bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical evaluation of 51 dogs treated conservatively for disc‐associated wobbler syndrome
Authors: De Decker S. , Bhatti S. F. M. , Duchateau L. , Martlé V. A. , Van Soens I. , Van Meervenne S. A. E. , Saunders J. H. , Van Ham L. M. L.
Published: March 2009

Objectives:To evaluate the clinical evolution and potential risk factors of 51 dogs treated conservatively for disc‐associated wobbler syndrome.

Methods:Medical records of dogs treated conservatively for disc‐associated wobbler syndrome were reviewed, and owners were contacted regarding clinical evolution and survival of their animals. Relationships between age, treatment before diagnosis, type of neurological signs, results of medical imaging and outcome were determined.

Results:Fifty‐one dogs underwent conservative treatment for disc‐associated wobbler syndrome. A successful outcome was achieved in 45 per cent (23 of 51) of the patients. Median follow‐up period was 18.5 months, and median survival time was 47 months. In 85 per cent of the dogs in which euthanasia was performed because of disc‐associated wobbler syndrome, this was carried out in the first year after diagnosis. Outcome score was influenced by type of neurological signs and additional radiographic and/or myelographic abnormalities. Outcome score was not significantly associated with age, number of protruded intervertebral discs, occurrence, type and results of treatment before diagnosis.

ClinicalSignificance:Conservative treatment of disc‐associated wobbler syndrome is associated with a guarded prognosis. It can be considered in cases where all four limbs are not affected and no additional radiographic and/or myelographic abnormalities are detected.
Concurrent sialocoele and necrotising sialadenitis in a dog
Authors: McGill S. , Lester N. , McLachlan A. , Mansfield C.
Published: March 2009

A seven‐year‐old male, entire rottweiler was presented to Murdoch University Veterinary Hospital with a 24 hour history of blindness, chemosis, exophthalmus, pain on opening the mouth and hypersialism. Bilateral mandibular and zygomatic salivary gland enlargement with concurrent bilateral zygomatic salivary gland sialocoeles were identified. The cause of the mandibular salivary gland enlargement was confirmed as necrotising sialadenitis, while the cause of the zygomatic gland enlargement was presumed to be because of a similar disease process. No underlying aetiology was identified. Treatment consisted of supportive management, corticosteroids and paracentesis of the sialocoeles and resulted in resolution of the salivary gland enlargement and the associated clinical signs. This is an unusual presentation of salivary gland disease in the dog with multiple gland involvement and a spectrum of disease processes occurring at the same time.
Rabies Control in Finland: A 12‐Year Experience of Human and Veterinary Surveillance
Authors: Rimhanen‐Finne R. , Jakava‐Viljanen M. , Lyytikäinen O. , Davidkin I. , Kuusi M.
Published: March 2009

Little is known about the public health burden of rabies in rabies‐free countries. In these countries, the surveillance of suspected and treated cases serves as a substitute for estimating the risk and burden of human rabies because deaths due to rabies are extremely rare. Suspected rabies exposures among Finnish inhabitants were characterized using data from the National Infectious Disease Registry as well as animal surveillance data from the Finnish Food Safety Authority Evira, 1995–2006. In total, 195 suspected rabies exposures were reported (incidence 3/million inhabitants/year). Exposures were equally common among both genders and the median age was 35 years. Exposures were more common among 20‐ to 49‐year olds than among other age groups. Less than one‐third of the exposures occurred in Finland (incidence of indigenous exposures 0.9/million inhabitants/year). Indigenous rabies exposures were most frequently reported in southeastern Finland, with cats and dogs as the main sources. The high prevalence in the Baltic countries and Russia poses a risk for rabies reintroduction. The present control of wildlife rabies appears successful and important. The import of animals from endemic areas, however, remains a risk, which can be reduced by increasing public awareness of the disease, vaccination of imported animals and better rabies control in endemic countries.
Streptococcal Cellulitis Following Preparation of Fresh Raw Seafood
Authors: Koh T. H. , Sng L.‐H. , Yuen S. M. , Thomas C. K. , Tan P. L. , Tan S. H. , Wong N. S.
Published: March 2009

We describe three zoonotic streptococcal soft tissue infections resulting from fresh seafood contact. One was a localized thumb infection with Streptococcus iniae in an immunocompetent healthy young male resulting from a puncture wound from a crab pincer. The other two were cases of ascending upper limb cellulitis associated with bacteraemia in mastectomy patients. One of these infections was caused by S. iniae while the other was caused by Streptococcus dysgalactiae subsp. dysgalactiae, a species that has not been previously described as a cause of zoonotic infection. Hence when cleaning raw seafood, protective equipment should be used to minimize the risk of percutaneous injuries.
New Antivirals and Drug Resistance
Authors: Colman Peter M.
Published: March 2009

Progress in the discovery of new antiviral medicines is tempered by the rapidity with which drug-resistant variants emerge. A review of the resistance-suppressing properties of four classes of antivirals is presented: influenza virus neuraminidase inhibitors, HIV protease inhibitors, antibodies, and protein-based fusion inhibitors. The analysis supports the hypothesis that the more similar the drug is to the target's natural ligands, the higher the barrier to resistance. However, other factors, such as entropy compensation and solvent anchoring, might also be exploited for improved drug design.
Use of the Virtual Action Planning Supermarket for the Diagnosis of Mild Cognitive Impairment
Authors: Werner Perla , Rabinowitz Sarit , Klinger Evelyne , Korczyn Amos D. , Josman Naomi
Published: March 2009

Background: Although executive functioning (EF) was found to be associated with cognitive deterioration, the majority of the tests for assessing EF lack ecological validity. Aims: To examine the feasibility and the validity of the virtual action planning supermarket (VAP-S) for the diagnosis of patients with mild cognitive impairment (MCI). Methods: Thirty MCI patients (mean age = 69.5 years) were compared to 30 healthy elderly persons (mean age = 69.2 years) in their performance of the VAP-S. Results: Significant differences were found between the groups in the majority of the measures of the VAP-S. The combination of the MMSE and the trajectory duration provided the best predictive classification for the groups. Conclusion: MCI patients have EF deficits, and the VAP-S is a viable tool to assess EF deficits in patients with MCI and healthy elderly.
Development of the Subjective Memory Complaints Questionnaire
Authors: Youn Jong Chul , Kim Ki Woong , Lee Dong Young , Jhoo Jin Hyeong , Lee Seok Bum , Park Joon Hyuk , Choi Eun Ae , Choe Jin Yeong , Jeong Ji Woon , Choo Il Han , Woo Jong Inn
Published: March 2009

Aim: We aimed toevaluatethe psychometric properties of the Subjective Memory Complaints Questionnaire (SMCQ). Methods: The reliability of the SMCQ was evaluated by testing its internal consistency and test-retest reliability. Pearson correlation analyses were performed to assess the concurrent validity. Confirmatory factor analysis was used to evaluate the construct validity. Diagnostic ability for dementia was tested with receiver operator characteristic curve analyses. Results: Cronbach’s α coefficient and intraclass correlation coefficients of the SMCQ were 0.864 and 0.828 (p < 0.001), respectively. The SMCQ scores were significantly correlated with the scores on Camdex Memory Complaint Questionnaire, Seoul Informant Report Questionnaire for Dementia and cognitive tests from the CERAD (Consortium to Establish a Registry for Alzheimer’s Disease) neuropsychological test battery (p < 0.01). The results of confirmatory factor analyses confirmed that the SMCQ consisted of subjective memory complaints (SMC) for general memory and for everyday memory. The SMCQ score discriminated well between nondemented elderly without dementia and those with dementia (p < 0.01). The area under the curve value of the SMCQ was 0.84, indicating that it had high diagnostic ability. Conclusion: The SMCQ was found to be a brief, reliable and valid questionnaire for evaluating SMC. It might be useful for evaluating the cognition of elderly subjects when reliable informants are not available.
Ramifying Feedback Networks, Cross-Scale Interactions, and Emergent Quasi Individuals in Conway's Game of Life
Authors: Gotts Nicholas M.
Published: March 2009

Small patterns of state 1 cells on an infinite, otherwise empty array of Conway's game of Life can produce sets of growing structures resembling in significant ways a population of spatially situated individuals in a nonuniform, highly structured environment. Ramifying feedback networks and cross-scale interactions play a central role in the emergence and subsequent dynamics of the quasi population. The implications are discussed: It is proposed that analogous networks and interactions may have been precursors to natural selection in the real world.
A New Model for Investigating the Evolution of Transcription Control Networks
Authors: Jenkins Dafyd J. , Stekel Dov J.
Published: March 2009

Biological systems show unbounded capacity for complex behaviors and responses to their environments. This principally arises from their genetic networks. The processes governing transcription, translation, and gene regulation are well understood, as are the mechanisms of network evolution, such as gene duplication and horizontal gene transfer. However, the evolved networks arising from these simple processes are much more difficult to understand, and it is difficult to perform experiments on the evolution of these networks in living organisms because of the timescales involved. We propose a new framework for modeling and investigating the evolution of transcription networks in realistic, varied environments. The model we introduce contains novel, important, and lifelike features that allow the evolution of arbitrarily complex transcription networks. Molecular interactions are not specified; instead they are determined dynamically based on shape, allowing protein function to freely evolve. Transcriptional logic provides a flexible mechanism for defining genetic regulatory activity. Simulations demonstrate a realistic life cycle as an emergent property, and that even in simple environments lifelike and complex regulation mechanisms are evolved, including stable proteins, unstable mRNA, and repressor activity. This study also highlights the importance of using in silico genetics techniques to investigate evolved model robustness.
A Yankee Rebellion? The Regulators, New England, and the New Nation
Authors: Gross Robert A.
Published: March 2009

Was Shays's Rebellion a sign of a general crisis of self-government in the new nation, or was it a peculiarly Yankee affair? This essay suggests that wrenching changes, growing out of the Revolution in Massachusetts, turned a conflict over taxes common to all the states into a unique and short-lived political upheaval.
Thoreau's Unreal Estate: Playing House at Walden Pond
Authors: D'Amore Maura
Published: March 2009

This article analyzes Walden within the context of early suburbanization around northeastern cities. Drawing from and commenting on popular pattern-book literature, Thoreau seeks to address in a new way the well-published desires and concerns of the nation's city-trapped young men through the cultivation of unreal estate at Walden Pond.
Networks and Democracy
Authors: Roelofs Joan
Published: March 2009

Networks may appear to enhance democracy and abolish hierarchy, yet their many undemocratic implications are rarely examined. To quote Zbigniew Brzezinski, they “obscure asymmetries of power and influence.” The people's voice is attenuated by silent partners in organizations and public institutions. The networks examined include public-private partnerships, informal summitry, stakeholder conferences, client-patron relationships and interlocking directorates. Participants in network governance include citizens, non -governmental organizations, political parties, governments, inter-governmental organizations, private profit making corporations and non-profit corporations, especially foundations. We maintain that some participants in network governance are vastly more powerful than others. As for “civil society” organizations, support from corporate or private foundations is essential to almost all civil rights, social justice or environmental organizations that wish to be viable and visible; the funders exert control in many ways. Freedom of speech and association, surely requisites for democracy, are thereby diminished, as the beneficiaries are compelled to self-censorship.
Why the Market Subverts Democracy
Authors: Hahnel Robin
Published: March 2009

Proponents of neoliberalism contend that promoting free markets is nearly synonymous with promoting democracy. Even those who reject extreme neoliberalism and call for regulating markets often express reluctance to do so because such interventions, in their view, diminish economic freedom to some extent. After a critical examination of competing definitions of economic democracy, this article argues that, contrary to popular opinion, the market system undermines both economic and political democracy in a number of ways.
Workers' Cooperatives and Social Enterprise
Authors: Rothschild Joyce
Published: March 2009

Grounded in both domestic and international illustrations of modern-day worker cooperatives and social enterprises, this article shows how the practices of these examples of social property give rise to more democratic management of the workplace and equitable outcomes for society than would ever be possible with conventionally owned enterprises. The article offers public policy proposals that would encourage the formation of cooperative enterprises in the United States, at once offering a way to anchor well-paid jobs in U.S. communities and to extend the opportunity for shared ownership and control to working people. The article concludes with a consideration of how the extension of practical democratic rights into the economic realm might enhance citizens' capacity for and confidence in dialogue and democratic decision making in the political and civic realms of life.
What Kind of Nonprofit Sector, What Kind of Society?
Authors: Anheier Helmut K.
Published: March 2009

Nonprofit organizations and the nonprofit sector more generally are part of a complex dual transition from industrial to postindustrial society and from national state to transnational policy regimes. This transition shows the beginnings of a new policy dialogue in addressing the future role of nonprofit organizations and involves three broad perspectives that have become prominent in recent years: First, nonprofits are increasingly part of new public management and a mixed economy of welfare; second, they are seen as central to “civil society—social capital” approaches, specifically the Neo-Tocquevillian emphasis on the nexus between social capital and participation in voluntary associations; and third, they are part of a wider social accountability perspective that sees them as instruments of greater transparency, heightened accountability, and improved governance of public institutions.
The Complexity of Relocation and the Diversity of Trade Union Responses: Efficiency-oriented Foreign Direct Investment in Central Europe
Authors: Meardi Guglielmo , Marginson Paul , Fichter Michael , Frybes Marcin , Stanojević Miroslav , Tóth András
Published: March 2009

Relocations within an enlarged Europe are often portrayed as an unavoidable destiny or irresistible threat for workers. The article outlines a number of contingent factors which determine how serious are the threats and how feasible is an effective union response. Such factors are then tested through in-depth case studies of 12 plants in the automotive components sector (where cross-border competition is particularly strong), showing how varied can be the scenarios for industrial relations in multinational companies.
A Race to the Bottom? Trade Unions, EU Enlargement and the Free Movement of Labour
Authors: Krings Torben
Published: March 2009

When eight countries from Central and Eastern Europe joined the EU in 2004, unions in some countries argued that significant wage differentials between the old and the new member states necessitated transitional restrictions on free movement, but others insisted that employment standards should be protected by the enforcement of rights, not by restrictions. This article explores variations in union policies in comparative perspective, examining Austria, Germany, Ireland and the UK.
Job Satisfaction, Union Membership and Collective Bargaining
Authors: García-Serrano Carlos
Published: March 2009

This article uses data from a nationwide survey of Spanish workers to investigate whether job satisfaction is influenced by unionization when the terms of collective agreements are extended to all the workers, whether members or not. Empirical findings suggest that there is a negative influence of union membership on job satisfaction and a positive one for collective agreements at firm level, but these effects vanish once variables capturing working conditions and the industrial relations climate are taken into account.
Where Does Handwriting Fit In?
Authors: Cahill Susan M.
Published: March 2009

In today's environment of high-stakes testing, handwriting is a skill that is often overlooked in order to focus on other areas of the curriculum. However, research indicates that handwriting is tied to academic achievement, especially composition and literacy skills. This article provides strategies that can be used to support students with disabilities in the areas of handwriting, motor skill development, and practice during functional tasks.
Gifted Students With Asperger Syndrome
Authors: Bianco Margarita , Carothers Douglas E. , Smiley Lydia R.
Published: March 2009

Gifted students with Asperger syndrome (AS) frequently exhibit behaviors that puzzle and challenge teachers and other professionals. They display many of the behaviors typically associated with AS and therefore receive educational interventions designed to address their deficit areas. Often lacking is strength-based programming—that is, educational planning with systematic attention to students' learning strengths, interests, gifts, and talents. If their strengths are not addressed, these students are at social, emotional, and academic risk. Gifted students with AS require dually differentiated instruction, including interventions that foster interests and strengths while providing strategies to compensate for areas of weakness. This article offers suggestions and resources for developing strength-based programming for gifted students with Asperger syndrome.
Comparison of a phased experimental approach and a single randomized clinical trial for developing multicomponent behavioral interventions
Authors: Collins Linda M , Chakraborty Bibhas , Murphy Susan A , Strecher Victor
Published: March 2009

Background Many interventions in today's health sciences are multicomponent, and often one or more of the components are behavioral. Two approaches to building behavioral interventions empirically can be identified. The more typically used approach, labeled here the classical approach, consists of constructing a likely best intervention a priori, and then evaluating the intervention in a standard randomized controlled trial (RCT). By contrast, the emergent phased experimental approach involves programmatic phases of empirical research and discovery aimed at identifying individual intervention component effects and the best combination of components and levels.

Purpose The purpose of this article is to provide a head-to-head comparison between the classical and phased experimental approaches and thereby highlight the relative advantages and disadvantages of these approaches when they are used to select program components and levels so as to arrive at the most potent intervention.

Methods A computer simulation was performed in which the classical and phased experimental approaches to intervention development were applied to the same randomly generated data.

Results The phased experimental approach resulted in better mean intervention outcomes when the intervention effect size was medium or large, whereas the classical approach resulted in better mean intervention outcomes when the effect size was small. The phased experimental approach led to identification of the correct set of intervention components and levels at a higher rate than the classical approach across all conditions.

Limitations Some potentially important factors were not varied in the simulation, for example the underlying structural model and the number of intervention components.

Conclusions The phased experimental approach merits serious consideration, because it has the potential to enable intervention scientists to develop more efficacious behavioral interventions. Clinical Trials 2009; 6: 5—15. http://ctj.sagepub.com
Recruitment methods employed in the prostate, lung, colorectal, and ovarian cancer screening trial
Authors: Gren Lisa , Broski Karen , Childs Jeffery , Cordes Jill , Engelhard Deborah , Gahagan Betsy , Gamito Eduard , Gardner Vivien , Geisser Mindy , Higgins Darlene , Jenkins Victoria , Lamerato Lois , Lappe Karen , Lowery Heidi , McGuire Colleen , Miedzinski Mollie , Ogden Sheryl , Tenorio Sally , Watt Gavin , Wohlers Bonita , Marcus Pamela
Published: March 2009

Background The Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO) is a US National Cancer Institute (NCI)-funded randomized controlled trial designed to evaluate whether certain screening tests reduce mortality from prostate, lung, colorectal, and ovarian cancer. To obtain adequate statistical power, it was necessary to enroll over 150,000 healthy volunteers. Recruitment began in 1993 and ended in 2001.

Purpose Our goal is to evaluate the success of recruitment methods employed by the 10 PLCO screening centers. We also provide estimates of recruitment yield and cost for our most successful strategy, direct mail.

Methods Each screening center selected its own methods of recruitment. Methods changed throughout the recruitment period as needed. For this manuscript, representatives from each screening center provided information on methods utilized and their success.

Results In the United States between 1993 and 2001, ten screening centers enrolled 154,934 study participants. Based on participant self-report, an estimated 95% of individuals were recruited by direct mail. Overall, enrollment yield for direct mail was 1.0%. Individual center enrollment yield ranged from 0.7% to 3.8%. Cost per enrolled participant was $9.64—35.38 for direct mail, excluding personnel costs.

Limitations Numeric data on recruitment processes were not kept consistently at individual screening centers. Numeric data in this manuscript are based on the experiences of 5 of the 10 centers.

Conclusions Direct mail, using rosters of names and addresses from profit and not-for-profit (including government) organizations, was the most successful and most often used recruitment method. Other recruitment strategies, such as community outreach and use of mass media, can be an important adjunct to direct mail in recruiting minority populations. Clinical Trials 2009; 6: 52—59. http://ctj.sagepub.com
A web-based endpoint adjudication system for interim analyses in clinical trials
Authors: Nolen Tracy L , Dimmick Bill F , Ostrosky-Zeichner Luis , Kendrick Amy S , Sable Carole , Ngai Angela , Wallace Dennis
Published: March 2009

Background A data monitoring committee (DMC) is often employed to assess trial progress and review safety data and efficacy endpoints throughout a trail. Interim analyses performed for the DMC should use data that are as complete and verified as possible. Such analyses are complicated when data verification involves subjective study endpoints or requires clinical expertise to determine each subject's status with respect to the study endpoint. Therefore, procedures are needed to obtain adjudicated data for interim analyses in an efficient manner. In the past, methods for handling such data included using locally reported results as surrogate endpoints, adjusting analysis methods for unadjudicated data, or simply performing the adjudication as rapidly as possible. These methods all have inadequacies that make their sole usage suboptimal.

Purpose For a study of prophylaxis for invasive candidiasis, adjudication of both study eligibility criteria and clinical endpoints prior to two interim analyses was required. Because the study was expected to enroll at a moderate rate and the sponsor required adjudicated endpoints to be used for interim analyses, an efficient process for adjudication was required.

Methods We created a web-based endpoint adjudication system (WebEAS) that allows for expedited review by the endpoint adjudication committee (EAC). This system automatically identifies when a subject's data are complete, creates a subject profile from the study data, and assigns EAC reviewers. The reviewers use the WebEAS to review the subject profile and submit their completed review form. The WebEAS then compares the reviews, assigns an additional review as a tiebreaker if needed, and stores the adjudicated data.

Results The study for which this system was originally built was administratively closed after 10 months with only 38 subjects enrolled. The adjudication process was finalized and the WebEAS system activated prior to study closure. Some website accessibility issues presented initially. However, once these issues were resolved, the reviewers found the system user-friendly and easy to navigate.

Limitations Web-based data adjudication depends upon expeditious data collection and verification. Further, ability to use web-based technologies, in addition to clinical expertise, must be considered in selecting EAC members.

Conclusion The automated nature of this system makes it a practical mechanism for ensuring timely endpoint adjudication. The authors believe a similar approach could be useful for handling endpoint adjudication for future clinical trials. Clinical Trials 2009; 6: 60—66. http://ctj.sagepub.com
Mindfulness meditation training to reduce symptom distress in transplant patients: rationale, design, and experience with a recycled waitlist
Authors: Gross Cynthia R , Kreitzer Mary Jo , Reilly-Spong Maryanne , Winbush Nicole Y , Schomaker E Katherine , Thomas William
Published: March 2009

Background Solid organ transplant recipients must take immune suppressive medications that have side effects, cause complications, and lead to distressing symptoms that reduce health-related quality of life (QOL). Mindfulness meditation has been shown to reduce these symptoms in other patient populations, and it is unlikely to interfere with the immune suppressive medication regimen.

Purpose This article describes the design and rationale of a clinical trial to determine whether training in mindfulness meditation can reduce depression, anxiety and insomnia after transplantation, and summarizes baseline characteristics of the participants.

Methods Transplant recipients were randomized in equal numbers to one of three arms: a Mindfulness-based Stress Reduction (MBSR) program consisting of 8 weeks of group instruction, home practice and telephone monitoring; a time and attention control Health Education program; or a waitlist arm. After serving 6 months as waitlist controls, these participants were re-randomized to MBSR or Health Education. Evaluations were obtained at baseline (prior to the active interventions), 8 weeks, 6 months, and 1 year (after randomization to MBSR or Health Education only). The primary analysis will compare composite symptom scores between MBSR and Health Education, initially or after serving in the waitlist. Subsequent analyses will compare these two groups on depression, anxiety, and insomnia symptom scales and secondary outcomes of health-related QOL, actigraphy, and health care utilization. A separate analysis, using only data collected before re-randomization, will compare short-term outcomes between the waitlist and active treatment arms.

Results One hundred fifty recipients were randomized and 72% of waitlist participants (31/43) were recycled to an active intervention after 6 months. Patient characteristics were balanced across trial arms after initial and secondary randomizations.

Limitations Transplant recipients are a very select population. Their adherence to the intervention and willingness to serve as waitlist controls prior to re-randomization may be atypical. Participants were not blinded to treatment and primary outcomes are self-reports.

Conclusion The innovative design used in the trial enabled the waitlist group to directly contribute to the number in the primary analysis of active arms, and to also serve as an internal validation test. The trial may be a useful model for trials involving very small target populations. Clinical Trials 2009; 6: 76—89. http://ctj.sagepub.com
A centralized informatics infrastructure for the National Institute on Drug Abuse Clinical Trials Network
Authors: Pan Jeng-Jong , Nahm Meredith , Wakim Paul , Cushing Carol , Poole Lori , Tai Betty , Pieper Carl F
Published: March 2009

Background Clinical trial networks (CTNs) were created to provide a sustaining infrastructure for the conduct of multisite clinical trials. As such, they must withstand changes in membership. Centralization of infrastructure including knowledge management, portfolio management, information management, process automation, work policies, and procedures in clinical research networks facilitates consistency and ultimately research.

Purpose In 2005, the National Institute on Drug Abuse (NIDA) CTN transitioned from a distributed data management model to a centralized informatics infrastructure to support the network's trial activities and administration. We describe the centralized informatics infrastructure and discuss our challenges to inform others considering such an endeavor.

Methods During the migration of a clinical trial network from a decentralized to a centralized data center model, descriptive data were captured and are presented here to assess the impact of centralization.

Results We present the framework for the informatics infrastructure and evaluative metrics. The network has decreased the time from last patient-last visit to database lock from an average of 7.6 months to 2.8 months. The average database error rate decreased from 0.8% to 0.2%, with a corresponding decrease in the interquartile range from 0.04%—1.0% before centralization to 0.01—0.27% after centralization. Centralization has provided the CTN with integrated trial status reporting and the first standards-based public data share. A preliminary cost-benefit analysis showed a 50% reduction in data management cost per study participant over the life of a trial. Limitations A single clinical trial network comprising addiction researchers and community treatment programs was assessed. The findings may not be applicable to other research settings.

Conclusions The identified informatics components provide the information and infrastructure needed for our clinical trial network. Post centralization data management operations are more efficient and less costly, with higher data quality. Clinical Trials 2009; 6: 67—75. http://ctj.sagepub.com
Bayesian model averaging in meta-analysis: vitamin E supplementation and mortality
Authors: Berry Donald , Wathen J. Kyle , Newell Margaret
Published: March 2009

Context The strength and relevance of a meta-analysis depends on the validity of the statistical methods used. Of special importance is appropriately assessing different sources of variability. Many studies including meta-analyses have evaluated the efficacy and safety of vitamin E and have yielded varying results. Illuminating and resolving these disparities requires addressing study variability and model uncertainty.

Objective To describe Bayesian meta-analysis methods for combining data from clinical trials, using recent studies that analyzed the relationship between vitamin E dose and all-cause mortality.

Data Sources Studies used in a previously published meta-analysis appended by studies identified by a search of MEDLINE from August 2004 to December 2005 using the MeSH terms vitamin e and alpha tocopherol.

Study Selection Inclusion criteria: men and nonpregnant women; use of vitamin E alone or in combination with other vitamins or minerals; random allocation of participants to either vitamin E or a placebo or other control group; intervention and follow-up duration greater than 1 year; 10 or more deaths.

Data Extraction Independent data extraction by one author was reviewed and confirmed by a second author. Corresponding authors of the original publications were contacted when questions arose.

Data Synthesis Data collection included the number of patients and deaths, percent men, use of other vitamins or minerals, mean age, and length of follow-up. We combined study results using Bayesian hierarchical model averaging. Analyses used Markov chain Monte Carlo computational techniques.

Conclusions Vitamin E intake is unlikely to affect mortality regardless of dose. The Bayesian meta-analyses presented here are ideal for incorporating disparate sources of variability, including trial effect and model uncertainty. Clinical Trials 2009; 6: 28—41. http://ctj.sagepub.com
Activation of mixtures of natural clay and glass cullet rejects
Authors: Carvalho J. , Carvalho P. , Pinto A. T. , Labrincha J. A.
Published: March 2009

Alkaline activation involves a reaction between aluminium silicates and compounds with alkalis or alkaline-earth elements in a caustic environment and under certain thermal and pressure conditions. It has been used in the production of non-structural building materials and in so-called ‘green’ concrete, as products display high mechanical strength, low chemical reactivity and high resistance to fire. Green concrete could be an eco-efficient alternative to concrete made using ordinary Portland cement (OPC), reducing CO2 emissions substantially. The main goal of this work is to test common clays, glass cullet and other industrial wastes as an alternative to the commonly used binders (metakaolin or fly ash) in geopolymers. Optimized formulations show interesting mechanical strength (approaching 20 MPa) after just 48 h of curing. The addition of F-sand as aggregate minimizes the shrinkage upon curing and the amount of activator required, and increases the density/degree of compaction of the bodies, thus improving their mechanical resistance within certain limits. Curing in ambient conditions also has a beneficial affect on the mechanical strength.
Evaluation of the Redesign of an Undergraduate Cell Biology Course
Authors: McEwen Laura April , Harris dik , Schmid Richard F. , Vogel Jackie , Western Tamara , Harrison Paul
Published: March 2009

This article offers a case study of the evaluation of a redesigned and redeveloped laboratory-based cell biology course. The course was a compulsory element of the biology program, but the laboratory had become outdated and was inadequately equipped. With the support of a faculty-based teaching improvement project, the teaching team redesigned the course and re-equipped the laboratory, using a more learner-centered, constructivist approach. The focus of the article is on the project-supported evaluation of the redesign rather than the redesign per se. The evaluation involved aspects well beyond standard course assessments, including the gathering of self-reported data from the students concerning both the laboratory component and the technical skills associated with the course. The comparison of pre- and postdata gave valuable information to the teaching team on course design issues and skill acquisition. It is argued that the evaluation process was an effective use of the scarce resources of the teaching improvement project.
Ron Hoy
Authors: Hoopes Laura L. Mays
Published: March 2009

Note from the Editor

Educator Highlights for CBE—Life Sciences Education show how professors at different kinds of institutions educate students in life sciences with inspiration and panache. If you have a particularly creative teaching portfolio yourself, or if you wish to nominate an inspiring colleague to be profiled, please e-mail Laura Hoopes at lhoopes@pomona.edu.
Proposed Mechanisms for HOOOH Formation in Two Typical Enzyme Reactions Responsible for Superoxide Anion Production in Biological Systems
Authors: Kohno Masahiro , Sato Emiko , Yaekashiwa Noriko , Mokudai Takayuki , Niwano Yoshimi
Published: March 2009

We investigated the hypoxanthine (HPX)–xanthine oxidase (XOD) reaction by examining the chemiluminescence (CL) response mediated by a luminol analog, 8-amino-5-chloro-7-phenylpyrido[3,4-d]pyridazine-1,4-(2H,3H)-dione sodium salt (L-012). It was found that addition of a high concentration of dimethyl sulfoxide (DMSO), a potent •OH scavenger, could not completely reduce the CL response. This result suggests the existence of an unknown reactive oxygen intermediate other than O2−• and •OH. We further examined the HPX–XOD reaction and the nicotinamide adenine dinucleotide phosphate (NADPH) oxidation reaction by applying an electron spin resonance (ESR) spin-trapping method. In both reaction systems, similar responses were observed. That is, addition of DMSO increased the formation of 5,5-dimethyl-1-pyrroline N-oxide (DMPO) –OOH in a concentration-dependent manner. This indicates that scavenging of •OH increases the detected O2−• level, further suggesting the existence of an intermediate oxygen species derived from O2−• and •OH. One candidate for this species is HOOOH, presumably formed in the following way.

O2−• + H+ + •OH →HOOOH
Liquid Crystallinity and Biological Activity of a Novel Amphiphilic Compound
Authors: Yoshizawa Atsushi , Takahashi Yuuka , Terasawa Rie , Chiba Shota , Takahashi Kenji , Hazawa Masaharu , Kashiwakura Ikuo
Published: March 2009

We have designed an amphiphilic compound in which phenylpyrimidine and d-glucamine are connected via a flexible spacer. The compound shows two thermotropic lamellar bilayer mesophases with different layer spacings. The liquid-crystalline compound showed cytostatic activity against A549 human lung carcinoma cell lines, however an amphiphilic phenylpyrimidine derivative, d-glucamine, and an equimolar mixture of them were not active on cell lines under identical conditions.
Synthesis of a Novel Asymmetric Gemini Surfactant and pH-controlled Vesicle Aggregation
Authors: Yan Feng , Huo Ming , Wang Mingxia , Yao Haibin , Zhang Lu , Yu Jiayong
Published: March 2009

A novel asymmetric Gemini surfactant, comprising two nonidentical hydrocarbon chain lengths and two different hydrophilic groups, abbreviated as C13COONa–O–C8BSO3Na, has been synthesized. The unique aggregation behavior was investigated by transmission electron microscopy in aqueous solution. Spontaneous vesicle formation (approximately 100–300 nm) was observed. The reversible morphological change of vesicle aggregation took place by varying the solution pH. These results indicated the potential application of the present amphiphile, which may be used as a model for cell membranes and drug delivery systems.
A retrospective study of recurrent chlamydia infection in men and women: is there a role for targeted screening for those at risk?
Authors: Evans C , Das C , Kinghorn G
Published: March 2009

Summary

Chalmydia trachomatis remains the commonest sexually transmitted infection (STI) in the UK. This study identifies those at risk of recurrent infection (RI) attending a central genitourinary clinic, time to subsequent reinfection and duration of at-risk behaviour for the consideration of targeted chlamydia screening. From 1995 to 2005, a total of 14,011 patients' were diagnosed with chlamydia and 1743 (12.4%) had RI, classified as a repeat infection greater than three months after initial diagnosis. Individual risk factors for both sexes include young age <25, two or more partners and failure to attend for test of cure (TOC) and previous STI. Men of non-White ethnicity, symptoms and those self-referred were also at risk. Combined risk factors for both sexes were non-White ethnicity, symptoms, young age, previous STI and two or more partners. Attendance for TOC considerably reduced RI rates in men (odds ratio [OR] = 0.549; 95% confidence interval [CI] 0.359–0.840). Mean time to first and last reinfection in men was 1.91 and 2.49 years, in women 1.76 and 1.92 years. One in eight individuals with chlamydia infection are at risk of RI, the majority of which will occur within two years of initial presentation. These individuals have identifiable risk factors facilitating targeted re-screening, enhanced follow-up and support for behavioural change.
Prevalence of community-associated methicillin-resistant Staphylococcus aureus colonization in men who have sex with men
Authors: Antoniou T , Devlin R , Gough K , Mulvey M , Katz K C , Zehtabchi M , Polsky J , Tilley D , Brunetta J , Arbess G , Guiang C , Chang B , Kovacs C , Ghavam-Rassoul A , Cavacuiti C , Corneslon B , Berger P , Loutfy M R
Published: March 2009

Summary

Outbreaks of skin and soft tissue infections mediated by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) are being reported with increasing frequency among men who have sex with men (MSM). However, the potential role of asymptomatic colonization with this organism in perpetuating these infections is unclear. The purpose of this cross-sectional study was to determine the prevalence of colonization with CA-MRSA among a cohort of 500 MSM recruited from two inner city clinics in Toronto, Canada. Following the provision of informed consent, subjects completed a questionnaire capturing demographic and clinical variables, which may be associated with MRSA colonization. A nasal swab for MRSA was collected from each subject, and instructions were provided regarding the self-collection of a rectal swab. Cultured MRSA underwent pulsed-field gel electrophoresis and virulence testing for Panton-Valentine leukocidin gene expression. The prevalence of CA-MRSA colonization was 1.6% (95% CI: 0.5–2.6%).
Devolving of statin prescribing to general practitioners for HIV-infected patients receiving antiretroviral therapy
Authors: Benn P D , Miller R F , Evans L , Minton J , Edwards S G
Published: March 2009

Summary

Serious adverse events and medication errors are common in clinical practice and are associated with significant morbidity and mortality. Management of HIV-positive patients is likely to become more complex as people age, developing multiple medical conditions and thus requiring polypharmacy. We undertook a casenote review and interview of patients on antiretroviral therapy (ART) to audit the safety of devolving statin prescribing to general practitioners (GPs). Of 26 patients only 50% had their statin prescribing successfully been devolved to GPs. Many experienced significant difficulties and two of 26 (8%) were switched to simvastatin while receiving a protease inhibitor. We demonstrate that prescribing ART and non-ART medication by different practitioners on different sites can potentially expose patients to serious life-threatening adverse events. We make recommendations to minimize these risks and suggest that care pathways are reviewed to ensure they remain both convenient and user-friendly without compromising patient safety.
Acute syphilitic posterior placoid chorioretinitis in late latent syphilis
Authors: Tsimpida M , Low L C M , Posner E , Goh B T , Westcott M
Published: March 2009

Summary

Diverse manifestations of ocular syphilis may involve any structure in the eye, at any stage of the disease. Posterior uveitis in the form of posterior placoid chorioretinitis has been described in secondary- and tertiary-acquired syphilis. In this case report, we present a 47-year-old man with late latent syphilitic infection and fundoscopic, as well as angiographic findings consistent with acute syphilitic posterior placoid chorioretinitis. To our knowledge this form of patchy multifocal choroiditis has never been described in the latent stage of the disease.
Are there any differences between patients attending a genitourinary medicine clinic with appointments and those without?
Authors: Elawad B B
Published: March 2009

The aim of this study is to identify the demographic and diagnostic characteristics of patients attending a genitourinary medicine clinic with booked appointments and compare them with those of walk-in attendees. During a period of three months, 749 patients were seen with new episodes; 61% of them had booked appointments; 50.6% of walk-in attendees had symptoms compared with 40.6% in the appointment category; 58.6% of walk-in attendees gave specific reasons for attendance other than asymptomatic requests for sexual health assessment and tests, compared with 48.1% in the appointment category. It is more likely that students and individuals in employment to attend with appointments. The majority of individuals made the right decision for themselves whether to book appointments or just walk-in. The rates of non-D3 codes and sexually transmitted infections in the two groups were not statistically different.
Chlamydia trachomatis infection: the efficacy and safety of a fast-track referral and treatment system
Authors: Sethupathi M , Blackwell A
Published: March 2009

Summary

We introduced a Nurse/Health Advisor-led fast-track service for treating patients diagnosed with chlamydia outside a genitourinary medicine setting and contacts of chlamydia/non-specific urethritis/cervicitis wherever diagnosed. Asymptomatic patients were treated without initial testing and asked to return for full screening at four to six weeks. We assessed the efficacy and safety of the system and need for follow-up after treatment. Case-notes of 226 patients (121 men and 105 women) were analysed, of whom 140 attended follow-up. With the exception of one case of gonorrhoea, no other serious sexually transmitted infection was detected. Twenty-seven (19.2%) patients were re-treated for either chlamydia (six patients, 4.4%) or non-specific genital infection or because of having unprotected intercourse with untreated or partially treated partners. We conclude that in our relatively low-risk population, our fast-track service is safe and effective. Test of cure for chlamydia seems essential because of the high percentage of patients requiring re-treatment.
Calcium metabolism in pregnancy and lactation
Authors: White C P
Published: March 2009

Homeostatic adaptation to maternal calcium metabolism is a prerequisite for optimal delivery of sufficient calcium to the fetus and neonate during pregnancy and lactation, respectively. This article outlines the major adaptations known to occur and the physiological regulators likely to be principally involved. Importantly, different adaptive responses are used in pregnancy and lactation. The rarity of calcium disorders in pregnancy underscores the successful implementation of these adaptations in most women. For those few women with either pre-existing or pregnancy-acquired disorders of calcium metabolism, a knowledge of normal physiology is essential to understand the implications for managing these disorders in pregnant women.