahashi Miwako , Momose Toshimitsu , Akishita Masahiro , Ouchi Yasuyoshi
Published: September 2013

Objectives

Dementia with Lewy bodies (DLB) is the second most common form of neurodegenerative dementia after Alzheimer's disease (AD). DLB is characterised by intracytoplasmic inclusions called Lewy bodies that are often seen in the brainstem. Because modulation of the respiratory rhythm is one of the most important functions of the brainstem, patients with DLB may exhibit dysrhythmic breathing. This hypothesis has not yet been systematically studied. Therefore, we evaluated the association between DLB and dysrhythmic breathing.

Design

In this cross-sectional study consecutive inpatients who were admitted for the evaluation of progressive cognitive impairment were enrolled. We assessed breathing irregularity using polysomnographic recordings on bed rest with closed eyes, without reference to the clinical differentiation among DLB, AD and having no dementia.

Setting

Single centre in Japan.

Participants

14 patients with DLB , 21 with AD and 12 without dementia were enrolled in this study.

Primary outcome measures

The coefficient of variation (CV) of the breath-to-breath time was calculated. We also examined the amplitude spectrum A(f) obtained using the fast Fourier transform and Shannon entropy S of A(f) in patients with DLB compared with patients with AD and patients without dementia.

Results

The values of CV and entropy S were significantly higher in patients with DLB than in patients with AD and patients without dementia. No significant differences were observed between patients with AD and patients without dementia.

Conclusions

Patients with DLB exhibit dysrhythmic breathing compared with patients with AD and patients without dementia. Dysrhythmic breathing is a new clinical feature of DLB and the spectral analysis of breathing patterns can be clinically useful for the diagnostic differentiation of DLB from AD.
ASSOCIATION OF DEMENTIA WITH DELAYED ED ANALGESIA IN PATIENTS OVER 70 WITH ACUTE MUSCULOSKELETAL INJURY
Authors: Markey G , Rabbani W , Kelly P
Published: September 2013

Objectives & Background

Patients with dementia and traumatic injury require prompt and adequate pain relief. However we hypothesised that they may be at risk of under-treatment with analgesia in the emergency setting.

Methods

We identified patients over 70 who attended our ED with acute musculoskeletal injuries and were either referred to the Orthopaedics/Trauma surgeons on call or the fracture clinic. Using clinical records and discharge diagnosis coding, 61 injured patients with dementia were identified. 84 injured patients over 70 without dementia were also studied. Their ED prescription records were examined and whether analgesia was given or not, together with the time interval from arrival to administration of first analgesic was noted. Kaplan-Meier curves were constructed from the time-interval data. Significance testing was by the log rank test.

Results

62% of the patients with dementia had acute fractures. 77% of controls had acute fractures. The remaining patients (21% overall) had soft tissue injuries or joint dislocations. 50% of injured patients with dementia received analgesia in the ED phase of their care, compared with 56% of controls. There was a trend to delayed administration of analgesia to patients with dementia compared to controls (p=0.074, log rank). (Figure 1 for Kaplan-Meier curves).

Conclusion

Our findings suggest that injured patients with dementia are less likely to receive timely analgesia in the ED than patients without dementia. Further work is needed to identify the reasons behind this inequity and intervene accordingly.

Abstract 022 Figure 1

Kaplan-Meier plot of time interval from ED arrival to first analgesic; patients with dementia (upper curve) vs. controls (lower curve); p=0.074.
THE ACCURACY OF ALTERNATIVE TRIAGE RULES FOR IDENTIFICATION OF SIGNIFICANT TRAUMATIC BRAIN INJURY: A DIAGNOSTIC COHORT STUDY
Authors: Fuller G W , Woodford M , Lawrence T , Coats T , Lecky F
Published: September 2013

Objectives & Background

Traumatic brain injury (TBI) is a leading cause of death and disability in young adults. Reorganisation of trauma services with direct triage of suspected head injury patients to trauma centres may improve outcomes following TBI. This study aimed to determine the sensitivity of principal English triage tools for identifying significant TBI.

Methods

We performed a diagnostic cohort study using data prospectively collated from the Trauma Audit and Research Network database between 2005–2011. Adult head injury patients were retrospectively classified according to London Ambulance Service (LAS) and Head Injury Transportation Straight to Neurosurgery study (HITS-NS) triage criteria. Sensitivity and specificity were then calculated against a reference standard of significant TBI, comprising head region abbreviated injury score (AIS) ≥3 or neurosurgical operation. To investigate the determinants of triage rule sensitivity patient characteristics were compared between true positive and false negative groups using descriptive statistics and hypothesis testing. Additional analyses were conducted to explore the robustness of results to selection bias and examine the sensitivity of pre-hospital Glasgow Coma Score (GCS) for detecting significant TBI.

Results

6,559 patients were included in complete case analyses. The LAS and HITS-NS triage tools demonstrated sensitivities of 44.5% (95% CI 43.2–45.9) and 32.6% (95% CI 31.4–33.9) respectively for identifying significant TBI patients. These results were not materially changed following multiple imputation of missing data under a missing at random assumption. False negative significant TBI cases were relatively older, more likely to be female, more frequently secondary to low-level falls, and were less likely to have very severe AIS 5 or 6 head injuries, p<0.01. Pre-hospital GCS did not appear to be a sensitive discriminator for identifying significant TBI, with 44.9% of patients classified as having significant TBI presenting with a PH GCS of ≥13.

Conclusion

considerable proportion of significant head injury patients may not to be triaged directly to trauma centres. Investment is therefore necessary to improve the accuracy of existing triage rules and maintain expertise in TBI diagnosis and management in non-specialist emergency departments.
A STUDY TO ASSESS WHETHER THE CLINICAL BACKGROUND OF A PAEDIATRIC TRAUMA TEAM LEADER AFFECTS THEIR CHOICE OF IMAGING MODALITY IN COMPARABLE TRAUMA PATIENTS
Authors: Thorpe E , Mcleod K A , Vaidya M
Published: September 2013

Objectives & Background

Paediatric trauma team leaders (TTL) may be trained in different clinical sub specialties. The purpose of this study was to compare TTL trained in adult and paediatric emergency medicine in ordering pan CT scans in a similar category of trauma patient. Radiation doses received are often extremely high and carry with them a significantly increased risk for the child of developing cancer in the future.

Methods

A retrospective review of the case notes of 455 consecutive paediatric trauma patients aged 15 and younger between January 2010 and December 2012 at a London based tertiary paediatric trauma centre. 116 patients were identified whose mechanism of injury was pedestrian versus car (>10 MPH). The training background of the trauma team leader (TTL) in each case was identified and imaging recorded. The ISS (Injury Severity Scores) and the clinical yield of each pan scan were analysed.

Results

116 patients were identified whose mechanism of injury was pedestrian versus car (>10 MPH). 67 of these patients (58%) had a consultant TTL trained in adult emergency medicine (EM). 49 of the patients (42%) had a consultant TTL trained in paediatric emergency Medicine (PEM). Of the traumas lead by EM TTLs, 14 (21%) had an ISS >16 (polytrauma) and 26 (39%) had ISS <5. A total of 36 (54%) cases received a pan CT scan.15 patients (42%) required clinical intervention including admission to ICU for observation. The remaining patients (58%) were either managed for injuries identified on plain films or did not require medical management for their injuries. Of the traumas lead by PEM TTLs, 14 (28%) had an ISS >16 (polytrauma) and 17 (34%) had ISS <5. A total of 24 (49%) cases received a pan CT scan. 15 patients (62%) required clinical intervention including admission to ICU for observation. The remaining patients (38%) were either managed for injuries identified on plain films or did not require medical management for their injuries.

Conclusion

Trauma team leaders from paediatric and adult emergency background have a similar propensity to order CT pan scans in trauma. Regardless of who the TTL was, the overall yield of the CT pan scans was only 50%, so the need for weighing up the risks/benefits is imperative in this group.
DOES ANAPHYLAXIS MASQUERADE AS ASTHMA IN CHILDREN?
Authors: Sargant N , Lajeunesse M , Benger J
Published: September 2013

Objectives & Background

Anaphylaxis is under-reported in emergency settings and the potential for diagnostic confusion with acute asthma has been reported, especially in children who experience predominantly respiratory symptoms. However, no previous study has directly investigated the probability of unrecognised anaphylaxis in either adults or children presenting with acute asthma.

Methods

A retrospective case note analysis of children admitted with acute asthma to Bristol's Paediatric Intensive Care Unit (PICU) was conducted. Cases were identified from the PICU admission database and children with other pre-existing respiratory disease were excluded. A total of 73 cases remained eligible for inclusion and were subjected to analysis using the Brighton Collaboration Case Definition (BCCD) for anaphylaxis. Cases with evidence of anaphylaxis were assigned a level of diagnostic probability from 1 (high) to 3 (low) based upon the BCCD.

Results

The case notes of 84 children admitted to Bristol Royal Hospital for Children's PICU were obtained. 11 cases met exclusion criteria leaving 73 eligible for inclusion in the study. Clinical features consistent with a diagnosis of anaphylaxis were discovered in a total of 13 cases (17.8%). A single case (1.4%) met the criteria for level 1 (high probability) and the remaining 12 cases (16.4%) met criteria for level 2 (intermediate) probability. Following careful clinical review of each case meeting the BCCD, it became clear that anaphylaxis was probable in 3 cases (4.1%). The clinical features exhibited in the other 10 cases could each be more reasonably explained by the original diagnosis of acute asthma and/or concurrent infection.

Conclusion

The results support the conclusion that some cases of anaphylaxis are unidentified and managed as acute asthma in children. The local frequency was estimated at 4.1% of children admitted to PICU but larger prospective multi-centre studies are required to better define the true prevalence nationally.